Arunima Sehgal Mukherjee

• Modgil, Vinay; Sahay, Sundeep; Singh, Ravikant; Mukherjee, Arunima Sehgal; Surial, Rashmi & Bhoi, Bibekananda (2026). Health-system drivers of outpatient antibiotic use: evidence from prescribing, centralized supply, and catchment populations in public tertiary hospitals in Bihar, India. Frontiers in Health Services. 6. doi: 10.3389/frhs.2026.1800794. Fulltekst i vitenarkiv Vis sammendrag

  Background: In low- and middle-income countries (LMICs), antibiotic use is shaped not only by clinical decision-making but also by health-system factors such as centralized drug procurement, supply availability, and population catchment pressures. However, empirical evidence linking outpatient prescribing patterns with state-level antibiotic supply and catchment characteristics remains limited. Bihar, one of India's most populous and resource-constrained states, represents a critical yet under-studied setting for understanding these interactions. Methods: We conducted a multicentre observational study across three public tertiary care hospitals in Bihar, SKMCH Muzaffarpur, DMCH Darbhanga, and JLNMCH Bhagalpur, using outpatient prescription data collected between 2023 and 2025 (n = 8,822). These data were triangulated with state-level antibiotic supply records from the Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) for 2022–2025 and secondary data describing hospital catchment populations. Prescribing indicators, WHO AWaRe classification, essential drug list (EDL) status, and supply–prescription concordance were analysed to assess alignment with antimicrobial stewardship goals. Results: Across all sites, outpatient antibiotic use was characterized by high polypharmacy (4–4.7 drugs per prescription), extensive empirical prescribing, and minimal use of culture-based diagnostics (≤2.6%). Broad-spectrum antibiotics dominated prescribing, with Amoxicillin–Clavulanic acid (42.8%), Azithromycin (13.1%), and Cefixime (6.9%) being most frequently used. While Access-category antibiotic use exceeded 50% at two sites, Watch-category use was disproportionately high at JLNMCH (58%), a hospital serving an extensive rural catchment with long patient travel times. Supply–prescription analysis revealed strong alignment for commonly used antibiotics, indicating stable state-level procurement patterns; however, the continued use of Watch-category and non-EDL antibiotics, including Moxifloxacin, raised stewardship concerns. Notably, irrational fixed-dose combinations were prescribed despite not being supplied, indicating parallel private-sector access. Generic prescribing exceeded 97% across all sites, reflecting a positive institutional norm. Conclusions: Antibiotic prescribing in Bihar's public tertiary hospitals is influenced by the interactions of centralized supply stability, diagnostic constraints, and catchment-level pressures rather than prescriber behaviour alone. Persistent availability of broad-spectrum antibiotics through state procurement may be associated with entrenched prescribing patterns, particularly in high-volume, rural-serving facilities. Effective antimicrobial stewardship in such settings requires context-sensitive strategies that integrate supply-chain reform, strengthened diagnostic pathways, and locally tailored prescriber support, moving beyond uniform, guideline-only approaches.

• Modgil, Vinay; Sahay, Sundeep; Mukherjee, Arunima Sehgal; Banta, Rashi; Joshi, Neha & Surial, Rashmi [Vis alle 10 forfattere av denne artikkelen] (2025). Integrating procurement, prescription, and resistance data to strengthen antimicrobial stewardship: insights from a public health institution in India. Frontiers in Microbiology. 16. doi: 10.3389/fmicb.2025.1673019. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Sustained and sub-optimal antimicrobial use drives antimicrobial resistance (AMR), a major health systems challenge in low- and middle-income countries (LMICs) such as India. This study examined the relationship between institutional antimicrobial procurement and outpatient prescribing patterns, and how these influence resistance trends identified through antibiotic susceptibility testing (AST) in a public community hospital. Methods Data were collected from three sources: (i) procurement records (2018–2022), (ii) AST results from urine, pus, and stool samples (2023–2024), and (iii) outpatient prescriptions (2023–2024). Each dataset was analyzed individually and in an integrated framework to assess interrelationships between antimicrobial use and resistance. Results Amoxicillin-clavulanate, ciprofloxacin, and doxycycline were among the most procured drugs, with Escherichia coli (urine) resistance rates of 53%, 87%, and 39%, respectively. The most frequently prescribed antimicrobials were Amoxicillin-Clavulanate (24%), Cefixime (15%), and Azithromycin (11%); over 50% were broad-spectrum agents and over 90% belonged to the WHO AWaRe “Access” category. Correlation analysis revealed a weak positive association between procurement and sensitivity, indicating that higher procurement did not necessarily increase resistance. Discussion These findings demonstrate the feasibility of linking institutional datasets to identify inefficiencies in antimicrobial use and guide evidence-based stewardship interventions, including formulary revision, procurement alignment, and data-driven prescribing practices.

• Surial, Rashmi; Sahay, Sundeep; Modgil, Vinay; Mukherjee, Arunima Sehgal & Bhandari, Ritika Kondal (2025). A Biosocial Perspective to Understand Antimicrobial Prescription Practices: A Retrospective Cross-Sectional Study from a Public Community Health Center in North India. Antibiotics. 14(3). doi: 10.3390/antibiotics14030213. Fulltekst i vitenarkiv Vis sammendrag

  Background: It is well established by research that large-scale and indiscriminate prescribing, dispensing, and use of antimicrobials drive antimicrobial resistance (AMR) endangering the health and well-being of people, animals, and the environment. In the context of low- and middle-income countries (LMICs), the prescribing of antimicrobials is often not based on biomedical rationality but involves alternative logic driven by social, cultural, and institutional factors. This paper seeks to develop a “biosocial” perspective, reflecting a unified perspective that treats the biomedical and social conditions as two sides of the same coin. Methods: This analysis is based on an empirical investigation of prescription slips that patients carry to buy drugs from the pharmacy following an outpatient department encounter with the clinician. Data collection involves mixed methods, including the quantitative analysis of the antimicrobials prescribed and a qualitative analysis of the underlying reasons for these prescriptions, as described by doctors, pharmacists, and patients. Data analysis involved triangulating quantitative and qualitative data, to develop a “biosocial” perspective, which can provide implications for the development of antimicrobial stewardship policies, particularly relevant for health institutions in low- and middle-income countries. Results: Our analysis of 1175 prescription slips showed that 98% contained antimicrobials, with 74% being broad-spectrum antimicrobials. Only 9% of cases were advised antimicrobial sensitivity testing (AST) before initiating treatment. Qualitative findings indicated that patients had poor awareness of antimicrobials and pharmacists played a crucial role in counseling. Conclusions: This study highlights that antimicrobial prescriptions in public health settings are influenced by both biomedical and social factors, supporting a biosocial perspective. Although AMS interventions are predominantly biomedical, adhering to clinical standards and best practices, this study underscores the necessity of integrating a biosocial viewpoint by incorporating the experiences of pharmacists and patient groups. Strengthening diagnostic support, patient education, and interprofessional collaboration could improve rational antimicrobial uses in low-resource settings.

• Modgil, Vinay; Sahay, Sundeep; Taneja, Neelam; Qayyumi, Burhanuddin; Singh, Ravikant & Mukherjee, Arunima Sehgal [Vis alle 8 forfattere av denne artikkelen] (2025). Mapping the AMR Infection Landscape in Bihar: Implications for Strengthening Policy and Clinical Practice. Antibiotics. 14(7), s. 684–705. doi: 10.3390/antibiotics14070684. Fulltekst i vitenarkiv Vis sammendrag

  Background: Antimicrobial resistance (AMR) poses a significant threat to public health, especially in low- and middle-income countries (LMICs), where surveillance infrastructure is underdeveloped. Bihar, India’s third most populous state and one of its least-resourced states, has remained largely absent from national AMR monitoring initiatives. Methods: This study aimed to characterize the AMR infection landscape across five public tertiary care hospitals in Bihar over three years (2022–2024) and to assess the feasibility of integrating digital workflows for real-time microbiological reporting. Standardized antimicrobial susceptibility testing (AST) was performed on >48,000 urine, pus, and blood samples using CLSI guidelines. Facility-level data were digitized into an open-source AMR reporting system, enabling automated antibiogram generation. Results: The findings revealed substantial resistance: high resistance to beta-lactams, carbapenems, and fluoroquinolones across pathogens. For instance, E. coli sensitivity to nitrofurantoin varied from 86.5% at NMCH (Patna) to 44.7% at JLNMCH (Bhagalpur), while cephalosporin sensitivity in Klebsiella spp. dropped below 2% in several hospitals. MRSA prevalence exceeded 65% in two facilities, far above the national average of 47.8%. Digital integration led to a four-fold increase in culture testing in all facilities and improved data completeness and turnaround times. Spatial analysis and microbiology laboratory assessment revealed significant geographic disparities in diagnostic access, with facilities in remote districts facing delays of over four hours for basic testing. Conclusions: Our study is the first study from India to create such a broad, facility-associated AMR picture over time at a state level. Policy implications include the need for a state-level AMR surveillance dashboard, alignment of procurement with facility-specific resistance patterns, and routine stewardship audits. Clinically, this study demonstrates the utility of localized antibiograms for guiding empirical therapy in resource-limited settings. This study provides a scalable framework for embedding AMR surveillance into routine health system workflows in LMICs.

• Mukherjee, Arunima Sehgal; Surial, Rashmi; Sahay, Sundeep; Thakral, Yogita & Gondara, Amandeep (2024). Social and cultural determinants of antibiotics prescriptions: analysis from a public community health centre in North India. Frontiers in Pharmacology. 15. doi: 10.3389/fphar.2024.1277628. Fulltekst i vitenarkiv
• Charani, Esmita; Dlamini, Sipho; Koch, Anastasia; Singh, Sanjeev; Hodes, Rebecca & Laxminarayan, Ramanan [Vis alle 10 forfattere av denne artikkelen] (2024). Power Relations in Optimisation of Therapies and Equity in Access to Antibiotics (PROTEA) Study: investigating the intersection of socio-economic and cultural drivers on antimicrobial resistance (AMR) and its influence on healthcare access and health-providing behaviours in India and South Africa. Wellcome Open Research. 9. doi: 10.12688/wellcomeopenres.20193.1. Fulltekst i vitenarkiv
• Modgil, Vinay; Taneja, Neelam; Pahil, Sapna; Kaur, Harpreet; Singh, Nisha & Joshi, Neha [Vis alle 9 forfattere av denne artikkelen] (2023). Assessing Feasibility of Point-of-Care Antibiotics Susceptibility Testing Technologies for Mitigating Access Gaps for Peripheral Communities. https://doi.org/10.13140/RG.2.2.25698.64961. doi: 10.13140/RG.2.2.25698.64961. Fulltekst i vitenarkiv
• Thakral, Yogita; Sahay, Sundeep & Mukherjee, Arunima Sehgal (2023). Microfoundations of Data-Driven Antimicrobial Stewardship Policy (ASP). Antibiotics. 13(1), s. 1–12. doi: 10.3390/antibiotics13010024. Fulltekst i vitenarkiv Vis sammendrag

  This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments.

• Mukherjee, Arunima Sehgal; Sahay, Sundeep; Kumar, Rajesh; Banta, Rashi & Joshi, Neha (2023). “A living lab within a lab”: approaches and challenges for scaling digital public health in resource-constrained settings. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1187069. Fulltekst i vitenarkiv
• Mukherjee, Arunima Sehgal & Sahay, Sundeep (2023). Systems thinking based approaches to engage with health inequities shaping Antimicrobial Resistance in low and lower-middle-income countries. Journal of Infection and Public Health. ISSN 1876-0341. s. 129–133. doi: 10.1016/j.jiph.2023.11.008. Fulltekst i vitenarkiv
• Thakral, Yogita; Sahay, Sundeep & Mukherjee, Arunima Sehgal (2022). Strengthening digital monitoring of antibiotic resistance in low-resource settings. Journal of Global Health. ISSN 2047-2978. 12, s. 03061–03061. doi: 10.7189/jogh.12.03061. Fulltekst i vitenarkiv
• Sahay, Sundeep & Mukherjee, Arunima Sehgal (2022). Enabling sustainability qualifiers of health management information systems: Case study from Odisha, India, Digital Development: Stories of Hope from Health and Social Development. Practical Action Publishing. ISSN 9781788532051. doi: 10.3399/bjgp23X731673. Fulltekst i vitenarkiv
• Mukherjee, Arunima Sehgal & Sahay, Sundeep (2022). Enabling empowerment and platforms for learning: ICTs for strengthening maternal and child health in India, Digital Development: Stories of Hope from Health and Social Development. Practical Action Publishing. ISSN 9781788532051. doi: 10.3399/bjgp23X731673. Fulltekst i vitenarkiv
• Kaur, Harleen; Sahay, Sundeep & Mukherjee, Arunima Sehgal (2020). Patients’ Trust in Public Health System Mediated by Hospital Information Systems in Context of LMIC. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. s. 207–207. doi: 10.1007/978-3-030-64697-4_16. Fulltekst i vitenarkiv
• Sahay, Sundeep; Aurora, Gitika; Thakral, Yogita; Rødland, Ernst Kristian & Mukherjee, Arunima Sehgal (2020). Designing for Scale: Strengthening Surveillance of Antimicrobial Resistance in Low Resource Settings. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. doi: 10.1007/978-3-030-64697-4_19. Fulltekst i vitenarkiv
• Mukherjee, Arunima Sehgal & Mukoya, Festus (2019). ICT enabled peace network: Case study of conflict early warning system in kenya. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 551, s. 127–139. doi: 10.1007/978-3-030-18400-1_11. Fulltekst i vitenarkiv
• Mukherjee, Arunima Sehgal & Sahay, Sundeep (2019). Sinking under its own weight: Case of aadhaar mediated entitlements in India. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 551, s. 472–485. doi: 10.1007/978-3-030-18400-1_39. Fulltekst i vitenarkiv
• Sahay, Sundeep & Mukherjee, Arunima Sehgal (2017). Self-reinforcing linkages between value and local ownership: Rethinking sustainability of ICT4D project. IFIP Advances in Information and Communication Technology. ISSN 1868-4238. 504, s. 487–497. doi: 10.1007/978-3-319-59111-7_40. Fulltekst i vitenarkiv
• Mukherjee, Arunima Sehgal (2015). Capacity strengthening within a development context: Developing and applying a conceptual model. Electronic Journal of Information Systems in Developing Countries. 70(6), s. 1–22. doi: 10.1002/j.1681-4835.2015.tb00506.x. Fulltekst i vitenarkiv
• Sahay, Sundeep; Mukherjee, Arunima & Sundararaman, T (2014). Building locally relevant models for universal health coverage and its implications for health information systems: some reflections from India. Journal of Health Informatics in Africa, Journal of Health Informatics in Africa. ISSN 2197-6902. doi: 10.12856/JHIA-2014-v2-i2-113. Fulltekst i vitenarkiv

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• Jones, Matthew; Mukherjee, Arunima Sehgal; Thapa, Devinder & Zheng, Yingqin (2023). After Latour: Globalisation, Inequity and Climate Change. Springer Nature. ISBN 9783031501531. 390 s. Fulltekst i vitenarkiv

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• Mukherjee, Arunima Sehgal; Kolås, Åshild & Sahay, Sundeep (2021). Digital Identity, Surveillance and Vaccination. Fulltekst i vitenarkiv
• Sahay, Sundeep; Nielsen, Petter; Faujdar, Dharamjeet; Kumar, Rajesh & Mukherjee, Arunima Sehgal (2018). Frugal Digital Innovation and Living Labs: A Case Study of Innovation in Public Health in India. Fulltekst i vitenarkiv

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