Facilitators and Challenges in Patient's Satisfaction with Quality of Cervical Cancer Care in a Tertiary Care Hospital, Puducherry, India: A Qualitative Study.

Shikha YadavBackground Chronic diseases require more attention in terms of patient satisfaction due to their physically and mentally exhausting nature. Cancer burden in India for 2021 was 26.7 million disability-adjusted life years (DALYs), and is projected to rise to 29.8 million by 2025. The second most common cause of cancer DALYs among females was cervix uteri (98.6 per 100,000). Evaluation of factors that influence satisfaction can assist in finding solutions to improve the quality of services provided. Methods This study was conducted in the Regional Cancer Centre, Puducherry. One focused group discussion (FGD) was conducted among seven cervical cancer patients and eight key informant interviews (KII) with their healthcare providers (HCPs). The details collected included perceptions of patient satisfaction, difficulties they faced in achieving patient satisfaction, and possible recommendations for improvement. Thematic analysis was done after preparing transcripts. Results The major facilitating factors reported were proper information exchange, the approachability of staff, and assisting patients with transportation concession certificates. Obstacles highlighted by patients included lack of family support, side effects of treatment, inability to do routine work, and long travel time. HCP reported misalignment between and within departments, overworked staff, lack of equipment for smooth telemedicine services, and inadequate space for OPD, counseling, and waiting as barriers to providing satisfactory services to patients. Conclusions Most challenges were attributed to overworked staff, inequitable distribution of cancer center, and patients' knowledge and understanding of disease. Therefore, it is important to make patients aware of the disease, treatment, and value of the quality of life. It can enable them to make better use of resources, in addition to improvements in the health system.

Effect of treatment adherence on the association between sex and unfavourable treatment outcomes among tuberculosis patients in Puducherry, India: a mediation analysis.

BACKGROUND: A better understanding of the complex interplay between risk factors of tuberculosis (TB) is essential. This study was part of the Regional Prospective Observational Research for Tuberculosis (RePORT) India consortium and includes newly diagnosed TB patients in Puducherry between 2014 and 2018. We employed mediation analysis to identify the effect of treatment adherence on association between sex and unfavourable TB treatment outcomes. METHODS: Required demographic and treatment-related variables were extracted from the RePORT India consortium database and causal mediation analysis using parametric regression models was done. RESULTS: Of the 712 TB patients, ~87 (12.2%) had unfavourable TB treatment outcomes. Total effect of male sex was significantly associated with the unfavourable TB treatment outcomes [adjusted odds ratio (aOR) = 2.48; 95% confidence interval (CI): 1.11-5.55]. However, the overall association between male sex and TB treatment outcomes was dominated by the indirect pathway, as the direct pathway does not show significant association (aOR = 1.67; 95% CI: 0.75-3.75), while the indirect pathway shows significantly higher odds of TB treatment outcomes (aOR = 1.48; 95% CI:1.27-1.73), indicating complete mediation by the treatment adherence. CONCLUSIONS: The study has shown a complete mediation of sexes through TB treatment adherence for unfavourable treatment outcomes. Developing of treatment strategies require better understanding between the biological and social factors related to TB.

Development of prognostic scoring system for predicting 1-year mortality among pulmonary tuberculosis patients in South India.

BACKGROUND: Development of a prediction model using baseline characteristics of tuberculosis (TB) patients at the time of diagnosis will aid us in early identification of the high-risk groups and devise pertinent strategies accordingly. Hence, we did this study to develop a prognostic-scoring model for predicting the death among newly diagnosed drug sensitive pulmonary TB patients in South India. METHODS: We undertook a longitudinal analysis of cohort data under the Regional Prospective Observational Research for Tuberculosis India consortium. Multivariable cox regression using the stepwise backward elimination procedure was used to select variables for the model building and the nomogram-scoring system was developed with the final selected model. RESULTS: In total, 54 (4.6%) out of the 1181 patients had died during the 1-year follow-up period. The TB mortality rate was 0.20 per 1000 person-days. Eight variables (age, gender, functional limitation, anemia, leukopenia, thrombocytopenia, diabetes, neutrophil-lymphocyte ratio) were selected and a nomogram was built using these variables. The discriminatory power was 0.81 (95% confidence interval: 0.75-0.86) and this model was well-calibrated. Decision curve analysis showed that the model is beneficial at a threshold probability ~15-65%. CONCLUSIONS: This scoring system could help the clinicians and policy makers to devise targeted interventions and in turn reduce the TB mortality in India.

Predictors of weight loss during the intensive phase of tuberculosis treatment in patients with drug-susceptible pulmonary tuberculosis in South India.

BACKGROUND: Tuberculosis (TB) is well-known for causing wasting. Patients on treatment gain weight and weight loss is associated with unfavorable treatment outcomes. There is limited description of weight loss and its predictors during intensive treatment phase. The objective of this study was to assess the predictors of weight loss during intensive phase and to see if there is any association exists with sputum conversion at the end of intensive phase of treatment. METHODS: Data collected as a part of the prospective TB cohort (Regional Prospective Observational Research for TB India Phase 1) conducted in Pondicherry, Cuddalore and Viluppuram districts of Tamil Nadu were used for this study. Sputum smear and body weight comparison were made in the baseline and at the end of second month of treatment. RESULTS: In all, 726 participants had weight measurements at the two time points and 18.7% had weight loss; mean weight lost being 2.3 kg (SD 3.05). Mean weight loss was more among males (2.4 kg, SD 3.2), diabetics (2.8 kg, SD 3.9) and alcoholics (2.1 kg, SD 2.4). Alcohol consumption was the only predictor of weight loss after adjusting for age, diabetes, marital status and BMI (aRR 1.52, P 0.02). Weight loss was not associated with sputum conversion at the end of second month. CONCLUSIONS: Alcohol use emerged as the major predictor for weight loss during intensive phase.

Prevalence of Oral Lesions and Its Associated Risk Factors Among PLHIV Availing Anti-Retroviral Therapy from a Selected Tertiary Care Hospital, Puducherry - A Cross Sectional Analytical Study.

Background and Objectives: Oral lesions are among the earliest and most important indicators of infection with human immunodeficiency virus (HIV). The presence of oral lesions has a significant impact on the physical and mental health of the PLHIV. Hence, a novel attempt is made to assess the prevalence of various types of oral lesions among the adult people living with human immunodeficiency virus (PLHIV) undergoing antiretroviral therapy. Methodology: In this facility-based cross-sectional study, a total of 239 out of 300 eligible PLHIV were assessed between September and October 2018. All consecutive eligible patients encountered during the data collection period were included. Oral examination was carried out using disposable mouth mirrors, sterile piece of cotton, and bright illuminated torch. Results: The prevalence of oral mucosal abnormalities was found to be 25% (95% confidence interval: 20.03-30.97). The most prevalent oral lesions were acute necrotizing ulcerative gingivitis, acute necrotizing ulcerative periodontitis, and candidiasis. CD4 count <200 cells/mm3, current tobacco use, and alcohol usage were significantly associated with the prevalence of oral lesions. Conclusion and Recommendations: The study revealed that one-fourth of the study participants had oral lesions. Strategies for early detection and prompt treatment of oral lesions need to be planned and incorporated in the program to reduce the morbidity due to oral lesions.

Lung Function Impairment In Patients Treated For Pulmonary Tuberculosis and Associated Factors in Puducherry, South India.

Context: After completion of treatment, a proportion of pulmonary tuberculosis (TB) (PTB) patients experience lung function impairment (LFI) which can influence their quality of life. Aim: This study was aimed to determine the prevalence of LFI in patients treated for PTB and the associated factors. Settings and Design: A cross-sectional study was conducted among patients treated for PTB in eight primary health centers in Puducherry. Subjects and Methods: The study was carried out among 118 patients. Those aged 18 and above whose PTB treatment outcomes were declared as cured or completed between 2018 and 2019 were included. Demographic data, respiratory symptoms before TB diagnosis, comorbidities, and chest radiography findings before TB treatment were collected. All participants underwent spirometric tests before and after dilatation with salbutamol nebulization. Statistical Analysis: Multivariable analysis identified smear-negative TB and indoor exposure to biomass for cooking as significant independent risk factors for LFI. Results: Of 118 participants interviewed, 70.3% were male and the median age of the participants was 47.7 years. The prevalence of LFI was 62.7% (95% confidence interval: 53.3-71.4). Conclusion: LFI was frequent in patients treated previously for TB. Creating awareness about the possible LFI among these patients along with the awareness for seeking health care for this condition is the need of the hour.

The burden of the probable polycystic ovarian syndrome and its associated factor among college going late adolescents and young adults: a cross sectional analytical study in urban Puducherry, South India.

OBJECTIVES: Polycystic Ovarian Syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. In low income and developing countries like India, there are very high chances of developing PCOS due to marked variation between culture, ethnic groups, diet, lifestyle and genetic factors. This study aims to determine the burden of probable PCOS among college going students in Puducherry. METHODS: A cross sectional study was carried out among students aged 18 years and above in a Government College for Women located in urban Puducherry. A total of 610 students were selected through a cluster random sampling technique. A pretested validated proforma was administered after obtaining informed consent. RESULTS: 25.1% (21.8-28.7) of women were having probable PCOS, 18.7% (15.8-22.0) had irregular menstrual history, 8.4% (6.4-10.8) had Hirsutism and 2% (1.8-3.3) had both the symptoms. Regarding food habits, 43.1% were vegetarians and were having probable PCOS and this association was found to be statistically significant. No significant association was found between prevalence of probable PCOS and factors such as higher age, parental income, higher BMI and physical inactivity. CONCLUSIONS: The present study found a high prevalence of probable PCOS among college going students, especially among study respondents who were obese, physically inactive and vegetarians compared to the counterpart. Earlier detection and proper management of the symptoms can avoid some major co-morbidity in the future. Therefore, screening is an important part in the diagnosis and management of PCOS among adolescent girls.

Prevalence and factors associated with diabetes mellitus among tuberculosis patients in South India-a cross-sectional analytical study.

OBJECTIVE: To determine the prevalence and determinants of diabetes mellitus (DM) among tuberculosis (TB) patients and to assess the additional yield and number needed to screen (NNS) to obtain a newly diagnosed DM among TB patients. DESIGN: We undertook a cross-sectional analysis of the cohort data under Regional Prospective Observational Research for Tuberculosis-India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included. Pretested standardised questionnaires and tools were used for data collection. Prevalence of DM among TB patients was summarised as proportion with 95% CI. Type II DM was diagnosed if random blood sugar level was >200 mg/dL or if the participant had a documented history of DM. NNS by blood glucose testing to diagnose one new DM case among TB patients was also calculated. SETTING: Three districts of South India: Puducherry, Cuddalore and Villupuram SUBJECTS: Newly diagnosed sputum smear positive pulmonary TB patients aged ≥16 years RESULTS: In total, 1188 TB patients were included. Prevalence of DM among TB patients was 39% (95% CI: 36.2% to 41.8%). In unadjusted analysis, elderly TB, marital status, caste, gender, higher education level, household income and obesity had a significant association with DM. However, in adjusted analysis, only marital status (currently married aPR; 3.77 (95 CI: 2.20 to 6.49), widowed/separated/divorced aPR; 3.66 (95 CI: 1.96 to 6.83)) and body mass index category (normal weight aPR; 3.26 (95 CI: 2.55 to 4.16), overweight aPR; 3.86 (95 CI: 2.69 to 5.52), obesity aPR; 4.08 (95 CI: 2.81 to 5.94)) were found to be significant determinants. The number of TB patients needed to be screened to find a new DM case was 12. CONCLUSION: We found that one in three TB patients had coexisting DM. The number of TB patients needed to be screened to obtain a newly diagnosed DM patients was also determined. The study supports and highlights the need of RNTCP's effort in bidirectional screening of TB and DM.

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India.

The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60-69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.

Severe undernutrition in children affects tuberculin skin test performance in Southern India.

BACKGROUND: Undernutrition impairs immunity to Mycobacterium tuberculosis and is a risk factor for tuberculosis disease (TB). We aim to investigate if severe undernutrition affects the tuberculin skin test (TST) response among household contacts (HHCs) of pulmonary TB cases. METHODS: We analyzed data from HHCs (> five years) of pulmonary TB cases in Southern India. Undernutrition was defined as per World Health Organization based on body mass index (BMI) for adults (undernutrition 16-18.4 and severe undernutrition <16 kg/m2) and BMI relative to the mean for children (undernutrition 2SD-3SD and severe undernutrition < 3SDs below mean). Univariate and multivariate models of TST positivity (> five mm) were calculated using logistic regression with generalized estimating equations. RESULTS: Among 1189 HHCs, 342 were children (age 5-17 years) and 847 were adults. Prevalence of TST positivity in well-nourished, undernourished and severely undernourished children was 135/251 (53.8%), 32/68 (47.1%), and 7/23 (30.4%) respectively; among adults, prevalence of TST positivity was 304/708 (42.9%), 43/112 (38.4%) and 12/26 (46.2%), respectively. Severe undernutrition in children was associated with decreased odds of TST positivity (adjusted odds ratio 0.3; 95%CI 0.1-0.9). CONCLUSION: Severe undernutrition in children was associated with decreased odds of TST positivity. False-negative TSTs may result from undernutrition; caution is warranted when interpreting negative results in undernourished populations.

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India.

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.

Community-based assessment of postnatal care in Puducherry-A cross-sectional study.

INTRODUCTION: Postnatal period is a neglected period compared to the antenatal period. Providing adequate care to infant and mother during this vital period is essential. OBJECTIVES: To assess the postnatal care (PNC) received by the mothers and newborn children in Puducherry. MATERIALS AND METHODS: Community-based cross-sectional study done among the postnatal mothers under the care of two urban Primary Health Centers (PHC A and PHC B) in Puducherry in 2015-2016. Eligible mothers were contacted at their houses within 4 weeks of completion of their postnatal period to assess the postnatal care. RESULTS: Out of 227 postnatal mothers in the study, only 37.4% (85) (95%CI 31.3-43.9) of the mothers had received adequate counselling services on topics of nutrition, hygiene, contraception, essential newborn care, breastfeeding, and immunization. Cord care was given for 99.1% of the babies and breastfeeding position was checked for 88.5% of the babies. Among the mothers who had normal deliveries, 48.1% (76) (95% CI 40.4-55.9) of the mothers had initiated breastfeeding within 1 h of normal delivery and within 4 h of delivery for 72.4% (50) (95% CI 61.1-82.0) among the mothers who had a cesarean section. Only 20.7% (47) (95%CI 15.8-26.3) of the mothers and newborns had received at least one postnatal home visit and none of the mothers had received adequate postnatal home visits as per Indian Public Health Standards guidelines. Out of the 126 eligible mothers for JSY benefits, only 46% (58) (95% CI 37.5-54.8) of them had registered. Among those who were not registered, 20.6% had reported that they were unaware of the scheme. Out of 227 births, 14.1% (32) of them were of low birth weight (<2.5 kg) and 1.3% (3) were of very low birth weight (<1.5 kg) category. CONCLUSION: Although the antenatal care is satisfactory in the study setting, implementation of PNC needed further attention and active guidance via health system strengthening.

Preference on prenatal sex determination and its associated factors among currently married women of reproductive age group in Puducherry, India.

BACKGROUND: Sex determination refers to knowing the sex of foetus during prenatal period for non-medical reasons. Attitude of married women to sex determination is important to improve the sex ratio at birth. AIM AND OBJECTIVES: This study aimed to assess preference on sex determination and associated factors among currently married reproductive age group women. MATERIALS AND METHODS: This cross-sectional community-based study was done during 2016-2017 among 2228 currently married women of 18-49 years' age group in urban and rural Puducherry, India. Information on the demographic characteristics, level of awareness and preference for sex determination was obtained. Multiple logistic regression was used to identify factors influencing preference for sex determination. Unadjusted and adjusted odds ratio (AOR) as a measure of effects was used. RESULTS: Of 1979 respondents, all were aware that sex determination is possible. Majority of them did not prefer sex determination (95.4%, 1888). About 80 (4.0%) preferred, while 11 (0.6%) were undecided about it. Majority of them were aware that sex determination without medical indication is a crime. Common source of information was healthcare workers (76.4%). After adjusting for confounders, age group (18-24, AOR = 5.334; 25-29, AOR = 3.249; 30-34, AOR = 3.857; 35-39, AOR = 2.279), middle level education (AOR = 2.3), those with unmet need for family planning (AOR = 2.970) and urban area (AOR = 67.679) subjects were preferred more; housewife (AOR = 0.481) and those without living son (AOR = 0.406) had preferred lesser for sex determination compared to their counterparts. CONCLUSION: About one in 25 currently married women preferred sex determination. It is comparatively more in urban areas. High-risk groups should be educated to develop correct awareness and attitude on prenatal sex determination.

Risk factors for death during treatment in pulmonary tuberculosis patients in South India: A cohort study.

OBJECTIVE: Identifying the risk factors for deaths during tuberculosis (TB) treatment is important for achieving the vision of India's National Strategic Plan of 'Zero Deaths' by 2025. We aimed to determine the proportion of deaths during TB treatment and its risk factors among smear positive pulmonary TB patients aged more than 15 years. STUDY DESIGN: We performed a cohort study using data collected for RePORT India Consortium (Regional Prospective Observational Research in Tuberculosis). SETTING: Revised TB Control Program (RNTCP) in three districts of South India. PARTICIPANTS: The cohort consisted of newly diagnosed drug sensitive patients enrolled under the Revised National TB Control Program during 2014-2018 in three districts of southern India. Information on death was collected at homes by trained project staff. PRIMARY OUTCOME MEASURES: We calculated 'all-cause mortality' during TB treatment and expressed this as a proportion with 95% confidence interval (CI). Risk factors for death were assessed by calculating unadjusted and adjusted relative risks with 95% CI. RESULTS: The mean (SD) age was of the 1167 participants was 45 (14.5) years and 79% of them were males. Five participants (0.4%) were HIV infected. Among the males, 560 (61%) were tobacco users and 688 (75%) reported consuming alcohol. There were 47 deaths (4%; 95% CI 3.0-5.3) of which 28 deaths (60%) occurred during first two months of treatment. In a bi-variable analysis, age of more than 60 years (RR 2.27; 95%CI: 1.24-4.15), male gender (RR 3.98; 95% CI: 1.25-12.70), alcohol use in last 12 months (RR 2.03; 95%CI: 1.07-3.87), tobacco use (RR 1.87; 95%CI: 1.05-3.36) and severe anaemia (RR 3.53: 95%CI: 1.34-9.30) were associated with a higher risk of death. In adjusted analysis, participants with severe anaemia (<7gm/dl) had 2.4 times higher risk of death compared to their counterparts. CONCLUSION: Though deaths during TB treatment was not very high, early recognition of risk groups and targeted interventions are required to achieve zero TB deaths.

Comparing tuberculosis gene signatures in malnourished individuals using the TBSignatureProfiler.

BACKGROUND: Gene expression signatures have been used as biomarkers of tuberculosis (TB) risk and outcomes. Platforms are needed to simplify access to these signatures and determine their validity in the setting of comorbidities. We developed a computational profiling platform of TB signature gene sets and characterized the diagnostic ability of existing signature gene sets to differentiate active TB from LTBI in the setting of malnutrition. METHODS: We curated 45 existing TB-related signature gene sets and developed our TBSignatureProfiler software toolkit that estimates gene set activity using multiple enrichment methods and allows visualization of single- and multi-pathway results. The TBSignatureProfiler software is available through Bioconductor and on GitHub. For evaluation in malnutrition, we used whole blood gene expression profiling from 23 severely malnourished Indian individuals with TB and 15 severely malnourished household contacts with latent TB infection (LTBI). Severe malnutrition was defined as body mass index (BMI) < 16 kg/m2 in adults and based on weight-for-height Z scores in children < 18 years. Gene expression was measured using RNA-sequencing. RESULTS: The comparison and visualization functions from the TBSignatureProfiler showed that TB gene sets performed well in malnourished individuals; 40 gene sets had statistically significant discriminative power for differentiating TB from LTBI, with area under the curve ranging from 0.662-0.989. Three gene sets were not significantly predictive. CONCLUSION: Our TBSignatureProfiler is a highly effective and user-friendly platform for applying and comparing published TB signature gene sets. Using this platform, we found that existing gene sets for TB function effectively in the setting of malnutrition, although differences in gene set applicability exist. RNA-sequencing gene sets should consider comorbidities and potential effects on diagnostic performance.

Extent of contraception methods practised by unmet need couples after counselling: a cross-sectional follow-up study in Puducherry, South India.

BACKGROUND: Information is paucity about the extent of contraception practise among the unmet need eligible couples after counselling. OBJECTIVE: To assess the prevalence and associated factors of unmet need for family planning (FP), the extent to which they practise desired contraception methods after baseline counselling and the reasons for not practicing it. METHODS: A community-based cross-sectional analytical study was conducted between 2016 and 2019 among 2228 currently married couples with periodic follow ups of unmet need group. Baseline data on unmet need were collected based on the National Family Health Survey questionnaire. Individual and couple counselling were performed through informing choice and the support for decision making was based on the unmet need reasons with follow-ups. The data were analysed using Stata software version 12.0 (StataCorp, College Station, TX). RESULTS: The total study population was 1924. The prevalence of unmet need for FP was 7.1% (137) with 2.9% (55) of unmet need for spacing and 4.3% (82) of limiting births. Age groups between 18 and 24 [adjusted odds ratio (AOR) = 4.463], 25-29 (AOR = 2.339), not having a child (AOR = 0.250), having one child (AOR = 2.369) and having lower socioeconomic status (AOR = 0.155) were significantly associated with unmet need. During the follow-ups, 37.2% (29/78) received who desired limiting births, while 43.6% (34/78) changed to spacing methods. In fact, the main reason for not adopting limiting births is the fear of post-operative surgery-related health problems. CONCLUSIONS: This study emphasizes the need for follow-up counselling for guiding contraceptive use and recorded that majority of the unmet need couples started practicing contraception methods during the follow-ups. Besides, change in desired contraception methods was observed.

Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India.

BACKGROUND: There are paucity of studies on current fertility desire at community level. OBJECTIVE: To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India. METHODS: A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis. RESULTS: Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%-15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18-24 (APR = 2.91), 25-29 years (APR=2.48), 30-34 (APR=2.47), 35-39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60). CONCLUSION: The fertility desire is comparatively lesser than other areas. Those without or with a single child and high socioeconomic status group had comparatively more fertility desire.

Alcohol use and tuberculosis clinical presentation at the time of diagnosis in Puducherry and Tamil Nadu, India.

SETTING: Alcohol use increases the risk of tuberculosis (TB) disease and is associated with worse outcomes. OBJECTIVE: To determine whether alcohol use affects TB severity at diagnosis in a high-burden setting. DESIGN: Participants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C. Univariable and multivariable analyses were conducted. RESULTS: Of 1166 PLWTB, 691 (59.3%) were drinkers; of those, 518/691 (75.0%) were at-risk for AUD. Drinkers had more lung affected than non-drinkers (adjusted mean difference 10.8%, p<0.0001); this was not significant for those at-risk for AUD (adjusted mean difference 3.7%, p = 0.11). High smear grade (aOR 1.0, 95%CI: 0.7-1.4), cavitation (aOR 0.8, 95%CI 0.4-1.8), and TTP (mean difference 5.2 hours, p = 0.51) did not differ between drinkers and non-drinkers, nor between those at-risk and not at-risk for AUD. CONCLUSIONS: A large proportion of PLWTB were drinkers and were at-risk for AUD. Alcohol drinkers had more lung affected than non-drinkers. Studies are needed to explore mechanisms of this association.

Evaluation of factors influencing Mycobacterium tuberculosis complex recovery and contamination rates in MGIT960.

BACKGROUND: Tuberculosis (TB) is a major public health problem worldwide. Contamination rate and poor recovery of Mycobacterium tuberculosis complex (MTBC) in MGIT960 culture may affect the early diagnosis of TB. Evidence is needed to determine the factors associated with contamination rates and MTBC recovery in MGIT960. Hence, we undertook this study to compare the factors influencing MTBC culture positivity and contamination rates in MGIT960 in patients with Pulmonary tuberculosis (PTB). METHODS: A total of 849 sputum samples from newly diagnosed smear-positive TB cases enrolled into the Regional Prospective Observational Research for Tuberculosis India cohort between May 2014 to March 2017 were analyzed. Samples were inoculated into MGIT960 and positive cultures were examined for the presence of MTBC by immunochromatographic test for detection of MPT64 antigen. RESULTS: Of the 849 cases, 811 (95.5%) were culture positive for MTBC, 23 (2.7%) were culture negative and 15 (1.8%) were contaminated. Salivary sputum showed significantly less culture yield compared to mucopurulent/blood stained samples (p = 0.021). Sputum from individuals <20 or ≥60 years showed lower culture yield of 93.9%, compared to those aged 20-59years (98.2%) (p = 0.002). Based on smear grading, culture isolation of MTBC by MGIT960 was 86.1%, 93.6% and 99.5% for negative, scanty and positive (1+/2+/3+) samples, respectively (p ≤ 0.0001). Sputum from HIV negative patients showed higher culture yield, compared to HIV positive patients (p ≤ 0.0001). Chest X-Ray revealed that patient with cavity showed higher culture isolation of MTBC compared to patients without cavity (p = 0.035). Contamination rates were higher in smear negatives (6.0%), compared to scanty (2.1%) and smear positives (1.1%) (p = 0.007). However, delay in transport of the specimen to the laboratory was the only independent factor significantly associated with increase in culture contamination. CONCLUSION: Our results highlight that extremes of age, smear negativity, HIV infection, sputum quality and cavitation significantly influence the culture yield of MTBC, whereas transport duration and smear grading affected the contamination rates in MGIT960. Hence, addressing these factors may improve the diagnostic performance of MGIT960.