Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India.

In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with 'unsuccessful outcomes' among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient's mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The 'successful outcomes' (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were 'not evaluated'. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of 'unsuccessful outcomes' than those who availed of drugs from private pharmacies. The high 'successful outcomes' among TB patients treated by PPs are promising. However, higher 'unsuccessful outcomes' among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.

Level of awareness of risk factors and danger signs of pregnancy among pregnant women attending antenatal care in PHC, Nandagudi.

Danger signs of pregnancy are warning signs that women encounter during pregnancy, child birth and post-partum period. It is important, to know these warning signs for women and health care providers to rule out serious complications and initiate treatment immediately. OBJECTIVES: 1. To assess the awareness of danger signs of pregnancy among pregnant women attending antenatal care in Nandagudi PHC. 2. To give health education to the pregnant women about the risk factors and danger signs. METHODOLOGY: A cross sectional study was conducted in PHC, Nandagudi , field practise area of MVJMC and RH. Study was carried out from September 2017 to November 2017. A total of 210 pregnant women who attended the ante natal clinic at PHC, Nandagudi were the study subjects. A pre designed pretested questionnaire was used. Data collected was thus entered in M S excel and was analysed using SPSS 21 version. RESULTS: 60% of the study population belonged to the age group 23-27. Majority (90%) of them knew the importance of iron and folic acid. 72% of the cases knew the importance of blood group in pregnancy. Majority (91%) preferred hospital delivery compared to home delivery (9%). All 210 women knew about only 3 danger signs, they are bleeding per vagina, loss of consciousness and convulsions. CONCLUSION: Every pregnant woman faces the risk of sudden, unpredictable complication that could end in death or injury to herself or to her infant. Hence, it is necessary to employ strategies to overcome such problems as they arise.

Spatiotemporal analysis of drug-resistant TB patients registered in selected districts of Karnataka, South India: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) depicts heterogeneous spatial patterns with geographical aggregation of TB cases due to either ongoing person-to-person transmission or reactivation of latent infection in a community sharing risk factor. In this regard, we aimed to assess the spatiotemporal aggregation of drug-resistant TB (DR-TB) patients notified to the national TB program (NTP) from 2015 to 2018 in selected districts of Karnataka, South India. METHODS: This was a cross-sectional study among DR-TB patients notified from Dakshina Kannada, Udupi, and Chikamagalur districts of the state of Karnataka. Clinico-demographic details were extracted from treatment cards. The registered addresses of the patients were geocoded (latitude and longitude) using Google Earth. Using the QGIS software, spot map, heat maps and grid maps 25 km2 with more than the expected count of DR-TB patients were constructed. RESULTS: Of the total 507 patients studied, 376 (74%) were males and the mean (standard deviation) age of the study participants was 41.4 (13.9) years. From 2015 to 2018, the number of patients increased from 85 to 209 per year, the area of aggregation in square kilometers increased from 113.6 to 205.7, and the number of rectangular grids with more than the expected DR-TB patients (> 1) increased from 12 to 47. CONCLUSIONS: The increase in the number of DR-TB patients, area of aggregation, and grids with more than the expected count is a cause for concern. The NTP can use routine programmatic data to develop maps to identify areas of aggregation of disease for targeted TB control activities.

Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study.

BACKGROUND: Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. OBJECTIVES: (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. METHODS: A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n = 9) and presumptive TB patients (n = 9) and presumptive TB patients (. RESULTS: The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. CONCLUSION: The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.