Background: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resista... more Background: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resistant pathogens originate from antibiotic misuse and unsustainable socioeconomic patterns. Co-financed by the European Commission, the Erasmus + capacity building project, PREVENT IT | Risk Management and Prevention of ABR, aims to improve the effectiveness of the study programs of Indian universities vis-à-vis ABR. This study aimed to evaluate the impact of the ABR training programs on the knowledge, attitude, and practice (KAP) reflection of undergraduate and postgraduate students from five Indian universities. Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software. Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection. Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Background Evidence shows that a gap in the documentation of patients' past medical history leads... more Background Evidence shows that a gap in the documentation of patients' past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. Methods The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria-studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively. Results In total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited
Objective To review the available evidence on the benefit of patient-held health records (PHRs), ... more Objective To review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs). Methods The literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar. Results Six observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients' experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to patients (n=6) and HCPs (n=4). Most patients carry PHRs to healthcare visits. One study assessed the completeness of clinical handover information and found that only 41% (161/395) of PHRs were complete with respect to key information on diagnosis, treatment and follow-up. No protocols or guidelines for HCPs were reported for use of PHRs. The HCPs perceived the use of PHRs improved medical information availability from other HCPs. From the patient perspective, PHRs functioned as documented source of information about their own condition. Conclusion Limited data on existing PHRs make their benefits for improving health outcomes in LMICs uncertain. This knowledge gap calls for research on understanding the dynamics and outcomes of PHR use by patients and HCPs and in health systems interventions. PROSPERO registration number CRD42019139365.
Background and Aim: Antibiotic resistance (ABR) is one of the most pressing public health issues.... more Background and Aim: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resistant pathogens originate from antibiotic misuse and unsustainable socioeconomic patterns. Co-financed by the European Commission, the Erasmus + capacity building project, PREVENT IT | Risk Management and Prevention of ABR, aims to improve the effectiveness of the study programs of Indian universities vis-à-vis ABR. This study aimed to evaluate the impact of the ABR training programs on the knowledge, attitude, and practice (KAP) reflection of undergraduate and postgraduate students from five Indian universities.
Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software.
Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection.
Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Keywords: health, antibiotic resistance, training, innovations and health, attitude and practice, capacity building, equal access, awareness, increasing life expectancy, international health policy.
VT for providing their valuable suggestions to improve the study. My special thanks to entire stu... more VT for providing their valuable suggestions to improve the study. My special thanks to entire students of MPH 2013 batch who helped me to sail through the journey of research and thesis. I would like to individually acknowledge Dr.
Background Evidence shows that a gap in the documentation of patients’ past medical history leads... more Background Evidence shows that a gap in the documentation of patients’ past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. Methods The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection crite...
VT for providing their valuable suggestions to improve the study. My special thanks to entire stu... more VT for providing their valuable suggestions to improve the study. My special thanks to entire students of MPH 2013 batch who helped me to sail through the journey of research and thesis. I would like to individually acknowledge Dr.
Background Task-sharing interventions using non-physician health-care workers might be a potentia... more Background Task-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs). Methods We did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA 1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA 1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015). Findings We found 4213 studies from the literature search, of which 46 (1•1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA 1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA 1c when tasks were delivered by nurses (averaged pooled mean difference −0•54% [95% CI −0•89 to −0•18]; I²=80%) and pharmacists (−0•91% [−1•15 to −0•68]; I²=58%), but not when they were delivered by dietitians (−0•50% [-1•10 to 0•09]; I²=54%) or community health workers (0•05% [0•03 to 0•07]; I²=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference-36•26 mg/dL [-52•60 to-19•92]; I²=78%) but not nurses (-7•46 mg/dL [-18•44 to 3•52]; I²=79%) or community health workers (-5•41 [-12•74 to 1•92]; I²=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of-35•00 mg/dL (-65•96 to-4•04). Interpretation Task sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes.
ObjectiveTo review the available evidence on the benefit of patient-held health records (PHRs), o... more ObjectiveTo review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs).MethodsThe literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar.ResultsSix observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients’ experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to pa...
Background: The objective of the study was to describe participants’ and providers’ perspectives ... more Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nat...
Background: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resista... more Background: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resistant pathogens originate from antibiotic misuse and unsustainable socioeconomic patterns. Co-financed by the European Commission, the Erasmus + capacity building project, PREVENT IT | Risk Management and Prevention of ABR, aims to improve the effectiveness of the study programs of Indian universities vis-à-vis ABR. This study aimed to evaluate the impact of the ABR training programs on the knowledge, attitude, and practice (KAP) reflection of undergraduate and postgraduate students from five Indian universities. Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software. Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection. Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Background Evidence shows that a gap in the documentation of patients' past medical history leads... more Background Evidence shows that a gap in the documentation of patients' past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. Methods The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection criteria-studies explaining the use of HBRs in LMIC for maternal and child health care. The included study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results from all study designs were summarised narratively. Results In total, 41 papers were included in the review from 4514 potential studies. Included studies represented various study designs and 16 countries. The least evaluated function of HBR was information continuity across health care facilities (n = 6). Overall, there were limited
Objective To review the available evidence on the benefit of patient-held health records (PHRs), ... more Objective To review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs). Methods The literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar. Results Six observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients' experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to patients (n=6) and HCPs (n=4). Most patients carry PHRs to healthcare visits. One study assessed the completeness of clinical handover information and found that only 41% (161/395) of PHRs were complete with respect to key information on diagnosis, treatment and follow-up. No protocols or guidelines for HCPs were reported for use of PHRs. The HCPs perceived the use of PHRs improved medical information availability from other HCPs. From the patient perspective, PHRs functioned as documented source of information about their own condition. Conclusion Limited data on existing PHRs make their benefits for improving health outcomes in LMICs uncertain. This knowledge gap calls for research on understanding the dynamics and outcomes of PHR use by patients and HCPs and in health systems interventions. PROSPERO registration number CRD42019139365.
Background and Aim: Antibiotic resistance (ABR) is one of the most pressing public health issues.... more Background and Aim: Antibiotic resistance (ABR) is one of the most pressing public health issues. Resistant pathogens originate from antibiotic misuse and unsustainable socioeconomic patterns. Co-financed by the European Commission, the Erasmus + capacity building project, PREVENT IT | Risk Management and Prevention of ABR, aims to improve the effectiveness of the study programs of Indian universities vis-à-vis ABR. This study aimed to evaluate the impact of the ABR training programs on the knowledge, attitude, and practice (KAP) reflection of undergraduate and postgraduate students from five Indian universities.
Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software.
Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection.
Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Keywords: health, antibiotic resistance, training, innovations and health, attitude and practice, capacity building, equal access, awareness, increasing life expectancy, international health policy.
VT for providing their valuable suggestions to improve the study. My special thanks to entire stu... more VT for providing their valuable suggestions to improve the study. My special thanks to entire students of MPH 2013 batch who helped me to sail through the journey of research and thesis. I would like to individually acknowledge Dr.
Background Evidence shows that a gap in the documentation of patients’ past medical history leads... more Background Evidence shows that a gap in the documentation of patients’ past medical history leads to errors in, or duplication of, treatment and is a threat to patient safety. Home-based or patient-held records (HBR) are widely used in low and middle-income countries (LMIC) in maternal and childcare. The aim is to systematically review the evidence on HBRs in LMICs for (1) improving informational continuity for providers and women/families across health care visits and facilities, (2) to describe the perceived usefulness by women/families and healthcare providers, and (3) maternal and child health outcomes of using HBRs for maternal and child health care. Methods The protocol was registered in PROSPERO (CRD42019139365). We searched MEDLINE, EMBASE, CINAHL, and Global Index Medicus databases for studies with home-based records from LMICs. Search terms pertained to women or parent-held records and LMICs. Two reviewers assessed studies for inclusion using a priori study selection crite...
VT for providing their valuable suggestions to improve the study. My special thanks to entire stu... more VT for providing their valuable suggestions to improve the study. My special thanks to entire students of MPH 2013 batch who helped me to sail through the journey of research and thesis. I would like to individually acknowledge Dr.
Background Task-sharing interventions using non-physician health-care workers might be a potentia... more Background Task-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs). Methods We did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA 1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA 1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015). Findings We found 4213 studies from the literature search, of which 46 (1•1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA 1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA 1c when tasks were delivered by nurses (averaged pooled mean difference −0•54% [95% CI −0•89 to −0•18]; I²=80%) and pharmacists (−0•91% [−1•15 to −0•68]; I²=58%), but not when they were delivered by dietitians (−0•50% [-1•10 to 0•09]; I²=54%) or community health workers (0•05% [0•03 to 0•07]; I²=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference-36•26 mg/dL [-52•60 to-19•92]; I²=78%) but not nurses (-7•46 mg/dL [-18•44 to 3•52]; I²=79%) or community health workers (-5•41 [-12•74 to 1•92]; I²=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of-35•00 mg/dL (-65•96 to-4•04). Interpretation Task sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes.
ObjectiveTo review the available evidence on the benefit of patient-held health records (PHRs), o... more ObjectiveTo review the available evidence on the benefit of patient-held health records (PHRs), other than maternal and child health records, for improving the availability of medical information for handover communication between healthcare providers (HCPs) and/or between HCPs and patients in low-income and middle-income countries (LMICs).MethodsThe literature searches were conducted in PubMed, EMBASE, CINAHL databases for manuscripts without any restrictions on dates/language. Additionally, articles were located through citation checking using previous systematic reviews and a grey literature search by contacting experts, searching of the WHO website and Google Scholar.ResultsSix observational studies in four LMICs met the inclusion criteria. However, no studies reported on health outcomes after using PHRs. Studies in the review reported patients’ experience of carrying the records to HCPs (n=3), quality of information available to HCPs (n=1) and the utility of these records to pa...
Background: The objective of the study was to describe participants’ and providers’ perspectives ... more Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nat...
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Papers by Dona Boban
Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software.
Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection.
Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Keywords: health, antibiotic resistance, training, innovations and health, attitude and practice, capacity building, equal access, awareness, increasing life expectancy, international health policy.
Materials and Methods: In this multicentric study, the KAP reflection of the students was assessed before (pre) and after (post) the intervention of experiential ABR training. Paired t-test and one-way analysis of variance were used to analyze the impact of intervention using the Statistical Package for the Social Sciences software.
Results: A total of 515 students participated in the study. The findings indicate a significant improvement in the knowledge and attitude scores, while a minor change was observed in practice reflection.
Conclusion: The intervention conducted within the framework of the project could set a good practice for the prevention and risk management of antibiotic-resistant bacteria.
Keywords: health, antibiotic resistance, training, innovations and health, attitude and practice, capacity building, equal access, awareness, increasing life expectancy, international health policy.