Browsing by Author "Ramanathan, M"

Now showing 1 - 14 of 14
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    Commentary: Altruism in Organ Donation: Would Reciprocity Offer an Alternative Explanation?
    (In: Akabayashi A. The Future of Bioethic: International Dialogues. Oxford: Oxford University Press;, 2014-12) Ramanathan, M
    Organ donation for transplantation constitutes a social contract between citizens in Singapore. This social contract can be enforced by making waiting lists for organs for citizens who opt out of donation a lower priority. In these circumstances, it would be intriguing to examine whether altruism alone is required for organ donation. The shared social value of reciprocity in Asian societies may also lend itself as an explanation. As the identity of those who will require organs is unpredictable, this can also constitute a risk aversion strategy across kinship ties and generations. Organ donation following a death could potentially bring moral merit to the donor and benefit of donations which occur across kinship ties and generations.
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    Compensation for trial-related injury: does simplicity compromise
    (Indian J Medical Ethics, 2012-10) Ramanathan, M; Sarma, PS; Mishra, US
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    Conceptual model for dietary behaviour change at household level: a 'best-fit' qualitative study using primary data
    (BMC PUBLIC HEALTH, 2014) Daivadanam, M; Wahlstrom, R; Ravindran, TKS; Thankappan, KR; Ramanathan, M
    Background: Interventions having a strong theoretical basis are more efficacious, providing a strong argument for incorporating theory into intervention planning. The objective of this study was to develop a conceptual model to facilitate the planning of dietary intervention strategies at the household level in rural Kerala. Methods: Three focus group discussions and 17 individual interviews were conducted among men and women, aged between 23 and 75 years. An interview guide facilitated the process to understand: 1) feasibility and acceptability of a proposed dietary behaviour change intervention; 2) beliefs about foods, particularly fruits and vegetables; 3) decision-making in households with reference to food choices and access; and 4) to gain insights into the kind of intervention strategies that may be practical at community and household level. The data were analysed using a modified form of qualitative framework analysis, which combined both deductive and inductive reasoning. A priori themes were identified from relevant behaviour change theories using construct definitions, and used to index the meaning units identified from the primary qualitative data. In addition, new themes emerging from the data were included. The associations between the themes were mapped into four main factors and its components, which contributed to construction of the conceptual model. Results: Thirteen of the a priori themes from three behaviour change theories (Trans-theoretical model, Health Belief model and Theory of Planned Behaviour) were confirmed or slightly modified, while four new themes emerged from the data. The conceptual model had four main factors and its components: impact factors (decisional balance, risk perception, attitude); change processes (action-oriented, cognitive); background factors (personal modifiers, societal norms); and overarching factors (accessibility, perceived needs and preferences), built around a three-stage change spiral (pre-contemplation, intention, action). Decisional balance was the strongest in terms of impacting the process of behaviour change, while household efficacy and perceived household cooperation were identified as 'markers' for stages-of-change at the household level. Conclusions: This type of framework analysis made it possible to develop a conceptual model that could facilitate the design of intervention strategies to aid a household-level dietary behaviour change process.
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    Correlates of female sterilization regret in the southern states of India.
    (Journal of biosocial science, 2000)
    This study analyses factors associated with the incidence of sterilization regret in the four south Indian states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Using data from the National Family Health Surveys, in all four states the incidence of regret was found to be less than 10% and the factors significantly associated with it were child loss experience and quality of services. Hence, there is a need to improve the quality of services, both in terms of counselling and service provision, and women need to be counselled about the permanent nature of sterilization in order to avoid future regret.
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    Developing a conceptual model using primary qualitative data to facilitate dietary intervention planning at the household level
    (BMC Public Health, 2014) Daivadanam, M; Wahlstrom, R; Ravindran, TKS; Thankappan, KR; Ramanathan, M
    Background: Interventions having a strong theoretical basis are more efficacious, providing a strong argument for incorporating theory into intervention planning. The objective of this study was to develop a conceptual model to facilitate the planning of dietary intervention strategies at the household level in rural Kerala. Methods: Three focus group discussions and 17 individual interviews were conducted among men and women, aged between 23 and 75 years. An interview guide facilitated the process to understand: 1) feasibility and acceptability of a proposed dietary behaviour change intervention; 2) beliefs about foods, particularly fruits and vegetables; 3) decision-making in households with reference to food choices and access; and 4) to gain insights into the kind of intervention strategies that may be practical at community and household level. The data were analysed using a modified form of qualitative framework analysis, which combined both deductive and inductive reasoning. A priori themes were identified from relevant behaviour change theories using construct definitions, and used to index the meaning units identified from the primary qualitative data. In addition, new themes emerging from the data were included. The associations between the themes were mapped into four main factors and its components, which contributed to construction of the conceptual model. Results: Thirteen of the a priori themes from three behaviour change theories (Trans-theoretical model, Health Belief model and Theory of Planned Behaviour) were confirmed or slightly modified, while four new themes emerged from the data. The conceptual model had four main factors and its components: impact factors (decisional balance, risk perception, attitude); change processes (action-oriented, cognitive); background factors (personal modifiers, societal norms); and overarching factors (accessibility, perceived needs and preferences), built around a three-stage change spiral (pre-contemplation, intention, action). Decisional balance was the strongest in terms of impacting the process of behaviour change, while household efficacy and perceived household cooperation were identified as ‘markers’ for stages-of-change at the household level. Conclusions: This type of framework analysis made it possible to develop a conceptual model that could facilitate the design of intervention strategies to aid a household-level dietary behaviour change process.
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    Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)
    (BMJ OPEN, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Chaturvedi, V; Lloyd-Jones, DM; Reddy, KS
    Introduction: Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date. Methods: The authors estimated short-term and lifetime predicted CVD risk among 10 054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (>= 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups. Results: The mean age (SD) of the study population (men=63%) was 40.8 +/- 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively. Conclusion: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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    Distribution of 10-year lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (Cross –sectional survey results).
    (BMJ Open, 2011) Jeemon, P; Prabhakaran, D; Huffman, MD; Ramakrishnan, L; Goenka, S; Thankappan, KR; Mohan, V; Joshi, PP; Mohan, BVM; Ahmed, F; Ramanathan, M; Ajuja, R; Chaturvedi, V; Lloyd-Jones, D; Reddy, KS
    Introduction:Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.METHODS:The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (? 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.RESULTS: The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.CONCLUSION: Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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    Impact of comprehensive cardiovascular risk reduction program on risk factor clustering associated with elevated blood pressure in an Indian industrial population.
    (Indian Journal of Medical Research, 2012) Jeemon, P; Prabhakaran, D; Goenka, S; Ramakrishnan, L; Padmanabhan, S; Huffman, M; Joshi, P; Sivasankaran, S; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Sinha, N; Thankappan, KR; Reddy, KS
    Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions.
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    Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population
    (INDIAN JOURNAL OF MEDICAL RESEARCH, 2012) Jeemon, P; Prabhakaran, D; Goenka, S; Ramakrishnan, L; Padmanabhan, S; Huffman, M; Joshi, P; Sivasankaran, S; Mohan, BVM; Ahmed, F; Ramanathan, M; Ahuja, R; Sinha, N; Thankappan, KR; Reddy, KS
    Background & objectives: Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Methods: Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Results: Mean age of participants was 40.9 +/- 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and > 3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while continued to be high in the control arm without interventions (both within group and between group P < 0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P < 0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 113.3 to 17.8 per cent in the control arm (P < 0.001). Interpretation & conclusions: Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.
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    The interactions of ethical notions and moral values of immediate stakeholders of immunisation services in two Indian states: a qualitative study
    (BMJ Open, 2013-02) Varghese, J; Raman Kutty, V; Ramanathan, M
    Objectives :- This study examines the existing norms regarding immunisation within the communities and the ethical notions that govern the actions of different health professionals and their collective synergistic or conflicting effects on the governance of the programme. Design :- We used descriptive and analytical qualitative methods as it suited the research question. Setting :- The data were collected from areas under 16 primary health centres in Kerala and Tamil Nadu identified through a three-step sampling process. Participants :- This involved in-depth interviews with stakeholders including providers, beneficiaries and other stakeholders, focus group discussions with mothers of under-five children and participant and non-participant observations of vaccination-related activities. Results :-Unlike most other ethical analyses that look at the ethics of vaccination policies, the interactions of normative principles and notions are analysed in this article. Moral obligation of parents towards their children, beneficence of healthcare providers and the utilitarian aspirations of the state are the key normative principles involved. Our analysis points to the interplay of both synergy and conflict in ethical notions and moral values in the context of immunisation services. Paternalistic interventions like special immunisation campaigns against polio and Japanese encephalitis are a case in point: they generate conflict at the normative level and create mistrust. Conclusions :- Analysis of vaccination policies and programmes needs to go beyond factors that assess monetary benefits or herd immunity. Understanding the interactions of normative notions that shape the social organisation of the providers and the users of vaccination is important in creating a sustainable environment for the programme.
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    The Prevention of Parent-to-child Transmission Programme: is it fair to women?
    (Indian Journal for Medical Ethics, 2014-12) Nataraj, S; Ramanathan, M
    In February 2014, the Government of India launched a multi-antiretroviral drug regimen to treat infected women and infants in efforts to reduce parent-to-child transmission (PTCT) of the human immunodeficiency virus (HIV) (1). The announcement has been long awaited because the multidrug regimen can reduce the risk of transmission during childbirth from 30%–35% to less than 2% with replacement feeding (2). Multidrug regimens to prevent PTCT have been used in high-income countries since the 1990s and in many low- and middle-income countries (LMICs) since 2010, when the World Health Organisation (WHO) removed the single-dose nevirapine (SdNVP) regimen from its list of recommended treatments. However, until now, India has been one of the few countries where infected pregnant women and their infants received the SdNVP, which reduces the risk of transmission to 16% in combination with breastfeeding, and to 11% in combination with replacement feeding. Meanwhile, new recommendations from the WHO suggest that for maximum efficiency, antiretroviral therapy (ART) should be given to all HIVpositive pregnant women irrespective of their CD4 counts (3). However, India will initiate the multidrug regimen among women with CD4 count ≤350 cells/mm3 as per the recommendations of 2010 (4). This delay in switching to a multidrug regimen has been ascribed to the need to strengthen infrastructural and human capacity to handle the clinical and monitoring requirements of CD4 counts and treatment adherence involved in this regimen for women and infants (5). Unlike the SdNVP regimen, the multidrug regimen is initiated in HIV-positive women 14 weeks after conception and is continued until after the woman has stopped breastfeeding. Infants are recommended the one daily dose of NVP for about six weeks after birth. As effective as the multi-drug regimen is in preventing transmission from infected women to infants, the switch does not address the important aspect of preventing infection in women in the first place. This should be an integral component of the programme’s design and is the most effective way to ensure zero risk to infants, while protecting the mothers as well. We examine the impact of the Prevention of Parent to Child Transmission programme on women in India, especially because it is the only initiative in the country that targets women outside sex work for HIV prevention and care. We locate our discussion in the wider context of the subjugation of women’s autonomy and well-being in national health policies and practices related to population and reproductive health. Women account for 39% of all infected people in India but the overwhelming majority – over 90% – have been infected after marriage by husbands with a history of unsafe pre-marital or extra-marital sex and/or injecting drug use (7). Most often, the infection occurs early in the marriage but is usually identified only when the woman seeks antenatal care during pregnancy. In many cases, husbands too become aware of their HIV status only after the wife has tested positive (8). Thus, for most women marriage is the only risk factor (9). However, in stark contrast to the attention paid to preventing mother-to-child transmission, the issue of preventing husband-to-wife transmission still remains unaddressed, and women continue to be at risk. We draw attention to the ways in which women’s bodies are used to meet national and international goals to prevent mother-to-child transmission while their rights to autonomy and HIV prevention are overlooked, and the role of men in preventing transmission to women is ignored.
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    Reducing Neonatal Mortality in Jhagadia Block, Gujarat: We Need to go Beyond Promoting Hospital Deliveries
    (JOURNAL OF TROPICAL PEDIATRICS, 2013) Kutty, VR; Shah, P; Modi, D; Shah, S; Ramanathan, M; Archana, AR
    Background and Methods: We examined data from a cohort of births that occurred in the period 2004-08 in the SEWA-Rural project area, covering a population of similar to 175 000, in Gujarat, India, to assess the trends and risk factors for neonatal mortality. Results: In this population living in 168 villages, there has been a significant declining trend in infant and neonatal mortality, more marked in the tribal population, in whom this paralleled a rise in the proportion of women delivering in hospitals. The more important risk factors for neonatal mortality risk to emerge from multivariate analysis are low birth weight, prematurity, young age of mother, older mother and high birth order. Conclusion: Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health.