SDA-RF-AT-3.11.pdf
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SDA-RF-AT-3.11
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Appropriate Technology for Health Care
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Jan Swasthya Sahyog
Health Centre: Village & P.O. Ganiyari - 495 112, District Bilaspur. Chhattisgarh. India.
Office: 1-4 Parijat Colony. Nehru Nagar, Bilaspur-495 001, Chhattisgarh, India.
Mailing address (ordinary post): P.O. Box 39, Bilaspur -495 001, Chhattisgarh, India.
Phone: Health Centre: +91 - 7753 -244819.
Office: +91 - 7752 - 270966
Residences: +91 -‘7752 - 271632 /270751/271819/ 508060
Email: pkumar@nii.res, in; j ss gan i yari @red i fl ma i I .com
2006
Contents
page
Introduction
Health related technology’ kits already developed
Diagnostic kits
Urinary tract infection
Measurement of anemia status
Measurement ofanemia status using copper sulphate solutions
Diagnosis ofsickle cel! anemia
Sputum concentration system
A kit useful at the community levelfor disease prevention
Microbiological testing of water and disinfection system
Diagnostic kits under field evaluation
Glucose
Vaginal tract infections
Reproductive health test kit
Equipment useful in diagnosis and evaluation in health care
Stadiometer
Breath counter
Easy to read thermometers
Teaching stethoscope
Easy to read blood pressure apparatus
Training Material
Growth bookletsfor growth monitoring
Pictorial drugformularyfor semiliterate health workers
Items useful at the community’ level for prevention/treatment
Mosquito repellant oil based on Neem. DMPA and citronella
ORS packets
Appliancefor breaking tablets into 3-4 piecesfor childhood medication
Safe delivery kitsfor the mother, baby and the birth attendants
First aid kitfor villages
Soap
Nutritionalformulary
Amylase rich flour
Edible oil supplementation
Amla paachak
C hoona namak
Mineral mix
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In trod notion
Technology is necessary in health care at all levels, in prevention, diagnosis, in treatment and
rehabilitation. In as much health care is an important tool in attainment of better health, the
availability of appropriate health related technology is necessary for better health.
Health related technology has developed at a rapid pace in the last few years. But their impact
on indices of public health has been minimal. While in urban areas technology has influenced
health care significantly, its role and relevance into the processes of disease diagnosis, disease
treatment, and disease prevention in the rural areas in both the public and the private sector has
been poor. The situation is worse at the level of the health workers at the village level, where
these public health problems are most often seen, as they have even poorer or no access to
technology. We are now faced with a situation where we have technology that is very advanced
but cannot be used by the majority of population, because of its expense, inaccessibility and
inappropriateness to the problem being encountered.
At Jan Swasthya Sahyog, a voluntary organization composed of professionals working towards
better health care for the poor, based in Bilaspur in Chhattisgarh, we have been working over
the last 5 years on developing health related technologies for health care needs of the people
with limited resources identified at the field level. W'e strive to ensure that these technologies be
as accurate, if not more, as the prevailing ones and yet be simple, acceptable, and yet cheap and
which can be. used in the low-resource settings in the rural and community levels. We hope that
they can be used by the all levels of health workers especially the most peripheral health workers
and would make diagnosis more rational and decrease misuse of drugs. The scope of such
appropriate technologies includes aids, skills, and techniques, technologies that could be applied
towards the above aims.
How have these technologies been developed?
Development of these technologies follows a path of identification of the problem, development
of the technology, its validation, and then its application after training of the end-users.
First, the need for a certain technology for disease diagnosis, treatment or prevention is identified.
Public health problems for which the existing technology is either expensive or not accessible
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or too mystified or complicated are identified at the community health program or at the referral
centre or in the laboratories of Jan Swasthya Sahyog or by interaction with similar groups.
Thereafter, the development of appropriate technology is done using the principles of science.
Kits we fabricated for initial laboratory validation under controlled conditions against the gold
standard. Once validated, these kits arc made available to limited organizations for field validation
after training them. If validated, these kits are available for general use.
Given below arc the details of some of the instruments, tools and diagnostics kits developed by
us. These details are a rather brief, and we would be happy to provide more detailed information,
in case you need it. In this list some of the items have successfully completed a few rounds of
field trials and some are at the Held evaluation stage. In case you have a need for any of the
listed technologies/ kits, you can place your orders with us. The costs indicated in the brochure
are an estimate and the exact cost and the delivery time will be communicated after receiving
confirmed orders. I lowever, we can assure you that as JSS works with a non-profit ethos, the
rates reflect primarily the production costs. Also, we conduct training programmes for interested
individuals/groups for use of these equipment and tests.
Health related technology kits already developed
Diagnostic kits
I.
Urinary tract infection
The currently available techniques used for the diagnosis of this infection involve either
microbial cultures, which are not available at most places, or microscopy performed by
a well trained technician using a good microscope.
For these reasons the diagnosis of this rather
important infection, is in most settings far from
satisfactory, and often presumptive. Especially in
pregnancy. UTI is an important condition where
one particularly wants an accurate diagnosis. This
kit is based on detecting nitrite (as a surrogate for
bacteria, which produce nitrite from nitrates
present in urine) and the activity of the enzyme
leukocyte esterase, which is produced by the pus
cells in urine( as a surrogate for pus cells). Besides.
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this kit gives the report in less than 10 minutes. This test kit has been extensively tested.
The sensitivity and specificity of this test in certain situations is over 95%.
II.
Measurement of anemia status
While diagnosing severe anemia may be simple by clinical examination in adults, lesser
grades of anemia that are also a cause of significant morbidity are not diagnosed by
health professionals reliably. In children this problem is even bigger, where the clinical
diagnosis is liable to be more inaccurate. The present tests available are either inaccurate
(e.g. the sahli’s test), or require an
expensive colorimeter (for the
/
ferricyanide test). The estimation of
anemia status in this kit is done by
Q.
measuring the packed cell volume of
centrifuged blood. ‘Semi skilled' health
workers can perform it, as it does not
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involve a venous puncture to collect
blood samples. It requires only a finger
prick sample. Thus it is more suitable
\o
for use in the field situation for this
major public health problem. This kit
utilizes a portable capillary centrifuge (papifuge) and has been used extensively and
found to be working reliably. The capifuge can run on AC mains or battery. The spin off
advantage of this technique is the availability of the separated plasma which can be
subjected to tests such as biochemical tests like that of glucose estimation!
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III.
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Measurement of anemia status using copper sulphate solutions
While the above testing apparatus gives you an accurate report, it requires a certain
amount of training of the health worker. Another test that can be performed at the
community level to diagnose anemia is by measuring the density of blood using different
concentrations of copper sulphate solutions. The density of blood is primarily determined
by hemoglobin. If we take different concentrations of copper sulphate in a solution form
and allow drops of blood to fall on it, the ability of blood drops to fsink or float will
depend on its density. We have standardized 3 different concentrations of copper sulphate
that correlate with hemoglobins of 11, 9 and 6 grams percent. Thus, it allows rapid, very
visible ( and thus convincing) and cheap way to classify hemoglobins in the categories
of over 11, 8 lol 1, 6 to 8 and below 6 grams per cent. The other advantage is that it can
be performed very easily by village level health workers and also that it can be done in
a group setting. Pre weighed satchels of copper sulphate granules and refill packs that
need to be dissolved in water are available.
IV.
Diagnosis ofsickle cell anemia
Sickle cell disease is an important problem in several pails of India, in particular central
India and Southern India. This disease is common not only in several tribal groups and
several other caste groups, where it caused lifelong morbidity, and often death. An accurate
diagnosis is a must to make a correct
therapeutic plan. Much as the screening test
is often available in several health care set
ups. the confirmatory test of hemoglobin
electrophoresis is not available easily, and if
available is rather expensive because of the
initial expense of the equipment and the
running costs. Our kit is also based on
conventional electrophoresis, but is available
at a fraction of the cost of the one available in the market. It uses the agarose gel/
nitrocellulose paper as the medium. The kit has been evaluated.
IV.
Sputum concentration system for increasing the sensitivity of microscopic
diagnosis oftuberculosis
For all practical purposes, tuberculosis is transmitted only by patients with pulmonary
disease who shed M. tuberculosis in their sputum (also known as ‘open cases'). Therefore,
in order to control disease transmission, it is impoilant to detect 'open' cases as early as
possible by microscopy or culture of the sputum. Since culture for M. tuberculosis is
expensive and time-consuming, most laboratories in endemic areas rely on microscopy
for diagnosis for reasons of economy, convenience and time. Direct smears are made
from the sample without preliminary processing. They at their best can pick up less than
half as many cases as can be done by culture for M. tuberculosis. In reality, even this
potential is not achieved in most situations for reasons of high sample loads that lead to
less than optimal time being devoted to individual smears.
The technique suggested by us is the Ammonium sulphate - Sodium hydroxide technique
pioneered by Dr Vasanthakumari that has the unique advantage of providing reliable
concentration of tuberculosis bacteria without the need for centrifugation. Moreover, it
is a single step technique requiring very little hands on time is very easy to learn and
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perform and uses chemicals that are inexpensive. We have seen that it increases (he
detection rate of tuberculosis bacteria in sputum and other by 33%. The great advantages
this allows in the Classification of a larger number of patients as Sputum-Positive and
avoids the expense / logistic difficulties of a Chest X-ray, which at best allows only a
presumptive diagnosis. This technique also facilitates the follow-up of sputum-positive
patients during treatment when culture facilities are not available.
A kit useful at the community levelfor disease prevention:
Microbiological testing of water and disinfection system
The H2S paper strip test was developed by the DRDO in Gwalior as a simple test for the
detection of fecal contamination of water. It was used during an outbreak of waterborne
illnesses to identify safe sources of drinking water. The technique involved incubation
of the water sample in the H,S paper strip bottle in the laboratory for 48 hours. Jan
Swasthya Sahyog has adapted this test to use at the village level. This paper strip test to
detect fecal contamination of drinking water can be used by the community themselves.
Instead of laboratory based incubation it was found that if the water sample is incubated
by contact with the body, comparable results are obtained. If there is fecal contamination,
the water turns black.
Once the water is detected to be fecally contaminated, (he water can be treated using an
ultraviolet light based treatment apparatus. Unlike the commercial UV based technology
it can be used for water that is not running (as is the case for most rural and urban
households) can be used where there is no electricity and can be shared by many
households.
This disinfecting system uses a 254 nm light from a 9W tube light. In ten minutes 50
litres of clear water can be disinfected. It can run using either AC mains or 12V battery
or a cycle dynamo. The progress and completion of the disinfection process is also
displayed.
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Diagnostic kits underfield evaluation
I.
Glucose
Blood glucose is an important test in as much as it allows us to diagnose and monitor
diabetes mellitus, an increasingly important
public health problem. Its estimation is also
important in monitoring sick patients, say with
malaria.
In the kit for glucose estimation, a dedicated
colorimeter is used to readthe developed colour
by glucose present in the plasma and Otoluidine reaction. The plasma that is separated
while checking for anemia using the capillary
centrifuge can be used for this. This test can run on AC mains or battery. Beta version of
this kit is being evaluated presently. This chemical test docs not require refrigeration for
its reagents.
II.
Vaginal tract infections
Vaginal infections are an important cause of morbidity in women. Its diagnosis is either
not available (due to lack of suitable lab set up. lack of woman health workers, or even
due to reluctance of several women to allow even women health workers to perform an
internal examination to collect a fluid specimen from the vagina), or is not even attempted!
Several recommendations from important national and supranational bodies thus
recommend empirical therapy for anyone woman who presents with vaginal discharge.
In order to rationalize the diagnosis of this set of infections, this kit has been developed
which uses a self administered adsorbent testing pad which the woman can use to collect
a vaginal fluid sample on her own. Three tests, namely pH, KOH amine and leukocyte
esterase are performed. An algorithm to effectively use these three tests for the diagnosis
of vaginal infection is also included in the kit. The results allow one to distinguish
excessive normal discharge from vaginal infections. Besides, it allows one to rationalize
the therapy of infections by reducing the number of drugs that one may have to do if one
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was to use the otherwise prescribed syndromic approach. This test is presently being
evaluated further.
III.
Reproductive health test kit
This kit incorporates the above mentioned tests to diagnose urinary tract infection that
does not need a microscope, and to diagnose reliably diagnose the presence (or the
absence) of vaginitis or cervicitis among women presenting with vaginal discharge.
Besides, it includes urine pregnancy test strips that can enable a village health worker to
diagnose early pregnancy so that subsequent decisions be taken. It also includes reagents
that enable the detection of proteinuria as a secondary marker of pregnancy induced
hypertension- another common problem that causes significant mortality and morbidity
both in the mother and the baby. This assembly of these 4 diagnostic tests in addition to
the anemia diagnosis tests allows has the potential of strengthening reproductive health
programme by adding a laboratory component to public health.
Equipment useful in diagnosis and evaluation in health care
I.
II.
Stadiometer
Height is arguably the best way to measure the nutritional status
of the entire community, but is sparingly used for the want of a
simple technology that is portable. Use of height is also
necessary to identify high risk pregnancy who should be advised
institutional deliveries It can be used to assess the body mass
index (weight/ height squared) which is a robust marker of
nutritional status. Using a flexible tape stuck to a wall is liable
to be inaccurate. Our portable and inexpensive device can
measure heights in (he field, or even in the clinics.
C-‘
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Breath counter
Measurement of respiratory rates is essential for the early
diagnosis of lower respiraloty tract infections in children that
accounts for a large number of deaths. We believe that
accurate measurement of respiratory rates and remembering
different rate cutoffs for different age groups is not easy. Since
most health personnel whom most mothers access for health
problems and are available in the community have limited
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literacy and clinical skills, early diagnosis of pneumonia is a public health problem.
Semiliterate and neoliterate health workers find it difficult to measure rates in young
children, where rates are high, to maintain coordination between counting the breaths
and the watch and to remember various age specific cutoffs for abnormal respiratory
rates, is difficult. In fact it is difficult even for more literate and higher levels of health
workers including nurses and doctors. Our breath counter is a microcontroller based
counter, runs on a 9V battery, and records the rate of breathing by just pressing on a
button and gives the output in form of red or green signal for abnormally high rate or
otherwise.
III.
Easy to read thermometers
Measurement of temperature is a useful clinical tool. It distinguishes those illnesses that
are associated with fever (and require a different work up) from those that are not
associated with fever e.g. iron deficiency anemia). Thermometry also allows one to
assess the effect of medicines or non-drug
therapy given to bring the fever down.
However usual thermometers are difficult to
read for those health workers who have limited
literacy levels. Our thermometers are
essentially for these groups of health workers
in which the abnormal temperature range on it
are coloured red for easy use.
IV.
Teach ing steth oscope
This training aid allows a trainer to teach and evaluate the use of a stethoscope in clinical
care. A stethoscope is required in the measurement of blood pressure, finding and counting
fetal heart sounds in a pregnant woman and hearing the breath sounds to diagnose chest
problems ands in several other situations.
Essentially it has one chest piece and 2 sets of earpieces, one each for the trainer and the
trainee.
V.
Easy to read blood pressure apparatus
Measurement of blood pressure is a useful skill in picking up hypertension, an important
public health problem. In pregnancy its measurement has the very important function of
picking up Pregnancy induced hypertension/ preeclampsia, which if untreated can lead
to morbidity and mortality for both the baby and the mother. This skill is traditionally
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performed by senior health professionals like the nurse and the doctor’ the more peripheral
health workers, say at the village level usually do not measure this impoilant parameter
because ol the lack of availability of a simple, easy to understand apparatus.
Our easy to read blood pressure apparatus has the abnormal blood pressure ranges for
both the systolic and the diastolic values coloured red. This enables health workers with
limited literacy skills to be able to measure blood pressure.
Training Material
I.
Growth bookletsfor growth monitoring
We believe that growth monitoring is an important tool in nutrition improvement
strategies. But understanding the concept of the graph is not easy for health workers
with limited literacy skills. This growth booklet is an attempt to overcome this problem.
Our growth monitoring is with the help of a booklet, and not a card or graph, is based on
the two assumptions namely that each
child should follow his/ her own trajectoiy
of growth, which depends on the birth
weight. If the child grows normally, the
child should not slip below the designated
trajectory. Also, given additional inputs
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an undernourished child should catch up
the trajectory of a normal child, but at least
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retain his / her previously designated
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trajectory. Thus there is in fact a series of
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booklets to cater to a range of birth
weights that depict different trajectories
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for different weight and sex categories.
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The second assumption is that each point
on the growth trajectory is designated a separate page where the visual depiction and
interpretation of growth is done on an actual picture of the weighing scale aided by a
long established norm of red means danger and green means normal colour scheme
on the dial of the scale. The viewer can simply plot the weight on the picture and
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immediately read the nutrition status depending on where the plotting pencil stands- red
or green.
Seeing their child’s weight pictorially by long established norm of red means danger
and green means normal is likely to impress them about the need for action. In this
way, growth monitoring is likely to increase the acceptability of health education,
acceptability of food supplementation and impress the need to treat infections/ illnesses
in their child early. At a community level this is more likely to lead to demand for
implementation of food programmes or for changes in agricultural practices.
We see some other advantages of the growth booklet. In an environment of poverty, the
growth booklet is a record for the family; it may be the only record of the child. The
family members and the community arc likely to see the relation between food and
growth better, which unfortunately is not well appreciated by several people. The medical
community, has medicalized hunger as ‘’malnutrition" and is inclined to suggest non
food ways of managing it. With the help of the growth booklet the parents can see the
consequences of illnesses on the nutritional status, and conversely see the benefit on the
weight of the child due to additional food during recovery from illnesses.
//.
Pictorial drugformularyfor semiliterate
health workers
For the use of village health workers who have
limited literacy skills, we have developed a drug
formulary that is pictorial and has information
on about 15 drugs that a health worker would be
using in her usual service. There is also scope to
add information on new drugs that a health worker
may learn subsequently.
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Items useful at the community levelfor disease prevention and/or treatment
I.
Mosquito repelIant oil based on Neem, DMPA and citronella
In tribal areas where falciparum malaria is a major public health problem mosquito nets
alone are not enough for prevention of mosquito bites as people get bitten in the evening
hours, often at night while guarding the harvest, and in the early hours of the morning
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when people go out to the forest for work. Therefore there is a need for a mosquito
repellant which should be effective and yet cheap.
Effective mosquito repel hint creams and oils with a good odour at a fraction of commercial
cost using 5% neem oil, 10% Dimethyl phthalate and 5% citronella oil made in Mahua
oil have been developed here. They have been evaluated and found to be effective and
acceptable with one time application protects against mosquito bites for at least 4 hours.
IL
ORS packets
Oral rehydration solution (ORS) is universally accepted as one of the most important
lifesaving drug during a diarrheal episode. The Oral rehydration solution packs available
commercially are expensive. Homemade ORS has the limitations of not containing
potassium salts and in not being accurately weighed. The other problem that is often
seen in the field is that often poor families do not have sugar at home to make the ORS
solution and have to buy afresh. To circumvent this problem Jan Swasthya Sahyog trained
village health workers to make their own ORS in a packet form. Plastic spoons of such
a volume that they contain the required amount of salts and table sugar have been prepared.
The packs are sealed by a packet-sealing machine by the village health workers
themselves. The ORS pack contains the following:
Sodium chloride : 3.5 g.
Trisodium citrate: 2.9 g.
■
Potassium chloride: 1.5 g.
Sucrose : 40 g.
HL
Appliancefor breaking tablets into 3-4 pieces for childhood medication
When one dispenses tablet formulations to children, breaking a tablet accurately in two
pieces is not difficult, but breaking into accurate fractions of one third is not easy. This
tablet breaker helps is rather accurate breaking of a tablet into three pieces.
IV.
Safe delivery kits for the mother, baby and the birth attendants
At the time of birth of the child, there is clearly a requirement of an assortment of items
that should be clean, appropriate and readily available. Thus it has been a common
practice in public health care to make available delivery kits to pregnant women. However,
most of the delivery kits that we have seen do not have all the things that are required at
the time of delivery, both for the baby and the mother for at least one post partum day,
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and which is convenient to use. The delivery kits that have been developed here have
looked at these issues and have evolved over time on basis of feedbacks from the users.
The kits are ethylene oxide sterilized. They also contain a pictorial booklet suggesting
its use and a list of advice for the mother and child.
First aid kitfor villages
Primary care for acute health problems illnesses is a major lacuna in our health care
systems, which results in considerable hardships and impoverishment, besides causing
avoidable mortality and morbidity. Injuries and animal bitesl are common in the rural
areas and appropriate first aid for them is very often found wanting. Similarly, care for
common illnesses like fever, vomitings and diarrhea is necessary. There are several
problems such as drowning, cardiopulmonary arrest, choking on a foreign body and
epistaxis whose outcomes will improve dramatically if appropriate skills for immediate
care are available in the community at large. We have fabricated a kit that looks at the
needs of the rural people, and offers information, replenishable materials, and certain
essential equipment that allows first aid to be administered by someone who will need a
day long training programme in its use. This kit has 29 items and also includes things
like bamboo splints for fractures of lower limb and upper limbs, a cloth to make a
triangular sling for clavicular fracture, a peripheral blood smear making slide kit box, an
easy to read thermometer and a few disposable syringes for safe injections. Of course,
the other advantage of the use of this kit is fostering of this belief that self help is
possible without getting help from specialists, and even primary care for illnesses and
injuries is possible to be made available even through the lay people.
VI.
Soap
Soaps are made by our village health workers using locally available cheap oils (in our
area- from mahua (called Saral mahua soap) , from mustard or kusum oil) for use as a
public health measure. These soaps that are rather economical, and yet retain all the the
attractive properties like foam, good smell and the softness and lack of dryness after
soap use. It has been shown that use of soap reduces the incidence of diarrrheal illnesses
by 30%. Our objective for making these soaps is that village people should get good
quality soaps at a cheap rate and should preferably have there own individual soaps.
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Nutrition alformulary
While it is true that under nutrition is primarily due to poor food availability, knowledge
about feeding practices and the choice of foods has a role. Once a child (or an adult slips
into severe under nutrition, besides availability of appropriate foods, there is a role for
certain micronutrients, that should be available in a cheap and convenient formulation.
We have identified some important roadblocks in managing severe undernutrition where
technology has a role and have the following solutions:
Type of
intervention
Ta rget
Objective
Formulation
oil
calorie undemut
increase calorie density
200 ml bottles
amylase rich flour
under 5 children
ready to eat semisolid
food in areas where milk
is not available
am la pachak
iron deficiency anemia,
pregnant women
vitamin C provision
35 g packs, to finish in I week, enough
to provide the desired Vit C to ensure
iron absorption per day
choona namak
calcium deficiency
Provision of calcium
500 mg elemental calcium satchels
mineral mix
severe calorie
undernutrition
pottasium, zinc
and'magnesium
supplements
As sweet "bataashas" containing the
appropriate amounts
200 g packs
Amylase rich flour
Semisolid and liquid preparations of food which are calorie dense is an important
requirement of complementary feeding of children in the post weaning period i.e. from
the age of 6 months to 2 years of age. This is a critical time when children who have
previously been well nourished slip into under nutrition. Where available, use of animal
milk is used as an additive for softening feeds. However in many communities animal
milk is not available. Amylase rich Hour prepared by germinating cereals such as wheat.
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Ragi and jowar is useful in softening cereal based foods, making it sweeter, more
digestible and adding to the nutritive value.
II.
Edible oil supplementation
Adding oil to the food is a simple way to increase the calorie density and the calories
delivered without increasing the volume of food. Such advice can be made more effective
by making available such exclusive bottles that contain adequate oil for a week's need
of a child.
III.
Anda paachak
A ready source of Vitamin C, that is food based, and is dry and thus can be dispensed is
necessary, given the fact that the bulk of food that we consume is cereal- pulse based.
Amla ( Indian Gooseberry) is perhaps the richest source of dietary Vitamin C, and
significant amounts remain even after it is dried.
IV.
Choona namak
A dietary’ source of calcium is necessary. Drug based calcium is either expensive, or
most formulations contain very' little calcium. Our preparation- presently in satchel form
is called choona namak- literally calcium salt- and is actually 1.25 grams of calcium
carbonate, which provides 500 mg of elemental calcium, is supposed to be added to
food, like salt. 2 satchels of this should provide 1 gram of elemental calcium enough as
a therapeutic measure for pregnant and lactating women, for osteomalacia and
osteoporosis and for rickets.
V.
Mineral mix
Due to chronic food deficiency, besides calorie deficiency, we also observe deficiency
of several minerals- which if not supplied specifically will retard the recovery from the
stale of severe under nutrition. Among the prominent ones are potassium, zinc and
magnesium. Several studies have shown that failure to supplement potassium and zinc
have resulted in higher deaths and morbidity in the setting of severe under nutrition. We
have formulated the necessary amount of these minerals in the form of “Bataashas ”- a
sweet candy- to be consumed daily. These bataashas are also available to provide
potassium supplements alone too.
Work reported in this brochure is in pails financially supported by the
Department of Science and Technology, Government of India.
Position: 2693 (2 views)