How Did the Village Community Perceive and Draw Strategies Against the COVID-19 Pandemic? A Qualitative Exploration.

Objectives There is a lack of evidence about the difficulties faced by the villagers and the mechanisms they adopt to cope with the ongoing coronavirus disease 19 (COVID-19) pandemic. In this study, we tried to explore the various stressors experienced by the villagers and the coping mechanisms. We also tried to document the future strategies that could be adopted to address the current pandemic situation. Methods An exploratory, descriptive qualitative study was conducted in five purposively selected villages in the Kolar district of South India. We conducted face-to-face in-depth interviews among nine key informants, including personnel across various health, education, and administrative domains. Two investigators carried out a manual descriptive content analysis to identify the codes and categories under three broad themes. A hybrid approach was used for coding the respondents' views in the most appropriate words/phrases. Results A total of 146 codes were identified and grouped into 19 different categories under three broad domains viz. 'stressors', 'coping strategies' and 'suggestions for future actions' for the existing COVID-19 pandemic. The stressors mainly were due to household level problems like finance management and familial disruptions. Coping mechanisms adopted include social capital, government support, judicial resource management, child marriages and apathetic attitude. The suggestions for future actions included an emphasis on the involvement of gram panchayats, adoption of the 'stay in village' concept, better communication framework and financial pooling for future exigencies. Conclusion The stressors due to COVID among villagers were mostly related to household level issues. The mechanisms adopted to cope up with the stressors included both positive and negative mechanisms. The suggestions for future actions mainly emphasized the involvement of gram panchayats.

To start or to complete? - Challenges in implementing tuberculosis preventive therapy among people living with HIV: a mixed-methods study from Karnataka, India.

Background: Isoniazid preventive therapy (IPT) has been shown to reduce the risk of tuberculosis (TB) among people living with HIV (PLHIV). In 2017, India began a nationwide roll-out of IPT, but there is a lack of evidence on the implementation and the challenges.Objectives: Among PLHIV newly initiated on antiretroviral therapy (ART) from January 2017 to June 2018, to: (i) assess the proportion who started and completed IPT and (ii) explore reasons for non-initiation and non-completion from health-care providers' and patients' perspectives.Methods: An explanatory mixed-methods study was conducted in two selected districts of Karnataka, South India. A quantitative phase (cohort analysis of routinely collected program data) was followed by a qualitative phase involving thematic analysis of in-depth interviews with providers (n = 22) and patients (n = 8).Results: Of the 4020 included PLHIV, 3780 (94%) were eligible for IPT, of whom, 1496 (40%, 95% CI: 38%-41%) were initiated on IPT. Among those initiated, 423 (28.3%) were still on IPT at the time of analysis. Among 1073 patients with declared IPT outcomes 870 (81%, 95% CI: 79%-83%) had completed the six-month course of IPT. The main reason for IPT non-initiation and non-completion was frequent drug stock-outs. This required health-care providers to restrict IPT initiation in selected patient subgroups and earmark six-monthly courses for each patient to ensure that, once started, treatment was not interrupted. The other reasons for non-completion were adverse drug effects and loss to follow-up.Conclusion: The combined picture of 'low IPT initiation and high completion' seen in our study mirrors findings from other countries. Drug stock-out was the key challenge, which obliged health-care providers to prioritize 'IPT completion' over 'IPT initiation'. There is an urgent need to improve the procurement and supply chain management of isoniazid.

Household "rain water harvesting" - Who are practicing? Why are they practicing? A mixed methods study from rural area of Kolar district, South India.

BACKGROUND: "Rain Water Harvesting" is one of the identified strategies to replenish the ground water system in India. Household level of rain water harvesting could serve as an indicator for assessment of participation of local community. OBJECTIVES: To assess the proportion of household rainwater harvesting and factors associated with it and to find the reasons behind adoption of this practice in a rural area of Kolar district, Karnataka. METHODS: An exploratory sequential mixed methods study design with an initial cross-sectional quantitative study followed by qualitative in-depth interviews was done to assess the factors affecting household rain water harvesting and reasons behind the practice. Household survey with interview of one person from each household was done. Quantitative data were reported using proportions and qualitative data were reported using categories and verbatim quotes. RESULTS: Of the 82 households surveyed, 31 (37.8%, 95% CI: 27.8-48.6) had adopted at least crude method of rain water harvesting. Household belonging to either joint or three-generation family type was practicing rain water harvesting higher compared with nuclear family type. Reasons for adoption were included under the categories - purity, fresh, tradition, less work, passion, and why waste? CONCLUSION: About one in three households practiced rain water harvesting in the rural area under study with households belonging to joint or three-generation family practicing more compared with nuclear families. The reason for adoption was mostly based on beliefs and also felt needs by families.