Stakeholders' Initial Experience With Telemedicine Services Introduced at 13 Government Medical Colleges in Uttar Pradesh, India During the COVID-19 Lockdown: A Qualitative Study.

BACKGROUND: India went into a stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic in March 2020, and routine outpatient and elective health services were suspended. Thus, access to healthcare services got significantly disrupted. To mitigate the impact, 21 state-owned medical colleges in Uttar Pradesh, the most populous and among the most resource-constrained states in India, had to hastily launch telemedicine (TM) services. This created an opportunity to understand how stakeholders would react to such services and what initial challenges could be faced during service delivery. Through this study, we explored the experiences of stakeholders from 13 such "new-adopter" TM centres with the main objective to identify the perceived benefits and gaps related to TM services, and what "people-centric" TM services could look like going forward. METHODS: We used an exploratory-descriptive qualitative design with a constructivist paradigm. Using interview schedules with open-ended questions and unstructured probes, we interviewed 13 nodal officers, 20 doctors, and 20 patients (i.e., one nodal officer and one to two doctors and patients from each of the 13 new-adopter centres) and stopped thereafter since we reached saturation of information. We analysed the data on NVivo (QSR International, Burlington, MA) and reported the findings using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: The perceived benefits that were reported included non-dependency on physical contact, economic benefit, better management of patient load, and ease of access to healthcare services. The common gaps identified in the TM services were lack of physical clinical examination, impeded communication due to lack of face-to-face interaction, technological challenges (e.g., inconsistent internet connectivity and unavailability of smartphones), lack of human resources and resources to manage the TM centres, cumbersome compliance requirements coupled with unclarity on medico-legal implications, and limited awareness of services among clients. Need for adequate promotion of TM services through information-education-communication efforts and frontline workers, strengthening of logistics for long-term sustainability, setting up a dedicated TM department at the hospitals, capacity building of the existing staff, reducing gaps in communication between doctors and patients for better consultation, and improved access to the prescribed medicines were some of the suggestions from different stakeholders. CONCLUSION: The stakeholders clearly appreciated the benefits of TM services offered through the new-adopter centres amidst the pandemic disruptions. However, there were certain gaps and unmet expectations, which, if addressed, could improve the TM centres' performance with further people-centricity and enhance healthcare access and the popularity of system-based services. Avenues for sustaining the TM services and their efficient scale-up should be explored.

Implementing recommended breastfeeding practices in healthcare facilities in India during the COVID-19 pandemic: a scoping review of health system bottlenecks and potential solutions.

Background: Breastfeeding practices in institutional settings got disrupted during the COVID-19 pandemic. We reviewed the challenges faced and the "work-around" solutions identified for implementing recommended breastfeeding practices in institutionalized mother-newborn dyads in resource constrained settings during the pandemic with the aim to identify learnings that could be potentially adapted to the Indian and relatable contexts, for building resilient health systems. Methods: We conducted a scoping review of literature using the PRISMA ScR Extension guidelines. We searched the Medline via PubMed and Web of Science databases for literature published between 1st December 2019 and 15th April 2022. We included original research, reviews, and policy recommendations published in English language and on India while others were excluded. Further, we searched for relevant gray literature on Google (free word search), websites of government and major professional bodies in India. Three reviewers independently conducted screening and data extraction and the results were displayed in tabular form. Challenges and potential solutions for breastfeeding were identified and were categorized under one or more suitable headings based on the WHO building blocks for health systems. Results: We extracted data from 28 papers that were deemed eligible. Challenges were identified across all the six building blocks. Lack of standard guidelines for crisis management, separation of the newborn from the mother immediately after birth, inadequate logistics and resources for infection prevention and control, limited health workforce, extensive use of formula and alternative foods, inconsistent quality of care and breastfeeding support, poor awareness among beneficiaries about breastfeeding practices (and especially, about its safety during the pandemic) were some of the challenges identified. The solutions primarily focused on the development of standard guidelines and operating procedures, restricted use of formula, use of telemedicine services for counseling and awareness and improving resource availability for risk mitigation through strategic mobilization. Conclusion: The COVID-19 pandemic has provided rich learning opportunities for health system strengthening in India. Countries must strengthen learning mechanisms to identify and adapt best practices from within their health systems and from other relatable settings.

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region.

Background: Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research. Methods: We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer. Findings: We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization. Interpretation: While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

Prevalence of Asymptomatic Bacteriuria (ASB) in Pregnant Women in India: A Systematic Review and Meta-Analysis.

Background: Asymptomatic bacteriuria is prevalent during pregnancy. If it goes undetected, it can lead to urinary tract infection with severe maternal and neonatal complications. Until date, India does not have any guidelines to test for ASB during pregnancy. Objective: To estimate the pooled prevalence of asymptomatic bacteriuria in pregnant women at national level in India. Material and Methods: We searched Medline, Embase, Web of Science, and Google Scholar using search strategy with keyword. Two authors independently assessed the eligibility of study. The checklist of the JBI was used for evaluating the quality of reporting. The extracted data were analyzed, and the results were reported using a random-effects model with 95% confidence interval (CI). Subgroup analysis was conducted for zones of India, parity and trimester. Publication bias is reported as funnel plot. Result: Pooled prevalence of asymptomatic bacteriuria among pregnant women in India is 13.5% [CI 11.1; 15.8]. Subgroup analysis based on the various geographic zones of the country the pooled prevalence ranged from 9.2% in central zone to 14.8% in south zone. Distribution of prevalence of ASB as per parity was approximately identical. The prevalence of ASB was found to be high in third (21.8%). Conclusion: The prevalence of ASB is found to be high among Indian pregnant women, especially in third trimester. It is therefore recommended for guideline to screen and treat every pregnant woman for ASB to prevent further complications.

A Scoping Review of Interventions for Prevention and Control of Hypertension in India.

SUMMARY: In India, hypertension (HTN) is a raging public health problem and demands contextualized strategies to combat it. However, there is a gap in indigenous research output on interventions related to HTN that work in the Indian context. We aimed to identify, describe, and systematically compile context-derived evidence for the prevention and control of HTN in adults in India across the community, health-care organization, and health policy domains by reviewing papers published over the past 10 years (January 2013-December 2022). Our goal was to prepare a ready-reckoner document that could serve as a baseline critique for HTN researchers, policymakers, and program managers for planning their respective courses of action. We searched for relevant literature published between January 2013 and December 2022, indexed in PubMed and Web-of-Science. We extracted information using the Template for Intervention Description and Replication checklist and used the Innovative Care for Chronic Conditions Framework for analysis and reporting. Only 33 articles emerged as "eligible." The papers focused on community (39.4%), health-care organization (36.4%), and multi-domain (24.2%) strategies. Majority (69.7%) reported HTN control as an indicator to assess intervention effectiveness. Original research from India on HTN interventions is sparse. Thus, there is a need to promote research activities and publications that generate evidence for action in alignment with provisions and priorities of existing programs and policies, and with a focus on scalability and sustainability. Consequently, we call for increased attention to implementation science and research for HTN combat in India.

Barriers faced by health-care workers in use of personal protective equipment during COVID pandemic at tertiary care hospital Uttarakhand, India: A qualitative study.

BACKGROUND: To reduce the likelihood of transmission of infection to health-care workers (HCWs), personal protective equipment is used. However, wearing personal protective equipment (PPE) increases the risk of heat stress and loss of dexterity, leads to poor compliance to PPE. To address the issues of poor compliance to PPE, it was necessary to gain a deeper understanding about the factors that influence compliance. Thus this qualitative study was planned to explore barriers faced by HCWs while using PPE during a pandemic situation in a tertiary care hospital, Uttarakhand, India. MATERIALS AND METHODS: A exploratory qualitative study was undertaken among health care workers involved in the care of COVID patients. FGDs were done and an unstructured interview guide with open-ended questions was used which helped to explore the factors which can be potential barriers to the HCWs while working wearing PPE. RESULTS: Organizational and individual factors acting as barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, lack of comfort, inadequate size, and quality of PPE were identified as the major barriers in the present study. CONCLUSION: Future efforts to optimize PPE use should focus on to adequate supplies both in quality and quantity can help in avoidance of such barriers. Resources should be prioritized with the needs of the HCWs in the times of pandemic. Regular training and feedbacks are necessary for the satisfaction of HCWs and improving PPE compliance.

Content analysis of educational videos on hand hygiene during COVID-19 pandemic.

BACKGROUND: Online platforms are the most popular mode of entertainment, simultaneously imparting knowledge and education. During COVID pandemic, there was a sudden influx of educational videos on social media/websites with a purpose of spreading the information about hand hygiene (HH) practices. The aim of this study was to explore and assess the HH videos based on its content and technical quality to promote the learning experience of videos. MATERIALS AND METHODS: HH videos from the official sites of five international health organizations and 42 national health institutes were assessed based on their availability of the HH videos. Verified YouTube videos on HH since January 2020 were further screened and assessed using the author's designed validated checklist. Each video was systematically evaluated and scored against the seven categories, namely introduction, audio, visuals/background, speaker/demonstrator, content, timing, and appeal. RESULTS: A total of 50 videos were assessed for analysis. Of these, 82% of videos scored >50%, i.e., 14. Among low scorer, seven videos were from YouTube channel. Majority of the videos were technically sound, 44% aroused interest, 82% had a simple, understandable message; in around 46% of the videos, the presenter was a healthcare worker; and in 24%, the information was accurate as per the World Health Organization guidelines. CONCLUSIONS: This study concluded that most of the HH videos were found to be just above average in their content quality and technicality.