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Puliani R, Bhatt Y, Gupta S, R N A, B D T, Jayanna K. A Scoping Review of Barriers and Facilitators for Preconception Care: Lessons for Global Health Policies and Programs. Asia Pac J Public Health 2024:10105395241252867. [PMID: 38736330 DOI: 10.1177/10105395241252867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Preconception care (PCC) encompasses a set of actions taken before pregnancy to support the health and well-being of women before conception to improve maternal and child health (MCH) outcomes. The utilization of PCC services is influenced by multifaceted factors that can either enable or impede women's capacity to access and utilize them effectively. This scoping review examines the barriers and facilitators influencing the utilization of PCC services among women of reproductive age (15-49 years) at both individual and community levels. Through an extensive review of published articles from 2004 to 2021, including peer-reviewed sources, barriers and facilitators were identified. At the individual level, barriers included limited knowledge about PCC, neglect of self-health, and financial constraints. Community-level barriers encompassed insufficient supply of supplements, restricted access to health care, high health care costs, and setbacks due to delayed delivery of MCH services. Conversely, individuals reported that credible sources of information, such as friends, family, and community health volunteers, facilitated their engagement with PCC services. At the community level, facilitators included government-regulated supply chains for supplements and the involvement of community workers in health monitoring. Understanding and addressing these factors can help improve the utilization of PCC services among women of reproductive age (WRA) and improve MCH outcomes.
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Affiliation(s)
- Reedhika Puliani
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Yogita Bhatt
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Soumya Gupta
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Dehradun, India
| | - Agnita R N
- Karnataka Health Promotion Trust, Bengaluru, India
| | - Tejaswini B D
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
| | - Krishnamurthy Jayanna
- Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India
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Jayanna K. Integrative approach to lifestyle management: Implications for public health research & practice in the context of SDG-3. J Ayurveda Integr Med 2023; 14:100796. [PMID: 37738855 PMCID: PMC10692374 DOI: 10.1016/j.jaim.2023.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/24/2023] Open
Abstract
In the last 100 years, the communicable diseases have been replaced by non-communicable diseases as the leading cause of deaths across the world. Periodically, the communicable disease outbreaks continue to pose a challenge to the public health systems. Change in human behaviors and lifestyles are recognized as risk factors for the public health challenges we face today, which significantly affect wellbeing and quality of life. Healthy lifestyles are critical to not only controlling diseases, but also to promote good health and wellbeing. Modern Medicine has provided evidence-based approaches to lifestyle management, but there are challenges to implementing them effectively. The traditional disciplines such as Ayurveda, Yoga and Meditation are showing promise as complementary approaches to further community wellbeing. A new perspective and a model is proposed by the author called 'Integrative Lifestyle" which is informed by the evidence in the space of modern and traditional approaches to lifestyle management. The article describes the elements of the model, highlights the emerging evidence and implications for public health practice and research. The efforts by Government of India and its collaborators to promote integrative approaches is worthy of emulation and should be backed by sufficient investments into implementation research and population wide scale up for accelerating SDG-3 outcomes related to health and wellbeing.
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Affiliation(s)
- Krishnamurthy Jayanna
- Department of Public Health, Faculty of Life and Allied Health Sciences, M S Ramaiah University of Applied Sciences, Bangalore, India; Centre of Integrative Health and Wellbeing, Bangalore, India.
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Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
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Ramani VK, Jayanna K, Naik R. A commentary on cancer prevention and control in India: Priorities for realizing SDGs. Health Sci Rep 2023; 6:e1126. [PMID: 36824617 PMCID: PMC9941912 DOI: 10.1002/hsr2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023] Open
Abstract
In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non-communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control.
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Affiliation(s)
- Vinod K. Ramani
- Preventive OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
| | - Krishnamurthy Jayanna
- Department of Public Health, Faculty of Life and Allied Health SciencesM. S. Ramaiah University of Applied SciencesBangaloreIndia
| | - Radheshyam Naik
- Medical OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
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Dey S, Mukherjee A, Pati MK, Kar A, Ramanaik S, Pujar A, Malve V, Mohan HL, Jayanna K, N S. Socio-demographic, behavioural and clinical factors influencing control of diabetes and hypertension in urban Mysore, South India: a mixed-method study conducted in 2018. Arch Public Health 2022; 80:234. [DOI: 10.1186/s13690-022-00996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Inadequate control of diabetes and hypertension is a major concern in India because of rising mortality and morbidity. Few studies in India have explored factors that influence control of diabetes and hypertension. The current study aimed to improve the understanding of multifactorial influence on the control of diabetes and hypertension among patients in Primary Health Care Settings(PHC) of urban Karnataka.
Methods
We used a mixed-method study design, within a project aiming to improve non-communicable disease (NCD) continuum of care across PHC in Mysore city, India, conducted in 2018. The quantitative study was conducted among 399 patients with diabetes and/or hypertension and a logistic regression model was used to assess the factors responsible for biological control levels of diabetes and hypertension measured through Glycated Haemoglobin(HbA1c) and blood pressure. Further, in-depth interviews(IDI) were conducted among these patients and the counsellors at PHCs to understand the barriers and enablers for better control.
Result
The quantitative assessment found odds of poor control amongst diabetics’ increased with older age, longer duration of disease, additional chronic conditions, and tobacco consumption. For hypertensives, odds of poor control increased with higher body mass index(BMI), alcohol consumption, and belongingness to lower social groups. These findings were elaborated through qualitative assessment which found that the control status was affected by stress as a result of family or financial worries. Stress, poor lifestyle, and poor health-seeking behaviour interplay with other factors like diet and exercise leading to poor control of diabetes and hypertension.
Conclusion
A better understanding of determinants associated with disease control can assist in designing focused patient outreach plans, customized communication strategies, need-based care delivery plans, and specific competency-based capacity-building models for health care workers. Patient-centric care focusing on biological, social and behavioural determinants is pivotal for appropriate management of NCDs at community level in low-middle income countries.
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Jayanna K, Rao S, Kar A, Gowda PD, Thomas T, Swaroop N, Washington M, Shashidhar AR, Rai P, Chitrapu S, Mohan HL, Martines J, Mony P. Accelerated scale-up of Kangaroo Mother Care: Evidence and experience from an implementation-research initiative in south India. Acta Paediatr 2022. [PMID: 35146803 DOI: 10.1111/apa.16236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Though Kangaroo Mother Care (KMC) has demonstrated benefits for low birth weight newborns, coverage continues to be low in India. As part of a World Health Organization (WHO) multi-country study, we explored intervention models to accelerate KMC coverage in a high priority district of Karnataka, India. METHODS We used implementation-research methods, formative assessments and quality improvement approaches to design and scale-up interventions. Evaluation was done using prospective cohort study design; data were collected from facility records, and client interviews during KMC initiation, at discharge and at home after discharge. RESULTS KMC was initiated at health facilities for 87.6% of LBW babies under 2000 g. At discharge, 85.0% received KMC; 67.9% continued to receive KMC at home on the 7th day post-discharge. The interventions included training, mentoring and constant advocacy at many levels: public health facilities, private sector and the community. Innovations like a KMC case sheet, counselling, peer support group triggered KMC in the facilities; a KMC-link card, a microplanning and communication tool for CHWs helped to sustain practice at homes. CONCLUSION The study provides a novel approach to designing and scaling up interventions and suggests lessons that are applicable to KMC as well as to broader reproductive, maternal, neonatal and child health programmes.
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Affiliation(s)
- Krishnamurthy Jayanna
- Karnataka Health Promotion Trust Bangalore India
- M S Ramaiah University of Applied Sciences Bangalore India
| | - Suman Rao
- Department of Neonatology St John’s Medical College and Hospital St John’s National Academy of Health Sciences Bangalore India
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | - Arin Kar
- Karnataka Health Promotion Trust Bangalore India
| | | | - Tinku Thomas
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | | | - Maryann Washington
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
| | - A Rao Shashidhar
- Department of Neonatology St John’s Medical College and Hospital St John’s National Academy of Health Sciences Bangalore India
| | | | | | | | | | - Prem Mony
- Division of Epidemiology, Biostatistics & Population Health St John’s Research Institute St John’s National Academy of Health Sciences Bangalore India
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Mony PK, Tadele H, Gobezayehu AG, Chan GJ, Kumar A, Mazumder S, Beyene SA, Jayanna K, Kassa DH, Mohammed HA, Estifanos AS, Kumar P, Jadaun AS, Hailu Abay T, Washington M, W/Gebriel F, Alamineh L, Fikre A, Kumar A, Trikha S, Ashebir Gebregizabher F, Kar A, Bilal SM, Belew ML, Debere MK, Krishna R, Dalpath SK, Amare SY, Mohan HL, Brune T, Sibley LM, Tariku A, Sahu A, Kumar T, Hadush MY, Gowda PD, Aziz K, Duguma D, Singh PK, Darmstadt GL, Agarwal R, Gebremariam DS, Martines J, Portela A, Jaiswal HV, Bahl R, Rao Pn S, Tadesse BT, Cranmer JN, Hailemariam D, Kumar V, Bhandari N, Medhanyie AA. Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health 2021; 6:bmjgh-2021-005905. [PMID: 34518203 PMCID: PMC8438727 DOI: 10.1136/bmjgh-2021-005905] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%). Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice. Trial registration numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.
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Affiliation(s)
- Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Henok Tadele
- College of Health Sciences, Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Grace J Chan
- Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Department of Epidemiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aarti Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Sarmila Mazumder
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Selemawit Asfaw Beyene
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, Bangalore, India.,Ramaiah University of Applied Sciences, Bangalore, India
| | - Dejene Hailu Kassa
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | | | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Arun Singh Jadaun
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tedros Hailu Abay
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Maryann Washington
- St John's Research Institute, St John's Medical College, Bangalore, India
| | - Fitsum W/Gebriel
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Addisalem Fikre
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alok Kumar
- Governent of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sonia Trikha
- State Health Systems Resource Center, Panchkula, Haryana, India
| | | | - Arin Kar
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | - Raghav Krishna
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | | | - Samson Yohannes Amare
- Department of Software Engineering, School of Computing, College of Science and Technology, Mekelle University, Mekelle, Ethiopia
| | - H L Mohan
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | - Abraham Tariku
- Maternal & Child Health Department, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Arti Sahu
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Tarun Kumar
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Prabhu Deva Gowda
- Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore, India
| | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ramesh Agarwal
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Dawit Seyoum Gebremariam
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Harsh Vardhan Jaiswal
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Suman Rao Pn
- Department of Neonatology, St John's Medical College Hospital, Bangalore, India
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | | | - Nita Bhandari
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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Rao L, Prakash R, Rai P, Tharakan M, DL K, Kar A, HL M, Jayanna K. Investigating violence against Accredited Social Health Activists (ASHAs): a mixed methods study from rural North Karnataka, India. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.24351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lavanya Rao
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
| | - Ravi Prakash
- Karnataka Health Promotion Trust (KHPT), Bangalore, India; University of Manitoba, Winnipeg, Canada
| | - Prathibha Rai
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
| | | | - Kavitha DL
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
| | - Arin Kar
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
| | - Mohan HL
- Karnataka Health Promotion Trust (KHPT), Bangalore, India
| | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust (KHPT), Bangalore, India; M.S. Ramaiah University of Applied Sciences, Bangalore, India
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Lingaraju K, Basavaraj R, Jayanna K, S.Bhavana, Devaraja S, Kumar Swamy H, Nagaraju G, Nagabhushana H, Raja Naika H. Biocompatible fabrication of TiO2 nanoparticles: Antimicrobial, anticoagulant, antiplatelet, direct hemolytic and cytotoxicity properties. INORG CHEM COMMUN 2021. [DOI: 10.1016/j.inoche.2021.108505] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sankar Sylapan B, Nair AK, Jayanna K, Mallipeddi S, Sathyanarayana S, Kutty BM. Meditation, well-being and cognition in heartfulness meditators - A pilot study. Conscious Cogn 2020; 86:103032. [PMID: 33096504 DOI: 10.1016/j.concog.2020.103032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 01/07/2023]
Abstract
Meditative practices can vary considerably in technique as well as their effects. Heartfulness is a popular meditation technique that includes in its repertoire, a unique passive form of meditation. We carried out a pilot study recruiting male heartfulness meditators (proficient n = 24, with 6-28 years of meditation experience; novice n = 24, 5 to 16 months of experience) and subsequently recruited matched controls (n = 15). We examined well-being, and carried out high-density EEG recordings to examine indices of meditation and cognition in these groups. Well-being scores were significantly higher for the proficient meditators as compared to novice and intermediate for the controls. We did not find any group differences in cognitive processing. During meditation, enhanced occipital gamma was found in proficient meditators as compared to controls. We discuss the findings from this pilot study and suggest avenues for future research.
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Affiliation(s)
- Bhuvnesh Sankar Sylapan
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Center for Consciousness Studies, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ajay Kumar Nair
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Center for Consciousness Studies, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Krishnamurthy Jayanna
- Ramaiah University of Applied Sciences, Bengaluru, India; Center for Integrative Health and Wellbeing, Bengaluru, India; Heartfulness Institute, Bengaluru, India.
| | - Saketh Mallipeddi
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Center for Consciousness Studies, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sunil Sathyanarayana
- Dayananda Sagar College of Dental Sciences, Bengaluru, India; Heartfulness Institute, Bengaluru, India
| | - Bindu M Kutty
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India; Center for Consciousness Studies, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
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Pati MK, Swaroop N, Kar A, Aggarwal P, Jayanna K, Van Damme W. A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India. Public Health Rev 2020; 41:8. [PMID: 32435518 PMCID: PMC7222468 DOI: 10.1186/s40985-020-00128-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) account for a higher burden of noncommunicable diseases (NCD) and home to a higher number of premature deaths (before age 70) from NCDs. NCDs have become an integral part of the global development agenda; hence, the scope of action on NCDs extends beyond just the health-related sustainable development goal (SDG 3). However, the organization and integration of NCD-related health services have faced several gaps in the LMIC regions such as India. Although the national NCD programme of India has been in operation for a decade, challenges remain in the integration of NCD services at primary care. In this paper, we have analysed existing gaps in the organization and integration of NCD services at primary care and suggested plausible solutions that exist. METHOD The identification of gaps is based out of a review of peer-reviewed articles, reports on national and global guidelines/protocols. The gaps are organized and narrated at four levels such as community, facility, health system, health policy and research, as per the WHO Innovative Care for Chronic Conditions framework (WHO ICCC). RESULT The review found that challenges in the identification of eligible beneficiaries, shortage and poor capacity of frontline health workers, poor functioning of community groups and poor community knowledge on NCD risk factors were key gaps at the community level. Challenges at facility level such as poor facility infrastructure, lack of provider knowledge on standards of NCD care and below par quality of care led to poor management of NCDs. At the health system level, we found, organization of care, programme management and monitoring systems were not geared up to address NCDs. Multi-sectoral collaboration and coordination were proposed at the policy level to tackle NCDs; however, gaps remained in implementation of such policies. Limited research on the effect of health promotion, prevention and, in particular, non-medical interventions on NCDs was found as a key gap at the research level. CONCLUSION This paper reinforces the need for an integrated comprehensive model of NCD care especially at primary health care level to address the growing burden of these diseases. This overarching review is quite relevant and useful in organizing NCD care in Indian and similar LMIC settings.
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Affiliation(s)
- Manoj Kumar Pati
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - N. Swaroop
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - Arin Kar
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | | | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Wim Van Damme
- Health Policy Department, Institute of Tropical Medicine, Antwerp, Belgium
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Banadakoppa Manjappa R, Kar A, Jayanna K, Hallad JS, Cunningham T, Potty R, Mohan HL, Crockett M, Bradley J, Fischer E, Sudarshan H, Blanchard JF, Moses S, Avery L. Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys. BMC Pregnancy Childbirth 2020; 20:242. [PMID: 32326902 PMCID: PMC7181530 DOI: 10.1186/s12884-020-02942-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India. METHODS From 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n = 5240) and endline (n = 5154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2-7 and 8-28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility. RESULTS Overall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3-38.4) and 21.6 (95% CI 16.3-28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1-47.5) vs. 9.3 (95% CI 3.9-22.3) (p = 0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06-0.82, p = 0.02). CONCLUSION The nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings.
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Affiliation(s)
- Ramesh Banadakoppa Manjappa
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada.
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | | | - H L Mohan
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Janet Bradley
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | | | | | - James F Blanchard
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Stephen Moses
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
| | - Lisa Avery
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6, Canada
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Medhanyie AA, Alemu H, Asefa A, Beyene SA, Gebregizabher FA, Aziz K, Bhandari N, Beyene H, Brune T, Chan G, Cranmer JN, Darmstadt G, Duguma D, Fikre A, Andualem BG, Gobezayehu AG, Mariam DH, Abay TH, Mohan HL, Jadaun A, Jayanna K, Kajal FNU, Kar A, Krishna R, Kumar A, Kumar V, Madhur TK, Belew ML, M R, Martines J, Mazumder S, Amin H, Mony PK, Muleta M, Pileggi-Castro C, Pn Rao S, Estifanos AS, Sibley LM, Singhal N, Tadele H, Tariku A, Lemango ET, Tadesse BT, Upadhyay R, Worku B, Hadush MY, Bahl R. Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation. BMJ Open 2019; 9:e025879. [PMID: 31753865 PMCID: PMC6886988 DOI: 10.1136/bmjopen-2018-025879] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. METHODS AND ANALYSIS This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge. ETHICS AND DISSEMINATION Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination. STUDY STATUS WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019. TRIAL REGISTRATION NUMBER Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698).
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Affiliation(s)
- Araya Abrha Medhanyie
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Hibret Alemu
- Urban Health, John Snow Inc, Addis Ababa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Selemawit Asfaw Beyene
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Khalid Aziz
- Department of Neonatology, University of Alberta, Edmonton, Alberta, Canada
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Habtamu Beyene
- Southern Nations, Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia
| | - Thomas Brune
- Department of Neonatology, Karloniska Institute, Calgary, Alberta, Canada
| | - Grace Chan
- Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - John N Cranmer
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - G Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Dereje Duguma
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Addisalem Fikre
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
| | | | | | | | - Tedros Hailu Abay
- Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - H L Mohan
- Community Mobilization, Karnataka Health Promotion Trust, Bangalore, India
| | - Arun Jadaun
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - K Jayanna
- Quality Improvement, Karnataka Health Promotion Trust, Bangalore, India
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - F N U Kajal
- National Health Mission, Indian Administrative Service, Lucknow, India
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Raghav Krishna
- Global Health, Community Empowerment Lab, Lucknow, India
| | - Aarti Kumar
- Global Health, Community Empowerment Lab, Lucknow, India
| | | | - Tarun Kumar Madhur
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Rajini M
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, India
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Universitetet i Bergen Senter for internasjonal helse, Bergen, Norway
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Prem K Mony
- Division of Epidemiology and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Cynthia Pileggi-Castro
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Suman Pn Rao
- Department of Neonatology, St John's Medical College Hospital, Bangalore, India
| | | | - Lynn M Sibley
- Global Health, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Nalini Singhal
- Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henok Tadele
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Ephrem Tekle Lemango
- Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Ravi Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bogale Worku
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- Pediatrics Society, Addis Ababa, Ethiopia
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Potty RS, Lakkappa MH, Kar A, Bidappa M, Manjappa RB, Jayanna K. Influence of integrated community- and facility-based interventions on select maternal and neonatal outcomes in Northern Karnataka, India: Lessons for implementation and measurement. Indian J Public Health 2019; 61:19-25. [PMID: 28218158 DOI: 10.4103/0019-557x.200256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sukshema project provided technical assistance to National Health Mission of government of Karnataka to improve maternal, newborn and child health (MNCH) outcomes in eight districts of Karnataka between 2009 and 2015. The project designed tools, processes and provided mentoring to frontline workers, community structures, and facilities to improve demand generation and quality of MNCH services. OBJECTIVES To assess over time changes in selected MNCH care indicators among women who had delivered in the past 2 months in Bagalkot and Koppal districts. METHODS An innovative strategy was designed to collect routine monitoring data, namely community behavior tracking survey using mobile technology. The catchment area of an Accredited Social Health Activist (ASHA) was the primary sampling unit, and in each district 200, ASHA areas were selected. Women from these selected ASHA areas were interviewed and information collected on various MNCH care outcomes. Multivariate logistic regression was used to assess changes in selected MNCH care indicators. RESULTS Gradual increase was noticed in institutional delivery, hospital stay for 48 or more hours, initiation of breastfeeding within 1 hour and continuum of MNCH care. Forty-eight hours stay and initiation of breastfeeding improved marginally possibly due to health systems and cultural norms. CONCLUSIONS Results indicated that the interventions were successful in changing the critical MNCH care indicators and hence have potential for replication in similar high priority district settings.
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Affiliation(s)
| | - Mohan Harnahalli Lakkappa
- Senior Advisor, Programs, Community and Communications, University of Manitoba, Winnipeg, Canada; Managing Trustee, Karnataka Health Promotion Trust, Bengaluru, India
| | - Arin Kar
- Deputy Director, Monitoring and Evaluation, Karnataka Health Promotion Trust, Bengaluru, India
| | - Mallika Bidappa
- Deputy Director, Communication and Community Interventions, Karnataka Health Promotion Trust; Deputy Director, Communication and Community Interventions, Health Action Trust, Bengaluru, India
| | - Ramesh Banadakoppa Manjappa
- Assistant Professor, Department of Community Health Sciences; Research Associate, Centre for Global Public Health, University of Manitoba, Winnipeg, Cananda
| | - Krishnamurthy Jayanna
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; Director, Karnataka Health Promotion Trust, Bengaluru, India
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Anandh U, Jayanna K, Birajdar N. MON-088 FACTORS AFFECTING DIALYSIS ADEQUACY AND THE EFFECT OF DIALYSIS SHIFT TIME ON ADEQUACY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mony PK, Washington M, Rao S, Gajendran J, Thooya V, N S, Kar A, Jayanna K. Design and Implementation of a Structured Programme for Validation of Birth Weights in a District of Southern India: A Case Study. ACTA ACUST UNITED AC 2018; 17:37-44. [PMID: 31007165 DOI: 10.12927/whp.2018.25728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In India, though the prevalence of low birth weight (LBW) is estimated to be nearly 30%, routine reporting by the government consistently under-reports it as 12%, with resulting mismatched rectification efforts. We designed a programme comprising weight measurement standardization training, a pilot study-based sample size calculation, re-training and certification of personnel and finally a validation exercise. Paired birth weight readings of 404 newborns by a staff nurse and a research nurse were compared. LBW (<2,500 g) prevalence was 18% and 36% according to staff nurse and research nurse, respectively. Thus, it is feasible to set up simple validation exercises.
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Affiliation(s)
- Prem K Mony
- Professor, Division of Epidemiology & Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Maryann Washington
- Adjunct Professor, Division of Epidemiology & Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences , Bangalore, India
| | - Suman Rao
- Professor, Department of Neonatology, St. John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India
| | - Jayachitra Gajendran
- Field Supervisor, Division of Epidemiology & Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Virgin Thooya
- Nurse Coordinator, Division of Epidemiology & Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Swaroop N
- Technical Manager, Karnataka Health Promotion Trust, Bangalore, India
| | - Arin Kar
- Deputy Director, Karnataka Health Promotion Trust, Bangalore, India
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Abstract
A 71-year-old male, a renal allograft recipient, presented to us with a history of fever and right palm swelling. He had a history of fever 7 years back when he was treated with antitubercular treatment (ATT). Three years back, he was diagnosed to have gout and he was started on allopurinol. He developed severe bone marrow toxicity and allopurinol was changed to febuxostat. On admission, routine investigations did not reveal any focus of infection. The fluid aspirate from the palm revealed acid-fast bacilli (AFB). He was started on ATT; however, he did not show significant improvement. Two months later, he developed multiple subcutaneous lesions, and the pus again came positive for AFB. Due to lack of improvement, the aspirate was sent for molecular diagnostic identification. The mycobacteria was identified as Mycobacterium haemophilum. His treatment was changed to rifampicin, clarithromycin, and ciprofloxacin. As he showed slow improvement, his immunosuppression was tapered slowly. At 7 months of therapy, he is clinically better and his lesions are healing. His renal functions stayed stable despite tapering of cyclosporine in a patient who is on rifampicin. This case, the first report of M. haemophilum infection in a kidney transplant recipient in India, illustrates the difficulty in diagnosing nontubercular mycobacterial infection in transplant recipients. It also emphasizes the dilemma in tapering immunosuppressive drugs in disseminated nontubercular mycobacterial infections where there are considerable interactions between ATT and immunosuppressives.
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Affiliation(s)
- U Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - K Jayanna
- Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
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Bradley J, Jayanna K, Shaw S, Cunningham T, Fischer E, Mony P, Ramesh BM, Moses S, Avery L, Crockett M, Blanchard JF. Improving the knowledge of labour and delivery nurses in India: a randomized controlled trial of mentoring and case sheets in primary care centres. BMC Health Serv Res 2017; 17:14. [PMID: 28061783 PMCID: PMC5219705 DOI: 10.1186/s12913-016-1933-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Birthing in health facilities in India has increased over the last few years, yet maternal and neonatal mortality rates remain high. Clinical mentoring with case sheets or checklists for nurses is viewed as essential for on-going knowledge transfer, particularly where basic training is inadequate. This paper summarizes a study of the effect of such a programme on staff knowledge and skills in a randomized trial of 295 nurses working in 108 Primary Health Centres (PHCs) in Karnataka, India. METHODS Stratifying by district, half of the PHCs were randomly assigned to be intervention sites and provided with regular mentoring visits where case sheet/checklists were a central job and teaching aid, and half to be control sites, where no support was provided except provision of case sheets. Nurses' knowledge and skills around normal labour, labour complications and neonate issues were tested before the intervention began and again one year later. Univariate and multivariate analyses were conducted to examine the effect of mentoring and case sheets. RESULTS Overall, on none of the 3 measures, did case sheet use without mentoring add anything to the basic nursing training when controlling for other factors. Only individuals who used both case-sheets and received mentoring scored significantly higher on the normal labour and neonate indices, scoring almost twice as high as those who only used case-sheets. This group was also associated with significantly higher scores on the complications of labour index, with their scores 2.3 times higher on average than the case sheet only control group. Individuals from facilities with 21 or more deliveries in a month tended to fare worse on all 3 indices. There were no differences in outcomes according to district or years of experience. CONCLUSIONS This study demonstrates that provision of case sheets or checklists alone is insufficient to improve knowledge and practices. However, on-site mentoring in combination with case sheets can have a demonstrable effect on improving nurse knowledge and skills around essential obstetric and neonatal care in remote rural areas of India. We recommend scaling up of this mentoring model in order to improve staff knowledge and skills and reduce maternal and neonatal mortality in India. TRIAL REGISTRATION This study is registered at clinicaltrials.gov, Identifier No. NCT02004912 , November 27, 2013.
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Affiliation(s)
- Janet Bradley
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Krishnamurthy Jayanna
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Souradet Shaw
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Troy Cunningham
- Karnataka Health Promotion Trust, IT Park 5th floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore, 560 044 India
| | - Elizabeth Fischer
- IntraHealth, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC 27517 USA
| | - Prem Mony
- St. John’s National Academy of Health Sciences, Sarjapur Road, Bangalore, Karnataka State 560 034 India
| | - B. M. Ramesh
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Stephen Moses
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Lisa Avery
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - Maryanne Crockett
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
| | - James F. Blanchard
- Centre for Global Public Health, Faculty of Medicine, University of Manitoba, 771 Mc Dermot Avenue, Medical Rehabilitation Building, Room R070, Winnipeg, MB R3E 0T6 Canada
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Jayanna K, Bradley J, Mony P, Cunningham T, Washington M, Bhat S, Rao S, Thomas A, S R, Kar A, N S, B M R, H L M, Fischer E, Crockett M, Blanchard J, Moses S, Avery L. Effectiveness of Onsite Nurse Mentoring in Improving Quality of Institutional Births in the Primary Health Centres of High Priority Districts of Karnataka, South India: A Cluster Randomized Trial. PLoS One 2016; 11:e0161957. [PMID: 27658215 PMCID: PMC5033379 DOI: 10.1371/journal.pone.0161957] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/12/2016] [Indexed: 01/24/2023] Open
Abstract
Background In India, although the proportion of institutional births is increasing, there are concerns regarding quality of care. We assessed the effectiveness of a nurse-led onsite mentoring program in improving quality of care of institutional births in 24/7 primary health centres (PHCs that are open 24 hours a day, 7 days a week) of two high priority districts in Karnataka state, South India. Primary outcomes were improved facility readiness and provider preparedness in managing institutional births and associated complications during child birth. Methods All functional 24/7 PHCs in the two districts were included in the study. We used a parallel, cluster randomized trial design in which 54 of 108 facilities received six onsite mentoring visits, along with an initial training update and specially designed case sheets for providers; the control arm received just the initial training update and the case sheets. Pre- and post-intervention surveys were administered in April-2012 and August-2013 using facility audits, provider interviews and case sheet audits. The provider interviews were administered to all staff nurses available at the PHCs and audits were done of all the filled case sheets during the month prior to data collection. In addition, a cost analysis of the intervention was undertaken. Results Between the surveys, we achieved coverage of 100% of facilities and 91.2% of staff nurse interviews. Since the case sheets were newly designed, case-sheet audit data were available only from the end line survey for about 80.2% of all women in the intervention facilities and 57.3% in the control facilities. A higher number of facilities in the intervention arm had all appropriate drugs, equipment and supplies to deal with gestational hypertension (19 vs.3, OR (odds ratio) 9.2, 95% C.I 2.5 to33.6), postpartum haemorrhage (29 vs. 12, OR 3.7, 95% C.I 1.6 to8.3); and obstructed labour (25 vs.9, OR 3.4, 95% CI 1.6 to8.3). The providers in the intervention arm had better knowledge of active management of the third stage of labour (82.4% vs.35.8%, AOR (adjusted odds ratio) 10, 95% C.I 5.5 to 18.2); management of maternal sepsis (73.5% vs. 10.9%, AOR 36.1, 95% C.I 13.6 to 95.9); neonatal resuscitation (48.5% vs.11.7%, AOR 10.7, 95% C.I 4.6 to 25.0) and low birth weight newborn care (58.1% vs. 40.9%, AOR 2.4, 95% C.I 1.2 to 4.7). The case sheet audits revealed that providers in the intervention arm showed greater compliance with the protocols during labour monitoring (77.3% vs. 32.1%, AOR 25.8, 95% C.I 9.6 to 69.4); delivery and immediate post-partum care for mothers (78.6% vs. 31.8%, AOR 22.1, 95% C.I 8.0 to 61.4) and for newborns (73.9% vs. 32.8%, AOR 24.1, 95% C.I 8.1 to 72.0). The cost analysis showed that the intervention cost an additional $5.60 overall per delivery. Conclusions The mentoring program successfully improved provider preparedness and facility readiness to deal with institutional births and associated complications. It is feasible to improve the quality of institutional births at a large operational scale, without substantial incremental costs. Trial Registration ClinicalTrials.gov NCT02004912
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Affiliation(s)
- Krishnamurthy Jayanna
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
- * E-mail:
| | - Janet Bradley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Prem Mony
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Troy Cunningham
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Maryann Washington
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Swarnarekha Bhat
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Suman Rao
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Annamma Thomas
- St John’s National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Rajaram S
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Arin Kar
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Swaroop N
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Ramesh B M
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Mohan H L
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Karnataka Health Promotion Trust, Bangalore, Karnataka, India
| | - Elizabeth Fischer
- IntraHealth International, Chapel Hill, North Carolina, United States of America
| | - Maryanne Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Blanchard
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen Moses
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Avery
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Mony PK, Jayanna K, Varghese B, Washington M, Vinotha P, Thomas T. Adoption and Completeness of Documentation Using a Structured Delivery Record in Secondary Care, Subdistrict Government Hospitals of Karnataka State, India. Health Serv Res Manag Epidemiol 2016; 3:2333392816647605. [PMID: 28462277 PMCID: PMC5266437 DOI: 10.1177/2333392816647605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/05/2016] [Indexed: 12/01/2022] Open
Abstract
Objective: Poor medical record documentation remains a pervasive problem in hospital delivery rooms, hampering efforts aimed at improving the quality of maternal and neonatal care in resource-limited settings. We evaluated the feasibility and completeness of labor room documentation within a quasi-experimental study aimed at improving emergency preparedness for obstetric and neonatal emergencies in 8 nonteaching, subdistrict, secondary care hospitals of Karnataka state, India. Methods: We redesigned the existing open-ended case sheet into a structured, delivery record cum job aide adhering to principles of local clinical relevance, parsimony, and computerizability. Skills and emergency drills training along with supportive supervision were introduced in 4 “intervention arm” hospitals while the new delivery records were used in eight intervention and control hospitals. Results: Introduction of the new delivery record was feasible over a “run-in” period of 4 months. About 92% (6103 of 6634) of women in intervention facilities and 80% (6205 of 7756) in control facilities had their delivery records filled in during the 1-year study period. Completeness of delivery record documentation fell into one of two subsets with one set of parameters being documented with minimal inputs (in both intervention and control sites) and another set of parameters requiring more intensive training efforts (and seen more in intervention than in control sites; P < .05). Conclusion: Under the stewardship of the local government, it was possible to institute a robust, reliable, and valid medical record documentation system as part of efforts to improve intrapartum and postpartum maternal and newborn care in hospitals.
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Affiliation(s)
- Prem K Mony
- Division of Epidemiology, Biostatistics & Population Health, St John's Medical College & Research Institute, Koramangala, Bangalore, India
| | | | - Beena Varghese
- Division of Epidemiology, Biostatistics & Population Health, St John's Medical College & Research Institute, Koramangala, Bangalore, India
| | - Maryann Washington
- Division of Epidemiology, Biostatistics & Population Health, St John's Medical College & Research Institute, Koramangala, Bangalore, India
| | - P Vinotha
- Division of Epidemiology, Biostatistics & Population Health, St John's Medical College & Research Institute, Koramangala, Bangalore, India
| | - Tinku Thomas
- Division of Epidemiology, Biostatistics & Population Health, St John's Medical College & Research Institute, Koramangala, Bangalore, India
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Washington M, Jayanna K, Bhat S, Thomas A, Rao S, Perumal G, Cunningham T, Bradley J, Avery L, Fischer E, K. Mony P. Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.66048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mony PK, Jayanna K, Bhat S, Rao SV, Crockett M, Avery L, Ramesh BM, Moses S, Blanchard J. Availability of emergency neonatal care in eight districts of Karnataka state, southern India: a cross-sectional study. BMC Health Serv Res 2015; 15:461. [PMID: 26444272 PMCID: PMC4596301 DOI: 10.1186/s12913-015-1126-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 09/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Emergency Neonatal Care (EmNC) is an important service for the health and survival of newborns. The objective of our study was to assess the availability of emergency neonatal care services in the north-eastern region of Karnataka state in India. METHODS We undertook a cross-sectional epidemiologic study in the year 2010. We assessed the provision of eight life-saving 'signal functions' (Comprehensive EmNC) or at least five 'signal functions' (Basic EmNC) by self-reporting through a structured questionnaire, coupled with verification by direct observation for presence of drugs and equipment in the prior three months. The assessment was undertaken in 443 government and 422 private healthcare facilities of eight districts of Karnataka. RESULTS There was an average of 3.6 EmNC facilities available per 500,000 population for the entire region. Only three out of eight districts and 10 of 42 sub-districts in the region had the recommended [greater than or equal to 5] EmNC facilities per 500,000. Further, over 95 % of CEmNC facilities and 88 % of BEmNC facilities were within the private sector. About 80 % of government hospitals at district and sub-district levels did not have EmNC capability. CONCLUSIONS This study demonstrates the feasibility of using a simple assessment tool to measure health facility availability of life-saving services for newborn care. EmNC availability was seen to be suboptimal at the regional, district and sub-district levels within the northern part of Karnataka state. There is a need to improve availability of emergency newborn care in health facilities, with special emphasis on equity at population level.
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Affiliation(s)
- Prem K Mony
- St John's National Academy of Health Sciences, Bangalore, India.
- Division of Epidemiology & Population Health, St John's Medical College &Research Institute, St John's National Academy of Health Sciences, 100 feet road, Koramangala, Bangalore, 560034, India.
| | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, Bangalore, India.
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Swarnarekha Bhat
- St John's National Academy of Health Sciences, Bangalore, India.
| | - Suman V Rao
- St John's National Academy of Health Sciences, Bangalore, India.
| | - Maryann Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Lisa Avery
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - B M Ramesh
- Karnataka Health Promotion Trust, Bangalore, India.
| | - Stephen Moses
- Karnataka Health Promotion Trust, Bangalore, India.
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - James Blanchard
- Karnataka Health Promotion Trust, Bangalore, India.
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
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Bruce SG, Blanchard AK, Gurav K, Roy A, Jayanna K, Mohan HL, Ramesh BM, Blanchard JF, Moses S, Avery L. Preferences for infant delivery site among pregnant women and new mothers in Northern Karnataka, India. BMC Pregnancy Childbirth 2015; 15:49. [PMID: 25884166 PMCID: PMC4345019 DOI: 10.1186/s12884-015-0481-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/13/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The National Rural Health Mission (NRHM) of India aims to increase the uptake of safe and institutional delivery among rural communities to improve maternal, neonatal and child health (MNCH) outcomes. Previous studies in India have found that while there have been increasing numbers of institutional deliveries there are still considerable barriers to utilization and quality of services, particularly in rural areas, that may mitigate improvements achieved by MNCH interventions. This paper aims to explore the factors influencing preference for home, public or private hospital delivery among rural pregnant and new mothers in three northern districts of Karnataka state, South India. METHODS In-depth qualitative interviews were conducted in 2010 among 110 pregnant women, new mothers (infants born within past 3 months), their husbands and mothers-in-law. Interviews were conducted in the local language (Kannada) and then translated to English for analysis. The interviews of pregnant women and new mothers were used for analysis to ultimately develop broader themes around definitions of quality care from the perspective of service users, and the influence this had on their delivery site preferences. RESULTS Geographical and financial access were important barriers to accessing institutional delivery services in all districts, and among those both above and below the poverty line. Access issues of greatest concern were high costs at private institutions, continuing fees at public hospitals and the inconsistent receipt of government incentives. However, views on quality of care that shaped delivery site preferences were deeply rooted in socio-cultural expectations for comfortable, respectful and safe care that must ultimately be addressed to change negative perceptions about institutional, and particularly public hospital, care at delivery. CONCLUSIONS In the literature, quality of care beyond access has largely been overlooked in favour of support for incentives on the demand side, and more trained doctors, facilities and equipment on the supply side. Taking a comprehensive approach to quality of care in line with cultural values and community needs is imperative for improving experiences, utilization, and ultimately maternal and neonatal health outcomes at the time of delivery.
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Affiliation(s)
| | | | - Kaveri Gurav
- Karnataka Heath Promotion Trust, Bangalore, India.
| | | | - Krishnamurthy Jayanna
- University of Manitoba, Winnipeg, Canada.
- Karnataka Heath Promotion Trust, Bangalore, India.
| | - Haranahalli L Mohan
- University of Manitoba, Winnipeg, Canada.
- Karnataka Heath Promotion Trust, Bangalore, India.
| | - Banadakoppa M Ramesh
- University of Manitoba, Winnipeg, Canada.
- Karnataka Heath Promotion Trust, Bangalore, India.
| | | | | | - Lisa Avery
- University of Manitoba, Winnipeg, Canada.
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Jayanna K, Mony P, BM R, Thomas A, Gaikwad A, HL M, Blanchard JF, Moses S, Avery L. Assessment of facility readiness and provider preparedness for dealing with postpartum haemorrhage and pre-eclampsia/eclampsia in public and private health facilities of northern Karnataka, India: a cross-sectional study. BMC Pregnancy Childbirth 2014; 14:304. [PMID: 25189169 PMCID: PMC4161844 DOI: 10.1186/1471-2393-14-304] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The maternal mortality ratio in India has been declining over the past decade, but remains unacceptably high at 212 per 100,000 live births. Postpartum haemorrhage (PPH) and pre- eclampsia/eclampsia contribute to 40% of all maternal deaths. We assessed facility readiness and provider preparedness to deal with these two maternal complications in public and private health facilities of northern Karnataka state, south India. METHODS We undertook a cross-sectional study of 131 primary health centres (PHCs) and 148 higher referral facilities (74 public and 74 private) in eight districts of the region. Facility infrastructure and providers' knowledge related to screening and management of complications were assessed using facility checklists and test cases, respectively. We also attempted an audit of case sheets to assess provider practice in the management of complications. Chi square tests were used for comparing proportions. RESULTS 84.5% and 62.9% of all facilities had atleast one doctor and three nurses, respectively; only 13% of higher facilities had specialists. Magnesium sulphate, the drug of choice to control convulsions in eclampsia was available in 18% of PHCs, 48% of higher public facilities and 70% of private facilities. In response to the test case on eclampsia, 54.1% and 65.1% of providers would administer anti-hypertensives and magnesium sulphate, respectively; 24% would administer oxygen and only 18% would monitor for magnesium sulphate toxicity. For the test case on PPH, only 37.7% of the providers would assess for uterine tone, and 40% correctly defined early PPH. Specialists were better informed than the other cadres, and the differences were statistically significant. We experienced generally poor response rates for audits due to non-availability and non-maintenance of case sheets. CONCLUSIONS Addressing gaps in facility readiness and provider competencies for emergency obstetric care, alongside improving coverage of institutional deliveries, is critical to improve maternal outcomes. It is necessary to strengthen providers' clinical and problem solving skills through capacity building initiatives beyond pre-service training, such as through onsite mentoring and supportive supervision programs. This should be backed by a health systems response to streamline staffing and supply chains in order to improve the quality of emergency obstetric care.
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Affiliation(s)
- Krishnamurthy Jayanna
- />Karnataka Health Promotion Trust, IT Park, 5th floor, No 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044 India
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Prem Mony
- />Depart of Epidemiology, St John’s Research Institute, St John’s National Academy of Health Sciences, Bangalore, India
| | - Ramesh BM
- />Karnataka Health Promotion Trust, IT Park, 5th floor, No 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044 India
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Annamma Thomas
- />Depart of Obstetrics, St John’s Medical College and Hospital, St John’s National Academy of Health Sciences, Bangalore, India
| | - Ajay Gaikwad
- />Karnataka Health Promotion Trust, IT Park, 5th floor, No 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044 India
| | - Mohan HL
- />Karnataka Health Promotion Trust, IT Park, 5th floor, No 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044 India
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - James F Blanchard
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Stephen Moses
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Lisa Avery
- />Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
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Jayanna K, Ramesh, Bhowmik A, Thomas A, Mony P, Shankar K, Schurmann A, Moses S, Avery L, Blanchard J. O338 MANAGEMENT OF ECLAMPSIA AND POSTPARTUM HEMORRHAGE: CHALLENGES AND OPPORTUNITIES TO IMPROVE QUALITY OF CARE IN NORTHERN KARNATAKA, INDIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kumar PM, Jayanna K. P5-S6.37 A community led decentralised and integrated approach for personalised prevention and care services to PLHIV in Karnataka, South India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jayanna K, Washington R, Moses S. P2-S7.04 Maximising the impact of positive prevention practices in people living with HIV: learning's from Karnataka, South India. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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R M, Jayanna K, Washington R, Das A, Pise G, Dhanunjaya R, Mary J. Understanding positive prevention practices among people living with HIV in Karnataka, Southern India. Australas Med J 2011; 4:150-61. [PMID: 23393506 DOI: 10.4066/amj.2011.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Understanding positive prevention practices among people living with HIV (PLHIV) can provide useful insights to guide our efforts in preventing further HIV transmission, and helps to enable PLHIVs to lead healthy and responsible lives. METHOD A cross-sectional study was conducted in three sites of Karnataka: namely Belgaum (North Karnataka), Bellary (Central Karnataka) and Hassan (South Karnataka) districts. The study period was from March to September 2010. A total of 477 PLHIV were sampled and interviewed with the help of a structured interview schedule. The interviews were conducted by trained PLHIV community interviewers. RESULTS Disclosure of status was fairly good among the studied population. The majority of men disclosed their HIV status first with their spouses, whereas women disclosed first with their mothers. Status disclosure was less among urban PLHIV when compared to rural PLHIV. Knowledge about Sexually Transmitted Infections (STIs) among unmarried men and women was low; higher proportions among them were involved in sexual relationships; and they reported no condom use with their regular partners. Condom use with regular partners is found to be more effective when public health messages are given through peers. Status disclosure is having a role in motivating communities for Regular CD4 testing and ART uptake. CONCLUSION Unmarried PLHIV need to be prioritised in our prevention efforts, to enable them to adopt safe sex practices through appropriate peer-mediated strategies. As status disclosure with family members has an important role in adhering to ART, status disclosure with family members needs to be emphasized in our programmes.
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Affiliation(s)
- Manjunatha R
- Karnataka Health Promotion Trust, Bangalore, India
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Mishra S, Naik B, Venugopal B, Kudur P, Washington R, Becker M, Kenneth J, Jayanna K, Ramesh BM, Isac S, Boily MC, Blanchard JF, Moses S. Syphilis screening among female sex workers in Bangalore, India: comparison of point-of-care testing and traditional serological approaches. Sex Transm Infect 2009; 86:193-8. [DOI: 10.1136/sti.2009.038778] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jayanna K, Washington RG, Moses S, Kudur P, Issac S, Balu PS, Badiger S, Mendonca V, Bhavimani S, Banandur P. Assessment of attitudes and practices of providers of services for individuals at high risk of HIV and sexually transmitted infections in Karnataka, south India. Sex Transm Infect 2009; 86:131-5. [PMID: 19854702 DOI: 10.1136/sti.2008.035600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A key component of prevention programmes aimed at reducing the risk of HIV and sexually transmitted infections (STI) among high-risk groups such as female sex workers (FSW) is the provision of quality STI services. The attitudes and practices of care providers are critical factors in the provision of services and in achieving better participation of high-risk individuals in accessing services. OBJECTIVES To assess the attitudes and practices of STI care providers towards FSW, and the perceptions of FSW towards STI services, following training. METHODOLOGY After an intensive physician capacity building programme, 393 exit interviews of FSW were conducted following clinical encounters, and discussions were held with 131 STI care providers (physicians) across several districts in Karnataka. Focus group discussions were held among FSW to understand the perceptions of non-users of services. RESULTS 60% of women reported that the clinics were accessible. 76% of the women who visited clinics for STI consultations were offered a speculum examination. 85% received a condom demonstration, but only 52% were advised for partner treatment. 69% of women were referred for HIV testing. 79% of physicians felt that sex workers were responsible for spreading HIV in the community, and 47% believed that sex work should be banned to control HIV. CONCLUSIONS Following physician training, quality of care appears to be generally acceptable, but it is important to improve further the attitudes of providers towards sex work, and improve practices such as speculum examination and partner referral that can enhance quality of care.
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Affiliation(s)
- Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, IT/BT Park, #1-4, Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bangalore 560044, India.
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