1. Care seeking in Childhood Pneumonia Management: An Exploratory Study
The study executed using a mixed methods approach seeks to assess care seeking behaviour with respect to treatment of pneumonia in the community and understand the influences of cultural factors on care seeking. It also seeks to describe the roles of the private and public health sectors in various state contexts with regard to care and management of pneumonia and understand their perceptions on the relative benefits of promotive/ preventive/ curative approaches towards childhood pneumonia management.
2. Evaluation of the six Delivering HOPE India NGO partners program of BMSF.
NGO partners supported by Bristol-Myers Squibb Foundation have been engaged in several activities as part of their mandate to rid the country of Hepatitis Some of these programmes have specifically targeted high risk groups like sanitation workers, doctors and nurses, staff working at blood banks, sex workers, injection drug users etc. Others have focussed on communities, schools and colleges, pregnant women and children. Samarth is undertaking an external evaluation of the Hepatitis programmes of 6 such NGO partners, namely, MAMTA-New Delhi, United Way-Mumbai, AmeriCares-Mumbai, HOPE-Lucknow, AIIDR-Ahmedabad and the Liver Foundation of West Bengal.
1. Effectiveness of Kadukkai Mathirai - (a Siddha Medicine Preparation) in Treating Anaemia in Tamil Nadu
Samarth in collaboration with the Central Council for Research in Siddha (CCRS) and funded by the Department of Ayurveda Yoga Unani Siddha and Homeopathy (AYUSH), New Delhi, have prepared a research protocol which aims to study the “Effectiveness of Kadukkai Mathirai - (a Siddha Medicine Preparation) in Treating Anaemia in School going girls inTamil Nadu”. The objectives of the study are 1) To assess the effectiveness of Kadukkai Mathirai (KM) a Siddha preparation in improving Hb levels and other haematocrit parameters in urban school going adolescent girls (13-15 yrs) and 2) To assess the perceived acceptability and compliance of KM among adolescent girls.
The proposal had been submitted to the ethics committees of both CCRS and Samarth. Following the first round of reviews, both committees had raised several issues for which they had sought our responses. Approvals were finally received from the following agencies:
|1.||Samarth Ethics Committee Approval||18/05/2015|
|2.||Siddha Central Research Institute, Institutional Human Ethics Committee:||04/11/2015|
With all approvals through we are in the process of working with the Siddha Institute in finalizing time lines, getting the KM tablets ready and obtaining permissions from the school education department to recruit school girls aged between 11-13 years of age from 2 – 3 selected state government run girls schools.
1. Development and Validation of a Questionnaire to Assess Attitudes of Health Care Providers towards Persons with Leprosy
The attitude of Health Care Provider’s (HCP) is important in the management of any disease. In the case of leprosy the positive beliefs and attitudes of HCPs plays an important role in early diagnosis of cases thereby serving to prevent disabilities. Leprosy is one of the major diseases which have been closely associated with and sometimes even synonymous with stigma. The common deformed physical image, the fear of infection and the belief that it is incurable are the root causes of the inhumane treatment that is often meted out to those affected with leprosy. The German Leprosy and TB Relief Association had sub-contracted Samarth to develop a questionnaire that could be used to assess the attitudes of health care providers towards patients with leprosy. The specific study objectives were: 1) Explore and understand HCPs attitudes towards and beliefs about persons with leprosy to inform the development of a questionnaire to measure attitudes of HCPs towards such persons. 2) Validate a questionnaire to measure attitudes of HCPs towards persons with leprosy. The study was divided into two phases. Phase I involved carrying out qualitative interviews and Focus Group Discussions (FGDs) with different cadres of health care providers (HCPs) and patients with leprosy.The findings so generated helped inform the development of a questionnaire to measure attitudes of HCPs towards persons with leprosy. Phase II involved the validation of this questionnaire wherein validity and reliability assessments were carried out on a sample of about 50 HCPs.. Qualitative data collection involving semi structured interviews (SSIs) and focus group discussions (FGDs) were undertaken in Kancheepuram and Villupuram districts in July and August 2015. A total of 5 SSIs were done with the doctors and health inspectors and 3 with patients. A total of two FGDs were conducted with VHNs from the two districts respectively. Transcribing of the interviews and analysis was then completed. The findings were presented by Samarth team members and discussed in a workshop held on November 12th 2015 at the GLRA offices attended by representatives from GLRA, government functionaries like the Additional Director of Rural Health Services (Leprosy), Health Inspectors and a few recovered leprosy patients. A draft questionnaire had been developed by Samarth based on findings from the qualitative interviews as well as the review of instruments measuring attitudes towards stigmatizing conditions. This 38 item questionnaire was presented at the workshop and inputs sought from the participants. Following incorporation of suggested changes this draft questionnaire was sent to panel of 10 experts for the purpose of scaling. The scaling exercise resulted in a total of 27 items, the remainder of which were discarded owing to poor agreement among the experts regarding its relevance. Barring a few items that were seen to be repetitive, all other items in the scale were reported as being culturally relevant and applicable to the measurement of the construct. While 54 persons participated in the test, thirty eight persons (70%) completed the re-test. The ICC for test-re-test reliability of the 27 items scale was 0.6 (95% CI 0.20-0.78) indicating moderate intra class correlation. The Cronbach’s alpha was 0.83 indicating good degree of consistency and homogeneity between the items. The final report has been submitted to GLRA.
2. An Intervention to Prevent Suicides among Srilankan Refugees: A Feasibility Study Supported by Sneha India & ADRA India & VHS (June 2014- December 2015)
A collaborative study between Sneha India, the Voluntary Health Services (VHS), ADRA India and Samarth was carried out to understand suicidal behavior and depression among Sri Lankan Tamil refugees living in refugee camps in Tamil Nadu state. There are a total of 111 camps all around Tamil Nadu with a total refugee population of 67,165. The Q branch which regularly monitors these camps had estimated that suicide and suicide attempts were high in these areas. Consequently, the department of rehabilitation at the state and the Q branch requested the NGOs which provided support to these refugees to plan for interventions to reduce suicidal behavior among the Sri Lankan refugees. This study aimed to test the effectiveness of Brief Intervention and Contact (BIC), as an intervention strategy to reduce/prevent suicidal behavior among the refugees residing in these camps. The BIC entailed identifying community volunteers who would then be empowered with skill sets to deliver pycho- social support to depressed and suicidal individuals which would be expected to reduce their distress and thereby their suicidal thoughts and tendencies. A team consisting of 10 research assistants were recruited by ADRA India an NGO working with these refugees. Members from Samarth carried out a two day training programme during the month of September 2014. They were given an orientation to the study objectives and methodology and were trained to administer the quantitative questionnaire. The team then carried out a household survey in the selected intervention and control camps to identify depressed and suicidal individuals. Consenting adults who scored 16 or more on the CESD-R (Centers for Epidemiological Studies-Depression Revised) in the intervention sites were asked to participate in the BIC programme wherein the community volunteers met with them once in two weeks and provided psycho social support. In the control site the participants were only given some basic information about where they could go to seek mental health care. Before commencement of the survey, the Samarth team visited the intervention and control sites and carried out focus groups discussions, one each with men and women in both intervention and control sites to understand the perceptions of Sri Lankan refugees about suicidal behavior in their camps and their attitude towards the community volunteers intervention. These FGDs were repeated following conclusion of the intervention, 15 months later in October 2015. Upon conclusion of the intervention the quantitative data were entered, cleaned and analysed. The study has been concluded and paper writing is underway.
3. Collaborative Care for Depression and Diabetes in India. Collaborative project with University of Washington, USA, Emory University, USA, Madras Diabetes Research Foundation (MDRF), Chennai, All India Institute of Medical Sciences, New Delhi. Funded by NIMH, USA. (February 2014- July 2014) The over-arching goal of this study is the adaptation of an integrated depression-diabetes intervention programme developed in the US, to Indian settings. The adaptation was carried out through qualitative interviews with patients, family members and health care providers which helped provide insights as to its cultural acceptability and relevance. This qualitative component was sub-contracted to Samarth. The adapted intervention will be tested in a randomized clinical trial.
4. Assessment and Documentation of Access and Utilisation of Family Planning Services and Linkages with Prevention of Parent To Child Transmission (PPTCT) and Maternal and Child Health Care Services for Women and Couples Living with HIV in Select districts in Tamil Nadu. Project carried out in collaboration with UNICEF and funded by UNICEF. (December 2013 – December 2014)
This study broadly sought to understand the family planning and contraceptive services provided and accessed by HIV positive pregnant and lactating women in select districts in the state of Tamil Nadu with a view to understanding potential barriers to accessing such services. The study also documented the capacities of health care providers under the RCH and HIV programmes to provide effective linkages and access to family planning services for mothers and couples living with HIV. The long-term aim of the study was to guide policy recommendations for implementation and operationalization of integrated services for RCH and HIV.
5. Amphetamine-Type Stimulants in India: A Situation Assessment Study. Project funded by the United Nations Office of Drugs and Crime (UNODC) (February 2013- August 2013)
This study explored the range, pattern and frequency of Amphetamine Type Stimulants (ATS) use among a sample of young persons’ residing in the cities of Chennai, Chandigarh, Aizawl, Imphal and Kolkata in order to understand factors associated with its use. The study also explored the adverse consequences related to its use.
6. Psychological Distress among Pregnant Women in South India- Towards Intervention Development. Collaborative project with the University of Washington Global WACh (Women, Adolescent and Child Health) Integrated Health Seed Grant: (June 2012, May 2013)
This study estimated the prevalence of depressive and post traumatic stress disorder (PTSD) symptoms among pregnant women seeking antenatal care and examined the impact of these symptoms on birth outcomes. The information gathered provided insights into how to culturally adapt therapeutic techniques to reduce depression and PTSD symptoms in these women.
7. NIH Grant No.1 R21 - Integrating Screening into HIV Care settings in Southern India. Collaborative project with the University of Washington and CMC- Vellore- funded by NIH, USA (Nov. 2010- May 2013).
This study sought to integrate mental health care in HIV care settings and involved the identification and validation of the most appropriate tool to screen HIV positive individuals in South India for depression. The study also estimated the prevalence and correlates of depression among HIV patients seeking care in an urban HIV clinic and examined barriers and facilitators to integrating depression screening into existing HIV care services
8. Community Care for People with Schizophrenia in India (COPSI). Collaborative project with Sangath, Goa, funded by Wellcome Trust, London UK: (Jan 2011 – Sept. 2012).
This programme sought to understand which of two treatments was better for people with schizophrenia, in reducing their symptoms and in improving their social functioning: Facility Based Care (FBC) or Collaborative Community Based Care (CCBC). Initial qualitative interviews were carried out with patients, family members and mental health professionals to obtain their perceptions on the programme.
9. Premium Project: A Project on Effective Mental Health Interventions in Under-resourced Health Systems. Collaborative project with Sangath, Goa, funded by Wellcome Trust, London, UK (Feb. 20111- September 2011).
This study aimed at mapping the psychological procedures accessed by people affected by depressive disorders and alcohol use disorders and explored the acceptability, feasibility and effectiveness of these procedures from the patients’ perspective. It also mapped the psychological procedures delivered by health care providers and explored the acceptability, feasibility and effectiveness of these strategies from the care provider’s perspective. The study sought to prioritise the procedures identified for their perceived effectiveness and potential barriers/scalability in delivery by non-specialist health workers.
10. Acceptability Study of Substitution of Brown Rice for White Rice. Collaborative project with Mohan’s Diabetes Foundation International Diabetes Federation through the BRiDGES Grant (April 2009- May 2011)
This was a preliminary qualitative study carried out to study the acceptability of brown rice viz-a-viz white rice as a substitute rice staple. It involved doing focus groups discussions with pre-diabetic men and women to understand their perceptions on switching to brown rice as a means of adopting a healthier diet.
11. Understanding Informed Consent in the Medical Settings funded by the CMC –Vellore Research Development Fund (February 2010 – December 2010)
The study sought to understand patient and health care providers’ perceptions on the process of informed consent. It involved doing in-depth interviews with patients following surgery, and with doctors to ascertain how this process was perceived by them - its relevance, need and potential barriers/constraints if any.
12. Diabetes Community Lifestyle Improvement Programme (D Clip). Collaborative project with Mohan’s Diabetes Foundation funded by the International Diabetes Federation through the BRiDGES grant (June 2010- March 2012)
The overall goal of this study was to test a culturally specific, community-based lifestyle intervention programme for the prevention of type 2 diabetes in men and women living in Chennai, India. The qualitative component carried out sought to understand the perceptions of the participants on the programme and their interests in continuing with it.
13. Study on Maternal Nutrition in Three States of India: Bihar, Tamil Nadu and Uttar Pradesh. Collaborative project with Mohan’s Diabetes Foundation and Emory University funded by the Bill and Melinda Gates Foundation (October 2010-February 2011)
The objective of the study was to review current maternal and child health policies and programme implementation experiences in these three states with a view to identifying potential delivery platforms and inform implementation of future maternal health programmes.
14. Pilot study to Asses the Acceptability and Effectiveness Of Central Storage Of Pesticides In Preventing Suicides: A Community controlled trial. Collaborative project with the Voluntary Health Services (VHS) and CMC-Vellore and funded by WHO. (April 2009 – March 2011)
This study assessed the acceptability and effectiveness of a central pesticide storage facility as a programmatic intervention to reduce pesticide related suicides and attempted suicides in selected villages in the state of Tamil Nadu. The study involved the construction of a central pesticide storage facility that was easily accessible to farmers thereby providing a safe storage space for pesticides and reducing access to a lethal means of suicide.
15. Evaluation of the HIV Fellowship Programme at the Government Hospital for Thoracic Medicine (GHTM), Tambaram, Chennai (2007- 2008) funded by International Training and Education Center for Health (I-TECH).
The Fellowship programme aimed to train physicians in HIV/AIDS medicine. These physicians would then move into positions of direct patient contact and care, and in course of time become leaders in the field of HIV/AIDS care, prevention, research and program management. This trained manpower resource would further help to reduce the burden on existing medical doctors at GHTM. Samarth undertook and evaluation of these doctors to understand their satisfaction with the programme, its content and training teams as well as their plans for the future.
16. Formation of Community Based Organizations for High Risk Groups - A Needs Assessment Report: funded by the AIDS Prevention and Control Project - APAC (August-September 2008)
This study aimed to obtain a deeper understanding of various groups at risk for HIV, namely, Aravanis, Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs). The study focused on their perceptions of community based organizations, their ability to run them and problems/barriers envisaged.
17. Testing a Mass Media Campaign on Stigma and Discrimination Faced by HIV+ Persons: funded by the AIDS Prevention and Control Project – APAC (March-April 2008)
The AIDS Prevention and Control Project (APAC) wanted to conduct a mass media campaign aimed at addressing stigma and discrimination faced by HIV+ persons in the state of Tamil Nadu. The campaign was in the form of educational messages that were intended to be aired on radio and television and printed in newspapers so as to have maximum reach. Samarth pre-tested these messages with various categories of people to obtain feedback on its appropriateness and relevance.
18.Effect of Stigma on HIV Care-Seeking Behaviours and Mental Health in Tamil Nadu, India: Collaborative project between Samarth, BRTC-Christian Medical College, Vellore and the University of Washington funded by Puget Sound Partners Grant, USA (October 2007 – September 2008)
This study investigated the relationship between HIV-associated stigma and depression in Tamil Nadu among HIV-positive persons affiliated with support networks and validated a stigma assessment scale for use in clinical settings. The findings from this study have reiterated the need to address stigma related issues during counselling sessions with HIV positive persons.
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