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Diarrhoea is one of the major waterborne diseases spread through the faecal--oral route causing over 10 million cases and over 1,000 deaths per year in India. This study critically evaluates the interlinkage between bacteriological water quality, i.e. faecal coliforms and diarrhoea cases for the three pre-pandemic years 2017, 2018 and 2019 based on multiple sources. With around 17% of households tap water connectivity as of August 2019, the majority of the Indian population depends on raw groundwater (GW) and surface water sources. For this, faecal coliform (FC) levels in surface and GW have been mapped at district levels using data from India's National Water Quality Monitoring Programme. Health Management Information System's data on diarrhoea have been used to understand the monthly and district-wise variation of diarrhoea. The trends of FC, diarrhoea inpatient cases, and diarrhoea inpatient rates have been discussed. The analysis showed issues associated with the reliability and usefulness of these datasets with 43% of total India districts with no reported FC values for the study period. This study reveals a clear gap in the interlinkage between diarrhoea and bacteriological water quality with the unavailability of granular water quality data as a major challenge. [ABSTRACT FROM AUTHOR]

Background: Understanding causes and contributors to maternal mortality is critical from a quality improvement perspective to inform decision making and monitor progress toward ending preventable maternal mortality. The indicator "maternal death review coverage" is defined as the percentage of maternal deaths occurring in a facility that are audited. Both the numerator and denominator of this indicator are subject to misclassification errors, underreporting, and bias. This study assessed the validity of the indicator by examining both its numerator—the number and quality of death reviews—and denominator—the number of facility-based maternal deaths and comparing estimates of the indicator obtained from facility- versus district-level data. Methods and findings: We collected data on the number of maternal deaths and content of death reviews from all health facilities serving as birthing sites in 12 districts in three countries: Argentina, Ghana, and India. Additional data were extracted from health management information systems on the number and dates of maternal deaths and maternal death reviews reported from health facilities to the district-level. We tabulated the percentage of facility deaths with evidence of a review, the percentage of reviews that met the World Health Organization defined standard for maternal and perinatal death surveillance and response. Results were stratified by sociodemographic characteristics of women and facility location and type. We compared these estimates to that obtained using district-level data. and looked at evidence of the review at the district/provincial level. Study teams reviewed facility records at 34 facilities in Argentina, 51 facilities in Ghana, and 282 facilities in India. In total, we found 17 deaths in Argentina, 14 deaths in Ghana, and 58 deaths in India evidenced at facilities. Overall, >80% of deaths had evidence of a review at facilities. In India, a much lower percentage of deaths occurring at secondary-level facilities (61.1%) had evidence of a review compared to deaths in tertiary-level facilities (92.1%). In all three countries, only about half of deaths in each country had complete reviews: 58.8% (n = 10) in Argentina, 57.2% (n = 8) in Ghana, and 41.1% (n = 24) in India. Dramatic reductions in indicator value were seen in several subnational geographic areas, including Gonda and Meerut in India and Sunyani in Ghana. For example, in Gonda only three of the 18 reviews conducted at facilities met the definitional standard (16.7%), which caused the value of the indicator to decrease from 81.8% to 13.6%. Stratification by women's sociodemographic factors suggested systematic differences in completeness of reviews by women's age, place of residence, and timing of death. Conclusions: Our study assessed the validity of an important indicator for ending preventable deaths: the coverage of reviews of maternal deaths occurring in facilities in three study settings. We found discrepancies in deaths recorded at facilities and those reported to districts from facilities. Further, few maternal death reviews met global quality standards for completeness. The value of the calculated indicator masked inaccuracies in counts of both deaths and reviews and gave no indication of completeness, thus undermining the ultimate utility of the measure in achieving an accurate measure of coverage. [ABSTRACT FROM AUTHOR]

Introduction: Hydatid cysts of the liver (HCL) are a severe yet unappreciated public health concern in underdeveloped nations such as India. HCL is mostly caused by the tapeworm Echinococcus granulosus [1]. In 2010, a research conducted by the World Health Organisation (WHO) estimated the incidence of cystic echinococcosis per 100,000 individuals in Southeast Asia to be 0.8 (95% confidence interval (0.2-2)) [2]. Estimating HCL's influence in India is difficult, though, for a variety of reasons. First, the total frequency of the illness is greatly underreported in many epidemiological studies and series due to a lack of thorough research and surveys covering the whole endemic population. Furthermore, there is a propensity for the Health Management Information System, the government of India's monitoring system, to underreport. Aim: To evaluate hepatic hydatid cyst patients' clinical symptoms, therapy, and sociodemographic characteristics in a poor country. Materials And Methods: During the course of 24 months, the Department of General Surgery at FM Medical College and Hospital in Balasore, undertook this retrospective study. A retrospective, descriptive study was performed on 23 patients who had been identified with a liver hydatid cyst based on clinical symptoms, imaging testing, or serology. To present the study's findings, the data was assessed and statistically analysed using IBM SPSS 23.0 for Windows. Results: The age group of 25 to 45 was the most commonly affected (10, 43.47%), with an average age of 36 among the patients. Female patients made up 56.5% of the total patients. Palpable liver (7, 30.4 %) and stomach discomfort (21, 91.3 %) were the most common symptoms. Abdominal ultrasonography and computed tomography were the two primary imaging techniques used to establish a diagnosis. Anechoic, unilocular cystic lesions were the most prevalent kind. Most liver cysts in these individuals were found in the right lobe. In 44.4 percent of the patients, hydatid cysts were surgically removed; the most common kind of surgical operation was pericystectomy. Conclusion: In India, hepatic hydatid cysts are frequently the source of illness. For most patients, surgery remains the primary course of treatment; diagnosis requires a clinical examination accompanied by imaging investigations. [ABSTRACT FROM AUTHOR]

This paper describes a case study of an Outreach and Drop-in Centre (ODIC) established under the National Action Plan for Drug Demand Reduction, Ministry of Social Justice and Empowerment, Government of India. In the quantitative part, data were gathered from the ODIC office documents and analysed using MS Excel. Linear regression analysis demonstrated a relationship between the number of in-centre clients and the number of Community Outreach Programmes (COPs). Similarly, this study examined the relationship between the number of networks established and the number of participants in COPs. Hence, two regression lines were derived accordingly. In addition, qualitative data collected through key informant interviews corroborated the quantitative results. This case study highlights the importance of networks and COPs in increasing the reach of ODIC and ensuring the quality of services. Finally, in partnership with other government agencies, this ODIC sets a model for engaging marginalised adolescents in reducing substance abuse. [ABSTRACT FROM AUTHOR]

The rapid spread of the COVID-19 pandemic necessitated unprecedented collective action against coronavirus disease. In this light,we are proposing a novel online platform for the visualization of epidemiological data incorporating social determinants for understanding the patterns associated with the spread of COVID-19. The current AI computational platform combines modeling methodologies along with temporal geospatial visualization of COVID-19 data, providing real-time sharing of graphic analytical simulation of vulnerable hotspots of recurrent (nowcasting) and emergent (forecasting) infections visualized on a spatiotemporal scale on geoportals. The proposed study will be a secondary data analysis of primary data accessed from the national portal (Indian Council of Medical Research (ICMR)) incorporating 766 districts in India. Epidemiological data related to spatiotemporal visualization of the demographic spread of COVID-19 will be displayed using a compartmental socio-epidemiological model, reproduction number R, epi-curve diagrams as well as choropleth maps for different levels of administrative and development units at the district levels. [ABSTRACT FROM AUTHOR]

Purpose: The World Report on Vision highlights that health information systems (HIS) should collect information on the determinants of eye conditions and vision impairment (VI) as a step toward integrated people-centered eye care (IPEC). Thus, this retrospective study aims to elucidate VI trends across age and gender of the patients who visited our centres in southern and eastern India. Methods: Electronic medical records of all new patients who visited the network were included. VI was defined as visual acuity less than 6/12; unilateral VI was based on the worse presenting eye (the other eye being normal), and bilateral VI was based on the better eye. "Total VI" includes both unilateral and bilateral VI. Results: The records of 7,31,307 patients from January to December 2019 were extracted. Males were 54%. The mean age was 40 years (SD: 19.16 years). The majority of patients (46.54%) visited a primary care centre. Centres in Andhra Pradesh saw the largest number of patients (46%). Approximately 65% of all patients presented had no VI in either eye. Total VI was 23.5% at the primary-centre level and approximately 45% at other levels, the highest being in Odisha. More females accessed care at primary and secondary centres (46.6%) than at higher levels of care (44%). Odisha had the lowest number of females accessing care (43.01%). Conclusion: Non-visually impairing conditions form an important reason for patients visiting our eye care facilities. Strategies focusing on improving access to eye care for females should be planned at all levels, especially in Odisha. [ABSTRACT FROM AUTHOR]

Background: A structured and organized public health set up with systematically trained personnel to manage and deliver public health services from grassroot levels to higher administrative levels with separate public health directorate is the need of the hour. The objective of this study was to conduct a situational analysis of public health cadre in select states in India to gain an in-depth understanding of the progress and explore the gaps and challenges in its implementation. Methods: Four states from the country were selected based on stages of implementation of the cadre. The WHO health systems framework was the basis of assessment. In-depth interviews of 78 stakeholders from public health system across various categories and levels were conducted. Results: Every state has a dedicated cadre for public health in the form of a separate hierarchical structure and Directorate. There are deficits in human resources skilled enough to manage and implement public health across all levels. Its penetration below districts level is limited. There are limited opportunities available for contractual staffs in terms of remuneration and job progression. The respondents strongly emphasized on having personnel with training in public health, especially at leadership positions. Funding was not reported to be a problem although some challenges in the timeliness of release of funds were reported. Under the existing Health Management Information System, duplication of data exists and there is underutilization of data for policy making. Conclusion: A dedicated public health cadre is under evolution in India. The main challenge is inadequate workforce skilled in public health management. States are committed to finding solutions to overcome these barriers. [ABSTRACT FROM AUTHOR]

Youth is a critical phase that epitomizes cognitive, physiological, and psychological growth leading to an individual's and community's well-being. Unfortunately, various lifestyle or non-communicable diseases(NCDs) have percolated, resulting in significant adverse effects; on the present health outcomes, which are transited into adulthood. Recent social communication tools provide a colossal prospect for educating audiences of diverse social strata to adopt lifestyle modifications for better health. This study sought to evaluate the social communication modes influencing health-behaviour modulations for managing NCDs amongst Durgapur, West Bengal, India college students. The study included youth; a primary survey was conducted amongst 87 undergraduate and postgraduate students from May to June 2022. The results revealed that 14% were overweight and obese. They spend significant time on social media, using channels like television, radio, and social networking sites, exposing them to multiple health promotion campaigns. 78% were intrigued and influenced by these initiatives. 70% of them pursue the recommended propaganda demonstrated, which guides modulated living to prevent NCDs. Almost all students opting for change experienced a positive result. However, only half of the population had continued the reform lifestyle. There is no ambiguity about social communication's importance in achieving better health for our youth. The standards policies integrated with the action can create a paradigm shift. It is suggested to have automated sourced content, recommended audio-visuals, peer-reviewed, acknowledged, and from the reputed antecedent. The various cost-competent interventions, preventive tools, and social media propagation promote delayed onset, reducing mortality and morbidity in young adults. [ABSTRACT FROM AUTHOR]

Background & objectives: Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. Methods: We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. Results: The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. Interpretation & conclusions: Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered. [ABSTRACT FROM AUTHOR]

The misreporting of administrative health data creates an inequitable distribution of scarce health resources and weakens transparency and accountability within health systems. In the mid-2010s, an Indian state introduced a district ranking system to monitor the monthly performance of health programmes alongside a set of data quality initiatives. However, questions remain about the role of data manipulation in compromising the accuracy of data available for decision-making. We used qualitative approaches to examine the opportunities, pressures and rationalization of potential data manipulation. Using purposive sampling, we interviewed 48 district-level respondents from high-, middle- and low-ranked districts and 35 division- and state-level officials, all of whom had data-related or programme monitoring responsibilities. Additionally, we observed 14 district-level meetings where administrative data were reviewed. District respondents reported that the quality of administrative data was sometimes compromised to achieve top district rankings. The pressure to exaggerate progress was a symptom of the broader system for assessing health performance that was often viewed as punitive and where district- and state-level superiors were viewed as having limited ability to ensure accountability for data quality. However, district respondents described being held accountable for results despite lacking the adequate capacity to deliver on them. Many rationalized data manipulation to cope with high pressures, to safeguard their jobs and, in some cases, for personal financial gain. Moreover, because data manipulation was viewed as a socially acceptable practice, ethical arguments against it were less effective. Potential entry points to mitigate data manipulation include (1) changing the incentive structures to place equal emphasis on the quality of data informing the performance data (e.g. district rankings), (2) strengthening checks and balances to reinforce the integrity of data-related processes within districts and (3) implementing policies to make data manipulation an unacceptable anomaly rather than a norm. [ABSTRACT FROM AUTHOR]

The Health and Demographic Surveillance System (HDSS) is a valuable longitudinal cohort study that tracks the health and demographic changes of a geographically defined population, serving as a platform for research and evidence-based policymaking. In India, there are nearly 20 HDSS sites covering diverse areas and populations totaling around two million. To foster collaboration, the Indian HDSS Network (IHN) was formed, comprising 19 sites from 16 institutes, covering a population of 1.5 million. The IHN aims to standardize data collection processes while allowing site-specific autonomy, generating high-quality longitudinal health, and demographic data. To ensure effective coordination, a governance structure with a rotating secretariat and working committee was proposed. The IHN envisions conducting robust multicentric research, supporting data-driven efforts to improve population health, and promoting research-policy synergy. The network's outcomes have the potential to optimize health research funding, generate epidemiological data, and provide evidence for public health policy. Collaboration within the IHN strengthens HDSS sites in newer technologies and community-based research, fostering capacity building. Seed funding is being sought to formalize and support the day-to-day functioning of the network, which holds promise for advancing population health and informing policymaking in India. [ABSTRACT FROM AUTHOR]

A resilient health system necessitates strong governance, political commitment, effective administrative entities and inter-organisational collaboration. This paper examines India's current health policy landscape and explores the analytical and operational capacities required to establish a robust post-pandemic health system using the policy capacity framework described by Wu et al. (2015). We emphasised the need for a coordinated policy response to strengthen health information systems, health service management, human resource management and healthcare financing. The role that the planned implementation of Indian public health management cadres would play in the coming era, the importance of a comprehensive health information management system and the need for operational coordination between government and non-governmental organisations has also been emphasised. [ABSTRACT FROM AUTHOR]

Background: Antenatal care coverage has dramatically increased in many low-and middle-income settings, including in the state of Telangana, India. However, there is increasing evidence of shortfalls in the quality of care women receive during their pregnancies. This study aims to examine dimensions of antenatal care quality in Telangana, India using four primary and secondary data sources.Methods: Data from two secondary statewide data sources (National Family Health Survey (NFHS-5), 2019-21; Health Management Information System (HMIS), 2019-20) and two primary data sources (a facility survey in 19 primary health centres and sub-centres in selected districts of Telangana; and observations of 36 antenatal care consultations at these facilities) were descriptively analysed.Results: NFHS-5 data showed about 73% of women in Telangana received all six assessed antenatal care components during pregnancy. HMIS data showed high coverage of antenatal care visits but differences in levels of screening, with high coverage of haemoglobin tests for anaemia but low coverage of testing for gestational diabetes and syphilis. The facility survey found missing equipment for several key antenatal care services. Antenatal care observations found blood pressure measurement and physical examinations had high coverage and were generally performed correctly. There were substantial deficiencies in symptom checking and communication between the woman and provider. Women were asked if they had any questions in 22% of consultations. Only one woman was asked about her mental health. Counselling of women on at least one of the ten items relating to birth preparedness and on at least one of six danger signs occurred in 58% and 36% of consultations, respectively.Conclusion: Despite high coverage of antenatal care services and some essential maternal and foetal assessments, substantial quality gaps remained, particularly in communication between healthcare providers and pregnant women and in availability of key services. Progress towards achieving high quality in both content and experience of antenatal care requires addressing service gaps and developing better measures to capture and improve women's experiences of care. [ABSTRACT FROM AUTHOR]

Need for Strategies to Improve Capture Leprosy Data Across India Nikusth is presently being used more as an online application for developing a database of leprosy patients. India, despite achieving the status of leprosy elimination at the national level in December 2005, accounted for 58% of new cases reported globally for 2019-2020, with 114,451 new cases being detected during this period.[[1]] India has the highest leprosy burden in the world and is among the 22 "global priority countries" that contribute 95% of the total cases of leprosy worldwide.[[2]] Children accounted for 6.86% of the total cases. [Extracted from the article]

Background: The primary health care services in India suffer from inconsistent availability of providers, lack of quality, poor availability of medicines and diagnostics, and a poorly functioning referral linkage. A multi-pronged approach is required to address these issues. Methods: We describe here a model of electronic sub-health centers (e-SHCs) managed by trained nurses supported by a general practitioner over telemedicine. The e-SHCs are expected to meet two objectives – 1) to create a point of comprehensive primary health care delivery at an affordable cost and 2) to create a referral support system backed by information technology and physical movement. Results: The model is described in nine sections – service delivery framework, human resources, diagnostics, infrastructure, quality improvement, health management information system, materials management, financing, and branding. It is a video-based real-time (synchronous) health worker to the registered medical practitioner telemedicine facility. The model has been compared with five other telemedicine and five other tele-rehabilitation models. Conclusion: Although there are inherent challenges to operationalize this model, it also presents a unique opportunity of testing an innovative approach of providing quality primary health care at an affordable cost. The process will generate learnings for addressing the primary care health care delivery gaps in the country. [ABSTRACT FROM AUTHOR]

Background: The use of a nursing information system (NIS) provides significant benefit to the nurses in the management of real-time patient data and contributes to improving the operational effectiveness of nursing services. Aim: To assess the knowledge of, attitude towards and use of an NIS. Methods: A prospective cross-sectional study was carried out among 230 hospital nurses in India, using a validated questionnaire including demographic characteristics, and questions on knowledge of, attitude towards and use of an NIS. Findings: The study found that more than 70% of nurses had good computer skills and knowledge about the information system. About 75% of the nurses reported that the NIS could be a tool to support them in improving patient care, and medical documentation, although 42% claimed that the use of NIS depersonalises nursing care. Seventy-one per cent of the nurses expressed the need for formal education and training on using an NIS during and after their nursing education. Conclusion: Training and demonstration of NISs during nurse education would improve nurses' knowledge, build confidence and positive attitudes, and enhance the acceptability and sustainability of NISs in healthcare settings. [ABSTRACT FROM AUTHOR]

High prevalence of anaemia is a severe public health problem in India. In 2018, India launched the Anemia Mukt Bharat (AMB) strategy that focuses on six beneficiary groups for coverage, six institutional mechanisms for health system strengthening and six programmatic interventions to accelerate reductions in anaemia prevalence. This paper uses the Health Management Information System data (2017-18 to 2019-20) to examine gains in IFA coverage across Indian states. A coverage-based AMB index is computed to review performance across states. After the launch of AMB strategy, the Iron and Folic Acid (IFA) supplementation coverage between 2017-18 and 2019-20 has increased for all beneficiary groups [pregnant women from 78% to 90%; lactating mothers from 34% to 49%; school going adolescent girls (boys) from 23% to 40% (21% to 42%); out-of-school adolescent girls from 6% to 23%; children 5-9 years from 8% to 3% and children 6-59 months from 7% to 15%]. Coverage was relatively low for target groups being served through a multi-departmental convergence mechanism (health and other departments such as education department for schools or women and child development department for Anganwadi centres) than compared to those served by health department alone. However, no major gender disparities are noted in the coverage of IFA supplementation among school-going girls and boys. Bulk of the variations in coverage is attributable to state-specific differences. Training and sensitization workshops for state and district officials are found to be associated with increased coverage across beneficiary groups. The paper argues that despite following international best practices in the field, it is important to harness synergy in programme implementation across line departments to eliminate coverage inefficiencies. [ABSTRACT FROM AUTHOR]

Telemedicine has been a buzzword in India since the 1990s. In 2020, due to the COVID-19 pandemic in India, a national lockdown limited access to in-person healthcare services. The Ministry of Health & Family Welfare issued India's first set of government guidelines for the use of telemedicine. Emphasis was placed on training doctors and gearing up teleconsultations. This effort led to a significant increase in consultations and the recruitment of additional clinicians to practice telemedicine. However, there remain challenges relating to privacy, patient data storage, unevenness in telecom infrastructure and a systematic approach to integrating teleconsultation data with the overall patient record and public health information systems. This paper will provide an overview of telehealth, examine key interventions that have occurred in India during the pandemic and explore potential future approaches that can leverage the benefits of telehealth across the health care spectrum. [ABSTRACT FROM AUTHOR]

Objective: Despite operational guidelines, anecdotal evidence suggests that newborn vitamin K1 prophylaxis is not practiced routinely in India. This study determined the coverage of vitamin K1 prophylaxis among newborns in the country.Design: Nationwide cross-sectional data on live births and newborns receiving vitamin K1 during the 2019-2020 reporting period were abstracted from the Health Management Information System (HMIS). The coverage estimates of newborn vitamin K1 prophylaxis were derived nationally and also for individual states and union territories (UT). Additionally, coverage heterogeneities were investigated using classifiers, viz. geography, socio-demographic index (SDI), special developmental categories and institutional birth rate (IBR).Setting: India.Participants: 20 208 804 newborns documented with HMIS.Results: Vitamin K1 was administered to overall 62·36 % newborns (95 % CI: 62·34 to 62·38 %). The Central zone (49·0 %), low SDI states (54·39 %), Empowered Action Group states (53·32 %) and states with low IBR (44·69 %) had the lowest coverage amongst their respective groupings. Across the individual states and UT, the coverage ranged widely from 22·18 % (in Tripura) to 99·38 % (in Puducherry), exhibiting considerable variability (coefficient of variation: 33·74 %) and inequality (Gini coefficient: 0·17). While the coverage in eight states/UT (i.e. Arunachal Pradesh, Manipur, Nagaland, Tripura, Uttar Pradesh, Uttarakhand, Telangana and Andaman & Nicobar Islands) was below 50 %; only five states/UT (i.e. Chandigarh, Gujarat, Goa, Puducherry and Tamil Nadu) achieved above 90 % coverage.Conclusion: Vitamin K1 prophylaxis was not practiced in more than one-third newborns in India. It calls for identifying the barriers, addressing the gaps and implementing newborn vitamin K1 prophylaxis more effectively throughout the country. [ABSTRACT FROM AUTHOR]

Surveillance is an information for action. India has created considerable improvement in control, prevention and eradication of certain communicable diseases. Few such diseases that have been effectively controlled are polio, smallpox, vector-borne illness, nipah, Coronavirus Disease-2019 (COVID-19) and so on. These achievements are the outcome of an active surveillance system incorporated at community, facility, and health system level. Any of these progresses is impossible without a robust public health surveillance structure. Therefore, enhancing the public health surveillance system further will be helpful in managing upcoming pandemics at its earliest. Improvements in public health surveillance should be synchronised with the goals of Universal Health Coverage and its regulating standards of safe guarding universal health as a right besides privilege, ensuring equity, non-discrimination, guarding the affected individual's rights and respect their choice and placing health in people's hand. In alignment with the National Digital Health Mission, the new Integrated Health Information Platform (IHIP) aims to substitute traditional surveillance data-entry system with modern advances in digital health and technology. This platform also initiates various sector collaboration, including public and private healthcare organisations and civil societies. Recommendations to strengthen the surveillance system starts with enhancement of laboratory infrastructure, referral networks and health organisations at the block level with the aim of strengthening community-based surveillance and responding in a timely manner for upcoming outbreaks. [ABSTRACT FROM AUTHOR]

Background: Records of vital events like death constitute an important component of the Health Information System. Patterns of mortality decline that occur with the demographic transition is a change in the distribution of deaths by cause away from a pattern dominated by communicable diseases toward one in which non-communicable diseases account for the overwhelming majority of deaths. Aims and Objective: To identify the mortality pattern in Burdwan Medical College as per ICD-10 classification in the year 2017.The study also evaluated socio-demographic distribution and causes of deaths during that period. Materials and Methods: It was an Institution based retrospective observational study. Complete enumeration of all hospital records of medically certified deaths of inpatients from different departments except the Paediatrics who died in 2017 was done. The underlying cause of death was classified according to I.C.D 10th revision, version 16. Information collected included also the demographic characteristics like age, gender, date of admission, place of residence and date of death for the study. Results: In this study, most of the deaths were seen in males (59.99%), with a sex ratio of female to male deaths to be 667 per thousand. The major proportion of deaths was in the age group of 55 to 64 years (23.53%). The percentage distribution of ten major cause groups of death for the period from January to December during 2017 reveals that the group "Diseases of the Circulatory System" had occupied the position of the top-most killer and it had maintained the trend throughout the year with the highest rate in the month of March (43.9%). The cause of death was more in Non-Communicable diseases (Chapter IX, Chapter XIX) compared to that of Communicable diseases. Conclusion: Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data needed for epidemiological research or public health policy formulation. [ABSTRACT FROM AUTHOR]

• The study covered 7457 SARS-CoV-2 positive samples from 16 Indian states, with 3002 samples passing the sequencing quality control criteria, making it the most comprehensive genomic surveillance for the region. • The study identified 104 different SARS-CoV-2 pango-lineages classified into 19 clades, revealing the diversity of virus variants circulating in the region. • The month-wise dynamics of SARS-CoV-2 over two years clearly showed a transition from the Delta variant to the Omicron variant in January 2022. • The analysis identified eight mutations of interest, including L18F, K417N, K417T, L452R, S477N, N501Y, P681H, P681R, and the mutation of concern E484K in the spike glycoprotein region. Reading the viral genome through whole genome sequencing (WGS) enables the detection of changes in the viral genome. The rapid changes in the SARS-CoV-2 viral genome may cause immune escape leading to an increase in the pathogenicity or infectivity. Monitoring mutations through genomic surveillance helps understand the amino acid changes resulting from the mutation. These amino acid changes, especially in the spike glycoprotein, may have implications on the pathogenicity of the virus by rendering it immune-escape. The region of Vidarbha in Maharashtra represents 31.6 % of the state's total area. It holds 21.3 % of the total population. In total, 7457 SARS-CoV-2 positive samples belonging to 16 Indian States were included in the study, out of which 3002 samples passed the sequencing quality control criteria. The metadata of 7457 SARS-CoV-2 positive samples included in the study was sourced from the Integrated Health Information Platform (IHIP). The metadata of 3002 sequenced samples, including the FASTA sequence, was submitted to the Global Initiative on Sharing Avian Influenza Data (GISAID) and the Indian biological data centre (IBDC). This study identified 104 different SARS-CoV-2 pango-lineages classified into 19 clades. We have also analysed the mutation profiles of the variants found in the study, which showed eight mutations of interest, including L18F, K417N, K417T, L452R, S477N, N501Y, P681H, P681R, and mutation of concern E484K in the spike glycoprotein region. The study was from November 2020 to December 2022, making this study the most comprehensive genomic surveillance of SARS-CoV-2 conducted for the region. [ABSTRACT FROM AUTHOR]

Background: Globally in 2021, 247 million malaria cases were reported from 84 malaria endemic countries. India is committed to eliminate malaria by year 2030. India reported >160,000 malaria cases in 2021 and 2022; 65% cases from four states-West Bengal, Chhattisgarh, Orrisa and Jharkhand. Objectives: We assessed malaria surveillance system in Jashpur district to describe epidemiology of reported malaria cases, for its strengths and weaknesses and to provide evidence-based recommendations. Methodology: We analyzed surveillance data for the year 2022. We assessed timeliness and completeness attributes of the system using US CDC guidelines for evaluating the surveillance system of the five randomly selected reporting units (RUs) for January-March 2023. We reviewed surveillance data reporting portal, hospital records and interviewed key informants. We analyzed data using MS Excel and calculated frequencies and proportion Results: Jashpur reported 269 cases in 2022; 51% female, 58% among tribal community, 89% above 15 years and 90% were of plasmodium falciparum. The maximum number of cases were reported during July to November with peak in the month of August. The annual parasite index (API) per 1000 population was 0.3 for the district, however two blocks had API of >0.5. All the five RUs submitted monthly reports timely. Of the ten reporting formats reviewed, 48% critical blank fields were not filled. Conclusion: Malaria surveillance system in Jashpur detected cases largely among tribal community, identified high burden blocks with good timeliness but require improvement in complete information. We recommended district to focus preventive public health measures in high burden blocks and orient the laboratory technicians for complete data entry in line list of cases. [ABSTRACT FROM AUTHOR]

This short paper offers some reflections on the role, effectiveness and challenges for health information systems in developing countries. It is argued that such systems need to support the use of information for action, but that this is often compromised by poor quality data. In addition, good data and related ICTs are inadequate by themselves since effective action also needs knowledgeable people and supportive institutions. Some approaches are discussed on software philosophy, educating people and changing institutions. The paper also includes a brief reflection on theory and its role in relation to action in health information systems, and ends with some reflections for practice. Illustrative examples in the paper are drawn mainly from India, but the issues discussed are relevant to engagement across the globe. [ABSTRACT FROM AUTHOR]

Ontology design and querying the data set to obtain accurate results has been a topic of research. The aim of the paper is to represent ontological knowledge in the field of Medical Information Systems to store the knowledge about Swine flu disease and thereby querying the data and formalize the knowledge base development. The developed knowledge from RDF is converted to rules and then querying is done through different methods and performance analysis has been done on the retrieved query. The results predicted determine the suitability of the method where querying gives the accurate result for swine flu disease ontology. [ABSTRACT FROM AUTHOR]

Health information systems (HIS) in India, as in most other developing countries, support public health management but fail to enable healthcare providers to use data for delivering quality services. Such a failure is surprising, given that the population healthcare data that the system collects are aggregated from patient records. An important reason for this failure is that the health information architecture (HIA) of the HIS is designed primarily to serve the information needs of policymakers and program managers. India has recognised the architectural gaps in its HIS and proposes to develop an integrated HIA. An enabling HIA that attempts to balance the autonomy of local systems with the requirements of a centralised monitoring agency could meet the diverse information needs of various stakeholders. Given the lack of in-country knowledge and experience in designing such an HIA, this case study was undertaken to analyse HIS in the Bihar state of India and to understand whether it would enable healthcare providers, program managers and policymakers to use data for decision-making. Based on a literature review and data collected from interviews with key informants, this article proposes a federated HIA, which has the potential to improve HIS efficiency; provide flexibility for local innovation; cater to the diverse information needs of healthcare providers, program managers and policymakers; and encourage data-based decision-making. [ABSTRACT FROM AUTHOR]

Mental health information systems are increasingly being used to measure the effectiveness of mental health interventions. Little or no data is available for mental health service availability and service uptake in lowand middle-income countries. Through a narrative review, this paper illustrates the importance of routine monitoring data and suggests methods for developing, implementing and evaluating mental health indicators in low- and middle-income countries with a primary focus on India. [ABSTRACT FROM AUTHOR]

Routine health data is rich in information but underutilised for research in Low and Middle-Income countries. The present study was carried out to understand spatiotemporal patterns of dengue and its association with risk factors using routine data from health and allied sectors. ESTDA included estimation of dengue incidence rates, time series features and correlation coefficients up to the sub-district level. Scatter plots and correlation coefficients were used to identify relationships between covariates. Dengue incidence in 2015–19 was 47.76, 33.64, 52.03, 49.71, and 33.36 per 100,000, respectively, with a mean (SD) age of 34.33 (16.78) years and the majority being males (63.94%). Dengue had significant cross-correlation, non-linear relationships, and spatio-temporal associations with climatic, environmental, and socio-demographic risk factors. Significant autocorrelation of dengue occurrence was present at a lag of one month with seasonal patterns. The reproducible open-source algorithms add value to existing Routine Health Information Systems, and the findings will enable the development of Spatio-temporal models in future research. The research was done using R version 4.1.0. • Routine Health Information System (RHIS) datasets are underutilised for research. • Dengue is associated with eco-socio-demographic factors in the local context. • Exploratory analysis will enable feature selection for disease forecasting. [ABSTRACT FROM AUTHOR]

Digital technology has encompassed all aspects of healthcare. There are many international and national organizations, guidelines, and formats available in health information systems (HIS), but many are presently still not being used in India. The aim is to give a flawless, secure, and user-friendly health information technology (IT) system for Indian healthcare. We discuss the timeline of digital technology in hospital administration, administrative applications, and the importance of clinical quality in health. Clinical perspectives of clinical information systems (CIS), both in acute as well as chronic clinical care models. Cross-integration of healthcare in IT (HIT) in electronic health records (EHR) or electronic medical records (EMRs), in chronic disease management (CDM) systems, and in clinical decision support systems (CDSS) are elaborated. Also, practical strategic application methods are discussed. The limitations of the current HIS software in India are mostly used for transaction reporting, prescription, and administrative tools. They lack CIS and strategic business applications as compared to mature multinational company (MNC) HIS software. Along with this, various features and levels of HIS Software, challenges of HIT adoption, Indian health IT standards, and the future framework of IT in health in India are systematically analyzed. We aim at all physicians in India and at all levels of practice, from individuals, group practices, health institutes, or corporate hospitals, and to encourage them to make strategic use of CIS and strategic IT applications in their individual practice and hospital management. This will improve clinical outcomes, patient safety, practitioner performance, adherence to treatment guidelines, and reduction in medical errors, along with efficiency improvements and cost reductions. How to cite this article : Taneja D, Kulkarni SV, Sinha S, et al. Digital Technology in Hospital Administration: A Strategic Choice. J Assoc Physicians India 2023;71(10):83-88., (© Journal of the Association of Physicians of India 2023.)

A living lab is an emerging concept, particularly in Europe, as a vehicle to develop digital innovations through a process of co-produced design and development, which takes place, physically and socially, in real-life use contexts. However, there is limited research relating to guiding our understanding of the process by which such labs are established, and digital innovations are co-created and scaled to other settings requiring similar solutions. Furthermore, beyond Europe, the concept of a living lab has not found widespread application in low- and middle-income countries (LMICs), particularly in their public health contexts. Public health systems offer the unique scaling challenge of "all or nothing", implying that data are required from the whole population rather than isolated pilot settings. The living lab approach promises the rich potential to strengthen public systems but comes with twin interconnected challenges. First, for building appropriate digital solutions to address local public health challenges, and second, in scaling them to other public health facilities. This article investigates these twin challenges through ongoing empirical work in India and identifies three key domains of analysis, which are as follows: the first concerns the process of establishing an enabling structure of a "living lab within a lab"; the second concerns leveraging the capabilities offered by free and open-source digital technologies; and the third concerns the driving impetus to scaling through agile and co-constructed technical support., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mukherjee, Sahay, Kumar, Banta and Joshi.)

[Display omitted] • Indian females are most vulnerable to IDA with high Fe requirements and low intake. • Food-to-food fortification approaches have been emphasized. • Case-study highlights need for alternative food-based solutions. • Product efficacy warrants optimised hybrid food processing techniques. Malnutrition is among the top 6 risk factors for death in India, and iron deficiency anemia (IDA) is regarded as one of the major contributors, with nationwide prevalence > 60 % among women. Nutritional anemia accounts for ∼70 % anemia prevalence among Indian children and adolescents, specifically in females. Evidence suggests that current supplementation and fortification practices alone may make little difference in reducing the risk of IDA. Sustainable food-based strategies need to be determined. This review provides an overview of IDA in India and elaborates the food-based solutions. Factors that affect iron bioavailability have been discussed while exploring different plant-based food synergies to improve iron absorption. Nutritional and non-nutritional challenges have been highlighted. A case study has been incorporated that analyses Health Management Information System data for certain pregnancy outcomes among severely anemic pregnant women. It highlights the need for implementing alternative food-based strategies apart from the government programs. Iron-rich plant sources, with appropriate ratios of bioavailability enhancers and inhibitors can be utilized to develop effective products. However, this cannot be easily achieved. Obtaining higher concentrations of iron from food sources alone is challenging. Processing techniques may lower antinutrient content but risk mineral loss and vitamin degradation from the food matrix. Most studies focus on increasing iron content via fortification rather than enhancing its bioavailability. Safety, accessibility, and affordability issues of previous approaches need to be addressed. It is essential to understand the chemistry behind iron bio-accessibility and absorption to develop ready-to-eat plant-based food formulations, with highly bioavailable iron, which could be a plausible solution. [ABSTRACT FROM AUTHOR]

Abstract: As many low- to middle-income countries strive to achieve targets of reduced maternal, neonatal and infant mortality set by the Millennium Development Goals, health system innovations which can accelerate progress are being carefully examined. Among these are technologies and systems which aim to strengthen frontline health workers and the health systems within which they work, by enabling the registration of pregnancies, births and outcomes. Accurate, population-based numerators and denominators can help to improve accountability of the health system to provide expected routine antenatal and post-natal care, as well as emergency support and referral, as needed. The enumeration of women of reproductive age, followed by prospective, voluntary registration of pregnancies has the potential to support governments, health agencies, and the populations they serve, to ensure public health service delivery and to guide informed policies. [Copyright &y& Elsevier]

While decentralisation is a much‐used term in development discourse, there is lack of clarity about how much autonomy should be granted to local agencies in programme implementation. This is particularly the case in the health sector in developing countries where decentralisation has resulted in the primary health centre (PHC) being identified as the focal point for the delivery of basic health services to rural citizens. An important element of primary healthcare reform has been the implementation of health information systems (HIS). These systems primarily account for monies spent to higher levels of administration and funding bodies rather than account for primary healthcare provision to citizens. In this article, we focus on various emergent processes of change that are occurring under the auspices of the National Rural Health Mission (NRHM) in India to strengthen the interface between the PHC and the community. We present a case study of Gumballi PHC in Karnataka, South India. Our findings reveal ways in which these new processes can be supported by conceptualising the HIS as more than a mere reporting tool. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There is an urgent need to address the issue of non-integrated health information systems (HIS) in developing countries. The existing literature on information systems (IS) integration, however, is overly optimistic and prescriptive. It is predominantly technical in orientation, often touting new and better technical approaches to deal with the integration challenges. We identify and build on critical literature that goes beyond the largely unchallenged consensus that integration is desirable (and doable). We are not arguing against integration per se, but discussing the challenges of actually achieving integration, specifically the political aspects of integration. The empirical material is drawn from an ongoing effort to computerize the health care sector and integrate IS systems in India. We focus on the sociotechnical and political aspects of integration of these systems. Our aims are (1) to address the conceptualizations of integration within IS and (2) to provide guidelines for how integration can or should be managed in practice. This article, in understanding the political–technical aspects of integration, has implications not only to health and India, but also to other domains of IS in both developed and developing countries. © 2009 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This article addresses the issue of scaling of information systems (IS) in both theoretical and empirical terms. Scaling is an important issue in IS, especially in the contemporary context of globalization, as attempts are ongoing to expand IS in the same context as well as take it into other contexts. Theoretically, an information-infrastructure (II) perspective is drawn on to analyze the challenge of scaling, viewing it not merely as a technical problem, but as a socio-technical one involving a heterogeneous network constituted of technology, people, processes, and the institutional context. Empirically, scaling is analyzed based on experiences from an ongoing project to implement health information systems within the primary health care sector in India. The theoretically informed empirical analysis leads to some preliminary insights relating to the questions of what is being scaled and how it is being scaled. Some conclusions are drawn on theoretical and practical challenges related to scaling, and on implications for human-resource capacity development. © 2006 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

An effective health management information system (HMIS) that captures accurate, consistent, and relevant data in a timely fashion can enable better planning and monitoring of health programs and improved service delivery, in turn helping increase the impact of different interventions. In 2009, the Government of Uttar Pradesh (GOUP) implemented HMIS, India's national-level health information platform. However, key challenges, including difficulties in accessing the data through a web-based portal and its limited relevance to decision making and managerial needs, reduced its usability at the district and state levels. In 2015, with the support of the Uttar Pradesh Technical Support Unit, the GOUP created its own data platform, the Uttar Pradesh HMIS (UP-HMIS), to capture data elements missing from HMIS but important to UP decision makers. The UP-HMIS was redesigned to capture these data elements to holistically measure and monitor the performance of health programs and inform decision making at the district and state levels. In addition, the GOUP implemented complementary initiatives to improve data quality and data use processes. To improve HMIS data quality, the GOUP established data validation committee meetings at the block, district, and state levels. To promote the use of these validated data, in 2017, the GOUP developed and implemented the UP Health Dashboard, which ranks each of UP's 75 districts on a set of key HMIS priority health indicators. These policy guidelines have brought greater attention to UP-HMIS data quality and use; however, additional strengthening is required to improve the quality and use of HMIS data. There is a need to increase the overall capacity and understanding of HMIS data, not only for staff with specific data-related responsibilities but also for program managers and senior decision makers., (© Meghani et al.)

In many developing countries like India, there is a widespread lack of general awareness about the importance of good oral health, which causes dental patients to neglect their oral hygiene, thus precipitating many long-term ailments. We developed an application that promotes the significance of regular dental checkups and oral health care by explaining to patients how these are intrinsic to overall health. Our application, in essence, extracts relevant health information from published scientific studies according to a patient's medical history and shares it with the patient at the discretion of the supervising dentist, thereby empowering patients to make more informed decisions. We present a detailed overview of our semi- autonomous machine learning-based solution, along with the complex challenges involved in the design, development, and real-world deployment of our application. Finally, we conducted a randomized parallel-group study in India with 224 dental patients over two years to assess the utility of our proposed solution. Results show our application improved the patient recall rate from 21.1% to 37.8% (p-value = 0.024).

Introduction: Information and Communication Technologies (ICTs) are acknowledged as vital tools to strengthen Primary Health Care (PHC) in low- and middle-income countries (LMICs). However, these technologies have been used only for selected services. Moreover, there is limited evidence on how effective these interventions are in improving comprehensive primary health care in LMICs. Therefore, we developed an integrated digital solution and field-tested its impact on PHC services in an urban community of India., Methods: An integrated health information system for primary health care (IHIS4PHC) was designed on a free and open source digital platform which provided multiple features for registration of population and tracking for promotive, preventive, and curative health services (e.g. Antenatal Care, Immunization, TB, Malaria, and Hypertension Treatment etc.), and for generation of aggregate reports for real-time monitoring. The IHIS4PHC was implemented in an urban health centre of Chandigarh (India) which catered to about 25,000 population. A quasi-experimental study design was chosen for analysing the impact of IHIS4PHC on PHC services. Household sample surveys were conducted at baseline and endline in the intervention and comparison community to estimate the coverage of selected health indicators using standard questionnaires. Difference-in-difference method with adjusted generalised estimating equation was used for the assessment of the net impact of IHIS4PHC., Results: In relation to the comparison community, statistically significant (p < 0.05) increase was observed at the IHIS4PHC implementing centre in primary health care adequacy (7.2 %), and in the care-seeking behaviour for chronic illness (16.5 %). Improvements were also noticed in other health indicators such as mean blood pressure, adherence to antihypertensive medication, intake of dietary salt by hypertensives, intention to quit tobacco, and vitamin A supplementation., Conclusions: The digital IHIS4PHC design was found to be effective in improving PHC-based health services. Therefore, IHIS4PHC like digital solutions should be considered for strengthening PHC services in LMICs., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Chronic diseases have emerged as the leading cause of death globally, and 20% of Indians are estimated to suffer from a chronic condition. Care for chronic diseases poses a major public health challenge, especially when health care delivery has been geared traditionally towards acute care. In this study, we aimed to better understand how primary care for diabetes and hypertension is currently organised in first-line health facilities in rural India, and propose evidence-based ways forward for strengthening local health systems to address chronic problems., Methods: We used qualitative and quantitative methods to gain insight into how care is organised and how patients and providers manage within this delivery system. We conducted in-depth interviews with the medical doctors working in three private clinics and in three public primary health centres. We also interviewed 24 patients with chronic diseases receiving care in the two sub-sectors. Non-participant observations and facility assessments were performed to triangulate the findings from the interviews., Results: The current delivery system has many problems impeding the delivery of quality care for chronic conditions. In both the public and private facilities studied, the care processes are very doctor-centred, with little room for other health centre staff. Doctors face very high workloads, especially in the public sector, jeopardising proper communication with patients and adequate counselling. In addition, the health information system is fragmented and provides little or no support for patient follow-up and self-management. The patient is largely left on their own in trying to make sense of their condition and in finding their way in a complex and scattered health care landscape., Conclusions: The design and organisation of care for persons with chronic diseases in India needs to be rethought. More space and responsibility should be given to the primary care level, and relatively less to the more specialised hospital level. Furthermore, doctors should consider delegating some of their tasks to other staff in the first-line health facility to significantly reduce their workload and increase time available for communication. The health information system needs to be adapted to better ensure continuity of care and support self-management by patients.

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology&rsquo;s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad&rsquo;s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country&rsquo;s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.