A qualitative study exploring factors influencing clinical decision-making for influenza-like illness in Solapur city, Maharashtra, India.

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2-3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful.

Tuberculosis knowledge and awareness in tribal-dominant districts of Jharkhand, India: implications for ACSM.

SETTING: Forty hard-to-reach villages in the East and West Singhbhum Districts of Jharkhand State, India. OBJECTIVES: To document knowledge and awareness of tuberculosis (TB) among the general population, understand gender differences and inform intervention activities for the improvement of TB control programmes in tribal-dominant hard-to-reach areas in India. DESIGN: A cross-sectional community-based survey was carried out among 825 respondents using population proportionate sampling. RESULTS: Most of the respondents were in the 18-35 years age group, tribal and married; 44% were illiterate. The study shows poor knowledge about TB symptoms, causes, modes of transmission and moderate awareness about government TB services. Correct knowledge about the cause of TB was negligible: half of the respondents reported local liquor as the cause, 61% considered TB as transmissible and one third considered sharing of food as the mode of transmission. Awareness about the availability of free treatment services at government health facilities was high, but awareness about DOTS was low. Significant gender differences were observed in knowledge and awareness levels. CONCLUSION: Study findings point to the importance of urgent intensification of culturally congruent and gender-sensitive advocacy, communication and social mobilisation activities.

Contexte : Quarante villages difficiles d'accès de l'Est et de l'Ouest des districts de l'état de Singhbhum, Jharkhand, Inde.Objectifs : Documenter les niveaux de connaissances et de sensibilisation en matière de la tuberculose (TB) parmi les membres de la communauté, de comprendre les différences entre les sexes et de contribuer à l'élaboration d'activités d'intervention afin d'améliorer le programme de lutte contre la TB dans des zones à dominante tribale difficiles d'accès en Inde.Schéma : Une enquête transversale à base communautaire a été réalisée auprès de 825 répondants grâce à une méthode d'échantillonnage proportionnel de la population.Résultats : La majorité des répondants appartenait à la tranche d'âge 18­35 ans, à une minorité ethnique et étaient mariés ; 44% étaient illettrés. L'étude a montré une faible connaissance des symptômes, causes et modes de transmission de la TB et une connaissance modérée des services gouvernementaux de TB. Les connaissances relatives à la cause exacte de la TB était négligeables­la moitié des répondants a attribué la TB à la consommation d'alcool local ; 61% savaient que la TB était transmissible et un tiers affirmait que le partage de nourriture était une voie de transmission. La connaissance de la disponibilité de services gratuits de prise en charge dans des structures de santé étatiques était élevée, mais la stratégie DOTS était très mal connue. Des différences significatives entre les sexes ont été observées en matière de niveau de connaissance et de sensibilisation.Conclusion : Les résultats de l'étude soulignaient l'importance d'une intensification urgente des activités de plaidoyer, de communication et de mobilisation sociale culturellement adaptées et spécifiques au genre.

Marco de referencia: Cuarenta poblaciones de difícil acceso de los distritos de Singhbhum oriental y occidental en el estado de Jharkhand de la India.Objetivos: Documentar los conocimientos y la sensibilización en materia de tuberculosis (TB) de los miembros de la comunidad general, comprender las diferencias asociadas con el sexo y aportar recomendaciones a la formulación de intervenciones destinadas a mejorar el programa contra la TB en las zonas de difícil acceso con predominio de población tribal, en la India.Método: Se llevó a cabo una encuesta transversal comunitaria a 825 personas escogidas mediante un muestreo proporcional a la población.Resultados: La mayoría de las personas que respondieron a la encuesta se encontraba en el grupo etario de 18 años a 35 años, pertenecía a un grupo tribal y su estado civil era casado; el 44% era analfabeto. El estudio puso en evidencia un conocimiento precario de la TB con relación a los síntomas, las causas y los modos de transmisión y una sensibilización moderada a la existencia de servicios gubernamentales de atención de la TB. El grado de conocimientos sobre causa real de la TB era exiguo, pues en la mitad de las respuestas se atribuía la TB al consumo de un licor local. El 61% de quienes respondieron consideraba que la enfermedad era contagiosa y un tercio atribuía el modo transmisión al hecho de compartir los alimentos. Se observó un alto grado de conocimiento de la existencia de servicios de tratamiento sin costo en las instituciones públicas de salud, pero pocos conocían la estrategia DOTS. Se observaron diferencias notables entre los sexos en materia de conocimientos y sensibilización.Conclusión: Los resultados del estudio destacan la urgencia de intensificar las actividades de promoción, comunicación y movilización social que sean culturalmente adaptadas y tomen en consideración las diferencias entre los sexos.

Gender and community views of stigma and tuberculosis in rural Maharashtra, India.

Stigma associated with tuberculosis (TB) is often regarded as a barrier to health seeking and a cause of social suffering. Stigma studies are typically patient-centred, and less is known about the views of communities where patients reside. This study examined community perceptions of TB-related stigma. A total of 160 respondents (80 men and 80 women) without TB in the general population of Western Maharashtra, India, were interviewed using Explanatory Model Interview Catalogue interviews with same-sex and cross-sex vignettes depicting a person with typical features of TB. The study clarified features of TB-related stigma. Concealment of disease was explained as fear of losing social status, marital problems and hurtful behaviour by the community. For the female vignette, heredity was perceived as a cause for stigmatising behaviour. Marital problems were anticipated more for the male vignette. Anticipation of spouse support, however, was more definite for men and conditional for women, indicating the vulnerability of women. Community views acknowledged that both men and women with TB share a psychological burden of unfulfilled social responsibilities. The distinction between public health risks of infection and unjustified social isolation (stigma) was ambiguous. Such a distinction is important for effective community-based interventions for early diagnosis of TB and successful treatment.