Climate Change and Health: VRHP approach

Vadu Rural Health Program (VRHP) conducted a study to determine the association of mortality with temperature and rainfall in a rural population of different age and sex. The analysis concluded that the level of (all cause) mortality in all age groups, in area of Vadu Health and Demographic Surveillance System (HDSS) is highly affected by both high and low temperatures and rainfall events. The association was strong in children, women and elderly people.

These results suggest that population in rural India is vulnerable to both heat and cold, and weather related mortality may be a public health problem today. Furthermore, as changes in local climate occur, adaptation measures should be considered to mitigate the potentially negative impacts on public health in these rural communities. This study is part of Vijendra Ingole's PhD work, affiliated with Vadu HDSS and Umeå University, Sweden. Related to his studies, VRHP jointly organized an international workshop on Climate and Health in India from 14th- 16th October at KEM Hospital Research Centre Pune. Umeå University, Sweden partnered to organize this workshop. The workshop was attended by 28 participants from various parts of the country. Dr. V.S. Padbidri, director, KEMHRC Pune, welcomed the participants and the introduction to the workshop was given by Dr. Barbara Schumann, Umea University, Sweden, and Mr. Vijendra Ingole. Dr. Gufran Beig, Program Director SAFAR, IITM, Dr. Sundeep Salvi, Director, Chest Research Foundation, Dr. Joacim Rocklöv and Dr. Rebekah Lucas Umeå University, Sweden chaired various sessions during the workshop. The discussions focused on effects of global climate change on health in India.

Dr. Dilip Chate of IITM spoke on the effects of air pollution on health in India. This was followed by discussions on climate change and health in India, its status and the views of policy makers towards this issue. These discussions were led by Dr. Papiya Mazumdar, TERI University, Dr. Aditya Pradyumna, SOCHARA, Bangalore. Dr. Rebekah Lukas, Umeå University, Sweden highlighted the health effects of heat exposure on humans which was followed by a presentation on heat- health vulnerability in rapidly urbanizing regions of Western India by Mr. Ajit Rajiva of IIPH Ahmedabad. Group activity on addressing various issues of Climate Change and Health were facilitated by Dr. Sanjay Juvekar, Officer in charge VRHP. The aim of the group discussions was to foster networking across institutions in India that work on climate/environment and health. Mr. Vijendra Ingole, who is currently pursuing his doctoral studies on this issue informed about his approach towards weather variability and mortality and his participation in INDEPTH- CLIMO Working Group which works on the same issue in several developing countries. Dr. Urvashi Chandra, IGSSP Delhi presented on the policy status on climate change and its effect on health.

The workshop resulted in formation of a working group on Climate and Health and would work towards research on health effects due to climate change. The workshop concluded with a short course on climate and health research methods facilitated by the participants from the Umea University, Sweden. The overall arrangements of the workshop were done by Mr. Vijendra Ingole and were supported by Mr. Ramesh Pardeshi



"I have learnt so much in those 3 days and I hope to strengthen our relationships going forward!" One of the participants of workshop exclaimed which shows the completion of the objective. The workshop aimed for closer collaboration, strengthening leadership capabilities and capacity building of finance managers working in Health and Demographic Surveillance Systems in the Network. Vadu Rural Health Program (A division of KEM Hospital (Research) Centre, Pune) in collaboration with INDEPTH Network organized a 3 days (6th – 8th July 2011) workshop on "Building a transparent and credible research Institution in the South, the contribution of the Finance Manager." It was organized in Hotel Phoenix, Pune and 23 participants from various countries in Africa and Asia attended the workshop. Sr. Accounts and Admin Manager of KEMHRC, Pune Mrs. Rajalaxmi leaded in organizing and hosting this workshop. Mr. Neeraj Kashyap and other staff of the centre provided all their time and support for this successful event. After a warm welcome to all the participants, the workshop was initiated with an address by Senior Health Scientist and vice chair of INDEPTH Network Dr. Sanjay Juvekar on 6th July 2011. Dr. Juvekar talked on 'Health and Demographic Surveillance Systems for Monitoring Population Health and Development and Evaluations of Innovative Interventions'. He addressed all finance managers to work as one unit though they work in and for various institutions and countries. He expected the participants to understand INDEPTH Finance systems, in place, which would enable implementation of collaborative research. His address was led by an overview of general accounting system and procedures at KEMHRC, Pune (Parent institution of Vadu HDSS) which was presented by Mrs. Rajalaxmi. Participants from other INDEPTH Sites also expressed their way of functioning as regarding accounts procedure. These participants include Mr. Casimir Ouedraogo from Burkina Faso, Ms. Sadiya Ooni, Mrs. Luvantherie Naidoo both from South Africa and Mr. Michael Jacko Kibuuka of Uganda. Mr. Sixtus Apaliyah, Finance and Administrative Manager INDEPTH Secretariat presented on 'Code of ethics of Professional Accountants'. 'Grant making process' was explained by Felicia Manu whereas Adam Osman and Raymond Akparibo informed about the 'IPSAS relevance in Public Sector Institutions.' These sessions were followed by discussions on 'Good corporate Governance in Research Institutions; the finance manager's contribution in health research Institutions and roles and responsibilities of finance managers and fund-raising'. The participants also discussed about the 'Reporting requirement of donors', 'Globalization impact on NGO's' and 'Internal controls in Financial Management' A field visit was organized at Vadu Rural Health Program. A short film on VRHP was screened for all participants. The participants were well informed with the functioning of various ongoing activities at Vadu. The appreciations for all Vadu activities from the team would now act as boosters for better work at the centre. The participants also had few rounds of city to shop for their loved ones back at their home countries. The workshop was a successful interactive session for all finance managers from different HDSS sites. This would surely lead to continuous financial interactions amongst various HDSS sites of INDEPTH Network.



Vadu HDSS, Vadu rural Health Program(VRHP), KEMHRC, Pune organized a workshop on Indoor Air Pollution at Chest Research Foundation in Kalyani Nagar, Pune from 19th to 21st March 2012. Chest Research Foundation (CRF), Pune, INDEPTH Network and Swiss tropical institute are other collaborating institutions for this workshop. Prof. Don De Savigny, Dr. Daniel Maeusezahl (Swiss Tropical Institute, Basel, Switzerland), Dr. Sundeep Salvi (CRF) and Dr. Ajay Ojha were few of the distinguished speakers for the workshop. Dr. Sanjay Juvekar of VRHP is the study coordinator as well as the key person to organize this workshop and propose this study. The workshop was attended by 17 participants from 9 different countries. Indoor Air pollution is one of a major cause for respiratory diseases. Conducting studies on Measuring Indoor air pollution, identifying indicators for respiratory diseases and introducing interventions to reduce it, has become a need due to increase in the burden of respiratory diseases, especially in children and women. The objectives of the workshop is to develop a strategy on interventions for Indoor air pollution which will be a multi-site trial to reduce the risks in communicable and non-communicable diseases in children and their mothers in Africa and Asia. It has been estimated that Indoor Air Pollution is responsible for nearly two million deaths annually in developing countries and around 4% of burden of disease expressed as disability adjusted life years (DALYs). In India, it has been estimated that about half a million women and children die each year from indoor air pollution (ICMR Bulletin, 2001). In the energy ladder, biomass fuels namely animal dung, crop residues, and wood are at the bottom and are used mostly by households with poor economic conditions. The 1991 National Census revealed that 90% of the rural population relied upon the biomass fuels. In VRHP, we have conducted projects on Indoor Air Pollution to measure levels of concentration of pollutants such as Carbon Monoxide and Particulate Matter. In 2005 we collaborated with London School of Hygiene and Tropical Medicine to measure the levels of concentration of carbon monoxide as an indicator for indoor air pollution in households which were recruited for studying the risk factors for acute respiratory infections in children between the age group of 6 and 18 months. In 2009 in collaboration with Chest Research Foundation we measured the levels of indoor air and outdoor air pollution by installing air samplers in households recruited to study the prevalence of COPD. Presently, we are conducting a pilot study in the households using biomass fuels to investigate the effects of biomass smoke particulate matter on the lungs in collaboration with John Hopkins University, School of Public Health, IGIB and Chest Research Foundation.



Translational Research and Innovative Science through Ayurgenomics (TRISUTRA)- a CSIR Unit at IGIB, New Delhi, previously known as Ayurgenomics project has expanded and would be functional at 5 places in India. The primary objective of this Ayurgenomics Unit -TRISUTRA is to develop affordable health care solutions based on traditional knowledge of Ayurveda and modern genomic knowledge and medicine. CSIR TRISUTRA in partnership with Vadu Rural Health Program has organized a 7 day (16th -22ndMarch) workshop. Around 30 participants from New Delhi, Belgaum, Kolkata and Jamnagar including Principle Investigators of centers attended this workshop held at Vadu and KEMHRC,Pune. Workshop was initiated by a warm welcome by Director, KEMHRC, Dr. V.S Padbidri. Dr. Mitali Mukerji, Program Director of CSIR—TRISUTRA @IGIB initiated by informing the Background behind the activities and present situation of CSIR-TRISUTRA@IGIB. Dr. Bhavana Prasher Principal Investigator and Head Ayurveda CSIR-TRISUTRA introduced the TRISUTRA concept and mentioned salient features of Ayurgenomics. An overview of workshop activities was given by Rutuja Patil and overall idea of the mode of working at Vadu was briefed by Senior Health scientist and Officer Incharge (Vadu) Dr.Sanjay Juvekar. Dr.Girish Dayma gave a brief description about importance of documentation and SOP's (Standard Operating Procedures).

Dr.Shaunak Kulkarni (Reader, Anthropology Dept. Uni Pune) and Dr. Sanjay Juvekar illustrated anthropometry with practical hands on training by Vadu team and CSIR-TRISUTRA including Sanjay Juvekar, Aruna Kale, Vaibhav Raut, Nilofer Shaikh and Dr.Ankita Shrivastava and Himangi Lubree, Binuja Varma and Dr Bhavana Prasher. Fundamentals of spirometry were depicted by Dr.Sundeep Salvi (Director, Chest Research Foundation). Group-wise demonstration and hands on practical training was given to each participant on Spirometry by FRS Bharat Chaudhari, Nitin Lawangare (Chest Research Foundation), HRV (Heart Rate Variability) by Dr.TavpriteshSethi (SRF, IGIB Delhi) and FRA- SantoshShivale and, Gustatory by FRA- Aruna Kale and Dr.AnkitaShrivastava, and Skin tests by FRA-NilofaShaikhr and RutujaPatil. A field visit was organized at Vadu Rural Health Program. Mr. Anil Shinde of Vadu organized this visit. The participants also enjoyed Maharashtrian food along with the visit to historical place of Sambhaji Maharaj's Samadhi, Vadu. As rightly said in a proverb-- "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."



Clinical Development Services Agency (CDSA), an extramural unit of Translational Health Science and Technology Institute (THSTI), Department of Biotechnology, Government of India are promoting development of translational and clinical research capacity in India through it's 'Clinical Investigator Development Program'. In this endeavor, it is being actively supported by the Institute for OneWorld Health (OWH), an affiliate of the Program for Appropriate Technology in Health (PATH). The CIDP workshop was held at KEM Hospital Research Centre, Pune and Vadu Rural Health program from 17th June 2013 to 20th June 2013. The objectives of the workshop were, To strengthen capacity of individuals from institutions that are primarily conducting epidemiological and observational studies to conduct population based clinical studies. To encourage and train hospital based clinical trial experts to conduct population based clinical studies. The CIDP workshop was organized by KEMHRC, Pune and VRHP with the support from CDSA, PATH and OWH. The day one of the workshop started with a welcome note from Dr Ashish Bavdekar (Associate Professor, KEM Hospital, Pune) for the 40 participants from organizations across India. It was later followed by an address from the Director KEM research, Dr V S Padbidri. Dr Girish Dayma (Asst. Project Manager, KEMHRC Pune) provided introduction of all the participants at the workshop. This session was followed by presentations from Dr Sudhakar Bangera (Program Director, CDSA), Dr Vivek Ahuja (director clinical research and development, PATH), Dr Sanjay Juvekar (Officer In Charge, VRHP), Professor RK Mutatkar (Medical anthropologist and president of MAAS, Pune), Mr Saju Joseph , (Member Secretary, Research Advisory Board, MAAS Pune), Dr Mohan Gupte (Former Director National Institute of Epidemiology, Chennai), Prof J.P Muliyul (Professor, Community Health, CMC, Vellore), Dr C.S Yajnik (Director, Diabetes Unit KEMHRC Pune) and Dr K Kumaran (research consultant, Diabetes unit, KEMHRC Pune). This session was followed by group activity discussion, wherein Md Hanif Shaikh (Sr. Project Manager, VRHP) discussed a scenario on Oral Cholera vaccine trial with the delegates. The delegates were divided in 4 groups which were assigned 4 different topics to work on designing a trial. The day 2 began with a presentation by Prof J P Muliyil. This was followed by presentations from Dr NK Arora, Dr Urmila Thatte (Professor & Head, Dept. of Clinical Pharmacology, Seth GSMC & KEM Hospital, Mumbai), Mr Tathagatha Bhattacharjee, Dr Sanjay Juvekar (Officer In Charge, VRHP), and Dr Anand Kawade (Paediatrician, VRHP).The day ended with group activity which was coordinated efficiently by Md Hanif Shaikh (Sr. Project Manager). The aim of the group activities was to implement practically all the knowledge gained from the presentation. Each day the last session concluded with group activities.




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