Background Prioritizing zoonotic diseases is one of the emerging tasks for developing multi-sectoral collaboration within One Health. Globally, many efforts have been made to prioritize zoonotic diseases at national levels, especially in low resource settings. Prioritization of zoonoses has been conducted in different countries at different levels (i.e. national, regional and local) for different purposes. India has also initiated prioritization of zoonotic diseases at the national level. However, in a country like India with wide climatic variations, different animal-human and vector densities, it is important to look at these zoonotic conditions in local settings too. The present study aims to determine which zoonoses should be prioritized for collaboration between stakeholders in the Indian city of Ahmedabad. Methods The present study followed a participatory research method, entailing a stakeholder workshop for prioritizing zoonotic diseases in Ahmedabad. It was carried out through a facilitated consultative process involving 19 experts in zoonoses from the human and animal health systems during a one-day workshop in September 2018. To prioritize the zoonotic diseases, the One Health Zoonotic Disease Prioritization (OHZDP) tool of the U.S. Centers for Disease Control and Prevention was adopted. The Analytical Hierarchical Process (AHP) and decision-tree analysis were used to rank the diseases. Results Out of 38 listed zoonotic diseases, 14 were selected for prioritization. These were scored and weighed against five criteria: severity of disease in humans, potential for epidemic and/or pandemic, availability of prevention and/or control strategies, burden of animal disease existing inter-sectoral collaboration. The top five diseases that have been prioritized for Ahmedabad are Rabies, Brucellosis, Avian Influenza (H5N1), Influenza A (H1N1) and Crimean-Congo Hemorrhagic Fever. Sensitivity analysis did not indicate significant changes in zoonotic disease prioritization based on criteria weights. Conclusion Prioritization of zoonotic diseases at the local level is essential for development of effective One Health strategies. This type of participatory disease prioritization workshop is highly recommended and can be replicated in other Indian cities, as well as in other low and middle-income countries.
Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries’ regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study’s findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.
Background Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting. Methods This case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide). Results The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers. Conclusion ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.
Background and Aims:Globally, breast cancer is one of the major public health problem. In Indian women, breast cancer is now the most common cancer, having recently overtaken cervical cancer in this respect. Breast Cancer though on the rise among Indian women, they still do not perceive themselves at risk. Poor awareness about the disease, its risk factors and the absence of population-based screening contribute to delayed diagnosis. The aim of this study is to assess knowledge and practice of breast cancer in general and breast self-examination (BSE) amongst urban accredited social health activist in Ahmedabad, Gujarat.Methods:The study was conducted in three phases: pre-intervention phase, intervention phase, and post-intervention phase during 2018. A total of 104 ASHA participants were included and awareness about breast cancer and practices of breast self-examination was assessed through interviewing two different groups at two points of time: Control and Intervention group at the base line and end line. Interventional breast health education was administrated through lectures, charts and silicon breast model for the basic knowledge of the breast cancer. The data had been analyzed by using software Epi info.Results:There was a significant improvement in knowledge regarding breast cancer and breast self-examination among the intervention group from pre- to post-test. An overall increase in the awareness of breast cancer 33%, Method of doing BSE of 54% and 42% of BSE practice was observed in the study group after intervention.Conclusion:A significant changes were observed in the knowledge. However, the behavior change requires reinforced training in regular interval.
Background: Community Health Workers (CHWs) are the mainstay of the public health system, serving for decades in low resource countries. Their multi-dimensional work in diverse health care services, including the prevention of communicable diseases and health promotion for non-communicable diseases, are making CHWs the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of the western cities of India, Ahmedabad, targeted to identify OHA by exploring the motivation to become an OHA in a local setting.Methods: This case study explores two major CHWs i.e. female (Accredited Social Health Activists-ASHA) and male (multipurpose male health worker) on their motivation for becoming an OHA. The data was collected between September 2018 and August 2019 through a mixed design i.e. quantitative data (cross-sectional structured questionnaire) and qualitative data (focus group discussion with a semi-structured interview guide). Results: The motivation of the CHWs for OHA was found to be low. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. ASHAs were found to be willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Conclusion: The high demotivation of CHWs that has been documented on the individual, community, and health system level needs to be urgently addressed in future policies.
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