Indian State Of Kerala Research Articles

A critique of the policy discourse on Primary Health Care Aardram Mission of Kerala.

In 2017, the State of Kerala in India, launched the 'Aardram' mission for health. One of the aims of the mission was to enhance the Primary Health Care (PHC) provisioning in the state through the Family Health Centre (FHC) initiative. This was envisaged through a Comprehensive PHC approach that prioritized preventive, promotive, curative, rehabilitative and palliative services, and social determinants of health. Given this backdrop, the study aimed to examine the renewed policy commitment towards comprehensive PHC and the extent to which it remains true to the globally accepted ideals of PHC. This was undertaken using a Critical Discourse Analysis (CDA) of the policy discourse on PHC. This included examining the policy documents related to FHC and Aardram as well as the narratives of policy-level actors on PHC and innovations for them. Through CDA we examined the discursive representation of PHC and innovations for improving them at the level of local governments in the state. Though the mission envisaged a shift from the influence of market-driven ideas of health, the analysis of the current policy discourse on primary healthcare suggested otherwise. The discourse continues to carry a curative care bias within its ideas of PHC. The disproportionate emphasis on strategies for early detection, treatment and infrastructural improvements meant limited space for dimensions like preventive, protective and promotive, thus digressing from the gatekeeping role of PHC. The subdued emphasis on preventive and promotive dimensions and depoliticization of social determinants of health within a PHC discourse indicates that, in the long run, the mission stands to risk its stated goals of social justice and health equity envisioned in the FHC initiative.

Narayana Bhattathiri: New Experiment and Styles in Contemporary Malayalam Calligraphy

Calligraphy is an important art form in art world and it has long history. In India have diversity of languages, each languages have it’s own uniqueness in the scripts. Malayalam is a language spoken in Indian state of Kerala. Narayana Battathiri have done notable experiments in Malayalam calligraphy. He is an artist and calligrapher from Kerala. He has been constantly experimenting in the art of Malayalam calligraphy last four decades. He has a major role to raise Malayalam calligraphy into the national international level and also popularizing the art of calligraphy in Kerala. This paper to highlights the different styles, patterns , new innovative experiments from his recent works in Malayalam calligraphy

Assessment of Soil Quality Index in the Southern Coastal Sandy Soils of Kerala, India

Context: The Indian state of Kerala has a long coastline of 589.50 km all along its western border, which has a great potential in biomass production. The agro-ecological unit 1 (AEU 1) in Kerala represents the southern coastal plains, with typical sandy soils. The major constraints of these coastal sandy soil with regard to agriculture are: low organic matter and clay content, as well as their poor water holding capacity, resulting in limited ability to hold nutrients.
 Aims: A study was carried out to evaluate the physico-chemical parameters and quality of the soils of coastal sandy soils in AEU 1.
 Methods: Fifty geo-referenced composite soil samples were taken from different locations of AEU-1 in Thiruvananthapuram district, and were characterised for physical, chemical and biological attributes. Principal component analysis (PCA) was carried out for the analysed soil properties which resulted in 6 principal components (PCs) and a minimum data set (MDS) was obtained using the selected indicators i.e., texture (clay %), water holding capacity, bulk density, soil pH, organic carbon, available nutrients such as potassium, sulphur, zinc, manganese and boron. The soil indicators were changed to unit-less scores after the development of MDS, and were assigned with appropriate weights based on existing soil conditions and soil nutrient content.
 Key Results: Value of SQI recorted the highest in Kadakkavoor and the lowest in Anchuthengu. Further, the locations were classified into three groups namely poor, medium, and good, based on the relative soil quality index (RSQI). Less than 50% of RSQI is considered poor, from 50% to 70% is medium, while more than 70% is considered good. From the study, majority of the land area (60% of samples) in AEU 1 of Thiruvananthapuram district were observed to have a medium level of relative soil quality index.

Developing Prehospital Care in India–A Potential Model for Low- and Middle-income Countries

Introduction:Road traffic accidents and natural disasters cause significant numbers of deaths and life-changing injuries in low & middle-income countries. Most of these countries have limited resources for pre-hospital care and training. In 2021, there were 155,622 deaths due to road accidents and >18,000 railway-related deaths. Natural and manmade disasters also contribute to high numbers of serious injuries and deaths in the region. India is the pilot for developing an international training course for prehospital trauma care.Method:A review of pre-hospital care training and ambulance services in Tamil Nadu and Kerala states of India was carried out in 2019. An international workshop on developing pre-hospital care in India was held in Chennai in October 2022. The workshop included experts from UK and India and 52 practitioners from various parts of India.Results:India has developed a country-wide ambulance service sub-contracted to private providers under a public-private partnership initiative and in addition, there are private and charitable providers. In-transit care and resuscitation are limited and the vehicles are primarily a transport mechanism with a scoop-and-run policy. Infrastructure, traffic congestion, rural and hard-to-reach areas, poorly equipped ambulance services and variations in training and scope of practice contribute to the challenges of providing high quality pre-hospital care.Conclusion:There is a need for high-quality pre-hospital care training, regulation and continuing professional development within the pre-hospital care sector. Delivery of pre-hospital care could be reinforced by wider involvement of doctors such as General Practitioners and other allied health care professionals. It was agreed by all delegates and speakers that an international course on pre-hospital care based upon an existing UK course from the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh, edited to take account of India’s current resources, should be piloted in Chennai in 2023.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

Is There a Vaccine to Save Public Healthcare from the Endemic of Privatization? One Doctor’s Healing Touch Says It All.

Crumbling walls, cramped and crowded spaces, dirty floors, scurrying rodents, the long wait, and neglect - are these the first things that come to your mind when you think of a government health care facility? You would be surprised to know that there is a stellar exception to this disappointing picture, right here in our small state of Kerala in India. A grand reception, beautiful wall art, and a children’s play area- this is how the Punalur Taluk Hospital greets its visitors. If you are sceptical of the outer polish, then the quality of service offered and the inspiring work environment here are sure to convince you otherwise. All it took was one person’s unique vision and his unflinching commitment to it. Dr. Shahirshah is the man behind the scene. His relentless work and farsightedness have transformed the unassuming taluk hospital into a beacon of humanitarian healthcare. As the People’s Plan Campaign basks in the pink of its Silver Jubilee, Dr. Biju Terrence and Dr.Biju S.K., have a passionate conversation with Dr.Shah on how he developed a sustainable democratic public healthcare by integrating local people into its planning. Excerpts from the interview:

Role of decentralised governance in implementing the National AIDS Control Programme in Kerala.

In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). To examine the role of local governments in the implementation of NACP in tune with SDGs. We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically. Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes. The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care.

Prevalence and Associated Factors of Overweight and Obesity Among Middle Aged Population of selected Flats in Thiruvananthapuram Corporation of Kerala State in India

Prevalence and Associated Factors of Overweight and Obesity Among Middle Aged Population of selected Flats in Thiruvananthapuram Corporation of Kerala State in India

Forecasting stochastic consumer portability visitation pattern in fair price shops of India

In India, the Public Distribution System (PDS) is a critical tool for accomplishing the aim of “Zero Hunger”. Despite the enormous resources used, PDS has several inefficiencies that are caused by the monopoly of agents engaged in last-mile grain supply. Various state governments in India have been employing portability as an innovative solution to address this problem. In this article, we examined a huge-scale data on the deployment of portable beneficiaries arriving in a particular FPS of Kerala state in India over three years. A comparison is made between Auto-Regressive Integrated Moving Average (ARIMA) method which makes forecasts in univariate data and ARIMA with exogenous variables called ARIMAX. We followed Mean Absolute Percentage Error (MAPE) and Mean Absolute Deviation (MAD) as the accuracy performance measure of the models and observed that the ARIMAX model outperforms the ARIMA model with the least forecasting errors.

OTT Platform Accessibility: A Glimpse from the Indian State of Kerala

OTT Platform Accessibility: A Glimpse from the Indian State of Kerala

Green Financing as a Means for Fostering Organic Farming: An Evidence from the Indian State of Kerala

Green Financing as a Means for Fostering Organic Farming: An Evidence from the Indian State of Kerala

THE PRESERVER, THE ARBITER, THE DESTROYER: THE SEA AS ADJUDICATOR IN CHEMMEEN

The sea as an object of veneration is a universal idea that has been promoted by many since perhaps the beginning of humankind. This paper explores the archetype of the sea as an adjudicator and as a divine and sentinel entity in the Indian author Thakazhi Sivasankara Pillai’s translated work, Chemmeen. The novel features the myth of Kadalamma (Kadal meaning ‘sea’ and amma meaning ‘mother’ in Malayalam, a regional language spoken in the south-western state of Kerala in India) that governs the people of the fishing community living on the coast. The paper briefly considers the ecocritical considerations of the myth as well.

Climate variability and change in the spices and plantation cropping systems in Kerala state, India

Kerala state in India has rich bio-diversity and tropical rain forests and is spread in 13 agro-ecological zones under the humid tropics. Rainfall decline (annual as well as monsoon), increase in temperature and climate shift towards lesser humid zones within the humid climate are the notable characteristics of the state. Cropping system changes, as well as changes in the production of spices and plantation crops in Kerala, were analyzed from 1952-53 to 2018-19. Area and production changes of various crops in the Idukki district have also been studied and presented in this paper. The average temperature in Kerala has risen by 0.65 °C from 1956 to 2014. In Idukki high ranges, the maximum temperature is increasing, and the minimum temperature is declining, resulting in a widening of temperature ranges. Such a scenario may adversely affect the thermo-sensitive crops, which may need urgent attention as these crops are grown in the forest-agro-ecosystems across the Cardamom Hill Reserve (CHR) of the Idukki district. Deforestation, the shift in cropping systems, declining wetlands, and depletion of surface and groundwater resources had deepened the adverse effects of floods and droughts on spice and plantation crops. Therefore, there is an urgent need for proactive steps on a short and long-term basis against the climate change risks for the sustenance of crop production both in terms of quality and volume.

Capacity in motion: comparative COVID-19 governance in India and South Africa

ABSTRACT With the COVID-19 pandemic, critical questions have surfaced in several countries regarding the capacity of the state to respond with agility to the crisis, and to use the crisis in a transformational way over the longer term. These questions are addressed in a comparative study of the State of Kerala in India and the Province of Gauteng in South Africa. The study contributes to two partial gaps in the literature: (1) inadequate attention to the subnational dimensions of crisis governance; and (2) the temporal dimension of state capacity, noting historical and contextual factors conditioning capacity, with shifts through the course of a crisis and beyond. While both territories showed significant agility in response to the crisis, Kerala strengthened its capacities in a way that Gauteng did not, and this had significant implications for the abilities of these governments to both manage the pandemic and leverage the pandemic for longer term benefit.

Individuals' Vulnerability Based Active Surveillance for TB: Experiences from India.

Community-based active TB case finding (ACF) has become an essential part of TB elimination efforts in high-burden settings. In settings such as the state of Kerala in India, which has reported an annual decline of 7.5% in the estimated TB incidence since 2015, if ACF is not well targeted, it may end up with a less-than-desired yield, the wastage of scarce resources, and the burdening of health systems. Program managers have recognized the need to optimize resources and workloads, while maximizing the yield, when implementing ACF. We developed and implemented the concept of 'individuals'-vulnerability-based active surveillance' as a substitute for the blanket approach for population/geography-based ACF for TB. Weighted scores, based on an estimate of relative risk, were assigned to reflect the TB vulnerabilities of individuals. Vulnerability data for 22,042,168 individuals were available to the primary healthcare team. Individuals with higher cumulative vulnerability scores were targeted for serial ACF from 2019 onwards. In 2018, when a population-based ACF was conducted, the number needed to screen to diagnose one microbiologically confirmed pulmonary TB case was 3772 and the number needed to test to obtain one microbiologically confirmed pulmonary TB case was 112. The corresponding figures in 2019 for individuals'-vulnerability-based ACF were 881 and 39, respectively. Individuals'-vulnerability-based active surveillance is proposed here as a practical solution to improve health system efficiency in settings where the population is relatively stationary, the TB disease burden is low, and the health system is strong.

The profile of HSPA1A gene expression and its association with heat tolerance in crossbred cattle and the tropically adapted dwarf Vechur and Kasaragod

Certain livestock breeds are adapted to hot and humid environments, and these breeds have genetics that could be useful in a changing climate. The expression of several genes has been identified as a useful biomarker for heat stress. In this study, the responses to heat exposure of heat-tolerant Vechur and Kasaragod cattle found in Kerala state in India (also known as dwarf Bos taurus indicus) were compared to crossbred cattle (crosses of Bos t. taurus with Bos t. indicus). At various time points during heat exposure, rectal temperature and the expression of HSPA1A were determined, and the relationship between them was characterized. We characterized HSPA1A mRNA in Vechur cattle and performed molecular clock analysis. The expression of HSPA1A between the lineages and at different temperature humidity index (THI) was significant. There were significant differences between the expression profiles of HSPA1A in Kasaragod and crossbred (p < 0.01) and Vechur and crossbred (p < 0.01) cattle, but no significant difference in expression was observed between Vechur and Kasaragod cattle. The genetic distance between Vechur, B. grunniens, B. t. taurus, and B. t. indicus was 0.0233, 0.0059, and 0.007, respectively. The genetic distance between Vechur and the Indian dwarf breed Malnad Gidda was 0.0081. A molecular clock analysis revealed divergent adaptive evolution of Vechur cattle to B. t. taurus, with adaptations to the high temperatures and humidity that are prevalent in their breeding tract in Kerala, India. These results could also prove useful in selecting heat-tolerant animals using HSPA1A as a marker.

Diabetic Emotional Burden and Post Covid-19 Health Care Services for Diabetic Patient: A New Dimension of Access to Healthcare

In the era of post-covid-19, new trends have emerged in healthcare services and healthcare access. Diabetic patients are more concerned about their health care services as social awareness is increased. This study aims to investigate the role of diabetic emotional burden and healthcare services as a moderator in the relationship between interpersonal distress, physician &amp; nurse distress, and access to healthcare. The population of this study was the patients with diabetes in different public and private hospitals from Kerala state of India. The study concludes diabetic emotional burden and health care services positively moderate the relationship between interpersonal distress and access to healthcare. This research is a contribution to knowledge as no study earlier was conducted to discuss this gap in the literature. This study has practical and theoretical implications concerned to improve the access to the healthcare system for diabetic patients in Kerala and the rest of the world.

Preventable Causes Dominate Mortality in Hemophilia : A Retrospective Observational Study from India

Background and Objective: Bleeding symptoms in people with Hemophilia (PwH) can range from mild ecchymosis to fatal Central Nervous System (CNS) bleeding. With the advent of Clotting Factor Concentrates (CFCs) and prophylaxis there has been improved life expectancy in PwH in developed countries. However, in low middle income countries (LMIC) like India with a huge hemophilia burden (22,594 cases as per the data by World Hemophilia Federation global survey 2020, with probably far more undiagnosed/ undocumented cases), the mean per-capita factor use(Factor VIII -0.27IU,Factor IX 0.01) is far less than developed countries. Lack of access to safe and effective treatment is a major factor that influences the mortality rate in Hemophilia. This retrospective observational study was done to assess the cause of death in PwH in Kerala state of India. Methods: PwH with Hemophilia A and B registered under patient organizations (PO) in different districts of Kerala from 2015 January to 2022 April were included in the study. A questionnaire was structured and telephonic interview done to collect information on date of birth, Hemophilia type, severity, inhibitor status, target joint, HIV and HCV status, family history, type of treatment (prophylaxis/episodic).Hemophilia severity was categorized as severe (<0.01 IU/mL), moderate (0.01-0.05 IU/mL), or mild (>0.05-0.40 IU/mL). Information on Hemophilia severity, type and inhibitor status were verified with medical reports available with PO. Further data on immediate cause of death, place of death, availability of CFCs at the time of death and the distance of the patient's home to the hospital were collected over telephone. Cause of death was categorized into death due to bleeding, death due to other causes related to hemophilia and death due to causes not related to hemophilia. Statistical analysis was done using the IBM SPSS software version 20. Results: Out of 1032 PwH contacted during this study period there were total 34 death reported, which estimates to 32.9 deaths per 1000 patients.25 (73.5 %) were cases of Hemophilia A and 9 (26.5 %) cases of Hemophilia B. Twenty four patients (70.6%) had severe disease; three(8.8 %) had inhibitors. The cause of death was bleeding in 19(55.88 %) cases, Hemophilia related but not bleeding in 8 (23.52 % cases) and in 7 cases (20.6 %) death was due to causes not related to Hemophilia. The most common cause of death due to bleeding was intracranial bleed seen in 14 (41.17 %) cases, followed by death due to gastrointestinal bleed in 3 cases (8.82 %), hemoptysis and chronic bleed from wound comprised 1 (2.95%) each of all causes of death. In non-bleeding but Hemophilia related category hepatitis C associated liver failure was the cause of death in 8 (23.52 %) cases. In not Hemophilia related causes, cause of death was pneumonia in 4 (11.76 % causes), Myocardial infarction in 2(5.88 %) (refer figure 1). The age at death varied from 1 year to 77 years with mean age being 39.6 years. Out of these 5(17.64 %) deaths occurred in children less than 18 years of age of which 4(80 % )were due to bleeding. Three (8.8 %) deaths were reported at home. The distance from home to hospital ranged from 17.3 kilometer (km) to 257 km with a mean distance of 118 km. All the patients who died were neither on prophylaxis nor on home therapy. Conclusion: Majority of the patients who died had a preventable cause of death. Access to prophylaxis would have prevented deaths caused due to bleeding. None of the patients who died were on prophylaxis which is the standard of care for Hemophilia. None of these patients received home therapy and had to travel for long distances to acquire the factors. Improved access to safer clotting factor concentrates will help to prevent transfusion transmitted infection related deaths. Adequate sustainable supply and availability of factors at affordable costs, along with implementation of prophylaxis for PwH will be useful to bring down the mortality rate among hemophilia patients in LMICs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of pesticide ban on suicide trend – a 20-year study from a tertiary care center in Central Kerala from 2001 to 2020

Introduction: We assessed the effect of the pesticide regulations implemented in 2011 on suicide trend in Kerala state of India. Materials and methods: Data were collected from case records of suicide autopsies done in a single tertiary care hospital in Thrissur district of Kerala in 2001–2020. Linear trends in overall suicide rates were identified using joinpoint regression analysis. We used Poisson regression models to estimate the annual expected number of suicides in 2011–2020 and calculated the rate ratios between the observed number of suicide and that expected according to the linear pre-ban suicide trend (2005–2010). Results: There were a total of 14,593 suicide autopsies (2501 pesticide autopsies) in 2001-2020. Carbofuran was the commonest pesticide identified, followed by quinalphos, zinc phosphide, and chlorpyrifos. In 2011–2020, overall suicide rates were 22%–48% and pesticide suicide rates were 20%–55% lower than those expected according to pre-ban suicide trends (2005–2010), with the only exception of a 16% higher-than-expected pesticide suicide rate in 2011. There was no change in trend in hanging suicides. Conclusion: Lower-than-expected overall and pesticide suicide rates were found in Thrissur district after the 2011 bans of pesticides in Kerala, with no evidence of means replacement to hanging.

Analyzing the Employability Skills of Engineering Graduates using AHP Techniques - A Case Study of Kerala State in India.

In the present era, only competent graduates can survive in the global economy. The Washington accord suggested twelve graduate attributes essential for competent engineering graduates. Various accreditation agencies measure the competency of engineering graduates in terms of these graduate attributes. This paper presented the perception of academicians’ and industry professionals’ regarding the most important skill needed for a competent engineering graduates. Also, the paper discussed how far the present undergraduate engineering curriculum prepares the engineering graduates to be industry ready. Identification of the most important skill needed for engineering graduate is done by employing one of the multi criteria decision method called Analytical hierarchy process (AHP). AHP incorporates several criteria and order of preference in evaluating and selecting the best option among many alternatives based on the desired outcome. The responses from academicians as well as industry professionals from Civil Engineering stream in Kerala, India were collected. The criteria weights were determined based on the procedure given by Saaty. The consistency index values reinforced the reliability of judgment. The study showcased that problem solving skill and teamwork are the most important skill needed for an engineering graduate from academicians’ viewpoint. According to industry professionals, engineering knowledge is more important than problem solving skills. Also, in the present study academicians and industry professionals unanimously suggested the revision of curriculum, internships for students, the collaboration between academicians and industry professionals both in academia and industry, exposure of students to real world problems are some of the means to develop competency in Civil Engineering graduates.