Using mHealth to improve health care delivery in India: A qualitative examination of the perspectives of community health workers and beneficiaries.

BACKGROUND:mHealth technologies are proliferating globally to address quality and timeliness of health care delivery by Community Health Workers (CHWs). This study aimed to examine CHW and beneficiaries' perceptions of a new mHealth intervention (Common Application Software [CAS] for CHWs in India. The objectives of the study were to seek perspectives of CHWs and beneficiaries on the uptake of CAS, changes in CHW-beneficiary interactions since the introduction of CAS and potential barriers faced by CHWs in use of CAS. Further, important contextual factors related to CHW-beneficiary interface and dynamics that may have a bearing on CAS have been described. METHODS:A qualitative study was conducted in two states of India (Bihar and Madhya Pradesh) from March-April 2018 with CHWs (n = 32) and beneficiaries (n = 55). All interviews were conducted and recorded in Hindi, transcribed and translated into English, and coded and thematically analysed using Dedoose. FINDINGS:The mHealth intervention was acceptable to the CHWs who felt that CAS improved their status in the communities where they worked. Beneficiaries' views were a mix of positive and negative perceptions. The divergent views between CHWs and beneficiaries surrounding the use and impact of CAS highlight an underlying mistrust, socio-cultural barriers in engagement, and technological barriers in implementation. All these contextual factors can influence the perception and uptake of CAS. CONCLUSIONS:mHealth interventions targeting CHWs and beneficiaries have the potential to improve performance of CHWs, reduce barriers to information and potentially change the behaviors of beneficiaries. While technology is an enabler for CHWs to improve their service delivery, it does not necessarily help overcome social and cultural barriers that impede CHW-beneficiary interactions to bring about improvements in knowledge and health behaviors. Future interventions for CHWs including mHealth interventions should examine contextual factors along with the acceptability, accessibility, and usability by beneficiaries and community members

Effects of an mHealth intervention for community health workers on maternal and child nutrition and health service delivery in India: protocol for a quasi-experimental mixed-methods evaluation.

INTRODUCTION:Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes. METHODS AND ANALYSIS:This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries. ETHICS AND DISSEMINATION:Ethical oversight is provided by the Committee for the Protection of Human Subjects at the University of California at Berkeley, and the Suraksha Independent Ethics Committee in India. The results will be published in peer-reviewed journals and analysis data will be made public. TRIAL REGISTRATION NUMBER:ISRCTN83902145

DETERMINANTS OF MENSTRUAL HYGIENE PRACTICES AMONG YOUNG WOMEN IN INDIA: EVIDENCE FROM DISTRICT-LEVEL HOUSEHOLD SURVEY

Objective: Menstrual hygiene management is a neglected and silent issue in India with less than 12% of women having access to commercial sanitary napkins. This paper identifies key determinants of usage of sanitary napkins among young women in India. Methods: Data from a cross-sectional, population-based District level Household Survey (DLHS-3) 2007-08 were analyzed. A sample of 81,506 women, aged 15-24 years, were included in the analysis to assess wealth, education, residence, caste, region, awareness of reproductive tract infections and attitudes toward reproductive health as determinants of usage of sanitary napkins. Results: Multivariate analyses found that background variables such as wealth, education, caste and residence are significant determinants of usage of sanitary napkins. Further, autonomy, awareness of reproductive tract infections, and attitude toward receiving reproductive health education are critical towards improving menstrual hygiene practices. Conclusion: Effective programming should focus on ending taboos associated with menstrual hygiene management by educating women about the importance and usage of safe menstrual hygiene practices. This is also important to dispel myths, misconceptions and negative perception around menstruation. Further, increasing access to subsidized quality sanitary napkins to adolescent girls and women should also be considered along with safe, private places to change and wash themselves along with safe disposal of products.Master of Public Healt

Identification and molecular characterization of drug targets of methicillin resistant Staphylococcus aureus

Antimicrobial resistance is a major world health concern and drug-resistant Staphylococcus aureus is a serious threat. Due to the emergence of multidrug-resistant bacterial strains, there is an urgent need to develop novel drug targets to meet the challenge of multidrug-resistant organisms. The main objective of the current study was to determine molecular targets against S. aureus using by computational approach. S. aureus was cultured in brain heart infusion broth medium and MRSA (Methicillin resistant S. aureus) protein was extracted acetone-sodium dodecyl sulfate method. The cell lysate was treated with various antibiotics and proteinase K stable proteins were analyzed. The molecular weight of Geninthiocin-targeted protein of interest in S. aureus ranged from 46 to 50 kDa. A prominent protein band in SDS-PAGE indicated that the protein corresponding 50 kDa was resistant against proteinase K. The SDS-PAGE separated sample was excised and trypsinated, and the peptides were characterized using Nano Liquid Chromatography with tandem mass spectrometry (LC-MS/MS) analysis. Spectrum with clusters of molecular peptides and peptide fragments ranging from 110.0716 to 1002.7093 mass/charge ratio (m/z) were displayed against intensity or relative abundance in the excised gel band. The spectral data from nano LC-MS/MS was subjected to mascot search in the NCBIprot database (taxonomy-bacteria (eubacteria), resulting in seven bacterial proteins. Geninthiocin target proteins were determined against MRSA. To conclude, antibiotic target proteins were identified using a machine learning approach and these targets may have a lot of applications in developing a novel lead molecule against drug-resistant bacteria

Association between coordinated counseling from both ASHA and Anganwadi Workers and maternal health outcomes: A cross-sectional study from Madhya Pradesh and Bihar, India.

Community Health Workers (CHWs) play crucial roles in health promotion and services in rural India. Previous research investigating the effectiveness of coordinated health promotion by different community health workers (CHWs) cadres on health practices is scarce. This study examines the effectiveness of coordinated health promotion by different CHW cadres, specifically Accredited Social Health Activists (ASHA) and Anganwadi Workers (AWW), on maternal health outcomes. Using endline data from a 2019 impact evaluation of 6635 mothers with children <12 months in Madhya Pradesh and Bihar, we compared the association between standalone and coordinated counseling by ASHA and AWW on various maternal health practices. Outcomes included four or more antenatal care visits, birth preparedness, institutional delivery, postnatal care visits, and contraceptive uptake. Fixed effects logistic regression with robust standard errors, corrected for multiple hypothesis tests, was used for analysis. Results showed that 39.6% of women received four or more ANC visits, 31.2% adopted birth preparedness practices, 79.6% had institutional deliveries, 23.3% received postnatal care, and 19.5% adopted a postpartum contraceptive method. Coordinated counseling from both ASHA and AWW was associated with a greater prevalence of four outcomes (birth preparedness, institutional delivery, PNC visit, and contraception) compared to standalone counseling from either ASHA or AWWs. These findings suggest that health promotion by AWW complements that of ASHA, collectively associated with improved health outcomes. This study underscores the effectiveness of coordinated health promotion and highlights the need for multisectoral and coordinated efforts among different CHW cadres at the community level. The results emphasize the importance of integrating various CHW roles to enhance maternal health practices and outcomes in rural India. Trial registration number: https://doi.org/10.1186/ISRCTN83902145. Date of registration: 08/12/2016

Effects of economic empowerment and relationship strengthening intervention on financial behaviors among couples living with HIV: The Mlambe pilot trial in Malawi.

INTRODUCTION: Economic insecurity, relationship issues, and gender-based financial disparities pose significant challenges for couples living with HIV in sub-Saharan Africa, potentially undermining treatment adherence and health outcomes. We evaluated Mlambe, an integrated economic empowerment with relationship strengthening intervention for couples living with HIV. METHODS: We conducted a pilot randomized controlled trial in Zomba, Malawi with 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C. Couples were recruited from HIV care clinics and randomized to either the Mlambe intervention (n = 39 couples) or enhanced usual care (EUC) control (n = 39 couples). The 10-month Mlambe intervention combined incentivized savings accounts, financial literacy education, relationship education, and couples counseling. EUC included brief alcohol counseling. We used linear mixed-effects models to evaluate Mlambes impact on (i) confidence to save, (ii) attitudes towards savings, (iii) equitable financial decision-making. RESULTS: At 10 months follow-up, participants in the Mlambe intervention showed significantly higher confidence to save compared to EUC (coefficient = 0.18, 95% CI: 0.05, 0.32, p < 0.001), with women having greater improvements than men (p < 0.001). However, these effects were not sustained at 15 months. No significant differences were observed between arms in attitudes towards savings. Participants in the intervention showed greater equitable financial decision-making at 10 months (coefficient = 0.13, 95%CI: 0.11, 0.25; p = 0.03) compared to EUC, with effects sustained at 15-months (coefficient = 0.21, 95% CI: 0.11, 0.32, p < 0.001). CONCLUSION: Our findings suggest that Mlambe intervention holds promise, underscoring the benefits of an integrated economic and relationship strengthening interventions among HIV-affected couples. CLINICAL TRIAL NUMBER: NCT04906616

The Role of Gender Norms on Intimate Partner Violence Among Newly Married Adolescent Girls and Young Women in India: A Longitudinal Multilevel Analysis.

Gender norms have been posited to impact intimate partner violence (IPV), but there is scant evidence of the longitudinal association between community-level gender norms and IPV. Using longitudinal data on 3,965 married girls surveyed in India, we fitted mixed-effects ordinal and binary logistic regression models for physical IPV intensity and occurrence of sexual IPV. We found a 26% increase in the odds that women experience frequent physical IPV per one unit increase in greater community-level equitable gender norms. We did not find an association between community-level equitable gender norms and sexual IPV. Findings suggest that the relationship between gender norms and physical and sexual IPV differs, indicating the need for tailored interventions for different types of IPV

Individual empowerment and community norm effects of engaging young husbands in reproductive health in rural India: findings from a pilot study

BackgroundDespite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men's perspective of the pilot of a gender transformative intervention for newly married couples in India.MethodsA pilot study was conducted of TARANG, a 4 month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June 2023-January 2024.ResultsMen had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community.ConclusionsMen in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement. TRIAL REGISTRATION CLINICALTRIALS.GOV : 03/13/24.NCT06320964