Ravi Prasad Varma’s research while affiliated with Sree Chitra Tirunal Institute for Medical Sciences and Technology and other places

Introduction In Kerala, strategic thinking on noncommunicable diseases (NCD) control began in the early 2000s with several localized programs being implemented, involving different levels of administration. This study was conducted to explore how the local governments are complimenting the national- and state-level programs in combating NCDs. Materials and Methods This was a qualitative study incorporating a review of documents, key informant, and in-depth interviews with relevant stakeholders who had central roles in implementing NCD control activities in the state. Results A myriad of innovations had been implemented by local self-governments (LSGs) at the primary, secondary, and tertiary levels of prevention across the state. LSGs often stepped in to provide human resources and medicines and improve the infrastructure and services, including laboratory services, to support the functioning of family health centers. Involvement of LSGs assisted in tackling the social determinants of health through intersectoral coordination and increased community participation. Conclusion Overall, this exploration into the role of LSGs in NCD control revealed many successful models of how LSGs can contribute to the control of NCDs. If certain inadequacies like, the lack of sustainability of interventions and a heightened emphasis on secondary prevention, are addressed, the initiatives of the LSGs can assist in achieving the sustainable development goals of the state in NCD control. Training is essential for the elected leaders along with the health-care workers to analyse and interpret the locally available data, with mapping of good practices and scaling up to improve the health outcome of the population.

Background Family caregivers are vital for long-term care for persons with serious health-related suffering in Kerala. Long-term caregiving and ageing may become burdensome and detrimental to patients and caregivers. We compared the caregiver burden and quality-of-life of ageing caregivers with younger caregivers. We also explored the palliative care nurses’ perceptions of the family caregivers’ issues. Methods We did a mixed method study focusing on two groups: (i) three in-depth interviews and a cross-sectional survey among 221 caregivers of palliative care patients in five randomly selected panchayats (most peripheral tier of three-tier local self-government system in India concerned with governance of a village or small town) of Kollam district, Kerala, as part of development and validation of the Achutha Menon Centre Caregiver Burden Inventory; (ii) five in-depth interviews with purposively selected primary palliative care nurses as part of a study on local governments and palliative care. We used a structured interview schedule to collect cross-sectional data on sociodemographic and caregiving-related characteristics, caregiver burden, and health-related quality of life using the EuroQol EQ5D5L and interview guidelines on caregiver issues tailored based on participant type for qualitative interviews. Results Older caregivers comprised 28.1% of the sample and had significantly poorer health and quality-of-life attributes. More senior caregivers experiencing caregiver burden had the lowest mean scores of 0.877 (Standard deviation (SD 0.066, 95% confidence intervals (CI) 0.854–0.899) followed by younger caregivers with high burden (0.926, SD 0.090, 95% CI 0.907–0.945), older caregivers with low burden (0.935, SD 0.058, 95% CI 0.912–0.958) and younger caregivers with low burden (0.980, SD 0.041, 95% CI 0.970–0.990). Caregivers faced physical, psychological, social, and financial issues, leading to a caregiver burden. The relationships between the palliative care nurses and family caregivers were complex, and nurses perceived caregiver burden, but there were no specific interventions to address this. Conclusion In our study from Kollam, Kerala, three out of ten caregivers of palliative care patients were 60 years of age or older. They had significantly lower health-related quality of life, particularly if they perceived caregiver burden. Despite being recognized by palliative care nurses, caregiver issues were not systematically addressed. Further research and suitable interventions must be developed to target such problems in the palliative care programme in Kerala.

Background Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

Introduction: Family caregivers of patients with chronic conditions face challenges such as emotional and physical stress, which can lead to caregiver burden. A good sense of coherence (SOC) is crucial in promoting resilience, positive health outcomes, and coping. Caregivers with a high SOC are optimistic about their caregiving roles and finding meaning and purpose in their responsibilities. In this background, we looked into the contextual influences that facilitate or impede the sense of coherence of the family caregivers of patients with chronic conditions requiring home-based long-term care. Methods: We conducted telephonic interviews with 10 self-identified primary family caregivers of patients with chronic conditions. We utilized semi-structured interview guidelines, transcribed the interviews verbatim, and performed thematic analysis. Potential factors influencing caregivers' SOC were identified through inductive coding, allowing themes to emerge from the data. However, we report themes along the three components of SOC. Results: Good knowledge about the disease conditions, open communication with care recipients and providers, and past caregiving experiences all contribute to improving comprehensibility. Insufficient knowledge about the condition could be distressing. Effective management requires adapting care strategies through learning, planning, and utilizing available resources, and support networks, too, play a crucial role. However, insufficient caregiver support and neglecting one's health can result in distress and disruptions in care management. Maintaining positive perspectives and ascribed values to interpersonal connections can enhance meaningfulness among caregivers. These interpretations may not apply to caregivers with affective disorders. Conclusion: Various aspects influence the comprehensibility, manageability, and meaningfulness pertaining to the situation of family caregivers, and these in turn impact their well-being and ability to provide quality care. Understanding these factors can help create support systems with targeted interventions and strategies to reduce caregiver burden and improve quality of life.

Background BUDS (not an acronym) institutions are free and open special institutions established by Kudumbashree in Kerala for children from low-income households with intellectual or psychosocial impairments. We explored the impact of COVID-19 pandemic on BUDS beneficiaries and the organizational adaptation for continued operations during the period. Methods We conducted telephonic in-depth interviews with eight BUDS teachers, three beneficiaries’ parents, and two local government (LG) representatives. We did a deductive analysis to describe two major themes: one pertained to the physical, mental, and social challenges faced by beneficiaries and families of BUDS institutions and other on organizational adaptation to the situation in terms of sustaining classes for children and continued support for meeting basic needs. Results Beneficiaries lost some therapeutic gains, while parents faced financial hardships. Trainers and LGs made active efforts for sustaining contact with children and parents, distribution of necessities for children, and home visits. Some trainers displayed an exemplary level of dedication. LGs facilitated service provision by continuing remuneration to trainers, and collaborating with various stakeholders like education and health, and initiating locally suitable measures. The Thenkoodu app for continued training was deemed not very useful by trainers and parents. Conclusion Committed human resources, acceptance of ground realities, quick decision–making, and collaboration across stakeholders were important aspects of the response of LGs for continued service provision to BUDS beneficiaries during the COVID-19 pandemic. Our findings suggest that decentralized space where BUDS institutions emerged and expanded is beneficial for organizational resilience of community-based rehabilitation institutions.

Background Addressing the health needs of interstate migrants in India is a complex challenge. We undertook a case study of Garima , a migrant health intervention in Kozhikode district, Kerala, and explored the perspectives of the health system and the role of local governments with regard to the programs targeting the health of migrant laborers in Kerala. Methods We used a qualitative descriptive case study approach as described by Baxter and Jack and used Braun and Clarke’s intermediate Q thematic analysis approach. We conducted one key informant interview (KII) and one in-depth interview (IDI) and review of 23 documents obtained from the corporation health department and online sources, including media and social media review. We also did two KIIs with experts and nine IDIs with field workers of the health department of the state. Results Intervention execution was mainly through inspectorial health teams comprising representatives from multiple sectors, including local governments, law enforcement, and health. Actions included registration, screening, disease surveillance, and care provisioning through regular medical camps. Referral and follow-up through regional health-care centers were consistently made available in Garima . Migrant health programs increasingly focus on living conditions, including hygiene and sanitation, and employers, contractors, or building owners are to take responsibility for these. Conclusions The Garima project for the health of interstate migrant laborers reflected a shift in the Kerala health system toward welfare rather than disease control and intersectoral coordination. Local governments hold the promise of advancing such interventions and scaling them up across the state.

This case study discusses the ethical dilemmas faced by the researchers when a woman with disability voluntarily disclosed her experience of intimate partner violence during an in-depth interview on positive mental health and resilience in wheelchair users. The interviewer's role as a researcher and public health professional raised dilemmas relating to the tenets of privacy, confidentiality and nonmaleficence. Professionals working with women with disability and similar vulnerable participants should anticipate such ethical challenges around violence and discrimination that such individuals face, and strive to resolve challenges based on basic ethical tenets within a context-informed approach.

Aims To evaluate the quality of life of children who underwent the arterial switch operation for Transposition of Great Arteries in our population; specifically, to explore early modifiable factors and the influence of parental and socio-economic factors on the quality of life of these children. Materials and Methods Cross sectional study using Paediatric Quality of Life Inventory™ 3.0 Cardiac Module was carried out on 3 – 12 Yr old children who had undergone arterial switch operation between the years 2012–2018. Socioeconomic status was calculated using the Modified Kuppuswamy scale (2019). Other clinical factors with possible bearing on the outcome were also analysed. Results Immediate survival after surgery was 196 out of 208 (94.2%) with an attrition of 19 patients (9.6%) over the follow-up period. Most surviving children (98.9%) had started formal schooling in age-appropriate classes. Two children had severe neuromotor impairment. The median cumulative Health-related Quality of Life Score of the children was 97.9 (IQR 4.2) at 5.6 ± 1.27 years of life. The median scores each of the HRQOL parameters, viz, heart problem symptoms, treatment compliance, perceived physical appearance, treatment-related anxiety, cognitive problems and communication was 100 with negative skewing. Conclusions Excellent quality of life was observed in the majority of children after arterial switch operation with the median total PedsQL scores in all domains of 97.9. Social factors did not show a statistically significant influence on the Quality-of-life parameters in the current cohort. The gradually declining trend across the age groups emphasizes the need for continued follow-up for early identification of possible correctable factors and initiating intervention to ensure good QOL into teenage and adulthood.