Quarterly Newsletter of National Programme for Control of Blindness Theme of the Issue:
New Initiatives of
National Programme for
Control of Blindness
Volume: 1
From the Editor's Desk New Initiatives of National Programme for Control of 1. Editorial: New Initiatives of National Programme for Control of Blindness: National Programme for Control of Blindness was launched in the Dr. (Mrs) R. Jose, year 1976 as a 100% centrally sponsored Scheme with an absolute Addl. DG (Ophthalmology) .1 objective to reduce the prevalence of blindness to 0.3%. The target set for the terminal year of the 10th Plan was to reduce prevalence of 2. Refractive Errors in School Children: blindness to 0.8% by 2007. The pace of progress of NPCB has been A Review from Punjab gradual and sustained and can be gauged through the performance of Dr. Nitin Batra, Cataract Surgery performed in India since 1990. Cataract still Dr. Dhawal Kaushal, remains the most common cause of blindness in India. During the Dr. Amitoj Singh Gill .2 year 2006, about 50 lakhs cataract surgery were performed in the country.
3. Global News in Prevention of The basic objectives of this National Program for Control of
Blindness still remains, as planned initially since its inception and Dr. Manoj Kr. Dhingra, these are (a) Reduce the backlog of blindness through identification Dr. R. Jose, Dr. A.S. Rathore, and treatment of the blind. (b) To develop eye care facilities in every Dr. V. Rajshekhar .5 district. (c) To develop human resources for providing eye care services and (d) To improve quality of service delivery (e) To secure 4. Activities under NPCB participation of Voluntary Organization engaged in Eye Care. (Oct.-Dec. 2007) .6 The new initiatives under the Eleventh plan includes prevention,
screening and management of Diabetic Retinopathy, Hospital based
screening of Glaucoma and prevention of Childhood Blindness.
The Eleventh plan of NPCB clearly emphasizes the need to screen for Diabetic Retinopathy, in known diabetic patients and screen for

Quarterly Newsletter of National Programme for Control of Blindness glaucoma in all patients above the age of 35 years who HbA1c (trend Chi square: 51.6, P<0.001) from 8.1 per are attending eye clinics. The operational guidelines cent (HbA1c level < 6.9 %) to 31.7 per cent (HbA1c for this are by screening all known diabetics for DR level >10.3%). For every 2 per cent elevation of and providing laser treatment to those who may HbA1c, the risk for DR increased by a factor of 1.7. require it. The overall prevalence of Diabetic (Rema M et al, 2005). Proper emphasis on IEC and
Retinopathy according to the CURES (Chennai Urban strengthening of early diagnosis in relatives having Rural Epidemiology) Eye Study in south India was DM could go a long way in capturing the base of DM 17.6 per cent among the 1715 diabetic subjects. (Rema and this may require an integrated service delivery M et al, 2007). The CURES Eye study used four-field under the National Rural Health Mission stereo retinal photographs and Early Treatment Also, early screening of glaucoma and its management Diabetic Retinopathy Study (ETDRS) grading to at PHCs/CHCs and District hospitals is another document DR in the patients under study. Further, as important issue, which has been duly addressed in the shown in the CURES Eye Study, a linear trend was observed in the prevalence of Retinopathy with increase in quartiles of (Glycosylated hemoglobin) REFRACTIVE ERRORS IN SCHOOL CHILDREN: 2001). According to the National Blindness Survey A REVIEW FROM PUNJAB (1989), 1.4% of the population of India has social blindness (visual acuity <6/60 in the better eye with *Dr. Nitin Batra, *Dr Dhawal Kaushal, *Dr Amitoj Singh Gill best correction) of which 7.35% is caused by *Department of Ophthalmology, CMC & Hospital,
uncorrected refractive errors (Limburg et al, 1999). Most of the refractive errors can usually be corrected with the use of spectacles or contact lenses (Dandona et al , 1999). Reduced vision because of uncorrected refractive errors is a major public health problem in school children in School screening programmes have been an India (Dandona et al, 2002). Vision screening should be established part of the school health service since 1907 done to identify children with unsuspected remediable and remain universally recommended. These conditions, so that programmes are primarily aimed at detecting treatment can be amblyopia and refractive errors (Spoward et al, 1998). In this study which lasted for 3 years, a presentation educational and has been made of the results of the ongoing School social progress is Screening programme in the Department of Ophthalmology, Christian Medical College, Ludhiana. conditions that a r e c o m m o n l y detected in eye The importance of early detection and treatment of visual impairment in children is obvious. In most school children countries, school screening programmes are done routinely. The objective of school screening errors (myopia, astigmatism and hypermetropia) and programme is to find cases of refractive errors, amblyopia, apart from other ocular diseases. amblyopia, strabismus and other ocular diseases. Refractive errors are common in children and easily Early correction of refractive error results in a correctable, usually with the use of spectacles reduction in the number of school children with poor (Kalikivayi et al, 1997. It is the commonest cause of sight (Jensen and Goldschmidt, 1986). Vision defects visual impairment around the world and the second due to myopia typically appear during school years
leading cause of treatable blindness (Dandona et al, (Mantyjarvi, 1983). It is the commonest refractive NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS IN INDIA
error in school going children and its timely and 8.6%; hyperopia 22.6%; astigmatism 10.3% and proper correction saves permanent disability amblyopia to be 1.1%. There are reports on the (Chandra et al, 1982). On the other hand, hyperopia
prevalence of refractive errors from other populations. also known as hypermetropia can be considered the Population based data concerning the prevalence of opposite of myopia in a strict optical sense. The visual impairment due to uncorrected refractive child's eye can easily increase its refractive power by errors and ocular diseases in children are not 10 or more diopters with accommodation, so that available for India (Kalikivayi et al, 1997).
except in rare, extreme degrees of hyperopia, visual acuity remains normal (Greenwald, 2003). MATERIAL AND METHODS This study was done on students aged 5 yrs. to 15 yrs. Astigmatism is the second commonest refractive
from - randomly selected urban as well as rural cause of reduced vision in childhood. It is optically schools in and around Ludhiana city, Punjab. Formal correctable by cylindrical lenses, which have power permission was taken from the principals of these that is concentrated in one meridian? (Greenwald, schools. The list of all the students was taken from the attendance registers along with their age, address, Amblyopia is reduced visual acuity; even with
telephone number , parents occupation, and whether proper optical correction in one or both eyes, they were immigrants or not. All students aged 5-15 resulting from altered visual development despite yrs (class 1 to 10) in these schools were screened. A ophthalmoscopically normal retinal and optic nerve detailed ocular history was taken about present and anatomy (Rubin & Nelson, 1993). Anisometropia is
past ocular problems along with history of use of one of the leading causes of amblyopia (Townsend et spectacles. Visual acuity unaided and aided (if spectacles were being used by the subject) was a In a study, done by Dandona et al in 2002 in the rural recorded using standard technique for distance and population of Andhra Pradesh, the prevalence of near. The visual status of those children who were uncorrected vision was 2.7%. Refractive error was the already wearing glasses, was also assessed for further cause in 61% of the eyes with visual impairment and improvement. Students who were found to have a amblyopia in 12%. Myopia of -0.50D or more was visual acuity equal to or less than 6/9, were given a seen in 4.1% of the cases. There was a gradual shift letter asking the parents to get their children to the towards myopia with increasing age in both boys and Department of Ophthalmology, Christian Medical College, Ludhiana for further evaluation.
Myopia risk was associated with female gender and At the base hospital, visual acuity was assessed again having a father with higher level of schooling. and a complete eye examination was done. A written Hyperopia of 2D or more was seen in 0.8% of consent was taken from the parents for cycloplegic children, with no significant predictors. Prevalence of retinoscopy. Post mydriatic refraction was done after astigmatism was 2.8%. Another study done by one week of cycloplegic retinoscopy and appropriate Murthy et al, in the same year in the urban
spectacles were prescribed to the children, as per the population of New Delhi showed that refractive error protocol. Appropriate statistical methods were was the cause in 81.7% of eyes with visual employed to assess the data obtained.
impairment; amblyopia in 4.4%. Hyperopia OBSERVATIONS AND DISCUSSION accounted for 7.7% of visual impairment. A higher The present descriptive study was conducted on prevalence oh hyperopia was observed in girls in the children aged 5-15 years from 11 schools (5urban; 6 11-13 year age group. Prevalence of myopia was 7.4%. rural) in Ludhiana city and district. The data thus Fathers with higher levels of education were more collected is from the ongoing School Screening likely to have children with myopia, a finding that programme of the Department of Ophthalmology, was also true in rural India. Incidence of astigmatism Christian Medical College, Ludhiana.
was 5.4%. A study done on visual impairment in school children in Southern India by Kalikivayi et al A total of 19,610 students were examined over 3 years in 1997 revealed prevalence rate of myopia to be (2003–2005) of these 11,200 were males and 8,410 Quarterly Newsletter of National Programme for Control of Blindness were females. There were 8,834 students in the 5-10 Table 3 - Comparison of decreased vision in children
years age group and 10,776 in the 11 – 15 years age from urban vs rural schools:
group. The number of students who had decreased vision (defined as distant visual acuity of 6/9 or less) was 2,485. Of these, there were a total of 1,366 myopes; 748 hyperopes; 284 with astigmatism and 87 amblyopic children (64 unilateral; 23 bilateral). The The children from urban schools, with decreased distribution of decreased visual acuity in males and visual acuity are definitely more, when compared to females is shown in Table - 1. their counter-parts in rural schools. This difference is Table 1 - Comparison of decreased visual acuity in
statistically significant (p<0.01). Similar findings males and females:
have been reported in the urban (Dandona et al, 1999) Total (n=19610) Male (n=11200)
and rural populations (Dandona et al, 2002) of Andhra Pradesh.
However, in this study we did not consider the predictors of refractive errors (mainly myopia) as reported in several studies. These include socio-economic status, parent's education, hereditary factors From this table, we observe that the number of girls and the prolonged use of Visual Display Terminals and with decreased visual acuity is higher as compared to Television viewing. The data presented here pertains males. The difference is statistically significant for only to decreased visual acuity due to refractive errors, myopia, hyperopia and astigmatism, as per the which improved with the prescription of proper p-value calculated in the table. However, in another spectacles. Children with corneal opacities (due to study by Murthy et al, 2002, the distribution of ulcers / trauma etc), Vitamin A deficiency, retinal decreased visual acuity did not differ between boys pathology, allergic conjunctivitis and strabismus and girls. This is probably because age – sex (though encountered in very few cases) were excluded distribution of the examined population was not from this study.
The comparison of decreased visual acuity in different age groups is shown Table - 2.
If would be interesting to study the results of School Screening programmes conducted by other centers. In Table 2 - Comparison of decreased visual acuity in
fact a multi-centric survey on the causes of visual different age groups:
impairment in school children should be designed and implemented. School Screening should be made mandatory by the Govt. Health authorities. We wish to acknowledge the guidance of Dr. Rajesh Isaac, Lecturer, Department of Community Medicine, Christian Medical College, Ludhiana, towards the statistical analysis and final touches to this study.
As seen in the Table 2, the number of students with decreased vision increased with age. This difference is 1. Chandra DB, Swarup D, Srivastava RK. Prevalence and pattern along with socio-economic factor of myopia in school-going statistically significant. However, since there were more children 8 to 16 years. Indian J Ophthalmol 1982; 30: 517 -518. children in the 11-15 years age group (n = 10,776), 2. Dandona R, Dandona L, Srinivas M, et al. Refractive errors in therefore we may have found more children with children in Rural Population of India. Invest Ophthalmol Vis Sci 2002; 43: 616 - 622. decreased vision in this group. Similar findings were 3. Dandona R, Dandona L, Naduvilath TJ, et al. Refractive errors in an reported by Kalikivayi in 1997.
urban population in Southern India: The Andhra Pradesh Eye disease study. Invest Ophthalmol Vis Sci 1999; 40: 2810 -2814. The comparison of decreased vision in children from 4. Dandona R, Dandona L, Srinivas M, et al. Refractive errors in Urban and Rural schools is shown in Table-3.
children in rural population of India. Bull WHO 2001; 96-1002.

district and sub-district level; an issue of utmost GLOBAL NEWS: PREVENTION OF importance for an Integrated service delivery under NRHM. However, prevention of DM and DR need to *Dr. Manoj Kr. Dhingra, *Dr. R. Jose, *Dr. A.S. Rathore, be urgently enhanced by health promotion and *Dr. V. Rajshekhar improving screening for at risk population. What are the preventive measures available to prevent the *Directorate General of Health Services
development of DM.
Prevention of Diabetes Retinopathy Health promotion with emphasis on obesity Type 1 diabetic mellitus is an management and regular exercise is important. auto -immune diseases with Prevention of DR can be studied at various levels: selective destruction of the insulin-producing beta-cells in - Prevention of diabetes itself the islets of Langerhans leading - Prevention of DR in a diabetic to consequent insulin deficiency. Prevention of Type I DM and ii) Secondary level
subsequent Diabetic Retinopathy - Prevention of non-blinding form of DR to progress to its blinding forms is an intriguing and an important are of research.
According to (Sarah Wild et al, 2004), the total
- Prevention of blindness due to diabetic number of people affected by Type I and II Diabetes maculopathy and PDR Mellitus was 171 million in 2000 and this is expected Another method of prevention could be the rational to rise to 366 million by 2030. For India, the number use of nicotinamide (Cabrera-Rode E, et al, 2006).
of people living with DM was 31.705 million in 2000 How far nicotinamide is useful in preventing Type 1 and this is expected to reach 79.441 million by 2030. DM. One such study of interest is the ENDIT study, (Agarwal S et al, 2005).
which was carried out in Europe to investigate
whether nicotinamide leads to a reduction in the rate
of progression of DM in at risk relatives. Over 40,000
first-degree relatives aged 5-40 years were screened
throughout centers in Europe and North America.
(Gale EA et al, 2004). In this study, the dose of
nicotinamide was oral modified release nicotinamide
(1.2 g/m2). At this dose, nicotinamide was ineffective
to prevent the onset of type 1 diabetes. In one of the
study carried out by Department of Pediatrics,
Salmaniya Medical Complex, Manama, Bahrain, 66
children with newly diagnosed type 1 diabetes were
given nicotinamide in a dose of 1-2 mg/kg per day.
*(Sarah Wild et al, 2004) * (Agarwal S et al, 2005)
The group receiving oral nicotinamide had lower insulin requirement and prolonged honeymoon In Chennai, the overall prevalence of Diabetic period. (Kamal M et al, 2006).
Retinopathy according to the CURES (Chennai Urban Rural Epidemiology) Eye Study in south India was The European Nicotinamide Diabetes Intervention 17.6 per cent among the 1715 diabetic subjects. Trial and the Diabetes Prevention Trial (DPT-1) have (Rema M et al, 2005). For every 2 per cent elevation of
failed to show any credence on the prevention of DM HbA1c, the risk for DR increased by a factor of 1.7. by Nicotinamide. However, newer therapies are on trial such as anti-CD3 antibody, DiaPep277 and GAD With the rising trends in the prevalence of DM in (Glutamic acid decarboxylase).
India the quantum no of cases of DR would rise. Adept management of the diagnosed cases may be the Recently, the Fenofibrate Intervention for Event key to decrease the overall prevalence of DR. This Lowering in Diabetes (FIELD) study has shown in may require integration with the physicians at the patients having type 2 diabetes, there was a

Quarterly Newsletter of National Programme for Control of Blindness significant (30%) reduction for the need of first retinal ACTIVITIES UNDER NPCB IN OCTOBER- laser therapy in the group treated with fenofibrate 200 mg daily. (Dodson PM, 2007). Further, the (ACCORD-
EYE) study, Action to Control Cardiovascular Risk in
1. World Sight Day, Bhubaneshwar Diabetes Eye Study, conducted at NIH, USA has a The World Sight Day was celebrated on 11th October strategic objective to investigate whether a 2007, in Bhubaneshwar, Orissa. It was a grand success therapeutic strategy targeting a glycosylated with the coordinated efforts of Ministry of Health & hemoglobin [HbA(1c)] level <6.0% would reduce
Family Welfare, Govt. of India, Vision 2020 and development and progression of DR. (Chew EY et al,
International Association for Prevention of Blindness 2007) The findings of this study are important to
(IAPB). The occasion was graced by Smt. Panabaka formulate a goal of HbA1C as 6.0% or below, as a Lakshmi, Hon'ble Union Minister of State, Health and therapeutic goal to monitor the therapy for DM in the Family Welfare, who was the Chief Guest of function, National Program for Prevention and Control of The Brand Ambassador of Vision 2020, Mrs. Hema Diabetes Mellitus, Cardiovascular diseases and Malini, MP, Rajya Sabha, Dr. (Mrs.) R. Jose, Addl. DG Stroke, which is in the pilot mode in 6 districts and 6 (O), Dr V. Rajshekhar DADG (O), Mr. V. K. Sharma, states in India. These states include Assam, Under Secretary (NCD), Dr. V. K. Tewari, Health Karnataka, Kerala, Tamil Nadu, Rajasthan and Punjab.
Education Officer, Ministry of Health & Family In another study in India, emphasis has been laid on Welfare, Mr. Tulsi Raj, Director, Arvind Eye Hospital, annual retinal examination and early detection of DR. Dr. G.N. Rao President, International Association for Prevention of Blindness (IAPB), Mr. Acharya, Director This article also mentions the beneficial effect of Health Services, Orissa, Mr. Mohanty, Director JPM curcumin an active ingredient of turmeric, which Rotary Eye Hospital Cuttack, Orissa, and Mr. A. remains investigational. (Rema M et al, 2007).
Samanta Vice Chancellor of KIIT Campus Orissa. Thus strengthening IEC activities in a systematic Hon'ble Union Minister of State, in her speech stated manner to promote healthy life-styles remains a key that NPCB was doing a excellent work along with the component of prevention where Private-public NGOs which is a brilliant public and private partnership could be enhanced to increase coverage. At partnership to strengthen the comprehensive Eye the Public Health care level, this could well addressed Care Services in all the under performing States of by training ASHAs to inculcate these healthy life style India. She has announced a grant of Rs. 1550 crores practices at home and in the school. This component in the proposed 11th Plan in order to improve upon could be added in addition to the school eye screening the Infrastructure, Procurement of equipments, and programme currently delivered under the National Human resources through National Programme for Programme for Control of Blindness.
Control of Blindness. Mrs. Hema Malini, also in her speech expressed great pleasure in her participation in this celebration and 1. Agarwal S, Raman R, Paul PG, Rani PK, Uthra S, Gayathree R, McCarty C, Kumaramanickavel G, Sharma T. Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS 1): study design and research methodology. Ophthalmic Epidemiol. 2005 Apr; 12(2):143-53. 2. Cabrera-Rode E, Molina G, Arranz C, Vera M, González P, Suárez R, Prieto M, Padrón S, León R, Tillan J, García I, Tiberti C, Rodríguez OM, Gutiérrez A, Fernández T, Govea A, Hernández J, Chiong D, Domínguez E, Di Mario U, Díaz-Díaz O, Díaz-Horta O. Effect of standard nicotinamide in the prevention of type 1 diabetes in first degree relatives of persons with type 1 diabetes. Autoimmunity. 2006 Jun; 39(4): 333-40. Suggestions and opinions on the above topics are
welcome and could be mailed at
E mail: [email protected]

committed herself for the great cause of avoidable 4. Webel Electronics Communications Systems Ltd., blindness in children. She also contributed by Kolkata, West Bengal performing in an ad film, which was also released the 5. Sankara Netralaya, Chennai.
6. Arvind Eye Hospitals, Madurai Dr. (Mrs.) R. Jose, Mr. Tulsi Raj and Dr. G.N. Rao emphasized on the improvement of Eye Care Services focusing especially on childhood blindness in rural During the workshop there was a live demonstration India by establishing Vision Centers in the PHC level of the MOBILE model of Tele-ophthalmology. Tele- and below catering a population of 50,000. Ophthalmology has many applications in Eye Care and this could be used in imaging for diabetic A set of eight leaflets in multicolour on various retinopathy, fluorescein angiography; Fundus aspects of Eye Health Care were also released by photographs; slit-lamp exams and visual field testing. Hon'ble Union Minister of State.
In this workshop, 2 delegates each from 8 States On the occasion of World Sight Day, a National medical colleges and 15 NGOs participated Seminar on Childhood Blindness was also organized on 10th Oct. 2007 in Bhubaneshwar Eye Institute – All delegates were shown a live demonstration of the software with relevance to its data management, transmission and clinical opinion retrieval by an Various topics like Vitamin A deficiency, pediatric ophthalmologist. This thus provides a single window cataract, pediatric glaucoma, community eye care of opportunity for multiple consultations of the same children, retinopathy of prematurity, future strategies patient by several specialists. It was opined by the to tackle childhood blindness and over all group that fixed models are more sustainable than improvement of social economic status of the poor and under privileged which would further prevent mobile models.
blindness in children. 3. Survey for Prevalence of Trachoma in District 2. Regional Workshop in Tele-ophthalmology Bulandshahr (Pilot Run) held on 12th-13th October held at CDAC, Rapid Assessment of Trachoma (RAT) was carried out in October 2006 in six states in India, so as to rapidly ascertain the burden of this disease in the country. This regional workshop which was held at CDAC, Mohali from 12th-13th October, 2007 was to: These states included Gujarat, Haryana, Punjab, Rajasthan, Uttar Pradesh and Uttarakhand. The a) To study the features of fixed/mobile based Tele- findings of this Rapid Assessment showed that the Ophthalmology in Indian conditions.
prevalence of active infection (TF/TI) of Trachoma: b) To assess the applicability of technology in (Trachomatous Inflammation: Follicular/Trachomatous present day Eye Care services. Inflammation: Intense) was 0.9% in (Gujarat); 4% in c) To develop proposal writing capacity in Tele- Haryana; 7.6% in Rajasthan; 5.9% in Uttar Pradesh; Ophthalmology to the participating delegates. 15.2% in Uttarakhand; and 5.5% in Punjab. d) To familiarize the operational aspects of Thereafter, an Expert Group Meeting was held to functioning of E-SANJEEVANI. discuss the current scenario and Elimination of NPCB has extensively worked out the area of Tele- Trachoma in India which was held on 12th ophthalmology for deployment in the country as it September, 2007 at the Conference Hall, Nirman has successfully implemented the six pilot projects of Bhawan, New Delhi. Further, the districts of Bikaner, the same. These Six Institutions were provided Rs. 10 Pauri Garhwal, Mewat and Bulandshahr needed more lakh each to pilot the technology in April 2006. These attention. A final decision was taken on 12 September institutions are: 2007, in this expert group meeting of Trachoma that a 1. C-DAC, Mohali, Punjab.
pilot study in one of the district should be conducted 2. St. Stephens Hospital, Delhi before going for prevalence study of Trachoma in 3. Deptt. of Computer Sciences & Engineering, IIT, India. The district, which was selected, was District Bulandshahr, Uttar Pradesh.

Follow these Golden Rules for
protecting your child's Vision:

ü Give Vitamin- A enriched food to childrenü Provide supplementary dose of Vitamin- A solution (syrup) to al children below 6 years of ageü Keep sharp-edged and pointed objects out of their reachü Discourage games like bows & arrows, gul y-danda, use of chemicals in Holi & crackers in Diwaliü In case of any eye problem, consult a doctor immediatelyü Do not treat the child yourself W rld Sight Day ü Spectacles can correct visual problem For further information contact nearest Primary Health Centres, District Hospitals, Medical Colleges and other NGO Hospitals 11th October 2007 National Programme for Control of Blindness, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi-110011
Join hands to stabilize India's population, donate generously to Jansankhya Sthirata Kosh
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Chief Advisor : Dr. R.K. Srivastava, Director General of Health Services, Chief Editors : Dr. (Mrs.) R. Jose, Additional Director General (Opthal.) &
Shri Vineet Chawdhry, Joint Secretary, Ministry of Health and Family Welfare Editors: Dr. V. Rajshekhar, M.S. (Ophth.), DADG (O), Dr. A.S. Rathore,
Assistant Director General (O), Shri Sanjay Prasad, Director (NCD) and Dr. V. K. Tewari, Health Education Officer (NPCB) Editorial Board: Dr. K.P.S.
Malik, HoD (Ophth.), SJH, New Delhi, Dr. P. Disouza, Lady Harding Medical College, HoD (Ophth.), LHMC, Dr. Praveen Vashist, Dr. R. P. Centre,
AIIMS, Shri V. K. Sharma, Under Secretary (NCD), Ministry of Health and Family Welfare.
Design & Printed by: BLUE BELL, M-26 A, 3rd Floor, Malviya Nagar, New Delhi-110 017
NPCB-India is a quarterly newsletter of the National Programme for Control of Blindness. For further information, contact Additional
Director General (Ophthalmology), 342-A, Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhawan,
New Delhi-110 108. Telefax: 23061594. Email: [email protected]

Source: http://npcb.nic.in/writereaddata/mainlinkfile/File137.pdf

Growing american ginseng in ohio: an introduction

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