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Deepak N.N.,Qutab Institutional Area | Tripathi V.,Family and Reproductive Health
Midwifery | Year: 2013

Objective: this qualitative study aimed to document provider and community practices regarding uterotonic use during labour and delivery in Uttar Pradesh, India, as well as the knowledge, attitudes, and values that underlie such use. Methods, setting, and participants: a total of 140 in-depth interviews were conducted between May and July 2011 in Agra and Gorakhpur districts, with clinicians, nurses, recently delivered women, mothers-in-law with at least one grandchild, traditional birth attendants, unlicensed village doctors, and pharmacist assistants at chemical shops. Findings: interviews reveal that injectable uterotonic use for the purposes of labour augmentation is widespread in both clinical and community settings. However, use of uterotonics for postpartum haemorrhage prevention and treatment appears to be relatively limited and was rarely discussed by respondents. Key beliefs underlying uterotonic use were identified, including high valuation of labour pain, rapid delivery, and biomedical intervention, particularly administration of medicines. Other factors promoting the use of uterotonics for labour augmentation included lack of knowledge about adverse effects, provider beliefs that prolonged labour poses risks to the baby, community perceptions that modern women are less able to have spontaneous delivery, and financial incentives for uterotonic administration. Conclusions and implications: major challenges to overcome in minimising uterotonic misuse include entrenched use for labour augmentation in both institutional and community deliveries, perceptions of injectable uterotonics as curative agents symbolic of biomedical care, and the widespread availability of these drugs. The findings demonstrate a need for programmes that reduce inappropriate use of uterotonics, promote appropriate use for postpartum haemorrhage prevention and treatment, and ensure adherence to evidence-based guidelines. © 2012 Elsevier Ltd.


Maurer W.,Medical University of Vienna | Seeber L.,Charité - Medical University of Berlin | Rundblad G.,King's College London | Kochhar S.,Qutab Institutional Area | And 4 more authors.
Expert Review of Vaccines | Year: 2014

The majority of vaccines are administered during childhood. Vaccination records are important documents to be kept for a lifetime, but the documentation of immunization events is poorly standardized. At the point of care, paper records are often unavailable, making it impossible to obtain accurate vaccination histories. Vaccination records should include batch specifications to allow the tracking of licensed vaccines in cases of recall. The WHO have generated the International Certificate of Vaccination or Prophylaxis for the documentation of childhood and travel vaccinations as well as seasonal and booster immunizations. When moving vaccination records into the digital age, data standards and interoperability need to be considered. The ideal vaccination record should facilitate the interpretation of safety reports and promote a data continuum from pre-licensure trials to post-marketing surveillance. The current article describes which data elements are essential, and how vaccination documentation could be streamlined and simplified. © 2014 Informa UK, Ltd.


Arora H.,Qutab Institutional Area | Arora P.,University of Delhi
International Journal of Services and Operations Management | Year: 2015

In a service industry like banking, measuring service quality as seen from the 'eyes' of customers is complex. Superior service quality can help banks achieve competitive advantage. Using SERVQUAL as the underlying theoretical framework, this paper measures and evaluates service quality dimensions in commercial banks in India. Results of factor analysis reveal interesting patterns on the four factors extracted namely, 'customer-friendliness', 'trustworthiness', 'assurance' and 'tangibles'. Interestingly, tangibles always load on single factor distinct from the other intangibles variables. Gap analysis of SERVQUAL model using t-test indicate that a significant difference exists between service expected and service perceived (performance) by bank customers, indicating presence of service quality gaps in commercial banks in India. Results imply that Indian commercial banks ought to focus their attention and efforts towards improving service quality through 'customer-friendliness' if they wish to survive and grow in the long run. Copyright © 2015 Inderscience Enterprises Ltd.


Satyanarayana S.,Qutab Institutional Area
Tropical Medicine and International Health | Year: 2013

Objective: To assess feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) within the routine healthcare setting across the country at: eight tertiary care hospitals and more than 60 peripheral health institutions in eight tuberculosis units. Methods: Agreement on how to screen, monitor and record was reached in October 2011 at a stakeholders' meeting, and training was carried out for staff in the facilities in December 2011 and January 2012. Implementation started from January 2012, and we report on activities up to 30 September 2012. Results: Of 8269 TB patients diagnosed and initiated on treatment in participating facilities, 8109 (98%) were assessed for DM and 1084 (13%) were found to have DM; of these, 682 (8%) had a previously known diagnosis of DM and 402 (5%) were newly diagnosed. There was a higher prevalence of DM in patients with TB diagnosed in tertiary care hospitals (16%) than in those diagnosed in tuberculosis units (9%) (P < 0.001) and amongst those from South India (20%) than from North India (10%) (P < 0.001). The screening and referral process worked well although significantly more patients with DM diagnosed in hospitals were referred to DM care (96%) than patients diagnosed in tuberculosis units (92%) (P < 0.05). Conclusion: This pilot project shows that it is important and feasible to screen patients with TB for DM in the routine setting, resulting in earlier identification of DM in some patients and opportunities for better management of comorbidity. A policy decision has since been made by the National TB Control Programme of India to implement this intervention countrywide. © 2013 Blackwell Publishing Ltd.


Walia K.,Qutab Institutional Area
Indian Journal of Pediatrics | Year: 2013

The good quality laboratory services in developing countries are often limited to major urban centers. As a result, many commercially available high-quality diagnostic tests for infectious diseases are neither accessible nor affordable to patients in the rural areas. Health facilities in rural areas are compromised and this limits the usability and performance of the best medical diagnostic technologies in rural areas as they are designed for air-conditioned laboratories, refrigerated storage of chemicals, a constant supply of calibrators and reagents, stable electrical power, highly trained personnel and rapid transportation of samples. The advent of new technologies have allowed miniaturization and integration of complex functions, which has made it possible for sophisticated diagnostic tools to move out of the developed-world laboratory in the form of a "point of care"(POC) tests. Many diagnostic tests are being developed using these platforms. However, the challenge is to develop diagnostics which are inexpensive, rugged and well suited to the medical and social contexts of the developing world and do not compromise on accuracy and reliability. The already available POC tests which are reliable and affordable, like for HIV infection, malaria, syphilis, and some neglected tropical diseases, and POC tests being developed for other diseases if correctly used and effectively regulated after rigorous evaluation, have the potential to make a difference in clinical management and improve surveillance. In order to use these tests effectively they would need to be supported by technically competent manpower, availability of good-quality reagents, and healthcare providers who value and are able to interpret laboratory results to guide treatment; and a system for timely communication between the laboratory and the healthcare provider. Strengthening the laboratories at the rural level can enable utilization of these diagnostics for improving the diagnosis and management of infectious diseases among children which require prompt treatment and thus, considerably reduce morbidity and mortality among the pediatric age group. © 2013 Dr. K C Chaudhuri Foundation.


Chauhan R.,Qutab Institutional Area
Lecture Notes in Business Information Processing | Year: 2015

Information Technology (IT) offshoring is changing the way IT departments are run and organized by organizations. Enterprise Resource Planning (ERP) applications are changing the way organizations run their businesses. Both are seminal trends which bring along with their associated benefits to organizations. However, both IT offshoring and ERP implementations are loaded with risks. When IT offshoring and ERP implementations happen together, the risks get compounded. This paper presents the critical success factors of offshoring ERP implementations. The study is an exploratory and qualitative study that starts with in depth interviews and concludes with a focus group discussion. The findings reveal that six factors are critical in offshoring of ERP implementations, namely communication & culture, offshoring partner, organization change management, project management, team skills and work & team distribution. The scope of the study was restricted to offshoring happening from Europe to India and the focus was on large offshoring engagements. © Springer International Publishing Switzerland 2015.


Satyanarayana S.,Qutab Institutional Area
Tropical Medicine and International Health | Year: 2013

Objective: To assess the feasibility, results and challenges of screening patients with diabetes mellitus (DM) for tuberculosis (TB) within the healthcare setting of six DM clinics in tertiary hospitals across India. Method: Agreement on how to screen, monitor and record the screening was reached in October 2011 at a national stakeholders' meeting, and training was carried out for staff in the six tertiary care facilities in December 2011. Implementation started in the first quarter of 2012, and we report on activities up to 30th September 2012. Patients with DM were screened for TB on each clinic attendance using a symptom-based enquiry, and those with positive symptoms were referred for TB investigations. Results: In the three quarters, 26% of 7218, 52% of 12237 and 48% of 11691 patients with DM were screened for TB. A total of 254 patients were identified with TB, of whom 46% had smear-positive pulmonary disease. There were 18 patients newly diagnosed with TB as a result of screening and referral, with the remainder being patients already diagnosed from elsewhere. TB case rates per 100 000 patients attending the DM clinic each quarter were 859, 956 and 642. Almost 90% of patients with TB were recorded as starting or being on anti-TB treatment. Major implementation challenges related to human resources and recording systems. Conclusion: In India, it is feasible to screen patients with DM for TB resulting in high rates of TB detection. More attention to detail, human resource requirements and electronic medical records are needed to improve performance. © 2013 Blackwell Publishing Ltd.


Ramachandran P.,Qutab Institutional Area
Indian Journal of Medical Research | Year: 2012

The Indian Council of Medical Research (ICMR) undertook screening of asymptomatic persons from high risk group with the ELISA test for HIV infection in 1986 and found that HIV infection has reached India. ICMR in collaboration with the central and State health services initiated the national sero-surveillance programme for HIV infection in 43 surveillance and five reference centres to determine the major modes of transmission and magnitude of infection. Data from the sero-surveillance showed that HIV infection was present in all the known high risk groups and in the general population in all the States both in urban and rural areas. HIV was getting transmitted through all the known modes of transmission. In most States heterosexual transmission was predominant but in Manipur intravenous (iv) drug use was the most common mode of transmission. Prevalence of HIV infection in high risk groups was not high and that in low risk groups was quite low. ICMR initiated hospital based sentinel surveillance in high risk groups and general population to obtain time trends in seroprevalence. Between 1986 and 1991, National AIDS Programme was carried out as a collaborative effort of ICMR, and central and State health services. As the dimensions of the epidemic unfolded, rational evidence based interventions which could be implemented within the existing health system, were initiated. National AIDS Control Programme (NACP) continued and upscaled all these interventions. Effective implementation of a multi-pronged, rational strategy for HIV infection containment and control right from the initial stages, and dedicated work done by committed professionals belonging to government and voluntary sectors, cultural ethos of the country, responsible behaviour of the population and relatively low iv drug use have resulted in rapid decline in new infection and in prevalence of infection within a quarter of a century after the initial detection of HIV.


Ramachandran P.,Qutab Institutional Area
Indian Journal of Pediatrics | Year: 2010

India recognized the importance of improving the health and nutritional status of children, and initiated steps to improve access to nutrition and health services soon after independence. Over the years, the infrastructure and human resources for manning the health and nutrition services have been built up and currently cover the entire country. However these are inadequacies in terms of content and quality of services and undernutrition rates and under five morality rates continue to be high. Undernutrition begins in utero, and with low birthweight, effective antenatal care can help in reducing low birth weight. The poor infant and young child feeding (IYCF) practices, repeated morbidity due to infections and poor utilization of health and nutrition services are other causes of undernutrition in children in India. The key intervention to prevent undernutrition is nutritional and health education through all modes of communication, to bring about is a behavioral change towards appropriate IYCF and utilization of health care. Appropriate convergence and synergy between health and nutrition functionaries can play a major role in early detection and effective management of both undernutrition and infections, accelerate the pace of reduction in both undernutrition and under five mortality and enable India to reach Millennium Development Goals.

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