About IndiaCLEN
Background of the Organisation
The Indian Clinical Epidemiology Network (IndiaCLEN) is a cluster of seven regional clinical epidemiology units that are members of International Clinical Epidemiology Network (INCLEN). and has been exemplary in the importance of the regional work that it has undertaken. These units are located in medical schools in
- All India Institute of Medical Sciences, Delhi
- King George Medical College, Lucknow
- Governmnet Medical College, Nagpur
- Christian Medical College, Vellore
- Government Medical College, Trivandrum
- Dr.M.G.R. Medical University, Chennai
- Madras Medical College, Chennai
It was founded over 10 years ago when the individual members got together to form a non governmental organization called IndiaCLEN.
IndiaCLEN's goal is to improve the health of populations through the application of the principles of clinical epidemiology, to improve the efficacy, effectiveness and efficiency of health care. The network comprises of over 80 trained clinical epidemiologists, health social scientists, health economists and biostatisticians each of whom were trained under the INCLEN programme and are actively engaged in research and training. Much of these research and training programmes are primarily channeled through the government medical colleges/hospitals and thereby the main focus is on the health care needs of the vulnerable populations. These programmes are both hospital and community based and in the process have a wider reach. IndiaCLEN's main aim is to carry out research that will influence or shape policy, eventually leading to definitive action that in turn will improve health status of the people. Funding for this activity has largely been at two levels. At the global level the Rockefeller Foundation, the US Agency for International Development, the Australian Agency for International Development etc. have funded several of the network's activities and research programmes. At the local level, participating medical schools have mobilized funds to complement the grants from INCLEN.
 Some Contributions Of The Network
Some of the contributions of the IndiaCLEN network to the field of health care knowledge and practice are:
- The assessment of the national pulse polio immunization programme,. coordinated by the AIIMS-IndiaCLEN. This project provided a unique opportunity for policy relevant research and its objective was to evaluate the national pulse polio immunization programme to assess the implementation process. This was carried out for 3 consecutive years using rapid assessment procedures. It was conducted in 24 districts covering 16 states and 48 medical colleges spread across the country. Its major recommendations were that a multidisciplinary approach, social mobilizations through educational and communication programmes were important and needed to be reinforced.
- A series of studies are underway designed to assess various aspects of the problem of emerging infections relevant for health decision making in the areas of surveillance, sexually transmitted disease, antimicrobial resistance to respiratory pathogens and tuberculosis. The studies currently ongoing are:
- Prevalence of sexually transmitted diseases in Tamil Nadu
- Invasive bacterial infection surveillance (IBIS)
- Community anti-microbial resistance
- Risk factors for multi drug resistant tuberculosis
- Short course amoxycillin treatment in non-severe pneumonia
- Multicenter study of abuse against women in the family environment in India (IndiaSAFE). This study was the first community based scientifically designed study providing empirical evidence of the prevalence of family violence in the country. Carried out in rural, urban slum and urban non-slum sites, the study found that nearly 20% of the women in India experienced physical violence while over 40% experienced psychological violence in their marital life. This study also helped to identify risk and protective factors which have been found to be valuable in planning sustainable intervention strategies for such victims of violence - a process that is now underway.
- The Family Health Awareness Programme Evaluation carried out by IndiaCLEN aimed to evaluate the implementation of this national programme. This was carried out in 9 states representing major sociocultural and geographic regions. The recommendation of this evaluation which are now being incorporated into policy decisions are : priority targeting of adolescent boys and girls, social mobilization using all channels of communication, conducting health camps to improve the reach of the programme.
- Another very important area in which IndiaCLEN has been invited to play a significant role is in the field of disease surveillance. The government of India has recognized the importance of the need for an integrated , decentralised disease surveillance system in India and the IndiaCLEN network by virtue of their expertise have been invited by the government to assist in the development of the project implementation plan.
- Depression in primary care: This study is part of a larger project undertaken by an international collaborative group of mental health researchers from INCLEN and will be done in cooperation with the World Psychiatric Association (WPA). It is proposed to be conducted initially in Chennai-India, Beijing-China and Colombia and aims to develop a method of adapting and implementing the training materials recently developed by WPA to improve the ability of primary care physicians to recognize and manage depression.
Contribution By Individual Members
In addition to the above, members in their individual capacity have been identified as key players and have collaborated with various national and international organizations to further contribute to research. Some of these path-breaking studies are:
- Iodine deficiency disorders (Govt. of India and Micronutrient Initiative)
- Intervention programme for nutritional anemia and haemoglobinopathies amongst some primitive tribal population in India (Funded by Department of Biotechnology, India)
- Programme for prevention for sickle cell disease (Funded by Indian Council for Medical Research)
- Abuse assessment screen in antenatal care (Funded by OXFAM)
- Community participatory approach to childhood disability management (Collaboration with Govt. of Kerala)
- Integration of Sexually Transmitted Infection with Maternal and Child Health Care services (Collaboration with Aids Prevention and Control Society)
- Group A Streptococcal Pharyngitis in children (Collaboration with John Hopkins School of Public Health)
Innovation in Programme Design
The multidisciplinary expertise of IndiaCLEN has been of considerable use in the planning and development of innovative research designs in various studies. For example:
- In the Pulse Polio Immunization Evaluation, Rapid Assessment Procedures (RAP) a qualitative research technique was used. Similar method was used successfully in the Family Health Awareness Evaluation programme.
- The IndiaSAFE study used a combination of qualitative and quantitative techniques. The qualitative component helped not only in informing the development of the instrument but also in understanding in-depth, the factors related to the phenomena of family violence and community norms on violence. The quantitative component brought out the magnitude of the problem.
- The process of integration of STI services with MCH care was evaluated using operations research methodology. This design examines an ongoing programme and helps to identify its strengths and weaknesses in order to make modification for better implementation and results.
- The integrated disease surveillance programme is a comprehensive programme that is designed to usher in a holistic approach to disease surveillance. Integration at various administrative and technical levels with quick feedback for prompt action is the unique feature of this programme.
Organisational Capacity & Collaboration with Others
The organizational capacity of the network lies in its flexibility and adaptability. There is no rigid hierarchy, members are drawn from different clinical disciplines and they complement and support each other in their research and training activities. The administrative office, which is located in Chennai, functions as the nodal office and helps to coordinate the activities of the network. The office also maintains a data bank on the research activities and interests of the network. The office also liases with other national and international research and funding organizations keeping alive the interests of the network. The network by virtue of its multidisciplinary character and their links with INCLEN have been successful in establishing collaborative partnerships with other clinical epidemiology units and networks in other countries like, China, South East Asia, Africa and South America and the United States of America.
Teaching and Training
The training programmes that we are running now are as follows :
- M.Phil in Clinical Epiodemiology, CEU, Trivandrum.
- MSC in Epidemiology, CMC, Vellore.
- Short course on Biostatistics, CMC, Vellore.
- Short course on Strategies in Mental Health Research,CEU, Chennai.
- Short course in health economics, CEU, Lucknow.
In addition each of the CEUs run regular teaching workshops on epidemiology, health social science and biostatistics for medical and para-medical students (Both undergraduate and postgraduate levels) The individual CEU members are also engaged in guiding the medical students on their postgraduate and doctoral thesis.
|
