Search

ABSTRACT: Background: This study aims to address the lack of substantial evidence regarding the effect of COVID-19 on maternal and child health (MCH) services in India and also highlight the role of primary care physicians in maintaining essential services during a pandemic. While studies conducted worldwide and in India have examined the effects of COVID-19 on these services, a significant gap in robust evidence remains. Methods: Forty-two districts were selected randomly from seven regional states of India. Data on five selected MCH indicators were extracted from HMIS for the months from March to June 2019 and 2020. Relative changes in service utilization for each month from March to June over the two years were compared. Comparisons were also made between the selected districts based on the COVID-19 categorization into red and green zones. Results: COVID-19 and its associated restrictive measures created significant disruption to essential MCH service utilization in India across all states reviewed. Both institutional, and outreach services were impacted; however, hospital-based services were more impacted. Institutional deliveries and emergency obstetric services saw a decline in March and April 2020 which gradually improved between May and June in some states. Immunization sessions held in 2020 observed a decrease in April. Conclusions: The analysis indicates a disruption in service delivery during the initial phase of the lockdown. However, the services resumed gradually as national and state-specific operational guidelines were implemented to maintain a continuum of care. [ABSTRACT FROM AUTHOR]

Objective To determine the acceptability of keeping a self-written health diary among members of low-income communities, with the aim of generating needed health data. Methods We identified three different types of impoverished communities (tribal, inner-city slum and rural) in north India, and conducted a baseline survey to establish the sociodemographic properties of the members of 595 (tribal), 446 (slum) and 51 (rural) households. We designed health diaries with a single page to fill in per month, each with a carbon duplicate, and distributed diaries to willing participants. Health volunteers visited households each month to assist with diary completion and to collect duplicate pages for a period of one year. We compared the frequency of illnesses reported in health diaries with baseline survey data. Findings A total of 4881 diary users (tribal: 2205; slum: 2185; rural: 491) participated in our project. In terms of acceptability, 49.6% (1093/2205), 64.7% (1413/2185) and 79.0% (388/491) at the tribal, slum and rural sites, respectively, expressed satisfaction with the scheme and a willingness to continue. In the tribal and slum areas, we observed increased reporting of illnesses from health diaries when compared with baseline data. We observed that influenza-like illnesses were reported with the highest frequency of 58.9% (2972/5044) at the tribal site. Conclusion We observed high levels of acceptability and participation among the communities. From our initial field studies, we have observed the benefits to both our study participants (timely preventive education and referrals) and to service providers (obtaining health data to allow improved planning). Objectif Determiner si les membres des communautes a faible revenu sont prets a accepter de tenir eux-memes un carnet de sante afin de generer les donnees requises en la matiere. Methodes Nous avons identifie trois differents types de communautes defavorisees (communautes tribales, bidonvilles en milieu urbain et communautes rurales) en Inde du Nord. Nous avons mene une enquete de reference afin de definir les caracteristiques sociodemographiques des membres de 595 menages parmi les communautes tribales, 446 dans les bidonvilles et 51 parmi les communautes rurales. Nous avons concu des carnets de sante comportant une page a remplir par mois, chacune munie d'une copie carbone, et les avons distribues aux participants. Pendant un an, les volontaires de sante ont rendu visite aux menages chaque mois pour les aider a completer leur carnet et recolter les copies carbone. Nous avons compare la frequence des maladies mentionnees dans les carnets de sante avec les donnees de l'enquete de reference. Resultats Au total, 4881 personnes ont participe a notre projet et tenu un carnet de sante (communautes tribales: 2205; bidonvilles: 2185; communautes rurales: 491). En termes d'acceptation, 49,6% (1093/2205) des membres de communautes tribales, 64,7% (1413/2185) des habitants de bidonvilles et 79,0% (388/491) des membres de communautes rurales ont exprime leur satisfaction vis-a-vis du systeme et sont prets a continuer. Dans les deux premieres communautes, nous avons remarque qu'un plus grand nombre de maladies etaient signalees dans les carnets de sante que dans les donnees de reference. Nous avons egalement constate que c'est dans les communautes tribales que les syndromes grippaux ont ete les plus frequemment rapportes, avec 58,9% (2972/5044). Conclusion Nous avons observe un niveau eleve d'acceptation et de participation au sein des communautes. En examinant nos etudes initiales sur le terrain, nous avons pu voir les avantages de cette methode pour nos participants (education preventive et renvoi vers un specialiste dans un delai convenable) et pour les prestataires de services (obtention de donnees sur la sante permettant d'ameliorer la planification). Objetivo Determinar la aceptabilidad de llevar un diario de salud escrito por uno mismo entre los miembros de las comunidades de bajos ingresos, con el objetivo de generar los datos de salud necesarios. Metodos Identificamos tres tipos diferentes de comunidades empobrecidas (tribales, barrios marginales del centro de la ciudad y rurales) en el norte de la India, y realizamos una encuesta de referencia para establecer las propiedades sociodemograficas de los miembros de 595 (tribales), 446 (barrios marginales) y 51 (rurales) hogares. Se disenaron diarios de salud con una sola pagina para rellenar al mes, cada uno con un duplicado en papel carbon, y se distribuyeron los diarios a los participantes dispuestos. Los voluntarios sanitarios visitaron los hogares cada mes para ayudar a rellenar el diario y recoger los duplicados durante un ano. Se comparo la frecuencia de las enfermedades declaradas en los diarios de salud con los datos de la encuesta de referencia. Resultados Un total de 4.881 usuarios de diarios (tribales: 2.205; de barrios marginales: 2.185; rurales: 491) participaron en nuestro proyecto. En cuanto a la aceptabilidad, el 49,6% (1093/2205), el 64,7% (1413/2185) y el 79,0% (388/491) de las zonas tribal, barrios marginales y rural, respectivamente, expresaron su satisfaccion con el programa y su voluntad de continuar. En las zonas tribales y de barrios marginales, observamos un aumento de la notificacion de enfermedades en los diarios de salud en comparacion con los datos de partida. Observamos que las enfermedades similares a la gripe se notificaron con la mayor frecuencia, el 58,9% (2972/5044), en la zona tribal. Conclusion Hemos observado altos niveles de aceptacion y participacion entre las comunidades. A partir de nuestros estudios iniciales sobre el terreno, hemos observado los beneficios tanto para nuestros participantes en el estudio (educacion preventiva oportuna y remisiones) como para los proveedores de servicios (obtencion de datos sanitarios que permiten mejorar la planificacion)., Introduction The third sustainable development goal (SDG) aims to ensure healthy lives and promote well-being for all at all ages. The 2030 SDG targets include reducing mortality through education and [...]

Background Utilization of maternal health care services by tribal population could be detrimental in reducing high maternal mortality in Madhya Pradesh, India. A growing body of evidence indicates the positive association between male involvement and increased use of antenatal care services. Further research is required to understand barriers and possible solutions to develop culturally appropriate interventions to engage men to promote the utilization of maternal health care services. Methods The study used qualitative data collected through 8 focus group discussions with men and women and 8 key informant interviews with either a community representative or health worker in two blocks dominated by Saharia tribes in Gwalior district, Madhya Pradesh, India in 2018. Information on the perception of utilization of maternal and child health services, male involvement, challenges and opportunities were elicited using a structured guide. Framework analysis was used to analyse the data. Results Findings document barriers at the individual (poor knowledge, fear of loss of wage, choice of home as a place of delivery), community (practices that reinforced the prevailing gender norms) and health care facility level (quality and attitude of health care providers) to male engagement in utilization of maternal health services. Community perceptions on possible solutions to address these were more likely to be gender exploitative interventions. Conclusion To promote utilization of maternal health care services among Saharia tribes, this study highlights the importance of developing gender sensitive interventions that addresses the individual, community and health care facility level barriers of male involvement and do not reinforce existing gender norms., Author(s): Saritha Nair [sup.1] , Tulsi Adhikari [sup.1] , Atul Juneja [sup.1] , K. Bal Gulati [sup.1] , Ashpinder Kaur [sup.1] , M. Vishnu Vardhana Rao [sup.1] Author Affiliations: (1) [...]

Aim: This analysis was conducted to review the number, and describe the characteristics of first-in-human (FIH) Phase 1 clinical trials registered in India from 2008 to 2022. Materials and Methods: The data were extracted from the Clinical Trials Registry - India database for all FIH Phase 1 clinical trials registered between 2008 and 2022. Early-phase trials that were not FIH trials (e.g., pharmacokinetic studies and drug-drug interaction studies) were excluded from the study. Results: A total of 1891 trials were retrieved and 220 were included in the analysis. Most of the investigational products were drugs (55%) followed by vaccines (38.2%). The most common therapeutic class of drugs was cancer chemotherapy (19.8%), followed by antimicrobial chemotherapy and endocrinology (18.2% each). The most common vaccine was the influenza vaccine (21.4%), followed by the measles-mumps-rubella vaccine (15.5%). The pharmaceutical industry was the predominant sponsor for most (91%) of the Phase 1 trials. Of the top five sites where most of the Phase 1 trials were conducted, three were private nonacademic centers (cumulatively 31%) and two were tertiary care medical colleges (cumulatively 9%). Conclusion: Phase 1 clinical trials seem to be conducted in India predominantly with industry sponsorship. There is a need to have an alternate ecosystem to take forward molecules that do not receive adequate attention from the industry and molecules that are of national health priority other than areas such as chemotherapy, antimicrobials, and endocrinology. The Indian Council of Medical Research is setting up Phase 1 clinical trial capacity for molecules that predominantly may arise from nonindustry channels. [ABSTRACT FROM AUTHOR]

Byline: Mendu. Rao, Mohua. Maulik, Atul. Juneja, Tulsi. Adhikari, Saurabh. Sharma, Jyotsna. Gupta, Yashmin. Panchal, Neha. Yadav OBJECTIVE: To present a descriptive analysis of the clinical studies registered in the [...]

Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children. More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India. [ABSTRACT FROM AUTHOR]

Byline: Atul. Juneja, Tulsi. Adhikari Sir, 'The Clinical Trials for the drugs used in the US/UK may be waived.[1]' This news drew the attention of all clinical researchers in India [...]

Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015-2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting ('anthropometric failure') across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive. [ABSTRACT FROM AUTHOR]

Background: Lack of research data is one of the major challenges identified in traditional medicine (TM). Further, there is an urgent need to strengthen and streamline clinical research processes as well as develop research databases in TM. The Clinical Trials Registry-India (CTRI), a free, online primary register of the WHO's International Clinical Trials Registry Platform, undertakes registration of all clinical trials being conducted in India, including TM trials. However, as the CTRI data set items are primarily designed to capture information of interventional trials of the conventional system of medicine, key fields relevant to the TM system are not adequately captured in the CTRI. Aims and Objectives: The current study was conceptualized with the objective to review the type and quality of trials registered in the CTRI as well as identify the specific data set items in CTRI which may be customized as per Ayurveda studies. Materials and methods: The trials registered from July 1, 2018, to March 31, 2020, were analyzed to decipher the kind of research being undertaken in the field of Ayurveda. These trials were manually reviewed independently by two Ayurveda reviewers to gain insights into the discrepancies. Along with these analysis, brainstorming sessions with Ayurveda experts were also held. Results: The fields which were identified and need tweaking and customization were the fields "health condition" and "intervention/comparator agent." Conclusions: These modifications in the CTRI would enable the capture of more effective Ayurveda-specific information which would in turn help to standardize and streamline research practices as well as raise the standard of research. [ABSTRACT FROM AUTHOR]

The molecular mechanism of iron transfer across placenta in response to maternal anemic status/ iron supplementation is not clear. We hypothesized that maternal iron/ anemia status during early trimesters can be utilized as a biomarker tool to get estimates of placental iron status. Early interventions can be envisaged to maintain optimum placental/ foetal iron levels for healthy pregnancy outcomes. One hundred twenty primigravida were recruited and divided into non-anemic and anemic group on the basis of hemoglobin levels. The groups were randomly allocated to receive daily and weekly iron folic acid (IFA) tablets till six weeks postpartum. Hematological and iron status markers in blood and placenta were studied along with the delivery notes. Weekly IFA supplementation in anemic primigravidas resulted in significantly reduced levels of hematological markers (p < 0.01); whereas non-anemic primigravidas showed lower ferritin and iron levels, and higher soluble transferrin receptor levels (p < 0.05). At baseline, C-reactive protein and cortisol hormone levels were also significantly lower in non-anemic primigravidas (p < 0.05). A significantly decreased placental ferritin expression (p < 0.05); and an increased placental transferrin expression was seen in anemic primigravidas supplemented with weekly IFA tablets. A significant positive correlation was observed between serum and placental ferritin expression in anemic pregnant women (r = 0.80; p < 0.007). Infant weight, gestational length and placental weight were comparable in both the supplementation groups. To conclude, mother's serum iron / anemia status switches the modulation in placental iron transporter expression for delivering the optimum iron to the foetus for healthy pregnancy outcomes. Trial Registration: Clinical Trial Registry-India: CTRI/2014/10/005135. [ABSTRACT FROM AUTHOR]