Mobile people, immobile structures: a study of internal migrants in India and access to social protection

This thesis compares the experiences of internal migrants engaged in low-skilled and unskilled labour, with their local non-migrant counterparts in urban India to explore patterns and structures of access to state social protection. While Indians are constitutionally permitted to work and settle anywhere within the country, migrants face a range of barriers to accessing state social protection, in term of policy and implementation. The thesis uses the example of the Public Distribution System (PDS) - a universal food subsidy scheme and India’s largest social protection programme - and takes into account the role of governance to explore how social protection access is experienced by diverse types of labour migrants, with local labourers living in the same city. The thesis is based on evidence gathered over nine months through mainly qualitative methods (semi-structured interviews and observation, supplemented by a sampling survey) in two cities: Ahmedabad and Nashik, representing the states of Gujarat and Maharashtra respectively. A final round of supplementary key informant interviews was conducted in Delhi. The empirical findings show that both migrants and local labourers face a range of significant barriers to access, though to varying degrees. However, a strong dichotomy between their experiences is not observed. Instead these complex and diverse experiences can be represented as a broad and overlapping ‘spectrum’ of vulnerabilities: where local labourers face relatively fewer barriers, and migrants – varied in terms of spatial and temporal factors – face distinctly intense barriers. The findings also highlight that, while individual state context does not have a strong effect on barriers to accessing the PDS, divergences between constitutional law, government policy and implementation across India are influential in structuring the experiences of precariousness among labour migrants. Finally, the thesis presents evidence on how all poor, urban labourers deploy multiple strategies to overcome barriers to access. Migrant agency however is displayed in distinct forms. The findings illustrate how labour migrants, regardless of temporal or spatial factors, actively maintain ‘multi-locational’ linkages between places of destination and origin to overcome access barriers

Social accountabilty initatives in health and nutrition: lessons from India, Pakistan and Bangladesh

South Asia is home to nearly a quarter of the world’s population and is a region of dynamic economic growth, yet it performs relatively poorly on health and nutrition indicators. As a potential route towards addressing this poor performance, a range of accountability initiatives has been implemented to improve service delivery in the health and nutrition sectors. This is a rich and vibrant field, with a great deal to offer in terms of best practice; but there is little work that focuses on South Asian innovation and practice generally, and takes a comparative and theoretical perspective to ground existing and future accountability initiatives in health and nutrition specifically. This report fills this gap. It first summarises current concepts and issues in accountability thinking and practice, focusing on practices commonly referred to as ‘social accountability’. It goes on to contrast these with the ‘standard model’ of political and administrative accountability, which is prevalent in the literature, and points to ways in which reality often deviates from this standard model. Against this general conceptual and theoretical backdrop, it examines health systems in South Asia in the light of assumptions underpinning the standard model of accountability.DFIDUSAIDSIDAOmidyar Networ

Comparison Of The Effectiveness Of Daily Versus Weekly Oral Iron Supplementation In Preventing Anemia During Pregnancy

  Introduction: Daily oral iron and folic acid intake is recommended as part of antenatal care but adherence to this regimen, due to gastrointestinal side effects, interrupted intake of iron. Weekly oral iron therapy has been introduced as an alternative to the daily iron regimen. Objective: To compare mean hemoglobin and hematocrit in non-anemic pregnant females receiving daily oral iron versus weekly iron supplements in third trimester of pregnancy. Material and Methods This randomized Controlled Trial study was carried out in department of obstetrics and gynecology of holy family hospital, Rawalpindi during 20th November 2019 to 20th May 2020. 70 pregnant females of 15 to 45 years, with singleton pregnancies, at gestational amenorrhea 14 to 22 weeks at the time of inclusion with hemoglobin level 11g/dl and above were included. They were randomly divided into two equal groups using SPSS, Group A (35) received daily oral iron and Group B, 35 received weekly oral iron.  Results: There was no statistically significant difference could be detected between both groups as regards the hemoglobin level before starting iron supplementation and duration of supplementation and this can be attributed to proper randomization. Mean post treatment hemoglobin was 13.2±0.93 g/dl in group A and 12.9±0.95 g/dl in group B (0.118), mean change of hemoglobin was 1.07±0.34 g/dl in group A and 0.63±0.56 g/dl in group B (0.000), mean post treatment hematocrit was 35.857±0.87 % in group A and 32.857±0.91 % in group B (p 0.000), mean change of hematocrit was 2.942±0.59 % in group A and 1.000±0.00 % in group B (p 0.000).     Conclusion: Weekly iron supplementation as a prophylaxis in non-anemic pregnant women is as good as daily supplementation as regards the hemoglobin level.     &nbsp

Assessment of knowledge & practice of contraceptives in females of reproductive age group at a tertiary care hospital

Abstract Objectives: To assess the knowledge & practice of contraceptives in females of reproductive age group.Study Design: Cross sectional descriptive. Place and Duration of Study: OPD of Fauji Foundation Hospital from February 2008 – September 2008.Subjects and Method: 339 Females of age b/w of 15 – 49 years attending OPD of Fauji Foundation Hospital were included in study. A structured questionnaire was used to collect data.Results: Eighty eight percent of the females in our study sample were familiar with one or more methods of contraception (72.7%were familiar with combined oral contraceptive pill (COCP), 60.7% were aware of intra uterine contraceptive device (IUCD) &76% knew about condoms) whereas 12% showed ignorance. 64.6% of the study population was contraceptive users & 35.4% were not using any method of contraception. Regarding preferred method of contraception 34.6% of females said they are using COCP, about 21.8% females said their tubes had been liagated whereas 26.9%& 16.7% were using IUCD & Condoms respectively. Almost 46%of our study population said that contraceptive method they were using was suggested by their husbands, 44 % said by health professional .Only 10 % of the study population were using a method of their own choice.Conclusion: The present study concludes that there is a gap between knowledge (88%) and use (64.6%) of contraceptives among females of reproductive age group. Another important inference drawn from the study is that men should be made equal targets of such programs in since 46% females in our study population were using method of contraceptive suggested by their husban

Should our academic approach towards researching South asia change due to COVID-19?

As COVID-19 disrupts established research norms, many methodological and ethical questions have come to the forefront of the debate on how we study South Asia. Here Nabeela Ahmed, Sally Cawood, Sarita Panday, Megnaa Mehtta, Glyn Williams, Jiban Kumar Karki and Ankit Kumar (Research collective, University of Sheffield) reflect on their recent discussions on whether researchers should consider changing the way they conduct their work in the wake of the pandemic

Medical students in Karachi and COVID-19: Myths and facts

Objectives: COVID-19 pandemic brought mortalities, morbidities, fear, and financial despair among people around the world. As it advanced, misinformation and myths about it caught wildfire, contributing to misbelief among the already shocked population. Medical students are the building blocks of the medical community and can provide a pivotal role in combating COVID-19 misinformation by delivering correct knowledge and awareness to the non-medical population of the country. Hence, it is important to assess their knowledge and perception of COVID-19 myths. Therefore, this study evaluates medical student\u27s knowledge regarding myths and misinformation related to COVID-19 infection and its vaccine. The study also assesses the belief of medical students on various conspiracy theories of COVID-19.Methods: An online cross-sectional survey was conducted among 401 undergraduate medical students of Karachi in June-August 2021. A validated, structured, and self-administrated questionnaire was used for data collection. The data were entered on an open EPI version 3.01 and Statistical Package of Social Science version 26 for analysis. A chi-square test was performed to identify determinant factors. All p-values less than 0.05 were considered significant.Results: Overall knowledge score of participants about myths and misinformation related to COVID-19 and its vaccine was as follows: 166 (28.9) participants possess good knowledge, while 167 (41.6) and 118 (29.4) had moderate to poor knowledge, respectively. Senior students, vaccinated, and participants infected by COVID-19 had good to moderate knowledge. Overall, 139 (34.7) participants strongly disagree and 103 (25.7) participants somewhat disagree with conspiracy theories related to COVID-19. Absence of belief in the conspiracies is associated with vaccinated participants.Conclusion: The study shows that most medical students possess adequate knowledge of misinformation about COVID-19 and its vaccines, and have low belief in conspiracy theories of COVID-19

COVID-19 Prognostic Models: A Pro-con Debate for Machine Learning vs. Traditional Statistics.

The SARS-CoV-2 virus, which causes the COVID-19 pandemic, has had an unprecedented impact on healthcare requiring multidisciplinary innovation and novel thinking to minimize impact and improve outcomes. Wide-ranging disciplines have collaborated including diverse clinicians (radiology, microbiology, and critical care), who are working increasingly closely with data-science. This has been leveraged through the democratization of data-science with the increasing availability of easy to access open datasets, tutorials, programming languages, and hardware which makes it significantly easier to create mathematical models. To address the COVID-19 pandemic, such data-science has enabled modeling of the impact of the virus on the population and individuals for diagnostic, prognostic, and epidemiological ends. This has led to two large systematic reviews on this topic that have highlighted the two different ways in which this feat has been attempted: one using classical statistics and the other using more novel machine learning techniques. In this review, we debate the relative strengths and weaknesses of each method toward the specific task of predicting COVID-19 outcomes

Evaluation the effectiveness of abridged IMNCI (7-Day) course v standard (11-Day) course in Pakistan

Background: The conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.Methods: We conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.Results: The improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was - 12.4 (95% CI - 18.5, - 6.4) and - 6.4 (95% CI - 10.5, - 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was - 6.3 (95% CI - 11.3, - 1.3) in the 7-day training group and - 9.1 (95% CI - 11.5, - 6.6) in the 11-day group, p = 0.308.Conclusion: An abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course

Bacteraemia variation during the COVID-19 pandemic; a multi-centre UK secondary care ecological analysis

BackgroundWe investigated for change in blood stream infections (BSI) with Enterobacterales, coagulase negative staphylococci (CoNS), Streptococcus pneumoniae, and Staphylococcus aureus during the first UK wave of SARS-CoV-2 across five London hospitals.MethodsA retrospective multicentre ecological analysis was undertaken evaluating all blood cultures taken from adults from 01 April 2017 to 30 April 2020 across five acute hospitals in London. Linear trend analysis and ARIMA models allowing for seasonality were used to look for significant variation.ResultsOne hundred nineteen thousand five hundred eighty-four blood cultures were included. At the height of the UK SARS-CoV-2 first wave in April 2020, Enterobacterales bacteraemias were at an historic low across two London trusts (63/3814, 1.65%), whilst all CoNS BSI were at an historic high (173/3814, 4.25%). This differed significantly for both Enterobacterales (p = 0.013), CoNS central line associated BSIs (CLABSI) (p ConclusionsSignificantly fewer than expected Enterobacterales BSI occurred during the UK peak of the COVID-19 pandemic; identifying potential causes, including potential unintended consequences of national self-isolation public health messaging, is essential. High rates of CoNS BSI, with evidence of increased CLABSI, but also likely contamination associated with increased use of personal protective equipment, may result in inappropriate antimicrobial use and indicates a clear area for intervention during further waves

Redefining the role of urban studies Early Career Academics in the post-COVID-19 university

We are an international collective of Early Career Academics (ECAs) who met throughout 2020 to explore the implications of COVID-19 on precarious academics. With this intervention, our aims are to voice commonly shared experiences and concerns and to reflect on the extent to which the pandemic offers opportunities to redefine Higher Education and research institutions, in a context of ongoing precarity and funding cuts. Specifically, we explore avenues to build solidarity across institutions and geographies, to ensure that the conduct of urban research, and support offered to ECAs, allows for more inclusivity, diversity, security and equitability. *The Urban ECA Collective emerged from a workshop series described in this article which intended to foster international solidarity among self-defined early career academics working within urban research.ITESO, A.C