Lifestyle, Tech, Travel

What Causes High Prevalence of Anemia in Rural Hinterland- A case study to assess the gap

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Anemia is most prevalent in low-resource settings, where it goes undetected until becomes severe. Despite the implementation of several initiatives by the Government, India has made only 13 percent progress in eradicating anemia (Global Nutrition Report, 2017).1

Periodic screening and early diagnosis are the keys to controlling anemia. The conventional Hb tests involve invasive methods with the requirement of hygienic infrastructure and skilled healthcare providers. But with the huge gap in basic health infrastructure, rural community members have very little provision for diagnostic facilities.

In Kenduapal Village of PaschimMedinipur, West Bengal shows 88 percent of reproductive-age women have undergone Hb tests for the first time in their lives. They were not aware, if they are prone to a high-risk pregnancy or not. It also indicates the behavioral risk factor which contributes to delay in Anemia detection.

According to WHO recommendation, a non-invasive hemoglobin device is proved to be a good addition. Non-invasive point of care devices can eliminate the potential contamination, bio-hazard handling and can even enable frontline health workers with basic education to perform Hb Test.2 Joseph et al. (2016) also affirm that non-invasive methods are safer than invasive methods and improve patient satisfaction.3Bandyopadhyay S., Neogi, and John D. et al. (2019) further contributed to the fact that as most of the anaemia screening happen in outreach settings, where provision for laboratory support seems difficult, the device ought to be tested in field settings with health workers, non-invasive diagnostic provides viable accuracy.4

iKure’s non-invasive anemia screening initiative started with the vision of reaching out to the last mile community. Members are chosen from the community and are technologically and clinically trained to use them for screening patients. The community health workers are further mobilized to collect other health parameters important to understand the risk of the patients. Instead of using a paper-based format, CHWs use WHIMS that is able to collect patients’ vitals on a cloud server. The data available on the cloud are further sent to medical professionals for referral and counseling.

However, while iron deficiency is the main cause, micronutrient deficiency, inflammations and inherited disorders also contribute to anemia. A baseline report of mother and child health camps reveals that 64% of pregnant women were anemic and 30% with milder anemia. Nutritional experts suggested that a large section of the community are found to be anemic because of women’s ‘‘non-compliance/non-adherence” to the consequences of the anemia and fear and anxiety towards invasive blood drawing.5 Also, women’s consumption rate of IFA supplements are low since they complain of suffering from gastrointestinal upset. Altering such behavior requires regular counselling. iKure’s CHWs are deployed to spread awareness and bring positive health-seeking behavior among pregnant women, new mothers, and adolescent girls.

iKure’s non-invasive anemia testing initiative has been rolled out successfully in school health program and mother and child health camps catchment areas. Within few months, it has gained significant traction such as:

 

  • In West Bengal and Karnataka more than 50% population are found to improve IFA tablets consumption rate.
  • Regular awareness and counseling by iKure medical team during health camps have altered care-seeking behaviour with a reduced percentage of anemic patients
  • The introduction of non-invasive screening devices has improved patients’

    footfall with more women willing for Hb tests

While priorities and approaches may differ according to geographic settings, but strategies to curb anemia remain the same. At iKure, we believe in bringing the desired change soon in India’s rural villages.

Reference :

1. “From promise to impact ending malnutrition by 2030”,Global Nutrition Report,2017,
2. Ma’ayan L., Choppe L., Tikva P., Israel, Lausanne, “Non-Invasive Hemoglobin Screening for Diagnosis and Monitoring of Anemia”, Read More
3. Josheph, Bella., Haider, Ansab., Rhee, Peter., “Non-invasive hemoglobin monitoring”, International Journal of Surgery, 33 (2016):254-257
4. Neogi SB, John D, Sharma J et al. Cost-effectiveness of invasive devices versus non-invasive devices for screening of anemia in field settings in India: A study protocol [version 1; peer review: 1 not approved] F1000Research 2019, 8:861 Read More
5. “Nutritional Anaemias: Tools for Effective Prevention and Control”, World Health Organization, 2017, Read More

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Featured

World Alzheimer’s Day

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This Day is observed on the 21st September every year, as a day in the World Alzheimer Month…by organisations and foundations worldwide with this name.

Alzheimer’s disease is a slowly progressing cascade of cognitive decline affecting subjects in the senile age group and is regarded as multifactorial in its origin and with no significant treatment as yet, assuring a reversal or stoppage in the progress of this slow brain cell death…ending up with bodily cessation of functions in course of time.

The hallmark of this disease is dementia and this particular condition is the commonest cause of dementia affecting human kind.

It has an obscure aetiology this far ..speculated to being caused by the abnormal deposition of proteins amidst the brain cells….like Amyloid ..causing plaques and and Tau…which remain entangled with the neurons in the brain.

While the unmodifiable factor(s) could be…age/familial/genetic…modifiable ones could be lifestyle/environmental/smoking/depression-due to any cause/sedentary life in solitude /exposure to cumulative effects of noise /untreated hearing loss etc. Also morbid grief after losing a loved one , financial worries,health anxiety of chronic debilitating illnesses could be a common precipitant of this condition. It is seen to have a gender bias..as to slightly more common in women above 65 years than men of similar age.

Some common pointers towards this affection is the initial presentation of very mild memory loss/cognitive decline…appearing to be normal of this age, but gradually advancing to affect the normal ability of a person, to execute the very basic tasks of day to day lives and failing to recall the names of familiar persons and simple objects of life, accompanied with inappropriate social behavior and lack of mental restraints. With this begins a phase of dependency on others around, to lead a normal daily life and ultimately ending up with immobility and gross paucity of activities towards the terminal phase of this phenomena…of senile dementia.

Since this disease does not kill immediately…a chosen caregiver has an immense role to play in caring for such affected individuals in their twilight years.Empathy and not sympathy is the sheet anchor of an approach to any person affected with Alzheimer’s. In fact..it is always better if a normal personwho is supposed to play the role of a caregiver, to undergo a brief orientation session, as to how to deal with a person affected with Alzheimer’s Disease.

Some important aspects of communicating with persons suffering from this condition may be as below …

  • To speak in simple sentences with them,in a slow pace, stressing more on long term past memories and avoid asking questions which emphasize on short term memory.
  • On seeking for preferences….as to wishing to have egg/fish for lunch..it is better to show them the objects ,for a better clarity in the question and response.
  • The speaker must remain aware of his/her own’s body language or mannerism while talking to the affected one…focusing on direct eye contact and in the absence of any sensory distraction.
  • Demonstrate ample amount of patience while communicating with a dementic person…till the patient is able to comprehend the topic on which spoken to.
  • Never ever comment on the mental /intelligent set back on the faculties of an affected person in front of the communicator.
  • Be aware of the limitations of the affected person….on memory loss/difficulty in handling complex tasks/problems in planning and organizing their personal lives/difficulty in coordination and locomotion etc. etc.Preventive aspects on this condition are many ….which includes leading a simple lifestyle….avoid being affected by extremes of emotions…regular touch with friends and relatives….cutting down on caffeine intake to increase the sleeping hours,following a simple rule to keep the cognition active…by doing simple calculations mentally-trying to recall all those whom the person had met earlier in life-trying to place the names of persons by visuals (pictures/photos)-and spiritual recourse at convenient timings in day to day lives.

Researches are on for a definitive management strategy of this disease but the results are yet to come forth in a big way.

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Tech, Travel, Uncategorized

Population Scale Impact Through Societal Platform Lens

iKure’s journey started in 2010 to address the inadequate and inaccessible primary healthcare for the last mile using technology. We have impacted 12 M population across 8 states in India. We have the data capability powered by AI and machine learning algorithm for actionable research interventions and many more. With a full proof model, we began at a small scale. But soon, we learnt the limitation of the model that could reach only a fraction of the population when the problem was common for 70% of the India’s rural villages.

We wondered, can iKure solve the problem individually? Can we create doctors overnight or build infrastructure to solve the problem at scale? The answer was no. The problem is dynamic and multivariant in nature. On one hand, we have primary health centres that remains ineffective and less utilized due to the shortage of staff, resources and quality care and on the other hand, India with a vast population of 1.3 billion needs to build 200,000 health and wellness centres to address the demand and supply gap. In this context, iKure with 200 centres was insignificant to match up to the need.

Societal Platform thinking was important for us to reflect that technology can be the key enabler to scale, but it cannot bring different actors co-create solution together and amplify at a population scale. iKure aimed to build a shared infrastructure for multiple actors to come together to solve the common goal. We wanted to create such infrastructure, where people can access the health system with hope and newer possibilitiesThe Naga telehealth was an effort to introduce the platform thinking of co-creating together with the Government, technology partners, research partners, NGOs and grassroot members. The system opened access to healthcare, prevention and wellness for the entire state of Nagaland leveraging 192 sub health centres and 19 primary health centres.

The prototype model is adapted in Khunti District, Jharkhand with JICA to transform the ineffective health system into a dynamic one. It is serving the district hospitals, community sub-centres, and primary health centres. This has set an example for other state governments to follow, where we are partnering with 5 State governments to leverage the shared digital infrastructure for greater utilization and access to health and wellness centres and promote prevention and awareness at the community level through frontline health workers. The platform is also available in hybrid model to drive rapid adaption and evolution in local context using physical health workforce presence at patient’s door-steps. The shared digital infrastructure has co-created network of engagement at different levels. It has enabled remote health monitoring services through NGOs and self-help groups and addressing the behavioural and cultural barriers that cause vaccine hesitancies in rural villages through frontline health workers. It will bring 200,000 frontline health workers using the shared infrastructure at a mass level. In all these cases, the architecture design needs to foster trust and ownership. Use of AI model can only find relevance, if the platform ensures data privacy for all the actors in the ecosystem. Towards this, iKure is working with ODI-Microsoft to develop an automated open data platform ensuring right data reaches to right hands. A shared and collective understanding of different stakeholders can solve the problem of healthcare in totality. Through our shared infrastructure, we aim to reach out to our beneficiaries irrespective of where they are.  iKure through SP lens believes the power of shared infrastructure can amplify its potential to serve at a population scale.

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Lifestyle

Mucormycosis

 

 

 

 

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Lifestyle

Covid-19 & iKure

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Covid-19 and the adaptation by iKure in the service offerings……with hints in the way ahead….

Preamble :

Covid-19 has churned out the whole human civilization into an abyss of indefinite uncertainty..withapalling incidents and consequences ,including an unacceptable record of deathsand sufferings worldwide, which has thrown mankind out of gear and the uphill struggle for a safe survival continues, with no sight of a vaccine yet and no definite medical guidelines to resort to, in order to tackle this pandemic in a manageable framework of confidence…within the medical fraternity.

Coupled with this disease menace, is the scenario of economic gloom arising out of job layouts,downsizing of companies, lack of new job prospects etc which is bringing in an enormous amount of despondency and negative affections of mind and body ,unheard of this kind earlier.

iKure being a population service provider enabled by Technology and research oriented objectives,has made an attempt to be a forerunner in the sector of healthcare in rendering its services, during such difficult times, to all stake holders…in more than one novel ways…backed by the skills and expertise of our employees from all walks of training and experience.

Ways in which iKure stood out to adapt to the current unprecedented crisis ..

•  Based on the three prongs of prevention…ie..social distancing/usage of barrier tools like masks & hand sanitizers..to say the minimum, iKure has embarked on a path of remote consultation for patients..through the new concept of Telemedicine..which has enabled a large no. of clients/patients to seek medical attention from the safe confines of their homes and the Physicians feeling safe at their point of presence.

•  In the events of some subjects/patients approaching our hubs/clinics, the safety measures have been strictly put in place,(with PPE-s etc) to ensure safety of all concerned and a smooth play of operations to continue as earlier…within the norms of recommended prevention guidelines.

•  Special measures have been put in place to render door step services( albeit with mutual protection of subjects & staff) to deliver medicinal items/ related consumables and any other medical attention/advice that may need at any point of time…through our field workers ( CHW-s).

•  Our Doctors have been attuned to the call of the times , to be sensitive towards our patients, at the same time being on guard to detect suspicious infected cases and do the needful as per the advised protocol of the health authorities.

•  Special projects are being undertaken with big business sectors ( such as realty and housing industry) to screen the blue collar workers for Covid-19 by means of well decided clinical vital parameters at site and follow the recommended protocols of suspicion of the infection in any of the persons screened. Our ground staff are physically attending such events with due precautions ,almost on a daily basis,thisfar,and providing a social service in a proactive approach to healthcare.

•  A good number of projects for population screening for the Covid-19 infection are on the way, across several locales in the nation, to provide such services with impunity.

•  Since a second resurge is feared in this country, as well as elsewhere,theGovt would need more and more private sector operators to enter a PPP in order to tackle the growing menace of this crisis.

•  Modalities could be……..allowing screening in the semi-urban areas on a request basis/enabling testing by the private sector liberally without much regulatory protocol and paperwork/leasing ground workers for day to day support to an organization like us, for more community approach to reach out the needy and non-privileged/helping in a proactive manner to set up small check up kiosks in prominent areas where most of the population are expected to visit…etc.

•  A recent glaring example of a PPP may be cited by mentioning the launch of a Telemedicine collaboration with theGovt of Nagaland, in joint efforts with another prominent Indian association, to serve the community of Nagaland,which is a hilly terrain basically, in seeking medical attention from Doctors at Govt Health Centresthere.,,by means of remote consultations on general and specific health issues.

•  To boost the morale of our staff, iKure had arranged a whole remote session with a ‘clinical psychologist’,to address the common feelings of our employees during this pandemic season, where ‘work from home’ has been the norm, so that alongwith their psyche the productivity does not sag and they can adapt themselves to cope up with any such mental issues in their stride.

The way ahead………

• iKure wishes to plan with foresight ventures involving our service offerings in other states and may be beyond Indian shores based on the success of our initiatives this far.

•  More and more Technological advances in the form of devices and tools are being incorporated in our operations, to assist the ground workers for a quicker and better screening with results approaching to the 100th percentile. A robust Telemedicine platform is fine tuned, to enable Physicians to get universal access to an easy going software for navigation and patient prescribing…with maintenance of EMR.

•  Work in the Non-communicable Disease area ( NCD) which is the need of the hour in this country ,keeping the Covid-19 affection in mind, is being planned, since this particular virus affects the CVS in a major way, along with other co-morbidities, as surfacing from those who contracted the disease and those who recovered from the illness !

•  Some critical research areas are also been looked into, which engages the data acquired in re-guiding us through AI and/or ML mechanisms,
on few members of NCD-s..as the scope may be obtained…such as Diabetes/Hypertension etc.

•  Stake holder partnerships are being explored by our business associates for more and more Govt/Pvt. Collaborations and grant providers ,based on our track record of success and innumerable accolades that theOrganisation has achieved by dint of merit amidst tough competitions.

Since the pandemic is far from over yet…we do not know what is in store for mankind ,once the Virus leaves civilization !

Whether we have really achieved Herd Immunity..whether we have managed to eradicate the virus for good..what are the residual signs/symptoms of those who have been affected by the Virus..are only issues that time will tell..and help us unfold..but till then, iKure shall continue with its offerings in healthcare in all possible ways….both traditional and innovative…in nature…to mitigate the health issues in the post-pandemic era.

Dr. Lalmohan Banerjee
Sr. Medical Adviser & Medical Director, iKure

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