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.

Exploring the Lives of Women Rag Pickers in an Indian Metropolitan City: A Mixed-Methods Cross-Sectional Study on Social and Occupational Determinants Shaping Their Existence.

BACKGROUND: Globally, occupational hazards are a concern, especially in waste management. With 31.2% of its population in urban areas, India is confronted with escalating waste management challenges. People worldwide generate about two-thirds of a kilogram of waste daily. Effective solid waste management is crucial due to population growth, changing waste patterns, and rapid urbanisation. It profoundly impacts environmental, resident, and worker health. Rag picking is an informal profession undertaken by a marginalised population of the society, which involves collecting waste from trash cans, streets, and household waste. To assess the burden and the pattern of morbidity, and the occupational factors associated with it, as well as their health-seeking behaviour, the present study was carried out among women rag pickers in Mumbai, India. METHODOLOGY: A cross-sectional descriptive study was conducted through a mixed-method approach in Mumbai's Chembur and Govandi areas, focusing on women rag pickers aged 15 to 49 years. The research was conducted over a period of three months, during which a total of 150 female rag pickers from individual families were identified and included in the study through purposive sampling. The structured questionnaires gathered quantitative data on socio-demographics, health-seeking behaviour, morbidity, and monthly expenses. The qualitative data were collected through focus group discussions with rag pickers, analysing themes related to rag picking as occupational preference and substance usage factors. Ethical approval from the institute and informed consent from each participant were obtained prior to data collection. RESULTS: Among the cohort of 150 women rag pickers, 67.3% were aged between 15 and 30 years, with 82% belonging to the lower socio-economic class. A notable 43.4% of these women engaged in significant tobacco use, primarily through oral consumption, while about 56.7% of their family members exhibited high substance use, including pan, tobacco, and alcohol. In terms of health-seeking behaviour, 51% refrained from seeking treatment for minor ailments, 29% resorted to home remedies or self-medication, and 20% sought care at hospitals. A morbidity analysis over the past three months revealed prevalent health issues, informing potential interventions. Examination of monthly expenditure patterns unveiled an average income of 9000 INR (130 USD), with a significant 61% allocation towards food and grocery expenses. Qualitative insights indicated that the preference for rag picking was driven by limited alternatives and substance use was influenced by peers and served as a means to cope with stress. These findings underscore distinct health-seeking behaviours, and the unique needs of women rag pickers, providing valuable guidance for targeted policies to enhance their well-being. CONCLUSION: These findings underscore the need for targeted interventions to improve the well-being and socio-economic conditions of women rag pickers in India. Universal healthcare coverage, community-based initiatives, and social inclusion are vital for addressing their unique challenges and enhancing their quality of life.

Establishment of cross-cradle hold technique combined with intensive breastfeeding counselling positively impacts the weight gain rate in early infancy.

A quasiexperimental field study was undertaken in 576 exclusively breastfed (EBF) infants from 0 to 14 weeks in Gujarat, India to assess the effect of the use of appropriate breastfeeding techniques on daily weight gain rate and on reducing the underweight rate in early infancy. The interventions were delivered through the existing health system and focused primarily on counselling pregnant women during antenatal and post-natal sessions for ensuring 'effective breastfeeding' by adoption of the technique of 'cross cradle hold', appropriate breast attachment, emptying of one breast before shifting to the other along with conducting regular monitoring of infant's weight. The intervention care group (ICG) of 300 EBF infants were compared with 276 EBF infants in the control standard care group (SCG). The findings revealed that median weight gain per day between 0 and 14 weeks was significantly higher (p = 0.000) in ICG (32.7 g) as compared with SCG (28.05 g). The median weight-for-age Z at 14 weeks of age was also significantly higher in ICG compared with SCG (p = 0.000). Underweight prevalence was three times lower in ICG (5.3%) compared with SCG (16.7%) at 14 weeks of age. Infants in the ICG were noted to be 2.65-fold more likely to achieve a weight gain of 30 g or more per day compared with infants in SCG. Nutrition interventions, therefore, must aim not only on mere promotion of EBF for up to 6 months but stress on ensuring EBF is 'effective' for optimum transfer of breastmilk through adoption of appropriate techniques, including cross-cradle hold, by mothers.

A flexible analytic wavelet transform based approach for motor-imagery tasks classification in BCI applications.

BACKGROUND AND OBJECTIVE: Motor Imagery (MI) based Brain-Computer-Interface (BCI) is a rising support system that can assist disabled people to communicate with the real world, without any external help. It serves as an alternative communication channel between the user and computer. Electroencephalogram (EEG) recordings prove to be an appropriate choice for imaging MI tasks in a BCI system as it provides a non-invasive way for completing the task. The reliability of a BCI system confides on the efficiency of the assessment of different MI tasks. METHODS: The present work proposes a new approach for the classification of distinct MI tasks based on EEG signals using the flexible analytic wavelet transform (FAWT) technique. The FAWT decomposes the EEG signal into sub-bands and temporal moment-based features are extracted from the sub-bands. Feature normalization is applied to minimize the bias nature of classifier. The FAWT-based features are utilized as inputs to multiple classifiers. Ensemble learning method based Subspace k-Nearest Neighbour (kNN) classifier is established as the best and robust classifier for the distinction of the right hand (RH) and right foot (RF) MI tasks. RESULTS: The sub-band (SB) wise features are tested on multiple classifiers and best performance parameters are obtained using the ensemble method based subspace kNN classifier. The best results of parameters are obtained for fourth SB as accuracy 99.33%, sensitivity 99%, specificity 99.6%, F1-Score 0.9925, and kappa value 0.9865. The other sub-bands are also attained significant results using subspace KNN classifier. CONCLUSIONS: The proposed work explores the utility of FAWT based features for the classification of RH and RF MI tasks EEG signals. The suggested work highlights the effectiveness of multiple classifiers for classification MI-tasks. The proposed method shows better performance in comparison to state-of-arts methods. Thus, the potential to implement a BCI system for controlling wheelchairs, robotic arms, etc.

Infant and Young Child Feeding Index and its association with nutritional status: A cross-sectional study of urban slums of Ahmedabad.

BACKGROUND: Infant and young child feeding (IYCF) practices are multidimensional and change rapidly in short intervals in the 1st year of life, asking for simultaneous assessment of various feeding dimensions in children of 6 months and older. Infant and Child Feeding Index (ICFI) is a composite index which measures complete feeding practices for infants and young children. The present study was conducted to assess IYCF practices for children aged 6-36 months in terms of ICFI and some sociodemographic factors and find out the association of ICFI with nutritional status. MATERIALS AND METHODS: A cross-sectional study was conducted from July 2015 to October 2015 in Girdharnagar ward of Ahmedabad. Two hundred and ten mother-child pairs were selected by two-staged cluster sampling and were interviewed using a schedule adapted from Knowledge, Practices, and Coverage 2000+ model questionnaire. Appropriate anthropometric measurements were taken and nutritional indicators were calculated. Chi-square test, t- test, and regression analysis were applied wherever required. Epi info version 7.0 and MS Excel 2007 were used for statistical analysis. RESULTS: Nearly 65.2% of the children were stunted, 43.3% were underweight, and 11.9% were wasted. Only 38.3% of the children were initiated on breastfeeding within 1 h of birth. Only 19.1% of the children were breastfed for 2 years and beyond. Meal frequency was adequate in 64.3% and dietary diversity of >4 food groups was given to only 15.7% of the children. Significant higher proportions of children with low ICFI scores had illiterate mothers, were older, and belonged to lower socioeconomic strata. There was statistically significant association of ICFI with all the three nutritional status indicators. Higher proportion of children with lower ICFI scores had lower weight-for-height Z-scores, weight-for-age Z-scores, and height-for-age Z-scores. CONCLUSION: The present study revealed that ICFI can be used to measure IYCF practices in a single composite index, which in turn can reflect the nutritional status of the children.