ICMR recommends tests for TB, hepatitis at PHCs: How will this improve public health?
The National List of Essential Diagnostics — first released in 2019 — is a list of all the tests that must be available at different levels of health facilities, such as sub-centres, primary health centres or district hospitals. One of the key changes in the second iteration of the list is the inclusion of several rapid diagnostic and biochemical tests at lower levels of health centres, keeping in mind the expanding infrastructure over the years.
The government's healthcare delivery mechanism provides primary care through sub-centres, primary healthcare centres (PHCs) and community healthcare centres (CHCs), secondary care through sub-district hospitals, tertiary care through district hospitals and super-speciality care through medical colleges.
Why was the list revised?
'In the six years since the first list was released, there have been significant changes. Take, for example, the government investing in semi-auto analyzers at the PHC level. This means the tests can be performed at the PHC itself, instead of the samples being sent to a higher centre for analysis in a hub-and-spoke model,' said Dr Kamini Walia, senior scientist at ICMR, who was behind the compilation of the list. 'There have also been changes to the Indian Public Health Standards and the Integrated Public Health Laboratory Standards, so it was a good idea to revisit the list,' she added
What are the new tests in the 2025 list compared to the one released six years ago?
Several rapid diagnostic tests that have been added include those for sickle cell anaemia, thalassaemia, Hepatitis B and syphilis at the sub-centre level. Many of these are priority diseases for the government.
The new list also recommends collecting samples for dengue testing at the sub-centre level. Over the years, the spread of the mosquito-borne disease has expanded to all states of the country, making it a bigger public health challenge.
Many of the blood tests — such as those to check for blood glucose levels, liver enzymes, and cholesterol — which could not be performed at the primary health centre level earlier, are now recommended at that level, with semi-auto analyzers (machines for conducting chemical and biological analysis of samples with minimal human intervention) becoming available.
What do the new tests mean for public health?
The updated list, once implemented, will have significant public health implications. Experts point out that the list has been updated keeping in view the ambitious targets set for specific diseases. For instance, the government runs a national mission aimed at eliminating sickle cell anaemia by 2047 by screening people and making them aware of whether they are carriers of the faulty gene. The mission also focusses on quick and accurate diagnosis of the disease and providing quality care to patients. The government runs the National Viral Hepatitis Control Programme, which focusses on reducing cases and deaths due to the various hepatitis infections.
How this is likely to enhance sample collection for critical diseases at the sub-centre level
The 2025 list recommends collecting samples for molecular TB testing right from the sub-centre level. For sub-centres and primary health centres, it recommends collecting sputum samples and sending them to a higher centre. From the community health centre level onwards, it recommends performing these tests in-house.
This has been made possible due to the penetration of cost-effective molecular testing machines even in smaller centres during the pandemic. The country's National TB Elimination Programme recommends that molecular diagnosis become the first line of testing, instead of the less sensitive microscopy. The burden of the pathogen has to be much higher for it to test positive using microscopy, meaning the use of molecular tests can detect many more cases, including asymptomatic ones. It can also determine if a person is resistant to commonly used medicines.
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The list calls for samples for sophisticated tests — such as HbA1c, which shows average blood glucose levels over a period of three months — to be collected at the PHC level and sent to a higher centre. The government has been focusing on controlling and caring for people with lifestyle diseases such as diabetes, hypertension and cancer.
At the CHC level, the new list has also added tests such as the TB skin test, which can detect the presence of the pathogen even in people who do not have an active infection. Dental X-rays have now been added at the CHC level. This is important, considering the government's goal of ensuring these tests are available at its centres.
'This list is important because it is implemented in the health centres under the Free Diagnostics Service Initiative, which ensures that these tests are available at all health centres and, in turn, reduces people's out-of-pocket expenditure on healthcare,' said Dr Walia.
In addition, the 2025 list has also merged the diagnostic lists for sub-district hospitals and district hospitals. This is because sub-district hospitals are being upgraded to district hospitals, while district hospitals are being upgraded to the level of medical colleges across the country, Dr Walia explained.
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Indian Express
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High amounts of salt in the body results in water retention, which further increases the pressure on the heart to pump larger volumes of fluid, causing hypertension. The primary culprit, experts agree, is ultra-processed food. According to the NIN's Dietary Guidelines, processed foods such as 'snacks, savouries, soups, sauces, ketchup, salted butter, cheese, canned foods, papads, and salted dry fish, salted nuts/dry fruits contribute to higher intake of salt. Preserved meats/vegetables and ready-to-eat foods contain a lot of sodium'. Prompted by the 'alarming' salt consumption patterns, earlier this month, ICMR-NIE (the National Institute of Epidemiology) launched Project Namak, a three-year-long community-led programme that focuses on salt reduction in individuals with hypertension. 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'If you are a coastal person, most of your salt would come from sea water fish. The pungency of mustard oil, which is used generously in Bengali cuisine, ensures a limited requirement of salt…Now, if you are a Maratha living away from the coast line, and you are eating millets, which are not very palatable on their own, you will increase the levels of salt and chillies. Or if you are having preserved foods like papad or bari, salt content is higher,' Pant says. Concerns of excessive salt intake and its detrimental effects on public health have prompted a host of studies and small-scale interventions to produce 'low-sodium' salt. This involves replacing a part of the sodium in sodium chloride with other additives, primarily potassium. But so far, these experiments haven't achieved the required scale in India. 'The concern in salt is the sodium. To reduce sodium, other kinds of salts are added. 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There were also concerns over whether low-sodium salt would cause hyperkalemia (excess potassium levels in the blood) in the elderly with renal function though there were successful trials in the US that said it was safe for them. But the findings weren't accepted because the trials were small,' Reddy says, while pointing to a study conducted in China by the George Institute for Global Health. With a 'fairly large' sample size of over 20,000 participants from 600 rural villages in five provinces in the country, the China Salt Substitute and Stroke Study (SSaSS), published in 2023 and conducted over five years, found that 'replacing salt with a reduced-sodium added-potassium 'salt substitute' significantly lowers the risk of stroke, heart disease, and death'. The institute has submitted a funding request to ICMR to conduct a similar study in India, said Dr Vivekananda Jha, Executive Director at The George Institute for Global Health, India. 'The study in China proves the point that lower than usual levels of dietary sodium can be tolerated without ill-effects, and a certain amount of potassium is required to balance the sodium. But whether that's going to become public policy in India, whether people are going to accept the altered tastes, we will have to see,' says Dr Reddy, emphasising that 'ideally', potassium, which negates the effects of sodium, should be consumed in the form of fruits and vegetables rich in the mineral. 'One can consume bananas and coconut water. But everybody may not be able to take all of it all through the year. So introducing a salt substitute like in the China trial is something we should maybe consider… Do some pilots to see what the response is, what the safety is, and what the popular acceptance is,' he adds. The last time a population-level health intervention in salt was carried out was in 1962, when common salt was fortified with iodine under the National Goitre Control Programme. 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Time of India
16 hours ago
- Time of India
ICMR study found Covid vaccination didn't raise risk of unexplained sudden deaths among young adults: J P Nadda
New Delhi: An ICMR study has found that Covid vaccination did not increase the risk of unexplained sudden deaths among young adults in India, Union Health Minister J P Nadda told Lok Sabha on Friday. Past Covid hospitalization, family history of sudden death and certain lifestyle behaviours increased the likelihood of unexplained sudden deaths. Responding to a question, Nadda said the Indian Council of Medical Research (ICMR) has informed that it and the National Centre for Disease Control (NCDC) explored two approaches to investigate the causes of sudden death. The first approach was a retrospective case-control study to determine the risk factors associated with sudden death and the second approach of the study was to prospectively investigate sudden deaths in young adults using a virtual autopsy approach. The ICMR-National Institute of Epidemiology (NIE) conducted a study titled "Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study" at 47 tertiary care hospitals located across 19 states and Union territories during May-August 2023. Cases were apparently healthy individuals without any known co-morbidity, who suddenly (less than 24 hours of hospitalization or seen apparently healthy 24 hours before death) died of unexplained causes during October 1, 2021-March 31, 2023, Nadda stated. Four controls were included per case matched for age, gender and neighbourhood. Information was collected regarding data on COVID-19 vaccination/infection, post-Covid conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency, binge drinking and vigorous-intensity physical activity two days before death among the cases or interviewed controls, he said. A total of 729 sudden death cases and 2916 controls were included in the analysis. It was observed that receiving two doses of Covid vaccine significantly reduced the odds of unexplained sudden death, Nadda stated. Past COVID-19 hospitalization, family history of sudden death, binge drinking 48 hours before death/interview, use of recreational drug/substance and performing vigorous-intensity physical activity 48 hours before death/interview increased the odds of sudden death. "Hence, the study observed that COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviours increased the likelihood of unexplained sudden death," he said. The second study, titled "Establishing the cause in sudden unexplained deaths in young" conducted by the All India Institute of Medical Sciences (AIIMS), Delhi with funding and in collaboration with ICMR, is a prospective work aimed at determining the common causes of sudden deaths in young adults. Early analysis of data from the study indicates that heart attacks, or myocardial infarction (MI), continue to be the leading cause of sudden death in this age group. Importantly, no major changes in the pattern of causes have been observed when compared with previous years before the Covid pandemic. Together, these two studies offer a more comprehensive understanding of sudden unexplained deaths in young adults in India, Nadda said. It has also been revealed that Covid vaccination does not appear to increase the risk, whereas, the role of underlying health issues, genetic predisposition and risky lifestyle choices does play a role in unexplained sudden deaths, he said.
