RCZI’s work on
JE represented at national and international Fora
Key findings and outcomes of some of the studies and initiatives launched by the Roadmap to Combat Zoonoses Initiative (RCZI) in India have been presented at various prestigious fora. The work being done by RCZI in the area of JE is also being looked at with interest amongst the EcoHealth community. This has led to RCZI’s increasing presence at multiple fora providing opportunity to present views, findings, concepts and also creating opportunities to collaborate and network. Making Poster presentations, taking part in panel discussions, making presentations on specific themes and topics related to JE and being part of strategic dialogue at various national and international think tanks has contributed to expanding RCZI’s understanding of JE. Some of the platforms at which RCZI has made its presence felt are enumerated below.
Research Poster on an EcoHealth approach to understanding JE transmission in an epidemic-prone Indian district
This poster highlighted the interdisciplinary methodology and study protocol that used both quantitative and qualitative methods.Since the disease causes frequent seasonal outbreaks in rural India with high morbidity and mortality in children, specifically in eastern Uttar Pradesh, where transmission patterns and risk drivers remain under-explored, the study acquired even greater significance, focusing on micro-ecosystems in the JE-endemic district of Kushinagar to understand human-animal-vector-environment interactions determining JE transmission in humans.
Research poster on community and health system perceptions influencing JE transmission in an endemic region The health system’s reported efforts for JE prevention/control are rarely corroborated by community perceptions of such activities across villages. Thisposter presented at EcoHealth 2012, Kunming, China described findings from pilot study that provided a backdrop of potential socio-demographic, behavioural and operational risk drivers that could affect JE transmission in an endemic area. Understanding of these drivers is critical for success of public health action. These findings provided the basis for the subsequentlarger mixed-methods study that followed.
Pathogen diversity and the big picture: The case of JE in northern Uttar Pradesh
Until recently, JE was considered the leading cause of acute encephalitis syndrome (AES) in northern Uttar Pradesh. However, this aetiology of AES has been questioned in recent times. Several explanations have been proposed to describe this apparent change in the epidemiology of AES, including changes in properties of the JE virus and diversity of pathogens responsible for AES in these areas. These assumptions were viewed in light of the bigger picture of surveillance and control of AES in northern Uttar Pradesh in a scientific presentation in New Delhi in a Consultation on “Pathogen Diversity: Exploiting Pathogen Genetics for New Control Strategies”, organised by ICMR, PHFI, ICGEB & LSHTM in 2013. The presentation examined the case of JE in northern UP attempting to situate pathogen diversity and pathogen-based research in the larger public health context.
Research priorities in Acute Encephalitis Syndrome, India
Research prioritisation in the case of AES must keep the social, economic and systemic gaps in mind before effective solutions can be found. This presentation drew the attention of the research community and programme managers to shift focus from the biomedical side to the bigger picture of knowledge gaps in the understanding of the prevention and control of AES/JE. The presentation was made at a 2-day Workshop on Disease Surveillance, Laboratory Networking and other related aspects of JE for SPOs and Laboratory in-charges at the National Vector Borne Disease Control Programme (NVBDCP) in New Delhi in the 2013.
Identifying source, pathways and risk drivers in ecosystems of JE – experience of undertaking an EcoHealth Research study
While building a case for holistic approach in enriching enquiry, such as development of community focus in the epidemiology aspects of the study, it is equally important to be cognisant of the challenges that emanate from conducting such a broad-based research study. Often this results in trade-offs between breadth and depth of enquiry when incorporating multiple study components. This presentation discussed the experiences of the India EcoHealth Research Core Group and their experience of being part of the EcoHealth study at the “Cross-sectoral collaboration for health and sustainability: A new agenda for generating and assessing research impact in the face of complexity”, a joint IDRC-ILRI workshop at the Prince Mahidol Awards Conference in Bangkok in 2013.
Developing quality assurance plan for multidisciplinary, multistage and complex community-based EcoHealth research study in India
EcoHealth research is transdisciplinary, cross-sectoral, participatory and systems-based. Though a complex ‘field of practice’, these principles ensure sustainable knowledge translation. Inspite of Quality Assurance (QA) being a vital component in administering research studies, there is little guidance for it in EcoHealth research. The RCZI team designed a QA plan for an EcoHealth study involving entomological, environmental, microbiological and veterinary enquires for JE in Kushinagar, Uttar Pradesh. This poster presented at EcoHealth 2014, Montreal, Canada described the systematic approach of developing and executing a QA plan, and how it ensured adherence to principles of EcoHealth research while maintaining core elements of QA. Similar fraemworks would help develop good QA practices in data collection.
Limited understanding of perceptions, practices and health seeking behaviours constrains JE/AES interventions in a high endemic district of North India: A qualitative enquiry
Commonly referred to as ‘Mastishk Jwar’ or ‘Dimaghi Bukhar’ in north India, JE and AES remain poorly understood phenomena at societal and biomedical levels. Social and cultural perceptions and practices, human interaction with animals and health-seeking behaviours are all important factors which have unfortunately failed to get the attention of researchers and programme managers. Resultantly, they not suitably informed the interventions that can prevent JE/AES. This presentation made at EcoHealth 2014, Montreal, Canada highlighted the insights gained from JE study’s qualitative enquiry that was conducted in the three community development blocks of Kushinagar and touched upon the core themes of JE/AES as a deadly disease.
Using EcoHealth approach to identify sources, pathways and drivers of JE in India’s high endemic district
This presentation made at EcoHealth 2014, Montreal, Canada described the conceptualisation, development and execution of the JE study. The process of linking eco-epidemiology to developmental issue of poverty, socio-economic status, gender and environment in a conceptual framework and the cross sectoral drivers identified were described.
Resolving dilemmas of AES aetiology in India through systems Thinking and EcoHealth approach
Japanese encephalitis is a zoonoses with multiple host range and complex transmission cycle spanning across different sectors. While response of India’s scientific community has been to explore other aetiologies of AES, failure to recognise larger systemic issues, besides ignoring social, cultural and environmental determinants within and across sectors, have gone unaddressed. This is reflected in the poor quality surveillance data in Kushinagar. Quality of surveillance is one such systemic driver that when compromised, contributes to this ambiguity, besides impacting planning and estimating effect of interventions, effective utilisation of public health resources, and developing policy. AES control efforts are in urgent need for broader EcoHealth type systems approach that can generate evidence, recognise the problem and identify solutions from a transdisciplinary and cross-sectoral perspective for sustainable and effective solutions.
JE outbreaks are being reported from previously unknown foci. Further, encephalitis outbreaks of other aetiologies in endemic areas have only added to their complexity. For programme managers, researchers and community health professionals, access to accurate and updated information is key to planning interventions and other relief measures.read more