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Item Do integrative approaches to health contribute to self-reliance in primary healthcare? reflections from a community case study in Kerala, India(Health Psychology and Behavioral Medicine, 2022) BS Shivanand; M Tushara; PM Unnikrishnan; Jayanna KrishnamurthyIntegrative healthcare practice is fragmented due to variations in the evidence perception by the people.Item A realist evaluation of the implementation of a large-scale school eye health programme in India: a qualitative study(Ophthalmic Physiol. Opt., 2021) Bharani Seelam; Hueiming Liu; Rishi Raj Borah; Sethu Sheeladevi; Lisa Keay; Amit Mohan; Anuradha Narayanan; Asim Sil; Elizabeth Joseph; Jameel Riz-Wana Hussaindeen; Kuldeep DolePurpose This study investigates how and in what circumstances a school-based eye health programme, the Refractive Errors Among CHildren (REACH) programme, achieved its desired outcomes: accessibility, standards of refractive care, fidelity and availability of comprehensive services, for over 2 million school children in six districts across India. Methods We conducted a realist evaluation to identify programme aspects and their causal relationships with outcomes. Deductive and inductive thematic analysis of qualitative data included three phases: 1. theory gleaning, 2. eliciting programme theory, 3. revisiting programme theory. The Initial Programme Theories (IPTs) were developed and revised through review of the literature, programme documents and field notes. We reviewed informal and formal discussions from the participatory advisory workshops and conducted semi-structured interviews with key stakeholders for the development and refinement of the IPTs. We based our analysis on the programme designers' perspective; used contexts, mechanisms and outcomes configuration for the analysis and presentation of the findings and reported the revised IPTs for the REACH programme. Results We identified four major programme aspects of the REACH programme for evaluation: programme governing unit, human resource, innovation and technology and funding. Based on the intended outcomes of the programme, themes and contexts were sorted and IPTs were defined. We revised the IPTs based on the analysis of the interviews (n = 19). The contexts and mechanisms that were reported to have potential influence on the attainment of favourable programme outcomes were identified. The revisions to the IPTs included: co-designing a collaborative model and involving local government officials to reinforce trust, community partnerships; local well-trained staff to encourage participation; use of the web-based data capturing system with built-in quality control measures and continued technical support; pre-determined costs and targets for the outputs promoted transparency and adherence with costs. Conclusion This process provided a comprehensive understanding of the opportunities and possibilities for a large-scale school eye health programme in diverse local contexts in India. This illustrated the importance of embracing principles of system thinking and considering contextual factors for School Eye Health programmes in low and middle-income countries.Item A population-based screening program for early detection of common cancers among women in India - methodology and interim results(Indian J. Cancer, 2015) G. A. Mishra; H. D. Dhivar; S. D. Gupta; S. Kulkarni; S. S. ShastriBACKGROUND: Cancers of the uterine cervix, breast, and oral cavity accounted for 134,420, 115,251, and 24,375 cases, respectively, and were responsible for 52.8% of the total cancers among women in India in 2008. AIM: The major objectives were to create awareness regarding common cancers among women, to detect pre-cancers of the uterine cervix and oral cavity, and early cancers of the breast, uterine cervix, and oral cavity, by conducting screening with simple, low-cost technology, within the community, and to facilitate confirmation of diagnosis among the screen positives and treatment and follow-up among the diagnosed cases. SETTINGS AND METHODS: This is a community-based screening program for early detection of breast, uterine cervix, and oral cancers, being implemented among the socioeconomically disadvantaged women in Mumbai, India. The process involves selection of clusters, household surveys, health education, and screening the eligible women for breast, uterine cervix, and oral cancers, by primary healthcare workers, at a temporarily set-up clinic within the community. The program is planned to cover a 125,000 disadvantaged population in five years. RESULTS: Twenty-one thousand and fifteen people, with 4009 eligible women, have been covered to date. The compliance for screening for breast, cervix, and oral cavity has been 85, 70, and 88% and the screen positivity rates are 3.9, 14.9, and 3.9%, respectively. Twenty-seven oral pre-cancers, 25 cervix pre-cancers, one invasive cancer of the breast, two of the cervix, and one oral cavity cancer have been diagnosed among the screened women and all of them have complied with the treatment. CONCLUSIONS: The program is raising awareness about the common cancers and harms of tobacco among the disadvantaged women population in Mumbai. It is also helping in detecting pre-cancers and cancers among asymptomatic women and is assisting them in receiving treatment.Item Reorienting health systems towards: Primary Health Care in South Asia(The Lancet Regional Health Southeast Asia, 2024) Susie Perera; Sudha Ramani; Taufique Joarder; Rajendra S. Shukla“Primary health care in South Asia”, is an effort to provide region-specific, evidence-based insights for reorienting health systems towards PHC. Led by regional thinkers, this series draws lessons from five countries in South Asia: Bangladesh, India, Nepal, Pakistan, and Sri Lanka.Item A comparative study of health risks of selected potentially toxic metals in household dust from different socio-economical houses of Dhanbad city, India(Air Qual. Atmos. Health, 2024) Shravan Kumar; Manish Kumar JainIn this study, the determination of heavy metal concentrations (Fe, Mn, Ni, Cd, Cr, Cu, Co, Zn) in dust samples collected from different socioeconomic households in the urban area of Dhanbad city was investigated. Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) was utilized to detect the heavy metal content of the dust samples after digestion and filtration. The mean concentrations of Fe found 19,983.25 mg kg-1 followed by Mn (313.03 mg kg-1), Zn (296.05 mg kg-1), Cu (62.16 mg kg-1), Cr (37.87 mg kg-1), Ni (33.67 mg kg-1), Co (11.66 mg kg-1), and Cd (5.65 mg kg-1). Contamination Factor (CF) for elements Fe, Mn, Ni, and Co obtained values less than 1 signifying low contamination, CF values for element Cu ranged between 1 to 3 signifying moderate contamination whereas Zn comes under considerable contamination. CF values for elements Cd signify high contamination in all types of households. Cd was found to be highly enriched with a mean value of EF greater than 20 followed by Zn, Cu, Cr, Ni, Co, and Mn. The hazard index (HI) of selected heavy metals was less than 1 and the carcinogenic risk (CR) values for Cd, Cr, and Ni were found below safe levels (1E-06 to 1E-04) for both adults as well as children. The HI value for children was around five times that of adults, suggesting that children are at a greater risk of exposure to heavy metals in indoor dust from all socioeconomic type households.Item Hospitalization & health expenditure in Odisha: Evidence from National Sample Survey (1995-2014)(Indian Journal of Medical Research, 2022) Jayakant Singh; Kalosona Paul; Jalandhar PradhanThis study investigated hospitalization and patient health expenditure in Odisha State over two time periods (1995 and 2014) using the national sample survey data.