Megha Sharma

Megha Sharma

Affiliated to Research
Visiting address: Widerströmska huset Tomtebodavägen 18 A, plan 3, 17165 Solna
Postal address: K9 Global folkhälsa, K9 GPH Stålsby Lundborg, 171 77 Stockholm

About me

  • I am an Associate Professor at the Department of Pharmacology, R. D. Gardi
    Medical College, Ujjain, India and an Affiliated Researcher at Department of
    Global Public Health, Karolinska Institutet, Stockholm, Sweden in research
    group, Health Systems and Policy (HSP): Medicines, focusing antibiotics.
    Presently, I am the Coordinator of three multinational collaborative research
    projects titled- 1) “Antibiotic stewardship program including infection
    prevention and control and wastewater treatment – Implementation research
    in hospital and community in India (APRIAM)” between Sweden and India since
    2017
  • 2) Building equity in digital global health: the case of antimicrobial
    resistance in low- and lower-middle-income countries (EquityAMR) *for *R. D.
    Gardi Medical College, Ujjain (Norway, India, SriLanka and Sweden) and 3)
    "Antibiotic resistance: Preventive measures and minimizing consequences in
    Community, Patients and the Environment through risk assessment and targeted
    interventions in the context of India" between Sweden and India since 2022.
    I have worked as Post Doctoral fellow at the Division of International Health
    (IHCAR), Karolinska Institutet in the HSP research group. In addition, I have
    coordinated and researched in three multinational, multidisciplinary
    collaborative research projects acronym APRIAM I, II and III” during
    2007-2010, 2010 -2013 and 2013-2017 respectively.
    My main area of research is improving the judicious prescribing of
    antibiotics at healthcare facilities, rationalizing the use of antibiotics at
    the community level and minimizing antimicrobial resistance. I have collected
    baseline data of antibiotic prescribing for over 200, 000 in-patients from two
    tertiary care, private-sector hospitals from the private sector in Central
    India. I have established a strong system of manual data collection in the
    study hospitals, with the help of nursing staff.
    Improving hygiene in healthcare facilities and the community is another
    research area of my interest, in order to combat antimicrobial resistance. I
    am the team leader for an interventional study that focuses to improve
    overall hygiene focusing on hand hygiene and the introduction of
    alcohol-based hand rub in healthcare facilities in Central India. The long
    term aim of this study is to minimize healthcare-associated infections (HAI)
    and minimize the spread of infections, both at healthcare facility and
    community level, that will lead to minimizing the overall use of antibiotics.
    I have been regularly involved in teaching to 4-year undergraduate medical
    students in India and Sweden, and actively participate in academic activities
    at Karolinska Institutet, Sweden. I have supervised National and
    International students for their Master's degree in Master of Global Health
    from the Department of Global Public Health, Karolinska Institutet and
    Medical degree during their Master of Medicine at Karolinska Institutet.
    Presently, I am supervising 2 doctoral students and have co-supervised one
    PhD student (2020), registered at Karolisnka Institutet. I have published
    several research articles in peer-reviewed, indexed, international journals.
    My work has been acknowledged and awarded in many International and National
    conferences.
    PhD- Isolation & identification of active constituents of medicinal plants
    /Citrullus colocynthis /& /Artabotrys odoratissimus/, 2001
    MSc (Drugs and Pharmceuticals)- Gold Medalist, 1997

Research

  • Increasing bacterial resistance and an increase in incidences of
    healthcare-associated infections (HAIs) are topics of global concern. Lack of
    knowledge, financial constraints and humid and moist climate of low-
    middle-income countries put them at higher risk of antibacterial (antibiotic)
    use, the spread of infectious diseases including healthcare-associated
    infections (HAIs) and thereby the development of bacterial resistance. A
    significant number of mortalities and morbidity, cost of treatment and
    duration of hospital stay could be minimized by reducing the use of
    antibiotics, preventing the spread of HAIs and bacterial resistance.
    A long term study was designed and is being conducted at two tertiary care
    study hospitals in Central India since 2008. The main aim of the study was to
    provide a baseline of antibiotic prescribing patterns and trends in the
    settings. Based on the results of the pre-intervention phase (Baseline data)
    context-relevant diagnosis-specific prescribing guidelines were developed and
    implemented at high-risk departments. The impact of the interventions will be
    evaluated in terms of a) reduction in antibiotic prescribing and rationality
    in prescribing antibiotics in relation to the diagnosis.
    Another aspect of the spread of infections is to reduce the spread of
    hospital-associated infections (HAIs) and b) to decrease antimicrobial
    resistance These hospitals are private, tertiary care hospitals
  • one teaching
    (850 beds) and one non-teaching (350 beds). Both are located in the Ujjain
    district in Madhya Pradesh, India.
    The study design includes three phases: pre-intervention (baseline),
    intervention and post-intervention. As part of the pre-intervention phase, a
    continuous data collection of antibiotic prescribing in both hospitals has
    been conducted since April 2008. Monitoring of HAI incidence started in
    high-risk wards from August 2010. Up to date over 90, 000 patients have been
    enrolled in prescribing study and 843 suspected HAIs samples. High antibiotic
    prescribing was observed in both hospitals with high rates of HAIs. A
    recently published qualitative study from our group has shown that several
    infrastructural constraints hinder hand hygiene (HH) practices in the
    setting. These results suggest the need for relevant guidelines for rational
    antibiotic prescribing and to improve the HH practice in the settings.
    The intervention package consists of feedback meetings, development and
    implementation of antibiotic prescribing guidelines, the introduction of
    alcohol-based hand rub (ABHR) and training and educational meetings with the
    staff. The intervention phase for HH started with the introduction of
    in-house prepared cost-effective ABHR in high-risk wards (WHO formulation),
    along with educational meetings in August 2011. Awareness campaigns for HH
    are also been conducted for the staff.
    Further, repeated feedback meetings will be done to present antibiotic
    prescribing patterns and HAI incidence data and will be discussed with the
    prescribers. This will be in order to develop the context relevant
    prescribing guidelines with the consensus of the prescribers. Pocket-sized
    printed guidelines will be distributed to the prescribers and posted in the
    wards. The mobile technology will be used to send reminders both for
    improving HH practice and for compliance with the guidelines.
    In the post-intervention phase, the data of antibiotic prescribing will be
    recorded continuously to analyse compliance with the local guidelines. HAI
    incidence rates will be monitored continuously. The compliance to HH practice
    will be observed, documented and analysed at several points. Economic
    feasibility will be checked to introduce the ABHR to the rest of the wards in
    the settings.

Teaching

  • I am teaching undergraduate medical students at R. D. Gardi medical college,
    Ujjain, India on regular basis and regularly contribute to various courses
    held at Karolinska Institutet, Stockholm, Sweden.
    I have supervised 15 Medical students for their degree project in Medicine
    from Karolinska Institutet and 16 students for their Masters in Global/
    Public Health. Nine medical students have received various grants to visit
    and study at the Indian site. I have co-supervised one Doctoral student who
    defended her thesis titled: ‘Antibiotic prescribing at hospitals in Central
    India with limited access to diagnostic methods - what can be improved in
    order to reduce unnecessary antibiotic use and development of antibiotic
    resistance’ in 2020.
    At present, I am supervising two doctoral students registered at Karolisnka
    Institutet.

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