Project Update 1: Context Setting
Project Update 2: Embarking on the Inception Phase
Project Update 3: Identifying Project Sites and Including Additional Sites
Project Update 4: Finalising Partner Organisations & Leadership Team
Project Update 5: Data Collection Begins

Project Update 1: Context Setting

Peri-urban settings are marked by rapid growth and increased contact between humans, animals and the environment. The Public Health Foundation of India (PHFI) and the International Livestock Research Institute (ILRI) have come together to establish an applied research programme housed within PHFI under the India Research Initiative on Peri-Urban Human-Animal-Environment Interface.

The India Research Initiative on Peri-Urban Human-Animal-Environment Interface is the first institutionalised multi-sector effort in the country and region that focuses on food safety and security and animal and public health in peri-urban settings. As the first applied research programme on small-holder dairy farms in peri-urban settings, the study will also provide a model for other countries in the region.

The Research Initiative aims to create and maintain sustainable multidisciplinary and multi-actor partnerships for policy-relevant research aimed at decreasing health and environmental problems from livestock agriculture and overcrowded conditions in peri-urban ecosystems. The Initiative will accomplish this by establishing a policy-relevant research programme while generating evidence to influence the coordination of policy and practices that support safe food production, healthy livestock and improved public health. While PHFI/RCZI will steer the project in India, ILRI will provide a larger strategic role in charting a vision for the Initiative, sharing experiences and best practices from other settings. It will help them adapt to the Indian context, facilitating access to resources, providing technical input and policy networks and suggesting appropriate methodologies

Project Update 2: Embarking on the Inception Phase

The inception phase of the Initiative involved extensive research, assessments and stakeholder engagement. This was followed by identifying priority issues that needed to be addressed in order to bring about greater improvement of public health, livestock health and sustainable development in peri-urban livestock farms. The conviction being that only once this was done would the stage be set for policy-relevant research.

Once the inception phase got over, the findings helped inform the proposed research studies and identification of additional research enquiries. This led to the development of strategies for advocacy and policy initiatives that were based on the evidence that was thus generated.

Baseline Survey conducted by the team informed larger studies and other enquires such as research prioritisation, stakeholder analysis and study of gender dimensions

Now, as the project gains momentum, this systematic and inclusive prioritisation will help develop a strategic research agenda that will provide the vision and framework for research on peri-urban health issues that can go even beyond the purview of the Initiative.

Learning from similar studies
The study team drew parallels and lessons from previous EcoHealth research and capacity building experience from other settings and diseases. Notable amongst these were:

  • EcoHealth study of micro-ecosystems of Japanese encephalitis in a high endemic district of India (http://zoonoses.phfi.org/JE/)
  • EcoHealth approach to assessing vector control for Visceral Lieshmaniasis in Bihar
  • In an assessment of rabies control interventions in Tamil Nadu conducted by RCZI, a framework for estimating costs of the rabies control initiative was developed. The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. Costs for scaling up this programme (as well as additional interventions) were estimated using programme data (http://zoonoses.phfi.org/RCZI-organises-expert-meeting-to-assess-impact-of-rabies-and-its-interventions.html)
  • ILRI’s research on zoonotic risks in peri-urban ecosystems such as Africa and  promotion of rational drug use by farmers in a way that can help apply to lessons learnt from other parts of the world

Having in place a dedicated study team
A core team of researchers was identified and brought on board in PHFI in New Delhi, including collaborators from ILRI. All project sites now have a research team of senior and mid-level local collaborators and field staff for data collection and project coordination and management. Each site has a senior investigator from the Veterinary College’s Department of Veterinary Public Health; Department of Veterinary Pharmacology and the Department of Extension Services. In each of these departments, junior researchers and field staff have been assigned to carry out data collection and related activities.

Identifying study methods
Research studies will focus on understanding the peri-urban ecosystem in terms of public health risks and the process of urbanisation and development. Risk and economic assessment methods will be used to quantify public health risks and engagement with stakeholders will allow integration of others’ perspectives to develop a holistic characterisation of this ecosystem.

The Initiative has undertaken two major research projects as a means to develop and implement this platform. This will pave the way for engagement with different government (public health, animal health, urban planning), academic and local actors on concrete problems that require prompt action. The themes that these studies will explore in detail include:

  • Zoonotic potential of bovine tuberculosis
  • Antibiotic use practices as an unsustainable means of increasing food output

The focus of both projects is on the man-bovine interface in smallholder dairy farms in three different peri-urban ecosystems of the country. Both these issues have been identified as high importance to both Indian stakeholders and the global health community. Also, both problems are created in farms and require multi-disciplinary research and action.

Project Update 3: Identifying Project Sites and Including Additional Sites
As per the initial protocol, it was decided to conduct the study in peri-urban areas surrounding Tier 1, Tier 2 and Tier 3 cities. These were going to be based on the different levels of population density and urbanisation in a manner that could help establish a reasonable comparison of the public and animal health situations across ecotypes.

The sites were to be identified, keeping in mind factors such as presence of significant peri-urban dairy farming; location of these dairy farms identified in authorised zones surrounding the centre of the city; and presence of and access to credible and key partners that are willing to carry out research activities. These will include the veterinary college and local NGO that has the experience of working with dairy farmers in these areas.

However, during Formative Research, it was observed that among Tier 1 cities, none met the criteria/case definitions of the study, either in terms of the peri-urban ecosystem or/and small holding cattle size (<=10) or presence of credible veterinary partner.

Infectious diseases are an important public health issue in India. Efforts for their prevention and control are often hampered due to lack of evidence with respect to their burden and risks. Keeping this in mind, the research group proposed that if resources permit, the study would be expanded geographically to gain a more comprehensive and systematically estimated picture that is also more representative of the national scenario. In these additional sites, the expanded scope was to be limited to the baseline survey and the study of risk factors.

In addition to meeting the case definitions, one of the main criteria to select any city was the presence of a credible veterinary college, preferably a Veterinary Public Health Department and/or good lab facility, like deep freeze storage since the study would be dealing with collection and storage of perishable milk samples at prescribed temperature. This necessitated the inclusion of a third new site, namely, Ludhiana where the School of Public Health and Zoonosis, GADVASU was shortlisted. The institute’s credibility was already established, having being on board as a laboratory partner.

The intervention phase has been therefore modified and now includes Guwahati, Bengaluru and Ludhiana as study sites. Legal, financial and ethical approvals have been obtained in order to expedite their being part of the study which includes five sites on board. Apart from the three new inclusions mentioned above, the other two are Bhubaneswar and Udaipur. The MoU and Sub-grant agreements have been signed with all five partners.

Project Update 4: Finalising Partner Organisations & Leadership Team
The selection of the right NGO was critical for smooth implementation, providing information on study sites, conducting census, rapport building with communities, setting up interviews with dairy farmers and seeking consent and other clearances.

At project secretariat level, a mechanism was established to provide leadership and guidance as the project got under way at multiple sites, responding to changing ground realities and advising on policy and programme research related aspects. The Initiative Leadership and Steering Committee comprised members from PHFI/RCZI and ILRI in addition to Dr Sanjay Chaturvedi, Head Department of Community Medicine, UCMS, Delhi and Dr Ashok Kumar, Principal Scientist and Head, Veterinary Public Health Division, Indian Veterinary Research Institute (IVRI). The research group comprised of these members and site partners.

Project Update 5: Data Collection Begins
The RCZI team has taken a number of steps to make the data collection process smooth, accurate and efficient.

For the first time, the team is using tablets to collect data from the field. This will increase speed and efficiency of data collection. The data that is collected in the tablet is directly transferred to the main server housed at PHFI, New Delhi at the end of data collection each day.

One of the chief advantages of this system is the complete omission of the data entry process. This will be a time saver both at the level of data entry as also in terms of reducing any chance of error (data entry from hardcopy questionnaire to excel). The output made available can be directly imported to the data analysis software. The digital format of the questionnaire too will be developed and maintained by a gold medallist who holds a graduate degree in computer science from NIT Kurukshetra.

The GPS location will be captured with the feature that is inbuilt in the survey format. This enables each dairy farm to be geo-tagged. The advantage of this is that it will make the study team relate well to the survey with geographical indicators like land use/land cover patterns.

As per the approved protocol, initially the study was limited to testing of bovine tuberculosis (M. bovis) and Antibiotic residue in the milk sample. The research group however proposed that if resources are adequate, the study should also test for E.coli, brucellosis, and pesticide residue in the milk samples. Based on expert knowledge these conditions/infections having immense public health significance can be transmitted under these settings. Utilising available resources, additional pathogens and residue testing in milk samples will undoubtedly, inform the study team on critical aspects of the disease burden and residue thus contributing to evidence informed policy making.

For all the above, ethical and financial approvals have been obtained and additional funds provided to the laboratory partners. Laboratory investigations comprise of:

Residues: Antibiotic Residue and Pesticide Residue

Pathogens: M. Bovis (Bovine Tuberculosis); Brucellosis; E. Coli

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