International Journal of Medical Science and Public Health, 2016
Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free di... more Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%. Objectives: The objective of the present work was to investigate the factors associated with low SCR at the end of 2 months of treatment in Sira TB unit, Tumkur District, India. Material and Methods: It is a retrospective cohort study of all new sputum smear-positive patients registered in RNTCP in 2011. Data were retrieved from the TB register maintained at the District TB center. Chi-square and Student’s t-test were used for analysis of the study variables between patients who were sputum positive and sputum negative at the end of 2 months of treatment. Multivariate logistic regression was applied to determine the risk contributed by the variables towards non-conversion of sputum. Results: Of the 268 included patients, 66.7% patients were sputum negative. Patients aged ≥ 45 years were twice prone to be sputum positive (OR = 2.14) (P = 0.007). The odds of being sputum positive after 2 months of treatment was observed to be significantly high (OR = 7.12; 95% C.I. = 1.52–33.22; P = 0.01) for sputum grade 3+ at the time of diagnosis, respectively. Conclusion: Elderly patients with a high bacilli load should be advised and counselled well regarding adherence to treatment. Further, advice should be given on preventing spread of the disease by practising cough hygiene, as they are more infectious than other patients with less sputum-positive grade.
We comparatively assessed the performance of six simple obesity indices to identify adults with c... more We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. No single obesity index consistently performed statistically si...
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2015
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In a... more Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.
Health systems with strong comprehensive primary health care (CPHC) are known to result in better... more Health systems with strong comprehensive primary health care (CPHC) are known to result in better health outcomes for people. In India, there is a recent push to strengthen CPHC through Ayushman Bharat. This study aimed to document lessons from successful CPHC initiatives in rural and urban India using a qualitative case study approach. A total of 72 CPHC initiatives were identified through desk review and 12 of these were studied as cases. The following two main models of CPHC delivery were seen in India: (a) a hospital or health centre with outreach and (b) social franchising model, prevalent in rural and urban contexts, respectively. Themes identified were related to organisation of services, workforce, financing and challenges in practice. Services being comprehensive, dialoguing with the community, addressing social determinants were themes under organisation of services. There is need for more generalists and training health professionals towards CPHC. Financing of CPHC especi...
Facility assessment. This provides the details of the assessment done for each health facility in... more Facility assessment. This provides the details of the assessment done for each health facility in the study. (DOCX 120 kb)
Facility assessment tool. This tool was created using documents (WHO Essential package of service... more Facility assessment tool. This tool was created using documents (WHO Essential package of services and the Indian public health standards) that describe minimum available resources that should be available at primary level care. (DOCX 102 kb)
Observation guide. This was a guide used to provide structure to the non-participant observations... more Observation guide. This was a guide used to provide structure to the non-participant observations. (DOCX 15 kb)
International Journal of Medical Science and Public Health, 2016
Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free di... more Background: In India, Revised National Tuberculosis (TB) control programme (RNTCP) offers free diagnosis and treatment for TB, based on the Directly Observed Treatment Short (DOTS) course strategy. Under RNTCP, sputum conversion rate (SCR), at the end of 2 months of treatment is an important operational indicator, which is ideally expected to be 90%. Objectives: The objective of the present work was to investigate the factors associated with low SCR at the end of 2 months of treatment in Sira TB unit, Tumkur District, India. Material and Methods: It is a retrospective cohort study of all new sputum smear-positive patients registered in RNTCP in 2011. Data were retrieved from the TB register maintained at the District TB center. Chi-square and Student’s t-test were used for analysis of the study variables between patients who were sputum positive and sputum negative at the end of 2 months of treatment. Multivariate logistic regression was applied to determine the risk contributed by the variables towards non-conversion of sputum. Results: Of the 268 included patients, 66.7% patients were sputum negative. Patients aged ≥ 45 years were twice prone to be sputum positive (OR = 2.14) (P = 0.007). The odds of being sputum positive after 2 months of treatment was observed to be significantly high (OR = 7.12; 95% C.I. = 1.52–33.22; P = 0.01) for sputum grade 3+ at the time of diagnosis, respectively. Conclusion: Elderly patients with a high bacilli load should be advised and counselled well regarding adherence to treatment. Further, advice should be given on preventing spread of the disease by practising cough hygiene, as they are more infectious than other patients with less sputum-positive grade.
We comparatively assessed the performance of six simple obesity indices to identify adults with c... more We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. No single obesity index consistently performed statistically si...
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2015
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In a... more Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.
Health systems with strong comprehensive primary health care (CPHC) are known to result in better... more Health systems with strong comprehensive primary health care (CPHC) are known to result in better health outcomes for people. In India, there is a recent push to strengthen CPHC through Ayushman Bharat. This study aimed to document lessons from successful CPHC initiatives in rural and urban India using a qualitative case study approach. A total of 72 CPHC initiatives were identified through desk review and 12 of these were studied as cases. The following two main models of CPHC delivery were seen in India: (a) a hospital or health centre with outreach and (b) social franchising model, prevalent in rural and urban contexts, respectively. Themes identified were related to organisation of services, workforce, financing and challenges in practice. Services being comprehensive, dialoguing with the community, addressing social determinants were themes under organisation of services. There is need for more generalists and training health professionals towards CPHC. Financing of CPHC especi...
Facility assessment. This provides the details of the assessment done for each health facility in... more Facility assessment. This provides the details of the assessment done for each health facility in the study. (DOCX 120 kb)
Facility assessment tool. This tool was created using documents (WHO Essential package of service... more Facility assessment tool. This tool was created using documents (WHO Essential package of services and the Indian public health standards) that describe minimum available resources that should be available at primary level care. (DOCX 102 kb)
Observation guide. This was a guide used to provide structure to the non-participant observations... more Observation guide. This was a guide used to provide structure to the non-participant observations. (DOCX 15 kb)
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