INDIAN COUNCIL OF MEDICAL RESEARCH

DIVISION OF EPIDEMIOLOGY AND COMMUNICABLE DISEASES

Minutes of the Meeting to Identify the “Future directions in Tribal Health Research (Communicable Diseases)” - 8th May, 2012, ICMR Hqrs, New Delhi

The meeting was attended by the following experts:<= /o:p>

Members

1.      Lt. Gen. Dr= . D. Raghunath         Chairman
2.      Dr. D. S. Agarwal
3.      Dr V. P. Sharma
4.      Dr. U. Sengupta
5.      Dr. G. S. Sonal, NVBDCP
6.      Dr. Sarala Subbarao, Consultant, ICMR
7.      Dr. Neeru Singh, Director, RMRCT, Jabalpur
8.      Dr. Neena Valecha, Director, NIMR, Delhi
9.      Dr= . S. Mehendale, Director, NIE, Chennai
10.    Dr. Arvind Pandey, Director, NIMS, Delhi
11.    Dr. P. Vijayachari, Director, RMRC, Port Blair 12.    Dr G K Medhi, Scientist-E, RMRC, North East        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;

13. Dr. Malay Mukherjee, Scientist D, NIIH, Mumbai = &nb= sp; = =

I= CMR Secretariat &n= bsp; = ; &n= bsp; = ; &n= bsp; = ; &n= bsp; =

Dr. Rashmi Arora, Scientist ‘G’ and Head, ECD&nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p;

Dr. Ayan Jha, Scientist C

Dr J. Mahanta, Director , RMRC, North East*. = ;

Dr. P. Jambulingam, Director, VCRC, Pondicherry*

Dr. S. K. Kar, Director, RMRC, Bhu= baneswar*

^=
*could not attend

Dr. Rashmi Aror= a, Sc. ‘G’ and Head, ECD, welcomed the members on behalf of Secretary = DHR & DG, ICMR and thanked them for attending the meeting despite their busy schedule. She appraised the members about the initiation and the follow-up activities being carried out in the Tribal Health Forum under the Chairmans= hip of DG, ICMR. While briefing about the agenda of the meeting she said that D= r. Ayan Jha, Scientist C shall present an overview of the ongoing projects und= er Tribal Sub-plan, Div. of ECD, with reference to the priority areas in Tribal Health Research identified by the Division in 2010. She also requested all experts to thereafter suggest the areas in which Division should carry out research projects, and also to identify Institutes that will collaborate wi= th Medical colleges in conducting Tribal Health research on priority areas.

She further inf= ormed that the Director, RMRCT, Jaba= lpur is the coordinator of the Tribal Health Research Forum (THRF). She requested Dr. Neeru Singh to give her remarks on the expectations of the individual Divisions at the Hqrs from the Tribal Health Forum as well as recommendatio= ns about the proposal (submitted to ECD) by NIIH, Mumbai on “Newborn Screening (NBS) for Sickle Cell Disease to understand the natural history a= nd providing comprehensive care of Sickle Cell Disease in Tribal and Non Tribal population in India”.

With these rema= rks Dr. Arora then requested Lt. Gen. Dr. D. Raghunath to chair the meeting.

Lt. Gen Dr. Raghu= nath thanked ICMR for inviting him for the meeting and expressed satisfaction ov= er the initiatives taken by the Division of ECD in pioneering Tribal Health research on behalf of the Council.

The proceedings of the meeting were as follows:

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Dr. Ayan Jha, Scientist C, ECD presented a brief overview of the ongoing projects in area of Tribal Health in Div. of ECD, as well as the priori= ty areas identified experts in 2010.

The p= riority areas identified were - Burden of communicable diseases in different tribes; Stratification for malaria control in tribal dominated high malarious state= s; Studies on prevalence of Tuberculosis and Filariasis; Helminthiasis; and Socio-cultural practices in tribal. He informed the Committee that the Divi= sion has successfully funded 13 out of 23 complete project proposals received an= d at present, there are 19 ongoing projects being funded under Tribal Sub–= Plan (ECD) with total funding during FY 2011-12 of Rs. 1, 22, 67, 987, exceeding the initially allotted budget. A copy of the detailed presentation is attached at Annexure 1.

Dr. J= ha also suggested that for future “call for proposals” there is need to identify gaps in research priorities, and promote research proposals with appreciable public health interventions and definite deliverables. There is also the need to identify ICMR Institutes for priority research, in collaboration with local Medical Colleges.

Dr. Neeru Singh, Director, RMRCT, Jabalpur and Coordinator, Tribal He= alth Research Forum (THRF), ICMR appraised the committee about the activities of THRF and recommendations made in the pr= evious two quarterly meetings held at NIN , Hyderabad with emphasis on nutritional studies and at NIIH, Mumbai accented on haemoglobinopathies. Dr. Neeru Singh also infor= med the experts that a compendium on research carried out by ICMR on Tribal Hea= lth is to be prepared. This compendium will have state wise, tribal wise and disease wise information on both communicable and non communicable disease.= All institutes will be required to provide information on the work done in 11th Five years plan along with proposed activities vision for 12th Plan.

She also briefed about the project submitted by Director NIIH, Mumbai on “Newborn Screening (NBS) for Sickle Cell Disease and providing comprehensive care to understand the natural history of Sickle Cell Disease in Tribal and Non- Tribal population= in India” which will be presented by = Dr. Malay Mukherjee, Scientist D, NIIH, Mumbai. A copy of the presentati= on is attached at Annexure 2

T= here was an in-depth discussion on addressing the real needs of the tribal population and prioritizing the research areas for “call for proposals” by the Division. The following are the recommendations by = the Expert Committee:

The following suggestions and recommendations were made:

<= span style=3D'mso-list:Ignore'>1.&n= bsp; It was suggested that the Secretary DHR and DG, ICMR Chairman Tribal Health Re= search Forum may consider to propose MoHFW to formulate a “National Tribal H= ealth Programme”.

<= span style=3D'mso-list:Ignore'>2.&n= bsp; In view of streamlining the priority areas f= or research, it was felt that studies with definitive public health interventi= ons aimed at producing specific deliverables so as to result in actual betterme= nt of health and quality of life of the tribal population must be encouraged specifically on the importance of studying health-seeking behavior, researc= h on process evaluation of ongoing national health programmes in tribal areas an= d on addressing the social determinants of health.

<= span style=3D'mso-list:Ignore'>3.&n= bsp; It was also suggested that common protocols should be developed by the Council in relevant research areas to ensure quality, comparability and uniformity of work and to carry out multicentric studies.

The following priority areas were suggested:

1. Communicable Diseases –<= o:p>

a)      Situational analysis to assess the burd= en of Communicable Diseases in tribal population viz: vector borne diseases esp. Malaria, HIV–Tuberculosis co infections, occurrence of Cholera outbreaks etc. <= /o:p>

b)      Process evaluation of ongoing National Health Programmes pertaining to communicable diseases (NVBDCP - Malaria, Dengue, Lymphatic Filariasis, Kala-azar, Japanese Encephalitis and Chikungunya; NACP; RNTCP) should be focused on. Studies sh= ould be carried out in close collaboration with the local health authorities = 211; gaps must be identified and interventions should also be planned simultaneously.

c)      Operational research = on health-care seeking behavior and improving access to health-care services should be prioritized.

d)      Childhood Infectious Diseases &= #8211; Vaccine-preventable diseases, Immunization coverage, Diarrheal diseases and LRTIs

2.      Tuberculosis –

<= span style=3D'mso-list:Ignore'>a)&n= bsp;     Studies to address awareness, health-care seeking behavior, response to treatment, applicability of DOTS in inaccessi= ble tribal areas

<= span style=3D'mso-list:Ignore'>b)&n= bsp;     To study whether different strategies are ne= eded to institute diagnostic measures and deliver the treatment regimens in the tribal areas

<= span style=3D'mso-list:Ignore'>c)&n= bsp;     Operational research to improve treatment re= ach

<= span style=3D'mso-list:Ignore'>d)&n= bsp;     MDR and XDR TB – prevalence and determinants

<= span style=3D'mso-list:Ignore'>e)&n= bsp;     Scientific research to study pathogen and ho= st pathogen interaction, nature of the disease, and the clinical course,<= /o:p>

3.      STDs and HIV – prevalence, health promotional interventions to develop risk-free approaches, awareness, health-care seeking behavior

4.      H= elminthiasis – Epidemiology and impact on= the population especially nutritional anemia and growth of children=

5.      Genetic Aspects – Genetic association in tribals in context of susceptibility to communicable diseases, HLA typing, polymorphisms (SNPs) as well as on prevalence of haemoglobin= opathies in tribal population.

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It was also suggested that Common Proto= cols should be developed at ICMR Hqrs. for above priority areas.

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·= ;      = The project proposal titled “Newborn Screening (NBS) for Sickle Cell Disease and providing comprehensive care to= understand the natural history of Sickle Cell Disease in Tribal and Non Tribal populat= ion in India” under Dr. K. Ghosh, Director, NIIH, Mumbai was presented by Dr. Malay Mukherjee, Scientist = D, NIIH, Mumbai and following are the recommendations:

T= he concept of this project proposal is very good and relevant as it addresses = an important area of tribal health. However, the project needs to be modified = on following lines:

<= span style=3D'mso-list:Ignore'>a.&n= bsp;      The PI should clearly indicate what are the research outcomes of the stud= y and its applicability for benefit of the community

<= span style=3D'mso-list:Ignore'>b.&n= bsp;     The number of study sites may be reduced to 3 (Jabalpur, Maharashtra, Gujarat)<= /p>
<= span style=3D'mso-list:Ignore'>c.&n= bsp;      The budget should be modified accordingly. T= he revised project with modified budget should be submitted to ICMR for its co= nsideration.

The meeting ended with vote of thanks to the Chair.=