|Research and Public Health Initiatives|
Key Projects :
Andhra Pradesh Children and Parents Study (APCAPS)
A rural intergenerational cohort (N=7,000) is being studied, whose participants have been exposed to: a) a controlled trial of nutritional supplementation in pregnancy and early childhood in 1987-90; and b) rapid but uneven economic development since 2005. Long-term follow up of this cohort is aimed at understanding the mechanisms through which early-life socio-economic disadvantage and societal and environmental determinants contribute to chronic disease risk. This knowledge is being used to develop interventions for prevention of chronic diseases in urbanising rural communities.
Impact of graphic health warnings as a tobacco control measure
A cross-sectional mixed methods study was conducted to assess feasibility, perceived effectiveness and the politico-legal environment around introduction of standardized packaging with graphic health warnings as a tobacco control measure.
Evaluation of a pilot youth-driven, arts-based intervention to reduce mental health stigma in India
Negative attitudes and beliefs about mental health problems go unaddressed among college students in India. Arts-based interventions and peer education have demonstrated effectiveness in reducing public stigma associated with mental health problems among young people. However, a majority of these interventions have been developed and evaluated in high income countries and limited evidence exists in low and middle income settings. The doctoral research study aims to conduct a pilot study to evaluate feasibility, acceptability and impact of a youth-driven, arts-based intervention to reduce stigma associated with mental health problems among college students in Telangana, India.
Evaluation of Safe Childbirth Checklist Program, Rajasthan, India
An evaluation of the safe childbirth checklist implemented in Rajasthan, India was conducted. The evaluation indicated that there has been a significant reduction in the death rate of babies born in facilities implementing the checklist programme. The evaluation involved the use of some advanced and sophisticated data analysis and modelling techniques. This activity was supported by the CIFF and UBS Optimus foundation.
Referral systems for emergency obstetric care
A project to design and develop strategies for improving the referral systems for emergency obstetric care in India is underway as a doctoral research study. Assessing their contribution to reducing maternal mortality in India is a step that shall lead to efficacious interventions for impact.
Preventing tobacco use among adolescents in India
The data, collected in focus groups discussions among teachers, parents and schoolchildren, has been analysed using qualitative data analysis software, and written up as a report. Manuscripts are in preparation on the findings. The research was conducted in two states in India and was supported by the BMGF.
Public Health impacts of children's travel to school in Hyderabad, India
Primary data has been collected on approximately 6,000 children in 45 schools in Hyderabad in order to develop causal pathways of the impacts of choice of mode of travel to school, relationship between distance to school and mode of travel to school, distribution and determinants of mode of travel to school and to construct a model to estimate the impacts of a policy that restricts school choice, on the distribution of mode of travel to school, and health outcomes. Preliminary findings for this doctoral research study have been noted and scientific papers are under preparation, to be sent to peer-reviewed journals.
Management of workload and work pattern among Public Health Functionaries
A time and motion study is being conducted to provide an evidence-based understanding of how front-line health workers – Auxiliary Nurse Midwife (ANM), Accredited Social Health Care Activist (ASHA), Staff Nurse and Anganwadi Worker (AWW) spend their time on specified health services/targeted daily operations. The study is being conducted in Telangana and Andhra Pradesh and is being supported by the Department of Child Sciences-CESS and UNICEF-AP.
Evaluation of Safe Care Saving Lives (SCSL) programme
Another initiative, supported by the London School of Hygiene and Tropical Medicine, the Safe Care Saving Lives (SCSL) programme, funded by CESS, implements a quality improvement initiative in NICUs and associated labour rooms of hospitals empanelled in Aarogyasri. The evaluation of the SCSL includes a process and impact evaluation using non-randomised study design, a cost analysis and an assessment of the feasibility of leveraging on the Aarogyasri health insurance network.
Postings and transfers among health system personnel
This study examines the policies, practices and experiences related to postings and transfers among personnel in the public health system in India. Research methods include in-depth interviews, observation, and review of policy documents in four Indian states. The project is supported by DfID.
DAS Simple- Disability Assessment and Support made Simple
A mobile application that can guide assessment, automate calculation, provide instant analysis, certify, and then link the person to customized benefits and also continuously track the outcomes has been developed. As part of the project, the world’s first real time augmented reality based goniometer for measuring Range of Movements (RoM) has also been developed. This initative is supported by Grand Challenges, Government of Canada.
Exploring potential of technology in providing inclusive primary health care
The overall goal of the project is to explore the potential of technology in providing inclusive primary health care and contribute in empowerment of the vulnerable tribal population. Strengthening the services and increasing uptake of services shall enable tribals to benefit from curative, preventive, promotive and family welfare services.
Trusted Mobile Platform for self-management of chronic illness in rural areas (TRUMP)
This initiative is exploring the potential of mobile phone technologies and the development of a platform to support chronic disease management considering the needs of rural areas of India and to do this in a manner which fully addresses various issues of trust. Two common chronic conditions – diabetes and depression – provide exemplars for the development of this m-health platform and its evaluation.
Improving Functional Outcomes for Children with Impairments through community health workers in India using mHealth (INFORM)
The potential impact of this idea is to transform the lives of children with Neuro-developmental Disabilities in low and middle income countries and simultaneously address the unmet need for families for evidence based home delivered interventions. The process of developing and evaluating mHealth Technology is underway. It is envisioned as a platform to enhance the quality of interventions, by disseminating animations and videos to demonstrate techniques to parents at relatively low cost and with assured quality. Additionally, video-taping may be used for discussion with a trained supervisor in appropriate settings. Pilot testing of this technology will provide valuable ideas on feasibility and next steps.
Smartphone-enabled, Carer-supported Educational intervention for management of Post- Stroke Disability in India
This formative research study aims to systematically develop an educational intervention to bridge the gaps in service access for rehabilitation of individuals with stroke-related disability in India. The feasibility and acceptability of delivering the intervention using Smartphones and with caregiver support is being evaluated. The doctoral research study is being conducted in Chennai, India. If successful, it will help realize the potential of using Smartphone-enabled, carer-supported educational interventions, providing valuable information for clinicians and policy makers.
Technology for Inclusive Health: A proof of concept action research project among tribals in Telangana and Karnataka
The overall goal of the project is to explore the potential of technology in providing inclusive primary health care and contribute to empowerment of the vulnerable tribal population. Strengthening the services and increasing uptake of services shall enable tribal populations to benefit from curative, preventive, promotive and family welfare services. This study is being conducted in Adilabad District, Telangana and Kodagu District, Karnataka. It is supported by the DST SERB & PHFI-Public Health Research Initiative.
Latent Variable Model for Multivariate Longitudinal Data
Experiments in medical and social science research are often complex and characterized by multiple observations on several outcomes measured repeatedly over time. Special methods are required to analyse the resulting data as repeated observations on any given response are likely to be correlated over time while multiple responses measured at a given time point will also be correlated. This doctoral research study proposes to analyse such data by introducing multiple latent variables having a longitudinal correlation structure.
Manual for health professionals
A manual for health professionals was developed in 2013-14 on Non Communicable Diseases and Standard Treatment Guidelines for the Karnataka State Health Systems Development and Reforms Project and Karnataka State Health Systems Resources Centre, Bangalore. This document was developed with support from the World Bank and is available at www.healthykarnataka.org.
Hyperglycaemia in pregnancy and risk of chronic diseases-Extension of an existing cohort
The success of establishing the cohort through an earlier pilot study and overseeing its continuity has led to extending the recruitment of another 5,000 pregnant women into the birth cohort. Apart from screening for gestational diabetes the study will also store the blood samples in a bio repository for future analysis. The mothers and infants will be followed up for a duration of five years. The population includes those who attend public health facilities including urban slums in India. The study will be conducted in partnership with Dr.Sanjay Kinra, LSHTM; Dr.Sarah Benjamin Neelon, Johns Hopkins University, Dr Anura Kurpad, St John's Research Institute and is supported by the Wellcome Trust –DBT India Intermediate fellowship.
Effect of hyperglycaemia in pregnancy on adiposity in their infants in India
In 2012, a pilot study examined the feasibility of setting up a birth cohort in public health facilities in Bangalore. The pilot study recruited 964 pregnant women and screened 840 women for gestational diabetes. 347 (40%) women were followed-up soon after birth. The subsequent follow ups are being carried out with the help of outreach workers in urban Bengaluru. The study is supported by the Wellcome Trust Capacity Strengthening Strategic Award.
Follow up of mothers with diabetes and their children
A pilot study is being conducted to establish feasibility of a large cohort study specifically to test the logistics of the study methodology and feasibility of cord-blood serum C-peptide level, glucose testing in infants and testing HbA1C levels in non-diabetic south Indian women for the larger cohort study. This shall aid in obtaining effect estimates (albeit underpowered) to determine sample size and power calculations required for robust effect estimates in the main study. It shall also shed light on recruitment issues, mobility of pregnant women and determinants of following them up successfully, and viability of following pregnant women from diverse backgrounds. This effort is being funded by the Wellcome Trust till 2015. Presently, ‘Hyperglycemia in pregnancy and risk of chronic diseases’, a large cohort study is being implemented in the hospitals of the local sub-government and Department of Health and Family Welfare.
Introduction of the HPV vaccine
Cervical cancer is second most common cancers among women. Human Papilloma virus (HPV) is one of the most common sexually transmitted infection and nearly 80% of cervical cancers associated with HPV infection. Around 75-80 % of the sexually active individuals are affected with HPV in their lifetime. In India, the cervical cancer is nearly one-fourth of global burden. There are several risk factors known to contribute high incidence of cervical cancer. The current HPV vaccine provides protection against 75% of the HPV infection associated cervical cancers. Though there is a huge burden of cervical cancer associated with HPV infection in India, the government has suspended the demonstration of vaccine in response to pressure from several influential groups. This research will explore the socio-political nature of HPV vaccine policy problem in Indian context. The doctoral research study adopts qualitative method, it involves interview of health system actors, key informants interviews and interest groups.
Nutrition policy review
Review of existing national and state specific nutrition programme guidelines is being conducted for conceptualization, designing, development of nutrition programs in Karnataka State. The review study’s main focus was to identify, develop pragmatic direction and action plan, advocate for renewed commitment to nutrition, and intensify state’s efforts to sustainably address malnutrition in the wake of the worsening nutrition status of vulnerable groups across the state. The study made several recommendations including establishment of Karnataka state nutrition authority, strategic direction to healthcare providers for under nutrition in young children and nutritional data surveillance. Identified barriers, enablers and options were consultatively developed for Ashoka Innovators for the Public, Bengaluru.
International Clinical Intervention, Co-ordination and Biomarker Centre (CICBC): EXHALE Center Project
The potential adverse effects of IAP on pregnant women and children constitutes integral part of the “International Clinical Intervention, Coordination and Biomarker Center (CICBC): EXHALE Center Project”. We aim to introduce improved cook stoves in these slums and compare the perinatal outcomes before and after the intervention in the birth cohort. We are also interested in following up the pregnant women among these slums and assess other health outcomes in the context of exposure to IAP. The population includes those who attend public health facilities including urban slums in India. The study is being conducted in partnership with Maastricht University and Cornell University and is supported by the National Institute of Health.
Gender and reproductive health
A study exploring the role of gender in explaining reproductive health-related behaviour among Hindu and Muslim women in India has been commissioned as a PHFI- Wellcome Trust Programme Research Fellowship for three years. The specific research questions pertain to why Muslim girls in India are less likely to obtain modern education as compared to Hindu girls, whether girls’ education induces agency among Muslim and Hindu women in the process of marriage negotiation. As a next step, the nature of sex-preferences (child) that can be distinguished across the different sections of Muslim and Hindu population of India, what causes these differences, and what implication do they have for family size and whether religious norms explain differentials in the nutritional status of Hindu and Muslim women in India, or connection with infant and child mortality outcomes are also being investigated.
A National Urban Health Mission Action Report has been developed to provide action points for the city of Bengaluru in aid of the Karnataka State Health Systems Resources Centre (KSHSRC), Bangalore. Previously, a policy framework on Human Resources for Health and a Documentary Film on maternal mortality were prepared for training, advocacy and sensitisation.
Universal Health Coverage
A document has been conceptualised and developed, distilling the vision and way forward for Universal Health Coverage in Karnataka for the Government of Karnataka. Technical support and assistance for roll out of Universal Health Coverage in the pilot districts of Mysure and Raichuru is currently being provided. The key objective of UHC Pilots in Karnataka is to expand the coverage for population that is currently left uncovered or is partially covered. The project has so far highlighted the strengths and gaps with regard to who is covered (population coverage), facilities available (public and Private), what services are provided and financing issues.