Evidence-based universal health coverage interventions delivery in infectious disease of poverty elimination and eradication.

The recent 78th United Natiions General Assembly (UNGA) declaration relaunched a new health priority and political commitment in accelerating Universal Health Coverage (UHC), adopted by the United Nations (UN) in 2015 and are intended to be met by 2030. At mid-way point of UHC implementation, we advocate for the much needed programmatic implementation research, evidence-based interventions (EBIs) policies and strategies leadership and management capacity building to enable robust, resilient and sustainable multi-sectoral partnerships, integrated coordination and governance mechanisms capabilities in accelerating UHC package mainly infectious diseases of poverty elimination and eradication agenda.

Prevalence of pulmonary tuberculosis among the tribal populations in India.

IMPORTANCE: There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. OBJECTIVE: To estimate the prevalence of TB among the tribal populations in India. DESIGN, PARTICIPANTS, SETTING: A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. MAIN OUTCOME AND MEASURES: Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. RESULTS: A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496-754] in the central zone and least 153 [95% CI: 24-281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504-1101] and Jammu and Kashmir the lowest 127 [95% CI: 0-310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. CONCLUSION AND RELEVANCE: The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.

Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms.

BACKGROUND AND OBJECTIVES: Understanding the drivers for care-seeking among those who present with symptoms of TB is crucial for early diagnosis of TB and prompt treatment, which will in turn halt further TB transmission. While TB is a challenge among the tribal population, little is known about the care-seeking behaviour and the factors influencing care-seeking behaviour among the tribal population across India. METHODOLOGY: This community-based descriptive study was carried out in 17 states of India across 6 zones, covering 88 villages from tribal districts with over 70% tribal population. The sample population included individuals ≥15 years old who were screened through an interview for symptoms suggestive of pulmonary TB (PTB), currently and/or previously on anti-TB treatment. Those with symptoms were then assessed on their health-seeking behavior using a semi-structured interview schedule. RESULTS: Among 74532 eligible participants screened for symptoms suggestive of TB, 2675 (3.6%) were found to be presumptive TB cases. Of them, 659 (24.6%) sought care for their symptoms. While 48.2% sought care after a week, 19.3% sought care after one month or more, with no significant difference in the first point of care; 46.9% approaching a private and 46.7% a public facility. The significant factors influencing care-seeking behaviour were knowledge on TB (OR: 4.64 (3.70-5.83), p < 0.001), age<35 years (OR: 1.60 (1.28-2.00), p < 0.001), co-morbidities like asthma (OR: 1.80 (1.38-2.35), p < 0.001) and blood pressure (OR: 2.59 (1.75-3.85), p < 0.001), symptoms such as blood in sputum (OR: 1.69 (1.32-2.16), p < 0.001), shortness of breath (OR: 1.43 (1.19-1.72), p < 0.001) and weight loss (OR: 1.59 (1.33-1.89), p < 0.001). The cough was the most often reported symptom overall. There were gender differences in symptoms that prompted care-seeking: Males were more likely to seek care for weight loss (OR: 1.78 (1.42-2.23), p<0.001), blood in the sputum (OR: 1.69 (1.25-2.28), p<0.001), shortness of breath (OR: 1.49 (1.18-1.88), p<0.001) and fever (OR: 1.32 (1.05-1.65), p = 0.018). Females were more likely to seek care for blood in sputum (OR: 1.68 (1.10-2.58), p = 0.018) and shortness of breath (OR = 1.35, (1.01-1.82), p = 0.048). The cough did not feature as a significant symptom that prompted care-seeking. CONCLUSION: Delayed healthcare-seeking behaviour among those with symptoms presumptive of TB in the tribal population is a major concern. Findings point to differences across gender about symptoms that prompt care-seeking in this population. Gender-sensitive interventions with health system strengthening are urgently needed to facilitate early diagnosis and treatment among this population.

Progressive disability in elderly population among tribals of Telangana: a cross sectional study.

BACKGROUND: The tribal population of Telangana, India, lives in remote and difficult conditions. This study was carried out to find out estimate, the prevalence and progression of disability in elderly population among tribals of Khammam District, Telangana state, India. METHODS: A population based cross sectional survey was conducted in villages of Tribal Sub Plan area. Elderly people who are 60 years or older were chosen with a two stage sampling procedure: (1) probability proportion to size was used to select clusters and (2) in each selected cluster households were selected by systematic random sampling. The participants were interviewed with the 36 item Telugu version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. Socio- demographic information, behavioral measurements, health and social benefit indicators were also assessed. Descriptive analytical methods were used for prevalence estimation and logistic regression was used to examine the associations of progressive age over disability among elderly. RESULTS: A total of 506 elderly people from 1349 households in 20 villages across 31mandals of Khammam were interviewed. Majority of elderly population among tribals were illiterate (men 88.94%; women 99.33%), used tobacco (men 81.25%; women 57.72%), consumed alcohol (men 80.77%; women 47.32%) and were hypertensive (men 53.85%; women 63.42%). The prevalence of disability was higher in women. Maximum disability in the interviewed elderly population was seen in domains of performing house hold activities, and mobility. In comparison with men, women expressed more disability for majority of domains. As age progressed, the disability for self-care domain increased to a maximum of 2.6 times in men and 6.6 times in women and for mobility domain increased to a maximum of 9.7 times in men and 7.2 times in women. CONCLUSIONS: Although present disability modifying mobility Assistive Devices (AD) can help elderly in overcoming disability, these are primarily designed for built environments. As the needs, cultural sensitivities, and living environment of elderly population in tribals are unique, newer innovative assistive devices should be designed and developed.

Subcutaneous Infraorbital Dirofilariasis.

Dirofilariasis is a parasitic infection transmitted by mosquitoes from domestic and wild animals. Humans accidentally get infected and can present with a lung nodule, subcutaneous mass or an ocular lesion which will be either subconjunctival or periorbital. Proper microbiological and histopathological examinations aid in proper diagnosis. Herein, we present a case report of a 64-year-old female patient from Kerala with an infraorbital mass diagnosed as dirofilariasis.

Health equity for internal migrant labourers in India: an ethical perspective.

In the developing countries, internal migration is a survival strategy for many labourers in search of a better livelihood and opportunities. It is inevitable that many of them will leave their home towns and villages in the coming years, and that the future will see an increase in the number of migrant labourers in developing countries such as India. Migrant workers face unique health problems and it is important for the health system to prepare itself to face these. In this context, the system will need to address certain key ethical issues. There is plenty of published literature on international migration and its ethical aspects.However, there is a scarcity of information on ethical issues relating to internal migration. This article examines these issues in the context of India. It addresses the issues of equity, non-discrimination,the provision of culturally competent care to migrants, allocation of scarce resources, and achieving a balance between benefits and risks for migrants. Our analysis should be considered while planning any healthcare intervention for internal migrant workers in all developing countries.

Monitoring 'monitoring' and evaluating 'evaluation': an ethical framework for monitoring and evaluation in public health.

Monitoring and evaluation (M&E) is an essential part of public health programmes. Since M&E is the backbone of public health programmes, ethical considerations are important in their conduct. Some of the key ethical considerations are avoiding conflicts of interest, maintaining independence of judgement, maintaining fairness, transparency, full disclosure, privacy and confidentiality, respect, responsibility, accountability, empowerment and sustainability. There are several ethical frameworks in public health, but none focusing on the monitoring and evaluation process. There is a need to institutionalise the ethical review of M&E proposals. A theoretical framework for ethical considerations is proposed in this paper. This proposed theoretical framework can act as the blueprint for building the capacity of ethics committees to review M&E proposals. A case study is discussed in this context. After thorough field testing, this practical and field-based ethical framework can be widely used by donor agencies, M&E teams, institutional review boards and ethics committees.