Papers by Premila Webster
European Journal of Public Health, 2018
BMJ global health, 2018
India implemented larger 85% pictorial health warnings on all tobacco products from 1 April 2016.... more India implemented larger 85% pictorial health warnings on all tobacco products from 1 April 2016. However, to remove the last bit of glamour and attraction from the tobacco packs, it must now embrace plain packaging. Plain packaging prevents tobacco packs from carrying the tobacco industry brand imagery as mobile billboards. Postimplementation of larger 85% pictorial health warnings on all tobacco products, this analysis was undertaken to assess the feasibility of plain packaging as the next logical tobacco control policy measure in India. As part of this analysis, the research team reviewed the available literature on legal and policy challenges to plain packaging as a tobacco control policy initiative for India. Literature from 2010 to 2016 in English language was reviewed, which reveals that, India has taken several preparatory steps implemented by other countries like Australia and the UK that have introduced plain packaging, for example, stronger smoke-free laws, ban on tobacco...
BMJ global health, 2016
To assess the feasibility of establishing a simple maternal morbidity surveillance system in Assa... more To assess the feasibility of establishing a simple maternal morbidity surveillance system in Assam (Indian Obstetric Surveillance System-Assam (IndOSS-Assam)) to investigate the incidence and trends in severe maternal complications. This study presents the surveillance platform of IndOSS-Assam. Four tasks were undertaken: (1) setting up of a steering committee; (2) establishing priorities for the region; (3) mapping of surveillance sites; (4) piloting case-notification systems in selected centres. Two government tertiary hospitals in the state. Pregnant women delivering in the hospitals between March and August 2015. Incidence and case fatality rates with 95% CIs. Local stakeholder ownership and a simple uncomplicated anonymous system for case notification were the key strengths of this project. Cases and deaths were reported for six conditions: eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure. Among 10 475 women deliver...
Archives of osteoporosis, 2017
Evidence-based management can reduce deaths and suffering of older adults with hip fractures. Thi... more Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospi...
Journal of the American Heart Association, 2016
Background The relationships between physical activity ( PA ) and both cardiovascular disease ( C... more Background The relationships between physical activity ( PA ) and both cardiovascular disease ( CVD ) and type 2 diabetes mellitus (T2 DM ) have predominantly been estimated using categorical measures of PA , masking the shape of the dose‐response relationship. In this systematic review and meta‐analysis, for the very first time we are able to derive a single continuous PA metric to compare the association between PA and CVD /T2 DM , both before and after adjustment for a measure of body weight. Methods and Results The search was applied to MEDLINE and EMBASE electronic databases for all studies published from January 1981 to March 2014. A total of 36 studies (3 439 874 participants and 179 393 events, during an average follow‐up period of 12.3 years) were included in the analysis (33 pertaining to CVD and 3 to T2 DM ). An increase from being inactive to achieving recommended PA levels (150 minutes of moderate‐intensity aerobic activity per week) was associated with lower risk of CV...
BMJ Global Health, 2016
Main outcome measures: ORs with 95% CIs to estimate the association between maternal iron deficie... more Main outcome measures: ORs with 95% CIs to estimate the association between maternal iron deficiency anaemia and the adverse maternal and infant outcomes. Potential interactive roles of infections and induction of labour on the adverse outcomes were explored. Results: 35% (n=351) pregnant women had moderate-severe anaemia. Women with severe anaemia had a higher odds of PPH (adjusted OR (aOR) =9.45; 95% CI 2.62 to 34.05), giving birth to low birthweight (aOR=6.19; 95% CI 1.44 to 26.71) and small-forgestational age babies (aOR=8.72; 95% CI 1.66 to 45.67), and perinatal death (aOR=16.42; 95% CI 4.38 to 61.55). Odds of PPH increased 17-fold among women with moderate-severe anaemia who underwent induction of labour, and 19-fold among women who had infection and moderate-severe anaemia. Conclusions: Maternal iron deficiency anaemia is a major public health problem in Assam. Maternal anaemia was associated with increased risks of PPH, low birthweight, small-for-gestational age babies and perinatal death. While the best approach is prevention, a large number of women present with severe anaemia late in pregnancy and there is no clear guidance on how these women should be managed during labour and delivery.
Pilot and Feasibility Studies, 2016
Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 mil... more Background: Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. In India, conservative estimates suggest an annual incidence of 600,000 osteoporotic hip fractures and this is expected to increase significantly due to ageing and increase life expectancy. Protocol-based 'care pathways' for the management of adults, over 60 years of age, with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and reduction in healthcare costs. The study objectives are to determine appropriateness, acceptability and feasibility of adopting best-practice guideline or protocol-based care for the management of hip fractures among older adults in India. The study will also identify barriers and facilitators in recruiting patients and retention till the agreed follow-up period. Methods: This will be a mixed-methods prospective cohort study. The quantitative data collection will involve recruitment of consecutive patients aged >50 years with an X-ray-confirmed hip fracture admitted in four tertiary care hospitals in Delhi, India, over a 2-month period. The quantitative data will be collected at three points: from patients at admission to hospital, from medical records at discharge and by telephone interviews with patients at 30 days post hip fracture. Qualitative data collection will involve key informant interviews, conducted with clinical leads and focus group discussions, conducted with groups of healthcare providers and patients and/or their carers. COMB theoretical framework (capability, opportunity, motivation and behaviour) will be used to explore healthcare providers' behaviour in order to facilitate development and implementation of appropriate integrated care pathway for management of older adults with hip fractures in India. Discussion: The proposed study will identify gaps in best practice in the management of older people with hip fractures in tertiary care hospitals in Delhi and document barriers and facilitators to the implementation of protocol-based care through recording the contextual realities of the health systems and care-seeking behaviours. Insights into these factors will be used to facilitate the development of protocol-based management of older people with hip fractures that is appropriate, context specific and acceptable by stakeholders in a low-and middle-income country setting, such as India.
Indian journal of community health
Routine immunisation and Vitamin A supplementation are two of many services offered by Government... more Routine immunisation and Vitamin A supplementation are two of many services offered by Government of India to reduce child mortality and morbidity. The three groups of community level workers (CLWs) i.e. Auxiliary Nurse Midwives from health department, Anganwadi Workers from women and child development department and Accredited Social Health Activists (ASHAs) are responsible for raising awareness and demand for these services. The paper assesses the knowledge and participation of CLWs in generating awareness about the two services namely immunisation and Vitamin A supplementation among eligible mothers; and mother's knowledge on these two services. The study was conducted in 16 villages of two administrative blocks of Udaipur district in Rajasthan. Multistage purposive sampling was used for study area selection. Data collection was done using mixed methods-1) observations of 16 Maternal and Child Health and Nutrition days; 2) questionnaire based survey of 46 CLWs; and 3) questio...
Health Promotion International, 2015
The WHO European Healthy Cities Network has from its inception aimed at tackling inequalities in ... more The WHO European Healthy Cities Network has from its inception aimed at tackling inequalities in health. In carrying out an evaluation of Phase V of the project (2009-13), an attempt was made to examine how far the concept of equity in health is understood and accepted; whether cities had moved further from a disease/medical model to looking at the social determinants of inequalities in health; how far the HC project contributed to cities determining the extent and causes of inequalities in health; what efforts were made to tackle such inequalities and how far inequalities in health may have increased or decreased during Phase V. A broader range of resources was utilized for this evaluation than in previous phases of the project. These indicated that most cities were definitely looking at the broader determinants. Equality in health was better understood and had been included as a value in a range of city policies. This was facilitated by stronger involvement of the HC project in city planning processes. Although almost half the cities participating had prepared a City Health Profile, only few cities had the necessary local level data to monitor changes in inequalities in health.
Healthy Cities Phase V evaluation: further synthesizing realism
Health promotion international, 2015
In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluati... more In this article we reflect on the quality of a realist synthesis paradigm applied to the evaluation of Phase V of the WHO European Healthy Cities Network. The programmatic application of this approach has led to very high response rates and a wealth of important data. All articles in this Supplement report that cities in the network move from small-scale, time-limited projects predominantly focused on health lifestyles to the significant inclusion of policies and programmes on systems and values for good health governance. The evaluation team felt that, due to time and resource limitations, it was unable to fully exploit the potential of realist synthesis. In particular, the synthetic integration of different strategic foci of Phase V designation areas did not come to full fruition. We recommend better and more sustained integration of realist synthesis in the practice of Healthy Cities in future Phases.
BMJ open, 2012
To compare trends in metrics of socioeconomic inequalities in premature coronary heart disease (C... more To compare trends in metrics of socioeconomic inequalities in premature coronary heart disease (CHD) mortality in Great Britain. Time trend ecological study with area-level deprivation as exposure. Great Britain, 1994-2008. Men and women aged younger than 75 years. No lower age limit. None. CHD mortality rates. There has been a decrease in socioeconomic inequalities in CHD mortality in absolute terms but an increase in relative terms. CHD mortality rates in men aged younger than 75 years fell by 69 per 100 000 (95% CIs 64 to 74) in the least deprived quintile and by 92 per 100 000 (95% CI 86 to 98) in the most deprived quintile (p for trend: <0.001). Mortality rate ratios comparing the most deprived quintile to the least deprived quintile increased in women aged younger than 75 years from 1.77 (95% CI 1.68 to 1.86) to 2.32 (95% CI 2.14 to 2.52). There was a weak negative association between the average decline of relative rates and area deprivation. It could either be said that i...
Impact of mothers' employment on infant feeding and care: a qualitative study of the experiences of mothers employed through the Mahatma Gandhi National Rural Employment Guarantee Act
BMJ open, Jan 2, 2014
To explore the experiences of mothers employed through the Mahatma Gandhi National Rural Employme... more To explore the experiences of mothers employed through the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) using focus group discussions (FGDs) to understand the impact of mothers' employment on infant feeding and care. The effects of mothers' employment on nutritional status of children could be variable. It could lead to increased household income, but could also compromise child care and feeding. The study was undertaken in the Dungarpur district of Rajasthan, India. Mothers of infants <12 months of age. Ten FGDs, two in each of the five administrative blocks of the study district were conducted. The groups were composed of a minimum of 5 and maximum of 8 participants, giving a total of 62 mothers. Thematic analysis was conducted to assess patterns and generate emergent themes. Four major themes were identified-'mothers' employment compromises infant feeding and care', 'caregivers' inability to substitute mothers' care', ...
BMJ open, 2011
Introduction It is unclear how much of the geographical variation in coronary heart disease (CHD)... more Introduction It is unclear how much of the geographical variation in coronary heart disease (CHD), stroke and cancer mortality rates within the UK is associated with diet. The aim of this study is to estimate how many deaths from CHD, stroke and cancer would be delayed or averted if Wales, Scotland and Northern Ireland adopted a diet equivalent in nutritional quality to the English diet. Methods Mortality data for CHD, stroke and 10 diet-related cancers for 2007-2009 were used to calculate the mortality gap (the difference between actual mortality and English mortality rates) for Wales, Scotland and Northern Ireland. Estimates of mean national consumption of 10 dietary factors were used as baseline and counterfactual inputs in a macrosimulation model (DIETRON). An uncertainty analysis was conducted using a Monte Carlo simulation with 5000 iterations. Results The mortality gap in the modelled scenario (achieving the English diet) was reduced by 81% (95% credible intervals: 62% to 108...
Cochrane Database of Systematic Reviews, 2014
Family and carer smoking control programmes for reducing children's exposure to environmental tob... more Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke.
Factors affecting the performance of community health workers in India: a multi-stakeholder perspective
Global Health Action, 2014
Journal of Urban Health, 2012
The evidence-base for a health strategy should include information on the determinants of health ... more The evidence-base for a health strategy should include information on the determinants of health and how they link together if it is to influence the health of the population. The WHO European Healthy Cities Network developed a set of 53 healthy city indicators (HCIs), to describe the health of its citizens and capture a range of local initiatives addressing the wider dimensions of health. This was the first systematic effort to collect and analyze a range of data from European cities. The analysis provided important insights into the interpretation, availability, and feasibility of collecting data, resulting in the development of a revised set of 32 indicators with improved definitions. An analysis of the revised indicators showed that this data was more complete and feasible to collect. It provided useful information to cities contributing to developing a description of health and thus helping to identify health problems. It also highlighted issues about the importance of collecting qualitative as well as quantitative data, the number of indicators and the appropriateness of using the indicators to compare different cities. HCIs facilitated the collection of routinely available health data in a systematic manner. The introduction of HCIs has encouraged cities to adopt a structured process of collecting information on the health of their citizens and build on this information by collecting appropriate local data for developing a city health profile to underpin a city health plan that would set out strategies and interventions to improve health and provide the evidence-base for health plans.
Journal of Public Health, 2011
Background The aim of this paper is to describe UK-trained doctors' early intentions about seekin... more Background The aim of this paper is to describe UK-trained doctors' early intentions about seeking careers in public health and their eventual speciality destinations. Methods Analysis of longitudinal studies of medical graduates from all UK medical schools in selected year-of-qualification cohorts from 1974 to 2008; data collected by postal questionnaires at various times after qualifying; and selection, for this paper, of doctors who expressed an early preference for a career in public health and/or who eventually practised in it. Results Of all doctors eventually practising in public health, for whom we had early choices, public health had been the unreserved first choice of 8% (10/125) in their first post-qualification year, 27% (33/122) in their third year and 59% (51/86) in their fifth year. Including first choices for public health 'tied' with an equal preference for a different speciality, and doctors' second and third choices for public health, 19% (24/125) of practising public health doctors had considered public health as a possible career in their first post-graduation year, 41% (50/122) in the third and 83% (71/86) in the fifth year. Conclusions Comparisons with other specialities show that doctors in public health chose their speciality relatively late after qualification.
Journal of Public Health, 2008
Objective To determine the trends in overweight and obesity among White and South Asian children ... more Objective To determine the trends in overweight and obesity among White and South Asian children aged 5-7 years born between 1991 and 1999 and included in the East Berkshire Child Health System. Methods Children were grouped into nine cohorts based on their year of birth. The UK National BMI percentile classification was used to classify the children as overweight and obese and to examine the prevalence and trends by year of birth, sex and ethnicity.
Journal of Public Health, 2007
Objectives To explore whether the English Breast Screening Programme's leaflet improved women's k... more Objectives To explore whether the English Breast Screening Programme's leaflet improved women's knowledge of breast cancer screening. Design Before and after postal questionnaire survey. Participants A random sample of 100 women aged between 49 and 64 years registered with GPs in Oxfordshire on whom data from a prospective, questionnaire survey was available on knowledge and perception of breast cancer screening. Results Women's knowledge of lifetime risk had improved significantly (p , 0.0001) after the leaflet; however, the 'qualitative' interpretation of this numeric risk varied. The proportion of women who said the purpose of screening was to enable simpler treatments had increased from 34 to 45% (p ¼ 0.05). Thirty-two per cent who had previously responded that screening prevented breast cancer now responded correctly; 20% who responded correctly before the leaflet now responded incorrectly. None of the women thought that all screen-detected cancers could be cured; 95% of the women said they were very likely to attend breast screening if invited, and the rest said they were 'fairly likely' to attend. Additional information women wanted included: what causes breast cancer; percentage rates for survival with and without mammograms; and lifestyle advice on how to avoid breast cancer. Conclusions Although the leaflet had improved women's knowledge of the purpose of screening in some areas, some simple messages in the leaflet had not been understood by all women.
Journal of Public Health, 2009
Background Although moderate alcohol consumption has been shown to confer a protective effect for... more Background Although moderate alcohol consumption has been shown to confer a protective effect for specific diseases, current societal patterns of alcohol use impose a huge health and economic burden on modern society. This study presents a method for estimating the health and economic burden of alcohol consumption to the UK National Health Service (NHS). Methods Previous estimates of NHS costs attributable to alcohol consumption were identified by systematic literature review. The mortality and morbidity due to alcohol consumption was calculated using information from the World Health Organization Global Burden of Disease Project and routinely collected mortality data. Direct health-care costs were derived using information on population attributable fractions for conditions related to alcohol consumption and NHS cost data. Results We estimate that alcohol consumption was responsible for 31 000 deaths in the UK in 2005 and that alcohol consumption cost the UK NHS £3.0 billion in 2005-06. Alcohol consumption was responsible for 10% of all disability adjusted life years in 2002 (male: 15%; female: 4%) in the UK. Conclusions Alcohol consumption is a considerable public health burden in the UK. The comparison of the health and economic burden of various lifestyle factors is essential in prioritizing and resourcing public health action.
Uploads
Papers by Premila Webster