RESUMO
BACKGROUND: Government of India recognizes the use of "information, communication, and technology" in the provision of comprehensive primary healthcare. In 2014-2015, Karuna Trust, a nongovernmental organization, Bengaluru, India, introduced an electronic health record (EHR) innovation, namely "Comprehensive Public Health Management" application (CPHM App). Data could be entered in an offline mode followed by syncing with cloud. The CPHM App was piloted in primary health center (PHC) Gumballi, in Karnataka, with focus on household survey and maternal and child health (MCH) services. OBJECTIVES: To compare the consistency of selected MCH process indicators for Health Management Information System [HMIS] available from paper-based records and those generated through the CPHM App (2016-2017). We also explored the implementation enablers, barriers, and suggested solutions from the user perspective. METHODS: A sequential mixed-method study design was followed. Quantitative phase involved aggregate data analysis looking into the consistency of selected MCH process indicators available from paper-based records and those generated through the CPHM App (2016-2017) followed by thematic analysis of in-depth interviews of healthcare providers. Consistency was defined as a percentage where the numerator was the HMIS-related process indicator data from CPHM App and denominator was the data from paper-based records. RESULTS: Three out of 12 selected MCH indicators had consistency of >80%. The quarterly consistency reduced over the 2 years. Dual burden of entry and regular monitoring of paper-based records by district health and family welfare department were the reasons why more importance was given to entry in paper-based records. Ability to generate aggregate indicators with CPHM App, easy to use and retrieve data in the field, and reminder facility for planned health activities were some of the factors facilitating CPHM implementation. The key barriers were limited technical expertise and support from the technical team and no internet connectivity in the field and traveling to PHC to sync the data. Provision of real-time technical support and availability of data connectivity in the field were some of the solutions suggested. CONCLUSION: There should be a minimum of 1-2 years of simultaneous use of EHR and paper-based records after which one must shift to EHR.
RESUMO
BACKGROUND: For decades, tuberculosis and other communicable diseases like human immunodeficiency virus/acquired immune deficiency syndrome, leprosy, etc., have been associated with stigma and discrimination by the society; this can interfere with the lifestyle and disease management among these patients. OBJECTIVE: To assess the stigma experienced by tuberculosis patients and to find the factors associated with stigma. METHODS: A cross-sectional study was conducted among 209 sputum-positive and sputum-negative tuberculosis patients. Convenient sampling was used to identify the patients. A predesigned, pretested proforma from Explanatory Model Interview Catalogue developed by World Health Organization was used for data collection. RESULTS: The study revealed that out of 209 respondents, 51.2% of the respondents experienced some form of stigma. Majority of the patients have received only primary education and 71.3% of the respondents were males. Most of the patients were under category 1 of Directly Observed Treatment Short course. Age, education, and smear status of the patient were found to be associated with stigmatization (P<0.05), whereas factors like gender, income, occupation, family history, and marital status were found to be not significantly associated with stigmatization. CONCLUSION: Effective counseling measures are recommended for tuberculosis patients with advancing age and education which can help reduce stigmatization and thereby improve quality of life.
