Rigorous research at our centres and institutes spans multiple disciplines (e.g., demography, anthropology, epidemiology, genetics, health economics, psychology, and nutrition) and includes a range of study designs, ranging from prevalence and cross-sectional surveys to genetic, epigenetic, environmental and risk factor epidemiology, cohort and multi-generational cohorts, outcomes evaluation and cost-effectiveness, qualitative methods, programme evaluation, clinical trials, translation research and systematic reviews.
KEY THEMATIC AREAS
PREVENTION AND CONTROL OF NON COMMUNICABLE DISEASE
India is undergoing major social and economic changes leading to rapid increases in the prevalence of chronic diseases, notably cardiovascular disease, cancer, chronic pulmonary disease and diabetes. Chronic diseases have their roots in early life, yet very little is known about what causes them to emerge at a young age or the pathways through which societal and environmental changes linked to urbanisation affect chronic disease risk. Today, half of India’s deaths are due to diabetes, stroke, heart disease, chronic obstructive pulmonary disease (COPD), cancers, mental health disorders and injuries. There is an alarming acceleration in the prevalence of these chronic, non-communicable diseases (NCDs). Notably, NCDs not only disproportionately impact people at younger ages in India compared to developed countries causing premature loss of life, but also increasingly afflict the poorer sections of society.
Our efforts have been aimed at building evidence for understanding the NCD burden, etiology and interventions, education and training of health workers and health professionals, capacity building from the district to state and national levels, health communication and advocacy to promote health-seeking behaviours, and influencing policy through rigorous analysis of evidence and engagement with stakeholders and political leadership.
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. Capitalising on the opportunity afforded by these two experiments, our long-term follow up of this cohort is aimed at understanding the mechanisms through which a) early-life socio-economic disadvantage and b) societal and environmental determinants contribute to chronic disease risk. We are also using this knowledge to develop interventions for prevention of chronic diseases in urbanising rural communities. Risk factor data for major chronic diseases, stored blood samples and DNA are available on the cohort participants. Basic socio-demographic information has been collected on all the residents of the 29 study villages (N=85,000) and the built environment and air quality is currently being characterised. Under this project a seminar on ‘Urbanisation and Chronic Disease Research in India: Challenges and Opportunities’ was organized in March, 2015. The primary focus of this meeting was to share knowledge and understanding across various disciplines involved in research on urbanisation and health, to come to a new and more multifaceted understanding of the concept of urbanisation, and its impact on health. However there has previously been limited knowledge exchange or consensus between researchers from different fields, with either the definition of urbanisation, or the methodologies used to capture it and its impact on health and disease.
This meeting brought together researchers from diverse disciplines such as epidemiology, urban planning, nutrition, information technology, and policy, to present research, discuss challenges, and develop a more unified understanding of urbanization. While previously urbanisation was conceptualised as a uniform and single track process, the meeting ended with an understanding that there were several different types of urbanisation taking place simultaneously even within India, and so any research in the field would have to take that into account. The discussions fostered new research directions, which are now being translated into research programs being developed in APCAPS. Crucially, a framework is being developed for a multi-disciplinary common tool, used for data collection on urbanisation. A survey has been planned to understand how aspects of the built environment in a transitioning community influence chronic disease risk factors, as well as access and use of health systems.
Biological and social mechanisms of cardiovascular disease in a transitional rural community in India
This is a cohort study based in 28 transitional villages outside Hyderabad. Since 2013 we have profiled the demographics and built environments of the villages, aiming to understand the mechanisms through which urbanisation in India in influencing chronic disease risk.
Cardiovascular Health Effects of Air Pollution in Rural India (CHAI)
CHAI builds on the APCAPS prospective cohort where 300 individuals have been measured for personal exposure and three different locations for ambient measures of particulate matter aiming to investigate the cardiovascular health effects of exposure to air pollution from outdoor and household sources.
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.
WOMAN, CHILD AND ADOLESCENT HEALTH
India accounts for a quarter of all global maternal deaths during childbirth. Each year at least 212 mothers die for every 1 lakh live births. With over 240 million children under the age of five, India contributes 25 percent of the world’s child deaths. These can be prevented.
Simple clinical procedures, blood tests, consultation with doctors, clean delivery rooms and the presence of a trained midwife can bring about a far-reaching reduction in pregnancy-related deaths – continue to be denied to many women across the world. Additional vulnerability to sexual and reproductive health issues, nutritional deficiencies affect the status of women, bearing implications for new born, infants, adolescents; spanning the entire life course.
IIPH-H is aiming to understand how proven health interventions for reducing newborn deaths and improving maternal and child health may be applied to the local context. It is therefore working towards bridging the dearth of information on scalable community-based approaches that may ensure a rapid and sustainable impact.
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. Assessing their contribution to reducing maternal mortality in India is a step that shall lead to efficacious interventions for impact.
This research is underway as part of doctoral studies of Dr Samiksha Singh from the London School of Hygiene and Tropical Medicine, UK. It is supported by the PHFI-UKC Wellcome Trust Capacity Building Programme.
Pune Maternal Nutrition Study (PMNS)
In this project three basic research questions were answered. The first was to identify determinents of cognitation based on life cycle, nutrition, maternal, pre pregnancy and social variables. The sophisticated technique of Bayesian Model Averaging (BMA) was used to identify the determinents for each cognitive function. The second research question was to investigate the life course of B12 for children and the various determinents. A longitudinal model with Generalised Estimating Equations (GEE) was employed to infer about the vitamin B12 life course for the PMNS subjects. The third research question was to search for anthropometric indicators of prediabetes under a longitudinal framework.
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 and Oro-facial clefts in India.
The research was conducted in phases to examine the questions related to periconceptional folic acid deficiency across selected Indian locations and its related consequences especially neural tube defects and orofacial clefts through the hierarchical evidence-based approach. Based on the study findings a third draft of the guidelines on periconceptional usage of folic acid has been submitted to Ministry of Health and Family Welfare.
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.
Utilization distribution, rate and equity at sub-district level of Aarogyasri state health insurance scheme in Khammam District, Telangana: a retrospective study.
The objectives of this study were: (a) to analyze the socio demographics distribution of Aarogyasri state health insurance scheme beneficiaries at mandal level; (b) to analyze the distribution of Aarogyasri state health insurance scheme beneficiaries with in mandals at village level; (c) estimate the equity of distribution; (d) to analyze the utilization rate of beneficiaries per 1000 population at mandal level and; (e) evaluate and quantify the effect of distance from district headquarters to mandals on utilization rate. The broad aim is to improve the utilization distribution, rate and equity of Aarogyasri state health insurance scheme in Telangana.
Technical support for strengthening public health service delivery focusing on District Hospital (DH’s). The First Refferal Units (FRU’s) in the High Priority Districts (HPD’s) of Chhattisgarh
The scarcity of human resource for specialized health services was identified as a predominant reason which impedes the delivery of efficient maternal and child health care services at the First Referral Unit (FRU) level in this region. UNICEF together with Govt conceived an innovative approach to improve Human Resources for Health (HRH). For this Public Health Foundation of India was selected for it being the leading public health institution with its expertise to initiate an innovative project for developing a strategy to attract and retain specialist doctors in the District Hospitals of Bijapur and Sukma districts of the Bastar region. The first phase of the project envisages operationalizing the FRUs in both Bijapur and Sukma, the conflict affected districts.
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. In many clinical studies, interest is often on variables which are not directly observable and several surrogate outcomes characterizing the endpoint are observed repeatedly. Traditional multivariate mixed models are not appropriate for such data as they do not account for the fact that the outcomes are attempting to measure the same underlying construct.
This research work proposes to analyse such data by introducing multiple latent variables having a longitudinal correlation structure. In representation this is similar to a conventional factor analysis model in presence of random effects. However, conventional factor analysis models are more restrictive having a diagonal correlation structure of the factor or the latent variables. This research considers a more generalised situation where the latent variables themselves have a temporal correlation. Also the effect of time comes in as a semiparametric smooth function. The use of semiparametric framework allows the shape of the functional relationship between covariates and dependent variable to be determined by the data in contrast to parametric frame-work where the shape is determined by the model.
The research would involve computationally intensive methods such as Monte Carlo methods, the EM algorithm and its variants and data augmentation/ imputation algorithms. An aim of the research work is to develop a public domain R package to implement the above. The study is being conducted by Souvik Kumar Bandyopadhyay as part of his PhD research.
Statistical Support To Fernandez Hospital
This project aims at providing statistical support to all the DNB fellows working at Fernandez hospital. The support includes preparation of protocols for DNB thesis, designing database structures and tools in collecting and storing data and helping in analysis of data. Apart from the DNB fellows, the project also provides support to the clinicians in their their individual research work by assisting them at different phases of their statistical and data analysis.
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 have been noted and scientific papers are under preparation, to be sent to peer-reviewed journals.
This research is underway as part of doctoral studies of Dr Shailaja Tetali from the London School of Hygiene and Tropical Medicine, UK. It is supported by the PHFI-UKC Wellcome Trust Capacity Building Programme.
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 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.
This research is underway as part of doctoral studies of Dr Suresh Kumar Kamalakannan from the London School of Hygiene and Tropical Medicine, UK. It is supported by the PHFI-UKC Wellcome Trust Capacity Building Programme.
INDIAN INSTITUTE OF PUBLIC HEALTH – BENGALURU CAMPUS
With the aim of strengthening public health capacity and achieving improved health outcomes in the state of Karnataka, the Bengaluru campus of IIPHH was started by PHFI in 2012. This effort has been in partnership with the Government of Karnataka, through a Memorandum of Understanding and is housed in a spacious integrated building provided by the Govt. of Karnataka in the Leprosy Hospital Compound. The institute has conducted academic programmes, research activities, short term trainings and workshops. The activities at the campus commenced from April 2012 and academic programmes started from November 2012. The Bengaluru campus during the last three years has undertaken ten short term trainings courses/workshops, six research projects are currently in vogue. Five projects have been completed for the Govt. of Karnataka. The campus has a total of 10 faculty members and administrative staff and is being ably guided by Prof. G.V.S. Murthy.
The academic programme has been running continuously for three years. The first batch of Post Graduate Diploma in Public Health Management (PGDPHM) comprised 30 medical officers of the Department of Health and Family Welfare. The second batch consisted of 30 medical officers and 6 AYUSH doctors. The third batch of 16 medical officers, 6 AYUSH doctors & 2 staff nurse of the department of H&FW. This campus has applied for affiliation from Rajiv Gandhi University of Health Sciences for Masters in Public Health course and is hopeful of securing affiliation in the year 2016-17.
Technical support to the Government is a strong element at the IIPH- Bengaluru Campus, as it has developed action points for the National Urban Health Mission for the city of Bengaluru and in conducting a review of nutrition programmes in Karnataka to highlight key barriers, enablers and options. The campus is providing technical assistance to the government in rolling out Universal Health Coverage in the pilot districts of Raichuru and Mysuru. The faculty is active in reviewing existing national and state specific programmes, from their conceptualization, design, development and implementation.
WOMEN AND CHILD HEALTH
Maternal Antecedents of Adiposity Studying the Transgenerational Role of Hyperglycaemia and Insulin (MAASTHI)
MAASTHI involves assessing the impact of hyperglycaemia and psychosocial stressors in the pregnant women on childhood obesity. Currently, we are involved in setting up mechanisms to address high prevalence of GDM and psychosocial distress in pregnant women for appropriate treatment.
Pregnancy on the risk of Low birth weight and Ensuing Effects in Infants (APPLE); A cohort study in South India
The aim of this study is to prospectively assess the effects of ambient and indoor air pollutant levels in pregnancy on the risk of adverse infant outcomes, especially in predicting the risks of chronic diseases in infants
Social Detriments 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.
Gender, Religion and Reproductive Health among Muslims and Hindus in India.
This research involved analyzing qualitative data draw through in-depth interviews among two groups of women: women in reproductive age group and college going young adults.
Health Systems Support
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.
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.
Study on cost to Government of Karnataka for providing primary and secondary level health care services
The study using a bottom-up costing technique estimated the standard cost of the health care services provided at the .primary and secondary care level government health care institutions
Study on health seeking behaviour and out-of-pocket expenditure in Mysore and Raichur districts of Karnataka State
The study surveyed 2000 households to understand how households seek health care when any of their member falls ill; if yes, which provider do they prefer, private or Government; reason behind the choice of the provider; and the out of pocket expenditure they may incur while utilising the health are services.
Study on cost to Government of Karnataka for providing primary and secondary level health care services
The study using a bottom-up costing technique estimated the standard cost of the health care services provided at the primary and secondary care level government health care institutions.
Training and capacity building
Public Health training to AYUSH professionals was conducted to strengthen community level health service delivery and care quality, equity and access through pluralism and integration.
IIPHH-Bengaluru Campus conducted a training for state level nodal officers to strengthen, re-direct the capacity, to orient & reinforce the skills in motivation, communication, supervision, identifying gaps, inspection of programmatic, administrative, financial issues as well as improving the liaison between departments. Technical support to KSHSRC provided during re-orientation workshop on the supportive supervision for these nodal officers of Karnataka during Jan. 2015.
A two week Field Epidemiologists Training Programme (September 2014) was conducted for District Surveillance Officers of the Indian Integrated Disease Surveillance Programme (IDSP), Government of India. District Surveillance Officers from Gujarat, Rajasthan, Kerala states along with District Surveillance Officers of Karnataka participated in this training programme. The objective was to impart skills to handle data, operate surveillance for decision making, respond to limited, localized outbreaks, exchange within the health system, monitor surveillance activities, analyze surveillance data by time, place and person voluntary limitation in scope, need to analyze/ use data at district level, need of a competency-based course, expected benefit, address the need to analyze / use data in India.
A four-day Short Course on Qualitative Research Methods July was to impart and imbibe participants with a deep theoretical grounding along with hands-on practical application of important methodological concepts using analytical software. The workshop was meant for those who are beginners as well as advanced practitioners in the development sector, especially, in the health and the allied domains.
As part of the third batch of Post Graduate Diploma in Public Health Management, 24 candidates deputed by the Government of Karnataka in November 2014 have completed the course during 2014-15. For 2015-16, 40 candidates (34 medical officers, 3 AYUSH doctors and 3 staff nurse) have been deputed by the Govt. of Karnataka for the same course. As a part of their learning, these participants undertake short research program under the guidance of a faculty mentor and 86 research projects have been completed till now covering various programmes of the Department of Health and Family Welfare. Other than teaching at IIPHH Bengaluru Campus for the Post Graduate Diploma in Public Health Management course, the following faculty are technically supporting Government projects:
Dr T N Sathyanarayana
Expert Committee member, Traditional Medicine for Urban Health Council
Advisory Committee Member, AYUSH Grama
Dr Giridhara R Babu
External Examiner, Manipal University
Dr Suresh S Shapeti, Dr Giridhara R Babu and Dr T N Sathyanarayana
Technical Advisors, Karnataka State Health System Resource Centre
Advisory Committee Members of Nutrition project, Ashoka Innovators for the Public
Committee Members, Karnataka Public Health Act