Gvs Murthy

Evaluation of the feasibility and acceptability of the ‘Care for Stroke’ intervention in India, a smartphone-enabled, carer-supported, educational intervention for management of disability following stroke

Objectives (1) To identify operational issues encountered by study participants in using the ‘Care for Stroke’ intervention; (2) to evaluate the feasibility and acceptability of the intervention. Design Mixed-methods research design. Setting Participants home. Participants were selected from a tertiary hospital in Chennai, South India. Participants Sixty stroke survivors treated and discharged from the hospital, and their caregivers. Intervention ‘Care for Stroke’ is a smartphone-enabled, educational intervention for management of physical disabilities following stroke. It is delivered through a web-based, smartphone-enabled application. It includes inputs from stroke rehabilitation experts in a digitised format. Methods Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 30 stroke survivors for 2u2005weeks. In the second phase, the finalised intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers for 4u2005weeks. Primary and secondary outcome measures Primary outcomes: (1) operational difficulties in using the intervention; (2) feasibility and acceptability of the intervention in an Indian setting. Disability and dependency were assessed as secondary outcomes. Results Field-testing identified operational difficulties related to connectivity, video-streaming, picture clarity, quality of videos, and functionality of the application. The intervention was reviewed, revised and finalised before pilot-testing. Findings from the pilot-testing showed that the ‘Care for Stroke’ intervention was feasible and acceptable. Over 90% (n=27) of the study participants felt that the intervention was relevant, comprehensible and useful. Over 96% (n=29) of the stroke survivors and all the caregivers (100%, n=30) rated the intervention as excellent and very useful. These findings were supported by qualitative interviews. Conclusions Evaluation indicated that the ‘Care for Stroke’ intervention was feasible and acceptable in an Indian context. An assessment of effectiveness is now warranted.

'Care for Stroke', a web-based, smartphone-enabled educational intervention for management of physical disabilities following stroke: feasibility in the Indian context.

Introduction Stroke rehabilitation is a process targeted towards restoration or maintenance of the physical, mental, intellectual and social abilities of an individual affected by stroke. Unlike high-income countries, the resources for stroke rehabilitation are very limited in many low-income and middle-income countries (LMICs). Provision of cost-effective, post-stroke multidisciplinary rehabilitation services for the stroke survivors therefore becomes crucial to address the unmet needs and growing magnitude of disability experienced by the stroke survivors in LMICs. In order to meet the growing need for post-stroke rehabilitation services in India, we developed a web-based Smartphone-enabled educational intervention for management of physical disabilities following a stroke. Methods On the basis of the findings from the rehabilitation needs assessment study, guidance from the expert group and available evidence from systematic reviews, the framework of the intervention content was designed. Web-based application designing and development by Professional application developers were subsequently undertaken. Results The application is called ‘Care for Stroke’. It is a web-based educational intervention for management of physical disabilities following a stroke. This intervention is developed for use by the Stroke survivors who have any kind of rehabilitation needs to independently participate in his/her family and social roles. Discussion ‘Care for stroke’ is an innovative intervention which could be tested not just for its feasibility and acceptability but also for its clinical and cost-effectiveness through rigorously designed, randomised clinical trials. It is very important to test this intervention in LMICs where the rehabilitation and information needs of the stroke survivors seem to be substantial and largely unmet.

Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study : Protocol of birth cohort at Bangalore, India.

BackgroundIndia is experiencing an epidemic of obesity-hyperglycaemia, which coincides with child bearing age for women. The epidemic can be sustained and augmented through transgenerational transmission of adiposity and glucose intolerance in women. This presents an opportunity for exploring a clear strategy for the control of this epidemic in India. We conducted a study between November 2013 and May 2015 to inform the design of a large pregnancy cohort study. Based on the findings of this pilot, we developed the protocol for the proposed birth cohort of 5000 women, the recruitment for which will start in April 2016. The protocol of the study documents the processes which aim at advancing the available knowledge, linking several steps in the evolution of obesity led hyperglycemia.MethodsMaternal Antecedents of Adiposity and Studying the Transgenerational role of Hyperglycemia and Insulin (MAASTHI) is a cohort study in the public health facilities in Bangalore, India. The objective of MAASTHI is to prospectively assess the effects of glucose levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the possible risk markers of later chronic diseases. The primary objective of the proposed study is to investigate the effect of glucose levels in pregnancy on skinfold thickness (adiposity) in infancy as a marker of future obesity and diabetes in offspring. The secondary objective is to assess the association between psychosocial environment of mothers and adverse neonatal outcomes including adiposity. The study aims to recruit 5000 pregnant women and follow them and their offspring for a period of 4xa0years. The institutional review board at The Indian Institute of Public Health (IIPH)-H, Bangalore, Public Health Foundation of India has approved the protocol. All participants are required to provide written informed consent.DiscussionThe findings from this study may help to address important questions on screening and management of high blood sugar in pregnancy. It may provide critical information on the specific determinants driving the underweight-obesity-T2DM epidemic in India. The study can inform the policy regarding the potential impact of screening and management protocols in public healthcare facilities. The public health implications include prioritising issues of maternal glycemic control and weight management and better understanding of the lifecourse determinants in the development of T2DM.

Development and evaluation of a Smartphone-enabled, caregiver-supported educational intervention for management of physical disabilities following stroke in India: protocol for a formative research study

The incidence and prevalence of stroke in India has reached epidemic proportions. The growing magnitude of disability in patients with stroke in India poses a major public health challenge. Given the nature of the condition, affected individuals often become disabled with profound effects on their quality of life. The availability of rehabilitation services for people with disabilities is inadequate in India. Rehabilitation services are usually offered by private hospitals located in urban areas and many stroke survivors, especially those who are poor or live in rural areas, cannot afford to pay for, or do not have access to, such services. Thus, identification of cost-effective ways to rehabilitate people with stroke-related disability is an important challenge. Educational interventions in stroke rehabilitation can assist stroke survivors to make informed decisions regarding their on-going treatment and to self-manage their condition with support from their caregivers. Although educational interventions have been shown to improve patient knowledge for self-management of stroke, an optimal format for the intervention has not as yet been established, particularly in low- and middle-income countries. This formative research study aims to systematically develop an educational intervention for management of post-stroke disability for stroke survivors in India, and evaluate the feasibility and acceptability of delivering the intervention using Smartphones and with caregiver support. The research study will be conducted in Chennai, India, and will be organised in three different phases. Phase 1: Development of the intervention. Phase 2: Field testing and finalising the intervention. Phase 3: Piloting of the intervention and assessment of feasibility and acceptability. A mixed-methods approach will be used to develop and evaluate the intervention. If successful, it will help realise the potential of using Smartphone-enabled, carer-supported educational intervention to bridge the gaps in service access for rehabilitation of individuals with stroke-related disability in India. The proposed research will also provide valuable information for clinicians and policymakers.

To Use or Not to Use- Dilemma of developing countries in introducing new vaccines

Public health intelligence and use of evidence-based public health practice in formulating Government policies is necessary, but available evidence shows that this is not the case in most developing countries. Few initiatives from organizations like World Health Organization (WHO) or Governments of developing countries are currently available which encourage and implement evidence-based public practice in developing countries. Supporting public health professionals working in developing countries through allocation of technology, platform and research grants can help in providing necessary evidence for Governments to either accept or reject any new vaccines. Very few such studies estimating vaccine efficacy and effectiveness based on contextual conditions in developing countries are currently available. For example, for centuries’ malaria and tuberculosis (TB) are plaguing developing countries and by far are the worst killers en masse with TB itself accounting for more than 1000 deaths per day in India.[6] However, except for the Guindy trial,[7-9] India has not been able to develop its own vaccines against killer diseases. In the absence of efforts by the Government to either generate data about disease burden or produce their own vaccines, international agencies such as WHO will need to take the lead in advocating vaccines based on evidence available from other countries.

A population-based survey of visual impairment and its correlates in Mahabubnagar district, Telangana State, India

ABSTRACT Purpose: To estimate the prevalence and correlates of visual impairment in Mahabubnagar district, Telangana, India. Methods: Fifty-one clusters of 80 people (all ages) were sampled with probability proportionate to size. Households within clusters were selected through the compact segment sampling. Visual acuity (VA) was measured with a tumbling “E” chart. An Ophthalmic Assistant or Vision Technician examined people with VA<6/12 in either eye. Other impairments (hearing, physical) were clinically assessed and self-reported functional difficulties measured using the Washington Group Extended Set. People with visual impairment and age-sex matched controls with normal vision were interviewed about poverty, employment and education. Results: 4,125 people were enumerated and 3,574 screened (86.6%). The prevalence of visual impairment (VA<6/12) was 8.0% (95% CI = 6.9–9.4%) and blindness was 0.4% (0.2–0.9%), and both increased rapidly with age. Uncorrected refractive error was the leading cause of visual impairment, and cataract the leading cause of blindness. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively low (41% of people at VA<6/60), while the post-surgery outcomes were good (81% of operated eyes had presenting VA≥6/18). Among the 287 people with visual impairment, 15% had a moderate/severe physical impairment or epilepsy and 25% had a moderate/severe hearing impairment. Self-reported difficulties in vision were relatively closely related to visual acuity. People with visual impairment were more likely to be in the poorest quartile (OR = 1.9, 95% CI = 1.0–3.4) or unemployed (5.0, 2.2–10.0), compared to controls. Conclusions: Visual impairment was common in Mahabubnagar district, was mostly avoidable, and was correlated with poverty markers.

Diabetic care initiatives to prevent blindness from diabetic retinopathy in India

It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20–50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.

Human resources for refraction services in Central Nepal

Uncorrected refractive error is a public health problem globally and in Nepal. Planning of refraction services is hampered by a paucity of data. This study was conducted to determine availability and distribution of human resources for refraction, their efficiency, the type and extent of their training; the current service provision of refraction services and the unmet need in human resources for refraction in Central Nepal.

Prevalence and causes of musculoskeletal impairment in Mahabubnagar District, Telangana State, India: results of a population-based survey

BackgroundnMusculoskeletal impairments (MSI) are the leading contributor to global years lived with disability. Comparable epidemiological data on MSI is lacking, and are needed to inform health and rehabilitative services. This study aimed to estimate the prevalence and causes of MSI in Telangana State, India.nnnMethodnA population-based survey used probability proportionate to size and compact-segment sampling to select 51 clusters of 80 individuals (all ages). Participants were screened using seven questions and any participant who screened positive underwent standardized examination by a physiotherapist for MSI presence, severity and diagnosis. Data were also collected on vision and hearing impairment, depression and self-reported difficulties with physical functioning.nnnResultsnThe prevalence of MSI was 19.6% (95% CI: 16.7-22.8%) and this increased with age. The majority (82%; 574/699) of MSI was classified as mild, 11% as moderate and 7% as severe. Over half (57%) of MSI diagnoses were acquired non-traumatic causes, with degenerative joint disease being the most common. There was a high unmet need for physiotherapy services (3% attended vs. 40% recommended). One-fifth (21%) of MSI cases also had at least one of vision (10%) or hearing (11%) impairment or depression (3%).nnnConclusionsnMSI is common among persons living in Mahabubnagar District, particularly older adults. These estimates can inform public health initiatives for the planning of health and rehabilitation services.

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

Objective To estimate the proportion of interfacility transfers (IFTs) transported by ‘108’ ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of ‘108’ services for pregnant women in India. Design A cross-sectional analysis of ‘108’ ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called ‘108’. Main outcomes Proportion of all pregnancies and institutional deliveries in the population who were transported by ‘108’, both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. Results The ‘108’ ambulances transported 6u200908u2009559 pregnant women, of whom 34u2009993 were IFTs (5.8%) in the five states. We estimated that ‘108’ transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by ‘108’ for IFTs—lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all ‘108’ IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95%u2009CI 2.09 to 2.27). There was considerable variation across states. Conclusion Only 6% institutional deliveries made use of the ‘108’ ambulance for IFTs in India. The vast majority did not have any complication or emergency. The ‘108’ service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT.