Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India

Background In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients. Methods From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1. Results During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested. Conclusions Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities

Size at birth and cognitive function among rural adolescents:a life course epidemiology study protocol of the Kisalaya cohort in Mysuru, South India

Introduction: It is proven that adverse intrauterine environment results in 'early life programming,' alterations in metabolism and physiological development of the fetus, often termed as 'Developmental Origins of Health and Disease' (DOHaD) resulting in a smaller size at birth, greater non-communicable diseases (NCD) risk factors during childhood and adolescence, and cardiometabolic disorders in adulthood. Nevertheless, very few studies have examined the relationship between DOHaD programming and cognition. This study aims to examine if impaired prenatal growth indicated by birth weight is associated with cognition among adolescents in the Kisalaya cohort, a rural birth cohort in South India, thus providing newer insights into DOHaD programming for adolescent mental health in a low-income and middle-income country setting.Methods and analysis: Kisalaya cohort was established in 2008, to provide integrated antenatal care and HIV testing using mobile clinics to improve maternal and child health outcomes. This cohort included pregnant women residing in 144 villages of Mysuru Taluk (rural) who received antenatal care through mobile clinics and delivered their children between 2008 and 2011. Data related to mother-infant dyads for all pregnant women who received care in the Kisalaya programme are available for this study. Presently, children born to women who received care through Kisalaya are adolescents between 10 and 12 years. At this point, information would be collected on sociodemographic data and assessments of mental health, stressful life events, cognition, vision, speech, language, hearing and anthropometric measures would be done and relevant maternal data and child data, available from the cohort would be retracted for analysis. We plan to retrace as many adolescents as possible out of 1544 adolescents who are currently available for study excluding twins, abortions, stillbirths and postdelivery deaths. Analyses will be extended to construct a life course pathway for cognition using structural equation modelling.</p

Evaluation of Educational Material for Low-Literacy Populations in India

During the COVID-19 pandemic, many children from limited-literacy communities in India did not receive information regarding COVID-19 safety due to the sudden shutdown of schools. Many parents from these communities could not afford virtual learning and lacked the ability to educate the children themselves. In July 2021, the research team developed comic, coloring, and activity books to provide children with fun, yet readable, educational materials. We consulted with teachers to simplify the language and understand the popularity of different cartoon characters. Between August 2021 and January 2022, our community health partners distributed the books to two age groups, ages 6–10 (n = 116, mean age 8.72) and 11–14 (n = 81, mean age 12.05). We conducted surveys with the children during and a week after distribution to assess any change in their knowledge about COVID-19 safety. The average age of children in this study was 10.09 (SD = 2.01) years. All resided in underresourced urban communities with low literacy rates and limited education. All questions were answered more correctly in the postsurvey, with the social distancing question having the greatest and most statistically significant increase (33.6%, p < 0.0001). The average increase in knowledge among children aged 6–10 (16.9%) was greater, though not statistically significantly so, than the average increase among children aged 11–14 (4.7%). These results indicate that child-friendly books can increase health education for children ages 6–14 in low-literacy populations. Additionally, the mechanism of the program is fit to be used in other low-resource populations globally

Using photovoice to understand the context of cervical cancer screening for underserved communities in rural India

Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30-51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women's health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Will increasing access to mental health treatment close India's mental health gap?

Background: India's National Mental Health Survey (NMHS) reports a treatment gap for common mental disorders of over 85 percent, which they attribute to lack of awareness and access to psychiatric services in India. Interventions aiming to close that treatment gap through task-sharing have gained significant traction in India, but have met with mixed success, particularly in long-term perspective. Aims: We critically examined the assumptions embedded in the NMHS report that the mental health treatment gap results from people in India lacking access and awareness to psychiatric services in a medium-sized Indian city. Method: We conducted qualitative interviews with a community-based sample of 66 adult women in Mysuru city, Karnataka about the causes of distress in their lives, their understandings of distress, and their care-seeking behaviors. The overall aim was to assess their familiarity with psychiatry and their relative willingness to engage with it. Results: Women were familiar with psychiatric models of mental illness and with the psychiatric services available in their community. They recommended these services for hypothetical others but uniformly refused them for their own distress, even when this distress was severe. Women reported fears of stigma, doubts about psychiatric effectiveness, and connected their distress to social and structural causes rather than medical causes. They therefore did not perceive that clinical care could help them resolve their distress. Conclusions: Cultural mismatch appeared to be responsible for at least a part of women's lack of use of psychiatry in the research context. We conclude with a set of recommendations addressing how future research and intervention could modify task-sharing approaches to incorporate culturally relevant conceptions of distress and its appropriate management, instead of relying solely on standard psychiatric approaches

Correlates of completing routinevaccination among children in Mysore,India

More than half of the over 18 million incompletely vaccinated childrenworldwide in 2011 lived in India (32%), Nigeria (14%) and Indonesia (7%). Overallimmunization coverage in India was 61% in 2009. Few studies have explored the roleof parental attitudes in children’s vaccination

Correlates of completing routine vaccination among children in Mysore, India

Summary: Background: More than half of the over 18 million incompletely vaccinated children worldwide in 2011 lived in India (32%), Nigeria (14%) and Indonesia (7%). Overall immunization coverage in India was 61% in 2009. Few studies have explored the role of parental attitudes in children's vaccination. Objectives: To explore the correlates of completion of routine vaccination among children in Mysore City, India. Methods: A two-stage probability sample of 800 girls aged 11–15 years was selected from 12 schools in Mysore to take home questionnaires to be completed by their parents. The questionnaire elicited information on socio-demographic characteristics, attitudes and practices relevant to vaccination. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with completion of routine vaccination. Results: Of the 797 (99.6%) parents who completed questionnaires, 29.9% reported completing all routine vaccinations for their children. Parents who had obtained optional vaccinations for their children (adjusted odds ratio [AOR]: 4.56; 95% confidence interval [CI]: 3.09–6.74), who believed in vaccines’ effectiveness (2.50; 1.19–5.28) and who asked doctors or nurses about vaccination (2.07; 1.10–3.90) were significantly more likely to report complete vaccination, after controlling for all other factors. Belief that the disease was more protective than vaccination was independently associated with lower likelihood of vaccination series completion (0.71; 0.52–0.96). No other attitudinal or socio-demographic factors were associated with vaccine completion. Conclusion: Interest and belief in vaccine effectiveness are important facilitators motivating parents to obtain full vaccination for their children in India. Keywords: Barriers, Facilitators, India, Parental attitudes, Vaccinatio

Correlates of completing routinevaccination among children in Mysore,India

More than half of the over 18 million incompletely vaccinated childrenworldwide in 2011 lived in India (32%), Nigeria (14%) and Indonesia (7%). Overallimmunization coverage in India was 61% in 2009. Few studies have explored the roleof parental attitudes in children’s vaccination

Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India

Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+) intervention of community mobilization strategy providing conditional cash transfers (CCT) to women’s SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3%) women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5%) received ANC in the SCIL+ arm ( ); 175 (97%) in the SCIL and 366 (98.6%) in the SCIL+ arm consented to HIV testing ( ). HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women’s microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages