Community Health Research Unit

 

KEMHRC Pune started its activities in 1973 with a vision to strive for excellence and to encourage clinicians and social scientists in conducting quality research. Established as a formal not-for-profit organization registered with the office of Charity Commissioner, the KEMHRC has emphasized research linked to its ongoing medical and public health programs. Its activities are focused on applied, problem-oriented, and problem-solving research with emphasis on the vulnerable sections of the population, i.e. women and children.

Various departments of KEM Hospital conduct research activities under the aegis of KEMHRC. The array of research ranges from laboratory and clinical to community-based research. In 1988, a community-based outreach program, named Vadu Project, now known as Vadu Rural Health Program (VRHP) was introduced, catering to the primary health care needs of the rural population of 22 villages in Shirur/Haveli blocks. This VRHP contributed to national programs on immunization, tubectomy, vasectomy, tuberculosis control, childhood disability identification program, and development of community health volunteer schemes. In 2002, the Health and Demographic Surveillance System (HDSS) was initiated in these 22 villages to understand the complex interaction between socio-demographic characteristics and health at the individual and population level. Soon after establishing Vadu HDSS, sometime in 2004, the Vadu Research team was established which was stationed at Vadu and conducted research in this area unlike previous decades when all research was done by investigators from KEMHRC Pune office. This worked very well especially as the HDSS facilitated national and globally relevant health research in epidemiology, vaccine trials, social sciences, technology and so forth.

In 2015-16, the research group of VRHP, expanded its study area in the northern part of Pune District including in Khed, Ambegaon, and Junnar blocks, spread across 500+ villages with an estimated population of around one million and about 18000 annual births to cater to need of Implementation Research in collaboration with the Public Health System (including facilities of 29 PHCs, three rural hospitals, and one sub-district hospital- SDH). Initially, the KEM team was housed at SDH but as work increased, KEMHRC has established its own office at Manchar.

On 21st February 2022, KEMHRC has recognized this research facility as its yet another department and named it as COMMUNITY HEALTH RESEARCH UNIT (CHRU). The (Figure 1) below shows area covered by CHRU and public health facilities in this area.

   area

CHRU’s first project “Early Implementation of Rollout of Rotavirus Vaccine in Public Health System” aimed to introduce indigenous rotavirus vaccine in India in a phased manner through relevant Government agencies. A network of private and public healthcare providers was created as part of sentinel surveillance. This project turned out to be a stepping-stone and provided a unique opportunity to broaden our research portfolio especially in collaboration with the public health system. The public health system being one of the most important stakeholders, helped us to strengthen our capabilities of conducting implementation and translational research. The role of KEMHRC in many of these projects was to provide technical oversight, training, monitoring, provide initial handholding whereas the public health system was primarily responsible for implementing the project. Through various trainings and CMEs and sharing our research experience has helped the process of capacity building of the public health staff and to some extent private healthcare providers as well. The positive results are evident in terms of healthcare delivery for the local community with effective implementation of some of the public health programs.

Some of the key research studies of policy relevance, conducted at CHRU are listed below:

1) 116 E Rotavirus Vaccine (BBIL) rollout in Public Health systems and sentinel surveillance of intussusception. This study showed that the systematic approach of the rollout of the new vaccine in the public health system results in effective implementation and results showed that vaccine has no increased risk of intussusception. This vaccine is now rolled out across the country in Universal Immunization Program (UIP).

2) The Possible Serious Bacterial Infection (PSBI) study was an innovative approach to simplify the management of sick young infants where referral is not possible in a rural area. This study revealed that the management of PSBI is feasible to implement in out-patient facilities in the public health system where referral is not possible. A sustainable adoption of this intervention by the health system can lead to decrease in neonatal mortality and morbidity.

3) The study to assess uptake and sustained use of cleaner cooking fuel-LPG through Pradhan Mantri Ujjwal Yojna (PMUY) revealed barriers such as accessibility and affordability which need to be addressed for better uptake.

4) Assessment of the feasibility of introducing pulse oximetry in IMNCI services in primary health facilities in Pune district is an ongoing study and its preliminary findings suggest that the usage of a pulse oximeter in IMNCI services in the public health system can be introduced to reduce misclassification of severe pneumonia, appropriate management, and reduction in morbidity and mortality in under-five children.

5) Phase III, Multicentre, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy of Probiotic Supplementation for Prevention of Neonatal Sepsis in 0-2 Months old Low Birth Weight (LBW) Infants in India. This ongoing study is crucial as reduction in infectious morbidity with probiotics intervention among most at-risk LBW infants is likely to impact neonatal mortality, growth, and development.

In recent pandemic time, as Government of India’s response to the COVID 19 Pandemic, the Department of Biotechnology (DBT)-Biotechnology Industry Research Assistance Council (BIRAC) selected and funded KEMHRC under “Mission COVID Suraksha” for strengthening its institutional capacity in order to accelerate efficient conduct of human clinical trials on vaccines for COVID-19 both at the hospital and community-based location at CHRU. From Mission COVID Suraksha funding, a state of the art clinical trial unit is now developed as per the industry standards. The current infrastructure includes (but is not limited to):

  1. 2-8 degree industry make refrigerators (2 units)
  2. -20 degree deep freezer (1 unit)
  3. Centralized Temperature Monitoring System
  4. Bio-Safety Cabinet (BSL II)
  5. Cooling Centrifuge Machine
  6. Barcode Reader Printer
  7. Defibrillator, ECG Machine, Multipara Monitor
  8. Oxygen Concentrator Machine
  9. Online UPS and 24x7 Power back-up
  10. Audio-Video Recording System for Informed Consent Process
  11. Video Conferencing System for meetings and training
  12. Call Centre Facility

CHRU now looks forward to scaling up operations in this geographic area to include regulatory vaccine studies of national and global importance along with continuing our forte in implementation research in collaboration with the public health system.

CHRU in Academics: In addition to the studies, following on the footsteps of VRHP, CHRU also has started its activities in academics. There are two PhD scholars (Mrudula Holkar and Rohan Shah) who are working for their thesis under the supervision of Prof. Sanjay Juvekar in CHRU area. Mrudula’s PhD work aims to increase TB case notification among Private Providers using the interventional package of Advocacy, Communication and Social Mobilization (ACSM) in Junnar block. In this study, all private providers of Junnar and Ambegaon blocks will be the target population for the study. Intervention group will be from Junnar block and control group will be from Ambegaon block. Rohan’s PhD aims to assess effect of cleaner cooking fuel (LPG) on blood pressure in women from rural Maharashtra. In this cross sectional study women using LPG as their primary source of cooking fuel and women using biomass as their primary source of cooking will be recruited. Both PhDs are in data collection phase.

Team CHRU: Dr. Girish Dayma matured as a clinical trials manager at Vadu who recently returned from Spain after completing his Masters in Global Health at University of Barcelona has been entrusted the responsibility to lead CHRU under able guidance of Dr. Ashish Bavdekar and Prof. Sanjay Juvekar. Currently, he has a team of about 35 staffs with different cadres including Project Coordinators, Study Physicians, Document Officer, Quality Assurance Officer, Pharmacist, Field Research Assistants at CHRU. This team is getting trained at regular interval by experienced team of VRHP which has helped to maintain the KEMHRC’s rigor of scientific work.

 List of Completed, Ongoing, and Upcoming Studies at CHRU (formerly Manchar facility)

 

Completed Studies

 Sr.No                   
 Title of the Project                     
 Funding Agency/Sponsor                                                     

 Name of associate Departments/Organizations, if Any            

 1. Early Implementation of Rotavirus Vaccine in Public Health System under monitoring

Bill & Melinda Gates Foundation and Society for Applied Studies, Delhi  

State Family Welfare Bureau- Pune, Zilla Parishad Health Department-Pune, INCLEN-Delhi, SAS-Delhi

 2. An Innovative Approach to Jump Start Simplified management of Sick Young Infant with PSBI where referral is not possible for potential Scale-up

World Health Organization (WHO)  

State Family Welfare Bureau-Pune, Zilla Parishad Health Department-Pune, World Health Organization

 3. Nasopharyngeal pneumococcal carriage study in South Asian infants

The University of Edinburgh  

State Family Welfare Bureau-Pune, University of Edinburgh, Sanofi Pasteur

 4. Enhancing Liquefied Petroleum Gas (LPG) Use During Pregnancy

Implementation Science Network (ISN)  

Implementation Science Network, University of California, Sri Ramchandra University-Chennai

 5. Toward exclusive LPG use: Ensuring increased LPG use through a second gas cylinder and reducing availability of the traditional chulha

Indian Council of Medical Research (ICMR)  

Indian Council of Medical Research (ICMR)

 6. Short term assessments to inform accelerated distribution, uptake, and promotion of increased use of LPG through PMUY

Indian Council of Medical Research (ICMR)  

Indian Council of Medical Research (ICMR)

 7. ASHA Workload and its Determinant

NIHR Global Health Unit in Respiratory Health (RESPIRE)  

State Family Welfare Bureau-Pune, Zilla Parishad Health Department-Pune

 8. Effect of maternal smokeless tobacco use in pregnancy on birth weight

K.E.M. Hospital Research Centre Pune  

K.E.M. Hospital Research Centre Pune

 

Ongoing Studies


 Sr.No                   
 Title of the Project                     
 Funding Agency/Sponsor                                                     

 Name of associate Departments/Organizations, if Any            

 1. Assessment of feasibility of introducing pulse oximetry in IMNCI services in primary health facilities in Pune District

NIHR Global Health Unit in Respiratory Health (RESPIRE)  

State Family Welfare Bureau-Pune, Zilla Parishad Health Department-Pune

 2. Implementation research on a government health program for management of high-risk pregnancies in tribal communities in Pune district: barriers, facilitators and scalability

World Health Organization (WHO)  

State Family Welfare Bureau-Pune, Zilla Parishad Health Department-Pune, World Health Organization

 3. Practices & perceptions of public & private, general medical practitioners (primary care physicians: “GPs”) in rural India for diagnosis & management of asthma & Chronic Obstructive Pulmonary Disease

NIHR Global Health Unit in Respiratory Health (RESPIRE)  

 

 4. Stakeholder Engagement in Community and Public Health System

NIHR Global Health Unit in Respiratory Health (RESPIRE)  

 

 5. A multicenter phase II/III double-blind, randomized, Placebo-controlled study to evaluate the efficacy safety of VPM1002 in the prevention of Tuberculosis (TB) recurrence in pulmonary TB patients after successful TB treatment in India

Serum Institute of India Pvt. Ltd  

Central TB Division, State TB Office, Zilla Parishad Health Department-Pune

 6. Human Microbiome Initiative of Select Endogamous populations in India

Department of Biotechnology (DBT)  

NCCS-University of Pune

 7. Establishing sentinel sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in the general population in rural Western India

NIHR Global Health Unit in Respiratory Health (RESPIRE)  

The University of Edinburgh, UK

 8. Phase III, Multicentre, Randomized, Double-blind, Placebo-controlled Study to Evaluate Efficacy of Probiotic Supplementation for Prevention of Neonatal Sepsis in 0- 2 Months old Low Birth Weight Infants in India

Indian Council of Medical Research (ICMR)  

MGIMS-Sewagram

 9. Enhancing capacity of KEM Hospital Research Centre, Pune for conduction of community-based human clinical trials on vaccines for COVID-19

DBT-BIRAC  

 

 

Upcoming Studies


 Sr.No                   
 Title of the Project                     
 Funding Agency/Sponsor                                                     

 Name of associate Departments/Organizations, if Any            

 1. Microbiota-directed complementary foods (MDCF) to treat children with moderate acute malnutrition (MAM)

SUN Pharma Advance Research, Mumbai  

CMC Vellore & SAS New Delhi

 2. Last-mile delivery of vaccines, samples and medical essentials in Rural Maharashtra using drones

Foreign Commonwealth & Development Office, UK  

Volar Alta, Pune

 3. The Impat of PMUY on Blood Pressure & ARI Morbidity in India

ICMR  

SAS-Delhi, ICMR Institutes, University of California

 4. Shigellosis Surveillance in Under Five Hospitalized Children

CMC Vellore & Wellcome Trust 

CMC Vellore and SAS Delhi

 

Academic and Intramural studies


 Sr.No                   
 Title of the Project                     
 Funding Agency/Sponsor                                                     

 Name of associate Departments/Organizations, if Any            

 1. An interventional Study to determine Impact of Advocacy, Communication and Social Mobilization (ACSM) on strengthening TB Case Notification under Revised National Tuberculosis Control Programme by Private Providers of Junnar Block in Pune district (RNTCP change to NTEP)

K.E.M. Hospital Research Centre Pune  

K.E.M. Hospital Research Centre Pune

 2. Effect of cleaner cooking fuel (LPG) on blood pressure in women from rural Maharashtra

K.E.M. Hospital Research Centre Pune  

K.E.M. Hospital Research Centre Pune

 
 

 Publications from Studies conducted at CHRU (formerly Manchar facility)(formerly Manchar facility)

Publications

A survey of the training and working arrangements of general practitioners providing asthma and COPD care in a rural area of Western India. RESPIRE Fellowship project (Submitted to BMC Health Services Research)
Patil R, Agarwal D, Kaur H, Gadgil M, Jackson T, Fernandes G, et al. Engaging with stakeholders for community-based health research in India: Lessons learnt, challenges and opportunities. J Glob Health [Internet]. 2021 Apr 24;11:03072. Available from: http://jogh.org/documents/2021/jogh-11-03072.pdf
Patil R, Roy S, Gore M, Ghorpade M, Pillarisetti A, Chakma J, et al. Energy for Sustainable Development Barriers to and facilitators of uptake and sustained use of LPG through the PMUY in tribal communities of Pune district. Energy Sustain Dev [Internet]. 2021;63:1–6. Available from: https://doi.org/10.1016/j.esd.2021.04.008
Sinha AP, Gupta SS, Poluru R, Raut A V., Arora NK, Pandey RM, et al. Evaluating the efficacy of a multistrain probiotic supplementation for prevention of neonatal sepsis in 0-2-month-old low birth weight infants in India-the “ProSPoNS” Study protocol for a phase III, multicentric, randomized, double-blind, placebo-controll. Trials. 2021;22(1):242.
Kawade A, Gore M, Lele P, Chavan U, Pinnock H, Smith P, et al. Interplaying role of healthcare activist and homemaker: a mixed-methods exploration of the workload of community health workers (Accredited Social Health Activists) in India. Hum Resour Health. 2021;19(1):1–12.
Harrell BS, Pillarisetti A, Roy S, Ghorpade M, Patil R, Dhongade A, et al. Incentivizing Elimination of Biomass Cooking Fuels with a Reversible Commitment and a Spare LPG Cylinder. Environ Sci Technol [Internet]. 2020 Dec 1;54(23):15313–9. Available from: https://pubs.acs.org/doi/10.1021/acs.est.0c01818
Bhandari N, Antony K, Balraj V, Rongsen-Chandola T, Kumar T, Sinha B, et al. Assessment of risk of intussusception after pilot rollout of rotavirus vaccine in the Indian public health system. Vaccine [Internet]. 2020;(xxxx):1–8. Available from: https://doi.org/10.1016/j.vaccine.2020.05.093
Pillarisetti A, Roy S, Diamond- N, Ghorpade M, Dhongade A, Balakrishnan K, et al. Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes. 2020;1–9.
Roy S, Patil R, Apte A, Thibe K, Dhongade A, Pawar B, et al. Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India. PLoS One [Internet]. 2020;15(8):e0236355. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32833993
Baviskar V, Patil R, Roy S, Doiphode S, Dhongade A, Juvekar S. Comparison of Immunization Coverage Status Reported through NFHS Coverage Evaluation Survey and HMIS in Maharashtra. Indian J Public Heal Res Dev. 2020;11(1).
Harish S, Smith KR, Josey A, Sreenivas A, Dabadge A, Parikh J. From Access to Sustained Usage Edited by. 2019;(August).
Roy BS, Patil R, Pillarisetti A, Harrell S, Levine D, Juvekar S. ( Ujjwala 2 . 0 series ) Health Benefits of PMUY : Challenges in Effective Implementation and Possible Solutions CCAPC is a joint activity of. 2019;
Pillarisetti A, Ghorpade M, Madhav S, Dhongade A, Roy S, Balakrishnan K, et al. Promoting LPG usage during pregnancy: A pilot study in rural Maharashtra, India. Environ Int [Internet]. 2019;127:540–9. Available from: https://doi.org/10.1016/j.envint.2019.04.017
Patil R. A joyful homecoming. Lancet Respir Med [Internet]. 2018;6(12):904. Available from: http://dx.doi.org/10.1016/S2213-2600(18)30474-0
KEM Hospital Research Centre Pune. Annapurna [Internet]. 2018. Available from: https://www.youtube.com/watch?v=c1hq1mTt6dk&t=12s

 
 

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