Key factors influencing public health students and curricula in India: Recommendations from a mixed methods analysis.

BACKGROUND: Building on a distinguished history of community medicine training, public health programs have been expanding in India in recent years. The COVID-19 pandemic has brought additional attention to the importance of public health programs and the need for a strong workforce. This paper aims to assess the current capacity for public health education and training in India and provide recommendations for improved approaches to meet current and future public health needs. METHODS: We conducted a desk review of public health training programs via extensive internet searches, literature reviews, and expert faculty consultations. Among those programs, we purposively selected faculty members to participate in in-depth interviews. We developed summary statistics based on the desk review. For qualitative analysis, we utilized a combination of deductive and inductive coding to identify key themes and systematically reviewed the strengths and weaknesses of each theme. RESULTS: The desk review captured 59 institutions offering public health training across India. The majority of training programs were graduate level degrees including Master of Public Health and Master of Science degrees. Key factors impacting these programs included collaborations, mentorship, curriculum standardization, tuition and funding, and student demand for public health education and careers. Collaborations and mentorship were highly valued but varied in quality across institutions. Curricula lacked standardization but also contained substantial flexibility and innovation as a result. Public sector programs were perceived to be affordable though fees and stipends varied across institutions. Further development of career opportunities in public health is needed. CONCLUSION: Public health education and training in India have a strong foothold. There are numerous opportunities for continued expansion and strengthening of this field, to support a robust multi-disciplinary public health workforce that will contribute towards achieving the sustainable development goals.

Strengthening institutions for public health education: results of an SWOT analysis from India to inform global best practices.

BACKGROUND: Developing public health educational programs that provide workers prepared to adequately respond to health system challenges is an historical dilemma. In India, the focus on public health education has been mounting in recent years. The COVID-19 pandemic is a harbinger of the increasing complexities surrounding public health challenges and the overdue need to progress public health education around the world. This paper aims to explore strengths and challenges of public health educational institutions in India, and elucidate unique opportunities to emerge as a global leader in reform. METHODS: To capture the landscape of public health training in India, we initiated a web-based desk review of available offerings and categorized by key descriptors and program qualities. We then undertook a series of in-depth interviews with representatives from a purposively sample of institutions and performed a qualitative SWOT analysis. RESULTS: We found that public health education exists in many formats in India. Although Master of Public Health (MPH) and similar programs are still the most common type of public health training outside of community medicine programs, other postgraduate pathways exist including diplomas, PhDs, certificates and executive trainings. The strengths of public health education institutions include research capacities, financial accessibility, and innovation, yet there is a need to improve collaborations and harmonize training with well-defined career pathways. Growing attention to the sector, improved technologies and community engagement all hold exciting potential for public health education, while externally held misconceptions can threaten institutional efficacy and potential. CONCLUSIONS: The timely need for and attention to public health education in India present a critical juncture for meaningful reform. India may also be well-situated to contextualize and scale the types of trainings needed to address complex challenges and serve as a model for other countries and the world.

Understanding the role of power and its relationship to the implementation of the polio eradication initiative in india.

Background: Power is exercised everywhere in global health, although its presence may be more apparent in some instances than others. Studying power is thus a core concern of researchers and practitioners working in health policy and systems research (HPSR), an interdisciplinary, problem-driven field focused on understanding and strengthening multilevel systems and policies. This paper aims to conduct a power analysis as mobilized by the actors involved in implementation of the polio program. It will also reflect how different power categories are exerted by actors and embedded in strategies to combat program implementation challenges while planning and executing the Global Polio Eradication Initiative. Methods: We collected quantitative and qualitative data from stakeholders who were part of the Polio universe as a part of Synthesis and Translation of Research and Innovations from the Polio Eradication Project. Key informants were main actors of the polio eradication program, both at the national and sub-national levels. Research tools were designed to explore the challenges, strategies and unintended consequences in implementing the polio eradication program in India. We utilized Moon's expanded typology of power in global governance to analyze the implementation of the polio eradication programme in India. Results: We collected 517 survey responses and conducted 25 key informant interviews. Understanding power is increasingly recognized as an essential parameter to understand global governance and health. Stakeholders involved during polio program implementation have exerted different kinds of power from structural to discursive, moral power wielded by religious leaders to institutional power, expert power used by professional doctors to commoners like female vaccinators, and network power exercised by community influencers. Hidden power was also demonstrated by powerless actors like children bringing mothers to polio booths. Conclusion: Power is not a finite resource, and it can be used, shared, or created by stakeholders and networks in multiple ways. Those people who seem to be powerless possess invisible power that can influence decision making. Moreover, these power categories are not mutually exclusive and may be deeply interconnected with each other; one type of power can be transformed into another. Power and relations play an important role in influencing the decision-making of the community and individuals. Mid-range theories of core implementation science like PARIHAS and CFIR can also add an important variable of power in their construct necessary for implementation success of any health program.

A bibliometric analysis of the published road traffic injuries research in India, post-1990.

BACKGROUND: Globally, road traffic injuries are the leading cause of death among those aged 15-29 years. However, road traffic injury research has not received adequate attention from the scientific community in low- and middle-income countries, including India. The present study aims to provide a bibliometric overview of research assessing road traffic injuries in India. METHODS: We used Scopus to extract relevant research in road traffic injuries published from 1991 to 2017. This study presented the key bibliometric indicators such as trends of annual publications and citations, top 10 authors, journals, institutions and highly cited articles, citation analysis of articles, co-occurrence of keywords, etc. Analysis was performed using Scopus, Microsoft Excel, and VOS-viewer. RESULTS: A total of 242 articles were retrieved with an h-index of 18, excluding self-citations. A steadfast growth of publications was documented in last decade, especially after the year 2010. The h-index of the top 10 authors, institutions, journals and highly cited articles did not surpass single digits. A network visualisation map showed that 'traffic accident', 'male', 'adolescent' and 'child' were the most commonly encountered key terms. The prominent authors were Gururaj G, Dandona R, and Hyder AA, whereas the top journals were the Indian Journal of Forensic Medicine and Toxicology, Medico Legal Update, and the International Journal of Applied Engineering Research and top institutions were the All India Institute of Medical Sciences, New Delhi, the Indian Institute of Technology, Delhi, and the Administrative Staff College of India. CONCLUSION: In India, road traffic injuries research is inadequate in quantity and quality, warranting greater attention from researchers and policy planners to address the burden of road traffic injuries.

Gall bladder cancer in north eastern Libya.

OBJECTIVE: Assessment of gall bladder cancer among cholecystectomy specimens. DESIGN: Retrospective study of all cholecystectomy specimens coupled with data from clinical oncology department. SETTING: Department of Pathology and Department of Clinical Oncology, Al Arab Medical University, Benghazi, Libya. SUBJECT: Gall bladder cancer among cholecystectomies and the pattern of survival of these patients. MATERIAL: Histopathology records available on all cholecystectomies performed between 1982 and 1997. Data available on staging and survival of cancer patients from clinical oncology upto 1996. RESULTS: Eighty nine cases of gall bladder cancer were found out of 7352 cholecystectomies performed over a period of 16 years. It was found more commonly in females with a mean age of 58.1 years. It was also observed that the incidence in males above 60 years was almost equal to that of females. Gall bladder cancer when primarily detected by the pathologist in cholecystectomy specimens removed for symptomatic cholelithiasis, was mostly in stage I. Most of the patients in stage III-IV cancer died within one year whereas most of the stage I cancer patients survived more than two years. CONCLUSION: Simple cholecystectomy is strongly advised in women above 50 years of age and in men above 60 years of age with symptomatic cholelithiasis.

Control of anaemia among pregnant women by iron supplementation.

PIP: The results of iron supplementation among 171 pregnant women registered at the maternal and child health (MCH) clinic of the Urban Health Training Center of Preventive and Social Medicine, S.M.S. Medical College, Jaipur, are reported. The registration of pregnant women was done at home visits. Initial hemoglobin level was estimated with Sahli's hemoglobinometer and 2 tablets of iron folic acid, each containing 60 mg of elemental iron and 0.5 mg folic acid were given each day for 90 days. Hemoglobin estimation was repeated every month. The regularity of intake was ensured by the MCH staff and women who consumed up to 75% of the period were considered as regular. Most of the women receiving iron supplementation were between 21-30 years of age, accounting for 62.6%. 29.2% of the women were under age 20. 51.5% were registered in their 2nd trimester and 1/3 in the 1st trimester. 14.6% were registered as late as the 3rd trimester. Only 9.4% had normal hemoglobin levels; the remaining 90.6% were anemic, 83% mild to moderate anemia and 7.6% severe anemia. The prevalence was highest in the 2nd trimester, in which 95.8% of the women were anemic. The prevalence was marginally lower in 1st and 3rd trimester, being 86.2% and 88.9%. Severity of anemia increased with increasing gestational age. The proportion of severely anemic women was as much as 25.9% in women in the 3rd trimester as compared to women in the 2nd trimester (8%) and none in the 1st trimester. The mean hemoglobin levels were almost similar in various trimesters, but the lowest mean levels were recorded in the 3rd trimester. The maximum changes were recorded in the 1st trimester, when the mean hemoglobin level increased but not significantly. Practically no change in mean hemoglobin was observed in the 2nd trimester, and there was a slight increase in the 3rd trimester after completion of iron supplementation. Trials are now on to fortify the common food commodity, particularly in wheat flour and common salt for continued iron supplementation.^ieng

Infant mortality in Rajasthan villages.

PIP: Social, cultural and economic factors, beside medical causes, contribute to the high percentage of infant mortality in India. This study was carried out in 12 villages in the area of the Rural Health Training Centre, Naila, India; all villages were being regularly visited by paramedical staff and doctors. During 1977 62 infants died. Most parents were illiterate and very poor. 50.3% of deaths occurred within the first 28 days of life, and 25.8% within the first 7 days of life; 72.8% of deaths occurred within the first 6 months of life. Infections and malnutrition accounted for 77.3% of all deaths; pneumonia alone claimed 25.8% of lives, malnutrition 19.3%, fever for unknown reasons 16.1%, diarrhea 14.5% and prematurity 12.9%. Deaths for pneumonia were 56.3% in the postneonatal period and 43.7% in the neonatal period, while fever predominated as a cause of death in the neonatal rather than in postneonatal period, with 70% and 30% of deaths respectively. 56.4% of deaths were recorded among children born to mothers aged 21-30, 30.7% among children of mothers over 30, and 12.9% among children of mothers below 20. 51.6% of dead children had a birth order of 5 and over; only 17.8% had first birth order. 50.1% of deaths were observed in infants who were born less than 12 months from the previous conception. Similar studies done in other Indian regions show similar percentages of infant mortality and of causes for mortality.^ieng