Study of anaemia in pregnancy and low birth weight in fluoride endemic area of Western Rajasthan: a cohort study.

Background: Fluoride is a noxious element known to destroy gastrointestinal mucosa, leading to erythrocytes' destruction and causing anaemia. The birth weight of newborn babies is a significant indicator of a child's vulnerability to the risk of childhood diseases and chances of existence. Methods: This prospective cohort study was planned to find linkages between fluorosis and the low-birth weight of newborn babies with anaemic mothers. Antenatal mothers until the 20th week of gestation were followed up till delivery in the Antenatal Clinic of a District Hospital in one of the known fluoride-endemic districts (Nagaur) and the other not-so-endemic district (Jodhpur) of Western Rajasthan. Results: Around 19% of the newborn in Jodhpur and around 22% in Nagaur had low birth weight. Mean fluoride values in water samples were measured to be 0.57 (range from 0.0 to 2.7 PPM) in Jodhpur and 0.7 (range from 0.0 to 3.4 PPM) in Nagaur. Conclusions: Thus, in fluoride endemic areas, other factors should be included besides iron and folic acid supplementation for improving anaemia in pregnant women. This calls for assessing the effectiveness of de-fluoridation activities along with the area's most common indigenous food practices.

Competence-Based Assessment of Biomedical Equipment Management and Maintenance System (e-Upkaran) Using Benefit Evaluation Framework.

Introduction To establish a centralized inventory management system for the efficient functioning of all healthcare facilities, e-Upkaran (equipment management and maintenance system) was launched in 2015 in the state of Rajasthan. This study is conducted to assess the functioning of e-Upkaran in Rajasthan. Methods The assessment of the e-Upkaran system for primary and secondary healthcare centers was carried out using a systematic review of the literature and a multi-indicator stakeholder questionnaire. The benefits evaluation framework focused on the system quality, information and service quality, use and user satisfaction, and net benefits utilized for the assessment. A review of the literature was done to highlight the importance of computerized medical equipment management and maintenance systems and appraise the challenges and benefits associated with such systems as compared to the traditional pen-paper register. Information was gathered based on available documents, field observation, and data obtained from specific hospital staff, including the bioengineers and other users of e-Upkaran. Results The finding of this study suggests that e-Upkaran efficiently improves documentation, reporting, maintenance, and management of medical equipment. It is more efficient than the traditional paper-pen system. It is designed to minimize downtime and maintain equipment in good operating condition and has potential benefits in terms of improving information quality, use, and net benefit. The cost of service ratio is within the benchmark value. This system has also considerably reduced out-of-pocket expenditure. Computer proficiency and the workload of other e-health programs pose a challenge in the implementation of this program. Conclusion The e-Upkaran system is competent in terms of improving information quality, use, and net benefit. Other Indian states could also adopt this system to improve their biomedical equipment management and maintenance system.

Economic analysis of ASHA-soft programme (online payment and monitoring system) in Jodhpur, Rajasthan.

Context: The Government of India under a performance-based payment scheme is providing remuneration as per the activities completed by the Accredited Social Health Activists (ASHA) health workers. Each state in India has a differentperformance-based payment system for ASHAs. The state of Rajasthan developed the ASHA-Soft system in 2014 for providing incentives to ASHAs. Aims: This study is planned to analyze the performance of ASHA-Soft considering the economic aspects as there is a paucity of studies in this context. Settings and Design: This study was conducted in Jodhpur, Rajasthan. Methods and Material: Economic analysis of ASHA-Soft program was performed based on Incentive paid to ASHA workers; Number of beneficiaries; Overall contribution of ASHAs in the health services; and unit cost per health service under ASHA-Soft program. Data of five financial years, that is, from the inception of ASHA-Soft was analyzed. Results: Consolidated incentive for maternal health, child health, and Immunization services provided to ASHAs through ASHA-Soft in the year 2015--16 was $96794.22, $35348.32, and $49016.83 which increased to $200285.00, $116320.52, and $101686.48 in the year 2019-20, respectively. Family planning and national program services were provided to 6,259 and 4,061 beneficiaries, respectively, in the year 2015--16 which markedly increased to 16,360 and 9,552 in the year 2019--20. Unit-cost of service provided by ASHAs in the National Programme ($1.13) was the lowest and for Family Planning Services ($5.71) were the highest. Conclusions: ASHA-Soft program seems a potential program to attract ASHA workers for delivering health care services. The findings of this study could assist policymakers in guiding further decision-making.

Approaches to Assess E-Health Programs: A Scoping Review.

CONTEXT: With the increasing trend of adopting e-Health technologies, the need for evidence for assessing e-Health technologies has become crucial. The appraisal of the e-Health program is important as this could provide guidance on further e-Health investment and adoption. AIMS: The aim of the study was to provide an articulated body of literature on the current state of knowledge about the assessment of e-Health interventions. SETTINGS AND DESIGN: Scoping review was conducted based on the framework provided by Arksey and O'Malley (2005) and considering enhancements proposed by Peters et al. (2015). SUBJECTS AND METHODS: We searched the electronic databases and available gray literature from inception until the last week of October 2019. PRISMA flowchart for the study selection process was used to guide reporting. Data extraction included information on study design, authors, year of study, country, and key findings in terms of approaches used for assessment of e-Health programs. Data were compiled and summarized narratively. RESULTS: Searches were performed between October and December 2019. Seventy-one relevant papers published between the years until the last week of October 2019 were reviewed and analyzed. After considering all the eligibility criteria, 15 papers were included. We identified 15 approaches for assessing e-Health programs, which were summarized and tabulated. CONCLUSIONS: This review showed that available literature on the assessment of e-Health programs is heterogeneous in terms of the methodology used. e-Health interventions are highly contextual; therefore; the phase of maturity and objective of the assessment should be considered while carrying out the assessment of e-Health programs.

Developing a health-promoting school using Knowledge to Action framework.

BACKGROUND: There is a lack of organized effort in the arena of school health promotion, which has been recognized as an effective approach to combat the growing incidence of communicable and noncommunicable diseases. With this view, a study was conducted to develop comprehensive and replicable model for health promotion in schools. MATERIALS AND METHODS: The Knowledge to Action (KTA) framework recognized by the World Health Organization as an implementational framework was used in an implementation study in a school of urban Jodhpur to assess the challenges and gaps associated with health promotion interventions in the school. Baseline regarding knowledge application and practices was gathered using interviews with school staff, parents, and group interaction with students. Knowledge synthesis was done by a thorough search of available literature and the gathered baseline. Resource mapping was carried out using checklists developed from knowledge synthesis. Tailor-made tools were constructed for knowledge implementation for each component of the action cycle. Knowledge of facts related to health behaviors among students was evaluated using pre- and postquestionnaires and practical application of knowledge was assessed using a checklist of 28 indicators on a 5-point Likert scale. Values of tests were gathered and compared with test values 3 and 6 months after the implementation of tailored interventions using descriptive and inferential statistics. RESULTS: Increase in correct answers by students (42% to 96%) and average response for indicators on the Likert scale (3.23-4.86) was seen on repeated interventions over 6 months. Tobacco consumption by school staff reduced by 20% and an increase in willingness among teachers was observed on follow-up interviews. CONCLUSION: The study thus developed a model for health promotion in a school with the help of the KTA framework using tailored interventions that could further be evolved in other setups based on local needs and available resources.

Overview of e-Health initiatives in Rajasthan: An exploratory study.

BACKGROUND: Government of Rajasthan has undertaken a series of e-Health initiatives, especially under various programs of National Health Mission in the past few years. There is a paucity of studies which document and provide appraisal of these initiatives in Rajasthan. AIM: To document ongoing e-Health Initiatives based on technologies and approaches used, coverage by the region and population, services provided and scope. MATERIALS AND METHODS: Primary data collection in form of key-informant interviews while secondary data collection in form of internet-based search of peer and non-peer reviewed literature was conducted to achieve the study objectives. Appropriate documents, records, and reports were reviewed to ensure that all necessary information was obtained. RESULTS: A total of 13 e-Health initiatives were included in the study. The e-Health programs were classified with the use of WHO's classification of Digital Health Interventions v1.0. Most of the initiatives perceived in the study were found to be beneficial to the community, covering the entire population targeted. Supporting agencies, technologies used, and challenges faced during the implementation were identified and documented. Lack of trained manpower, technical and software glitches and deficiency of awareness activities were few obstacles that were found consistent across all user groups. CONCLUSIONS: The overview from this study augmented the knowledge about further scopes and sustainability of these initiatives. Deploying dedicated professionals may improve the functioning of these initiatives. Since e-Health interventions significantly influence healthcare systems, further scale-up of such studies with appropriate evaluation should be planned to guide policy decisions.

Study of feasibility and effectiveness of ASHA-Soft (Online Payment and Performance Monitoring System) in Rajasthan.

OBJECTIVE: ASHA-Soft is the pioneer e-Health program which was launched to manage online payment and for monitoring performance of ASHA workers in Rajasthan. There is a paucity of studies which documents the feasibility and effectiveness of this program with aim to assess the feasibility and effectiveness of ASHA-Soft program. METHODS: Study was conducted in Jodhpur using quantitative and qualitative method. Primary and secondary data approach was used to assess feasibility and effectiveness of ASHA-Soft. Purposive sampling was done to recruit 150 ASHA workers having experience of more than 5 years to capture the perception before and after implementation of ASHA-Soft. Qualitative data was also obtained from ASHA workers and key stakeholders. To assess the effectiveness secondary data was obtained from various sources was analyzed. RESULTS: Mean age of participants were 35.51+ 6.7 years. Most of ASHAs agreed that ASHA-Soft mediated timely payment (68%) and payment according to their performance (81%). It also increased their motivational level (96%).There were no significant difference in different work experience of ASHAs and perception towards ASHA-Soft regarding timely payment (p=0.99), improving quality of life (p=0.66) and motivation level (p=0.40). This program has provided standard online procedure of online payment and monitoring for ASHAs. Incentives received by ASHAs increased to 77%, performance increased by 7% and 9% for maternal health and child health respectively within one year of its initial implementation. CONCLUSIONS: Study finding demonstrate that ASHA-Soft program is acceptable to the users and is effective in terms of meeting organizational requirement.

Assessment of monitoring and online payment system (Asha Soft) in Rajasthan using benefit evaluation (BE) framework.

CONTEXT: e-Health programs are implemented assuming that e-health/digital health can prove beneficial but pieces of evidence for assessing the actual benefits of e-health programs are lacking. AIMS: To utilize the benefit evaluation (BE) framework to assess Asha Soft, which is an online payment and performance monitoring system initiative taken by Rajasthan. SETTINGS AND DESIGN: BE of Asha Soft in Rajasthan. METHODS AND MATERIALS: BE of ASHA Soft was done using scoping review with consultation exercise. The rationale behind using this methodological framework is to contextualize knowledge of the current state of understanding within BE framework practice contexts. The themes used for data compilation and analysis were based on three broad dimensions of BE framework namely, health information technology quality, use, and net benefits. RESULTS: The state of Rajasthan has been the first in the country to start an online system of payment and monitoring of ASHA workers, through Asha Soft. It has administrative and supportive functions. Its simple and easy to use graphical user interference helps users to make accurate data entries and obtain desired monitoring and analytical reports. It has attributed to the availability of data on various parameters which help decision-maker to decide about the performance of ASHA worker and has brought a positive impact on the work performance of ASHAs. This online payment and monitoring mechanism has argumented motivational level and intention of use. The program has optimally utilized available human resources and no apparent monetary cost was involved in developing this software. CONCLUSIONS: This scoping study using the BE framework has provided evidence on the potential benefits of Asha Soft adoption in Rajasthan. It is recommended that future in-depth assessment of other e-health initiatives could be undertaken to guide the decision making.

Health-promoting school in India: Approaches and challenges.

Interventions early in life are the need of the hour when it comes to controlling the rising incidence of communicable and non-communicable diseases (NCDs) globally. WHO has issued guidelines towards health promotional initiatives at schools as a part of Global School Health Initiative, and the Government of India has directed many policies and programs to integrate health deep within the school activities. School Health Promotion is an international need with programmes implementing across continents due to numerous documented benefits, to not just the individuals but to the community and country as a whole. Simple teachings like hand hygiene have shown to reduce the incidence diarrhea by more than 50% amongst children (a major cause of mortality in India), thus raising an urgent need of developing a model for health promotion at schools that is replicable, sustainable, and can be modified to the local needs as well. Though the existent programmes have a few documented challenges, a multisectorial involvement of government agencies, educational boards, and health sector along with the school is the way forward to address those challenges and covert the theory of health promoting schools (HPS) into a well-established fact. It presents a scope for the various established and newly emerging Schools of Public Health in the country to come forward and collaborate with these multiple sectors. These collaborations can be the only way to ensure sustainability and incorporation of health promotion into the core academic structure of schools in a diverse and highly populous country like India.

Study on the perception of Swachh Bharat Abhiyan and attitude towards cleanliness among the residents of urban Jodhpur.

CONTEXT: Swachh Bharat Abhiyan (SBA) is an ambitious project and has been successful in bringing a difference at the facility and infrastructure level, and the objectives of this programme can be achieved if people are aware of this mission and basic sanitation and waste management practices. AIMS: To assess awareness and perception of SBA and attitude towards cleanliness among the residents of urban Jodhpur. SETTINGS AND DESIGN: A cross-sectional survey was done in the largest mixed-income housing society of Jodhpur. METHODS AND MATERIALS: A semi-structured questionnaire was designed for data collection. Sample size was 400. Participants aged above 18 years were included in the study. STATISTICAL ANALYSIS USED: Descriptive and inferential statistical analysis was done using Epi Info Version 7.1. The data were evaluated using Chi-square test and P < 0.05 was considered statistically significant. RESULTS: Mean age of female participants were 30.02 ± 11.34 years and male participants were 34.92 ± 13.10 years. Mean perception about SBA for being able to communicate the importance of cleanliness was 4.8, i.e. lying between strongly agree and agree. No significant association was observed between educational status and attitude towards cleanliness (P < 0.005). A significant association was seen between gender and knowledge about SBA in terms of correctly mentioning the duration of the SBA programme (P > 0.005). CONCLUSIONS: Existing knowledge about SBA and perception towards cleanliness among participants were positive but still there is need of programmes and strategies that help in bringing positive behaviour among group of people who are reluctant towards adopting proper cleanliness, sanitation and hygiene practices.