Arsiwala, Lubaina

School of Public Health



India-Antimicrobial use and diagnosis among hospitalized febrile patients in Pune, India

Antimicrobial resistance (AMR), a leading threat to human health, is enabled by unnecessary antibiotic use. Strategies to reduce unnecessary antibiotic use in India, the world's largest antibiotic consumer, are urgently needed. Although most patients hospitalized in India with acute febrile illness receive antibiotics, many cases of acute febrile illness are caused by mosquito-borne diseases, which do not require them. Lack of confirmed diagnosis for acute febrile illness limits judicious antibiotic use. However, the relationship between diagnostic uncertainty and antimicrobial prescription for acute febrile illness has not been well characterized.
Primary Objectives: To determine the impact of (Aim 1) missed diagnosis and (Aim 2) delayed diagnosis on antibiotic use in hospitalized patients in India with mosquito-borne disease.
Secondary Objective: To establish a repository of specimens to validate novel diagnostic techniques for acute febrile illness.

PI Mentor: Dr. Matthew Robinson

My initial feelings on arrival to Pune were happiness since I was glad to be back in my country of origin, India. I had no research experience in global health before coming to Johns Hopkins Bloomberg School of Public Health. The GHEFP experience has showed me how research projects are carried out in low-resource settings. It has widened my perspective on global health. I learned how inter-country projects can be managed and carried out. I have lived in India since birth, so I was familiar with the cultural environment. I learned about the logistical difficulties that can occur in performing research and how they can be circumvented. I learned how to implement the start of the follow-up phase of a longitudinal study. That was the most unique experience for me; from understanding the protocol of the new study phase, training the study nurses about it, figuring out the logistics, having participants start coming in, to identifying and solving any difficulties that may be encountered. It showed me the importance of being resourceful while working in certain circumstances. I count this experience as that which closely met my expectations.

Sassoon Hospital Main Entrance

I received better infrastructure amenities that I expected. I was aware that I would be required to learn a new statistical software for this GHEFP experience and I was looking forward to it. But it turned out to be more demanding than I expected it to be. Being comfortable with STATA, learning RStudio was a challenge. And it did push me out of my comfort zone. However, I believe it was an essential and beneficial experience for me.

I knew the two local languages that were mostly spoken in the area and I have lived in that culture hence I did not experience any ‘culture shock’ at all. The institution had some dressing requirements that I was initially unaware of but did not have any problem following. Despite hailing from that country, I found the food of that particular geographic area/community quite spicy. I would advise a student considering applying for a similar experience to take into account the weather conditions, accommodation and food options, dress code for the hospital and of course, the expectations of the study mentors.

Since India does not practice insurance-based healthcare the challenges are quite different from the United States. Also, it is a tropical country in the ‘developing country’ category (as defined by the World Bank). Hence the financial limitations have the largest impact on the people seeking health care. People from the lower socio-economic strata of society, geriatric patients, people without family and/or societal support tend to take the biggest hits of an already burdened healthcare system. People are trying to make avail of government or non-government healthcare services which are non-profit in nature. However, the schism between the demand and supply of healthcare services is unduly wide and will need a lot more efforts to be bridged. An increased amount of free basic healthcare services should be provided to the government hospitals. Especially, in terms of increasing the hospital staff (doctors, nurses, non-medical staff, etc). Overburdened healthcare providers with resource-limited settings are just ingredients for making an already bad situation, worse. Compared to India, in the United States, because of the health education, motivation and insurance, people are more involved in preventive procedures than therapeutic ones. This leads to lesser burden on USA’s healthcare system, especially fiscally.

Finally, I learned that I find global health quite interesting with a scope of lot of opportunities. I would like to explore and educate myself about the kind of projects and work available in global health. I have not made a significant career decision as yet, but I will definitely consider avenues of planning and carrying out epidemiologic research projects/studies more than earlier.

Thank you very much for providing me with the opportunity for this GHEFP experience.


January 2021



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