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Working towards a healthier India
PHFI is helping to build institutional and systems capacity in India for strengthening education, training, research and policy development in the area of Public Health.
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AVOIDABLE BLINDNESS

Five Year Initiative on Diabetic Retinopathy and Retinopathy of Prematurity

The Queen Elizabeth Diamond Jubilee Trust in partnership with the Public Health Foundation of India and the London School of Hygiene and Tropical Medicine are supporting IIPH-H and its eye health partners to implement two multi-state projects, covering twelve states for Diabetic retinopathy and five states for Retinopathy of Prematurity. These projects address management and information systems, capacity building, policy, communication and public information, research among a range of areas at the national and state level. A situational analysis each on Diabetic Retinopathy and Retinopathy of Prematurity has been completed to assess the general health systems capacity to tackle cases and to search for elements that may help to mould successful models for service delivery, modalities and management protocols for care and public awareness.

Diabetic Retinopathy is the leading cause of blindness among working adults and Retinopathy of Prematurity is a leading cause of infant blindness. The need for timely and effective screening, management and referral is critical. The Diabetic retinopathy program has been structured in a way that supports integration of diabetic care and eye care services in each district. This is being done by providing retina screening services to all the registered diabetics at the NCD Clinics set up at CHC level with an adequate linkage to the district hospital for delivering services. In July 2014, an extended National Diabetic Retinopathy Task Force meeting was convened by Deputy Commissioner, NCD, Ministry of Health and Family Welfare, Government of India. In September 2014, National Retinopathy of Prematurity Task Force was formed under the Ministry of Health and Family Welfare, Government of India and two meetings have been conducted till date. Stake holder meetings have been convened to finalize program components. Training of ophthalmologists and screening for ROP has begun in Madhya Pradesh and Telangana for DR trainings and screening has begun in Karnataka , New Delhi, Tamilnadu, Telangana, Kerala and Andhra Pradesh states.

A four-month Certificate Course in Evidence Based Management of Diabetic Retinopathy was launched in February 2016 to enhance knowledge, skills and core competencies of Primary Care Physicians (PCPs) to prevent and manage Diabetic Retinopathy. There is a once a month contact session scheduled on designated weekends at 10 Regional Centres across India. 185 participants have been enrolled, of whom 66% are physicians and 34% are ophthalmologists.

Retinopathy of Prematurity can cause irreversible blindness in premature infants, is an increasingly important cause of blindness in children in India. Visual loss from ROP can be almost entirely prevented through high quality neonatal care, and by early detection and treatment of the sight-threatening stages of the disease which can affect up to 10% of infants born at 34 weeks gestational age or less.

For the implementation of the project 5 states have been selected over two phases, namely Telangana, Madhya Pradesh, Rajasthan, Odisha and Maharashtra. In every state 4-5 SNCUs are being linked to one Government Medical College which will be mentored by the Local Mentoring Partners (Private/ Government Tertiary Care Hospitals) At the national and state level, our stakeholders include experts from AIIMS, PGIMER, LVPEI, Narayana Nethralaya, Sankara Nathralaya and H V Desai Eye Hospital, who have experience in training and management of ROP. Under this initiative, the programme has initiated and established a National Task Force; in order to involve key stakeholders at the National Level. The Task Force was constituted by Government of India and is chaired by Dr. Rakesh Kumar, IAS, Joint Secretary, Ministry of Health and Family Welfare (MOHFW).

A workshop, led by the neonatology capacity building team (AIIMS, PGIMER and GMCH) was held in Chandigarh to finalise tools for formative research on improving the quality of care for neonates, based on the inputs of the health care professionals involved (doctors and nurses). The Madhya Pradesh state level launch of ROP activities in March was attended by 70 key health officials and experts from the State Government (Deputy Director, National Health Mission), AIIMS, PGIMER and GMCH, and health personnel from Sick Newborn Care Units and hospitals of selected sites. A vibrant stall display and session at the 53rd Annual Conference of Indian Academy of Pediatrics (21-24 January 2016) have been used to sensitise visiting neonatologists of the need for ROP screening.

Visual impairment

A collaborative study to determine the cumulative incidence of blindness and visual impairment is being conducted in Andhra Pradesh. This involves follow up on an original APED Study cohort. The study is being funded by LV Prasad Eye Institute and Sightsavers International and in collaboration with the International Centre for Eye Health, LSHTM, UK and LV Prasad Eye Institute, Hyderabad.

Multi-centric collaborative study on impact of Global warming, environmental changes and ultra-violet radiation (UVR) exposure on Ocular Health in India

The purpose of the research is to collate a case study each of the Northeast region, coastal region in South India (Prakasam district, Andhra Pradesh) in comparison to Delhi/NCR (National Capital Region) for the impact of increased UVR on prevalence of cataract, dry eye, pterygium in people >40 yrs old and allergic disorders in children between 5-15 yrs of age. The study aims to estimate the change in stratospheric ozone and suspended particles to investigate the effect of environmental factors and global warming on the prevalence and /or exacerbation of eye diseases. For this purpose, the relevant data on ozone and UVR has been collected through satellite measurements at Guwahati and Prakasam district, Andhra Pradesh and the medical data was collected through Risk Assessment Surveys by teams from Dr. R. P. Centre, AIIMS (North India), Regional Institute of Ophthalmology Guwahati (North East) and coastal South India (SACDIR, Hyderabad). This study is funded by ICMR and was initiated in November 2010.

The National Survey of Blindness, Visual Impairment, Ocular Morbidity and Disabilities in Sri Lanka

The main objective of this survey is to find out the prevalence of blindness and disability in Sri Lanka. This is the first ever national study on blindness and disability in Sri Lanka. IIPHH provided technical support to the survey team. The back-end data base management and data analysis is also being coordinated by IIPHH.

MANAGING CHRONIC DISEASE-RELATED DISABILITY

Family led Rehabilitation after Stroke in India: The ATTEND Trial

Stroke is the sixth leading cause of global disease burden. It has been estimated that the annual new cases of stroke in India is 135 to 145 per 100,000 population, with early case fatality rates ranging from 27% to 41%. Although inpatient care and rehabilitation may meet important clinical, physical, and psychosocial needs during the early crisis phase, the needs of patients and family in the longer term are not easily addressed in hospital. The development of an effective low-cost community rehabilitation service for an emerging major chronic disease such as stroke, in India, has the potential to make an important public health impact. In this light, IIPH-H is conducting a multicentre, randomised, blinded outcome assessor, controlled trial to determine whether a family-led caregiver-delivered home-based rehabilitation intervention versus usual care is an effective, affordable strategy for those with disabling stroke in India. This research is being conducted in fourteen centres across India, in Delhi, Punjab, Kerala, Andhra Pradesh, Telangana, Tamil Nadu, Assam and West Bengal. This initiative is being conducted through a partnership between SACDIR, the National Health and Medical Research Council-Sydney, George Institute for Global Health, Sydney and Hyderabad and IIPH-Hyderabad.

IMPROVING THE EVIDENCE BASE ON DISABILITY

Rapid Assessment of Disability (RAD)

In collaboration with the Nossal Institute for Global Health, University of Melbourne, a Rapid Assessment of Disability (RAD) Survey is being conducted through the community health global network (CHGN). The RAD was conducted during the months of September 2014 to January 2015 in Prakasam district of Andhra Pradesh state. The main objectives of the study are to measure the prevalence of disability within a target population and to understand the impact of disability on well‐being and access to services, including barriers to access and further contribute to the evaluation of disability development project.

Rapid assessment of disability survey showed that the prevalence of disability in Prakasam district was 10.1%. RAD survey results were disseminated at Indian Institute of Public Health-Hyderabad with the participation of the officials from the SERP and Disabled Persons Organization members of the Prakasam district. Post RAD Survey a disability inclusive development program is being implemented in the surveyed villages of the Prakasam district.

Another study also seeks to provide a quantitative estimate on disability and provide data regarding different dimensions of disability in urban slums of Serilingampally in Ranga Reddy district. This study is also focused on clinical assessments of impairments related to vision, hearing and musculo-skeletal impairment. The prevalence of different types of impairments and adult wellbeing are being assessed among the people with disability in these slums. A comparative assessment of tools is also being used to measure disability in terms of their outcomes.

HEARING IMPAIRMENT

Behavioural problems in impaired children and associated caregiver strain in India – A descriptive study

The goal of the study is to find the determining factors that contribute to the difference of psychosocial difficulties in hearing impaired children, compared to another group of hearing impaired children that do not develop these psychosocial difficulties. As per our understanding, this study is the part of a limited pool of first hand evidence from low and middle-income countries. Findings of this study have direct implications for current public health screening programmes and practice. This initiative was conducted through a joint exchange and collaboration programme of PHFI and the Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, The Netherlands.

Gender as a determinant of uptake of services in persons with disabilities

This project aims to understand and generate evidence for disabilities and understand if gender is an important factor in the uptake of care and support services for persons with disabilities. Findings shall inform better planning and service delivery and bears relevance to care issues for self and family with relevance to health matters like antenatal care, immunization, care for chronic conditions like TB and acute care. The study is being conducted in two blocks/mandals of Medak in Andhra Pradesh and Bidar in Karnataka, where health, nutrition and development parameters are poor.

Expanding employment opportunities for persons with disability

There is a lack of evidence on the barriers faced by persons with disability in accessing employment opportunities in India. Therefore the study was undertaken to ascertain the barriers to employment and employability for persons with disability in the IT and IT Enabled Services sector in Hyderabad, Andhra Pradesh India. The study was funded by CBM South Asia Regional Office (SARO). The main aim of the study was to work towards orienting Indian employers on disability inclusiveness with regard to employment of persons with disabilities. It was also an attempt to make Indian society disability inclusive by assessing both the enabling factors to employment and the barriers to employability of persons with disabilities in India.

BIRTH DEFECTS

A three year project to understand 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 is underway. The methodology includes examining questions related to folic acid deficiency and its related consequences using a hierarchical evidence based approach from descriptive, analytical and experimental study designs. This project is funded by the UK Wellcome Trust Consortium to strengthen research capacity across PHFI institutions in an area related to maternal and child health and childhood disability.

BUILDING RESEARCH CAPACITY

Regional and Area office functionaries from Sightsavers were equipped with skills and knowledge of research design, methodology and techniques as relevant to their core areas of work– eye care, social inclusion and education. This involved an orientation of Sightsavers staff to strengthen skills in designing research, conducting and monitoring the research through writing a research proposal at a one week workshop at IIPH-Hyderabad so as to provide substantive inputs to partner organizations. Following this the two teams developed their project concept notes. One faculty was supporting each team and provided constant technical inputs. After the completion of data collection in the study areas, the teams returned to IIPHH for a second round of training on data analysis and report writing.

 
Last Modified : August 23, 2017, 5:28 pm