Causes, Consequences, and Policy Responses to the Migration of Health Workers: Key Findings from India

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers

Circulating Soluble Endoglin Levels in Pregnant Women in Cameroon and Malawi—Associations with Placental Malaria and Fetal Growth Restriction

Placental infections with Plasmodium falciparum are associated with fetal growth restriction resulting in low birth weight (LBW). The mechanisms that mediate these effects have yet to be completely described; however, they are likely to involve inflammatory processes and dysregulation of angiogenesis. Soluble endoglin (sEng), a soluble receptor of transforming growth factor (TGF)-β previously associated with preeclampsia in pregnant women and with severe malaria in children, regulates the immune system and influences angiogenesis. We hypothesized that sEng may play a role in development of LBW associated with placental malaria (PM). Plasma levels of sEng were measured in women (i) followed prospectively throughout pregnancy in Cameroon (n = 52), and (ii) in a case-control study at delivery in Malawi (n = 479). The relationships between sEng levels and gravidity, peripheral and placental parasitemia, gestational age, and adverse outcomes of PM including maternal anemia and LBW were determined. In the longitudinal cohort from Cameroon, 28 of 52 women (54%) experienced at least one malaria infection during pregnancy. In Malawi we enrolled two aparasitemic gravidity-matched controls for every case with PM. sEng levels varied over the course of gestation and were significantly higher in early and late gestation as compared to delivery (P<0.006 and P<0.0001, respectively). Circulating sEng levels were higher in primigravidae than multigravidae from both Cameroon and Malawi, irrespective of malarial infection status (p<0.046 and p<0.001, respectively). Peripheral parasitemia in Cameroonian women and PM in Malawian women were each associated with elevated sEng levels following correction for gestational age and gravidity (p = 0.006 and p = 0.033, respectively). Increased sEng was also associated with the delivery of LBW infants in primigravid Malawian women (p = 0.017); the association was with fetal growth restriction (p = 0.003) but not pre-term delivery (p = 0.286). Increased circulating maternal sEng levels are associated with P. falciparum infection in pregnancy and with fetal growth restriction in primigravidae with PM

Attitudes of undergraduate nursing students toward Objective Structure Practical Examination: An Exploratory study

Background: Objective Structured Practical Examination (OSPE) is a method of assessment of clinical competence. The examination is conducted at multiple stations. Besides practical and problem-solving skills, theoretical knowledge is also tested. OSPE can be traced back more than 40 years. OSPE has been included more than two decades, as a part of assessment in the College of Nursing, All India Institute of Medical Sciences (AIIMS), New Delhi. Objectives: This study was carried out to determine nursing students' attitudes towards OSPE as an assessment tool. Participants: The responses of all the 252 Undergraduate nursing students studying at the College of Nursing, AIIMS were obtained for this study (77 from B.Sc.(H) Nursing first year, 61 from the second year, 69 from the third year and 45 from the fourth year). Methods: The students attitudes towards OSPE were assessed by using a validated questionnaire containing 28 item statements on Likert's 5-point scale (LS) and 11 bipolar adjectives on Osgood's 7-point Semantic' Differential Scale (OSDS). Result: Most of the students approved of OSPE and felt that it was fair, useful, good, effective, exciting, interesting, practical, skill oriented but also taxing. The study also revealed that amongst the second years' students there was a strong correlation between Overall Rank in the Class and Assessment of OSPE. Conclusion: The study supports the introduction of OSPE as one of the methods of assessment of B.Sc. (Hons.) Nursing students. Keywords: Attitude of nursing students, Undergraduate nursing students, Objective Structured Practical Examinatio

Causes, consequences, and policy responses to the migration of health workers: key findings from India

Abstract Background This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries—Jamaica, India, the Philippines, and South Africa—that have historically been “sources” of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Methods Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Results Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Conclusions Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers

Infections among Contacts of Patients with Nipah Virus, India

We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, India. We detected 3 subclinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus