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Background: We herewith describe a novel methodology of teaching Medical Officers working at the Primary Health Centers under the Public Health Dept. of Maharashtra State. This course intends to develop competencies to manage adult and pediatric patients with common emergencies at primary health centre. There has been an immense shortage of Pediatricians & Physicians for the last 5 years due to 50-60% vacancies. Besides this, many of the patients in rural areas need to be addressed by a Pediatrician or Physician. With this in mind a short term certificate programme for the Medical Officers was designed. Method: Medical Officers working at Primary Health Centers were deputed like resident doctor for 6 months in the Pediatric/ Medicine Dept. of a Medical College. The methodology used was videoconferencing lectures, motivational lectures by renowned Pediatricians and Physicians, Professors, Padma Awardees from Mumbai, Nagpur, Pune and Aurangabad. The sessions were interactive with active involvement of the Doctors . They also attended all postgraduate programmes of the Department of the Medical College. They attended night duties, speciality clinics like resident doctors. An examination was taken at the end of 6 months after they had learnt state-of-the-art techniques in the subject. 169 students were taught from 2011 in 4 batches till date. The passing percentage varied from 88 to 96%. Result : At the end of the training, the students had acquired sound knowledge of theory and practicals in Medicine/ Pediatrics, had acquired necessary hands on skills, learnt state-of-the-art methodology and had established linkages with teachers in Medical Colleges. Conclusion: MOCP is thus a unique course successfully working only in the State of Maharashtra in India. [ABSTRACT FROM AUTHOR]

Background: For many people in the remote regions of India, medical help is inaccessible as 66% of rural Indians do not have access to critical medicine and 31% of the population travel more than 30 km seeking health care in rural India. Timely non-availability of doctors in healthcare facilities, especially in primary health centers (PHCs), leads to more dependency on the private healthcare practitioners for the out-patient department services. This needs immediate attention., Materials and Methods: The healthcare authority in Maharashtra has allowed doctors in 108 emergency ambulances to provide consulting services. The current study is based on the total consultations managed by the doctors on-board on the 108 ambulances in the state of Maharashtra in the years 2020, 2021, and 2022. The data are procured from the state-run Emergency Response Centre, and the analysis is done by using the basic statistical technique in MS Excel and SPSS16.0., Results: More than 9.35 lakh medical consultations were provided with an average 856 consultations per ambulance in the year 2022, showing a significant growth of 452% over the consultations in 2020. The base location of the 32% ambulance (298) in the PHCs has improved the round the clock accessibility in 16% of the total PHCs in the state of Maharashtra., Conclusion: The availability of the doctors in the state-run emergency ambulances for general healthcare services has improved the adherence of Indian Public Health Standards, and such practice must be examined for implementation in other states., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Community Medicine.)

The quality of emergency medical services remains a major public health issue in developing countries in terms of access, availability, or timely delivery, owing to high socio-economic and ethnic disparities. Particularly, the timeliness of EMS remains a drawback, leading to higher mortality and morbidity. The aim of the study is to assess the district-level differences and factors that influence ambulance travel time, as there was no study done in the Indian scenario. Sequential Explanatory Design was applied here, which involved a descriptive study and spatial analysis of the call volume and distribution to understand the operational challenges of MEMS, followed by in-depth interviews among medical officers and officials to explore the reasons for the challenges. The data, shared by the Department of Health, Government of Maharashtra, consisted of 38,823 records (emergency: 16,197 and hospital-to-hospital transfer: 22,626), including emergency and hospital-to-hospital transfer calls across 36 districts of Maharashtra for November 2022. Spatial analyses were performed to identify the districts with challenges of timeliness. The average ambulance response time (T) across the districts was reported at 134.5 min for emergency cases and 222.80 min for hospital-to-hospital transfer cases. The total ambulance response time, was classified as preparation time (t1:3.53 min for emergency, 3.69 min for hospital-to-hospital transfer), travel time from base to scene (t2: 23.15 min for emergency, 17.18 min for hospital-to-hospital transfer), time required at scene (t3: 12.12 min for emergency, 14.72 min for hospital-to-hospital transfer), travel time from scene to hospital (t4:39.41 min for emergency, 74.34 min for hospital-to-hospital transfer), patient handover time (t5: 10.85 min for emergency, 13.84 min for hospital-to-hospital transfer), and return from base to hospital (t6: 41.89 min for emergency, 94.72 min for hospital-to-hospital transfer). Multivariate linear regression was conducted to investigate the factors that influence ambulance travel time. The finding identifies that the ambulance travel time increased for the districts with lesser population density, lower road density, fewer hospitals, a higher district area served per ambulance, and a higher population served per ambulance. Additionally, socio-cultural reasons affecting health-seeking behaviour, early closing of healthcare centres, undercapacity and resource-deficit healthcare centres, and overloading of specialised tertiary hospitals were identified as determinants of delay in patient assessment and handover time in qualitative findings. A decisive and multi-sectoral approach is required to address the timeliness of EMS in the Indian context., (© 2023. The Author(s).)

Background: We developed a composite index-hospital preparedness index (HOSPI)-to gauge preparedness of hospitals in India to deal with COVID-19 pandemic., Methods: We developed and validated a comprehensive survey questionnaire containing 63 questions, out of which 16 critical items were identified and classified under 5 domains: staff preparedness, effects of COVID-19, protective gears, infrastructure, and future planning. Hospitals empaneled under Ayushman Bharat Yojana (ABY) were invited to the survey. The responses were analyzed using weighted negative log likelihood scores for the options. The preparedness of hospitals was ranked after averaging the scores state-wise and district-wise in select states. HOSPI scores for states were classified using K-means clustering., Findings: Out of 20,202 hospitals empaneled in ABY included in the study, a total of 954 hospitals responded to the questionnaire by July 2020. Domains 1, 2, and 4 contributed the most to the index. The overall preparedness was identified as the best in Goa, and 12 states/ UTs had scores above the national average score. Among the states which experienced high COVID-19 cases during the first pandemic wave, we identified a cluster of states with high HOSPI scores indicating better preparedness (Maharashtra, Tamil Nadu, Karnataka, Uttar Pradesh and Andhra Pradesh), and a cluster with low HOSPI scores indicating poor preparedness (Chhattisgarh, Delhi, Uttarakhand)., Interpretation: Using this index, it is possible to identify areas for targeted improvement of hospital and staff preparedness to deal with the COVID-19 crisis., Competing Interests: Dr Subramanian reports being the cofounder of Entrupy Inc, Gaius Networks Inc, and Velai Inc. He has also served as a consultant for the World Bank and the Governance Lab.: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India., Method: We collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence., Results: Out of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95))., Conclusion: These findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence., (© 2022. The Author(s).)

In the wake of the COVID-19 pandemic, digital health tools have been deployed by governments around the world to advance clinical and population health objectives. Few interventions have been successful or have achieved sustainability or scale. In India, government agencies are proposing sweeping changes to India's digital health architecture. Underpinning these initiatives is the assumption that mobile health solutions will find near universal acceptance and uptake, though the observed reticence of clinicians to use electronic health records suggests otherwise. In this practice article, we describe our experience with implementing a digital surveillance tool at a large mass gathering, attended by nearly 30 million people. Deployed with limited resources and in a dynamic chaotic setting, the adherence to human-centered design principles resulted in near universal adoption and high end-user satisfaction. Through this use case, we share generalizable lessons in the importance of contextual relevance, stakeholder participation, customizability, and rapid iteration, while designing digital health tools for individuals or populations., (©Ahmed Shaikh, Abhishek Bhatia, Ghanshyam Yadav, Shashwat Hora, Chung Won, Mark Shankar, Aaron Heerboth, Prakash Vemulapalli, Paresh Navalkar, Kunal Oswal, Clay Heaton, Sujata Saunik, Tarun Khanna, Satchit Balsari. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.01.2022.)

Background: Although many studies have provided evidence for all-cause mortality attributed to extreme temperature across India, few studies have provided a systematic analysis of the association between all-cause mortality and temperature., Objective: To estimate the risk associated with heat waves during two major heat waves of Nagpur occurred in 2010 and 2014., Methods: The association between temperature and mortality was measured using a distributed lag non-linear model (DLNM) and the attributable deaths associated with the heat waves with forward perspective in the DLNM framework., Results: From the ecological analysis, we found 580 and 306 additional deaths in 2010 and 2014, respectively. Moving average results also gave similar findings. DLNM results showed that the relative risk was 1.5 for the temperature above 45 °C; forward perspective analysis revealed that the attributable deaths during 2010 and 2014 were 505 and 376, respectively. Results from different methods showed that heat waves in different years had variable impacts for various reasons. However, all the results were consistent during 2010 and 2014; there were 30% and 14% extra-mortalities due to heat comparing to non-heat wave years., Conclusion: We strongly recommend the city Government to implement the action plans based on this research outcome to reduce the risk from the heat wave in future.

Corona virus disease (COVID-19) has created pandemic in the world as declared by WHO on March 12, 2020. It is a viral disease caused by SARS-CoV 2 virus and has affected large populations in over 120 countries. There is no specific treatment available and management is empirical. Until such time that an effective vaccine is available for COVID-19 viral infection, one can repurpose known therapeutic drug molecules such as angiotensin receptor 2 blocker, a commonly used antihypertensive drug, to control COVID-19 virus from gaining entry into the host cell by blocking the angiotensin receptor. Clinical trials should also be undertaken to use statins, which are lipid-lowering drugs but have anti-inflammatory and immunomodulatory properties to prevent acute lung injury in COVID-19 infection., (© 2020 Wiley Periodicals, Inc.)

In India, assembly constituencies (ACs), represented by elected officials, are the primary geopolitical units for state-level policy development. However, data on social indicators are traditionally reported and analyzed at the district level, and are rarely available for ACs. Here, we combine village-level data from the 2011 Indian Census and AC shapefiles to systematically derive AC-level estimates for the first time. We apply this methodology to describe the distribution of 11 education infrastructures-ranging from pre-primary school to senior secondary school-across rural villages in 3773 ACs. We found high variability in access to higher education infrastructures and low variability in access to lower education variables. For 40.3% (25th percentile) to 79.7% (75th percentile) of villages in an AC, the nearest government senior secondary school was >5 km away, whereas the nearest government primary school was >5 km away in just 0% (25th percentile) to 1.9% (75th percentile) of villages in an AC. The states of Manipur, Arunachal Pradesh, and Bihar showed the greatest within-state variation in access to education infrastructures. We present a novel analysis of access to education infrastructure to inform AC-level policy, and demonstrate how geospatial and Census data can be leveraged to derive AC-level estimates for any population health and development indicators collected in the Census at the village level.

Climate change impacts on health, including increased exposures to heat, poor air quality, extreme weather events, and altered vector-borne disease transmission, reduced water quality, and decreased food security, affect men and women differently due to biologic, socioeconomic, and cultural factors. In India, where rapid environmental changes are taking place, climate change threatens to widen existing gender-based health disparities. Integration of a gendered perspective into existing climate, development, and disaster-risk reduction policy frameworks can decrease negative health outcomes. Modifying climate risks requires multisector coordination, improvement in data acquisition, monitoring of gender specific targets, and equitable stakeholder engagement. Empowering women as agents of social change can improve mitigation and adaptation policy interventions., Competing Interests: The authors declare no conflicts of interest relevant to this study., (©2018. The Authors.)

A prospective, multicenter study was initiated by the Government of Maharashtra, India, to determine predictors of long-term outcomes of percutaneous coronary intervention (PCI) for coronary artery disease, and to compare the effectiveness of drug-eluting stents (DESs) and bare-metal stents (BMSs) in patients undergoing PCI under government-funded insurance. The present analysis included 4595 patients managed between August 2012 and November 2016 at any of 110 participating centers. Using the classical multivariable regression and propensity-matching approach, we found age to be the most important predictor of 1-year mortality and target lesion revascularization at 1 year post-PCI. However, using machine learning methods to account for unmeasured confounders and bias in this large observational study, we determined total stent length and number of stents deployed as the most important predictors of 1-year survival, followed by age and employment status. The unadjusted death rates were 5.0% and 3.8% for the BMS and DES groups, respectively (p = 0.185, log-rank test). The rate of re-hospitalization (p<0.001) and recurrence of unstable angina (p = 0.08) was significantly lower for DESs than for BMSs. Increased use of DES after 2015 (following establishment of a price cap on DESs) was associated with a sharp decrease in adjusted hazard ratios of DESs versus BMSs (from 0.94 in 2013 to 0.58 in 2016), suggesting that high price was limiting DES use in some high-risk patients. Since stented length and stent number were the most important predictors of survival outcomes, adopting an ischemia-guided revascularization strategy is expected to help improve outcomes and reduce procedural costs. In the elderly, PCI should be reserved for cases where the benefits outweigh the higher risk of the procedure. As unemployed patients had poorer long-term outcomes, we expect that implementation of a post-PCI cardiovascular rehabilitation program may improve long-term outcomes., Competing Interests: The authors have declared that no competing interests exist.