Exploring private sector perspectives on barriers and facilitators in availing tuberculosis care cascade services: a qualitative study from the Indian state.

INTRODUCTION: The private sector plays an important role in tuberculosis (TB) elimination by providing access to quality TB care services like diagnosis and treatment, advocacy for preventive measures, innovation to address challenges in TB elimination, vaccines etc. The study aims to understand the perspectives of private practitioners on patients' TB care cascade to reinforce existing interventions by assuring the quality of care to TB patients. METHODS: The study utilized a qualitative design through in-depth interviews of private practitioners and was conducted in Ranchi and Purbi Singhbhum District of Jharkhand State from March-August 2021. The pilot-tested, semi-structured, open-ended interview guide questionnaire collected information from private practitioners on various aspects of the TB care cascade. The data from the provider interviews were transcribed into multiple codes and themes on the TB program. An inductive analysis was carried out with a focus on content credibility to eliminate bias. Ethical approval was received from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar (IIPHG), India. Written consent was taken from the private practitioners involved in the study. RESULT: In-depth interviews of 17 private practitioners reveal various factors contributing to delays in TB care cascades, especially delay in access to TB diagnosis and TB Care, delay in providing treatment once after diagnosis and poor adherence to the TB treatment. According to the perception of private practitioners, there was an array of client, provider and system side factors affecting the TB care cascade gaps positively and negatively. Positive aspects mainly emerged from interviews: strong governance, consistent supply chain management, innovative PPP models and financial schemes reducing out-of-pocket expenditure (OOPE). Various factors affecting the TB care cascade negatively include awareness among the patient, socio-economic status, approach and decision-making power of providers, adverse effects of drugs, staff capacity building, etc. CONCLUSIONS: Engaging private practitioner in TB elimination efforts is critical to achieving global targets and reducing the burden of TB. The study helps to determine geography-specific barriers and facilitators of the TB care cascade to achieve the aim of providing universal access to TB healthcare with the inclusion of private practitioners.

An epidemiological investigation of a cholera outbreak in peri-urban slum settlements of Gujarat, India.

Background: Cholera is an acute diarrhoeal disease caused by consuming contaminated food and water. The burden may remain underreported due to several issues like the low capacity of epidemiological surveillance systems, laboratory testing facilities, and socioeconomic disparities in urban slums. The disease has very short incubation period resulted in quick clustering of cases. Aim: A thorough outbreak investigation was carried out with the objective of strengthening the surveillance activity, finding out the sources of infection, and recommending necessary actions to control the outbreak immediately. Methods: An unusual increase in cases of diarrhoea was reported in slum area of Kalol town during the first week of July 2021. The stool samples were taken and investigated for confirmation and declaration of the outbreak by the Rapid Response Team. Time, place, and person distribution were carried out to generate a hypothesis and provide an immediate public health response to contain the outbreak. This study was conducted during the emergency public health response, no ethical approval was sought before the survey. Results: The cholera outbreak was confirmed when three out of five stool samples were positive for the bacterium V. cholerae O1 biotype El Tor serotype Ogawa. The overall attack rate and case fatality rate were 3.6% and 1.1%, respectively. The leakages caused the mixing of drainage water with the drinking water supply, which could be the possible cause of outbreak. Conclusion: The early identification and management of the cases, source reduction, health education on water chlorination, and hand hygiene were initiated based on our recommendations, which controlled the present outbreak.

Protocol for the cost-effectiveness of parenteral iron and oral iron therapy for first-line management of anaemia among pregnant women in a natural programme setting in Gujarat.

INTRODUCTION: Maternal anaemia is a major public health issue in India. The government of India recommends parenteral iron to manage moderate and severe grades of anaemia. In contrast to its clinical efficacy, the cost-effectiveness of intravenous iron sucrose and ferric carboxymaltose is not yet established in Indian context. This article illustrates the protocol of health technology assessment to evaluate the cost-effectiveness of intravenous therapy on the improvement of haemoglobin concentration over oral therapy. METHODS AND ANALYSIS: The study will be carried out in two districts of Gujarat state. The study participants will be selected by a proportionate sampling method from the rural, tribal, desert and coastal region of the districts. Data will be collected over 1 year on key outcome indicators using a mixed-method approach. Key informant interviews will be conducted, and cost data will be gathered to perform cost-effectiveness analysis. ETHICS AND DISSEMINATION: This study is approved by the Technical Appraisal Committee of Health Technology Assessment India, Department of Health Research and Institutional Ethics Committee of the Indian Institute of Public Health, Gandhinagar.

Osteobiologics.

Osteobiologic adjuvants that aid in bone grafting have recently been popularized. Current osteobiologic technologies can be organized into 3 main categories: osteoconductive, osteogenic, and osteoinductive. Appropriate use of osteobiologic agents mimics autograft. Compared with autograft , synthetic adjuvants minimize donor morbidity. Understanding how synthetic agents can enhance bone formation and their appropriate use can aid the orthopedic surgeon in delivering optimal care in these difficult cases. The understanding of how synthetic grafts can enhance the normal bone healing cascade defines their role and use in treating fracture gaps.