Developing and transferring a children's surgical training program from India to Africa a south-to-south global initiative.

PURPOSE: The availability of children's surgical care in lower middle-income countries is lacking. The authors describe a hub and spoke global training initiative in children's surgery for adult teams from district hospitals (spokes) comprising general and orthopaedic surgeons, anaesthetists, and nurses and specialist children's surgical trainers from tertiary centres (hubs) in delivering the course. METHODS: The training course developed in Vellore, trained several sets of district hospital adult teams and trainer teams in India. Six specialist children's surgical trainer teams were invited from African countries to the course delivered in Vellore, India. The aim was to train them to deliver the course in their countries. RESULTS: Participants underwent a precourse 'train the trainer' program, observed and assessed the suitability of the district hospital training course. The program received positive feedback, government supported planning of similar courses in some of the countries and discussions in others. CONCLUSION: The availability of children's surgical care is similarly limited in the Asian and African continent, and the regions have shared challenges of disease burden, lack of access, poverty, deficient infrastructure, and trained human resources. They would benefit from this 'South to South' collaboration to impart training skills and modules to the children's surgical trainers.

Risk assessment of trace element accumulation in soil and Brassica oleracea after wastewater irrigation.

The risk assessment of trace elements has received substantial attention for the achievement of UN Sustainable Developmental Goals (UN-SDGs). The present study aimed to evaluate health and ecological risks associated with trace element accumulation in Brassica oleracea under wastewater irrigations from three different areas. This study, for the first time, compared the pros and cons of mixed water crop irrigation (wastewater with fresh/groundwater). A pot experiment was conducted to evaluate the buildup of eight trace elements (As, Cu, Cd, Mn, Fe, Pb, Ni and Zn) in soil and B. oleracea plants irrigated with wastewater alone and mixed with fresh/groundwater. Specific ecological [degree of contamination (Cd), potential ecological risk index (PERI), pollution load index (PLI), geo-accumulation index (Igeo)], phytoaccumulation [bioconcentration factor (BCF) and transfer factor (TF)] and health risk models [chronic daily intake (CDI), hazard quotient (HQ), cancer risk (CR)] were applied to assess the overall contamination of trace elements in the soil-plant-human system. Moreover, these indices were compared with the literature data. The concentration of Cd, Fe and Mn exceeded the threshold limits of 10, 500 and 200 mg kg-1, respectively, for agricultural soil. Overall, all the irrigation waters caused significant pollution load in soil indicating high ecological risk (Cd > 24, PERI > 380, Igeo > 5, PLI > 2). Not all the mixing treatments caused a reduction in trace element buildup in soil. The mixing of wastewater-1 with either groundwater or freshwater increased trace element levels in the soil as well as risk indices compared to wastewater alone. The BCF and TF values were > 1, respectively, for 66% and 7% treatments. Trace element concentration in plants and associated health risk were minimized in mixed wastewater treatments. There were 22% and 32% reduction in HQ and CR when wastewater was mixed with freshwater and 29% and 8% when mixed with groundwater. Despite total reduction, a great variation in % change in risk indices was observed with respect to the area of wastewater collection. Therefore, mixed water irrigation may be a good management strategy, but its recommendation depends on soil properties and composition of waters used for mixing. Moreover, it is recommended that the freshwater and wastewater of the particular area may be continuously monitored to avoid potential associated health hazards.

The role of registered charities in the delivery of global surgery in low- and middle-income countries - a personal experience.

The world's resources are unequally divided. Investment in healthcare in Low- and Middle-Income Countries (LMICs) has traditionally involved vertical public health strategies with little emphasis on the delivery of safe and effective surgery and anesthesia. The past 20 years has witnessed greater awareness of the numbers of people who have no access to surgery, the morbidity and mortality of such limited access, and the cost to the individual and society if a solution is not found. Global surgery has become a hot topic and The Millennium Development Goals (MDG) and the Sustainable Development Goals (SDG) have underlined the importance of surgery in national health care plans. The harsh metrics reported by the Lancet Commission has framed the problem in more concrete terms and as of today, over 5 billion people lack access to safe surgery, over 143 million extra surgeries are needed annually to affect the imbalance and more than 15,000 children die each day in Sub Saharan Africa and Southeast Asia from preventable disease, including the lack of access to safe surgery. Horizontal integrated healthcare that includes surgical provision is the new norm, but its introduction is expensive and will need time. The ambition of universal healthcare access for all people (SDG) with a corresponding reduction in child and maternal mortality will be difficult for most governments. Altruistic, Non-Governmental Organizations (NGOs) are ideally placed to assist this goal but must introduce changes in practice to include onsite and off-site training, broad partnerships with other NGOs and academic bodies and greater advocacy with governments to ensure sustainability. NGOs should work in concert with local agencies, hospitals and governments to meet local needs.

Emerging infectious diseases and outbreaks: implications for women's reproductive health and rights in resource-poor settings.

This century is witnessing dramatic changes in the health needs of the world's populations. The double burden of infectious and chronic diseases constitutes major causes of morbidity and mortality. Over the last two decades, there has been a rise in infectious diseases, including the severe acute respiratory syndrome virus (SARS), the H1N1 pandemic influenza, the Ebolavirus and the Covid-19 virus. These diseases have rapidly spread across the world and have reminded us of the unprecedented connectivity that defines our modern civilization. Though some countries have made substantial progress toward improving global surveillance for emerging infectious diseases (EIDs), the vast majority of Low-and Middle-income Countries (LMICs) with fragile health systems and various system-related bottlenecks remain vulnerable to outbreaks and, as such, experience dramatic social and economic consequences when they are reported. Lessons learned from past outbreaks suggest that gender inequalities are common across a range of health issues relating to Sexual and Reproductive Health and Rights (SRHR), with women being particularly disadvantaged, partially due to the burden placed on them. Though these countries are striving to improve their health systems and be more inclusive to this vulnerable group, the national/ global outbreaks have burdened the overall system and thus paralyzed normal services dedicated to the delivery of Sexual and Reproductive Health (SRH) services. In this paper, we discuss the global commitments to SRH, the impact of the EIDs on the LMICs, the failure in the delivery of SRH services, and the strategies for successful implementation of recovery plans that must address the specific and differentiated needs of women and girls in resource-poor settings.

Is obesity a problem among school children?

Reduction of premature mortality due to noncommunicable diseases through prevention and control forms the core issue of target 3.4 of sustainable development goals. Childhood obesity is an important public health challenge today. The current study was carried out in a large military station of North East India to find out prevalence of obesity among schoolchildren using World Health Organization body mass index-for-age charts for boys and girls. A total of 793 schoolchildren comprising of 328 girls and 465 boys between the age groups of 6 and 19 years were included. The prevalence of overweight and obesity among girls was 9.76% and 1.22%; and among boys, it was 10.97% and 3.23%, respectively. Overweight and obesity were more common among boys as compared to girls under the age of 13 years but trend changed afterwards. Lower prevalence of overweight and obesity found in our study could be because of availability of healthful environment in schools.

Neurological examination of healthy term infants at ages 6 and 10 weeks in Tshwane District.

Background: Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress. Objectives: Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE). Method: A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks' postnatal age in the Tshwane district. The statuses of infants' neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points. Results: Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively. Conclusion: This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages. Clinical Implications: The findings support the viewpoint to identify important milestone characteristics during early screening.

Process evaluation of a complex, multilevel, multicomponent scheme for the prevention and control of non-communicable diseases in Tamil Nadu, India: A mixed-methods protocol.

Background: Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality in India, necessitating development of multilevel and multicomponent interventions. Makkalai Thedi Maruthuvam (MTM) is a complex multilevel, multicomponent intervention developed and implemented by the south Indian State of Tamil Nadu. The scheme aims to deliver services for preventing and controlling diabetes, and hypertension at doorstep. This paper describes the protocol for planning and conducting the process evaluation of the MTM scheme. Methods and analysis: The process evaluation uses mixed methods (secondary data analysis, key informant interviews, in-depth interviews, conceptual content analysis of documents, facility-based survey and non-participant observation) to evaluate the implementation of the MTM scheme. The broad evaluation questions addressed the fidelity, contexts, mechanisms of impact and challenges encountered by the scheme using the Consolidated Framework for Implementation Research (CFIR) framework. The specific evaluation questions addressed selected inputs and processes identified as critical to implementation by the stakeholders. The CFIR framework will guide the thematic analysis of the qualitative interviews to explore the adaptations and deviations introduced during implementation in various contexts. The quantitative data on the indicators developed for the specific evaluation questions will be cleaned and descriptively analysed.

Local governments and community-based rehabilitation for developmental disabilities: leaving no one behind.

SETTING: The BUDS (not an acronym) institutions comprise a community-based rehabilitation initiative for children and families affected by developmental disabilities in Kerala, India. OBJECTIVE: To explore the role of local governments in the establishment and functioning of BUDS institutions. DESIGN: We used qualitative approaches comprising document review and in-depth interviews with trainers, parents of children with developmental disabilities and elected representatives. RESULTS: BUDS was created by Kudumbasree, a decentralised women empowerment and poverty alleviation initiative. Our findings illustrate the role of local governments in facilitating expansion through the establishment of infrastructure, therapy equipment, transportation and financial allocation for these, as well as through the development of human resources, assistance with enrolment for financial assistance and insurance programmes, and coordination with education and health sectors. Programme implementation varied considerably regarding available infrastructure, staffing and services among the institutions studied. The institutions were physically closed during the COVID-19 pandemic but continued to function in alternative ways. CONCLUSION: Despite variable implementation, local governments have supported the expansion of BUDS institutions, thereby creating more spaces for inclusive and integrated education and rehabilitation of persons with disabilities in Kerala. The expansion over the past two decades and measures during the COVID-19 pandemic suggest resilience and sustainability of the model.

CONTEXTE: Les institutions BUDS (ceci n'est pas un acronyme) ont mis en place une initiative communautaire pour la réhabilitation des enfants et familles touchés par des troubles du développement au Kérala, Inde. OBJECTIF: Analyser le rôle des gouvernements locaux dans la fondation et le fonctionnement des institutions BUDS. MÉTHODES: Nous avons utilisé des approches qualitatives fondées sur une analyse documentaire et sur des entretiens approfondis avec des formateurs, des parents d'enfants atteints de troubles du développement et des représentants élus. RÉSULTATS: BUDS a été créé dans le cadre d'une initiative décentralisée de réduction de la pauvreté et d'autonomisation des femmes, dénommée Kudumbasree. Nos résultats illustrent le rôle des gouvernements locaux dans la facilitation de l'expansion par la mise à disposition d'infrastructures, d'équipements thérapeutiques, de transports et l'allocation de fonds pour ceux-ci, ainsi que par le développement des ressources humaines, l'inclusion dans des programmes d'assistance financière et d'assurances, et la coordination avec les secteurs de l'éducation et de la santé. De grandes différences de mise en œuvre du programme ont été observées entre les institutions à l'étude, en matière d'infrastructures disponibles, de personnel et de services. Les institutions ont fermé leurs portes pendant la pandémie de COVID-19, mais elles continuaient de fonctionner de manière alternative. CONCLUSION: En dépit d'une mise en œuvre variable, les gouvernements locaux ont soutenu le développement des institutions BUDS et ainsi élargi l'espace pour une éducation et une réhabilitation inclusives et intégrées des personnes porteuses de handicaps au Kérala. Le développement de ces institutions au cours des 20 dernières années et les mesures instaurées pendant la pandémie de COVID-19 laissent transparaître la résilience et le caractère durable du modèle.

Palliative care management committees: a model of collaborative governance for primary health care.

SETTING: The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. OBJECTIVE: To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. DESIGN: This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. RESULTS: Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes. CONCLUSION: Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.

CONTEXTE: Le programme communautaire de soins palliatifs primaires du Kérala, Inde, a été applaudi sur la scène internationale. Le fonctionnement du programme est soutenu par des Comités de gestion des soins palliatifs (PMC) au niveau des gouvernements locaux (LG). OBJECTIF: Évaluer le fonctionnement des PMC au sein de l'espace de gouvernance décentralisée, afin d'identifier les réussites, les lacunes et les principales innovations. MÉTHODES: Dans le cadre de cette étude qualitative, sept entretiens avec des informateurs clés (KIIs), 28 entretiens approfondis et une analyse des politiques et documents accessibles au public ont été réalisés. Les transcriptions des KII ont permis de faire émerger les thèmes principaux. Les codes émergeant de l'analyse documentaire et des transcriptions des entretiens approfondis ont été associés aux domaines thématiques identifiés. RÉSULTATS: Les PMC les plus performants ont pu mobiliser des ressources, telles que de l'argent, des ressources humaines ou des équipements. Ils proposaient également des options de soins de qualité pour soulager les symptômes, facilitaient la réduction des frais à la charge du patient en fournissant des soins à domicile et des médicaments gratuits, et ont permis d'améliorer l'accès aux interventions qui s'attaquaient aux déterminants sociaux de la souffrance, tels que la pauvreté. Les capacités techniques et de gestion variaient d'un PMC à l'autre. Le programme de certains LG était faible, principalement limité à la fourniture de médicaments et d'aides et de matériels de base pour le domicile des patients. CONCLUSION: Malgré des schémas de mise en œuvre variés, les PMC du Kérala sont des exemples d'initiatives communautaires de santé soutenues par l'état qui peuvent potentiellement s'attaquer aux déterminants sociaux et médicaux de la souffrance.

Prevalence of stunting among under-five children in refugee and internally displaced communities: a systematic review and meta-analysis.

Background: A pooled estimate of stunting prevalence in refugee and internally displaced under-five children can help quantify the problem and focus on the nutritional needs of these marginalized groups. We aimed to assess the pooled prevalence of stunting in refugees and internally displaced under-five children from different parts of the globe. Methods: In this systematic review and meta-analysis, seven databases (Cochrane, EBSCOHost, EMBASE, ProQuest, PubMed, Scopus, and Web of Science) along with "preprint servers" were searched systematically from the earliest available date to 14 February 2023. Refugee and internally displaced (IDP) under-five children were included, and study quality was assessed using "National Heart, Lung, and Blood Institute (NHLBI)" tools. Results: A total of 776 abstracts (PubMed = 208, Scopus = 192, Cochrane = 1, Web of Science = 27, Embase = 8, EBSCOHost = 123, ProQuest = 5, Google Scholar = 209, and Preprints = 3) were retrieved, duplicates removed, and screened, among which 30 studies were found eligible for qualitative and quantitative synthesis. The pooled prevalence of stunting was 26% [95% confidence interval (CI): 21-31]. Heterogeneity was high (I2 = 99%, p < 0.01). A subgroup analysis of the type of study subjects revealed a pooled stunting prevalence of 37% (95% CI: 23-53) in internally displaced populations and 22% (95% CI: 18-28) among refugee children. Based on geographical distribution, the stunting was 32% (95% CI: 24-40) in the African region, 34% (95% CI: 24-46) in the South-East Asian region, and 14% (95% CI: 11-19) in Eastern Mediterranean region. Conclusion: The stunting rate is more in the internally displaced population than the refugee population and more in the South-East Asian and African regions. Our recommendation is to conduct further research to evaluate the determinants of undernutrition among under-five children of refugees and internally displaced populations from different regions so that international organizations and responsible stakeholders of that region can take effective remedial actions. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387156, PROSPERO [CRD42023387156].

Re-engineering primary healthcare in Kerala.

INTRODUCTION: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care. METHODS: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema. RESULTS: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed. CONCLUSION: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

INTRODUCTION: Dans le contexte des Objectifs de développement durable (SDG), l'État du Kérala, Inde, a transformé ses centres de soins primaires (PHC) existants en centres de santé familiale (FHC) conviviaux afin de fournir des soins primaires complets dans le cadre d'une initiative mandatée en mission ('Aardram'). Il était prévu que la mise en œuvre et le fonctionnement de cette mission fassent appel à la gouvernance décentralisée. Cette étude a examiné l'influence de la gouvernance décentralisée sur la réorganisation des soins primaires. MÉTHODES: L'étude a eu recours à une approche exploratoire, en utilisant des méthodes qualitatives : entretiens avec des informateurs clés (n=8), entretiens approfondis (n=20) et analyses documentaires. Une analyse thématique a été réalisée selon un codage déductif et les thèmes identifiés ont été structurés sous forme de schéma. RÉSULTATS: Les résultats peuvent être résumés en cinq thèmes principaux. Un engagement politique fort, associé à des compétences bureaucratiques, ont facilité la mise en œuvre et le fonctionnement des soins primaires de la mission 'Aardram'. Les connaissances acquises grâce à la formation multisectorielle ont aidé les gouvernements locaux (LG) à s'impliquer et à s'engager dans le système de santé en tant qu'équipe afin de planifier et de mettre en place des interventions. Les structures de gouvernance décentralisées ont permis de réorganiser les PHC en mobilisant des ressources financières, en fournissant des ressources humaines, en modifiant les infrastructures et en renforçant la participation communautaire à différents niveaux. Parmi les lacunes observées figurent le manque d'uniformité de l'engagement, l'engagement sous-optimal des LG urbains et les questions de durabilité et de suivi. CONCLUSION: La gouvernance décentralisée a joué un rôle positif dans la réorganisation des PHC, qui a été utilisée comme une plateforme pour illustrer les bonnes pratiques en matière de gouvernance sanitaire par le biais d'une approche participative. Cette étude met en évidence l'importance de l'autonomisation des LG au travers du renforcement des capacités afin de relever les défis liés à la réalisation des SDG en matière de soins primaires.

The psychological concept of social sustainability in the workplace from the perspective of sustainable goals: A systematic review.

Unlike environmental sustainability, social sustainability in the workplace is a relatively new concept that is still searching for its own definition and explanation. Therefore, in this paper, we systematically reviewed and critically evaluated recent research on this topic. In doing so, we identified important constructs that help us better define and understand the phenomenon of social sustainability in the workplace. We focused on articles from 2016 to 2022 with content related to three Sustainable Development Goals (SDGs), namely health and wellbeing (SDG-3), gender equality (SDG-5), and decent work (SDG-8). Given the harrowing events of the past 2 years, triggered by the COVID-19 pandemic and the global impact of the war in Ukraine, we also wanted to learn whether other categories, such as security (SDG-11) and peace (SDG-16), are embedded in the concept of social sustainability at work. The articles we studied were found through EBSCOhost, specifically in the Academic Search Complete, Business Source Premier, APA PsycInfo, SocINDEX with Full Text, and GreenFILE databases. We selected 67 articles and organized them according to the four levels of research and practice in work and organizational psychology. In reviewing the literature, we identified several constructs that can be classified at four levels of interest in work and organizational psychology. At the level focused on the job/work, we identified two main topics: (i) sustainable job/work characteristics and (ii) sustainable job (re)design. At the people-focused level, we identified the following topics: (i) pro-sustainable self-system, (ii) pro-sustainable job attitudes and motivation, (iii) sustainability work environment perceptions and other mediating mechanisms, and (iv) sustainable job behavior. The organization-focused level includes (i) organizations as human systems and (ii) pro-sustainable organizational policies and practices. The last (society-focused) level is defined by two main topics: (i) understanding society as a human system and (ii) pro-social mechanisms. In the discussion, we categorized specific constructs identified within the described focus levels into the theoretical model describing the psychological concept of social sustainability in the workplace from the perspective of sustainable goals.

Household "rain water harvesting" - Who are practicing? Why are they practicing? A mixed methods study from rural area of Kolar district, South India.

BACKGROUND: "Rain Water Harvesting" is one of the identified strategies to replenish the ground water system in India. Household level of rain water harvesting could serve as an indicator for assessment of participation of local community. OBJECTIVES: To assess the proportion of household rainwater harvesting and factors associated with it and to find the reasons behind adoption of this practice in a rural area of Kolar district, Karnataka. METHODS: An exploratory sequential mixed methods study design with an initial cross-sectional quantitative study followed by qualitative in-depth interviews was done to assess the factors affecting household rain water harvesting and reasons behind the practice. Household survey with interview of one person from each household was done. Quantitative data were reported using proportions and qualitative data were reported using categories and verbatim quotes. RESULTS: Of the 82 households surveyed, 31 (37.8%, 95% CI: 27.8-48.6) had adopted at least crude method of rain water harvesting. Household belonging to either joint or three-generation family type was practicing rain water harvesting higher compared with nuclear family type. Reasons for adoption were included under the categories - purity, fresh, tradition, less work, passion, and why waste? CONCLUSION: About one in three households practiced rain water harvesting in the rural area under study with households belonging to joint or three-generation family practicing more compared with nuclear families. The reason for adoption was mostly based on beliefs and also felt needs by families.