Research Fellowship

Research Fellow: Syed Shahid Abbas

Supervisors:
Manish Kakkar (India), Richard Coker (LSHTM)
Period:
2009 - 2010
Research project:
An appraisal of national disease surveillance systems in India: from NSPCD to IDSP and beyond

Despite the importance attached to infectious diseases as a public health priority in the Indian subcontinent, an integrated approach to their surveillance is a relatively recent phenomenon. This study aims to critically analyse the genesis of disease surveillance policies in India using a historical lens. It aims to document the global and national context that were crucial to the design and implementation of pilot programs on integrate disease surveillance and outbreak response. It seeks to examine the interactions between and the roles played by major actors and institutions in influencing the national strategy. The study uses case study method to study the successive surveillance models active in the country within the last twenty five years and document the policy formulation and implementation processes.

This is the first time that health systems approach will be used for analysing disease surveillance programs in India. It is expected that the study will result in policy papers and peer reviewed publications that can document the learnings from the past two decades for informing the preparation of the next generation of surveillance strategies.

Research Fellow: Mathew Sunil George

Supervisors:
Sunil Saksena Raj (India), Helen Lambert (UK)
Period:
2011 - 2013
Research project:
Challenges to accessing and remaining on art in India: perspectives of women and children living with HIV

In spite of the network of health care facilities across India that provide counseling and testing services, including specific programmes that address mothers who access health care facilities for ante natal visits, nearly five percent of the new HIV infections in India are attributable to parent to child transmission (Department of AIDS Control, 2010). Further, the epidemic disproportionately affects women with nearly 40% of those infected being women. In most cases women also tend to be the primary care givers for the children and have to both address their own adherence to therapy as well as that of their children who are HIV positive and in need of antiretroviral therapy.

This study seeks to explore the perspectives of women and children living with HIV in India in order to identify factors that promote or hinder access and adherence to antiretroviral therapy. The specific objectives of this study are i) Identify factors that enabled the decision to access ART among women and children ii) Map pathways from initial diagnosis to selection for treatment and subsequent maintenance on treatment iii) Map adherence to ART across two sites among women and children who are on treatment iv) Identify and explore factors that promote or inhibit access and adherence to ART among women and children across the two sites v) Explore the differences in factors if any that promote access and adherence among women and children on ART between sites in a high and a low prevalence area.

The following outcomes are expected i) Identify and describe patterns of adherence among women and children in India ii) Understand the factors that inhibit or promote adherence to ART among women and children iii) Recommendations for developing interventions to facilitate adherence among children and women who are accessing ART from the public health system.

Research Fellow: Akhtar Hussain

Supervisors:
Lalit Dandona (India), David Schellenberg (UK)
Period:
2011 – 2013
Research project:
An assessment of health system readiness to implement the policy transitions in malaria control in the state of Orissa

For effective control of malaria, the local healthcare structure, epidemiology of malaria and socio-economic factors are all likely to play a major part in determining what is appropriate in a given setting to control it. Global evidences suggest that, till now unfortunately far more effort of policy makers has gone into determining which antimalarials are efficacious than determining how to deliver them effectively, and health services are now having to play catch-up. In spite of several changes in the early diagnosis and treatment strategies which is being made at national level, the malaria burden in the state of Odisha has not shown any appreciable change over last five years. It accounted for one-fourths of total malaria cases, one-fifths of malaria deaths and 42% of Plasmodium falciparum infection of the national malaria burden in 2010.

This raises question about the effectiveness of the policy changes made in malaria control programme. Therefore this study proposes to analyze the context and process of new malaria drug policy formulation at national level; state public health system’s ability to implement it for prevention and control of malaria; and to analyze enablers and barriers of the health system in implementing this drug policy. This study will be a cross sectional study using a mix of both Quantitative and Qualitative study techniques. The study will help in identifying the ability of the state health system to implement the malaria drug policy, various steps the state has taken at different levels to adapt it and will help in identifying the various barriers and enablers in the programme implementation at the state level and thus help to improve the current practices.

Research Fellow: Neena John

Supervisors:
GVS Murthy (India), Clare Gilbert & Paul Sheils (UK)
Period:
2011 – 2013
Research project:
Determinants and markers of aging in India

The goal of the project is

  1. To review the epidemiological literature on aging and its risk factors To determine whether birth weight and early childhood nutrition and growth are associated with early onset of lens opacities and other signs of biological aging
  2. To study the relationship between early onset lens opacities and other physical markers of premature aging.

The 2,218 individuals examined in 1999-2002 will be traced and given unique id number. A lens opacity (LO) of 5-6% of will generate 75 to 90 participants with LO 80% of the cohort who are expected to participate. A total sample of 320 (3 controls per case and with 85% power to detect an odds ratio of 3 between the groups with two-sided 95% confidence level) will be chosen for a nested case-control study. Details on socio-demography and LO will be collected. Individuals with LO will be cases. Those who do not have LO on M-M grading identified by random sampling, and matched for age and gender will be recruited as controls. The two groups will be interviewed for information on vision, lens opacities, details on risk and confounding factors for LO. Digital retinal images will be taken and corneal endothelial cells counted for ocular aging markers. Hand grip strength, rising speed and walking speed will be measured for physical markers. Written consent will be obtained from participants. Quality of data will be maintained by training and monitoring of field team.

Expected Outcome:

  1. Determinants of aging
  2. Prevalence of risk factors for Lens opacity iii) Association of LO with early life events and physical markers of aging

Research Fellow: S G Prem Kumar

Supervisors:
Rakhi Dandona (India), Craig Morgan & Martin Prince (UK)
Period:
2010 – 2012
Research project:
Mental health consequences in children orphaned by AIDS: implications for service delivery

This research aims to investigate mental well-being of children orphaned by AIDS in India to recommend appropriate mental health intervention strategies for them.

The specific objectives are:

  1. To assess and compare mental health consequences of children orphaned by HIV/AIDS and those who are orphaned for reasons other than HIV/AIDS;
  2. To identify mental health service delivery issues for the children orphaned by HIV/AIDS;
  3. To make recommendations for mental health intervention programme and advocacy for children orphaned by HIV/AIDS in India.

Around 600 children aged 12 to 16 years who had had at least one parent die due to HIV/AIDS and those who had had at least one parent die because of reasons other than HIV/AIDS will form the study sample. They will be recruited from NGOs providing support services to orphans in Hyderabad. Face-to-face confidential interviews will be conducted with them to document the mental health issues in order to recommend appropriate mental health intervention strategies. Additionally, semi-structured interviews would be conducted with a sample of NGO staff from where these children will be recruited, relevant personnel at Andhra Pradesh State AIDS Control Society, National AIDS Control Organisation, and any other relevant key personnel identified during the study to document the issues related to mental health service delivery programs. National policy framework for orphans will be reviewed for relevant countries to guide formulation of such policy for India.

The expected outcomes from this study are:

  1. Increased understanding of mental health issues in orphaned children;
  2. Contribution to development of relevant mental health interventions for these children;
  3. Recommendations to facilitate delivery of mental health interventions and for an integrated national policy framework for orphaned children.

Research Fellow: Seema Murthy

Supervisors:
Krishna Dipankar Rao (India), Chris Grundy & Kara Hanson (UK)
Period:
2011 – 2013
Research project:
Barriers to access maternal health services in rural Andhra Pradesh with special focus on spatial access

The goal of this project is to develop methods to assess demand side barriers to access public health service, applicable in rural areas of a developing country.

The objectives are:

  1. Assess barriers to access to maternal health services in a rural area of Andhra Pradesh
  2. Spatial analysis using GIS software to map areas of access and gaps in access, for antenatal care and delivery
  3. Dissemination of findings to policy makers and community leaders.

Methods, Analysis and Outcomes: One district in AP will be purposefully selected. The three outcomes being studied are antenatal care, planned place for delivery and actual place of delivery. Information on distances, cost of traveling, transportation, connectivity and topography will be collected at the village level. Household surveys as well as exit interviews at health facilities will be done.

Multivariate regression will be done for analyzing the relative importance of the spatial, financial and cultural barriers. Digital maps will be acquired from Survey of India. A geo-database will be created linking spatial data, census data and data from the surveys. Buffer analysis will be used using Euclidean distance. Network analysis will be done based on the extent the software supports this. Underserved areas will be identified based on current population norms. This will be contrasted with underserved areas identified by the reasonable distance for travel obtained by the survey.

Research Fellow: Vivek Virendra Singh

Supervisors:
Lalit Dandona (India), David Heymann (UK)
Period:
2010 – 2012
Research project:
Importance of timeliness, completeness and timely response to an outbreak in disease surveillance: an evaluation of the critical components of IDSP in Andhra Pradesh, India

The goal of the project is to assess and review the factors (enablers and barriers) affecting the outcome of the disease surveillance and response system in the state of AP. The objective of the study is to assess factors which affect key inputs (manpower, trainings), processes (timeliness and completeness of routine reports) and outcome (timeliness of response to outbreaks) of the system. Correlation between the Laboratory, Syndromic and Presumptive surveillance components of the IDSP, for H1N1 cases and influenza like illnesses will also be assessed.

The study design will be a combination of quantitative (descriptive) and qualitative cross sectional study. The study would be conducted in 60 reporting units across 6 districts and by interviewing 38 H1N1 positive cases, selcted through multi stage stratified sampling strategy.

Output / Outcome: Identification of factors (enablers & barriers) which affect the desired output from the disease surveillance and response system in the state. Capacity building of stakeholders during the evaluation for using IDSP information for strategic program planning and monitoring – leading to optimal utilization of health system resources. Increase in Completeness & Timeliness of routine reports to 80%; strengthening of documentation of timeliness of response to outbreaks; reduction of average timeliness of response to outbreaks by 50% by the end of the year 2013.