IDENTIFICATION, TOOL DEVELOPMENT AND VALIDATION, AND ASSESSMENT OF CORE COMPETENCIES OF PUBLIC HEALTH PROFESSIONALS IN UTTAR PRADESH, INDIA

Core competencies are the key knowledge, skills, abilities, and attitudes that the health workforce should possess to effectively deliver essential public health services like epidemiological surveillance, situation assessments, and health promotion. Despite widespread recognition of the importance of core competencies, including by the World Health Organization, many low- and middle-income countries (LMICs) continue to face challenges in ensuring their public health workforce has the appropriate and adequate competencies. Contributing to this challenge are the absences of (i) agreed sets of core competencies, (ii) validated and reliable instruments to measure these competencies in these settings, and (iii) assessment of the factors such as self-assessed competencies and demographic variables that are associated with high competencies. This dissertation addresses these three research needs in Uttar Pradesh (UP), India’s most populous state with almost 230 million people, and some of the nation’s poorest health outcomes. The dissertation has three distinct but interlinked papers, each with their unique aims, methods, and results. The aim of Paper 1 was to identify a recommended set of core competencies for public health professionals in supervisory and program management roles in UP state. We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies for the state. Paper 2 aimed to develop and validate a reliable set of items that form a self-assessment tool to evaluate core public health competencies. It used a cross-sectional survey—adapted from the consensus focused Delphi technique (Paper 1)—to collect data from mid-level and senior health professionals in the state. We used an Exploratory Factor Analysis (EFA) as the primary statistical technique that utilized the Principal Component Analysis (PCA) method for factor extraction. Paper 3 explored the association of individual-level variables, including self-assessed competencies and demographic characteristics of health professionals, with performance on an objective core competency test. We relied on multiple linear regression to understand these associations. Paper 1 produced a consensus set of 40 core competencies in public health across eight public health domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. Paper 2 generated a 37 validated and reliable set of items that form the core public health competency (COPHEC) tool. Paper 3 found the seniority of public health professionals to be significantly associated with objectively measured competencies. Self-assessed competencies had a weak positive correlation with objectively assessed competencies. Paper 3 also discovered generally low competency scores for all respondents, and it found that mid-level professionals had lower objective measurement scores compared to senior health professionals, but higher self-assessment scores, perhaps indicating a cognitive bias. To our knowledge, this study presents a novel attempt to develop a framework and measurement tool for core competencies for practicing public health professionals in UP or elsewhere in India. The framework and tool can be used to review current training practices, assess competencies of public health professionals, and inform workforce development efforts such as the generation of competency-based job descriptions for recruitment and performance management in UP or other resource-poor settings globally. The significant association of seniority (and not the other variables such as the duration on a job) with objectively measured competency indicates that responsibilities may matter more in ensuring higher competency than time on the seat. Low scores in the objective test indicate significant gaps in competencies to perform public health functions, and opportunities to deploy measures like competency-based training to address these gaps. Given the low correlation between self-assessment and objective measurement, we recommend the administration of the COPHEC tool to be accompanied by objective measurement questions. Future research should test strategies to reduce cognitive bias by providing poor performers appropriate training, showing what good performance looks like, and providing meaningful feedback to strengthen competencies

Effect of different levels of nitrogen on growth and yield of hybrid maize (Zea mays L.) varieties

Nitrogen (N) fertilizer is considered as one of the most important factors affecting growth and grain yield of hybrid maize. This study was conducted to determine the effects of different rates of nitrogen and varieties on growth and yield of hybrid maize in Lamahi Municipality, Dang, Nepal from June to October, 2019. Three levels of hybrid maize varieties (10V10, Rajkumar F1 and NMH-731) and four levels of nitrogen (160, 180, 200 and 220 kg N ha-1) were evaluated using two factorial randomized complete block design with three replications. The results showed that grain yield and yield attributing traits of hybrid maize varieties increased with the increasing level of nitrogen from 160 to 220 kg ha-1. The application of nitrogen @ 220 kg N ha-1 produced the highest grain yield (10.07 t ha-1), cob length (16.33 cm), no of rows per cob (14.97), no of grains per row (33.37), cob diameter (4.54), thousand grain weight (276.77 g), stover yield (12.91 t ha-1), biological yield (23.00 t ha-1), harvest index (43.80), gross return (NRs. 208940 ha-1), net return (NRs.104488 ha-1) and B:C ratio (2.001). The hybrid maize variety 10V10 produced the highest grain yield (9.35 t ha-1), net returns (NRs. 91740.66 ha-1) and B:C ratio (1.91) accompanied by the highest cob length (16.25 cm), and as number of grains per row (32.35) as compared to other varieties. This study suggested that maize production can be maximized by cultivating hybrid maize variety 10V10 with the use of 220 kg N ha-1 in inner Terai region of Nepal

Infectious sources of Histoplasmosis and molecular techniques for its identification

Histoplasmosis, a fungal infection caused by Histoplasma capsulatum (H. capsulatum), acquired from contaminated soil with droppings of chicken or birds and found to be distributed in many parts of the world. The prevalence of histoplasmosis has not well studied in Nepal. The common symptoms of acute and epidemic histoplasmosis include high fever, cough, and asthenia and weight loss. Most of the infections associated with histoplasmosis are asymptomatic. People with compromised immune systems such as HIV/AIDS (PLWHA), cancer, and organ transplant recipients are at risk of developing this disease. In this review, we have summarised the current status of histoplasmosis in Nepal and molecular techniques available for its identification. To date, the significant outbreak is not reported in Nepal, but the risk of infection for the vulnerable population cannot be undermined. Appropriate preventive measures and treatment on time can reduce the burden of this fungal disease. Further, this review is also focused on molecular identification of H. capsulatum. Hence, careful considerations by concerned stakeholders for national surveillance programs and the treatment of patients on time after proper diagnosis is highly recommended

Evaluation of Phytochemical, Antioxidant and Antibacterial Activities of Selected Medicinal Plants

Medicinal plants are important reservoirs of bioactive compounds that need to be explored systematically. Because of their chemical diversity, natural products provide limitless possibilities for new drug discovery. This study aimed to investigate the biochemical properties of crude extracts from fifteen Nepalese medicinal plants. The total phenolic contents (TPC), total flavonoid contents (TFC), and antioxidant activity were evaluated through a colorimetric approach while the antibacterial activities were studied through the measurement of the zone of inhibition (ZoI) by agar well diffusion method along with minimum inhibitory concentrations (MIC) by broth dilution method. The methanolic extracts of Acacia catechu and Eupoterium adenophorum showed the highest TPC (55.21 ± 11.09 mg GAE/gm) and TFC (10.23 ± 1.07 mg QE/gm) among the studied plant extracts. Acacia catechu showed effective antioxidant properties with an IC50 value of 1.3 μg/mL, followed by extracts of Myrica esculenta, Syzygium cumini, and Mangifera indica. Morus australis exhibited antibacterial activity against Klebsiella pneumoniae (ZoI: 25mm, MIC: 0.012 mg/mL), Staphylococcus aureus ATCC 25923 (ZoI: 22 mm, MIC: 0.012 mg/mL), Pseudomonas aeruginosa (ZoI; 20 mm, MIC: 0.05 mg/mL), and methicillin-resistant Staphylococcus aureus (MRSA) (ZoI: 19 mm, MIC: 0.19 mg/mL). Morus australis extract showed a broad-spectrum antibacterial activity, followed by Eclipta prostrata, and Hypericum cordifolium. Future study is recommended to explore secondary metabolites of those medicinal plants to uncover further clinical efficacy

Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings

The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013–2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with ‘clinical manifestations of malaria’ as the top search in Africa, and ‘management of hepatitis B’ as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees

Use of neem (Azadirachta indica A. Juss) as a biopesticide in agriculture: A review

Neem (Azadirachta indica A. Juss) is a member of Meliaceae family, a fast-growing tropical evergreen plant whose products were found effective against economically important insect pests and diseases. All parts of this plant particularly leaf, bark, and root extracts have the biopesticidal activities. Azadirachtin, a biopesticide obtained from neem extract, can be used for con-trolling various insect pests in agriculture. It acts on insects by repelling them, by inhibiting feeding, and by disrupting their growth, and reproduction. Neem-based formulations do not usually kill insects directly, but they can alter their behavior in significant ways to reduce pest damage to crops and reduce their reproductive potential. The neem is considered as an eas-ily accessible, eco-friendly, biodegradable, cheap, and non-toxic biopesticide which control the target pests. Thus, this re-view highlighted the extract, byproducts and roles of neem that can be used as potential biopesticide in agriculture

Halting COVID-19 Requires Collective, Decentralized, and Community-Led Responses.

Many global health organizations are reliant on the funding provided by a few dozen high-income countries, making them fiscally insecure and fragile, especially during times of global crises. The COVID-19 pandemic could be an opportunity to move away from this status quo to a more decentralized, multipolar, and community-led approach. The global health community can take four immediate steps in response to the pandemic to start that paradigm shift now: support more regional and country-specific responses, convince national and regional business houses and philanthropies to make up for response funding shortfalls, leverage public health advocacy to improve investments in public health infrastructure, and put community leaders and members at the frontlines of mitigation efforts

An overview of multifaceted role of Trichoderma spp. for sustainable agriculture

The excessive use of chemical fertilizers and pesticides have caused several negative impacts on the environment and human health. They degrade soil fertility, build up resistance on pathogens, inhibit microbial activities and also enhance greenhouse gas emission. It is impossible and inappropriate to control plant pathogens by using chemical pesticides alone. Emphasize should be given towards organic fertilizers and pesticides to attain sustainability in agriculture. The use of Trichoderma is slowly increasing in the recent years among progressive farmers as an alternative to chemical fertilizers and pesticides. Slow rate of multiplication and colonization, susceptible to biotic and abiotic stresses, incomplete elimination of pathogens and high cost are the major problems behind its poor adoption among the farmers. To overcome these challenges different strains of Trichoderma should be identified which can multiply and colonize rapidly, least affected by environmental conditions and having wide host range on pathogens. In addition, farmers should be made aware about the importance of Trichoderma in agriculture through various extension facilities for its wide scale adoption. Trichoderma can be the viable and sustainable alternative which acts as biofertilizer, bioremediator and biocontrol agent. Nevertheless, the use of Trichoderma is limited on research activities and its application at farmers' level is not yet satisfactory. Thus, this study based on critical analysis of the research works from worldwide researchers aims to reveal the present scenario of the use of Trichoderma, its importance, modes of action, methods of application and multiplication, challenges for wide scale adoption and its appropriate solutions

Effect of Different Levels of Nitrogen on Growth and Yield of Hybrid Maize (Zea Mays L.) Varieties

Nitrogen (N) fertilizer is considered as one of the most important factors affecting growth and grain yield of hybrid maize. This study was conducted to determine the effects of different rates of nitrogen and varieties on growth and yield of hybrid maize in Lamahi Municipality, Dang, Nepal from June to October, 2019. Three levels of hybrid maize varieties (10V10, Rajkumar F1 and NMH-731) and four levels of nitrogen (160, 180, 200 and 220 kg N ha-1) were evaluated using two factorial randomized complete block design with three replications. The results showed that grain yield and yield attributing traits of hybrid maize varieties increased with the increasing level of nitrogen from 160 to 220 kg ha-1. The application of nitrogen @ 220 kg N ha-1 produced the highest grain yield (10.07 t ha-1), cob length (16.33 cm), no of rows per cob (14.97), no of grains per row (33.37), cob diameter (4.54), thousand grain weight (276.77 g), stover yield (12.91 t ha-1), biological yield (23.00 t ha-1), harvest index (43.80), gross return (NRs. 208940 ha-1), net return (NRs.104488 ha-1) and B:C ratio (2.001). The hybrid maize variety 10V10 produced the highest grain yield (9.35 t ha-1), net returns (NRs. 91740.66 ha-1) and B:C ratio (1.91) accompanied by the highest cob length (16.25 cm), and as number of grains per row (32.35) as compared to other varieties. This study suggested that maize production can be maximized by cultivating hybrid maize variety 10V10 with the use of 220 kg N ha-1 in inner Terai region of Nepal