Community health promotion and medical provision for neonatal health-CHAMPION cluster randomised trial in Nagarkurnool district, Telangana (formerly Andhra Pradesh), India.
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SUBMITTER: Boone P
PROVIDER: S-EPMC5497957 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million.Methods and findingsWe conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities.ConclusionsOur findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.
| S-EPMC6650044 | biostudies-literature
Project description:BackgroundThe collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India.ObjectiveWe present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach.MethodsThe mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data.DiscussionThis is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices.
| S-EPMC6419630 | biostudies-literature
Project description:From koppunuru study area totally 58 samples were collected in 7 different boreholes, minimum depth of 28 m and Maximum depth of 157.7 m. The borehole samples geochemical analysis (major and trace elements) was carried out at Atomic Minerals Directorate for Exploration & Research (AMD), Hyderabad, India. Major and trace element studies have been conducted on the Neoproterozoic Palnad sub-basin Andhra Pradesh, South India, to determine their Geochemistry, Uranium mineralization and provenance characteristics. Geochemically, this sedimentary basin has a different litho - unit like as gritty quartzite, conglomerate, and Shale. This study area mainly dominated by Uranium deposited and radioactive elements are predominately deposit. Strong positive correlation between Uranium and Lead (r = 0.887) suggested radiogenic nature of this system.
| S-EPMC5995752 | biostudies-literature
Project description:BackgroundImproving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change.MethodsWe used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results.ResultsOnly 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD - 1.3 percentage points, 95% CI - 2.6-0.1], on neonatal mortality at age 7 days [DiD - 1.6, 95% CI - 9-6.2] or 28 days [DiD - 3.0, 95% CI - 12.9-6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms.ConclusionDespite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.
| S-EPMC7788546 | biostudies-literature
Project description:The Geospatial Technologies like Remote Sensing (RS) and Geographic Information System (GIS) have been playing vital role in capable forecasting and management of imperative groundwater resources in the emerging nations. In recent times, the geospatial technologies like RS, GIS and Multi Influence Factor (MIF) methodology are helpful in identifying groundwater potential zone. For the present study, the geospatial technology is used to prepare various thematic maps such as Land Slope, Geomorphology, Geology, Soil, Drainage Density, Lineament Density, Landuse/Landcover, Hydrogeomorphology, and Annual consideration of the valuation of groundwater assets for the semi-arid region in and around Bommanahal Mandal of Anantapur District in Andhra Pradesh, Southern India. As a part of the study eight thematic layers and their functions have been designed applicable weights at the Saaty׳s scale according to their comparative connotation in groundwater occurrence. The designed weights are normalized by using AHP (Analytic Hierarchy Process) MIF techniques and eigenvector method to various thematic layers and their features. Further to create a groundwater potential map the chosen thematic maps are integrated by weighted linear grouping method in a GIS environment. Based on the groundwater potential index values, the study area is classified into four different groundwater potential zones such as 'good', 'moderate to good', 'moderate' and 'poor'. The new recharge structures have proposed to fulfill the demand of groundwater to expand the scope of groundwater for future generations. Considering the overlay analysis of geomorphology and drainage layer execution through GIS technologies, the appropriate sites for artificial recharge structures have been identified.
| S-EPMC5997622 | biostudies-literature
Project description:The data deals with the preparation of the groundwater potential zone map of gudur area, with the help of data like geology and geomorphology, structure/lineament, slope and drainage and the thematic layer were prepared through the Survey of India toposheet Nos. N/12,N/15,N/16 and IRS-P6 LISS-III(RESOURCESAT-2) satellite data. The groundwater potential zones were obtained and classified into four categories, viz., very poor, poor, good, and very good zones. The data explains lateritic plain moderate basement with poor potential zones whereas secondarily occupies alluvial plain contains the good prospecting zone.
| S-EPMC6171168 | biostudies-literature
Project description:Malaria is a major public health problem in tropical and subtropical countries of the World. During the year 1999, Visakhapatnam district of Andhra Pradesh, India experienced a major epidemic of malaria, and nearly 41,805 cases were reported. Hence, a retrospective malaria surveillance study was conducted from 2001 to 2016 and reported nearly a total of 149,317 malaria cases during the study period. Of which, Plasmodium vivax contributes 32%, and Plasmodium falciparum contributes 68% of the total cases. Malaria cases follow a strong seasonal variation and 70% of cases are reported during the monsoon periods. In the present study, we exploited multi step polynomial regression and seasonal autoregressive integrated moving average (SARIMA) models to forecast the malaria cases in the study area. The polynomial model predicted malaria cases with high predictive power and found that malaria cases at lag one, and population played a vital role in malaria transmission. Similarly, mean temperature, rainfall and Normalized Difference Vegetation Index build a significant impact on malaria cases. The best fit model was SARIMA (1, 1, 2) (2, 1, 1)12 which was used for forecasting monthly malaria incidence for the period of January 2015 to December 2016. The performance accuracy of both models are similar, however lowest Akaike information criterion score was observed by the polynomial model, and this approach can be helpful further for forecasting malaria incidence to implement effective control measures in advance for combating malaria in India.
| S-EPMC7410916 | biostudies-literature
Project description:The Andhra Pradesh Children and Parents Study (APCAPS) was originally established to study the long-term effects of early-life undernutrition on risk of cardiovascular disease. Its aims were subsequently expanded to include trans-generational influences of other environmental and genetic factors on chronic diseases in rural India. It builds on the Hyderabad Nutrition Trial (HNT) conducted in 1987-90 to compare the effects on birthweight of a protein-calorie supplement for pregnant women and children. The index children of HNT and their mothers were retraced and examined in 2003-05, and the children re-examined as young adults aged 18-21 years in 2009-10. The cohort was expanded to include both parents and siblings of the index children in a recently completed follow-up conducted in 2010-12 (N=∼6225 out of 10,213 participants). Recruitment of the remaining residents of these 29 villages (N=∼55,000) in Ranga Reddy district of Andhra Pradesh is now under way. Extensive data on socio-demographic, lifestyle, medical, anthropometric, physiological, vascular and body composition measures, DNA, stored plasma, and assays of lipids and inflammatory markers on APCAPS participants are available. Details of how to access these data are available from the corresponding author.
| S-EPMC4190511 | biostudies-literature
Project description:Traditionally, the distribution of the Mycobacterium tuberculosis genotypes in India has been characterized by widespread prevalence of ancestral lineages (TbD1+ strains and variants) in the south and the modern forms (TbD1(-) CAS and variants) predominating in the north of India. The pattern was, however, not clearly known in the south-central region such as Hyderabad and the rest of the state of Andhra Pradesh where the prevalence of both tuberculosis (TB) and human immunodeficiency virus (HIV) infection is one of the highest in the country; this area has been the hotspot of TB vaccine trials. Spoligotyping of 101 clinical isolates obtained from Hyderabad and rural Andhra Pradesh confirmed the occurrence of major genogroups such as the ancestral (or the TbD1+ type or the East African Indian (EAI) type), the Central Asian (CAS) or Delhi type and the Beijing lineage in Andhra Pradesh. Sixty five different spoligotype patterns were observed for the isolates included in this study; these were further analyzed based on specific genetic signatures/mutations. It was found that the major genogroups, CAS and "ancestral," were almost equally prevalent in our collection but followed a north-south compartmentalization as was also reported previously. However, we observed a significant presence of MANU lineage in south Andhra Pradesh, which was earlier reported to be overwhelmingly present in Mumbai. This study portrays genotypic diversity of M. tuberculosis from the Indian state of Andhra Pradesh and provides a much needed snapshot of the strain diversity that will be helpful in devising effective TB control programs in this part of the world.
| S-EPMC3219672 | biostudies-literature
Project description:Excess fluoride in drinking water has been one of the leading problem faced by the arid and semi-arid regions of the world. Significantly in India the people suffer from fluorosis comparing to other toxic elements like Arsenic etc., in drinking water. Approximately, in India the excessive fluoride in groundwater is noticed in 177 districts covering 21 states, affecting 66 million people, including 6 million children and Moreover, the latest estimation gives nearly 200 million people, from among 25 nations the world over, are affected by the deadly disease of fluorosis [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. The fluoride of the groundwater varies from 0.4 to 5.8 mg/L with a mean of 1.98 mg/L (Table 1 & 2), which indicates that the concentration of fluoride is not uniform in the study area. In general intake of small quantities of fluoride in the permissible limit of 0.5 to 1 mg/L is known to be beneficial for human health in production and maintenance of proper health. However, in India safe limit of fluoride in potable water is considered to be between 0.6 to 1.2 mg/L, less than 0.6 mg/L can cause dental caries, while higher than 1.2 mg/L leads to fluorosis [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16].
| S-EPMC5996165 | biostudies-literature