Carsten Butsch

Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India

Background Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. Design A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. Results Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioners willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. Conclusions The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted.Background Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. Design A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. Results Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioners willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. Conclusions The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted.

From habits of attrition to modes of inclusion: enhancing the role of private practitioners in routine disease surveillance.

BackgroundPrivate practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities.MethodsLiterature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed.ResultsThe current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance.ConclusionThe issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative partnerships between the public and private sectors and most importantly exercise regulatory authority where needed.

Health Inequities in the City of Pune, India

Since the so-called urban turn in the year 2008, more than half of the population worldwide is living in cities. This is leading to a growing number of people whose health is being influenced by urban living conditions. Whereas a third of the urban population worldwide is currently living in small urban centres with a population of below 100,000, 16% lives in so-called emerging megacities (five to ten million inhabitants) and megacities (above ten million inhabitants); two thirds of these megacities are located in poor or newly industrializing countries (UN 2010). Megacities – especially in Asia and Africa – have grown at a very high pace over the last decades with many implications for the urban population.

The ‘Indian diaspora’ in Germany – emerging networks and new homes

ABSTRACT Indo-German migration after World War II can be divided into four distinct phases, which are described in the first part of this paper. Changing migration patterns in the past 70 years has resulted in a heterogeneous Indian population in Germany. The number of Indian migrants to Germany has been increasing sharply, especially in the last 15 years. This paper describes the migration pattern of the four phases and explains why migration from professionals and students has led to the fact that the number of Indians in Germany more than doubled since the year 2000. In the second section of this paper, empirical findings from a project will be used to illustrate different pathways to Germany. Based on the analysis of in-depth interviews with Indian migrants in Germany and experts in this field, the reasons for migrating and the structures influencing migration will be portrayed. The structural linkages are increasing with globalization and through the migrants’ practices, which create new linkages and reinforce exiting ones. Furthermore, the factors that influenced the migrants’ decision to stay in Germany will be described. These are often linked to life-course and family events, but also to changes in India. Finally, findings regarding the migrants’ emotional attachment to citizenship will be portrayed. Many respondents describe the Indian citizenship as important part of their identity. The findings from this case study are reflected upon in the discussion and related to theoretical considerations and the literature on international migration.

Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

Background Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1-10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care.Background Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1–10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care.

Aktuelle Forschungsbeiträge zu Südasien: 3. Jahrestagung des AK Südasien, 25./26. Januar 2013, Heidelberg

Die vorliegende Schriftenreihe wurde vom Arbeitskreis Sudasien mit dem Zweck gegrundet, Einblicke in aktuelle geographische Forschung zu Sudasien zu ermoglichen und dient in erster Linie dazu, die vielfaltigen Forschungsarbeiten der Arbeitskreismitglieder vorzustellen. Hierzu werden Beitrage der Mitglieder auf den jahrlichen Arbeitskreistreffen in Form von Extended Abstracts in einem jahrlichen Sammelband zusammengefasst. Matthias Schmidt - Baltistan im Spiegel kolonialer und postkolonialer Diskurse Basabi Khan Banerjee & Georg Stober - Gorkhaland Movement in India: A Case of Indigeneity and/or a Struggle over Space? Daniel Karthe - Grenzuberschreitendes Wassermanagement in Sudasien: die Beispiele Indus und Brahmaputra Nahreen Islam Khan & Gregor C. Falk - Eco-tourism, Nature Conservation and Monetary Interests at Baikka Beel Wetland Sanctuary, Bangladesh: Local people as Victims of Conflictive Approaches? Tatjana Thimm - Indientourismus - Potenziale, Probleme, Besonderheiten Verena Florchinger, Sabrina Marx, Larissa Muller, Svend-Jonas Schelhorn, Fabian Schutt & Ulrich Selgert - Die touristische Entwicklung der Hochgebirgssiedlung Langtang in Nepal Thomas Hennig - Trends, Probleme und Herausforderungen in Indiens Energiesektor Thomas Lennartz - Milcherde und der Zorn der Gotter: Lokales Wissen zur Verringerung des Risikos durch Hangrutschungen in Nepal Helene Grenzebach - Offentlicher Raum und Konflikt in globalisierten, urbanen Kontexten: das Beispiel Hyderabad, Indien Benjamin Etzold - Street Food Governance in Dhaka Johannes Bertsch - Jugend in Bangladesch - Zukunftsorientierung analysiert im raumlichen Kontext der Provinzstadt Rajshahi Mareike Kroll, Carsten Butsch, Revati Phalkey & Erach Bharucha - Challenges for urban disease surveillance in India - a case study of Pune