Objectives: Women's self-help groups (SHGs) are actively promoted to advance women's empowerment. SHGs are estimated to cover 112 million households in 2017; more than 90% are women. This article ...answers if membership in women's group is associated with better health and women's empowerment. Methods: Data on district level health and empowerment indicators were obtained from the fourth round of the National Family Health Survey 2015-16. Data on SHG activity, defined as concentration of SHG at district, was obtained from publicly available data. Twelve indicators were clubbed to measure four domains: maternal health, women's empowerment, child health, and health protection. Binary logistic regressions were computed with education and wealth as control in each model to analyze the change in 12 indicators with the presence of SHG. Results: Districts with higher concentration of SHG members were associated with higher odds of women delivering their babies in an institution (OR: 1.53), taking iron pills, sprinklers, or syrup (OR: 1.11), using family planning methods (OR: 1.03), having knowledge of ovulatory cycle (OR: 1.10), owning house or land (either alone or jointly) (OR: 1.18) and lower odds of women suffering from anemia (OR: 0.92). The odds improve when districts with higher concentration of SHG members were compared with those with lower concentration. Conclusion: Membership in women's group is associated with better health measures as well as asset ownership; higher the concentration of SHG, higher is the impact.
To fulfil its commitment to universal health coverage, it will be necessary for the Indian government to expand access to appropriate and affordable health services. Through the mechanism of ...microfinance-based self-help groups (SHGs), poor women and their families are provided not only with access to finance to improve their livelihoods but also, in many cases, with a range of basic health services. Governments and non-governmental organisations in India have implemented large-scale programmes for the promotion of SHGs. With 93 million people organised nationally, the SHGs provide an established population base that can potentially be used to extend health coverage. However, the potential for working with SHGs to improve people's access to health services has not been an active part of the national policy discourse.
Introduction
Technology Enabled Community Health Operations (TeCHO+) is a mobile and web-based application (app) for frontline health workers. It includes features such as real-time data entry, ...automated generation of the work plan, and a decision support system generating alerts for high-risk cases. Since 2019, the programme is implemented across all 33 districts of Gujarat, catering to a population of over 60 million. This study aims to compare changes in the coverage, quality of data reporting maternal and child health services, and time spent in the documentation before and after the introduction of the TeCHO+ app.
Methods
To address the study aim, a mixed-method design with a realist evaluation approach was adopted. The survey was conducted with randomly selected beneficiaries from 32 sub-centers across two districts of Gujarat State in India. We surveyed 215 postpartum women and mothers of 102 children at baseline (pre) and 246 postpartum women and mothers of 119 children post 1 year of the TeCHO+ programme intervention in 2020. For qualitative data, total 29 Auxiliary Nurse Midwives, 12 Data Entry Operators and 10 Primary Health Center Medical Officers were purposively selected from 32 PHCs and interviewed to understand the pathways leading to the programme outcome.
Results
Following introduction of TeCHO+, the coverage of full antenatal care (ANC; 75.6% vs. 67.9%,
p
-value < 0.0001), consumption of at least 180 iron-folic acid tablets (93% vs. 77%,
p
-value < 0.001), early initiation of breastfeeding (42.7% vs. 24.2%,
p
-value < 0.001), five home-visits by ANM during the first month after delivery (36.2% vs. 27.9%,
p
-value = 0.056), HBV0 vaccination (67.2% vs. 35.3%,
p
-value < 0.0001) and Pentavalent 2 (100% vs. 95.1%,
p
-value = 0.015) improved. The overall concordance rate for routine maternal health indicators (a measure of data quality) improved from 69.1 to 80.5%, while that for routine child health indicators improved from 86.6 to 92.1%. The programme resulted in 1.7 h saving a day of ANM's productive time and 1.5 h (a day) of data entry operator's time.
Conclusions
The TeCHO+ programme has improved access to care. It impacted both coverage of maternal and child health services and data reporting quality of various maternal and child high-risk conditions. Considering the programme's success, other disease services might be added to the scope of TeCHO+ software.
Objective
This study compared the clinical efficacy and cost-effectiveness of parenteral iron, using intravenous iron sucrose (IVIS) therapy against the standard regimen of oral iron (OI) therapy for ...managing iron-deficiency anemia (IDA) among pregnant women in a natural primary care setting in Gujarat.
Design
A prospective cost-effectiveness study was conducted in natural programme setting wherein 188 pregnant women in their 14 to 18 weeks with moderate and severe anemia women enrolled from two districts of Gujarat, and 142 were followed up until the post-partum phase. The intervention group comprised of 82 participants who were administered IVIS, while the comparison group comprised of 106 participants who were put on OI therapy. Hemoglobin (Hb) levels were measured at periodic intervals, first during enrollment and then during each month of pregnancy period and finally on the 42nd day of the post-natal period.
Outcome measures
Change in mean Hb level from baseline was the primary outcome, while the incidence of morbidity and mortality was a secondary outcome measure.
Results
The intervention group showed a significant incremental mean change in Hb level from 8.2 g/dl to 11.45 g/dl at the fourth follow-up, while the control group's mean Hb level reduced from 9.99 g/dl to 9.55 g/dl. The discounted cost per beneficiary for IVIS was US$ 87, while that for OI was US$ 49. The incremental cost-effectiveness ratio (ICER) was US$ 9.84, which is 0.049% of India's per capita GDP.
Conclusion
IVIS therapy was more clinically effective and cost-effective than OI therapy among pregnant women for management of moderate and severe anemia.
Background: Gujarat has implemented an mHealth program, technology for community health operations-plus (TeCHO+) in 2019. TeCHO+ is a mobile and web-based application that essentially enables data ...entry by the frontline workers providing service at the time and place of service delivery to improve the coverage and data quality. It also facilitates early identification of morbid condition and timely treatment. This study assessed the cost-effectiveness of TeCHO+ program in Gujarat. Materials and Methods: The study compared key program outcome indicators before and after the launch of TeCHO+ program. As the program was launched across the State, eMamta, the previous version of mother and child tracking system was used for comparison. A decision tree was parameterized to estimate change in disability-adjusted life year (DALY) and cost as a result of implementing TeCHO+ from a health system perspective. Results: TeCHO+ incurred a cost of Rs. 2,624 per beneficiary against Rs. 1,075 per beneficiary under the previous eMamta program. TeCHO+ has resulted in significant DALY averted through early identification of high-risk cases both among pregnant women and children. Overall, cost-effectiveness analysis indicated that TeCHO+ incurred an incremental cost of Rs. 1802.84 per DALY averted, which is 1.19% of the GDP per capita of India (year 2020). Conclusion: This study concludes that TeCHO+ is cost-effective for mother and child care and can be considered for replicating.
Mental health burden is a major health concern worldwide. In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian ...context. This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery. The descriptive review of literature on innovative mental health programs in India was carried out. The initial search from google scholar and PubMed database yielded 1152 articles, of which 1114 were excluded that did not meet inclusion criteria. Full texts of 38 articles were reviewed and finally 22 studies were included for the study. Based on the review, most innovations are broadly summarized into five categories: (1) quality improvement mental health programs; (2) community-based mental health programs; 3) non-specialist mental health programs, 4) mobile-technology based mental health programs, 5) tele-mental health programs. These promising innovations in treatment and care can be customized as per the context for scale up and integrated into the primary healthcare system through District Mental Health Programme.The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.
Yoga, immunity and COVID-19: A scoping review Shah, Komal; Adhikari, Chiranjivi; Saha, Somen ...
Journal of family medicine and primary care,
05/2022, Letnik:
11, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Yoga is recognized and practiced for different levels of prevention since antiquity. The current scoping review aimed to identify and document the evidence reporting the effect of yoga interventions ...on immunity against COVID-19 infection. Three databases--PubMed, Cochrane, and Google Scholar, were searched to identify eligible studies. Articles published in English after 2010 and assessing the impact of any form of yoga (such as yogasanas, meditations, or pranayamas) on immunological markers were included in the review. The studies without information of the intervention on immunity markers, and experience sharing reviews were excluded. The search yielded 45 eligible articles with majority of the studies being published from the USA and India. Most of the studies were randomized controlled trials, enrolling the adult population with a specific focus on diseases like HIV, cancer, and heart failure. It was observed that a variety of yoga interventions along with meditation and pranayama, in different combinations were used by the authors. However, all these studies unanimously reported improvement in immunological profile (indicated by improved biochemical markers) of an individual (irrespective of disease state and type) with yoga. Moreover, the beneficial effects of these traditional Indian interventions were also found to have a positive impact on overall physical and physiological wellbeing and quality of life. Findings from the existing literature indicate that the practice of yoga has the potential to strengthen cell-mediated immunity and hence could be used as an effective preventive measure against COVID-19 where immunity plays a critical role.
Achieving the target for eliminating tuberculosis (TB) in India by 2025, 5 years ahead of the global target, critically depends on strengthening the capacity of human resources as one of the key ...components of the health system. Due to the rapid updates of standards and protocols, the human resources for TB health care suffer from a lack of understanding of recent updates and acquiring necessary knowledge.
Despite an increasing focus on the digital revolution in health care, there is no such platform available to deliver the key updates in national TB control programs with easy access. Thus, the aim of this study was to explore the development and evolution of a mobile health tool for capacity building of the Indian health system's workforce to better manage patients with TB.
This study involved two phases. The first phase was based on a qualitative investigation, including personal interviews to understand the basic requirements of staff working in the management of patients with TB, followed by participatory consultative meetings with stakeholders to validate and develop the content for the mobile health app. Qualitative information was collected from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar, and from the Surat districts of Gujarat State. In the second phase, a participatory design process was undertaken as part of the content creation and validation exercises.
The first phase collected information from 126 health care staff, with a mean age of 38.4 (SD 8.9) years and average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to TB program guidelines. The consultative process determined the need for a digital solution in easily accessible formats and ready reckoner content to deliver practical solutions to address operational issues for implementation of the program. Ultimately, the digital platform named Ni-kshay SETU (Support to End Tuberculosis) was developed to support the knowledge enhancement of health care workers.
The development of staff capacity is vital to the success or failure of any program or intervention. Having up-to-date information provides confidence to health care staff when interacting with patients in the community and aids in making quick judgments when handling case scenarios. Ni-kshay SETU represents a novel digital capacity-building platform for enhancing human resource skills in achieving the goal of TB elimination.
Background: Improved nutrition situation analysis can increase the understanding of the likely magnitude and main causes of the nutrient gap among children less than 2 years of age. The present study ...was aimed at assessing nutritional status and factors related to it in children less than 2 years of age in the Devbhumi Dwarka District of Gujarat, India. Methods: A descriptive cross-sectional study was conducted. The sample size for a population-based survey was calculated using Open Epi and considering 20% non-response rate. Sample size for the study was 1,200 but sample size achieved was 1,301. Chi-square analyses were performed to identify significant determinants of under-nutrition separately for stunting, wasting, and underweight. Results: The prevalence of wasting, underweight, and stunting was 14, 17, and 32%, respectively. Prevalence of low birth weight was recorded as 14% in the district. The overall prevalence of overweight was 20% and 6% as per weight for height and weight for age criteria, respectively. The proportion of children with exclusive breastfeeding observed to be decreasing with increasing age from birth to 6 months; 70% of children were exclusively breastfeed at the age of 6 months compared to 84% at their births. Chi-square analyses revealed that parity and spacing as significant determinants of under-nutrition in children less than 2 years in the district. Conclusion: In Devbhumi Dwarka, burden of malnutrition was recorded. Maternal literacy, parity, and spacing emerged as significant determinants of under-nutrition in children less than 2 years in the district. Multipronged and convergence approach is needed to combat menace of child malnutrition.
The Yashoda program, named after a legendary foster-mother in Indian mythology, under the Norway-India Partnership Initiative was launched as a pilot program in 2008 to improve the quality of ...maternal and neonatal care at facilities in select districts of India. Yashodas were placed mainly at district hospitals, which are high delivery load facilities, to provide support and care to mothers and newborns during their stay at these facilities. This study presents the results from the evaluation of this intervention in two states in India.
Data collection methods included in-depth interviews with healthcare providers and mothers and a survey of mothers who had recently delivered within a quasi-experimental design. Fifty IDIs were done and 1,652 mothers who had delivered in the past three months were surveyed during 2010 and 2011.
A significantly higher proportion of mothers at facilities with Yashodas (55 percent to 97 percent) received counseling on immunization, breastfeeding, family planning, danger signs, and nutrition compared to those in control districts (34 percent to 66 percent). Mothers in intervention facilities were four to five times more likely to receive postnatal checks than mothers in control facilities. Among mothers who underwent cesarean sections, initiation of breastfeeding within five hours was 50 percent higher in intervention facilities. Mothers and families also reported increased support, care and respect at intervention facilities.
Yashoda as mothers' aide thus seems to be an effective intervention to improve quality of maternal and newborn care in India. Scaling up of this intervention is recommended in district hospitals and other facilities with high volume of deliveries.
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