31 research outputs found
Identifying effective communication channels in a rural community: A field report from south India
Background: There is scarcity of information on communication channels in rural areas where about 38% of people are
illiterate.
Objective: To identify the channels of communication available in rural areas by interviewing key informants.
Method: This study was conducted in 51 villages of Ellapuram block, Tiruvallur district, Tamil Nadu in the year 2004.
Key informants selected from the villages were interviewed by a Medical Social Worker. The questionnaire included
information on modes of communication channels, availability of markets, public facilities, and local associations.
Result: The study block included 9893 households covering a population of 39255. Their main occupation was
agriculture (86%). Electricity was available in all the villages. More than 80% of the villagers had community TV/cable
connections, >50% of the villages had cinema star fan associations, mahila mandals, youth clubs, self-help groups,
anganwadi centres and ration shops. The main source of communication as per interview was television (100%), wallposters
(55%); publicity through panchayat office meetings (53%) and dandora or beat of drums(43%).
Conclusion: Main communication channels, commonly used to disseminate information were TV and wall
posters. More than 50% of villages had local associations which can be used for effective communication. This
information is vital for disseminating important information on public health programmes and educating the
rural community
Psycho-social dysfunction: Perceived and enacted stigma among tuberculosis patients registered under Revised National Tuberculosis Control Programme.
Objective: To examine the perceived and enacted stigma experienced by TB patients and the community.
Methods: We interviewed 276 TB patients registered for treatment during January-March 2004 in government health
facilities of two Tuberculosis Units of south India. Data on perceived and enacted stigma were collected after two months
of starting treatment, using a semi-structured interview schedule. In addition, four Focus Group Discussions were conducted
among Directly Observed Treatment (DOT) providers and community members. Narrative summaries were also taken
down to collect additional qualitative information.
Results: Of the 276 patients, 190 (69%) were males. There was no significant difference between the genders in relation
to social stigma. Perceived stigma was higher than enacted stigma in both genders and significantly higher among males
(Low self esteem p<0.05), change of behavior of community (p<0.05), ashamed to cough in front of others (p<0.05).
Conclusion: Considering the social and emotional impact of the disease, it is essential to adopt support strategies to
enhance acceptance and for a successful health programme
Prevalence and Risk Factors of HIV Infection among Clients Attending ICTCs in Six Districts of Tamilnadu, South India
Objective. To assess the HIV serostatus of clients attending integrated counseling and testing centres (ICTCs) in Tamilnadu, south India (excluding antenatal women and children), and to study its association with demographic, socioeconomic, and behavioral risk factors. Design. In a prospective observational study, we interviewed clients attending 170 ICTCs from six districts of Tamilnadu during 2007 utilizing a standard pretest assessment questionnaire. All the clients were tested for HIV with rapid test kits. Multiple logistic regression analysis was used to identify determinants of HIV infection. Results. Of 18329 clients counseled, 17958 (98%) were tested for HIV and 732 (4.1%; range 2.6 to 6.2%) were tested positive for HIV. Median age of clients was 30 years; 89% had never used condoms in their lives and 2% gave history of having received blood transfusion. In multivariate analysis HIV seropositivity was associated with HIV in the family (adjusted odds ratio) (AOR 11.6), history of having sex with sex workers (AOR 2.9), age ≥31 years (AOR 2.8); being married (AOR 2.5), previously tested for HIV (AOR 1.9), illiteracy (AOR 1.7), unemployment (AOR 1.5), and alcoholism (AOR 1.5). Conclusion. HIV seroprevalence being high in ICTC clients (varied from 2.6 to 6.2%), this group should also be included in routine programme monitoring of sero-positivity and risk factors for better understanding of the impact of the National AIDS Control Programme. This would help in evolving appropriate policies and strategies to reduce the spread of HIV infection
Default during the intensive phase of treatment under DOTS programme
Objective: To study default and its associated risk factors during the intensive phase of treatment among new sputum smear
positive patients registered under a Directly Observed Treatment- Short Course (DOTS) programme in Tiruvallur district,
Tamil Nadu.
Design: Analysis of data collected from the Tuberculosis Register, treatment cards and interview schedules during May 1999
to December 2002.
Results: Of the 1463 patients registered, drug regularity results were available for 1406 patients. The cure rate was 76% with
an overall default rate of 15%, of which nearly three-fourth occurred during the intensive phase. The potential risk factors
were identified by multivariate analysis. A higher likelihood of default was associated with age > 45 years (AOR=1.9; 95%
CI=1.2-3.0), illiteracy (1.6; 1.0-2.4), alcoholism (2.7; 1.8-4.2), DOTS inconvenience (1.9; 1.1-3.4) and cases identified
and referred by the community survey (1.8; 1.1-3.0). Of the 75 defaulters from two cohort periods visited separately, 53
defaulted during the intensive phase. Among these, only 31 patients were interviewed since 17 (32%) migrated, three died,
one was untraceable at the address provided while another had treatment elsewhere. Drug related (84%) and work related
(32%) problems were the other reasons for default reported by the patients interviewed.
Conclusion: The majority of defaults occurred during intensive phase of treatment. All efforts should be made to retrieve these
patients and return them to treatment to achieve the expected goal of the RNTCP
Is mirgration a factor leading to default under RNTCP?
Objective: To study the contribution of migration to treatment default among tuberculosis patients treated under RNTCP
Methods: Retrospective study by interviewing the defaulters using semi-structured interview schedule to elicit the reasons
for default including migration.
Results: Of the 531 patients registered under TB programme in 3rd and 4th quarters of 2001, 104 (20%) had defaulted for
treatment. Among defaulters, 24% had migrated. The reasons for migration were: occupational (48%), returning to the
native place (28%), domestic problems (12%) and other illnesses (12%).
Conclusion: After initiation of treatment, patients should be encouraged to report to the provider, if they are leaving the
area, to transfer treatment to the nearest centre to ensure continuity of treatment. These measures will help to reduce
default on account of migration and achieve the desired outcome in RNTCP. Availability of treatment under the DOTS
strategy should be popularized among patients, providers and community
Course of action taken by smear negative chest symptomatics: A report from a rural area in South India
Objective: To evaluate adherence to diagnostic algorithm of Revised National Tuberculosis Control Programme (RNTCP)
and course of action taken by smear-negative chest symptomatics (CSs).
Method: Interviewing smear-negative chest symptomatics.
Results: Of the 423 smear-negative CSs interviewed, 85 (20%) were not prescribed antibiotics and only 133 (39%)
received it for more than seven days. Of the 148 patients with persistence of symptoms, 83 (56%) returned for further
investigations and only 39% were X-rayed. Main reasons for not returning were: ‘not aware’ or ‘consulted another health
provider.’
Conclusion: Strict adherence to diagnostic algorithm and proper counselling of patients are important for diagnosing
smear-negative pulmonary tuberculosis (PTB) cases
Reasons for Non-compliance among Patients Treated Under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur District, South India
Objectives: To elicit reasons for treatment default from a cohort of TB patients under RNTCP and their DOT providers.
Methods: A total of 186 defaulters among the 938 patients registered during 3rd and 4th quarters of 1999 and 2001 in one
Tubercuflosis Unit (TU) of Tiruvallur district, Tamil Nadu and their DOT providers were included in the study. They were
interviewed using a semi-structured interview schedule.
Results: Sixteen (9%) had completed treatment, 25(13%) died after defaulting, and 4(2%) could not be traced. Main reasons
given by the remaining 141 patients and their DOT providers were: drug related problems (42%, 34%), migration (29%,
31%), relief from symptoms (20%, 16%), work related (15%, 10%), alcohol consumption (15%, 21%), treatment from
other centers (13%, 4%), respectively. Risk factors for default were alcoholism (P<0.001), category of treatment (P<0.001),
smear status (P<0.001), type of disease (P<0.001) and inconvenience for DOT (P<0.01).
Conclusion: This study has identified group of patients vulnerable to default such as males, alcoholics, smear positive cases,
and DOT being inconvenient. Intensifying motivation and counselling of this group of cases are likely to improve patient
compliance and reduce default
Evaluation of Directly Observed Treatment providers in the revised national tuberculosis control programme
Background: Non-governmental personnel such as Anganwadi workers and community volunteers have been used as
directly observed treatment (DOT) providers in the Revised National Tuberculosis Control Programme (RNTCP), but
their effectiveness has not been documented.
Aim: To assess the treatment outcome and problems encountered by patients managed by different DOT providers in the
RNTCP.
Material and Methods: Patients diagnosed with tuberculosis at 17 Primary Health Institutions (PHIs) in Tiruvallur
District during a 3-year period received DOT from one of the four types of trained DOT providers (PHI staff,
governmental outreach workers, Anganwadi workers, community volunteers), and their treatment outcomes were
compared. Of the 1131 new smear-positive patients treated between May 1999 through June 2002, 199 (18%) received
DOT from PHI staff, 238(21%) from outreach workers, 496 (44%) from Anganwadi workers, and 170 (15%) from
community volunteers. Twenty-eight patients (2%) collected drugs for self-administration.
Results: Treatment success rates among patients treated by different DOT providers, Anganwadi workers (80%),
governmental outreach workers (81%), community volunteers (76%) and PHI staff (76%), were statistically similar.
Patients who received drugs for self-administration were significantly more likely to fail to treatment or die than
patients who were treated by a DOT provider (5/28 versus 84/1103; odds ratio=4.1; 95% confidence interval=1.2-12.6;
p=0.02).
Conclusion: In addition to governmental staff, Anganwadi workers and community volunteers can be effectively
utilized as DOT providers
Management of Multi Drug Resistance Tuberculosis in the Field: Tuberculosis Research Centre Experience
Setting: Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients identified from a rural and urban area.
Objective: To study the feasibility of managing MDR TB patients under field conditions where DOTS programme has been
implemented
Methods: MDR TB Patients identified among patients treated under DOTS in the rural area and from cases referred by the
NGO when MDR TB was suspected form the study population. Culture and drug susceptibility testing were done at Tuberculosis
Research Centre (TRC). Treatment regimen was decided on individual basis. After a period of initial hospitalization, treatment
was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field.
Patients attended TRC at monthly intervals for clinical, sociological and bacteriological evaluations. Drugs for the month were
pre-packed and handed over to the respective center.
Results: A total of 66 MDR TB patients (46 from the rural and 20 from the NGO) started on treatment form the study
population and among them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km) including a case of
“XDR TB”. Less than half the patients stayed in the hospital for more than 10 days. The treatment was provided partially
under supervision. Providing injection was identified to be a major problem. Response to treatment could be correctly predicted
based on the 6-month smear results in 40 of 42 regular patients. Successful treatment outcome was observed only in 37% of
cases with a high default of 24%. Adverse reactions necessitating modification of treatment was required only for three
patients.
Implications Despite having reliable DST and drug logistics, the main challenge was to maintain patients on such prolonged
treatment by identifying a provider closer to the patient who can also give injection, have social skills and manage of minor
adverse reactions
Perceptions of tuberculosis patients about private providers before and after implementation of Revised National Tuberculosis Control Programme
Background: Most of the persons with chest symptoms in India approach private providers (PPs) for health care. It has been
observed that patients who start treatment with PPs for tuberculosis (TB) frequently switch over subsequently to the public
sector. The reasons for this discontinuation and their perceptions of the TB care provided by the PPs are unknown.
Objective: To document the perceptions about PPs India’s Revised National TB Control Programme (RNTCP) and the
reasons for discontinuation of treatment with PPs and subsequent attendance at a public provider.
Methods: This was a cross sectional study on patients registered under TB programme during 1997 and 2005in rural and urban
areas. During this period patients who were initially diagnosed and treated for TB in a private clinic and subsequently shifted
to public health facility were considered for the study. A semi-structured interview schedule was used to collect the factors
related to patient’s perceptions on PPs, the factors responsible for initiating treatment with PPs, reasons for discontinuing
treatment with PPs, and their willingness to continue treatment from government health facilities were collected. This data
was compared with data collected in 1997 before implementation of the RNTCP.
Results: A total of 1000 and 1311 TB patients were registered during 1997 and 2005 respectively. Among them, 203 (20%)
and 104 (8%) patients were identified as having been initially diagnosed and started on TB treatment by PPs and subsequently
shifted to government health facilities. There were significant changes in reasons for selecting PPs between the two periods:
being convenient (47% vs 10%; p<0.001), quality care (41% vs 19%; p<0.001), motivated by others (49% vs 19%; p<0.001),
confidentiality (19% vs 9%; p<0.05) and known doctor (6% vs 28%; p<0.001) respectively. Financial problems were the
most common reason for discontinuation of treatment in both periods. The use of sputum test for diagnosing TB by PPs was
significantly increased after RNTCP implementation.
Conclusion: This study suggests that slowly perceptions of patients have changed towards PPs, and RNTCP has begun to gain acceptance
amongst patients in terms of convenience, confidentiality and personal care