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El estado indio de Kerala, reconocido por su modelo de desarrollo humano cuyos logros distan del resto de India y del mundo en desarrollo, ha sido capaz de enfrentar el Covid exitosamente a pesar de las adversas condiciones específicas que caracterizan a la región. El legado del modelo de Kerala, especialmente la disponibilidad de un sistema de salud público y un alto nivel educativo de su población, junto con una efectiva acción colectiva desde donde se retroalimenta un estado proactivo y una sociedad organizada, explican los buenos resultados en la contención de la pandemia del Covid, así como en el alivio de sus impactos socioeconómicos.

The higher prevalence and incidents of chronic and life-threatening illnesses and the aging population living with morbidity and life-limiting conditions necessitate the need for care provisions like palliative care globally. Palliative care strives for the quality of life of patients with terminal illnesses and serious health conditions and their families. However, globally, access to palliative care remains very limited. The situation is similar in India, except for Kerala, where palliative care access to the needy population is almost universal. Kerala’s community palliative care model is globally acclaimed for its operation, which includes community participation and sustainability. The palliative care policy of Kerala, which was the first one in Asia, was a significant milestone in the palliative care movement of Kerala, as it mandated the interventions from government measures and further strengthened the community-managed palliative care interventions. The palliative care efforts in Kerala have significantly influenced the health scenario. However, discussion on the role of palliative care in achieving sustainable development goals (SDGs) is minimal. In this context, this article explores the policy and practices of palliative care in Kerala and its contribution to SDG-3, health and well-being. We have surrounded the discussion on the context of palliative care interventions and Sustainable Development Goal 3 through the unique features of the Kerala model of palliative care and its contribution to the healthcare scenario of the state. Through available literature and from the researchers’ first-hand experience, this article explores the reciprocity of palliative care interventions, policy, healthcare programs, and SDG-3. Documenting the potential of Kerala’s community-based palliative care for SDG-3 has implications for replications of this model in similar contexts.

Background: The palliative care operation in Kerala, unlike other parts of India, is widespread. Kerala's community-based approach to palliative care is often recognized in the current literature as a sustainable model. However, the sustainability of palliative care operations is not empirically studied, and the domains of sustainability are not clearly explained in the current literature. Aims: The present study attempted to explore the following research questions. First, are the community-based palliative care operations in Kerala really sustainable? Second, what are the dimensions of sustainability? Methods: To answer these research questions, an empirical field-based investigation was carried out using the case study method. The study was conducted among ten selected palliative care units in the Malappuram and Palakkad districts of Kerala. The records of service delivery, reports, and other available documents were accessed. Interviews were conducted with the key functionaries and other staff of the individual palliative care units. Results: The result of the study indicates that palliative care is delivering uninterrupted and comprehensive care to the needy in the region. Three dimensions were evident as the sustainability of palliative care operation. Conclusion: The replication of this model requires an understanding of these dimensions.

Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

Although Kerala was the first state in India to report COVID cases, it was well prepared drawing on its past experience in managing effectively the Nipah outbreak and Kerala floods. It knew and initiated the measures required for containment because of its prior experience with mobilizing community-based groups, involvement of local-self government in decentralized planning, and participation in the containment and relief measure as well as a system-ready health system and infrastructure. The measures taken to \"flatten the curve\" that is unique to Kerala and the determinants of success are described in detail as \"what worked\" using the framework we developed post the Nipah outbreak containment experience. These are being shared with the hope that the insights these measures undertaken by the state provide can be used elsewhere to translate and replicate components that work.

The paper is a debate on the ‘Kerala Model’. This trajectory of Kerala Development Model has been hailed for the substantial gains made by Malayali people. However, the marginalization of the non-malayali working population who were brought to Kerala, were not adequately addressed. The paper looks at the dynamics of the marginalization of plantation workers, who fought in the chengara land struggle, who are also dalits, landless and have an abjected life in the plantations.

Background: Transformation of Primary Health Centers to Family Health Centers (FHC) in Kerala is a new movement. It is important to study the perspectives of stakeholders about it so that strengthening of the facilitators and tackling the barriers can be done. Objectives: The objectives of this study were to understand the perspectives of patients and health-care workers on the facilitators and barriers of service utilization in a FHC in Central Kerala. Methods: Descriptive qualitative study was done for a period of 3 months at FHC, Mundur, Thrissur district, Kerala. In-depth interview of medical officer, health supervisor, and accountant was conducted. Two focus group discussions at the FHC among Accredited Social Healthcare Activists (ASHAs) and patients and one among community members were done. The Attride-Stirling's thematic network analysis framework was followed for data analysis. The findings are reported in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Results: The facilitators identified for service utilization are good behavior of staff, evening outpatient department and special clinics, improved infrastructure and clean premise, trust in ASHA workers, subsidized laboratory service, local self-government involvement, funds, and rewards. The barriers of service utilization are staff shortage and workload, lack of awareness among general population about some services, and shortage of medicines. Conclusion: The concept of FHC is agreeable to both the health-care workers and the community. The barriers can be tackled at this stage, and there is a scope to improve health-care quality if this model is introduced across the country.

The introduction establishes the book’s focus on the ways suicide has gained broad visibility as a problem of aspiration in Kerala’s capital city at a time when gains and losses are steep. It lays out the contemporary postcolonial landscape in Kerala, addressing how aspirational horizons have shifted with the liberalization of the Indian economy in the 1990s; the expansion of access to education under the developmental state; and the broadening of a network of money, goods, people, and ideas through transnational migration. Suicide, I argue, offers a powerful lens onto how development, liberalization, and global change feel and are made meaningful at the level of ordinary life. The introduction proceeds to confront the challenges to writing about suicide in the “developing world,” where the wilful destruction of life seemingly confounds the logic of the “needy nation.” It then outlines how what I call a “critical anthropology of suicide” departs from traditional clinical and social science approaches. The introduction concludes with a meditation on the responsibilities, possibilities, and limits for ethnography in the face of suicide.

In this study, a landslide susceptibility assessment is performed by combining two machine learning regression algorithms (MLRA), such as support vector regression (SVR) and categorical boosting (CatBoost), with two population-based optimization algorithms, such as grey wolf optimizer (GWO) and particle swarm optimization (PSO), to evaluate the potential of a relatively new algorithm and the impact that optimization algorithms can have on the performance of regression models. The Kerala state in India has been chosen as the test site due to the large number of recorded incidents in the recent past. The study started with 18 potential predisposing factors, which were reduced to 14 after a multi-approach feature selection technique. Six susceptibility models were implemented and compared using the machine learning algorithms alone and combining each of them with the two optimization algorithms: SVR, CatBoost, SVR-PSO, CatBoost-PSO, SVR-GWO, and CatBoost-GWO. The resulting maps were validated with an independent dataset. The performance rankings, based on the area under the receiver operating characteristic curve (AUC) metric, are as follows: CatBoost-GWO (AUC = 0.910) had the highest performance, followed by CatBoost-PSO (AUC = 0.909), CatBoost (AUC = 0.899), SVR-GWO (AUC = 0.868), SVR-PSO (AUC = 0.858), and SVR (AUC = 0.840). Other validation statistics corroborated these outcomes, and the Friedman and Wilcoxon-signed rank tests verified the statistical significance of the models. Our case study showed that CatBoost outperformed SVR both in case the models were optimized or not; the introduction of optimization algorithms significantly improves the results of machine learning models, with GWO being slightly more effective than PSO. However, optimization cannot drastically alter the results of the model, highlighting the importance of setting up of a rigorous susceptibility model since the early steps of any research.

Background & objectives: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has globally affected 195 countries. In India, suspected cases were screened for SARS-CoV-2 as per the advisory of the Ministry of Health and Family Welfare. The objective of this study was to characterize SARS-CoV-2 sequences from three identified positive cases as on February 29, 2020. Methods: Throat swab/nasal swab specimens for a total of 881 suspected cases were screened by E gene and confirmed by RdRp (1), RdRp (2) and N gene real-time reverse transcription-polymerase chain reactions and next-generation sequencing. Phylogenetic analysis, molecular characterization and prediction of B- and T-cell epitopes for Indian SARS-CoV-2 sequences were undertaken. Results: Three cases with a travel history from Wuhan, China, were confirmed positive for SARS-CoV-2. Almost complete (29,851 nucleotides) genomes of case 1, case 3 and a fragmented genome for case 2 were obtained. The sequences of Indian SARS-CoV-2 though not identical showed high (~99.98%) identity with Wuhan seafood market pneumonia virus (accession number: NC 045512). Phylogenetic analysis showed that the Indian sequences belonged to different clusters. Predicted linear B-cell epitopes were found to be concentrated in the S1 domain of spike protein, and a conformational epitope was identified in the receptor-binding domain. The predicted T-cell epitopes showed broad human leucocyte antigen allele coverage of A and B supertypes predominant in the Indian population. Interpretation & conclusions: The two SARS-CoV-2 sequences obtained from India represent two different introductions into the country. The genetic heterogeneity is as noted globally. The identified B- and T-cell epitopes may be considered suitable for future experiments towards the design of vaccines and diagnostics. Continuous monitoring and analysis of the sequences of new cases from India and the other affected countries would be vital to understand the genetic evolution and rates of substitution of the SARS-CoV-2.