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Need for operational simplicity and timely disbursal of benefits—a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India

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贫困所致传染病(英文) 2024年第3期13卷 58-72页

作者： Mohan Malu Thangaraj Jeromie W. V. Pandey Sumit Priya G. Sri Lakshmi Arunachalam Sivavallinathan Sharma Rahul shewade hemant deepak Aishwarya B. Afeeq K. Khatoon Afsana Gokulvijay B. Sireesha Gude Chandra Kavita Nandhakumar S. Samuel Prince Viswanathan C. Nanditha Shanmugasundaram Devika Rao Raghuram Murhekar Manoj V. Jeyashree Kathiresan Indian Council of Medical Research-National Institute of Epidemiology R-127 TNHB Ayapakkam Chennai Tamil Nadu India TB Support Network WHO Country Office for India New Delhi India Central Tuberculosis Division Government of India New Delhi India

Background Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY *** We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical *** Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and *** The optimal utilization of NPY is enabled by strong political commitment and

关键词： National Tuberculosis Elimination Programme Nutritional status Direct benefit transfer Ni-kshay Poshan Yojana Implementation Cash transfer scheme Grounded theory India

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Training medical undergraduates in the core disciplines of community medicine through community postings-an experience from India

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Family Medicine and Community Health 2016年第3期4卷 45-50页

作者： hemant deepak shewade Chinnakali Palanivel Kathiresan Jeyashree Department of Community Medicine Indira Gandhi Medical College and Research InstitutePuducherryIndia Department of Community Medicine Velammal Medical College Hospital&Research InstituteMaduraiIndia International Union Against Tuberculosis and Lung Disease(The Union) South-East Asia OfficeC-6Qutub Institutional AreaNew DelhiIndia Department of Preventive and Social Medicine Jawaharlal Insti-tute of Postgraduate Medical Edu-cation and Research(JIPMER)PuducherryIndia

Objective:Family medicine,epidemiology,health management and health promotion are the core disciplines of community *** this paper,we discuss the development of a commu-nity posting program within the framework of community medicine core disciplines at a primary health centre attached to a teaching hospital in Puducherry,***:This is a process documentation of our ***:There were some shortcomings which revolved around the central theme that post-ings were conducted with department in the teaching hospital as the focal point,not the primary health centre(PHC).To address the shortcomings,we made some changes in the existing com-munity posting program in *** feedback aimed at Kirkpatrick level 1(satisfaction)evaluation revealed that they appreciated the benefits of having the posting with PHC as the focal *** recommended some further changes in the community posting which could be addressed through complete administrative control of the primary health centre as urban health and training center of the teaching hospital;and also through practice of core disciplines of com-munity medicine by faculty of community ***:It is important to introduce the medical undergraduates to the core disciplines of community medicine early through community *** postings should be con-ducted with primary health centre or urban health and training centre as the focal point.

关键词： Family medicine community posting clinical posting community-based medical education undergraduate medical education epidemiology health management health promotion

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Knowledge,access and utilization of bednets among stable and seasonal migrants in an artemisinin resistance containment area of Myanmar

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Infectious Diseases of Poverty 2017年第1期6卷 1227-1234页

作者： Wint Phyo Than Tin Oo Khin Thet Wai Aung Thi Philip Owiti Binay Kumar hemant deepak shewade Rony Zachariah Regional Public Health Department Ministry of HealthBagoMyanmar Department of Medical Research Ministry of HealthYangonMyanmar National Malaria Control Program Ministry of HealthNaypyitawMyanmar Academic Model Providing Access to Healthcare(AMPATH) EldoretKenya GAVI the Vaccine Alliance GenevaSwitzerland International Union Against Tuberculosis and Lung Disease(The Union) South-East Asia Regional OfficeNew DelhiIndia Medecins Sans Frontieres Operational Research Unit(LuxOR)Luxembourg CityLuxembourg

Background:Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies(ACT).Migrant populations are more likely than others to spread ACT resistance.A vital intervention to reduce malaria transmission,resistance spread and eliminate malaria is the use of bed *** seasonal and stable migrants in an artemisinin resistance containment region of Myanmar,we compared a)their household characteristics,b)contact with health workers and information material,and c)household knowledge,access and utilization of bed ***:Secondary data from community-based surveys on 2484 migrant workers(2013 and 2014,Bago Region)were analyzed of which 37%were seasonal *** net access and utilization were assessed using a)availability of at least one bed net per household,and b)one bed net per two persons,and c)proportion of household members who slept under abed net during the previous night(Indicator targets=100%).Results:Over 70%of all migrants were from unstable work settings with short transitory *** household size was five(range 1-25)and almost half of all households had children under-five *** 10%of migrants were night-time *** than 40%of households had contact with health workers and less than 30%had exposure to information education and communication(IEC)materials,the latter being significantly lower among seasonal *** 70%of households were aware of the importance of insecticide-treated bed-nets/long-lasting insecticidal nets(ITNs/LLINs),but knowledge on insecticide impregnation and retreatment of ITNs was poor(<10%).Although over 95%of households had access to at least one bed net,the number with one bed net per two persons was grossly inadequate(13%for stable migrants and 9%for seasonal migrants,P=0.001).About half of all household members slept under a bed net during the previous ***:This study reveals important short-fa

关键词： Operational research Malaria Transmission Artemisinin Greater Mekong sub-region Mosquito

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Assessment of household ownership of bed nets in areas with and without artemisinin resistance containment measures in Myanmar

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Infectious Diseases of Poverty 2018年第1期7卷 199-205页

作者： Thae Maung Maung Tin Oo Khin Thet Wai Thaung Hlaing Philip Owiti Binay Kumar hemant deepak shewade Rony Zachariah Aung Thi Department of Medical Research Ministry of Health and SportsYangonMyanmar Department of Public Health Ministry of Health and SportsNay Pyi TawMyanmar Academic Model Providing Access to Healthcare(AMPATH) EldoretKenya Gavi the Vaccine AllianceGenevaSwitzerland International Union Against Tuberculosis and Lung Disease(The Union) South-East Asia Regional OfficeNew DelhiIndia Medecins Sans Frontieres Brussels Operational CentreLuxembourg cityLuxembourg National Malaria Control Program Ministry of Health and SportsNay Pyi TawMyanmar

Background:Myanmar lies in the Greater Mekong Subregion where there is artemisinin-resistant Plasmodium falciparum *** the artemisinin compound is the pillar of effective antimalarial therapies,containing the spread of artemisinin resistance is a national and global *** use of insecticide-treated bed nets/long-lasting insecticidal nets(ITNs/LLINs)is the key intervention for ensuring the reduction of malaria transmission and the spread of resistant strains,and for eventually eliminating *** study aimed at assessing household ownership of,access to,and utilization of bed nets in areas of Myanmar with and without artemisinin resistance containment ***:Secondary data from a nationwide community-based malaria survey conducted by the National Malaria Control Program in 2014 were *** on evidence of artemisinin resistance,Myanmar was divided into tiers 1,2,and 3:townships in tiers 1 and 2 were aggregated as the Myanmar Artemisinin Resistance Containment(MARC)areas and were compared with tier 3 townships,which were defined as non-MARC *** chi-square test was used to compare groups,and the level of significance was set at P≤***:Of the 6328 households assessed,97.2%in both MARC and non-MARC areas had at least one bed net(any type),but only 63%of households had ITNs/*** 44%of households in MARC areas and 24%in non-MARC areas had adequate numbers of ITNs/LLINs(one ITN/LLIN per two persons,P<0.001).Nearly 44%of household members had access to ITNs/*** the utilization of ITNs/LLINs,45%of household members used them in MARC areas and 36%used them in non-MARC areas(P<0.001,desired target=100%).Utilization of ITNs/LLINs among children aged below five years and pregnant women(high malaria risk groups)was low,at 44%and 42%,***:This study highlights the nationwide shortfalls in the ownership of,access to,and utilization of ITNs/LLINs in Myanmar,which is of particular concern in terms

关键词： Malaria Insecticide-treated bed nets Long-lasting insecticidal nets Myanmar artemisinin resistance containment Bed nets ownership Bed nets access Bed nets utilization Myanmar

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An inherent acceleratory effect of insulin on small intestinal transit and its pharmacological characterization in normal mice

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World Journal of Gastroenterology 2006年第16期12卷 2593-2600页

作者： Murali Krishna Reddy Peddyreddy Steven Aibor Dkhar Subramanian Ramaswamy Amrithraj Theophilus Naveen deepak Gopal shewade Department of Pharmacology Jawaharlal Institute of Postgraduate Medical Education and ResearchPondicherry-605006India Department of Pharmacology Aarupadai Veedu Medical CollegePondicherry-607 402India Department of Pharmacy Mbarara University of Science and TechnologyMbararaUganda

AIM： To study an inherent effect of insulin on small intestinal transit and to explore involvement of various systems/mechanisms in normal mice. METHODS： Insulin at the doses of 2 μU/kg, 2 mU/kg, 2 U/kg or vehicle was subcutaneously administered to four groups of overnight fasted normal male mice. Blood glucose （BG） levels were measured 2 min before insulin administration and 2 min before sacrificing the animals for the measurement of small intestinal transit （SIT）. Charcoal meal was administered （0.3 mL） intragastrically 20 min after insulin administration and animals were sacrificed after 20 min and SIT was determined. For exploration of the various mechanisms involved in insulin-induced effect on SIT, the dose of insulin which can produce a significant acceleration of SIT without altering BG levels was determined. The following drugs, atropine （1 mg/kg）, clonidine （0.1 mg/kg）, ondansetron （1 mg/kg）, naloxone （5 mg/kg）, verapamil （8 mg/kg） and glibenclamide （10 mg/kg）, were administered intravenously 10 min prior to the administration of insulin （2 μU/kg）. RESULTS： The lower doses of insulin （2 μU/kg and 2 mU/kg） produced a significant acceleration of SIT from 52.0% to 70.7% and 73.5% without lowering blood glucose levels （P〈0.01）, while the highest dose of insulin （2 U/kg） produced a fall in blood glucose levels which was also associated with significant acceleration of SIT （P〈0.01）. After pretreatment of insulin （2 μU/kg） group with atropine, insulin could reverse 50% of the inhibition produced by atropine. In clonidine-pretreated group, insulin administration could reverse only 37% of the inhibition produced by clonidine and inhibition of SIT was significant compared with vehicle ＋ insulintreated group, i.e. from 74.7% to 27.7% （P〈0.01）. In ondansetron-pretreated group, insulin administration could produce only mild acceleration of SIT （23.5%）. In naloxone-pretreated group, insulin administration could significantly reverse the inhibition of SIT produced by nal

关键词： Adrenergic system Blood glucose levels Ca2^+ channels Cholinergic system Insulin Intestinal transit Opioid system Serotonergic system

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阿片样物质介导多潘立酮和西沙必利对小鼠的镇痛作用(英文)

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Acta Pharmacologica Sinica 2002年第1期23卷 25-28页

作者： Isabella TOPNO,Mohammed ASAD,deepak Gopal shewade,Chanolean SHASHINDRAN,Subramanyan RAMASWAMY Department of Pharmacology Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry-605006 India Department of Pharmacology Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry-605006 India Department of Pharmacology Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry-605006 India Department of Pharmacology Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry-605006 India Department of Pharmacology Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry-605006 India

To study the anti-nociceptive effect of domper-idone and cisapride in mice. METHODS: Initially, the effect of these drugs on motor activity was tested using rotarod. The anti-nociception was tested using chemical and mechanical assay. In the chemical assay, the number of abdominal constrictions either in the saline treated animals or in the domperidone/cisapride (1, 5, or 10 mg/kg either po or ip) treated mice, were recorded for a period of 30 min after acetic acid challenge (10 mLAg, of 0.6 % acetic acid ip). In the tail clip assay, the time taken by the mouse to make attempts to dislodge the bulldog clamp placed at the tail (reaction time) was recorded with a cut off time of 30 s. The role of opioid pathways was examined by pretreating the animals with naloxone (1 mg/kg, ip) 30 min prior to domperidone and cisapride. RESULTS: Domperidone and cisapride, both reduced the number of abdominal constrictions when given orally or intraperitoneally. Domperidone (5 mg/kg) inhibited it to the extent of 57.0 % a

关键词：多潘立酮西沙必利镇痛药醋酸类纳洛酮

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Inequity in catastrophic costs among tuberculosis-affected households in China

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Infectious Diseases of Poverty 2019年第3期8卷 104-104页

作者： Cai-Hong Xu Kathiresan Jeyashree hemant deepak shewade Yin-Yin Xia Li-Xia Wang Yan Liu Hui Zhang Li Wang National Center for Tuberculosis Control and Prevention Chinese Center for Disease Control and PreventionBeijing 100226China 不详 Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences Chinese Academy of Medical SciencesSchool of Basic Medicine Peking Union Medical CollegeBeijing 100005China

Background:There are limited nationally representative studies globally in the post-2015 END tuberculosis(TB)era regarding wealth related inequity in the distribution of catastrophic costs due to TB *** the Chinese national tuberculosis programme setting,we aimed to assess extent of equity in distribution of total TB care costs(pre-treatment,treatment and overall)and costs as a proportion of annual household income(AHI),and describe and compare equity in distribution of catastrophic costs(pre-treatment,treatment and overall)across population ***:Analytical cross-seaional study using data from national TB patient cost survey carried out in 22 counties from six provinces in China in ***-susceptible pulmonary TB registered under programme,who had received at least 2 weeks of intensive phase therapy were *** was depiaed using concentration curves and concentration indices were compared using dominance ***:Of 1147 patients,the median cost of pre-treatment,treatment and overall care,were USD 283.5,USD 413.1 and USD 965.5,*** quintiles incurred significantly higher pre-treatment and treatment costs compared to poorer *** distribution of costs as a proportion of AHI and catastrophic costs were significantly pro-poor overall as well as during pre-treatment and treatment *** the concentration curves for catastrophic costs(due to pre-treatment,treatment and overall care)stratified by region(east,middle and west),area of residence(urban,rural)and type of insurance new rural co-operative medical system[NCMS],non-NCMSalso exhibited a pro-poor pattern with statistically significant(P<0.01)concentration *** pro-poor distribution of the catastrophic costs due to TB treatment was significantly more inequitable among rural,compared to urban patients,and NCMS compared to non-NCMS ***:There is inequity in the distribution of catastrophic costs due to TB *** health co

关键词： Catastrophic health expenditure tuberculosis Patient cost Universal health coverage Social protection Equity

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Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

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Infectious Diseases of Poverty 2021年第2期10卷 74-74页

作者： Ni Wang Lei Guo hemant deepak shewade Pruthu Thekkur Hui Zhang Yan-Li Yuan Xiao-Meng Wang Xiao-Lin Wang Miao-Miao Sun Fei Huang Yan-Lin Zhao National Center for Tuberculosis Control and Prevention Chinese Center for Disease Control and PreventionBeijingChina 不详

Background:In China,an indigenously developed electronic medication monitor(EMM)was designed and used in 138 counties from three *** studies showed positive results on accuracy,effectiveness,acceptability,and feasibility,but also found some ineffective *** this paper,we assessed the effect of implementation of EMMs on treatment ***:The longitudinal ecological method was used at the county level with aggregate secondary programmatic *** the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019,and rifampicinresistant cases were *** fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate,in which a mixed effects maximum likelihood regression using random intercept model was applied,by adjusting for seasonal trends,population size,sociodemographic and clinical characteristics,and clustering within counties.

关键词： Tuberculosis Treatment outcome Medication monitoring Digital technology Longitudinal study

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Treatment Initiation among Patients with Multidrug Resistant Tuberculosis in Bhopal District, India

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Journal of Tuberculosis Research 2017年第4期5卷 237-242页

作者： hemant deepak shewade Arun M. Kokane Akash Ranjan Singh Manoj Verma Malik Parmar Sanjay Singh Chahar Manoj Tiwari Sheeba Naz Khan Mukesh Nagar Sanjai Kumar Singh Pradeep Kumar Mehra Ajay M. V. Kumar International Union against Tuberculosis and Lung Disease (The Union) South-East Asia Office New Delhi India Department of Community Medicine and Family Medicine All India Institute of Medical Sciences (AIIMS) Bhopal India State TB cell Department of Health and Family Welfare Bhopal India World Health Organization Country Office in India New Delhi India International Union against Tuberculosis and Lung Disease (The Union) Paris France

Revised national tuberculosis control programme in India has limited co-hort-wise information about what happens to patients diagnosed with multidrug resistant TB (MDR-TB). We determined the pre-treatment loss to follow-up (non-initiation of treatment by programme within 6 months of diagnosis) and time from diagnosis to treatment initiation in Bhopal district, central India (2014). Pre-treatment loss to follow-up was 13% (0.95 CI: 7%, 23%), not significantly different from the national estimates (18%) and median time to initiate treatment was seven days, lower than that reported elsewhere in the country. Bhopal was performing well with reference to time to treatment initiation in programmatic settings.

关键词： Multidrug-Resistant Tuberculosis Operational Research Pre-Treatment Attrition Diagnosis and Treatment Pathway Initial Loss to Follow-Up

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脑室注射催产素对大鼠胃和十二指肠溃疡的作用

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Acta Pharmacologica Sinica 2001年第6期22卷 12-16页

作者： Mohammed AS AD, deepak Gopal shewade, Kallasam KOUMARAVELOU, Benny K ABRAHAM, Sadashivam VASU, Subramanian RAMASWAMY (Department of Pharmacology, Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry 605 006, India) Jawaharlal Institute of Post-graduate Medical Education and Research 印度

INTRODUCTION Central neurons that synthesize oxytocin are locatedin the supraoptic(SON) and paraventricular nuclei(PVN) of the hypothalamus. Magnocellular neurons inboth nuclei project to the posterior pituitary gland,

关键词：催产素阿托西班溃疡吲哚美辛组胺半胱胺

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