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Plowright RK, Ahmed AN, Coulson T, Crowther TW, Ejotre I, Faust CL, Frick WF, Hudson PJ, Kingston T, Nameer PO, O'Mara MT, Peel AJ, Possingham H, Razgour O, Reeder DM, Ruiz-Aravena M, Simmons NB, Srinivas PN, Tabor GM, Tanshi I, Thompson IG, Vanak AT, Vora NM, Willison CE, Keeley ATH. Ecological countermeasures to prevent pathogen spillover and subsequent pandemics. Nat Commun 2024; 15:2577. [PMID: 38531842 DOI: 10.1038/s41467-024-46151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Substantial global attention is focused on how to reduce the risk of future pandemics. Reducing this risk requires investment in prevention, preparedness, and response. Although preparedness and response have received significant focus, prevention, especially the prevention of zoonotic spillover, remains largely absent from global conversations. This oversight is due in part to the lack of a clear definition of prevention and lack of guidance on how to achieve it. To address this gap, we elucidate the mechanisms linking environmental change and zoonotic spillover using spillover of viruses from bats as a case study. We identify ecological interventions that can disrupt these spillover mechanisms and propose policy frameworks for their implementation. Recognizing that pandemics originate in ecological systems, we advocate for integrating ecological approaches alongside biomedical approaches in a comprehensive and balanced pandemic prevention strategy.
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Affiliation(s)
- Raina K Plowright
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA.
| | - Aliyu N Ahmed
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Tim Coulson
- Department of Biology, University of Oxford, Oxford, OX1 3SZ, UK
| | - Thomas W Crowther
- Department of Environmental Systems Science, ETH Zürich, Zürich, 8092, Switzerland
| | - Imran Ejotre
- Department of Biology, Muni University, P.O. Box 725, Arua, Uganda
| | - Christina L Faust
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Winifred F Frick
- Bat Conservation International, Austin, TX, 78746, USA
- Department of Ecology and Evolutionary Biology, University of California, Santa Cruz, CA, 95064, USA
| | - Peter J Hudson
- Centre for Infectious Disease Dynamics, Pennsylvania State University, State College, PA, 16801, USA
| | - Tigga Kingston
- Department of Biological Sciences, Texas Tech University, Lubbock, TX, 79409-3131, USA
| | - P O Nameer
- College of Climate Change and Environmental Science, Kerala Agricultural University, Kerala, 680 656, India
| | | | - Alison J Peel
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, 4111, Australia
| | - Hugh Possingham
- School of Biological Sciences, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Orly Razgour
- Biosciences, University of Exeter, Exeter, EX4 4PS, UK
| | - DeeAnn M Reeder
- Department of Biology, Bucknell University, Lewisburg, PA, 17937, USA
| | - Manuel Ruiz-Aravena
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, 4111, Australia
- Department of Wildlife, Fisheries and Aquaculture, Mississippi State University, Starkville, USA
| | - Nancy B Simmons
- Department of Mammalogy, Division of Vertebrate Zoology, American Museum of Natural History, New York City, NY, 10024, USA
| | | | - Gary M Tabor
- Center for Large Landscape Conservation, Bozeman, MT, 59771, USA
| | - Iroro Tanshi
- Department of Biology, University of Washington, Seattle, WA, 98195, USA
- Small Mammal Conservation Organization, Benin City, 300251, Nigeria
- Department of Animal and Environmental Biology, University of Benin, Benin City, 300000, Nigeria
| | | | - Abi T Vanak
- Centre for Policy Design, Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, 560064, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Neil M Vora
- Conservation International, Arlington, VA, 22202, USA
| | - Charley E Willison
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA
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Kochupurackal Ulahannan S, Srinivas PN, Soman B. Social Determinants of Child Undernutrition in Adivasi Population in Northern Kerala: A Study Using Syndemic Framework. Indian J Pediatr 2023; 90:77-84. [PMID: 37462817 PMCID: PMC7615388 DOI: 10.1007/s12098-023-04720-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To understand the complex interaction of structural inequalities, co-occurring health conditions, and child undernutrition among the Adivasi population in North Kerala, India. METHODS A mixed-method approach was employed in this study, which combined a cross-sectional survey and a case study design. A multistage cluster sampling method was used to select 167 children aged 24 to 60 mo from the study population. The mothers of these children were interviewed using a structured questionnaire to assess individual, parental, and household-level factors associated with child undernutrition. Two Paniya settlements, one with a high prevalence of child undernutrition (HPS) and the other with a low prevalence (LPS), were chosen as the primary units of the case study. RESULTS The study found that the absence of a kitchen garden with fruits and vegetables [adjusted odds ratio (AOR) 2.85; 95% confidence interval (CI): 1.04-7.81] and a history of cough and fever (AOR 2.93; 95% CI: 1.24-6.93) were both associated with a higher risk of undernutrition in children. The case studies revealed that Adivasi children are undernourished due to a complex set of factors that persist throughout their lives, including unequal access to social capital, healthcare, and food security, as well as differences in hygiene practices due to the lack of access to clean water and sanitation. CONCLUSIONS The findings underscore the need for social interventions to complement the current focus almost entirely on food supplementation programmes. Equitable action on Adivasi child malnutrition requires urgent policy and programmatic attention to social inequalities and access to basic amenities in Adivasi areas.
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Affiliation(s)
- Sabu Kochupurackal Ulahannan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
- Health Equity Cluster, Institute of Public Health, Bengaluru, India
| | | | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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N Srinivas P, Seshadri T, Velho N, Babu GR, Madegowda C, Channabasappa Y, Majigi SM, Bhat D. Response to correspondence article on the research protocol titled Towards Health Equity and Transformative Action on tribal health (THETA) studyto describe, explain and act on tribal health inequities in India: A health systems research study protocol. Wellcome Open Res 2023; 8:155. [PMID: 37766856 PMCID: PMC10521096 DOI: 10.12688/wellcomeopenres.19190.1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 09/29/2023] Open
Abstract
In this correspondence, we, co-authors and collaborators involved in the Towards Health Equity and Transformative Action on tribal health (THETA) study respond to a recent article published in Wellcome Open Research titled Correspondence article on the research protocol titled 'Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol' published in Wellcome Open Research in December 2019 In the first part, we provide overall clarifications on the THETA study and in the second part respond to specific comments by the authors of the aforementioned correspondence.
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Affiliation(s)
- Prashanth N Srinivas
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Tanya Seshadri
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | | | - Giridhar R Babu
- Indian Institute of Public Health, Bangalore, Karnataka, 560023, India
| | - C Madegowda
- Jilla Budakattu Girijana Abhivruddhi Sangha, Chamarajanagar, Karnataka, 571441, India
| | - Yogish Channabasappa
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Sumanth Mallikarjuna Majigi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, 570001, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, Mysore, Karnataka, 570015, India
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Asaaga FA, Purse BV, Rahman M, Srinivas PN, Kalegowda SD, Seshadri T, Young JC, Oommen MA. The role of social vulnerability in improving interventions for neglected zoonotic diseases: The example of Kyasanur Forest Disease in India. PLOS Glob Public Health 2023; 3:e0000758. [PMID: 36962744 PMCID: PMC10021172 DOI: 10.1371/journal.pgph.0000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/03/2023] [Indexed: 02/10/2023]
Abstract
Forest-based communities manage many risks to health and socio-economic welfare including the increasing threat of emerging zoonoses that are expected to disproportionately affect poor and marginalised groups, and further impair their precarious livelihoods, particularly in Low-and-Middle Income (LMIC) settings. Yet, there is a relative dearth of empirical research on the vulnerability and adaptation pathways of poor and marginalised groups facing emerging zoonoses. Drawing on a survey of 229 households and a series of key-informant interviews in the Western Ghats, we examine the factors affecting vulnerability of smallholder and tribal households to Kyasanur Forest Disease (KFD), an often-fatal tick-borne viral haemorrhagic fever endemic in south India. Specifically, we investigate how different socio-demographic and institutional factors interact to shape KFD vulnerability and the strategies employed by households to adapt to disease consequences. Although surveyed households generally perceived KFD as an important health issue in the study region, there was variability in concern about contracting the disease. Overall results showed that poor access to land (AOR = 0.373, 95% CI: 0.152-0.916), being at or below the poverty line (AOR = 0.253, 95% CI: 0.094-0.685) and being headed by an older person (AOR = 1.038, 95% CI: 1.006-1.071) were all significant determinants of perceived KFD vulnerability. Furthermore, KFD vulnerability is also modulated by important extra-household factors including proximity to private hospitals (AOR = 3.281, 95% CI: 1.220-8.820), main roads (AOR = 2.144, 95% CI: 1.215-3.783) and study location (AOR = 0.226, 95% CI: 0.690-0.743). Our findings highlight how homogenous characterisation of smallholder and tribal communities and the 'techno-oriented' approach of existing interventions may further marginalise the most vulnerable and exacerbate existing inequalities. These findings are important for designing context-specific and appropriate health interventions (including the prioritisation of awareness raising, knowledge networks, livelihood diversification) that enhances the resilience of at-risk social groups within the KFD context. More broadly, our findings highlight how a focus on social vulnerability can help national and international health planners improve health interventions and prioritise among diseases with respect to neglected endemic zoonoses.
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Affiliation(s)
| | - Bethan V. Purse
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
| | - Mujeeb Rahman
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, India
| | | | - Suresh D. Kalegowda
- National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Tanya Seshadri
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, India
- Agroécologie, INRAE, Institut Agro, Univ. Bourgogne, Univ. Bourgogne Franche-Comté, Dijon, France
| | - Juliette C. Young
- Tribal Health Resource Center, Vivekananda Girijana Kalyana Kendra, BR Hills, Karnataka, India
| | - Meera A. Oommen
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, Karnataka, India
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Pratt B, Seshadri T, Srinivas PN. Overcoming structural barriers to sharing power with communities in global health research priority-setting: Lessons from the Participation for Local Action project in Karnataka, India. Glob Public Health 2022; 17:3334-3352. [PMID: 35358014 PMCID: PMC7614143 DOI: 10.1080/17441692.2022.2058048] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Australia
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Tanya Seshadri
- Institute of Public Health, Bangalore, India
- Vivekananda Girijana Kalyana Kendra, Biligirirangan Hills, India
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Asaaga FA, Young JC, Srinivas PN, Seshadri T, Oommen MA, Rahman M, Kiran SK, Kasabi GS, Narayanaswamy D, Schäfer SM, Burthe SJ, August T, Logie M, Chanda MM, Hoti SL, Vanak AT, Purse BV. Co-production of knowledge as part of a OneHealth approach to better control zoonotic diseases. PLOS Glob Public Health 2022; 2:e0000075. [PMID: 36962247 PMCID: PMC10021618 DOI: 10.1371/journal.pgph.0000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022]
Abstract
There is increased global and national attention on the need for effective strategies to control zoonotic diseases. Quick, effective action is, however, hampered by poor evidence-bases and limited coordination between stakeholders from relevant sectors such as public and animal health, wildlife and forestry sectors at different scales, who may not usually work together. The OneHealth approach recognises the value of cross-sectoral evaluation of human, animal and environmental health questions in an integrated, holistic and transdisciplinary manner to reduce disease impacts and/or mitigate risks. Co-production of knowledge is also widely advocated to improve the quality and acceptability of decision-making across sectors and may be particularly important when it comes to zoonoses. This paper brings together OneHealth and knowledge co-production and reflects on lessons learned for future OneHealth co-production processes by describing a process implemented to understand spill-over and identify disease control and mitigation strategies for a zoonotic disease in Southern India (Kyasanur Forest Disease). The co-production process aimed to develop a joint decision-support tool with stakeholders, and we complemented our approach with a simple retrospective theory of change on researcher expectations of the system-level outcomes of the co-production process. Our results highlight that while co-production in OneHealth is a difficult and resource intensive process, requiring regular iterative adjustments and flexibility, the beneficial outcomes justify its adoption. A key future aim should be to improve and evaluate the degree of inter-sectoral collaboration required to achieve the aims of OneHealth. We conclude by providing guidelines based on our experience to help funders and decision-makers support future co-production processes.
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Affiliation(s)
| | - Juliette C. Young
- Agroécologie, INRAE, Institut Agro, Univ. Bourgogne, Univ. Bourgogne Franche-Comté Dijon, France
| | | | - Tanya Seshadri
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
- Tribal Health Resource Center, Vivekananda Girijana Kalyana Kendra BR Hills, Bengaluru, India
| | - Meera A. Oommen
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
| | - Mujeeb Rahman
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
| | - Shivani K. Kiran
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - Gudadappa S. Kasabi
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - Darshan Narayanaswamy
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
- ICMR-National Institute for Traditional Medicine, Belgavi, Karnataka, India
| | | | - Sarah J. Burthe
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
| | - Tom August
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
| | - Mark Logie
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
| | - Mudassar M. Chanda
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Ramagondanahalli, Yelahanka New Town, Bengaluru, Karnataka, India
| | | | - Abi T. Vanak
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance, Hyderabad, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bethan V. Purse
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
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Van De Pas R, Widdowson MA, Ravinetto R, N Srinivas P, Ochoa TJ, Fofana TO, Van Damme W. COVID-19 vaccine equity: a health systems and policy perspective. Expert Rev Vaccines 2021; 21:25-36. [PMID: 34758678 PMCID: PMC8631691 DOI: 10.1080/14760584.2022.2004125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Indexed: 12/03/2022]
Abstract
Introduction The global COVID-19 vaccine rollout has highlighted inequities in the accessibility of countries to COVID-19 vaccines. Populations in low- and middle-income countries have found it difficult to have access to COVID-19 vaccines. Areas covered This perspective provides analyses on historical and contemporary policy trends of vaccine development and immunization programs, including the current COVID-19 vaccination drive, and governance challenges. Moreover, we also provide a comparative health system analysis of the COVID-19 vaccine deployment in some countries from different continents. It recommends that the international Access to COVID-19 Tools Accelerator (ACT-A) partnership requires a strong governance mechanism and urgent financial investment. Expert opinion All WHO member states should agree on technology transfer and voluntary license-sharing via a commonly governed technology access pool and supported by a just Intellectual Property regime. Contextualized, dynamic understandings and country-specific versions of health systems strengthening are needed to improve vaccine equity in a sustainable matter.
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Affiliation(s)
- Remco Van De Pas
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Theresa J Ochoa
- Instituto De Medicina Tropical Alexander Von Humboldt Universidad Peruana Cayetano Heredia (Upch) Av. Honorio Delgado 430, Perú
| | - Thierno Oumar Fofana
- African Center of Excellence for the Prevention and Control of Communicable Diseases (CEA-PCMT), University Gamal Abdel Nasser Dixinn, Conakry, Guinea
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Nakkeeran N, Sacks E, N Srinivas P, Juneja A, Gaitonde R, Garimella S, Topp SM. Beyond behaviour as individual choice: A call to expand understandings around social science in health research. Wellcome Open Res 2021; 6:212. [PMID: 34622015 PMCID: PMC8453310 DOI: 10.12688/wellcomeopenres.17149.1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/20/2022] Open
Abstract
The focus of behavioural sciences in shaping behaviour of individuals and populations is well documented. Research and practice insights from behavioural sciences improve our understanding of how people make choices that in turn determine their health, and in turn the health of the population. However, we argue that an isolated focus on behaviour - which is one link in a chain from macro to the micro interventions - is not in sync with the public health approach which per force includes a multi-level interest. The exclusive focus on behaviour manipulation then becomes a temporary solution at best and facilitator of reproduction of harmful structures at worst. Several researchers and policymakers have begun integrating insights from behavioural economics and related disciplines that explain individual choice, for example, by the establishment of Behavioural Insight Teams, or nudge units to inform the design and implementation of public health programs. In order to comprehensively improve public health, we discuss the limitations of an exclusive focus on behaviour change for public health advancement and call for an explicit integration of broader structural and population-level contexts, processes and factors that shape the lives of individuals and groups, health systems and differential health outcomes.
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Affiliation(s)
- N Nakkeeran
- School of Global Affairs, Dr. BR Ambedkar University, Delhi, 110006, India
| | - Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, 21218, USA
| | - Prashanth N Srinivas
- Health equity cluster, Institute of Public Health, Bangalore, Karnataka, 560070, India
| | - Anika Juneja
- Health equity cluster, Institute of Public Health, Bangalore, Karnataka, 560070, India
| | - Rakhal Gaitonde
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, 695011, India
| | | | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townswille, Queensland, 4811, Australia
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Asaaga FA, Young JC, Oommen MA, Chandarana R, August J, Joshi J, Chanda MM, Vanak AT, Srinivas PN, Hoti SL, Seshadri T, Purse BV. Operationalising the "One Health" approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control. BMC Public Health 2021; 21:1517. [PMID: 34362321 PMCID: PMC8342985 DOI: 10.1186/s12889-021-11545-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India. METHODS A mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control. RESULTS Our findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward. CONCLUSION Our findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.
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Affiliation(s)
- F A Asaaga
- UK Centre for Ecology & Hydrology, Wallingford, OX10 8BB, UK.
| | - J C Young
- UK Centre for Ecology & Hydrology, Edinburgh, EH26 0QB, UK
- Agroécologie, AgroSup Dijon, INRAE, Univ. Bourgogne, Univ. Bourgogne Franche-Comté, F-21000, Dijon, France
| | - M A Oommen
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, 560 054, India
| | - R Chandarana
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, 560 054, India
| | - J August
- Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - J Joshi
- Centre for Disease Dynamics, Economics & Policy, B-25, Lajpat Nagar-2, New Delhi, India
| | - M M Chanda
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Ramagondanahalli, Yelahanka New Town, Bengaluru, Karnataka, 560064, India
| | - A T Vanak
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, 560 054, India
- School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, 3209, South Africa
- DBT-Wellcome Trust India Alliance, Hyderabad, 500034, India
| | - P N Srinivas
- Institute of Public Health, Banashankari 2nd Stage, Bangalore, 560 070, India
| | - S L Hoti
- ICMR-National Institute for Traditional Medicine, Belgavi, Karnataka, 590010, India
| | - T Seshadri
- Agroécologie, AgroSup Dijon, INRAE, Univ. Bourgogne, Univ. Bourgogne Franche-Comté, F-21000, Dijon, France
| | - B V Purse
- UK Centre for Ecology & Hydrology, Wallingford, OX10 8BB, UK
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Pati MK, Bhojani U, Elias MA, Srinivas PN. Improving access to medicines for non-communicable diseases in rural primary care: results from a quasi-randomized cluster trial in a district in South India. BMC Health Serv Res 2021; 21:770. [PMID: 34348723 PMCID: PMC8336076 DOI: 10.1186/s12913-021-06800-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A large proportion of non-communicable diseases (NCDs) are treatable within primary health care (PHC) settings in a cost-effective manner. However, the utilization of PHCs for NCD care is comparatively low in India. The Access-to-Medicines (ATM) study examined whether (and how) interventions aimed at health service optimization alone or combined with community platform strengthening improve access to medicines at the primary health care level within the context of a local health system. METHOD A quasi-randomized cluster trial was used to assess the effectiveness of the intervention (18 months) implemented across 39 rural PHCs (clusters) of three sub-districts of Tumkur in southern India. The intervention was allocated randomly in a 1:1:1 sequence across PHCs and consisted of three arms: Arm A with a package of interventions aimed at health service delivery optimization; B for strengthening community platforms in addition to A; and the control arm. Group allocation was not blinded to providers and those who assessed outcomes. A household survey was used to understand health-seeking behaviour, access and out-of-pocket expenditure (OOP) on key anti-diabetic and anti-hypertension medicines among patients; facility surveys were used to assess the availability of medicines at PHCs. Primary outcomes of the study are the mean number of days of availability of antidiabetic and antihypertensive medicines at PHCs, the mean number of patients obtaining medicines from PHC and OOP expenses. RESULT The difference-in-difference estimate shows a statistically insignificant increase of 31.5 and 11.9 in mean days for diabetes and hypertension medicines availability respectively in the study arm A PHCs beyond the increase in the control arm. We further found that there was a statistically insignificant increase of 2.2 and 3.8 percentage points in the mean proportion of patients obtaining medicines from PHC in arm A and arm B respectively, beyond the increase in the control arm. CONCLUSION There were improvements in NCD medicine availability across PHCs, the number of patients accessing PHCs and reduction in OOP expenditure among patients, across the study arms as compared to the control arm; however, these differences were not statistically significant. TRIAL REGISTRATION Trial registration number CTRI/2015/03/005640 . This trial was registered on 17/03/2015 in the Clinical Trial Registry of India (CTRI) after PHCs were enrolled in the study (retrospectively registered). The CTRI is the nodal agency of the Indian Council of Medical Research for registration of all clinical, experimental, field intervention and observation studies.
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Affiliation(s)
- Manoj Kumar Pati
- Karnataka Health Promotion Trust, IT park, 5th floor, No. 1-4, Rajajinagar Industrial Area, behind, KSSIDC admin. office, Rajajinagar, Bangalore, Karnataka, 560044, India.,PhD scholar, University of Antwerp, Antwerp, Belgium
| | - Upendra Bhojani
- Institute of Public Health, 3009 II-A Main, 17th Cross Banashankari 2nd Stage KR Road, Bangalore, Karnataka, 560070, India
| | - Maya Annie Elias
- Institute of Public Health, 3009 II-A Main, 17th Cross Banashankari 2nd Stage KR Road, Bangalore, Karnataka, 560070, India
| | - Prashanth N Srinivas
- Institute of Public Health, 3009 II-A Main, 17th Cross Banashankari 2nd Stage KR Road, Bangalore, Karnataka, 560070, India.
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11
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Kochupurackal SU, Channa Basappa Y, Vazhamplackal SJ, Srinivas PN. An intersectional analysis of the composite index of anthropometric failures in India. Int J Equity Health 2021; 20:155. [PMID: 34217308 PMCID: PMC8254924 DOI: 10.1186/s12939-021-01499-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nutritional inequality in India has been estimated typically using stunting, wasting and underweight separately which hide the overall magnitude and severity of undernutrition. We used the Composite Index of Anthropometric Failure (CIAF) that combines all three forms of anthropometric failures to assess the severity of undernutrition and identify the most vulnerable social groups and geographical hotspots. METHOD CIAF was constructed using child anthropometric data from the fourth round of the National Family Health Survey (NFHS-4, 2015-16). We considered 24 intersecting sub-groups based on intersections across four main axes of inequality i.e., caste [Scheduled Tribe (ST), Scheduled Caste (SC) and Other], economic position (poor and non-poor), place of residence (rural and urban) and gender (male and female) (eg. ST-Poor-Rural-Female). Cross-tabulation and logistic regression were done to assess the odds of CIAF among intersecting groups and to identify the most vulnerable sub-groups. Concentration curve was plotted to visualise economic position inequality in child undernutrition across caste categories. Choropleth maps were constructed and descriptive analysis of the district-level prevalence of CIAF was performed to identify the geographic clustering of undernutrition. RESULTS Overall 55.32% of children were undernourished by CIAF and 6.62% of children have simultaneous three anthropometric failure. In sub-group analysis, children from ST and SC caste have a higher risk of undernutrition irrespective of other axis of inequality. Compared with CIAF, economic position inequality was amplified for simultaneous-three-failures among all caste categories. Economic position inequalities within caste are more for other caste and SC categories than with ST. Economic position, caste and gender based inequality in all three failures is more consistent in rural areas than with urban areas. Based on the analysis of the high prevalence in the co-occurrence of two or three failures, 111 districts from 12 of 29 states in India were identified across four geographic clusters. CONCLUSIONS The study shows social and eco-geographical clustering of multi-dimensional anthropometric failures and indicates the need for focused nutritional interventions among SC and ST community in general and ST children from the poor households. Furthermore, governance interventions that target entire regions across districts and states combined with decentralised planning are needed.
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Affiliation(s)
- Sabu Ulahannan Kochupurackal
- Health equity cluster, Institute of Public Health, 3009, II-A Main, 17th Cross, KR Road, Siddanna Layout, Banashankari Stage II, Bengaluru, Karnataka, 560070, India
| | - Yogish Channa Basappa
- Health equity cluster, Institute of Public Health, 3009, II-A Main, 17th Cross, KR Road, Siddanna Layout, Banashankari Stage II, Bengaluru, Karnataka, 560070, India
| | | | - Prashanth N Srinivas
- Health equity cluster, Institute of Public Health, 3009, II-A Main, 17th Cross, KR Road, Siddanna Layout, Banashankari Stage II, Bengaluru, Karnataka, 560070, India.
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12
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Raman V, Seshadri T, Joice SV, N Srinivas P. Sickle cell disease in India: a scoping review from a health systems perspective to identify an agenda for research and action. BMJ Glob Health 2021; 6:bmjgh-2020-004322. [PMID: 33602689 PMCID: PMC7896595 DOI: 10.1136/bmjgh-2020-004322] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/11/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) disproportionately impacts Adivasi (tribal) communities in India. Current research has focused on epidemiological and biomedical aspects but there has been scarce research on social determinants and health systems aspects. Given its fragmented distribution, resources and programmes have emerged in west and central India. This scoping review seeks to identify geographical and evidence gaps for action on SCD from a health systems lens. METHODS We followed a scoping review protocol, using Google Scholar and PubMed for published literature. Keywords used included sickle cell anaemia/disease, health systems, tribal and India. We used Google search for grey literature. We compiled a list of 55 records (of which 35 were retained), with about half pertaining directly to India and others relevant to similar settings. Results were organised and analysed using the WHO health systems framework to identify geographical and evidence gaps. RESULTS We found substantial literature on biomedical and clinical aspects of SCD but little on the design and implementation of programmes in community and Adivasi-specific contexts as well as on social determinants of SCD. There were regional gaps in knowledge in southern and northeast India. Wherever community-based programmes exist, they have originated in civil society initiatives and relatively limited state-led primary healthcare-based efforts pointing to weak agenda setting. CONCLUSION Both research and action on SCD especially among tribal populations need immediate attention. While geospatial epidemiology has been well understood, gaps remain in context-specific knowledge for action in several parts, as well as evidence gaps across several health system building blocks, including governance and financing of care. Despite publication of a draft policy, delayed adoption and lapses in implementation have limited the response largely to local communities and non-governmental organisations.
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Affiliation(s)
- Vineet Raman
- Health equity cluster, Institute of Public Health, Bangalore, India
| | - Tanya Seshadri
- Health equity cluster, Institute of Public Health, Bangalore, India.,Tribal Health Resource Centre, Vivekananda Tribal Welfare Center, BR Hills, Karnataka, India
| | - Sangeetha V Joice
- Department of Biochemistry, Malabar Medical College and Research Centre, Modakkallur, India
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13
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Putturaj M, Van Belle S, Engel N, Criel B, Krumeich A, Nagendrappa PB, Srinivas PN. Multilevel governance framework on grievance redressal for patient rights violations in India. Health Policy Plan 2021; 36:1470-1482. [PMID: 34133734 DOI: 10.1093/heapol/czab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.
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Affiliation(s)
- Meena Putturaj
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.,Department of Health Ethics and Society, Maastricht University, 6200MD, Maastricht, The Netherlands.,Centre for Local Health Traditions and Policy, The University of Trans-disciplinary Health Sciences and Technology, 74/2, Post Attur via Yelahanka, Jarakabande Kaval, Bengaluru, Karnataka-560064, India.,Health Equity Cluster, Institute of Public Health, 3009, II A Main, 17th Cross, KR road, Sidanna Layout, Banashankari stage II, Banashankari, Bengaluru, Karnataka-560070, India
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Nora Engel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Bart Criel
- Department of Health Ethics and Society, Maastricht University, 6200MD, Maastricht, The Netherlands
| | - Anja Krumeich
- Department of Health Ethics and Society, Maastricht University, 6200MD, Maastricht, The Netherlands
| | - Prakash B Nagendrappa
- Centre for Local Health Traditions and Policy, The University of Trans-disciplinary Health Sciences and Technology, 74/2, Post Attur via Yelahanka, Jarakabande Kaval, Bengaluru, Karnataka-560064, India
| | - Prashanth N Srinivas
- Health Equity Cluster, Institute of Public Health, 3009, II A Main, 17th Cross, KR road, Sidanna Layout, Banashankari stage II, Banashankari, Bengaluru, Karnataka-560070, India
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14
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Burthe SJ, Schäfer SM, Asaaga FA, Balakrishnan N, Chanda MM, Darshan N, Hoti SL, Kiran SK, Seshadri T, Srinivas PN, Vanak AT, Purse BV. Reviewing the ecological evidence base for management of emerging tropical zoonoses: Kyasanur Forest Disease in India as a case study. PLoS Negl Trop Dis 2021; 15:e0009243. [PMID: 33793560 PMCID: PMC8016103 DOI: 10.1371/journal.pntd.0009243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Zoonoses disproportionately affect tropical communities and are associated with human modification and use of ecosystems. Effective management is hampered by poor ecological understanding of disease transmission and often focuses on human vaccination or treatment. Better ecological understanding of multi-vector and multi-host transmission, social and environmental factors altering human exposure, might enable a broader suite of management options. Options may include "ecological interventions" that target vectors or hosts and require good knowledge of underlying transmission processes, which may be more effective, economical, and long lasting than conventional approaches. New frameworks identify the hierarchical series of barriers that a pathogen needs to overcome before human spillover occurs and demonstrate how ecological interventions may strengthen these barriers and complement human-focused disease control. We extend these frameworks for vector-borne zoonoses, focusing on Kyasanur Forest Disease Virus (KFDV), a tick-borne, neglected zoonosis affecting poor forest communities in India, involving complex communities of tick and host species. We identify the hierarchical barriers to pathogen transmission targeted by existing management. We show that existing interventions mainly focus on human barriers (via personal protection and vaccination) or at barriers relating to Kyasanur Forest Disease (KFD) vectors (tick control on cattle and at the sites of host (monkey) deaths). We review the validity of existing management guidance for KFD through literature review and interviews with disease managers. Efficacy of interventions was difficult to quantify due to poor empirical understanding of KFDV-vector-host ecology, particularly the role of cattle and monkeys in the disease transmission cycle. Cattle are hypothesised to amplify tick populations. Monkeys may act as sentinels of human infection or are hypothesised to act as amplifying hosts for KFDV, but the spatial scale of risk arising from ticks infected via monkeys versus small mammal reservoirs is unclear. We identified 19 urgent research priorities for refinement of current management strategies or development of ecological interventions targeting vectors and host barriers to prevent disease spillover in the future.
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Affiliation(s)
- Sarah J. Burthe
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
| | | | | | - Natrajan Balakrishnan
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, India
| | | | - Narayanaswamy Darshan
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Subhash L. Hoti
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Shivani K. Kiran
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - Tanya Seshadri
- Vivekananda Gorukana Kalyana Kendra (VGKK), Chamarajanagar, India
| | - Prashanth N. Srinivas
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance Fellow, Hyderabad, India
- Institute of Public Health, Bangalore, India
| | - Abi T. Vanak
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance Fellow, Hyderabad, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bethan V. Purse
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
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15
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Asaaga FA, Rahman M, Kalegowda SD, Mathapati J, Savanur I, Srinivas PN, Seshadri T, Narayanswamy D, Kiran SK, Oommen MA, Young JC, Purse BV. 'None of my ancestors ever discussed this disease before!' How disease information shapes adaptive capacity of marginalised rural populations in India. PLoS Negl Trop Dis 2021; 15:e0009265. [PMID: 33705400 PMCID: PMC7987196 DOI: 10.1371/journal.pntd.0009265] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Smallholder farmer and tribal communities are often characterised as marginalised and highly vulnerable to emerging zoonotic diseases due to their relatively poor access to healthcare, worse-off health outcomes, proximity to sources of disease risks, and their social and livelihood organisation. Yet, access to relevant and timely disease information that could strengthen their adaptive capacity remain challenging and poorly characterised in the empirical literature. This paper addresses this gap by exploring the role of disease information in shaping the adaptive capacity of smallholder farmer and tribal groups to Kyasanur Forest Disease (KFD), a tick-borne viral haemorrhagic fever. We carried out household surveys (n = 229) and in-depth interviews (n = 25) in two affected districts-Shimoga and Wayanad-in the Western Ghats region. Our findings suggest that, despite the generally limited awareness about KFD, access to disease information improved households' propensity to implement adaptation strategies relative to households that had no access to it. Of the variety of adaptation strategies implemented, vaccination, avoiding forest visits, wearing of protective clothing and footwear, application of dimethyl phthalate (DMP) oil and income diversification were identified by respondents as important adaptive measures during the outbreak seasons. Even so, we identified significant differences between individuals in exposure to disease information and its contribution to substantive adaptive action. Households reported several barriers to implement adaptation strategies including, lack of disease information, low efficacy of existing vaccine, distrust, religio-cultural sentiments, and livelihood concerns. We also found that informal information sharing presented a promising avenue from a health extension perspective albeit with trade-offs with potential distortion of the messages through misinformation and/or reporting bias. Altogether, our findings stress the importance of contextualising disease information and implementing interventions in a participatory way that sufficiently addresses the social determinants of health in order to bolster households' adaptive capacity to KFD and other neglected endemic zoonoses.
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Affiliation(s)
| | - Mujeeb Rahman
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
| | - Suresh D. Kalegowda
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, India
| | | | | | | | - Tanya Seshadri
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
| | - Darshan Narayanswamy
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Shivani K. Kiran
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - Meera A. Oommen
- Ashoka Trust for Research in Ecology and the Environment, Bengaluru, India
| | - Juliette C. Young
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
- Agroécologie, AgroSup Dijon, INRAE, Univ. Bourgogne, Univ. Bourgogne Franche-Comté, Dijon, France
| | - Bethan V. Purse
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
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16
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Pratt B, Seshadri T, Srinivas PN. What should community organisations consider when deciding to partner with researchers? A critical reflection on the Zilla Budakattu Girijana Abhivrudhhi Sangha experience in Karnataka, India. Health Res Policy Syst 2020; 18:101. [PMID: 32912247 PMCID: PMC7488535 DOI: 10.1186/s12961-020-00617-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/22/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Community organisations and community members are increasingly being involved in health research projects worldwide as part of the engagement movement. Achieving deeper forms of community engagement like partnership demands that decision-making power be shared with community partners. However, how can community partners assess if meaningful engagement and shared decision-making will be possible when approached by prospective research partners? In this paper, we explore how community organisations decide to join health research projects when approached by health researchers. Methods Case study research was undertaken on a health systems research project in Karnataka, India called Participation for Local Action, which was carried out by local researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, a community development organisation. In-depth interviews were conducted with the researchers, Sangha leaders and field investigators from their community. Results Thematic analysis identified two main themes – ‘context’ and ‘deciding to engage’. The Sangha’s experience offers lessons to other community organisations that can help them when deciding to engage with researchers in terms of what features to look for in research partners and in proposed research projects, what requests to make of prospective research partners, and what sorts of outcomes or partnership agreements to accept. These lessons may be especially applicable in contexts where relationships of trust already exist between partners and where they have the skills to lead data collection and analysis. Conclusions We hope that this guidance will help empower community organisations to select good research partners and promote more equitable partnerships between community partners and academic researchers.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St., Carlton, Victoria, 3053, Australia.
| | - Tanya Seshadri
- Institute of Public Health, 3009, II-A Main, 17th Cross, Krishna Rajendra Rd, Banashankari Stage II, Bangalore, Karnataka, 560070, India.,Vivekananda Girijana Kalyana Kendra, BR hills, Chamarajanagar district, Karnataka, 571441, India
| | - Prashanth N Srinivas
- Institute of Public Health, 3009, II-A Main, 17th Cross, Krishna Rajendra Rd, Banashankari Stage II, Bangalore, Karnataka, 560070, India
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17
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Seshadri T, Velho N, Narasimhamurti NS, Srinivas PN. Examining tribal health inequalities around three forested sites in India: Results of a cross-sectional survey. J Family Med Prim Care 2020; 9:4788-4796. [PMID: 33102260 PMCID: PMC7116252 DOI: 10.4103/jfmpc.jfmpc_508_20] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/25/2020] [Accepted: 05/27/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The data available for the health of Scheduled Tribes (ST) in India are often coarse-scale snapshots at district and state levels and fine-scale comparison within and across site is often not possible. In this paper, we examine the health inequalities between the ST and non-ST populations in two forested sites and compare the healthcare parameters for ST populations across three forested sites. METHODS We conducted a cross-sectional household survey in three sites in and around three tiger reserves in Karnataka, Madhya Pradesh (MP) and Arunachal Pradesh (AP). In each site, multi-stage sampling and cluster analysis provided a representative sample of households across villages of 859 ST and non-ST households. We examined the sociodemographic and health-related information including self-reported illnesses and healthcare utilisation; from these, we explored the within-site health inequality patterns for the two sites and intersite differences among the ST households of the three sites. RESULTS In Karnataka, the ST and non-ST differences favoured the latter with regard to socio-economic characteristics with no difference in self-reported illness/injuries or healthcare utilisation. In MP, both groups were similar with regard to socio-economic characteristics and healthcare utilisation. AP ST households reported the highest healthcare utilisation, while MP ST households reported the lowest care seeking at hospitals and relied on home networks and health workers. High tobacco consumption was noted among ST groups in all the sites. CONCLUSIONS The ST and non-ST inequality patterns at a fine-scale were different between Karnataka and MP. The absence of health inequalities in MP indicates a uniform socio-geographical disadvantage while poor healthcare utilisation by ST people in Karnataka indicates health inequities. The ST households of AP reported the highest utilisation while those of MP reported the lowest. Programmes addressing the health inequalities of STs need to consider site-specific assessments of socio-geographical and health system factors.
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Affiliation(s)
- Tanya Seshadri
- Tribal Health Resource Centre, Vivekananda Girijana Kalyana Kendra, BR Hills, Karnataka, India
| | - Nandini Velho
- Department of Ecology, Evolution, and Environmental Biology, Columbia University, New York, USA
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Van Belle S, Affun-Adegbulu C, Soors W, Srinivas PN, Hegel G, Van Damme W, Saluja D, Abejirinde I, Wouters E, Masquillier C, Tabana H, Chenge F, Polman K, Marchal B. COVID-19 and informal settlements: an urgent call to rethink urban governance. Int J Equity Health 2020; 19:81. [PMID: 32493415 PMCID: PMC7267749 DOI: 10.1186/s12939-020-01198-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- S Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - C Affun-Adegbulu
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - W Soors
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | | | - G Hegel
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - W Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - D Saluja
- Independent Consultant, New Delhi, India
| | - I Abejirinde
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - E Wouters
- Centre for Population, Family & Health, University of Antwerp (Belgium) and Centre for Health Systems Research & Development, University of the Free State (South Africa), Sint - Jacobstraat 2 -4, 2000, Antwerp, Belgium
| | - C Masquillier
- Centre for Population, Family & Health, University of Antwerp (Belgium), Sint - Jacobstraat 2 -4, 2000, Antwerp, Belgium
| | - H Tabana
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - F Chenge
- School of Public Health, University of Lubumbashi and Health Knowledge Centre of the Democratic Republic of Congo, Lubumbashi, Democratic Republic of Congo
| | - K Polman
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - B Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
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Purse BV, Darshan N, Kasabi GS, Gerard F, Samrat A, George C, Vanak AT, Oommen M, Rahman M, Burthe SJ, Young JC, Srinivas PN, Schäfer SM, Henrys PA, Sandhya VK, Chanda MM, Murhekar MV, Hoti SL, Kiran SK. Predicting disease risk areas through co-production of spatial models: The example of Kyasanur Forest Disease in India's forest landscapes. PLoS Negl Trop Dis 2020; 14:e0008179. [PMID: 32255797 PMCID: PMC7164675 DOI: 10.1371/journal.pntd.0008179] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/17/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022] Open
Abstract
Zoonotic diseases affect resource-poor tropical communities disproportionately, and are linked to human use and modification of ecosystems. Disentangling the socio-ecological mechanisms by which ecosystem change precipitates impacts of pathogens is critical for predicting disease risk and designing effective intervention strategies. Despite the global "One Health" initiative, predictive models for tropical zoonotic diseases often focus on narrow ranges of risk factors and are rarely scaled to intervention programs and ecosystem use. This study uses a participatory, co-production approach to address this disconnect between science, policy and implementation, by developing more informative disease models for a fatal tick-borne viral haemorrhagic disease, Kyasanur Forest Disease (KFD), that is spreading across degraded forest ecosystems in India. We integrated knowledge across disciplines to identify key risk factors and needs with actors and beneficiaries across the relevant policy sectors, to understand disease patterns and develop decision support tools. Human case locations (2014-2018) and spatial machine learning quantified the relative role of risk factors, including forest cover and loss, host densities and public health access, in driving landscape-scale disease patterns in a long-affected district (Shivamogga, Karnataka State). Models combining forest metrics, livestock densities and elevation accurately predicted spatial patterns in human KFD cases (2014-2018). Consistent with suggestions that KFD is an "ecotonal" disease, landscapes at higher risk for human KFD contained diverse forest-plantation mosaics with high coverage of moist evergreen forest and plantation, high indigenous cattle density, and low coverage of dry deciduous forest. Models predicted new hotspots of outbreaks in 2019, indicating their value for spatial targeting of intervention. Co-production was vital for: gathering outbreak data that reflected locations of exposure in the landscape; better understanding contextual socio-ecological risk factors; and tailoring the spatial grain and outputs to the scale of forest use, and public health interventions. We argue this inter-disciplinary approach to risk prediction is applicable across zoonotic diseases in tropical settings.
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Affiliation(s)
- Bethan V. Purse
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Narayanaswamy Darshan
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Gudadappa S. Kasabi
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - France Gerard
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Abhishek Samrat
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
| | - Charles George
- UK Centre for Ecology and Hydrology, Wallingford, United Kingdom
| | - Abi T. Vanak
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance Fellow, Hyderabad, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Meera Oommen
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- Dakshin Foundation, Bangalore, India
| | - Mujeeb Rahman
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
| | - Sarah J. Burthe
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
| | - Juliette C. Young
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
- Agroécologie, AgroSup Dijon, INRAE, Univ. Bourgogne Franche-Comté, Dijon, France
| | | | | | - Peter A. Henrys
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, United Kingdom
| | - Vijay K. Sandhya
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - M Mudassar Chanda
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, India
| | | | - Subhash L. Hoti
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Shivani K. Kiran
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
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Aivalli PK, Elias MA, Pati MK, Bhanuprakash S, Munegowda C, Shroff ZC, Srinivas PN. Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India. BMJ Glob Health 2018; 2:e000644. [PMID: 29531844 PMCID: PMC5844374 DOI: 10.1136/bmjgh-2017-000644] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 11/19/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Generic medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines. METHODS The study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system. RESULTS The generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients' and health workers' perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system. CONCLUSION Negative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.
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Affiliation(s)
| | | | | | | | | | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Elias MA, Pati MK, Aivalli P, Srinath B, Munegowda C, Shroff ZC, Bigdeli M, Srinivas PN. Preparedness for delivering non-communicable disease services in primary care: access to medicines for diabetes and hypertension in a district in south India. BMJ Glob Health 2018. [PMID: 29527334 PMCID: PMC5841528 DOI: 10.1136/bmjgh-2017-000519] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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] [Indexed: 02/05/2023] Open
Abstract
Introduction Non-communicable diseases (NCDs) have become a major public health challenge worldwide; they account for 28 million deaths per year in low-and-middle-income countries (LMICs). Like many other LMICs, India is struggling to organise quality care for a large NCD-affected population especially at the primary healthcare level. The aim of this study was to assess local health system preparedness in a south Indian primary healthcare setting for addressing diabetes and hypertension. Methods This paper draws on a mixed-methods research study on access to medicines conducted in Tumkur, Karnataka, India. We used quantitative data from household and health facility surveys, and qualitative data from focus group discussions and in-depth interviews with health workers and patients. We identified systemic drivers that influence utilisation of services at government primary health centres (PHCs) using thematic analysis of qualitative data and a systems framework on access to medicines to assess supply and demand side factors. Results Majority of households depend on private facilities for diabetes and hypertension care because of the lack of laboratory facilities and frequent medicine stockouts at PHCs. Financial and managerial resource allocation for NCDs and prioritisation of care and processes related to NCDs was suboptimal compared to the prominence of this agenda at global and national levels. Primary healthcare has a limited role even in the activities under the national programme that addresses diabetes and hypertension. Discussion The study finds critical gaps in the preparedness of PHCs and district health systems in organising and managing care for diabetes and hypertension. Due to the lack of continuous care organised through PHCs, patients depend on expensive and often episodic care in the private sector. There is a need to improve managerial and financial resource allocation towards diabetes and hypertension (and other NCDs) at the district level. Trial registration number CTRI/2015/03/005640; Pre-results.
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Affiliation(s)
- Maya Annie Elias
- Health equity & evaluation cluster, Institute of Public Health, Bangalore, Karnataka, India
| | - Manoj Kumar Pati
- Health equity & evaluation cluster, Institute of Public Health, Bangalore, Karnataka, India
| | - Praveenkumar Aivalli
- Health equity & evaluation cluster, Institute of Public Health, Bangalore, Karnataka, India
| | - Bhanuprakash Srinath
- Health equity & evaluation cluster, Institute of Public Health, Bangalore, Karnataka, India
| | | | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Maryam Bigdeli
- Department of Health Systems Governance and Financing, WHO, Geneva, Switzerland
| | - Prashanth N Srinivas
- Health equity & evaluation cluster, Institute of Public Health, Bangalore, Karnataka, India
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Babu GR, Reddy GR, Srinivas PN, Chetty CS. Metabolic diversions in the oxidative metabolism of hepatic and neuronal systems of rat (Wistar strain) under induced benthiocarb stress. Biochem Int 1989; 19:477-87. [PMID: 2818608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Metabolic diversions in oxidative metabolism of hepatic and neuronal systems of rat were noticed during induced benthiocarb stress. The inhibition of dehydrogenases indicates disturbed mitochondrial integrity, and reduction in cytochrome-C-oxidase suggests possible respiratory distress. The drop in ATPases and PNPPase indicates the prevalence of energy crisis. The increased specific activities of NADP+ dependent dehydrogenases suggests augmented lipid biosynthesis in the wake of impaired oxidative metabolism.
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Affiliation(s)
- G R Babu
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Srinivas PN, Reddy GR, Babu GR, Chetty CS. Effects in vitro of benthiocarb on the uptake of 45Ca by neonatal rat (Wistar strain) brain synaptosomes. Biochem Int 1989; 19:463-8. [PMID: 2818607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In this study we report that uptake of 45calcium(45Ca) by neonate rat brain synaptosomes was disrupted during benthiocarb poisoning. This altered 45Ca uptake suggests possible derangement in the regulation of ionic pumps, ATP hydrolysis, neurotransmitter release and other calcium dependent phenomena.
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Affiliation(s)
- P N Srinivas
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Srinivas PN, Reddy GR, Chetty CS. Modulation of benthiocarb in vitro inhibited neonate rat (Wistar strain) brain Na+K+-ATPase by norepinephrine. Biochem Int 1989; 19:209-14. [PMID: 2550004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Effect in vitro of benthiocarb, an organocarbamate herbicide on neonate rat (3 day old) brain was studied to understand the interaction of benthiocarb with Na+K+-ATPase. Na+K+-ATPase of the developing rat brain was selected as an index enzyme since alterations in the Na+K+-ATPase activity leads to neuronal dysfunction. The assay of Na+K+-ATPase in the presence of 1-8 mu moles of benthiocarb showed decreased activity and a concentration dependent inhibition of Na+K+-ATPase was noticed upto 7 mu moles of benthiocarb. Based on IC50 values (median concentration), 50% inhibition of the enzyme was observed with 5 mu moles of benthiocarb. Norepinephrine (NE) was selected to study the modulation of benthiocarb inhibited enzyme. Maximum increase (76.7%) of Na+K+-ATPase was noticed with 35 mu moles of NE and effective concentration (EC50) of NE which produced 50% activation of the enzyme was found to be 20 mu moles. This study suggests that NE acts as a protective agent in reversing the benthiocarb in vitro inhibited neonate rat brain Na+K+-ATPase.
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Affiliation(s)
- P N Srinivas
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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Srinivas PN, Reddy GR, Chetty CS. Effects in vivo and in vitro of benthiocarb on developing rat (Wistar strain) brain Mg2+ and Ca2+-ATPases. Biochem Int 1989; 19:145-53. [PMID: 2528350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Effects in vivo and in vitro of benthiocarb on developing rat brain Mg2+ and Ca2+-ATPases have been studied. Decreased activities of Mg2+ and Ca2+-ATPases suggests impairment in energy synthesis and utilization processes in developing CNS of rat during benthiocarb poisoning. Effects in vitro of benthiocarb on these enzymes revealed that Km (Michaelis-Menten Constant) of both the enzymes increased whereas Vmax (Maximal velocity) decreased significantly indicating mixed type of inhibition on these enzymes by benthiocarb.
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Affiliation(s)
- P N Srinivas
- Department of Zoology, Sri Venkateswara University, Tirupati, India
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