Tucked away at the end of a labyrinth of corridors in Mumbai’s BJ Wadia Hospital for Children is South Asia’s first and only isolation ward for children with drug resistant tuberculosis (TB). Beyond the air curtain at the entrance are compartmentalised beds, where six children, including a 7 month old baby, are being treated. Part of the Drug Resistant Tuberculosis Centre, the ward is ground zero in India’s fight against paediatric TB.
“Our goal is to eliminate tuberculosis,” Ira Shah, head of paediatric infectious diseases, told The BMJ. A lofty goal indeed: childhood TB constitutes 10-20% of all TB in high burden countries like India. Each year, an estimated 25 000 children in India are diagnosed as having multidrug resistant TB (MDR-TB), in cases where the bacillus is resistant to isoniazid and rifampicin; and 1200 are diagnosed with extensively drug resistant TB (XDR-TB), a rare type of MDR TB that is also resistant to fluoroquinolone and at least one of three injectable second line drugs.
The paediatric infectious disease department at BJ Wadia Hospital opened the centre in April this year in response to the growing incidence of drug resistant TB among children, especially in poorer populations.
High impact projects such as this abound among the entries to this year’s BMJ Awards South Asia. Contenders from nine countries—Afghanistan, Bangladesh, Bhutan, India, the Maldives, Myanmar, Nepal, Pakistan, and Sri Lanka—are vying to be crowned champions in various areas of healthcare practice.
This year, the awards received 1575 entries across 10 categories, of which 436 nominations have been shortlisted. The projects display exceptional calibre and ingenuity in tackling challenges facing doctors in South Asia.
“Drug resistant TB is emerging as a major health challenge,” said Shah. “Our studies have found that its incidence among children in Mumbai has increased from 5% in 2007-2010 to 10% in 2013-2016, and continues to grow.”
With the support of Mumbai’s district TB office and the Revised National TB Control Programme, a government initiative, the centre provides children with DR-TB drugs free of cost for the entire course of treatment.
The centre also has a counsellor who provides patient education to families. This may help increase adherence and improve overall TB related morbidity and mortality. “For children with extensively drug resistant tuberculosis, we procure drugs like delamanid from overseas,” Shah said. So far, the team has treated more than 360 cases of paediatric DR-TB with a success rate of over 80%, earning the centre a place among semi-finalists for the Infectious Disease Initiative of the Year.
“The BMJ Awards South Asia have grown to become a prized recognition in the region’s medical community and continue to attract the best talent and work,” Prashant Mishra, managing director of BMJ in India and South Asia, said.
“This year, for the first time, we have more than 25% of nominations making it to the second round of selection, indicating very high quality submissions,” Prashant Jha, senior editor of The BMJ in South Asia, said.
This year’s most popular category is Research Paper of the Year, with 336 nominations. Shortlisted research includes a paper on managing patient safety and care quality in public hospitals in Pakistan and another on the identification of heart disease in children in remote areas in Nepal. The Post Graduate Thesis of the Year category was the second most popular, with 271 entries. Among entries shortlisted in the Healthcare Innovation of the Year category was an innovative method for feeding neonates born with cleft palate.
Most of the entries in the Non-Communicable Disease Initiative of the Year were for projects concerned with cancer and diabetes. Also among the semi-finalists was an initiative to develop collaborations to establish a low cost advanced diagnostic haematology laboratory in Peshawar, Pakistan.
One of the shortlistees in the Maternal and Child Health Team of the Year category was a dedicated fetal cardiology programme in Kerala, India. The project focuses on prenatal diagnosis of heart defects and the transport of pregnant women to facilities to save neonatal lives.
“Birth defects of the heart are the most common form of critical birth defects accounting for almost 25% of infant mortality,” said Balu Vaidyanathan, professor of paediatric cardiology and head of the fetal cardiology division at the Amrita Institute of Medical Sciences and Research Centre in Kochi. “Prenatal diagnosis of congenital heart defects (CHDs) has become standard care in most high income countries. However, in low and middle income countries this is still an unexplored concept,” he added.
“Many CHDs can be corrected with timely treatment. Identifying critical CHDs prenatally allows better planning, family centred counselling, safe transport of the unborn child in the mother’s womb, and monitored delivery in a comprehensive paediatric cardiac facility, resulting in improved perioperative outcomes for neonates,” Vaidyanathan said. Vaidyanathan trained at Guy’s and St Thomas’ Hospital in London and returned to India in 2008 to set up the fetal cardiology division within the existing paediatric cardiac programme. The team found that in cases where the diagnosis has been made prenatally and the neonate treated immediately at birth, the chances of success are far greater than in cases where diagnosis is made after birth.
One shortlisted initiative for Mental Health Team of the Year award focuses on outcomes among poorer patients in eastern Sri Lanka. The initiative is being run by the department of psychiatry at the District General Hospital, Ampara, and aims to improve efficiency of care for patients with severe mental illness. Hiranya Wijesundara, psychiatry consultant, told The BMJ that before the project started most patients with severe schizophrenia, schizoaffective disorder, and bipolar disorder got minimal care.
“Difficulty in accessing clinics and lack of drugs were common complaints from patients and caregivers,” she said, remarking on the many patients who stopped attending for treatment. This targeted intervention programme has increased the number of outreach clinics and availability of psychotropic drugs, provides home visits for assessments and interventions, and provides help if admission is needed to stabilise patients who have had a relapse.
The department runs seven outreach clinics, and the psychiatry team visits each of the clinics once a month. In addition, the team has trained health workers to identify mental illnesses in the community. The project has resulted in better screening, diagnosis, and management of mental illnesses in the region, added Wijesundara, and patients and care givers have reported greater satisfaction with services, and the rate of relapses has gone down.
This team was pitted against 15 other semi-finalists in this category. “Winning the BMJ Awards South Asia would provide much needed visibility for our work. Unfortunately, there isn’t much emphasis on mental health even at the policy level. If our team wins, the award might help us get more support and greater budgetary allocation,” Wijesundara said.
The second stage screening process for the awards is now complete and three finalists have been selected for each category, after a rigorous process. These finalists will be invited to present their work before an eminent jury panel who will select the winners, to be announced at the grand finale on 1 December at the Hilton Hotel in Chennai. Winners will be selected based on their data and methods and the impact, regional relevance, and scalability of their work as well as for patient engagement.