AYUSH Practitioners Research Articles

Utilization of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) Practitioners' Services Among Older Adults: Results From the Longitudinal Aging Study in India.

Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy (AYUSH) form an alternative system of medicine in India. Understanding the utilization of AYUSH practitioners' services is crucial to substantiating the current government initiatives to mainstream AYUSH in the Indian health system. The utilization of AYUSH practitioners' services among different sub-populations, including older adults, for various health conditions is underexplored. The present study explores the utilization of AYUSH practitioners' service among older Indian adults and its correlates. During 2017-2018, the Longitudinal Aging Study in India (LASI) conducted a nationally representative study among adults aged 45 years or more and their spouses. The study leveraged this data from publicly available LASI. Descriptive analysis and cross-tabulation were performed using a subset of older adults (age ≥ 60 years, n = 31,464). The utilization of AYUSH practitioners' services was taken as the outcome variable. A logistic regression model was employed to understand the independent effect of various explorative variables on the use of AYUSH practitioners' services. One in 14 older adults utilized the services of AYUSH practitioners. The socio-demographic factors that were looked at, including religion, residence, and castewere significant independent factors for AYUSH consultation. Among chronic conditions, hypertension (use-5.6%, AOR: 1.24, CI: 1.09-1.40), diabetes (use-4.2%, AOR: 1.31, CI: 1.09-1.57), and arthritis (use-9.1%, AOR: 0.59, CI: 0.52-0.67) were independent determinants of AYUSH practitioners' service utilization. In the fully adjusted model, the effect of explanatory variables is almost similar to that in the minimally adjusted model. Only the effect of the female gender was accentuated in magnitude, whereas the effect of diabetes was partially attenuated. The preference for AYUSH practitioners' service among older adults is determined by the complex interplay between socio-demographic factors and disease conditions. Though utilization of AYUSH practitioners' service was high among certain underprivileged sections, it is assuring that education and income do not affect older populations' preference for AYUSH practitioners' service.

Knowledge and practices of private healthcare providers regarding tuberculosis case notification in Rural Maharashtra

India carries the highest share of active and missing tuberculosis (TB) cases globally. The Government of India is prioritizing private sector engagement (PSE) in TB elimination activities, as most healthcare-seeking in the country happens in this sector. This study aimed to understand the knowledge and practices of private healthcare providers (PHP) on various aspects of TB case notification through the National TB Elimination Programme (NTEP). This cross-sectional study was carried out between Oct 2020 to April 2021 amongst PHPs in the Junnar Tuberculosis Unit (TU), Pune District, Maharashtra. Junnar Block has 299 PHPs who assess, diagnose, and/or treat TB cases. A total of 97 participants were enrolled in the study. About 89 (91.8%) PHPs are aware that TB case notifications are mandatory by law. However, 80.4% are unaware of the Ni-kshay portal (web-based case surveillance system) by NTEP. Similarly, 74 (76.3%) must be aware of incentives for PHPs to collaborate with the government healthcare delivery system. 82.8% of total Ayurveda, Unani, Naturopathy, Siddha, and Homeopathy (AYUSH) practitioners and 46.2% of Allopathic practitioners have poor knowledge about TB case notification, with a Chi-square value of 14.36 (p<0.01). Our study shows that the active engagement of private providers (PPs), especially AYUSH practitioners in rural areas, is a need of the hour in achieving TB elimination.

Effects of the Biological Diversity (Amendment) Bill, 2021 on India's AYUSH Industry

Background: Some of the most well-known ancient medical systems in India include Ayurveda, Yoga, Unani, Siddha, and Homoeopathy (AYUSH), whose medications are made primarily from medicinal plants gathered from forests. The Biological Diversity Act, of 2002 was created in India to carry out the 1992 United Nations Convention on Biological Diversity (CBD). The CBD aims for a sustainable, equitable, and shared distribution of benefits resulting from the use of biological resources and traditional knowledge. With one of its goals being to encourage the cultivation of medicinal plants, the Biological Diversity (Amendment) Bill, 2021, which proposes to amend the Biological Diversity Act of 2002, has been adopted by the lower house (Lok Sabha) of the Indian parliament. Objective: The goal of the study is to examine how the amendment will affect the AYUSH sector, which also happens to be the source of India's traditional medicines. Results: A distinction between cultivated and wild medicinal plants has been made, with cultivated medicinal plants being excluded from the access and benefit-sharing (ABS) mechanism upon acquiring the certificate of origin. This can give rise to false claims by the traders and manufacturers that their medicinal plants are cultivated. According to the most recent modification, the majority of traditional knowledge employed in the AYUSH systems of medicine is codified. There's a potential that the majority of people who have traditional knowledge will not be eligible for the benefits. The other argument is that eliminating AYUSH practitioners, growing medicinal plants, and codifying traditional knowledge from access and benefit sharing, would promote foreign investment in the AYUSH sector. Conclusion: This amendment must, in practice, ensure that tribes and vulnerable people profit from the sale of medicinal forest products, and decriminalising certain clauses actually advances AYUSH, and simplifies business operations. Striking a balance between encouraging economic growth and maintaining the long-term preservation of India's biodiversity is necessary.

Use of Ayush measures and advocacies by Ayush practitioners and health seekers for the prevention of coronavirus disease-19: Cross-sectional analysis of an application-based data

Introduction: Ayush Sanjivani is a mobile application launched by the Ministry of Ayush to gather information regarding the acceptability and extent of utilization of Ayurveda, Yoga, Unani, Siddha, Sowa-Rigpa, and Homoeopathy (Ayush) advocacies for the prevention of coronavirus disease-19 (COVID-19). The mobile application has different modules to garner the desired information regarding the trends of use of Ayush measures by the Indian public and practitioners. Objectives: The objectives of this study were to determine the trends of the utilization of Ayush measures by the beneficiaries for the prevention of COVID-19 and to determine the benefit obtained in terms of self-reported parameters of general well-being, the overall impact on general health, and in preventing the onset of flu or COVID-19 like symptoms such as fever, chills, headache, muscle or body aches, cough, sore throat, and runny nose. Methods: A cross-sectional study was undertaken to analyze the data generated through the “Ayush Sanjivani mobile application” from May to July 2020. The responses generated in terms of demographic profile, utilization pattern, benefits obtained, the interventions used, and the data of beneficiaries in terms of geographic location and the interventions prescribed were analyzed statistically to assess the trends of the utilization of Ayush measures for prophylaxis as reported by the Ayush practitioners. Results: Data of 74,568 Ayush physicians and 13,521,245 beneficiaries/health seekers were used for the analysis. Ayush advocacies/measures were utilized by 69,195 (92.8%) physicians for prophylaxis. Samshamani vati, Chyavanprasha, and Arsenicum album-30C were the most commonly used Ayush interventions. Improvement in terms of appetite, bowel movements, sleep, mental well-being, stamina, preexisting disease, and disposition was reported by 42,400 (61.3%) physicians. Maximum beneficiaries were from the state of Gujarat followed by Madhya Pradesh. Arsenicum album 30°C was the most commonly prescribed/distributed intervention among the beneficiaries/health seekers. Conclusion: Maximum physicians reported utilization of Ayush prophylactic measures for the prevention of COVID-19. A large number of health seekers were provided Ayush prophylactic measures across various geographical locations in India.

Secondary and Quaternary Delays in the Diagnosis of Breast Cancer: Are the Physicians Responsible too?

Causes of delay in presentation of breast cancer has been categorised into 'Primary Delay' (delay by the patient or her family); 'Secondary Delay' (delay by the doctors in the first contact - family physician or quacks/alternative medicine practitioners); 'Tertiary Delay' (delay in the system in a specialist breast care unit e.g. waiting list, delayed reporting, doctors on leave, strikes); and 'Quaternary Delay' (e.g. patient hopping from one competent breast cancer specialist to another or mid-course attrition to alternative treatments). In India, many patients have blind belief and high attrition towards the quacks and alternative medicine practitioners. Our study was to assess whether these 'Secondary and Quaternary Delays', particularly the attrition towards the alternative non-modern medical practitioners, have any effect on the delayed presentation and advancement of the overall anatomical staging among the breast cancer patients. We performed a retrospective observational study, based on 'Triple Assessment' and pre-structured Questionnaire. All pathologically confirmed female breast cancer patients admitted from 02/2017 to 08/2018 in the department of General Surgery in our Institute were included. Male breast cancer, histopathologically unconfirmed/inconclusive breast lumps, patients with previous breast surgery/radiotherapy/chemotherapy were excluded. Data from 267 patients was analysed. The mean age at presentation of breast cancer was 47.54years. The average delay between the onset of the first symptom and the histological diagnosis was 13.76 ± SD 13.08months. About half (50.2%) of our patients visited the non-modern medical practitioners at least once during their disease. The mean delay in diagnosis was significantly higher (p < 0.0001) among them. The average 'Secondary Delay' was significantly higher among those who visited the non-modern medical practitioners (9.7 ± SD 9.38months). The average delay between the visit to the first doctor and the histological diagnosis was also significantly higher among them (18.35 ± 14months). Patients with attrition to non-modern medical practitioners also were diagnosed in higher cT stages: cT4a (66.67%, 2 of 3) and cT4b (60%, 33 of 55). Most (56.9%) of stage IIIB patients visited the non-modern medical practitioners before their diagnosis. Patients who visited the non-modern medical practitioners had significantly more delay in the diagnosis of breast cancer. The 'Secondary and Quaternary Delays' form the major portion in the overall delay and lead to advancement of the anatomical staging of the disease. Creating public awareness, proper training and 'continued medical education' for primary care physicians, and the AYUSH practitioners are required. Further population-based studies are advised.

A practical approach of leech therapy: Insight from the Unani system of medicine

Abstract Leech therapy is an effective mode of treatment from time immemorial. However, our Indian System of Medicine has given a new platform to this practice of treating patients suffering from various diseases such as skin diseases, joint pain, inflammation, wounds, nonhealing ulcers, lumps, hemorrhoids, varicose veins, deep-vein thrombosis, and plastic and reconstructive surgeries. The objective of this study was to construct the standard operating procedures (SOPs) for leech therapy and to raise awareness among AYUSH practitioners and other health-care providers. This review study of SOP for leech therapy was carried out through the Unani classical textbooks and the recent research on leech therapy from sources such as PubMed, Scopus, AYUSH portal, Google Scholar, and ResearchGate. The collected material was studied in detail and analyzed for the development of standard operating procedures (SOPs) for leech therapy. This paper focused on the practical application and handling of leech during the procedure of leech therapy, and to some extent, an attempt to construct SOPs of leech therapy has been made with the help of some Unani experts, ancient Unani literature, and recent studies on leech therapy. Leech therapy is an effective, safe, feasible, beneficial, and economical treatment modality. Hence, the development of standard operative procedures (SOPs) considering leech therapy is the need of the hour. This paper is an initiative to develop an SOP for this practical procedure and hope it will be beneficial for all traditional healers.

Tuning Indian Bio Diversity Laws with Nagoya Protocol: An Analysis

The conservation of biological diversity is a serious and common concern. The better management of biological resources and biodiversity is essential for the welfare of human beings. As per the international obligation the Government of India, enacted the Biological Diversity Act, 2002. This Act provides conservation of biological diversity, presently there are many lacunas are present in this Act. But the cumbersome process regarding the permission and application of patent is the most impeding provision. New amendment in Biological Diversity Act 2002 endeavors to tune it with the Nagoya Convention. Secondly to remove the lacunas of the present Act and to create a favorable climate for collaborative research and investment. In new amendment Act it is also aimed to simplify the patent application procedure. In new amendment Act Ayush practitioners have been exempted from the Act’s scope. In new amendment Act seeks to bring more foreign investment in biological resources, research, patent and commercial utilization, without compromising the national interest. The major concern with the amendment bill is that the corporate or foreign interest could use the loopholes of permission given to traditional medicine and use it for commercial purposes, without sharing the benefits with the conservers of biodiversity. It is imperative that new laws not only be regulatory, but also be executed with the involvement of local people, particularly village sabhas and panchayats.

Awareness about Human Brucellosis in Healthcare Professional in India

Introduction: Human brucellosis is a widespread zoonosis of serious public health consequences. The infection is transmitted from animal to human through direct contact with infected animals or consumption of infected, unpasteurized animal milk. Being a disease with wide and non-specific clinical manifestations, a case of brucellosis can be detected only if the treating health care professional is aware of the disease and keeps a high rate of suspicion when dealing with suspected cases. We surveyed to find the extent of awareness about Human brucellosis in healthcare professionals in Gujarat, India.&#x0D; Methodology: A cross-sectional study was conducted among healthcare professionals from December 2020 to May 2021 using a self-administrated questionnaire. This study included healthcare professionals including AYUSH practicing in Gujarat. A validated questionnaire consisting of 23 items was administered to assess the knowledge of professionals toward suspecting, diagnosing, preventing, and managing a case of brucellosis. Both physical and Google forms were used to collect data. Data were analyzed using Statistical Package for the Social Sciences (SPSS) program, IBM version 22.&#x0D; Results: Sixty-nine healthcare professionals responded to the questionnaire. The findings of the study showed overall good awareness about brucellosis with a higher rate of knowledge in allopathic healthcare professionals and nurses in comparison to AYUSH doctors. Nearly 50% of respondents did not know the treatment as well as the preventive potential of human brucellosis.&#x0D; Conclusion: The current study suggests a need for creating more awareness in the healthcare professional, particularly AYUSH practitioners about brucellosis for better management and prevention.

Informal Providers, Pluralistic Health Systems, and India's COVID-19 Response: A Cross-Sectional Telephonic Study

Background: Informal providers (IP) have a large presence in India’s health workforce; they are usually first contact primary care providers for rural populations. Patients with COVID-19 symptoms will likely first see an IP. This study aims to understand COVID-19 knowledge and management practices of IPs and trained practitioners of Indian systems of medicine (AYUSH), and medical doctors (MBBS) in the state of Bihar, India.Methods: In a 2019 household survey we identified primary care providers who had served patients in the last month. Providers were contacted via telephone in July 2020 when Bihar was experiencing a rapid increase in COVID cases. Using structured questionnaires we interviewed 452 IPs, 57 AYUSH, and 38 MBBS doctors (including 23 government doctors) from 224 villages across 34 of 38 districts in Bihar.Findings: Most providers experienced a fall in patient visits during the pandemic. Most IPs and qualified private providers had no engagement with government agencies; their principal source of COVID-19 information was television and newspapers. IP knowledge levels of COVID-19 and its prevention was comparable with qualified providers. There was low stated compliance among IPs (16%) and qualified providers (15% of MBBS doctors, and 12% of AYUSH practitioners) with all WHO recommended practices for suspect COVID-19 cases.Interpretation: Government action to improve IP and other primary care provider COVID-19 knowledge and case management will strengthen efforts to control the pandemic, particularly in rural areas. Because IPs are embedded within communities, they can make important contributions to contact tracing efforts and public health messaging.Funding Statement: Bill and Melinda Gates Foundation, India.Declaration of Interests: None declared for KDR, JK, MKP, and NK. PN is employee of the funding agency.Ethics Approval Statement: Ethical approval was granted by the Indian Institutional Review Board in India (Reference number: 1007/IRB/20-21) as well as Johns Hopkins University Institutional Review Board. The purpose of the study was explained and oral informed consent was obtained from each respondent.

Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study

Purpose:In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral.Methods:The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls.Results:At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001).Conclusion:AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.

A critical appraisal of the maternal and child health scenario in a metropolitan city in India with reference to achievements of millennium development goals.

Background:Post 2015, the Millennium Development Goals (MDGs) will undergo a transition to Sustainable Development Goals (SDGs). Therefore, it becomes necessary to assess the determinants influencing the present status of MDGs. This study was conducted to assess the progress, short comings related to the transition from MDGs to SDGs in a metropolitan city. It provides practical insights for extrapolating need based strategies related to the SDGs.Methods:Study was conducted in a metropolitan city, Mumbai. Situational analysis of the city was done using monthly and annual performance reports and key informant's interviews at city level. Qualitative analysis was done using thematic analysis.Results:The current infant mortality rate of Mumbai is 26.72 and under-five mortality rate is 38.7/1000 live births. The current MMR of mumbai is 88. The responses from the key informants’ spanned three major themes: Concerns and challenges; Good practices and schemes in pipeline; and Opportunities envisioned. Eight major challenging areas were identified. Opportunities are sustainable models of public-private partnership; Involvement of NGOs and AYUSH practitioners; and IT sector involvement, HMIS, e- governance, and Corporate Social Responsibility (CSR).Conclusions:Significant progress has been made in the field of maternal and child health (MCH), and sustained efforts are required. Maternal mortality figures may be illusive because of the effect of migration and referral cases. Socio-demographic issues of development need to be addressed through governance. Mechanism for intersectoral coordination, IT support, surveillance, and tracking of pregnant mothers needs to be developed. The linkage of MCH services with developmental programs needed.

Medicine and the Cultural Politics of National Belongings in Contemporary India

AbstractThe Government of India claims to promote plural medical traditions, currently institutionalized under the acronym AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy). Yet, one medical system—Ayurveda—receives most social and ideological support: Ayurveda is routinely constructed as the only truly Indian, homegrown, and national medicine, while the national belonging of other AYUSH traditions is challenged. This essay explores discourses surrounding the promotion of AYUSH and the privileged position of Ayurveda, situating them within two competing nationalist ideologies: the ideology of inclusive secularism anchored in the principle of India’s cultural diversity and the ideology of Hindu nationalism, which promotes a distinctive image of India as a country with a culturally monolithic foundation. By doing so, I show how a nation can be differently imagined through one medical tradition or through medical plurality. Furthermore, by analyzing media reports, official statements, and the narratives of AYUSH practitioners, I outline factors that contribute to Ayurvedic hegemony. In particular, I argue that the exceptionalism of Ayurveda rests on the fact that, unlike other alternative medical systems in India, it has been promoted as both cultural (“Indian”) and universal medicine—that is, medicine with global appeal.

Knowledge and Skills of Ayurvedic and Homeopathic Practitioners to Provide Skilled Birth Attendance in India: An Observational Study.

Background:To overcome the dearth of trained skilled birth attendants, mainstreaming of doctors from the alternative systems of medicine has been adopted by some states in India.Objectives:The objectives of the study were to explore the adequacy of knowledge and clinical skills of AYUSH practitioners (APs) (ayurvedic and homeopathic) engaged by the state governments to provide maternity care services, with a view to identify gaps if any, and to suggest measures for improvement.Materials and Methods:A cross-sectional observational study was conducted in three states of India (Maharashtra, Rajasthan, and Odisha). The APs were assessed for (a) knowledge of essential obstetric care and identification and management of complications of pregnancy and (b) clinical skills during provision of antenatal and postnatal care (PNC) and during the conduct of deliveries. Adequate knowledge or skill demonstration was defined as a score of 70% or more.Results:A total of 109 APs engaged in 37 peripheral level facilities were assessed. Nearly 76% of APs had adequate theoretical knowledge of essential obstetric care and identification and management of complications of pregnancy. Most APs demonstrated adequate skills while providing antenatal care but were deficient in taking past history and counseling pregnant women for danger signs during pregnancy and childbirth. APs in Maharashtra and Rajasthan had adequate skills for conducting vaginal deliveries but performed poorly in Odisha. Skills for resuscitation of newborn were deficient. Skills for providing PNC were adequate only among APs in Maharashtra.Conclusion:Through provision of appropriate in-service training and an enabling environment, APs may be a useful human resource for providing maternity care in the primary health-care settings in India.

A cross-sectional study to assess knowledge, attitude and practices regarding H1N1 among AYUSH practioners at Panvel taluka

Background: The number of H1N1 cases and death in India in recent years is good enough reason to declare it as a major emerging disease. AYUSH practitioners have been newly integrated into the National Health Delivery System. As they are the first level of contact for the community, their knowledge, attitude and right practices can help in counteracting the spread of H1N1. The objective of the study was to assess knowledge, attitude and practices regarding H1N1 among AYUSH practitioners at Panvel taluka.Methods: A cross sectional study was carried out during October-December 2015 among AYUSH practitioners practicing at Panvel taluka. A total of 225 AYUSH practitioners were included in the study by stratified probability proportional systematic random sampling. They were interviewed face to face by predesigned pretested questionnaire to assess knowledge, attitude and practices regarding H1N1. Attitude was measured on a four point Likert’s scale. Data was analysed by mean, percentage and Chi–square Test using software SPSS (version 21).Results: Only 32.4% had knowledge about period of infectivity by H1N1 virus. More than half (56.7%) knew incubation period of the disease.75% correctly answered on signs and symptoms of the disease. Only 25.3% knew the mode of administration of giving H1N1 live vaccine. 78.66% doctors strongly agreed that they can get infection and 82.66% agreed that they can be cured by the infection. Only 27.11% practitioners were vaccinated against H1N1. 43.12% doctors followed hand washing practice after seeing suspected case. 43.5% doctors used mask regularly at clinic. 59.6% doctors correctly prescribed drugs for prophylaxis and treatment of H1N1. 62.3% practitioners used to refer the patient in hospital designated by government for treatment of H1N1 cases.Conclusions: AYUSH practioners had average knowledge and poor practices about H1N1 prevention which can be further improved by continuing medical education programme.

“Getting the water-carrier to light the lamps”: Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India

The government of India has, over the past decade, implemented the “integration” of traditional, complementary and alternative medical (TCAM) practitioners, specifically practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-rigpa, and Homoeopathy (collectively known by the acronym AYUSH), in government health services. A range of operational and ethical challenges has manifested during this process of large health system reform. We explored the practices and perceptions of health system actors, in relation to AYUSH providers' roles in government health services in three Indian states – Kerala, Meghalaya, and Delhi. Research methods included 196 in-depth interviews with a range of health policy and system actors and beneficiaries, between February and October 2012, and review of national, state, and district-level policy documents relating to AYUSH integration. The thematic ‘framework’ approach was applied to analyze data from the interviews, and systematic content analysis performed on policy documents.We found that the roles of AYUSH providers are frequently ambiguously stated and variably interpreted, in relation to various aspects of their practice, such as outpatient care, prescribing rights, emergency duties, obstetric services, night duties, and referrals across systems of medicine. Work sharing is variously interpreted by different health system actors as complementing allopathic practice with AYUSH practice, or allopathic practice, by AYUSH providers to supplement the work of allopathic practitioners. Interactions among AYUSH practitioners and their health system colleagues frequently take place in a context of partial information, preconceived notions, power imbalances, and mistrust. In some notable instances, collegial relationships and apt divisions of responsibilities are observed. Widespread normative ambivalence around the roles of AYUSH providers, complicated by the logistical constraints prevalent in poorly resourced systems, has the potential to undermine the therapeutic practices and motivation of AYUSH providers, as well as the overall efficiency and performance of integrated health services.

Alternative medicine: an ethnographic study of how practitioners of Indian medical systems manage TB in Mumbai.

Mumbai is a hot spot for drug-resistant TB, and private practitioners trained in AYUSH systems (Ayurveda, yoga, Unani, Siddha and homeopathy) are major healthcare providers. It is important to understand how AYUSH practitioners manage patients with TB or presumptive TB. We conducted semi-structured interviews of 175 Mumbai slum-based practitioners holding degrees in Ayurveda, homeopathy and Unani. Most providers gave multiple interviews. We observed 10 providers in clinical interactions, documenting: clinical examinations, symptoms, history taking, prescriptions and diagnostic tests. No practitioners exclusively used his or her system of training. The practice of biomedicine is frequent, with practitioners often using biomedical disease categories and diagnostics. The use of homeopathy was rare (only 4% of consultations with homeopaths resulted in homeopathic remedies) and Ayurveda rarer (3% of consultations). For TB, all mentioned chest x-ray while 31 (17.7%) mentioned sputum smear as a TB test. One hundred and sixty-four practitioners (93.7%) reported referring TB patients to a public hospital or chest physician. Eleven practitioners (6.3%) reported treating patients with TB. Nine (5.1%) reported treating patients with drug-susceptible TB with at least one second-line drug. Important sources of health care in Mumbai's slums, AYUSH physicians frequently use biomedical therapies and most refer patients with TB to chest physicians or the public sector. They are integral to TB care and control.

Public health perspectives in cross-system practice: past, present and future

Cross-system practice is widely prevalent in Indian settings. The recent policy decisions of the Government of India and the legalisation of cross-system practice in various states have brought this issue into the limelight once again. We aim to critically evaluate this issue from the philosophical, academic, and public health perspectives, as well as with reference to training. On the one hand, students of traditional Indian medicine are being introduced to allopathy without philosophical backing, practice based on the aetiological model and training in modern pharmacology. In addition, pharmaceutical industries are wooing AYUSH practitioners and their prescription patterns have already been "allopathised". As for the allopathic system, it is witnessing enormous scientific advances and growing increasingly complicated. The medicines are risky and also associated with many life-threatening side-effects. Meanwhile, the government is grappling with the humungous problem of ensuring health services for all. The government's intention is to expand the reach of health services by allowing cross-system practice, but the issue has much wider ramifications. The authors believe that before cross-system practice is allowed, there is a need for a comprehensive and deeper understanding of all the benefits and pitfalls of such as system. A few of these are discussed in this article. Specifically, we delve into the philosophical issues, syllabus and training, advances in medical technology, and larger public health perspectives. We end by suggesting a few steps that may help to improve public health in the country.

Feasibility of using partograph by practitioners of Indian system of medicine (AYUSH): An exploratory observation

Objectiveto understand the use of the partograph by Skilled Birth Attendance/Basic Emergency Obstetric Care (SBA/BEmOC) trained practitioners from Indian systems of medicine called AYUSH practitioners (APs). Designmixed method observational study, including an exploration of the views of APs, programme managers and SBA trainers on the necessity, feasibility and barriers to the use of partograph. Settingprimary and community health centres in two purposively selected districts in each of the three states (Rajasthan, Maharashtra and Odisha) in India where SBA/BEmOC trained APs are deployed to provide SBA services. In-depth interviews with state, district and block level programme managers were held at their respective headquarters. Participants83 APs plotted the simplified partograph based on a given labour case scenario. In-depth interviews were conducted with 36 programme managers and 37 APs (24 Ayurvedic and 13 Homoeopathic). Measurements and findingsthe completed simplified partograph was analysed according to a previously devised scoring system with a score of 70% or more indicating competency. APs in Rajasthan and Maharashtra demonstrated good partograph plotting skills (72.1% and 82% respectively) obtaining a competency score of more than 70%. However, overall performance of APs in Odisha was poor (11.1%) and except correct recording of fetal condition, the APs did not score well in the plotting of the other partograph components. Errors occurred mainly in the recording of cervical dilatation and uterine contractions. The in-depth interviews revealed that most APs demonstrated a good understanding of the tool in the context of decision making regarding timely referral in case of prolonged labour or fetal distress. There was a high perception of the need for more hands-on training in the SBA training curriculum. The programme managers also expressed the need for appropriate training and supervision to ensure good plotting of partograph. The barriers for partograph use included increased workload, insufficient training, unavailability of partograph forms and its non-utility for women coming late in labour. Key conclusionsknowledge of plotting and correct interpretation of partograph were generally good in two states but more practice is needed to improve providers׳ skills. Identified barriers could be addressed with further training and local managerial support. An analysis of the causes for the poor performance of APs in Odisha should be carried out. Pre-service and periodic in-service training of APs on the completion of the partograph, regular supportive supervision, implementation of programme guidelines on mandatory completion of partograph and an environment that supports its correct and consistent use are recommended. Implications for practicewith appropriate training, it is feasible for AYUSH practitioners to use partograph for monitoring progress of labour.

Task-shifting challenges for provision of skilled birth attendance: a qualitative exploration.

Shortage of skilled birth attendants (SBA) is one of the determinants of maternal mortality in India. To combat this shortage, innovative task-shifting strategies to engage providers of the Indian system of medicine (Ayurveda and Homeopathy), called AYUSH practitioners (AP), to provide SBA services is being implemented. Engagement of APs for SBA service provision was assessed in 3 states of India (Maharashtra, Rajasthan and Odisha) through 73 in-depth interviews (37 with APs and 36 with programme managers). The interviews explored the providers' SBA training experience, barriers for SBA service provision, workplace and community acceptance, and the perspective of programme managers on the competence and quality of SBA services provided. SBA training led to skill enhancement with adoption of appropriate maternal and newborn care practices. A dedicated trainer, more hands-on practice, and strengthening training on newborn care practices and management of complications emerged as the training needs. Conditional involvement in SBA-related work, a discriminatory attitude at the workplace and lack of legal/regulatory authorisation were identified as barriers to the inclusion of APs in SBA service provision. Quality skill enhancement measures, an enabling work environment, a systematic task-shifting process, role definition, supportive supervision and credentialing could be key for the integration of APs and their acceptance in the health system.

Health-seeking behavior of rural agricultural workers: A community-based cross-sectional study

Context: Majority of the Indian population lives in rural area, where the main occupation is agriculture. In developing countries, agriculture workers have multitude of health problems, whereas they do not have access to the adequate health care facilities. Aims: The present study was aimed to know the health-seeking behavior of agricultural workers. Settings and Design: This cross-sectional study was done from January 2009 to December 2009 in a rural area of Bhutaramanahatti sub-center (Vantamuri PHC), Belgaum District. Materials and Methods: A total of 400 agricultural workers of age 16-60 years were interviewed in their households/fields. Data were acquired on a predesigned and pretested questionnaire. Statistical Analysis Used: Percentages and Chi-square test. Results: Among the study participants 55.75% were males and 44.25% were females, with a male to female ratio of 1.25:1. Most of the agricultural workers (89.5%) were Hindus, 10.5% were Muslims, and 47% were illiterates, whereas 38% had passed first to fifth grades, 14.5% had passed sixth to tenth grades, and 0.5% had attended tenth plus. Of the 400 subjects, 295 (73.75%) belonged to Class V socioeconomic status. Overall, 48.75% opted government doctors and 28% opted private doctors as the first priority health care providers for their illness. 37.75% preferred private or AYUSH practitioners and 18.25% opted government doctors in case illness was not cured or they were not satisfied with the treatment given by the first health care provider. Conclusions: The present study reveals that most of the agricultural workers depended on government doctor for their illness. In order to overcome the situation, special health check-up camps need to be conducted with emphasis on improvement of health.