International Journal of Current Research and Review
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IJCRR - 2nd Wave of COVID-19: Role of Social Awareness, Health and Technology Sector, June, 2021

Pages: 123-130

Date of Publication: 11-Jun-2021


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Breastfeeding During COVID-19 Pandemic in India: Challenges and Prospects

Author: Patnaik S, Jena D, Subudhi RN, Behera MR

Category: Healthcare

Abstract:Breastfeeding during infancy is important for good health and wellbeing. In India, rapid response to the COVID-19 pandemic resulted in lockdowns and limited or no mobility. As a result, Anganwadies (institutions supporting infant and young child feeding practices and supplementary nutrition) were closed for long durations. Frontline grassroots health workers such as ASHA (Accredited Social Health Activists), who also is responsible for promoting breastfeeding, were stretched with additional allocated work on COVID-19 rapid response. In India, myths around the transfer of COVID-19 from mothers to infants during breastfeeding did round. It is expected that the nutrition status of newborns and infants may have further worsened during COVID-19. Researchers have established that limited or no breastfeeding impacts the growth and development of infants during the critical first 1000 days also resulting in stunting. In this review we aimed to ascertain the status of breastfeeding practices during COVID-19 pandemic times and the impact it may have on infants. The objective of this article is to review the challenges and prospects of breastfeeding in India during the COVID-19 pandemic period. Through a review of literature, case studies, experience from on-ground rapid response to the COVID-19 pandemic, the current status of breastfeeding practices in India was reviewed. It may be concluded that there are many challenges as well as prospects for future pandemic preparedness and planning and to reduce risks addressing under-nutrition conditions of children such as stunting. A practical way forward maybe by using the suggested prioritization of States and interventions thereof based on stunting and breastfeeding status and efforts towards doing away with myths around breastfeeding.

Keywords: COVID-19, Breastfeeding, Stunting, Under-nutrition, Frontline Workers, Food Security

Full Text:

INTRODUCTION

Breast milk is an elixir for newborn babies and infants. It contains all important nutrients and antioxidants helping infants survive, grow and develop.1 UNICEF and WHO, recommend breast milk to be fed to a child within an hour of birth and exclusively for six months.2,3 The World Health Assembly’s 55th round declared that there is none next to breastfeeding as an ideal food for development and growth of infants, breastfeeding has implications on the reproductive health of mothers also,  and that infant should be exclusively breastfed for the first six months for their optimal growth, development and health, this would be the global public health recommendation to be followed by all.4

Global Nutrition Report (GNR), 2020 indicates, India made limited progress towards achieving exclusive breastfeeding targets (58.0% infant aged 0-5 months breastfed). India is 'on course' to meet the target for stunting with 34.7% of children under 5 years stunted (higher than average for the Asia region: 21.8%).5 There is a need to address these gaps. If stunting is addressed effectively and given that it is “on course”, India can achieve being a nation free of at least one of the “nutrition burdens” i.e. “stunting”.6 In this scenario, development practitioners and frontline health workers shifted attention from nutrition towards rapid response to the COVID-19 outbreak. 

Myths around the transmission of the disease while breastfeeding need to be dismissed as there is no evidence of transmission of disease from mother to baby or from breast milk consumption by a baby.7-11 UNICEF (2020), in its brief on Infant & Young Child Feeding (IYCF) during COVID-19, highlights that where episodes of diarrhoea, respiratory infections and infectious morbidity are common in babies, the possibility of risk of transmission of COVID-19 while breastfeeding is yet to be reported and that known risks associated with replacement feeding are far more devastating.12

At the same time, the production, marketing and sale of breast milk substitutes were found to be steady globally during the pandemic (Fortune Business Insights, 2020). Such products have been distributed to the needy by promoting them as instant food for infants and food security to vulnerable people impacted by COVID-19. A decline in breastfeeding practices is expected, unless, strong measures are taken to practice and promote it. Achieving SDGs for equitable health and nutrition will be a challenge, in this light.

The article aims to ascertain the status of breastfeeding practices during COVID-19 pandemic times and the impact it may have on infants. The objective of this article is to review the challenges and prospects of breastfeeding in India during the COVID-19 pandemic period. Information from the secondary review of literature, case studies, and experience from on-ground rapid response to the COVID-19 pandemic was used to ascertain the current status of breastfeeding practices in India during the ongoing pandemic period.

BREAST MILK: A NATURAL PREVENTIVE AND COMPLETE BABY FOOD

An irreplaceable food for a baby, breast milk helps in gaining muscular weight, mental agility, physiological functions, capacity to fight pathogenic infections and diseases and is a rich source of antibodies and antioxidants.13,14,15 Exclusive breastfeeding for the first six months of infants and breastfeeding within the first hour of birth is a preventive measure for numerous diseases, infections and unwanted health outcomes of infants/ children.1 The likelihood of infants dying is 14 times more if they have not been breastfed, as breastmilk consumption protects from sudden infant death syndrome, it also catalyses childhood development and higher intelligence, and lowers the risk of getting leukaemia, obesity or type-II diabetes.16 Breast milk during the first 1000 days of an infant provides a unique opportunity for its future holistic growth and development of physical and mental health.1

STATUS OF BREASTFEEDING IN INDIA

Worrisome to note that percentage change of children under the age of 5 years who are stunted shows a minimal decrease of 0.3% between the 4th and 5th National Family Health Survey (NFHS), despite budget allocation, initiatives by the Government and other development partners under “Poshan Abhiyan” (a Govt. of India nutrition scheme). Further between NFHS-4 & 5 (Figure 1), the % change in exclusive breastfeeding for children under age 6 months is in the negative (-2.1%). It is expected, that in 2020-21 during the ongoing COVID-19 pandemic, with decreased access to supplementary nutrition, mid-day meals and take-home rations, as well as limited counselling on nutrition and breastfeeding practice by frontline health workers as a result of lockdowns, norms of social and physical distancing, the status of stunting and exclusive breastfeeding practices would further decelerate. This calls for a special study specifically to ascertain the status of stunting and breastfeeding practices during the COVID-19 pandemic and a speedup of initiatives by prioritizing on States.17,18

Figure 1. Status of change in percentage of stunting, breastfeeding within the first hour of birth and exclusive breastfeeding between NFHS 3 (2004-05) and NFHS-4 (2015-16), and NFHS 4 (2015-16) & NFHS-5 (2019-20), Source: NFHS-3, 4, & 517-19

The NFHS-5 survey (2019-20) reports 99% institutional births, yet it is reported that only 46.9% of the children were breastfed within the first hour of birth. Additionally, 46.9% of the children under age 3 years that were breastfed within the first hour of birth as reported by the NFHS-5 (2019-20), was a marginal increase from NFHS-4 (2015-16) where the exclusive breastfeeding status was 41.9%.17,18

            Ogbo et al.20 undertook a study in India to evaluate the prevalence of Exclusive Breastfeeding Practices (EBF) and found differing EBF practices from region to region. EBF practices were as high as 79.2% in Southern India, while it was 68% in North-Eastern India. EBF prevalence declined with infant age, declining faster in the South (about 44% at 5 months) as compared to that in the North-East region (54% at 5 months). Authors established, the association between higher maternal education with EBF in the Southern region, and an opposite association of same in the Central region of India, additionally, they found mothers from more wealthy households were less likely to engage in EBF in comparison with poorer households of Central India. A path-breaking study established that regional and local solutions are the need of the day and not an overall strategy for improving breastfeeding practices and overall nutrition outcomes of children.

            Kumar et al.21 observed that under-fives were at a significantly high risk of under-nutrition whenever there were delays in initiating breastfeeding, colostrum deprivation and improper weaning, thus, optimal infant feeding practices must be promoted ad protected in this context.

The percentage change (decrease) in stunting between NFHS 4 & 5 (2015-16 and 2019-20) is found to be 0.9%. GNR (2020) indicates that India will miss the bus to achieving local nutrition targets by 2025 as India stands among those countries which have the highest rates of social and domestic inequalities and malnutrition.5,6,17,18

COVID-19 AND BREASTFEEDING CHALLENGES IN INDIA

There is no direct evidence as yet of transmission of the SARS-Cov-2 virus which causes COVID-19 disease from lactating mothers to breastfeeding infants7-11 although there are myths doing rounds. However, the indirect impact of COVID-19 could be manifold. On separation from a mother infected by the disease or a mother’s death because of the disease or any myths around breastfeeding during the pandemic, infants can be indirectly impacted. Food security issues during the lockdown period leading to poor health & nutrition of the lactating mother may result in the inability to produce enough milk. This needs further exploration.

While, ASHA workers have been appointed as the first point of contact for any health-related demands of deprived women and children, who find it difficult to access health services22, including the important role of creating awareness on determinants of health including nutrition and counselling women on prenatal and anti-natal care, safe delivery, breastfeeding, immunization etc. yet, during the lockdown period in 2020, ASHA workers could not function optimally because of social and physical distancing, lockdowns and limited access to protective gear. Although the Ministry of Home Affairs (MHA) informed that all essential services would be functional across the country, additional responsibility was given to them for rapid response to COVID-19 by tracking COVID-19 transmission cases, thus diverting those from their core work. Thus, impacting nutrition and counselling on breastfeeding practices.23

Stakeholder consultations during rapid response to COVID-19 in Jagatsinghpur & Mayurbhanj district (Odisha) by Arupa Mission Research Foundation (AMR, 2020) to address food security and safety of the community, frontline workers (ASHA, Anganwadi) and elected representatives during the peak pandemic period in 2020 and learning from the case study from Angul district of Odisha by Saigal (2020) indicate the following important points24: a) Absence of Take Home Rations (THR) for pregnant & lactating women for initial two-three months; b) Messaging and counseling on breastfeeding or nutrition by ASHA and Anganwadi workers took a backstage as focus was on COVID-19; c) Clarification on myths around transmission of COVID-19 disease from lactating mother to breastfeeding infant in both urban and rural areas was not done clearly; d) Families feared to receive THR as they felt it may lead to transmission of disease; e) Lockdown and fear of disease left some children of reversed migrants and migrants nutritionally vulnerable; and f)  Focus of elected representatives, local governance bodies and CSOs was more towards food security for other vulnerable groups including migrants, and elderly, and contact tracing of super spreaders of COVID-19 disease; not on nutrition of infants. 

Kumar et al.21 surveyed 1292 mothers who delivered in rural Mysore Block of South India between 2008 and March 2011. They found the following: firstly, 23.7% of mothers felt that they did not have enough breastmilk and this was the most common reason cited by them for non-exclusive breastfeeding; secondly, 42.6% of non-exclusively breastfed infants were fed formula/animal milk and 18.4% were fed oil/ghee.

Food security was an issue during the COVID-19 pandemic and may have impacted the nutrition intake of lactating mothers. There were also myths around the transmission of COVID-19 from animal milk and dairy products. Both these factors may have led to poor breastfeeding practices and the onset of stunting. This needs to be explored. Bhatt26 reports that in Delhi, West Bengal and Jharkhand poor mothers and babies were donated milk substitutes during the pandemic, following which, Arun Gupta of Breastfeeding Promotion Network (BPNI), the Government’s appointee to monitor implementation of the ‘Infant Milk Substitute Act of 1992’25 which prohibits distribution and promotion of infant milk substitutes to children under two years of age, filed an action alert. The action alert was in the form of a public notification, “issued on the BPNI website and to the media, urging the central government to tell state authorities to stop acceptance and distribution of infant formula in pandemic relief. He also sent letters to the Ministry of Health & Family Welfare and the National Disaster Management Authority, highlighting the separation of mothers and babies in suspected and confirmed covid-19 cases in hospitals and asking for a committee to investigate formula companies that exploit the  pandemic for commercial gain.”27

CAGR (Compound Annual Growth Rate) forecast for 2019 to 2025 baby food market size by-products is 13.5% with value projection being 33 billion USD in 22 geographies including India.29 Although India adopted ‘The International Code of Marketing of Breast milk Substitutes (the Code) 1981’28 and ‘The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992’25 further amended in 200327, regulating production, supply, and distribution of infant milk substitutes, feeding bottles and infant food to protect/ enhance breastfeeding practices and regulated use of infant food, there is an evident spurt in baby food production worldwide. Thus the core objective of limiting the negatives of milk substitutes, its promotion and enhancing breastfeeding practices including exclusive breastfeeding is unmet. The aggressive baby food market in India, together with myths on breastfeeding during COVID-19 and the diverted role of frontline health workers to covid-19 rapid response, distribution of infant milk products to poor mothers instead of provisioning with a nutritious diet will certainly impact the breastfeeding narrative outcomes in India.29

WHO and UNICEF encourage women to continue to promote breastfeeding during the COVID-19 pandemic, even if mothers have confirmed or suspected being infected with COVID-19 and that the multiple benefits of breastfeeding prevail over the potential risks of illness associated with COVID-19, infant formula milk not being a safer or only option.30

PROSPECTS OF IMPROVING BREASTFEEDING DURING PANDEMIC

COVID-19 pandemic ushered in a new way of living. New strategies to improve breastfeeding practices and nutrition outcomes of infants are the need of the hour. No “one shoe fits all” formula for improving determinants of nutrition (including breastfeeding within an hour of birth and exclusive breastfeeding for six months) will be effective given the diverse Indian culture and geography. However, recommendations from nutrition experts have bright prospects to address concerns around breastfeeding and stunting. Direct and indirect impacts of COVID-19 on breastfeeding practices and infant nutrition needs to be unfolded.

            Menon et al.,31  on their district?focused analysis of stunting considered breastfeeding within an hour of birth and EBF as immediate determinants of stunting in India and recommended that there was a need for nationwide prevention of stunting as well as resolving district level variations of critical determinants of nutrition as well as inequalities and childhood stunting highlighted that in the Indian context if breastfeeding education is imparted at every anti-natal checkup, then even mothers with less than 10 checkups can learn about the benefits of breastfeeding and its methods. In the context of the COVID-19 pandemic, myths and fears doing rounds during the pandemic need to be studied and a campaign to address these via breastfeeding education implemented.32 

Myths and fears doing rounds during the pandemic need to be studied and a campaign to address these via breastfeeding education is needed. Ogbo et al.,20 stated that multidimensional efforts at national and sub-national level, dedicated financial allocation, appropriate policies need to be in place to address the regional variations in breastfeeding practices in India were much needed. Concerning the COVID-19 pandemic, regional variations in EBF practices during the ongoing pandemic needs to be studied and addressed.

American Association of Pediatrics11 emphasized that infants should be exclusively breastfed for the first six months of life and only fed infant formula which is fortified with iron in case human milk is not available at all. Thus in the context of COVID-19, when it is established that the disease is not transmitted through breastmilk, then myths on it should be dismissed and breastfeeding promoted.

NFHS 5 (2019-20) data has been released for 22 States and Union Territories (UTs) of India. Based on findings from the NFHS 5 for two indicators: stunting among children aged 0 to 5 years and 0 to 3 aged children having been breastfed within an hour of birth, States and UTs can be divided into low risk, medium risk and high risk. High-Risk States and UTs must have a robust programme to ensure breastfeeding practices are improved for better nutrition outcomes of infants, especially for reducing future stunting. The objective of this categorization is to consider stunting and limited or lack of breastfeeding practices as risks to infant and child nutrition which is detrimental to their growth and, which when coupled with the challenges that COVID-19 has posed with regards to access, services and myths, may be disastrous for the nutrition outcomes of children. It may be so that in the event of natural calamities or epidemics and pandemics infants and children under three years of age would be doubly vulnerable not because of the disease as much as because of access, consumption and practice of nutrition. The strategy also lays the ground for focusing initiatives based on State needs rather than a one shoe fits all strategy as given below:

Category 1: High-Risk States

Those States which have high stunting levels (36% to 66% or more, Figure 2) and the percentage of children under the age of 3 years breastfed within the first hour of birth varies between 0 to 35%. The Graph below indicates the same:

Figure 2. States with a high risk of stunted children 0 to 5 years and high-risk status of children in 0 to 3 years breastfed within an hour of birth (NFHS 5, 2019-20) in percentage.

According to the NFHS 5 data, Bihar has 42.9% of children in the age group of 0-5 years who are stunted, breastfeeding practice within an hour of birth is as low as 31.1% for children in the age group of 0 to 3 years and breastfed children exclusively breastfed for 6 months stands at 58.9 %. Similarly, two other critical States that need attention on priority are the Union Territories of Dadra & Nagar Haveli and Daman & Diu and the States of Gujarat, and Meghalaya. Meghalaya is an outlier, with a High proportion of stunting of children aged 0 to 5 years (46.5%) despite having a proportion of 0 to 3 year aged children breastfed within 1 hour of birth as high as 78.8%. The probability is that exclusive breastfeeding which is as low as 42.7% in Meghalaya, may be contributing to the stunting along with other factors. Meghalaya needs to be studied from the perspective of the impact

Category 2: Medium Risk States

Those States have the proportion of stunting varying from16% to 35% and the percentage of children under age 3 years breastfed within the first hour of birth varying from 36% to 66% (Figure 3). The States coming under the Medium Risk category include Andaman & Nicobar Islands, Kerala, Manipur, Goa, Jammu and Kashmir, Mizoram, Ladakh, Himachal Pradesh, Andhra Pradesh, Lakshadweep, Tripura, Nagaland, Telangana, West Bengal, Maharashtra, Assam and Karnataka. Sikkim is an outlier with a medium risk of stunting and a high risk of poor breastfeeding practices and would require special attention. The graph below indicates the same:

Figure 3. States with medium risk of stunted children in 0 to 5 years and medium risk of children in 0 to 3 years breastfed within an hour of birth (NFHS 5, (2019-20) in %

Category 3: Low-Risk States

Those States which have low stunting (0 to 15%) levels and the percentage of children under age 3 years breastfed within the first hour of birth varies from 67% to 100%. It may be noted that none of the States come under the low stunting category. However, the data for breastfeeding within an hour of birth is as high as 76.3% in Lakshadweep and 78.8% in Meghalaya. Given that Lakshadweep has 32% stunting, it has been included in the Medium Risk category and Meghalaya having 46.5% stunting has been included in the High-risk category.

A robust plan by prioritization of States and UTs with separate strategies for high and medium risk States is the need of the hour especially in the light of the COVID-19 pandemic and its indirect impact on infants and children (Table 1). If we map the on the ground experience of the lockdown from 25th May 2020 onwards in India with the categorization of States based on stunting & breastfeeding as given in Table 1 below, we can correlate the risks to infants in the context of stunting and breastfeeding practices, as well as the level of risks.

As part of the prioritization strategy mentioned earlier, serious thought needs to be given to the risk to infant’s access to breast milk and nutrition because of limited counselling of mothers by frontline health workers during the pandemic and limited access to take-home rations. The fears and myths around COVID-19 and breastfeeding can be minimized through a focused campaign and behavioural change methods. Further, the need of the hour is also to conduct a nationwide study on the impact of the indirect impact of COVID-19 on breastfeeding practices and infants thereof. “Capacity Building and Training of Frontline workers on managing nutrition concerns and innovative ways of delivering roles and responsibilities during natural calamities, epidemics and pandemics.”23

Additionally, display of nutrition status at the Anganwadi and Panchayat Office. Mapping of nutritionally vulnerable children to be done, especially children of reverse migrants and migrants already present in the local area.23 Other to do’s include, provision on personal protection equipment to frontline workers, busting the myths around the transmission of COVID-19 disease through breast milk since research is ongoing and no evidence has been found as yet. Promotion of WHO and UNICEF norms for breastfeeding during the COVID-19 times, Participatory and interactive ICT based strategies for motivating working women and educated women to practice exclusive breastfeeding., Greater role to be played by Panchayats/elected leaders and civil society for addressing issues around the promotion of breastfeeding, stunting and COVID-19 preparedness and prevention in general and Effective implementation of the Food Security Act, especially for Take-Home Rations for pregnant and lactating mothers and the monitoring of the same.23

Importantly, the Government needs to put strict directives for regulation of the distribution of manufactured baby food during such episodes of disease outbreaks unless it is truly a need where natural breastfeeding is not an option. The messaging by manufacturers of baby food products needs to be monitored so that they don’t take advantage of such situations for their profits. Advocacy for stricter norms for the reduction in production, marketing, advertising and push selling of artificial infant formulas, baby food and milk supplements.23 The importance of having social and domestic support for mothers for sharing breastfeeding experience, voicing concerns and initiating mothers support groups at the community level (both rural and urban) as part of the strategy. For future studies, clear subject selection criteria and definition of “exclusive breastfeeding”, reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help.33 Empirical studies on breastfeeding practices during the COVID-19 pandemic will inform on minimizing risks to nutrition because of pandemics, relevant information for all stakeholders to design and implement effective strategies for better nutrition outcomes for India. Addressing the burden of stunting effectively, given that it is on course, India must at least work towards achieving being a nation free of at least one of the nutrition burdens which is “stunting” with political will, right strategies and proper implementation.

CONCLUSION

India is at a critical juncture about nutrition outcomes. It is expected that India will miss achieving nutrition goals unless need-based measures are taken. It is found that there can be no one she fits all solution to address the nutrition gaps in a country with diverse cultures ad ways of living. Further, with the COVID-19 pandemic, access to nutrition and nutrition-based services had become restricted. Also, there were many myths around breastfeeding practices and the spread of the disease. Baby food manufacturing companies are also taking advantage of the situation. Given these challenges, India still has prospects to be a nation free of stunted children if the right strategies and prioritization of initiatives for improving breastfeeding practices and reducing stunting are adopted. There is scope for further empirical studies on how and to what extent breastfeeding practices and nutrition were impacted in the country during the ongoing pandemic. This would also be important for improved future risk management and preparedness in such situations of pandemics. Recommendations for national, regional, district-level need-based interventions based on variations and prioritization of strategies for high, medium and low-risk States is critical.

CONFLICT OF INTEREST: None

SOURCE OF FUNDING: None

ETHICAL APPROVAL: Not applicable for this manuscript

ACKNOWLEDGEMENTS: The authors thank Nibal Dibiat for his sincere comment on the draft and formatting of the manuscript. Further, we appreciate the body of work by various scholars and acknowledge that their articles cited & referenced in this manuscript has been of immense help.  We are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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