Research Grants

Principal Investigator: Veena Iyer

Principal Investigator:
Veena Iyer
Co-Investigator:
Gulrez Azhar
UK Collaborator:
Russell Dacombe (LSTM)
Period:
2011 – 2013
Research Project:
Laboratory Capacity for Infectious Diseases of Integrated Diseases Surveillance Project (IDSP) in Gujarat - Present Status and Way Forward

Rationale: Laboratory networks are recognized as the backbone of surveillance programs. In India, till date, labs across states or regions haven’t been adequately standardised. We do not have enough published data about the capacity and need of various labs in the country based on which future lab systems could be planned.Concurrently, the government is rapidly scaling up investments in health. A number of government medical colleges in Gujarat have recently been provided with PCR machines but most of them do not have adequately skilled staff to carry out the sophisticated investigations from these machines.The varied private labs in selected study areas will also be investigated to complete the picture. Of these, some are a part of the well-established branded chain of labs while others are dilapidated smaller labs usually located in far off and rural areas. The human resources operating them range from well qualified pathologists and microbiologists with MD (or equivalent) qualifications to untrained, trained on the job or under-qualified workers. In this study the researchers will explore the quality of linkages that have already been formed with private labs in the state, the breadth and depth of microbiological and biochemical tests possible in the best, medium and last of these labs.

Goal: Direction setting of laboratory capacity for infectious diseases surveillance in Gujarat.

Objectives:

  1. To document the present status of Infectious Diseases Surveillance in Gujarat
  2. To investigate a sample of District Hospital (L2) and Medical College (L3) labs for Infectious Diseases
  3. To investigate a sample of District Hospital (L2) and Medical College (L3) labs for Infectious Diseases
  4. To compare IDSP with ID surveillance programs in other countries

Current Status: The project is in its initial phase and has just commenced. We are completing the paper work required to hire a Research Associate and in the process of indentifying an appropriate candidate for the same.

Principal Investigator: Shridhar Kadam

Principal Investigator:
Shridhar Kadam
Co-Investigator:
Sanghamitra Pati, N. Srinivas, Akhtar Hussain, Kavya Sharma, Abhimanyu Chauhan
UK Collaborator:
Tim Martineau
Period:
2011 - 2012
Research Project:
Career Pathways for Doctors Working in Government Health Systems in Odisha: Current Scenario and Future Opportunities

Background: Doctors in addition to providing clinical services, play an important role in planning and implementation of health service delivery in public health system. However, the State of Orissa faces the problem of shortage of human resources particularly the doctors. Career progression of doctors not only plays key role in recruitment and retention of doctors but also efficient use of them. The present study can provide timely evidence for decision making and policy development and contribute to the efforts of the government for developing efficient health workforce in the state including development of public health cadre.

Goal: To chart existing career pathways for Doctors working in government health system in Orissa and enable policy makers for modifying the career pathways based on best practices explored through stakeholders’ consultation, available evidence and experience

Objectives:Describe composition and distribution of doctors working in government health system under directorate of health services in Orissa.

Study recruitment rules, promotion strategies, placement and transfers, monetary and nonmonetary incentives, professional growth opportunities for doctors in Orissa.

Understand the perceptions of key stakeholders related to career pathways for doctors.

Create a map of existing career pathways and design a career progression framework for doctors working in government health system in Orissa.

Suggest context specific and workable mechanisms of career progression for doctors in Orissa and provide inputs in government’s effort in developing public health cadre in Orissa.

Methodology: This is a cross-sectional study using both qualitative and quantitative techniques. Data collection will comprise three components - desk review, in-depth interviews with key informants and doctors and consultation workshop with stakeholders. The study period is one year from 15/10/2011 to 14/09/2012.

Current Status: The project has been approved and an agreement was signed to this effect with PHFI-WT capacity building programme. The team is in process of literature search and compiling of documents for the desk review.

Principal Investigator: Sailesh Mohan

Principal Investigator:
Sailesh Mohan
Co-Investigator:
Shweta Khandelwal, Roopa Shivashankar
UK Collaborator:
Neil Poulter (Imperial College)
Period:
2011 – 2013
Research Project:
Assessment of dietary salt intake levels among adults in Delhi and Haryana, India.

Background: Multiple epidemiological studies conducted worldwide have found excess dietary salt or sodium intake to be associated with increased risk of high blood pressure or hypertension. Given that nearly half of blood pressure related cardiovascular (CVD) events occur among those without clinical hypertension, population-wide salt reduction is clearly one of the most cost-effective strategies to prevent CVD. India has a very diverse dietary culture with extensive use of salt and spices. However, contemporary data on population salt consumption is very limited. Given the high and growing burden of hypertension and its inadequate management in India, population based prevention strategies are warranted. Thus, it is imperative to determine current salt consumption levels so that appropriate evidence based preventive public health action can be initiated. The overarching goal of this study is to assess dietary salt intake levels among a representative sample of adults aged ≥ 24 years residing in urban Delhi and rural Haryana by conducting a cross sectional survey.

Specifically, the study will:

  1. Determine the mean daily salt consumption through the collection of 24-hour urinary sodium excretion samples.
  2. Determine the main sources of salt in the diets using 24-hour dietary recall method.
  3. Assess knowledge, attitudes and behaviours with regard to salt consumption and its impact on health by a questionnaire.

Principal Investigator: GVS Murthy

Principal Investigator:
GVS Murthy
Investigators undergoing research capacity building:
Neena John, Sutapa Neogi, Hira Pant, Rashmi Pant, Sudha Ramani, N. Srinivas
UK Collaborator:
Pat Doyle & Sanjay Kinra (LSHTM), Andy Ness (Bristol)
Period:
2011 – 2013
Research Project:
The public health consequences of folic acid deficiency in mothers and benefits of peri-conceptional folic acid supplementation on pregnancy outcomes, with special reference to Neural tube disorders (NTD) and Oro-facial clefts (OFC) in India.

The project’s primary aim is to strengthen research capacity across Public Health Foundation of India (PHFI) institutions in an area related to Maternal and Child Health and Childhood disability.

The research will be undertaken in phases through the hierarchical evidence based approach from descriptive, analytical and experimental study designs. In Phase 1 Systematic Reviews will be conducted to summarise the existing research evidence on the public health impact of folic acid deficiency on adverse pregnancy outcome and the effectiveness of interventions using folic acid supplementation in India and other low and middle income countries.

In Phase 2, Prevalence & Descriptive Studies using Key Informant method will be done and assessment of whether key informants can identify NTD & OFC which are visible to the naked eye. The study will describe epidemiological characteristics of specific congenital anomalies such as NTD & OFC and explore contextual and systemic factors affecting the implementation of interventions to combat folic acid deficiencies.

Phase 3 will undertake case-control studies to identify risk factors for specific congenital anomalies in the study population.

In Phase 4, Intervention Studies (Trials) to plan and undertake randomized controlled trial using folic acid+ Vitamin B12 supplementation during the pre-pregnancy stage in mothers with previous history of child born with NTD or OFC in the previous pregnancy within the last 5 years. The RCT will be conducted in Mahbubnagar district in Andhra Pradesh.

Cost effectiveness analyses will be done for the intervention and in Phase 5 a cohort will be assembled for future research.

Progress so far:

  1. A collaborative India partners meeting through a teleconference to agree on the next steps and identifying roles and responsibilities was undertaken.
  2. The process for Ethical approval at PHFI is being pursued

Principal Investigator: N. Nakkeeran

Principal Investigator:
N. Nakkeeran
Co-Investigator:
Aruna Bhattacharya
UK Collaborator:
Sushrut Jadhav (UCL)
Period:
2011 – 2013
Research Project:
Exclusion and self-exclusion from supplementary nutrition program: Short ethnographies from selected villages of Gujarat

Aim
To understand the institutional barriers and sociological process that lead to exclusion and self-exclusion of families and children from ICDS services with a special focus on SNP.

Objectives

  1. To capture the social imagery of different socio-economic groups on SNP
  2. To understand the socio-cultural and institutional processes that operate in society leading to differentials in levels of utilisation SNP
  3. To bring out cultural practices associated with weaning and complementary feeding practices including acceptability of ready-to-cook take-home-rations.
  4. To identify programmatic measures to address the issue of low utilisation of SNP services in identified communities.

Current status

  1. Preparation for submitting proposal for ethical approval
  2. Instruments and tools being prepared
  3. TOR for recruitment of staff being drafted

Principal Investigator: Gitanjali Narayanan

Principal Investigator:
Gitanjali Narayan
Co-Investigator:
VS Ajay, Dimple Kondal
UK Collaborator:
Richard Holt (Southampton)
Period:
2011 – 2013
Research Project:
Psychiatric Determinants of Cardiovascular Diseases in Urban India

Goal: Psychiatric disorders are chronic, disabling conditions associated with marked health costs. In India, at least 7% of the adult population suffers from a mental illness, highlighting the need to examine its relationship with Cardiovascular Diseases (CVD). This has contributed to two core findings. Firstly, psychiatric disorders, particularly, depression acts as a risk factor for CVD such as coronary heart disease (CHD) and stroke, and is often concurrent with CVD risks such as diabetes and hypertension. Meta-analysis of data indicates current co-morbid prevalence rates between depression and diabetes to range from 22 to 29%, with pronounced gender differences. Secondly, the presence of CVD increases the risk of psychiatric illness, which may contribute to poorer treatment outcome and difficulties with medical concordance, and poor quality of life. The present 2-year study will therefore provide a powerful framework to examine psychiatric co-morbidity and psychosocial risk factors in CVD. It utilizes the research infrastructure of the ongoing CARRS (Center for Cardio-Metabolic Risk Reduction in South Asia) surveillance project with the objective of estimating the baseline prevalence of psychiatric disorders in 1500 participants detected with CVD (specifically, coronary heart disease, stroke, hypertension, diabetes) who will be recruited from the New Delhi site. Following this, we will employ a nested case-control design in 500 participants to investigate whether psychiatric disorders differ between CVD cases and matched controls. Standardized mental health questionnaires will be administered to all subjects.

Objectives

  1. Objective 1. To estimate the prevalence of DSM-IV (Diagnostic and Statistical Manual, American Psychiatric Association) defined Axis I psychiatric disorders in community participants from urban Delhi detected with CVD (specifically, CHD or stroke) and its risk factors (specifically, hypertension or diabetes mellitus) as measured using questionnaires, laboratory estimations and interviews from the CARRS surveillance study.
  2. Objective 2. To examine whether the prevalence of Axis I psychiatric disorders in CVD cases (defined using the CARRS criteria as participants above the age of 20 years, residing in community settings in urban Delhi and detected using appropriate diagnostic tools with CHD, stroke, diabetes or hypertension) differs from that of controls (defined as participants who will be sex, age and social setting matched with cases but who do not have CVD or its risk factors).
  3. Hypothesis 2A. The prevalence of all Axis I psychiatric disorders will be significantly higher in CVD cases (that is, in participants with CHD, stroke, diabetes or hypertension) than in controls.
  4. Hypothesis 2B. The presence of a co-morbid Depressive Disorder will act as a risk factor for CVD.

Current Status (1/10/2011-30/10/2011)

  1. Preliminary phase of study initiation: Tools have been compiled in English versions and available Hindi versions.
  2. Permissions have been obtained from authors for use of copyrighted tools
  3. Development of Manual of operations initiated
  4. Compilation of materials for Ethical clearance from Public Health Foundation of India, New Delhi, India. Plan for next 10 days: Submit proposal for ethical clearance at PHFI committee, recruit 2 research assistants, initiate translation of tools into Hindi and back-translation.

Principal Investigator: Preeti Negandhi

Principal Investigator:
Preeti Negandhi
Co-Investigator:
Himanshu Negandhi, Kavya Sharma
UK Collaborator:
Sarah Wild (Edinburgh)
Period:
2011 – 2012
Research Project:
An evaluation of the post graduate diploma in public health management

The National Rural Health Mission (NRHM) foresaw improved management through a sustained capacity development of in-service health personnel and their subsequent placement in the public health system. Recognizing the shortfall in public health managerial skills in the public sector, the PGDPHM programme was conceived under NRHM to enhance the managerial capabilities of public health professionals who would contribute substantially to the public health system of the country and improve the overall standard and the quality of the system.

It is imperative that the time and money invested yield good returns. In light of these investments, it is necessary to evaluate the impact of the programme on the work performance of the people in thepublic health system. This would also give an opportunity to understand how these skills and knowledge have influenced the candidates in terms of capacity building.

Aim:

  1. To evaluate the outcome of the Post Graduate Diploma (PGDPHM) in Public Health Management on the public health system across the country.

Objectives:

  1. To gauge the perspectives of the graduates about the PGDPHM programme.
  2. To assess whether the knowledge, attitudes, behavior and practices of the graduates have changed after participating in this programme.
  3. To understand the perspectives of the immediate supervisors of the graduates, work colleagues, their subordinates and senior state level officers as well as institute heads, course coordinators and faculty members about the programme and the work performance of the graduates after participating in the programme.
  4. To map the jobs secured by the self-sponsored graduates after completing the programme.

Current Status:

  1. The project proposal has been submitted to IEC at Public Health Foundation of India for ethics clearance. Response awaited.
  2. Steps to be undertaken as soon as ethics approval are being currently planned by the study team.

Principal Investigator: Hanimi Reddy

Principal Investigator:
Hanimi Reddy
Co-Investigator:
Sukumar Vellakal, Anil Chandran
UK Collaborator:
Pat Doyle, Kiran Nanchahal (LSHTM)
Period:
2011 – 2013
Research Project:
Multi-dimensional Analysis of Janani suraksha yojana programme Activities in eight EAG states

Goal: To provide a comprehensive overview of the roll-out of the Janani Suraksha Yojana (JSY) programme activities in eight empowered action group (EAG) states of India, over the past six years, in order to help planners of national rural health mission – phase two (NRHM-2, 2013-2020) in proposing evidence-based modifications /improvements to the programme.

Objectives:

  1. Estimate family costs of delivery care at different cut-offs (percentiles) according to place and type of delivery;
  2. Estimate average cost of: home, Government and private institutional delivery - among the JSY beneficiaries & non-beneficiaries;
  3. Assess proportion of JSY beneficiaries & non-beneficiaries who have borrowed money/sold property for meeting the delivery costs of a home / institution /normal /caesarean-section delivery;
  4. Determine the factors that influence JSY programme use in eight EAG states by analyzing secondary data from multiple sources;
  5. To list the pathways that lead families to borrow money or sell property for delivery care, when they benefit/do-not-benefit from the JSY programme;
  6. Understand the influence of: ASHA’s knowledge/performance and preparedness of health sub-centre (HSC) & primary health centre (PHC) to provide quality services - on JSY uptake.

Current Status: Analysing DLHS-3 data for the states/union territories of India, to understand how out-of-pocket expenditure on delivery care vary according to type & place of delivery. Variations in costs of delivery according to socio-economic and demographic profile of women of India were also looked into. Trying to understand what proportion these deliveries got JSY benefit and what is the influence of out-of-pocket expenditure on delivery care on the proportion of women/families opting for borrowings. The analysis done so far, will lead us to develop a research article (by December, 2011 end) which would address the first three objectives of the study. Networking with IIPS, Mumbai and UNICEF, New Delhi - for getting accessing their data-sets on JSY topic.

Principal Investigator: Somen Saha

Principal Investigator:
Somen Saha
Co-Investigator:
Rajesh Nair
UK Collaborator:
James Hargreaves (LSHTM)
Period:
2011 – 2013
Research Project:
Impact of credit with health access on health status of MFI clients in India: Study of MFI programs at different levels of integration

Research Task : The aim of the study is to analyze the effect of provision of credit plus health services on the clients of microfinance programs in India.

Key research questions for the study are:

  1. Does access to credit plus health have any differential impact on microfinance members’ health status, specifically institutional delivery and childhood diarrhea?
  2. Does having provision for credit plus health services protect the household incomes, and reduce out-of-pocket health expenditure of microfinance members?

Methodology: A before and after comparison study with control group will be carried out with two arms of: SEWA in Gujarat and SKDRDP in Karnataka. An area served by credit with health access will be selected as intervention arm for the study. A similar arm, served by the MFI, but with no linked health intervention, will serve as a matching control to allow for assessment of the additional benefits provided by health intervention. This will be a natural experiment.

The study will aim to address if access to credit plus health services have any differential impact on institutional delivery and childhood diarrhea, and its impact on health expenditure of clients.

Current Status: An orientation visit with SKDRDP was positive and the Executive Director of SKDRDP has requested doubling the sample size, with additional funding from SKDRDP resources. This will enable comparing new and old program areas of SKDRDP. This study is being integrated and will serve important information for the larger Johnson & Johnson funded study (credit plus health education) that Microcredit Summit Campaign is involved with SKDRDP.

First orientation meeting and site visit with SEWA is planned on 9th October 2011. A detail site specific study protocol is being designed for both SEWA and SKDRDP to obtain technical and ethical clearance for the study. We are in the process of recruiting Dr. Jasmine Lydia as Research Manager for the project.

Principal Investigator: Kabir Sheikh

Principal Investigator:
Kabir Sheikh
Investigators undergoing research capacity building:
JK Lakshmi, Devaki Nambiar, Venkatesh Narayan, TN Sathyanarayana
UK Collaborator:
John Porter (LSHTM)
Period:
2011 – 2013
Research Project:
Engaging Traditional, Complementary and Alternative Medical (TCAM) providers in the delivery of essential health services

Description: Traditional, Complementary and Alternative Medicine (TCAM) in India is constituted of a multitude of medical systems and traditions, of which six are formally recognized by the government: Ayurveda, Unani-Tibb, Homeopathy, Yoga and Naturopathy, Siddha and Sowa-Rigpa. As India moves towards Universal Health Coverage, it has become critical to consider the value of TCAM practitioners as widely utilized and preferred providers of primary care, and integrate them into mainstream systems of delivery of essential health services. This project is a policy (implementation) analysis of TCAM integration strategies in three States: Meghalaya, Kerala and Delhi. The study draws on in-depth interviews with health systems actors, and review of policy documentation, and uses the "framework" approach of qualitative data analysis for applied policy research, to 1) conduct a landscape review of TCAM policy in India, and 2) diagnose operational and ethical barriers and facilitators of mainstreaming TCAM providers. Our findings will inform the strategic directions of India’s UHC reforms, and will also contain key lessons for TCAM integration strategy in comparable low and middle-income country contexts. The project will also develop benchmark capabilities among mid-level and junior staff at PHFI for conducting Health Policy & Systems Research, using qualitative research methods. This project is a formative research activity of the recently instituted Health Governance Hub at PHFI.

Goals: To diagnose systemic and ethical challenges in integration of TCAM providers (including AYUSH) for delivery of essential health services in three Indian states, and apply this knowledge to derive lessons for strengthening integration strategies and making them more sustainable II. To develop benchmark capabilities at PHFI for conducting and leading Health Policy and Systems Research, with a focus on policy analysis and ethical analysis using qualitative research methods.

Principal Investigator: Archna Singh

Principal Investigator:
Archna Singh
Co-Investigator:
Suparna Ghosh Jerarth
UK Collaborator:
Karen Lock (LSHTM)
Period:
2011 – 2013
Research Project:
Trans fats in the food supply in India: a pilot study to align policy options with the population consumption pattern

Goal : The goal of the project is to identify interventions that are likely to be feasible at different levels of the food supply chain to reduce trans fat intake at a population level. The project will investigate the trans fat scenario in India at the three levels of the food supply chain i.e. the PHVO manufacturers/industry, the retailers and the consumers. These are the key players who are most likely to impact the success of the regulatory and implementation process. Hence, this proposal aims to provide evidence from multiple sectors to policymakers aiming to set limits for trans fat levels in cooking media being used in the country.

Objectives:

Manufacturer level:

  1. To examine the feasibility of lowering trans fat content in PHVOs at the manufacturing level and the cost effectiveness of the process.
  2. To investigate the industry perspectives on feasibility of manufacturing vanaspati with currently stipulated level of trans fat.

Retail Level:

  1. To assess readiness of the consumer and snack retail outlet owners street vendors to shift to healthier options/substitutes?
  2. To analyze trans fat levels in the commonly consumed snacks from vendors in the communities being studied.

Consumer Level:

  1. To estimate the proportion of daily energy intake contributed by trans fat in an urban and rural low SES community using validated dietary intake instruments.
  2. To analyze levels of trans fatty acids in the serum of a sub-sample of the two population groups surveyed.

Current status: the project will become officially operational on the 1st of November, 2011. The process of preparing documents for submission to the internal ethics committee of IIPH–Delhi and recruitment of sanctioned personnel is underway.

Principal Investigator: Giridhar Babu

Principal Investigator:
Giridhar Babu
Co-Investigator:
GVS Murthy, Anil Chandran
UK Collaborator:
Sanjay Kinra (LSHTM), Sara Benjamin Neelon (Cambridge)
Period:
2012 – 2014
Research Project:
Maternal Glucose levels and Adiposity in infants - A pilot study to establish feasibility of a large cohort study

Recent Studies conducted in selected populations suggest hyperglycemia in pregnancy may be an important risk factor for obesity and type-2 diabetes in their offspring. It is important to understand how varying levels of maternal glucose are associated imminent risk of non-communicable diseases. In order to study this, prospective examination of body fat distribution in children born to mothers with different glycemic levels is to be done.

The proposed study is an attempt to pilot a possible larger cohort to examine plausible association. The larger cohort study is planned with around 10000 pregnant women in India. Through this pilot, we are studying recruitment issues, mobility of pregnant women and determinants of following them up successfully and viability of following pregnant women in diverse background.

Currently, we are in the initial stages of recruiting for the pilot cohort study based on standard protocol and after obtaining informed consent. The women will be recruited at or before 24 weeks of gestation. Following delivery, the measurements of skinfold thickness and weight for length in infants will be taken at three times during infancy. The exposure of interest is continuous range of glucose as exposure. Standardization of the results will be done through central laboratory.

Primarily, we will calculate indicators addressed at feasibility and recruitment issues. We will also calculate adiposity as a marker of diabetes in children at birth, 3 months and 6 months of follow-up and examine its association with gradient of maternal glucose levels.

The pilot study by Giridhar is examining the idea conceived by Sanjay Kinra, Clinical Epidemiologist at London School of Hygiene and Tropical Medicine. The other collaborators on the study are Prof.GVS.Murthy, Vice President-PHFI (South), Director, IIPH-Hyderabad and Sara Benjamin Neelon from DUKE global health institute. Dr.Lavanya Garadi is research associate ably supported by Mr. Amaresh in this project.

Principal Investigator: Suparna Ghosh Jerath

Principal Investigator:
Suparna Ghosh Jerath
Co-Investigator:
Melina Magsumbol, Archna Singh
UK Collaborator:
Gail Goldberg (MRC, Cambridge)
Period:
2012 – 2014
Research Project:
Indigenous and traditional foods for addressing food and nutrition security: An enquiry into the possible contribution of bio diversity with emphasis on dietary diversity through consumption of indigenous/wild foods in the tribal communities of Jharkhand, India

Background:  Food and nutrition insecurity is a major concern for tribal populations.  Jharkhand state has 30 Scheduled Tribes; Santhal and Oraon being two most populous. Two percent of tribal population face chronic hunger and 10% experience seasonal food insecurity. Chronic energy deficiency affects 39% men and 48% women in Jharkhand. A rich habitat of indigenous foods in tribal environments have potential to promote food security, nutrition and health. Understanding food systems of indigenous peoples and strengthening them in context of nutrition and health pose unique challenges.  

Aims and Objectives: The current project aims to look at the nutritional status of the Santhal and Oraon tribal communities of Goda and Gumla district of Jharkhand respectively. Further, the indigenous foods consumed as a part of daily diet by these communities will be studied and the contribution of these foods in addressing food and nutrition security will be investigated.

Methods: This will be an exploratory, cross sectional study on Santhal and Oraon tribes (140 households each) in selected districts and stratified by villages. The study will use mixed methods.  Qualitative methods will include Participatory Rapid Assessment, Free listing, pile sorting and ranking, FGDs and Interviews. Quantitative methods will include anthropometry, 24-hour dietary recall, food frequency questionnaire, socio-demographic profile, food consumption patterns and food security assessment and lab analysis.

Outcome: Scientific appraisal of dietary patterns and their influence on the nutritional status of tribal communities can help in developing systems whereby communities can be encouraged to strengthen use and knowledge of local food and food systems. This can inform policies needed to improve food security, and promote indigenous food to mitigate the nutrition transition and help prevent environmental degradation, food chain contamination, and promote long-term sustainable ecosystems and health.

 

 

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Principal Investigator: Sanghamitra Pati

Principal Investigator:
Sanghamitra Pati
Co-Investigator:
Abhimanyu Singh Chauhan, Akthar Hussain, Shridhar Kadam
UK Collaborator:
Chris Salisbury (Bristol)
Period:
2012 – 2014
Research Project:
Prevalence, Pattern and Correlates of Multimorbidity in Primary Care Setting:  An Exploratory Study in Odisha, India

Multi morbidity defined as “the existence of two or more chronic diseases in one individual” is becoming a norm than exception in primary care. The presence of multimorbidity is associated with increased health service utilization and poorer health outcomes. Individuals with multimorbidity register a higher mortality rate, incur higher healthcare costs, and have a higher risk of hospital admissions; a poorer perception of their physical and mental health; a poorer quality of life ; and a lower functional capacity. Considering its incidence and socioeconomic impact, multimorbidity thus constitutes a challenge to healthcare services in the 21st century. Studies from different parts of the world showed prevalence of multimorbidity to vary from 10% to 83%.  In India, till date, there are limited studies on multi morbidity. Present study intends to assess the prevalence and pattern of multimorbidity among patients presenting to primary care and to assess the relation of multimorbidity with self rated health and quality of life. The specific objectives are to:

  1. Explore how common is self reported multimorbidity among patients attending public and private primary health care facility.
  2. Identify commonly occurring combinations or pattern of multimorbidity among these patients.
  3. Find out how multimorbidity varies with age, gender, socioeconomic characteristics and type of health facility.
  4. Explore health care utilization by patients with multimorbidity.
  5. Assess the relationship between multimorbidity and health related quality of life.

The results of the study would give an idea of the magnitude of the problem in primary care settings and accordingly provide insights for redesigning health services as well as   need based capacity building of public and private health care providers in prevention and management of multiple chronic diseases.

Principal Investigator: Melina Magsumbol

Principal Investigator:
Melina Magsubmol
Co-Investigator:
Arpita Ghosh, Archna Singh, Neelam Kler, Indrani Ganguli, Atul Srivastava
UK Collaborator:
Shakoor Hajat (LSHTM)
Period:
2012 – 2014
Research Project:
A retrospective cohort study of the impact of criteria air pollutants on birth outcomes in an urban community of New Delhi, India

This retrospective cohort study will use a semi-ecologic design to explore the association of environmental factors that impact or influence birth weight and gestational age in an urban community in New Delhi. The link between exposure to criteria air pollutants such as particulate matter or dust (PM10, PM2.5), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and negative birth outcomes is of immense interest to public health researchers. The current pilot study proposes to assess the impact of criteria air pollutants on infant birth weight and prematurity. The study will assess the feasibility of using hospital birth records linked with ambient air pollution monitoring data (as a marker for exposure) recorded from 2007-2012 in New Delhi. Birth records will be assessed for completeness especially for maternal risk factors that have been shown to impact birth outcomes in other studies. A community mapping exercise will also be conducted to determine other point sources of pollution that may be present in the maternal local environment.

The specific objectives of the project are:

a. To assess the gaps in current hospital health management information systems (prenatal, delivery, neonatal, discharge data) for environmental studies. This study will consider the feasibility of using hospital data for linking with environmental data.

b. To assess ambient exposure of pregnant women who live in an urban community in Delhi to criteria pollutants

c. Assess the relationship, if any, between criteria air pollutants to low birth weight (<2500g) and prematurity (<37 weeks gestation)

Study team:

Primary investigator:  Melina S. Magsumbol-Samaddar is a medical anthropologist studying the impact of environmental pollutants on birth outcomes and child survival.