Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India

The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage

The empathy factor: The role of empathy in knowledge, attitude, and practice of organ donation in India - A crossectional, observational study

Background: Due to the scarcity of organs available for transplantation, several patients lose their lives each year. Increased awareness and positive attitudes alone may be insufficient to increase an individual's willingness to donate (i.e., the basic tenets of the knowledge-attitude-practice/KAP model). Therefore, it is pertinent to examine other psychological determinants that are associated with engaging in the altruistic/prosocial act of organ donation. Objective: To understand the association between empathy and KAP of organ donation in an Indian population. This pilot is the precursor to a larger project which aims to develop and test an empathy intervention to promote organ donation. Methods: Using a cross-sectional design, Indians (N = 419; female = 261; mean age = 28.48 years) aged 18 years and above were recruited using convenience sampling through an online survey. Questionnaires included the Awareness, Attitudes, and Practice of Organ Donation (Chakradhar et al., 2016) and Empathy Quotient-8 (Loewen et al., 2010). Multiple regression analyses were carried out to analyze the data. Results: Results showed that empathy was related to: (i) Total KAP (β = 0.123, P = 0.014), and (ii) attitudes (β = 0.195, P < 0.001) towards organ donation. Conclusion: These pilot study findings indicate that public health messages focused on evoking empathy can use the technique of patient/donor narratives, and training clinicians on empathic communication skills can help increase individuals' KAP of organ donation. Further, this pilot elucidated the need to conduct mixed-method studies with a donor and nondonor population and clinicians prior to developing and testing a larger empathy-centered intervention aimed at promoting the KAP of organ donation. © 2022 Wolters Kluwer Medknow Publications. All rights reserved

Does spending matters? Re-looking into various covariates associated with Out of Pocket Expenditure (OOPE) and catastrophic spending on accidental injury from NSSO 71st round data

Abstract Background Accidental Injury is a traumatic event which not only influences physical, psychological, and social wellbeing of the households but also exerts extensive financial burden on them. Despite the devastating economic burden of injuries, in India, there is limited data available on injury epidemiology. This paper aims to, first, examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on accidental injury; second, to look into the level of Catastrophic Health Expenditure (CHE) at different threshold levels; and last, to explore the adjusted effect of various socio-economic covariates on the level of CHE. Methods Data was extracted from the key indicators of social consumption in India: Health, National Sample Survey Organisation (NSSO), conducted by the Government of India during January–June-2014. Logistic regression analysis was employed to analyse the various covariates of OOPE and CHE associated to accidental injury. Findings Binary Logistic analysis has demonstrated a significant association between socioeconomic status of the households and the level of OOPE and CHE on accidental injury care. People who used private health services incurred 16 times higher odds of CHE than those who availed public facilities. The result shows that if the person is covered via any type of insurance, the odd of CHE was lower by about 28% than the uninsured. Longer duration of stay and death due to accidental injury was positively associated with higher level of OOPE. Economic status, nature of healthcare facility availed and regional affiliation significantly influence the level of OOPE and CHE. Conclusion Despite numerous efforts by the Central and State governments to reduce the financial burden of healthcare, large number of households are still paying a significant amount from their own pockets. There are huge differentials in cost for the treatment among public and private healthcare providers for accidental injury. It is expected that the findings would provide insights into the prevailing magnitude of accidental injuries in India, the profile of the population affected, and the level of OOPE among households

Minimum data set (MDS) based trauma registry, is the data adequate? An evidence-based study from Odisha, India

Background: In majority of the low- and middle-income countries (LMICs), the societal cost of injuries are alarming. The severity and magnitude of the road traffic injuries (RTI) in India are not estimated accurately due to the lack of availability of data. The data are limited on the aspects such as demographics, cause, severity of injury, processes of care, and the final outcome of injuries. This study aimed to determine the feasibility of setting up a sustainable trauma registry in Odisha, India, and to determine the demographics, mechanism, severity, and outcomes of injury reported to the facilities/hospital. Materials and Methods: A prospective observational study was conducted at Srirama Chandra Bhanja Medical College and Hospital (SCB-MCH), Cuttack, India. Injured patients who reported/admitted to the emergency department were observed, and data were collected by using a minimum data set (MDS) developed by the World Health Organization (WHO). Data were collected for a period of one month in June 2015. Observations were collected on 20 variables. The completeness of data collection ranged from 60% (19 variables) to 70% (23 variables) out of total 33 variables. Results: This study uses 145 cases of injury reported in SCB-MCH. Out of the total reported population at the trauma registry, about 21% were females. Nearly 45% of the injury occurred on road/street. RTI accounted for 36.6% of injury. Out of the total admitted cases, 2.8% died in the emergency department, 11% were discharged to home, and 7.6% left against medical advice. Majority of the respondents have reported single injuries (77%). Head injuries were more common and severe among majority of the reported cases (44.1%), followed by neck injury (28.3%) and chest (15.9%). Conclusions: This study indicates the challenges in obtaining complete data on injury. Data were missing in terms of admission, discharge, and Glasgow Comma Scale (GCS) among the studied population. This study suggests that individual GCS scoring should be done instead of total GCS scoring in each trauma patient. By collection and storage of adequate data, better policy decisions can be implemented, which will minimize and prevent trauma cases and maximize the utilization of the available resources