Non-pharmacological Interventions in Hypertension: A Community-based Cross-over Randomized Controlled Trial

Background:

Hypertension is the most prevalent non-communicable disease causing significant morbidity/mortality through cardiovascular, cerebrovascular, and renal complications.

Objectives:

This community-based study tested the efficacy of non-pharmacological interventions in preventing/controlling hypertension.

Materials and Methods:

This is a cross-over randomized controlled trial (RCT) of the earlier RCT (2007) of non-pharmacological interventions in hypertension, conducted in the urban service area of our Institute. The subjects, prehypertensive and hypertensive young adults (98 subjects: 25, 23, 25, 25 in four groups) were randomly allotted into a group that he/she had not belonged to in the earlier RCT: Control (New Group I), Physical Exercise (NG II)-brisk walking for 50 to 60 minutes, three to four days/week, Salt Intake Reduction (NG III) to at least half of their previous intake, Yoga (NG IV) for 30 to 45 minutes/day, five days/week. Blood pressure was measured before and after eight weeks of intervention. Analysis was by ANOVA with a Games-Howell post hoc test.

Results:

Ninety-four participants (25, 23, 21, 25) completed the study. All three intervention groups showed significant reduction in BP (SBP/DBP mmHg: 5.3/6.0 in NG II, 2.5/2.0 in NG III, and 2.3/2.4 in NG IV, respectively), while the Control Group showed no significant difference. Persistence of significant reduction in BP in the three intervention groups after cross-over confirmed the biological plausibility of these non-pharmacological interventions. This study reconfirmed that physical exercise was more effective than Salt Reduction or Yoga. Salt Reduction, and Yoga were equally effective.

Conclusion:

Physical exercise, salt intake reduction, and yoga are effective non-pharmacological methods for reducing blood pressure in young pre-hypertensive and hypertensive adults.     

Tracking of Blood Pressure Among Adolescents and Young Adults in an Urban Slum of Puducherry

Background:

Early diagnosis of hypertension (HT) is an important strategy in its control. Tracking of blood pressure (BP) has been found useful in identifying persons with potential HT, particularly in youngsters. A cohort of 756 subjects (with baseline information as a cross-sectional study in 2002) was followed up in 2006 to comment on the distribution of BP and its attributes.

Objectives:

To track BP distribution in a cohort of adolescents and young adults, and assess the persistence of high/low normotensives; to measure the incidence of HT and study the relationship of BP with age, sex, socioeconomic status, BMI, physical exercise, salt intake, smoking and alcohol consumption.

Materials and Methods:

The baseline study cohort (2002) of 756 subjects (19-24 years) in urban field area of Department of Preventive and Social Medicine, JIPMER, was followed up between May and November 2006 by house visits for measurement of sociodemographic variables, anthropometry, salt intake, physical activity and BP.

Results:

A total of 555 subjects from the 2002 cohort were contacted (73.4%), in that 54.5% subjects who were below 5^th percentile, 93.6% subjects between 5^th and 95^th percentiles and 72% of those above 95^th percentile previously persisted in the same cut-offs for systolic blood pressure (SBP). The corresponding figures for diastolic blood pressure (DBP) were 46.2, 92.2 and 74.1%, respectively. Shift from one cut-off to another was not significant for both SBP and DBP, proving the tracking phenomenon. Annual incidence of HT was 9.8/1000. Baseline BP was the significant predictor of current BP for the entire cohort; BMI and salt intake were significant predictors only in certain sections of the study cohort.

Conclusions:

Early diagnosis of hypertension even among adolescents/young adults is an important preventive measure, as tracking exists in the population.     

Period Prevalence and Sociodemographic Factors of Hypertension in Rural Maharashtra: A Cross-Sectional Study

Background:

Hypertension is most common cardiovascular disease and it account for large proportion of all cardiovascular deaths and disability worldwide.

Research Questions:

What is the level of prevalence of hypertension in rural area? What are the soociodemographic factors associated with hypertension?

Objectives:

To find out prevalence of hypertension in rural area.

Study Design:

A community-based cross-sectional study setting: Rural Health Training Centre Paithan, field practice area of govt. medical college Aurangabad, Maharashtra.

Participants:

1297 persons aged 19 years and above.

Study Period:

June 2005 to December 2006.

Materials and Methods:

A house-to-house survey was conducted by the author himself, interviewed the participants by systematic random sampling method, using pretested structured standard questionnaire. Two independent blood pressure (BP) readings were taken in sitting position by visiting each participant at their home. Hypertension was defined as systolic BP more than or equal to 140 mm of Hg or diastolic BP more than or equal to 90 mm of Hg or those individuals currently taking antihypertensive treatment.

Statistical Tests:

Percentiles, Chi Square test, Chi-Square for linear trend, multiple logistic regression analysis on SPSS software Version 10.

Results:

Overall prevalence of hypertension in the study subjects was 7.24%. Multiple logistic regression analysis identified various factors significantly associated with hypertension were age, sex, BMI, additional salt intake, smoking, DM, alcohol consumption, and higher socioeconomic status.

Conclusions:

The overall prevalence of hypertension in study subjects was 7.24%.     

Impact of Short Term Yoga Intervention on Mental Well Being of Medical Students Posted in Community Medicine: A Pilot Study

Background:

High level of stress, anxiety and depression is seen among medical students.

Aims:

To assess the impact of brief structured yoga intervention on mental well being of MBBS students.

Materials and Methods:

The participants consisted of 82 MBBS students of 3^rd semester in the age group of 18-23 years. The students were assessed at baseline and at the end of one month of specific yoga intervention by using General Health Questionnaire-28 (GHQ-28).

Results:

The students reported improvement in general and mental well being following the intervention and difference was found to be highly significant.

Conclusion:

A short term specific yoga intervention may be effective in improving general and mental well being in MBBS students. It is feasible and practical to include yoga practice in block postings of community medicine.     

Prevalence, Awareness, Treatment, and Control of Hypertension in Rural Areas of Davanagere

Objective:

To study the prevalence, awareness, treatment, and control of hypertension in the rural areas of Davanagere.

Type of Study:

Cross-sectional community-based study.

Setting:

Villages belonging to six sectors of the Davanagere Taluk.

Materials and Methods:

General population above 18 years.

Methodology:

A community-based sample was chosen by a multistage sampling technique. Subjects were screened for hypertension by a house-to-house survey. Subjects with systolic blood pressure more than 140 and diastolic blood pressure more than 90 mm of Hg, on hypertensive treatment, and history of hypertension were classified as hypertensives. The data thus obtained was compiled and analyzed.

Results:

The prevalence rate of hypertension in the study population was 18.3% (95% CI, 16.7-19.9%). Prevalence of hypertension was more in males 19.1% (95% CI, 16.7-21.5%) than in females 17.5% (95% CI, 14.9-20.1%); 11.6%, 5.6%, and 1.2% of the total subjects had Grade I, Grade II, and Grade III, respectively. Only 33.8% of them were aware of their hypertensive status. Hypertensives of 32.1% were on treatment, and 12.5% adequately controlled their BP. About 6.9% of the total hypertensives had severe hypertension.

Statistical Analysis:

Proportions, One way Analysis of Variance, Chi-square test.     

Study on Prevalence of lodine Deficiency Disorder and Salt Consumption Patterns in Jammu Region

Research Question:

What is the situation of iodine deficiency disorder (IDD) and salt consumption in Jammu region?

Hypothesis:

The prevalence of IDD has decreased markedly as a result of medical as well as socio-economic factors.

Objective:

To assess the magnitude of IDD in Jammu region and also assess the salt consumption patterns in the region.

Design:

Cross-sectional study.

Setting:

Primary schools in both urban and rural areas.

Study Tools:

Clinical examination of study population for goiter, laboratory assessment of casual urine sample for urinary iodine estimation of I₂ content of salt samples collected from sub-samples of study population.

Participants:

School children in the age group of 6-12 years were selected for study using WHO 30-cluster methodology, urine samples were collected from 15% of selected children and salt samples from 5% of sub-sample.

Ethical Concern:

No ethical issues were involved.

Results:

An overall goiter prevalence of 11.98% was observed in the region. Females had a prevalence of 16.1% and males 10.1%. The median urinary iodine excretion in the region was 96.5 μg/l (range: 29.0-190.0 μg/l). Forty-nine percent of subjects had biochemical iodine deficiency with 6.7% having moderate and 42.53% mild iodine deficiency. In Jammu region, 74.47% of households consume powdered salt with 98.17% powdered salt samples having an I₂ content of greater than 15 ppm.

Conclusion:

Iodine deficiency remains a public health problem in the region, though the region seems to be in a state of nutritional transition from iodine deficiency to iodine sufficiency.     

Tracking Progress Toward Elimination of Iodine Deficiency Disorders in Jharkhand, India

Research question:

What is the current status of Iodine Deficiency Disorders (IDD) in the state of Jharkhand?

Objectives:

(1) To determine the status of iodine deficiency in the state. (2) To determine the availability and cost of adequately iodized salt at the retail shops. (3) To study the perceptions of the community regarding iodine deficiency, salt and iodized salt.

Design:

A cross-sectional community-based survey.

Study setting:

Thirty clusters selected through the probability proportion to size (PPS) sampling in the state of Jharkhand.

Study participants:

Children aged 6-12 years, households, retail shopkeepers and opinion leaders.

Study tool:

Quantitative and qualitative methodology using a pretested questionnaire and focus group discussion used to carry out the community-based survey.

Results:

Total goiter rate (TGR) was 0.9%. Median urinary iodine level was 173.2 µg/L. The proportion of individuals with urinary iodine levels less than 100 and 50 µg/L were 26.4% and 10%, respectively. Slightly less than two-thirds (64.2%) of the households were found to be consuming adequately iodized salt as measured by titration (greater than 15 ppm). Iodized salt was available across the state and the cost varied between Re. 1 and Rs. 8 per kilogram. A common belief among the community was that iodized salt is equivalent to refined packet salt that is further equivalent to expensive salt.

Conclusion:

The results of the present survey show that the iodine nutrition in the state of Jharkhand is optimal. Considering that the consumption of adequately iodized salt should increase from 64.2% to the goal of more than 90%, sustained efforts are required in this place to consolidate the current coverage of adequately iodized salt and increase it to greater than 90%.     

Effect of sodium restriction on blood pressure of unstable or uncontrolled hypertensive patients in primary care

BACKGROUND/OBJECTIVES

The aims of the present study are: 1) to quantify sodium consumption of patients with unstable or uncontrolled hypertension, 2) to investigate if reduced sodium intake can lower BP in these patients, and 3), to assess the acceptability and feasibility of this approach.

SUBJECTS/METHODS

This study included 25 adults (age: 50+ years) with frequently elevated BP or patients with uncontrolled, uncomplicated hypertension despite drug treatment in a general practice setting. BP and salt intake (24h urinary excretion and food records) were measured at baseline and after a sodium reduced diet.

RESULTS

Mean (± SD) systolic (SBP) over diastolic (DBP) blood pressure (mmHg) at baseline was 150.7 (± 9.5)/84.149 (± 5.6). Mean urinary sodium excretion was 146 mmol/24h. A reduction of 28 mmol sodium excretion decreased SBP/DBP to 135.5 (± 13.0)/82.5 (± 12.8) (P < 0.001). After one month of no dietary advice, only in 48%, SBP was still ≤140 mmHg.

CONCLUSION

Assessment of sodium intake using food records, 24h urine collections and probing questions to identify use of sodium containing supplements or drugs are essential for tailored advice targeted at sodium intake reduction. The results of the present study indicate that reduced sodium intake can lower BP after 4 weeks in unstable or uncontrolled hypertensive patients.     

Status of Iodized Salt Coverage in Urban Slums of Cuttack City, Orissa

Background:

For sustainable elimination of iodine deficiency disorders (IDD), it is necessary to consume adequately iodized salt on a regular basis and optimal iodine nutrition can be achieved through universal salt iodization.

Objective:

To assess the extent of use of adequately iodized salt in the urban slums of Cuttack.

Materials and Methods:

Using a stratified random multi-stage cluster sampling design, a cross-sectional study involving 336 households and 33 retail shops selected randomly from 11 slums of Cuttack was conducted in 2005. A predesigned pretested schedule was used to obtain relevant information and salt iodine was estimated qualitatively by using a spot testing kit and quantitatively using the iodometric titration method.

Statistical Analysis:

Proportion, Chi-square test.

Results:

Only 60.1% of the households in urban slums of Cuttack were using adequately iodized salt i.e., the iodine level in the salt was ≥15 ppm. Iodine deficiency was significantly marked in sample salts collected from katcha houses as compared with salts collected from pucca houses. Households with low financial status were using noniodized/inadequately-iodized salt. Both crystalline and refined salts were sold at all retail shops. Crystalline salts collected from all retailers had an iodine content < 15 ppm and refined salts collected from one retailer had iodine content < 15 ppm. About 48.5% of salt samples collected from retail shops were adequately iodized.

Conclusion:

In the urban slums of Cuttack, retailers were selling crystalline salts, which were inadequately iodized- this would be a setback in the progress towards eliminating IDD.     

Digital Education to Limit Salt in the Home (DELISH) Program Improves Knowledge,Self-Efficacy,and Behaviors Among Children

Objective

To determine the efficacy of a Web-based salt reduction program on children's salt-related knowledge, attitudes, and behaviors (KABs), self-efficacy, and intake of dietary salt.

Effectiveness of School-Based Intervention Programs in Reducing Prevalence of Overweight

Objectives:

To assess the effectiveness of school-based interventions program in reducing the prevalence of overweight or obesity among schoolchildren.

Data source:

Ovid Medline (1950-December 2012), Embase (1980-2012), CINAHL (1982-2012), secondary references, review articles, and expert in the field.

Study selection:

All published clinical trials were eligible for study if were randomized, methodologically strong-based on a validity assessment, aimed to evaluate a school-based intervention for childhood overweight or obesity, and measured outcome in term of prevalence/incidence difference in overweight and obesity among both groups. Studies involved in cost-effective analysis of school-based intervention have been excluded. Data from eligible studies abstracted and pooled for relative risk.

Results:

Five trials with 3,904 schoolchildren were included. Mean age of the students (boys and girls) ranges 8.6-12.6 years. Meta-analysis showed a statistical significance beneficial effect of school-based intervention programs on obesity status of schoolchildren (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.43-0.78) and suggested 42% reduction in prevalence of obesity among schoolchildren through school-based intervention programs. Individual studies also showed effectiveness of these school-based interventions.

Conclusion:

School-based intervention programs are effective in prevention of childhood overweight and obesity problem and our results quantitatively supported this argument.     

Clinical effects of yoga on asthmatic patients: a preliminary clinical trial

Background

Asthma is one of the commonest respiratory diseases in Jimma area as well as a significant disease burden worldwide costing billions of dollars. Anti-asthmatic drugs that are available in the market are expensive and have adverse effects. Thus, it is wise to look for an adjunct therapy to alleviate these problems. Therefore, the main aim of this study is to see the effect of yoga on patterns of clinical features, peak expiratory flow rates and use of drugs in asthmatic patients.

Methods

A preliminary controlled clinical trial study was conducted on 24 volunteer asthmatic patients who were getting support at the missionary of charity. They were grouped in yoga and control groups. An Indian yoga expert through a translator conducted the training on yogic practice, yogic posture, breath slowing technique and discussion at the end. Then, the yoga groups were supervised for four weeks taking yoga exercise daily for 50 minutes. Peak expiratory flow rate was taken using the mini Wright peak flow meter and vital signs were measured in both groups. Data were analyzed using web based Graph pad quick calcs statistical software.

Results

The male to female ratio was 1:1 in both cases and control groups, 8(66.7%) were Christian and 9 (75.0%) were farmers. The yoga group showed 66.7% reduction in the use of salbutamole puff and 58.3% salbutamole tablets. There was a 10% increment in the PEFR in the yoga group while only 2% in the control group. There was statistically significant reduction in day and night asthma attacks in the yoga group.

Conclusion

Yoga exercise among asthmatic patients resulted in a decreased number of day and night attacks and use of drugs. It also shows significant improvement in the peak expiratory flow rate. Further large scale study is recommended.     

Early adulthood: an overlooked age group in national sodium reduction initiatives in South Korea

BACKGROUND/OBJECTIVES

South Korean''s sodium consumption level is more than twice the upper limit level suggested by the WHO. Steep increases in the prevalence of hypertension and cardiovascular disease in Korea necessitate more effective sodium reduction programs. This study was conducted in order to compare sodium intake-related eating behaviors and key psychosocial factors according to age group and gender.

SUBJECTS/METHODS

Using an online survey, a total of 1,564 adults (20-59 years old) considered to be geographically representative of South Korea were recruited and surveyed. The major outcomes were perceived behaviors, knowledge, intentions, and self-efficacy related to sodium intake.

RESULTS

The results show that perceived behavior and level of self-efficacy related to low sodium consumption differed by age and gender. Female participants showed better behavior and intention towards low sodium intake than male counterparts. Young participants in their 20s showed the lowest intention to change their current sodium intake as well as lowest self-efficacy measures.

CONCLUSIONS

Future sodium reduction interventions should be developed with tailored messages targeting different age and gender groups. Specifically, interventions can be planned and implemented at the college level or for workers in their early career to increase their intention and self-efficacy as a means of preventing future health complications associated with high sodium intake.     

Study on Obesity and Influence of Dietary Factors on the Weight Status of an Adult Population in Jamnagar City of Gujarat: A Cross-Sectional Analytical Study

Background:

Obesity has reached epidemic proportions globally and is a major contributor to the global burden of chronic diseases. Dietary factors are the major modifiable factors through which many of the external forces promoting weight gain act.

Objectives:

The objectives were to find the prevalence of overweight and obesity in the urban population of Jamnagar and to explore the effect of dietary factors on the weight status of the people.

Materials and Methods:

A cross-sectional study was conducted among the adult population of Jamnagar city. Cluster sampling technique was used to select study samples. Data were collected in a prestructured questionnaire by interviewing subjects through house-to-house visits. Data were analyzed in Epi Info and appropriate statistical methods were used.

Results:

The prevalence of overweight and obesity was found to be 22.04% and 5.20%, respectively. Overweight was more prevalent in females than males. The prevalence rose with an increase in age up to 60 years. Among dietary factors, the total calorie intake and habit of snacking had a positive association with weight gain (P < 0.05). The mean intake of oil was more and the mean intake of vegetables was less among overweight subjects than nonoverweight subjects (P < 0.05).

Conclusion:

The prevalence of overweight and obesity in the urban population in Jamnagar was found to be 22.04% and 5.20%, respectively. Total calorie intake as well as composition of diet was the important dietary factor affecting weight gain.     

Interventions for physical activity promotion applied to the primary healthcare settings for people living in regions of low socioeconomic level: study protocol for a non-randomized controlled trial

Background

Regular physical activity practice has been widely recommended for promoting health, but the physical activity levels remain low in the population. Therefore, the study of interventions to promote physical activity is essential. Objective: To present the methodology of two physical activity interventions from the “Ambiente Ativo” (“Active Environment”) project.

Methods

12-month non-randomized controlled intervention trial. 157 healthy and physically inactive individuals were selected: health education (n = 54) supervised exercise (n = 54) and control (n = 49). Intervention based on health education: a multidisciplinary team of health professionals organized the intervention in group discussions, phone calls, SMS and educational material. Intervention based on supervised exercise program: consisted of offering an exercise program in groups supervised by physical education professionals involving strength, endurance and flexibility exercises. The physical activity level was assessed by the International Physical Activity Questionnaire (long version), physical activities recalls, pedometers and accelerometers over a seven-day period.

Result

This study described two different proposals for promoting physical activity that were applied to adults attended through the public healthcare settings. The participants were living in a region of low socioeconomic level, while respecting the characteristics and organization of the system and its professionals, and also adapting the interventions to the realities of the individuals attended.

Conclusion

Both interventions are applicable in regions of low socioeconomic level, while respecting the social and economic characteristics of each region.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01852981","term_id":"NCT01852981"}}NCT01852981     

Routine Immunization - Do People Know About It? A Study Among Caretakers of Children Attending Pulse Polio Immunization in East Delhi

Research question:

Do caretakers of children under five years have sufficient knowledge regarding routine immunization (RI)?

Objective:

To assess the knowledge about RI among caretakers of young children.

Settings:

Pulse polio immunization centres in East Delhi.

Study design:

Cross-sectional study.

Participants:

Six hundred and eighty-two caretakers accompanying children under 5 years to pulse polio booths in November 2006.

Study tool:

Pre-tested semi-open-ended questionnaire.

Statistical analysis:

Proportions, Chi-square test.

Results:

The proportions of respondents who had awareness about different aspects of RI, such as weekday of RI (37.0%), age group for RI (49.1%), number of visits required in the first year of life (27.0%), were all low. When asked to name the four diseases covered under the RI program in Delhi, only 268 (39.3%) could name at least three. The education level of respondents was strongly associated with their knowledge about RI.

Conclusion:

The need of the hour is to make RI a ‘felt need’ of the community. Making caretakers more aware about RI is a vital step in achieving this goal.     

Assessing Physical Activity,Fruit, Vegetable,and Sugar-Sweetened Beverage Intake Patterns of College Students in Kansas

Objective

To test the effectiveness of a 15-month intervention for reducing sugar-sweetened beverage (SSB) intake among college students and assess fruit and vegetable (F/V) intake and physical activity (PA) habits and their relationship to SSB intake.

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Validity of a Surveillance System for Childhood Injuries in a Rural Block of Tamilnadu

Background:

Childhood injuries are increasingly getting the attention of public health experts following WHO''s report on global burden of diseases. Surveillance is an important component of control of any disease and effectiveness of the surveillance system depends upon completeness of the information about occurrence of the health related events to the public health authorities.

Aims:

This study aimed to set up a surveillance system for childhood injuries and validate it by a survey and thereafter estimate the incidence of childhood injuries using capture recapture method.

Settings and Design:

Observational study design.

Materials and Methods:

Passive surveillance system for childhood injuries was created for 26,811 children of less than fourteen years of Kaniyambadi block and it was validated by cross sectional study at the end of surveillance period. Using these two independent information systems, capture recapture method was applied to find out the possible incidence of injuries in the given population at a given period of time.

Statistics:

Chi square, Lincoln Peterson formula for capture re-capture method.

Results:

Surveillance and survey for childhood injuries identified 13.59/1000 child-years (CI: 11.86 - 15.32) and 341.89/1000 child-years (CI: 254.46-429.33) of injury rates, respectively.

Conclusion:

Passive surveillance system underreports childhood injuries markedly but it does identify childhood injuries of serious nature.     

Challenges in Developing Competency-based Training Curriculum for Food Safety Regulators in India

Context:

The Food Safety and Standards Act have redefined the roles and responsibilities of food regulatory workforce and calls for highly skilled human resources as it involves complex management procedures.

Aims:

1) Identify the competencies needed among the food regulatory workforce in India. 2) Develop a competency-based training curriculum for food safety regulators in the country. 3) Develop training materials for use to train the food regulatory workforce.

Settings and Design:

The Indian Institute of Public Health, Hyderabad, led the development of training curriculum on food safety with technical assistance from the Royal Society for Public Health, UK and the National Institute of Nutrition, India. The exercise was to facilitate the implementation of new Act by undertaking capacity building through a comprehensive training program.

Materials and Methods:

A competency-based training needs assessment was conducted before undertaking the development of the training materials.

Results:

The training program for Food Safety Officers was designed to comprise of five modules to include: Food science and technology, Food safety management systems, Food safety legislation, Enforcement of food safety regulations, and Administrative functions. Each module has a facilitator guide for the tutor and a handbook for the participant. Essentials of Food Hygiene-I (Basic level), II and III (Retail/ Catering/ Manufacturing) were primarily designed for training of food handlers and are part of essential reading for food safety regulators.

Conclusion:

The Food Safety and Standards Act calls for highly skilled human resources as it involves complex management procedures. Despite having developed a comprehensive competency-based training curriculum by joint efforts by the local, national, and international agencies, implementation remains a challenge in resource-limited setting.