Counseling intervention improves treatment adherence among newly diagnosed drug sensitive Tuberculosis patients of Ahmedabad city - A mixed methods approach.

INTRODUCTION: Counselling sessions based on the health behaviour module for patients on TB treatment may help improve the level of understanding of tuberculosis and its treatment, importance of adherence to therapy, possible side effects, dietary habits and to address any misconceptions; leading to better adherence and improved outcome. Hence, study attempted to assess the impact of brief counselling intervention through treatment adherence supportive activist (TASA) in improving adherence to treatment among drug sensitive TB patients. METHODS: An explanatory mixed methods design (QUAN-Qual) was carried out. Out of 23 Tuberculosis units (TUs) in Ahmedabad Municipal Corporation (AMC) two were selected, one interventional group where trained counsellor was recruited while other was the control group. All drug sensitive TB patients diagnosed at both selected TUs during January to March 2020 were included in the study. Among all patients who were non-adherent in both the TUs, 14 were selected to explore factors contributing to non-adherence to treatment. RESULTS: At the end of intensive phase, drug adherence in the study TU was 85.71% while it was 67.5% in the control TU. At the end of one month of treatment, the proportion of patients having better level adherence was more among counselled patients as compared to non-counselled patients. Marital status, religion, gender did not affect the level of adherence. Reasons for non-adherence as well as perceived barriers to adherence to TB treatment were treatment related, patient related and social barriers. CONCLUSION: Dedicated NTEP counsellor (TASA) can help improve the treatment adherence and impact of physical counselling.

Cost-effectiveness analysis of parenteral iron therapy compared to oral iron supplements in managing iron deficiency anemia among pregnant women.

OBJECTIVE: This study compared the clinical efficacy and cost-effectiveness of parenteral iron, using intravenous iron sucrose (IVIS) therapy against the standard regimen of oral iron (OI) therapy for managing iron-deficiency anemia (IDA) among pregnant women in a natural primary care setting in Gujarat. DESIGN: A prospective cost-effectiveness study was conducted in natural programme setting wherein 188 pregnant women in their 14 to 18 weeks with moderate and severe anemia women enrolled from two districts of Gujarat, and 142 were followed up until the post-partum phase. The intervention group comprised of 82 participants who were administered IVIS, while the comparison group comprised of 106 participants who were put on OI therapy. Hemoglobin (Hb) levels were measured at periodic intervals, first during enrollment and then during each month of pregnancy period and finally on the 42nd day of the post-natal period. OUTCOME MEASURES: Change in mean Hb level from baseline was the primary outcome, while the incidence of morbidity and mortality was a secondary outcome measure. RESULTS: The intervention group showed a significant incremental mean change in Hb level from 8.2 g/dl to 11.45 g/dl at the fourth follow-up, while the control group's mean Hb level reduced from 9.99 g/dl to 9.55 g/dl. The discounted cost per beneficiary for IVIS was US$ 87, while that for OI was US$ 49. The incremental cost-effectiveness ratio (ICER) was US$ 9.84, which is 0.049% of India's per capita GDP. CONCLUSION: IVIS therapy was more clinically effective and cost-effective than OI therapy among pregnant women for management of moderate and severe anemia.

A Study of Maternal Anemia and Utilization of Antenatal and Postnatal Care Services in Devbhumi Dwarka, Gujarat.

Background and objective Despite significant gains and achieving progress in the last decade, maternal anemia remains a major public health concern in India. Both antenatal (AN) and postnatal (PN) women are populations adversely affected by anemia. Reducing anemia among AN and PN women is one of the national priorities of Anemia Mukt Bharat. The present study aimed at assessing the prevalence of anemia, utilization of AN and PN care (ANC and PNC) services, and drivers of anemia among pregnant and lactating women (PLWs) in Devbhumi Dwarka district, Gujarat. Methods A descriptive cross-sectional study was conducted in four blocks of Devbhumi Dwarka district, Gujarat. A total of 1,185 PLWs were interviewed. Anemia was determined based on the last Hb test record on the Mamta Card (Mother and Child Protection Card). Results The mean age of the study population was 25.19 ±3.91 years: 24.95 ±3.94 years for pregnant women and 25.45 ±4.01 years for lactating women. The prevalence of anemia among pregnant women (Hb: <11 g/dL) was 72.92%; 33.91% had moderate and 0.83% had severe anemia. The prevalence of anemia among lactating women (Hb: <12 g/dL) was 26%; 63.93% had moderate and 1.29% had severe anemia. The utilization of nutrition and health services was found to be limited. Of the other sociodemographic factors, age (p=0.045), birth spacing (p=0.014), and education (p=0.017) were significant determinants of anemia among pregnant women, whereas parity (p=0.002), birth spacing (p=0.003), religion (p=0.041), and receipt of take-home ration (THR) (p=0.018) were significantly associated with anemia among lactating women. Conclusion The study revealed a high prevalence of anemia among PLWs and sub-optimal utilization of nutritional and healthcare services in Devbhumi Dwarka. Implementing interventions such as comprehensive nutrition education and counseling can contribute toward improving maternal and child health outcomes.

Nutritional Status of Children Under Two Years of Age in the Devbhumi Dwarka District, Gujarat: A Descriptive Cross-Sectional Study.

Improvements in the analysis of child nutrition status can be helpful in increasing the understanding of the magnitude and critical causes of undernutrition. The present study aimed to assess the nutritional status and related factors in children under two years of age in the Devbhumi Dwarka District of Gujarat, India. A descriptive cross-sectional study was conducted for which the sample size was calculated using Open Epi and considering a 20% non-response rate. The sample size for the study was 1200, but the achieved sample size was 1301. Statistical analysis was performed to identify significant determinants of under-nutrition separately for stunting, wasting, and underweight. The prevalence of wasting, underweight, and stunting was 14%, 17%, and 32%, respectively. Prevalence of low birth weight was recorded as 14% in the district. The overall prevalence of overweight was 20% and 6% as per weight for height and weight for age criteria, respectively. The proportion of children with exclusive breastfeeding was observed to be decreasing with increasing age from birth to six months. About 70% of children were exclusively breastfed at the age of six months. Chi-square analyses revealed that parity and spacing are significant determinants of under-nutrition in children under two years in the Devbhumi Dwarka District. A multipronged and convergence approach is needed to combat the menace of child malnutrition.

Malnutrition in Devbhumi Dwarka: A Situation Analysis.

Background Malnutrition among children, adolescent girls and women is a serious public health issue in India. Malnutrition among adolescent girls is likely to carry on this vicious cycle by giving birth to low birthweight babies. Moreover, low birthweight babies who survive are likely to suffer growth retardation and illness throughout their childhood, adolescence and adulthood. Present situation analysis highlights not only the overall nutrition picture of Devbhumi Dwarka but also narrates the uptake of current nutrition and healthcare services in the Devbhumi Dwarka district. Methods A descriptive cross-sectional study was conducted with 3,738 study population (1,301 children, 1,185 pregnant and lactating women and 1,252 adolescent girls) across four blocks of the Devbhumi Dwarka district of Gujarat. Anthropometric assessments were carried out and the WHO Asia Pacific classification was used for the assessment of malnutrition. Results The prevalence of wasting, underweight and stunting was 14%, 17% and 32%, respectively, in children under two years of age. The prevalence of anaemia among pregnant women (Hb <11 g/dL) was 72.92%; 91.36% of lactating women were anaemic (Hb <12 g/dL). The prevalence of underweight (<-2 SD) among adolescent girls was 19.6%. Block-wise variation in prevalence was observed. Overall, utilization of integrated child development services and health services by these target groups remained sub-optimal. Conclusion The study has revealed the suboptimal nutritional status of children, pregnant and lactating women and adolescent girls of Devbhumi Dwarka, which signifies the need for urgent attention. Several areas of priority have been identified and discussed to improve the overall nutrition status in the district.

Epidemiological and Clinical Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital in Western India.

Introduction: Ahmedabad city reported the highest number of cases and deaths. In order to guide various interventions and monitor future trends, evidence is required. Hence, we conducted the present study to explore the epidemiological determinants, clinical profile, risk factors, and predictors of mortality of COVID-19. Methods: This was a retrospective record-based descriptive study of 2268 confirmed COVID-19 patients admitted in a designated COVID hospital of Ahmedabad city from March to July 2020. Results: The median age of patients was 54 years, and 60.9% of them were males. Majority (83.27%) had comorbidities; the most common comorbidity was hypertension (62.59%) followed by diabetes (44.76%). The most common symptoms reported were fever (69.76%), breathlessness (55.47%), and cough (53.18%). Majority (61.12%) of the patients showed lymphocytopenia, and in one-third (34.85%), D-dimer levels were elevated (>1 µg/ml). Odds of inhospital deaths were higher in patients having breathlessness and gastrointestinal symptoms and comorbidities. More of the deceased had leukocytosis and lymphocytopenia, high D-dimer levels, C-reactive protein, and altered liver function tests as compared to the survivors. Conclusion: While making decisions such as prevention of exposure of high-risk population to the infection, control of the existing comorbid condition, and prioritization of this population for vaccination, criteria of case definition for surveillance keeping in mind the typical and atypical manifestations of the disease, require robust evidence which the current study could provide insight to.

Cost-Effectiveness of mHealth Intervention (TeCHO+) for Improving Maternal and Child Health Indicators in Gujarat, India.

Background: Gujarat has implemented an mHealth program, technology for community health operations-plus (TeCHO+) in 2019. TeCHO+ is a mobile and web-based application that essentially enables data entry by the frontline workers providing service at the time and place of service delivery to improve the coverage and data quality. It also facilitates early identification of morbid condition and timely treatment. This study assessed the cost-effectiveness of TeCHO+ program in Gujarat. Materials and Methods: The study compared key program outcome indicators before and after the launch of TeCHO+ program. As the program was launched across the State, eMamta, the previous version of mother and child tracking system was used for comparison. A decision tree was parameterized to estimate change in disability-adjusted life year (DALY) and cost as a result of implementing TeCHO+ from a health system perspective. Results: TeCHO+ incurred a cost of Rs. 2,624 per beneficiary against Rs. 1,075 per beneficiary under the previous eMamta program. TeCHO+ has resulted in significant DALY averted through early identification of high-risk cases both among pregnant women and children. Overall, cost-effectiveness analysis indicated that TeCHO+ incurred an incremental cost of Rs. 1802.84 per DALY averted, which is 1.19% of the GDP per capita of India (year 2020). Conclusion: This study concludes that TeCHO+ is cost-effective for mother and child care and can be considered for replicating.

Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra.

Introduction: Adherence to tuberculosis (TB) medication is one of the critical challenges to tuberculosis elimination in India. Digital adherence technologies (DAT) have the potential to facilitate medication adherence and monitor it remotely. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is one such DAT piloted in Nasik, Maharashtra, from April 2020 to December 2021. The study aims to assess the adherence and cost-effectiveness of TMEAD compared to the standard of care among patients with drug-sensitive tuberculosis (DSTB) residing in the urban areas of Nasik, Maharashtra, India. Methods: A quasi-experimental study was conducted among new cases of TB as per the National TB Elimination Programme (NTEP) residing in the urban geography of Nasik. The intervention and control arms were purposively selected from non-contaminating TB units (TUs). A total of 400 DSTB patients (200 in the intervention group and 200 in the control group) were enrolled. After enrolment, patients in the intervention arm were provided with the TMEAD device and followed for 24 weeks to assess treatment outcomes. Adherence was measured as those patients who have completed 80% of prescribed doses, as reported during patient follow-up, and further validated by analyzing the trace of rifampicin in urine among 20% of patients from both arms. A budget impact analysis was done to assess the impact of the TMEAD program on the overall state health budget. Results: Out of 400 enrolled DSTB patients, 261 patients completed treatment, 108 patients were on treatment, 15 patients died, and 16 patients were defaulters over the study period. The study reported overall treatment adherence of 94% among those who completed treatment. Patient reports indicated high levels of treatment adherence in the intervention group (99%) as compared to the control group (90%). Adherence assessed through analyzing trace of rifampicin in the urine sample for the intervention arm was 84% compared to the control arm (80%). Per beneficiary (discounted) cost for TMEAD was Indian rupees (INR) 6,573 (USD 83). The incremental cost-effectiveness ratio of the intervention is INR 11,599 (USD 146), which shows that the intervention is highly cost-effective. Conclusion: This study revealed that patient-reported treatment adherence was high in TMEAD when compared to standard therapy of care for DSTB patients and the intervention is cost-effective. TMEAD could complement the national strategy to end TB by improving adherence to the treatment regimen in India.

Cross-Sectional Analysis of Nutritional Status, Knowledge and Uptake of Nutritional Services Among Adolescent Girls in Western India.

PURPOSE: Malnutrition status of adolescent girls remains a major public health problem in India. The present study assessed nutritional status, associated factors contributing to malnutrition and their access to health-care services in Dev Bhumi Dwarka district of Gujarat situated in western part of India. MATERIALS AND METHODS: The study was carried out using descriptive cross-sectional design. A total of 1252 adolescent girls from all four blocks of Dev Bhumi Dwarka district were interviewed by field investigators. The data were collected on socio-demographic characteristics, physical activities, diet, and anthropometry. The WHO classification for body mass index (BMI) was used to assess underweight, overweight, and obesity among adolescent girls. Chi-square analyses were performed to identify significant determinants of under-nutrition. RESULTS: Mean age of the study population was 13.82±2.31. Of the total, around 34% of the adolescent girls were out-of-school. The prevalence of underweight (<-2SD) was 19.6%, 8.9% were overweight, and 2.6% were obese. The mean BMI was 19.77±2.42 kg/m2, and height was 149.15 (2.23m2). In terms of knowledge, almost 79.6% were unaware of iron-deficiency anaemia, about 70% were not aware of haemoglobin test, and 44% did not know the benefit of using sanitary napkins. In addition, uptake of nutritional and health services was limited. The study found a statistically significant association of age (p = 0.00), the number of family members (p = 0.016), knowledge (p = 0.05), and use of toilet (0.041) with low-BMI. CONCLUSION: Existing nutritional interventions need to focus on nutrition, health and hygiene education. It also reinforces a need for implementation research to understand barriers in uptake of health and nutrition services.

Clinical features and outcome of COVID-19 among PLHIV in Gujarat, India: A case series.

Information on people living with HIV (PLHIV) and current COVID-19 pandemic is still scarce in Indian setting. This case series of PLHIV with COVID-19 describes clinical characteristics and outcome in this special group of patients. This case series included 11 confirmed cases of COVID-19 among PLHIV admitted at a tertiary care hospital in Gujarat, India during April-December 2020. This retrospective study was conducted by doing secondary data analysis from case records of patients for various variables including demographic, clinical characteristics, HIV-related parameters, and outcome (discharged/death). The mean age of patients was 39.2 years ranging from 20 to 55 years. Nearly, 18% (2/11) of patients had major comorbidities like diabetes and hypertension. All were taking antiretroviral therapy drugs with >95% drug adherence and had CD4 count ranging from 79/cu.mm. to 1189/cu.mm. Majority (91%) of patients recovered and were discharged while only one patient (9%) died during course of COVID-19 treatment. COVID-19 showed a similar clinical and epidemiological profile among PLHIV like other group of people. Further studies with large-sample size are recommended to find risks of COVID-19 among PLHIV and its impact on treatment outcomes.

Visually clean is not necessarily microbiologically safe: Learnings from WASH assessment of maternity units of Gujarat, India.

BACKGROUND AND AIMS: Water Sanitation and Hygiene (WASH) within the context of Sustainable Development Goal (SDG) is well debated; however, WASH in health care sector is still in nascent phase, especially for maternity units. Although there are studies on WASH in maternity units, least are focused towards the microbiological safety. The objective of present study is to compare the visual assessment with microbiological assessment of selected maternity units of Gujarat (India) and to document microbiological contamination and drug resistance. METHODS: A cross-sectional study was carried out in 10 selected maternity units of Sabarkantha and Gandhinagar district of Gujarat, India, during Feb-March 2018. Two steps of Tool Box Plus were used for documentation: visual and microbiological assessment. Antimicrobial Resistance (AMR) patterns amongst positive microorganisms were also documented. RESULTS: Although the majority of the studied maternity units were visually clean, the microbiological findings contraindicated the same. The overall visual score across all facilities was close to 50% indicating good visual cleanliness. Out of 195 samples collected, 18% (35) samples were positive for pathogenic organisms and the majority were identified from mops and labour table. 1/3rd of organisms were resistant to > 5 antibiotics. Pathogenic organism identified includes Acitenobacter, Klebsilla, MR CONS, E coli, Psudomonas Aeruginosa and Pseudomonas species. CONCLUSIONS: Visual assessment alone which is currently used for assessment of hygiene is not a proxy for safety. It should be validated by the microbiological method. Microbiology surveillance should be explored to get valuable insights on the effectiveness of cleaning practices of the maternity units.