Coverage, delays and implementation challenges of 'Direct Benefit Transfer' in the National Tuberculosis Elimination Programme - A mixed methods study.

INTRODUCTION: Food insecurity and undernutrition both contribute to the large tuberculosis burden in India. Indian government rolled out the direct benefit transfer (DBT) programme "Nikshay Poshan Yojana" on a national scale on April 1, 2018 largely to provide nutritional support. Hence, it was proposed to take up this study in Western Maharashtra (Pune district) to study the coverage, delays and implementation challenges of 'Direct Benefit Transfer' in the National Tuberculosis Elimination Programme as there have only been a limited number of studies conducted regarding the same. METHODOLOGY: This mixed methods study was conducted at Tuberculosis Units (TUs) under District Tuberculosis Officer (DTO) in Western Maharashtra (Pune district) for the duration August 2020 to September 2022. A total of 3373 participants were included for the quantitative component. For qualitative component In-depth interviews of key informants (healthcare providers involved in the implementation of Direct Benefit Transfer) and Focus Group Discussion (FGD) for patients and care givers was done and explored using thematic analysis. RESULTS: The total coverage was found to be 76.81%. The health providers reported staff related challenges (overburden and non-cooperative staff), bank related issues (local and cooperate banks not involved in the Public Financial Management System (PFMS) loop and lack of bank account), patient related issues (fear of being scammed), the DBT process (lengthy and complex) and software related issues as major hurdles involved in the scheme's implementation. The challenges to the implementation of DBT reported by the beneficiaries (TB patients) were lack of awareness and disbelief about the scheme, bank related issues (lack of bank account and necessary documents to open account), financial challenges (job insecurity, loans), physical challenges (weakness) and delays in delivering the benefit due to software errors. CONCLUSION: In the present study the DBT coverage was very encouraging. The common challenges identified by the staff members and patients in the implementation of the scheme were lack of awareness about the scheme, bank related issues and software issues. To increase the coverage of DBT, it is vital that these issues be resolved.

Influence of Packed Food Labeling on Shopping Practices: A Cross-Sectional Study.

Background: The basic product information, health, safety, and nutritional details, as well as food marketing, advertising, and promotion, are all provided on a packed food label. This study was carried out to assess the knowledge, attitude, and practices of the shoppers regarding food labels as there are few studies done in India and none in Pune. Methodology: A cross-sectional study was carried out among 226 participants using a validated semi-structured questionnaire, which consisted of sociodemographic details and questions on their knowledge, attitude, and practice regarding food labels while purchasing a packed food item. Quantitative data are presented in the form of mean, standard deviation, 95% confidence interval (CI) of mean, median, and interquartile range (IQR). Qualitative data are in terms of number (N), percentages (%), and 95% CI of percentage. Results: Of the 226 participants, 163 (72.12) were aware of the label on packaged foods. One hundred seventy-seven (78.32%) participants in all read the label on the packaged food. The maximum retail price (MRP) and expiration date were the most frequent labels sought. Although 17.7% of consumers did not consider nutrient composition when making a purchase, energy and protein were the most often considered nutrients. The majority (70.35%) falsely believed that juice was healthy. The packed food label's tiny font made it difficult to read for 30.38% of the customers. Conclusion: Despite the increased awareness about packed food labeling, a fraction of shoppers were not concerned about nutritional information. In contrast to the prevailing knowledge, the majority believes packed food has a positive effect on health.

Stress in Caregivers of Stroke Patients During Rehabilitation: An Observational Study.

INTRODUCTION: Stroke causes a high burden of death and disability all over the world. The majority of stroke survivors continue to have difficulties, and their families must shoulder a considerable portion of the expenditures of ongoing rehabilitation and long-term care. In India, stroke rehabilitation is still underachieved due to various reasons leading to delay or incomplete recovery of the patients thus adding up more burden on the caregivers. Thus, studying the caregiver burden of stroke rehabilitation will help policymakers tackle this issue faced by our lower economically challenged citizens. OBJECTIVES: The objective is to measure the perceived burden on caregivers during stroke rehabilitation. METHODS AND MATERIALS: The observational study was conducted by interviewing the stroke survivors' caregivers and visiting the physiotherapy OPD using the caregiver burden scale/questionnaire. RESULTS: The study had 76 caregivers, 51.32% were women and 48.68% were men. The average age for caregivers was 42 years and 55 years for patients. The average duration of giving care was six months. The perceived caregiver burden score was low (mean-19.61) suggesting that not all assistance is associated with stress. The correlation of each burden measure with Modified Rankin Scale for disability is significantly correlated (r=0.7, P<0.0001). Further investigation revealed that caregivers had considerably higher levels of stress when the patient needed to exercise, walk or use the restroom. A low yearly income, a higher secondary education, and a small number of family members were shown to be connected with individuals who scored the highest on stress. CONCLUSION: Based on this study, we conclude that people with low income residing in nuclear families require more support for caregiving during rehabilitation. We recommend that health and welfare policy measures be developed to lessen caregiver burden in order to improve caregivers' post-stroke experiences.

Challenges to Cardiac Rehabilitation Post Coronary Artery Bypass Grafting: A Qualitative Study in Pune.

Background Adherence to cardiac rehabilitation (CR) regimen is crucial in the post-coronary artery bypass grafting (CABG) period. Cardiac rehabilitation involves various lifestyle changes, including diet and exercise, regular follow-up in OPD, and implementing secondary prevention recommendations. This study aims to understand the challenges to CR post-CABG. Methodology Seven in-depth interviews using an interview guide were carried out in the outpatient section of the cardiothoracic vascular surgery (CTVS) department of a tertiary health care facility in Pune, India. A purposive sampling technique was followed. Results The qualitative study revealed that dietary restrictions were difficult to follow, that some patients could not quit smoking even after surgery, and that transportation costs were an issue regarding CR follow-up. The majority of the participants appreciated the importance of regular exercise in their post-surgery life. Conclusion Despite the hurdles, the majority of participants stated that the fact that CABG is a major treatment pushed them to attend routine CR follow-ups and adhere to the CR regimen. A solid CR team was one of the study's strengths, and the team established a routine of telephonic reminders for regular follow-up, which resulted in lower rates of loss to follow-up.