The utilisation of systematic review evidence in formulating India's National Health Programme guidelines between 2007 to 2021

Evidence informed policymaking integrates the best available evidence on programme outcomes to guide decisions at all stages of the policy process and its importance becomes more pronounced in resource constrained settings. In this paper, we have reviewed the use of systematic review evidence in framing National Health Programme (NHP) guidelines in India. We searched official websites of the different NHPs, linked to the main website of the Ministry of Health and Family Welfare (MoHFW), in December 2020 and January 2021. NHP guideline documents with systematic review evidence were identified and information on the use of this evidence was extracted. We classified the identified systematic review evidence according to its use in the guideline documents and analysed the data to provide information on the different factors and patterns linked to the use of systematic review evidence in these documents. Systematic reviews were mostly visible in guideline documents addressing maternal and newborn health, communicable diseases and immunization. These systematic reviews were cited in the guidelines to justify the need for action, to justify recommendations for action and opportunities for local adaptation; and to highlight implementation challenges and justify implementation strategies. Guideline documents addressing implementation cited systematic reviews about the problems and policy options more often than citing systematic reviews about implementation. Systematic reviews were linked directly to support statements in few guideline documents, and sometimes the reviews were not appropriately cited. Most of the systematic reviews providing information on the nature and scale of the policy problem included Indian data. It was seen that since 2014, India has been increasingly using systematic review evidence for public health policymaking particularly for some of its high priority NHPs. This complements the increasing investment in research synthesis centres and procedures to support evidence informed decision making, demonstrating the continued evolution of India's evidence policy system

Embodied negotiations, practices and experiences interacting with pregnancy care infrastructures in South India

Behavior change and improving health literacy based on normative ideals of motherhood is a dominant paradigm to address maternal health challenges. However, these ideals often remove women's control over their bodies overlooking how the bodily experiences of pregnancy are socially and culturally constructed. We report on 27 interviews with pregnant women and nursing mothers in rural and semi-urban areas of South India, and six focus groups with 23 frontline health workers as secondary data. We explore how the embodied pregnancy experiences are influenced and negotiated by the socio-cultural context and existing care infrastructures. Our findings highlight how the ways of seeing, knowing, and caring for a body of a pregnant woman through often conflicting norms, beliefs and practices of medicine, nourishment and care actively shape the experiences of pregnancy. We open up a space for novel opportunities for digital health technologies to enhance women's embodied experiences and pregnancy care infrastructures in the Global South

Towards enhancing everyday pregnancy care

We need a deeper understanding of the everyday challenges of pregnancy care in lower socio-economic settings in India. This paper reports reflections from three workshops involving multiple stakeholders, conducted as part of a larger project exploring the role of digital technology in enhancing everyday practices of pregnancy care. In particular, this paper only reports our initial engagement with community stakeholders in pregnancy care, including the local public and third-sector network of care-workers. Based on the findings, we present three reflections namely, a) tensions between traditional and everyday care practices versus requirements of modern pregnancy care, b) tensions in coordination between multiple stakeholders in pregnancy care, and c) the role of physical and digital infrastructures in pregnancy care. These reflections are introduced as concerns and highlight opportunities to further inform technology design to enhance everyday care of pregnant women in semi-urban and rural India, and beyond

Clinical Outcomes of Snuggle up Position Using Positioning Aids for Preterm (27-32 Weeks) Infants

ABSTRACTBackground: Preterm birth, if not actively managed with developmental supportive care, can significantly contribute to neurodevelopmental compromise. Use of appropriate positioning aids helps with mimicking the intrauterine environment and facilitating neuromuscular development. Herein, we aimed to determine the effectiveness of snuggle up positioning aids on clinical outcomes of preterm

Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review

BackgroundHypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. ObjectiveThis review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? MethodsThis review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. ResultsAs per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. ConclusionsThe evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. International Registered Report Identifier (IRRID)PRR1-10.2196/5179