The immunization service delivery support (ISDS) model was initiated in Andhra Pradesh, India, in November 2003 with the aim of strengthening immunization services through supportive supervision. The ISDS model involves a well-established supervision system built upon the existing health infrastructure. The objectives of this approach are to: (1) identify areas of high performance and those that need improvement, (2) assist staff in identifying and correcting wrong practices, (3) improve staff skills, (4) motivate staff, and (5) initiate corrective actions at appropriate levels through information sharing. An evaluation of cost and effectiveness of ISDS in 16 districts that participated in the programme found that the incremental cost associated with three rounds of supportive supervision visits was approximately US$ 110 630 (US$ 36 877 per round). The performance of health centre and immunization sessions was evaluated using 43-and 28-point checklists, respectively, and demonstrated significant improvement during and following the twoyear implementation of ISDS. The average percentage change in health centre performance scores from baseline to the fourth round of evaluation was approximately 36%, and immunization session performance scores increased by an average of 9%. The incremental costs per additional per cent increase in average health centre performance score and per additional per cent increase in average immunization session performance score over the evaluation period were estimated to be US$ 3091 and US$ 12 760, respectively. The incremental cost-effectiveness ratios are relatively sensitive to personnel and travel costs. Integration of ISDS into the Andhra Pradesh immunization system is projected to result in a 39% potential cost savings per round of supervision visit. Diptheria, Pertussis and Tetanus) coverage nationally and at least 80% DPT3 coverage in every district by the year 2005, the "90/80 goal" adopted by the GAVI Alliance.2 Supportive supervision involves on-site training by supervisors, which promotes quality at all levels of the health system by strengthening relationships within the system, focuses on the identification and resolution of problems, and helps to optimize the allocation of resources. The approach also promotes continuous improvements to the quality of care by providing leadership and support and by promoting high standards, teamwork and better two-way communication.3 Different approaches to supportive supervision to strengthen health worker performance and health services have been developed and documented. For instance, an integrated health package to guide essential health service delivery was developed by the United Republic of Tanzania Ministry of Health following health sector reform in 1999. This included a plan to bring a team of supervisors to district health facilities to evaluate how services are being delivered, to provide feedback and to conduct on-site training.4 Since implementation, supervisory visits occur more frequently and have become an opport...

A high demand exists for gluten free and hypoimmunogenic products from gluten sensitive population. The present study focuses on the development of hypoimmunogenic muffins using a combination of the blend (CB) consisting of modified (protease treated) Whole Wheat Flour (WWF) and Pearl Millet Flour (PMF). The batter density of CB was 0.97, and it varied between 0.91-0.93 and 0.97-0.99 g/cc with the use of emulsifiers and hydrocolloids respectively. The volume of the muffin made using CB was 70 mL, and it increased to 120 mL with the combination of additives (CAD) comprising of Carboxy Methyl Cellulose (CMC) and Polysorbate-60 (PS-60). The muffins made of CB + CAD had the lowest hardness (19.8 N) and gumminess (6.6 N) values and highest springiness value (13.3 mm) indicating that the texture was soft. Sensory characteristics of the muffin made with CB + CAD were good and had an overall quality score of 90.5 out of 100. Rheometer studies showed that the incorporation of additives improved the visco-elastic properties of muffin batters. Microstructure studies showed a change in gluten matrix of muffins followed by treatments. Immunochemical validation of muffins made using CB + CAD showed that the immunogenicity reduced by 70.8 % which may be suitable for patients with gluten sensitivity.

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SummaryDecalepis hamiltonii natural flavour extract, an endemic flavour was first time used in food processing in biscuit formulation. 2‐hydroxy 4‐methoxybenzaldehyde (2H4MB), a structural isomer of vanillin is the major flavour‐attributing compound used. During the study, aqueous (6%–12%), and ethanolic (0.5%–2%) extracts, which are reported to be rich in flavour metabolites, and having antioxidan activity were used.  These extracts were added at different concentrations and the physical, sensory, and biochemical properties of biscuits were evaluated along with bioactive retention. The breaking force required to break the +ve Control biscuit was 873 g force and was in the range between 916 and 988 g force for the biscuits with either of the tuber extracts. The biscuits made of ethanol extract have shown lighter colour with a low L value (61.84–58.36) compared to aqueous extract (63.67–56.87). Biscuit samples made with both aqueous and ethanol extracts showed good retention of bioactive compounds. However, the biscuit formulation with 1% ethanol extract showed good sensory (mouthfeel (8.7), flavour (8.6), and taste (8.6)) and in vitroantioxidant potential (11.6 ± 0.1 mg−1 100 g AAE) among formulations. The flavour metabolite in biscuits made of both extracts was quantified using HPLC and determined in range between 1 and 3 μg/g and compound presence is confirmed with mass spectrosocpy. With the present observations, we can infer that D. hamiltonii natural flavour extract can be used as an alternative to synthetic flavour in biscuit formulation.