Estimating provider cost for treating patients with tuberculosis under Revised National Tuberculosis Control Programme (RNTCP)

Background: The Indian tuberculosis control programme is the second largest health programme in the world. Sustaining this programme in India will require continued financial support, particularly for drugs and contractual personnel. In addition, the costs for diagnosis, supervision and salaries for regular programme personnel need to be sustained. Objective: To measure unit provider cost for treating patients with tuberculosis. Methods: All government health facilities situated in one tuberculosis unit (TU) of Tiruvallur district were visited in order to evaluate daily practice of TB diagnosis and treatment. We interviewed administrators in these health facilities to gather data on modalities for diagnosis, treatment and monitoring of tuberculosis patients. In addition, relevant financial records from all health facilities were scrutinised for data collection. The cost analysis was done for diagnosis, treatment and monitoring of TB patients treated under DOTS programme in the year 2002 For this study only the recurrent cost (not the capital cost) is considered, even though the programme puts in a lot of investment at the preparatory stage of the programme e.g. upgrading of labs and drugs stores, microscopes, motorcycles etc. Cost incurred on smear microscopy, chest X-ray and drugs were classified as direct cost. Indirect cost is calculated based on proportion of staff time for TB care delivery and for supervision of TB services. The exchange rate at the time study was 1$=Rs 46. Results: Unit cost for smear microscopy was estimated to be Rs 10/-; for radiography Rs 25/-; and drug cost for Category I Rs 392/-; Category I with extension Rs 495/-; Category II Rs 729/-; Category II with extension Rs 832/- and Category III Rs 277/-. Including other recurrent expenditures like salary, materials, and maintenance, the overall unit provider cost to treat a TB patient was Rs 1587/- for Category I, Rs 1924/- for Category II and Rs 1417/- Category III. Conclusion: TB inflicts considerable economic burden on the overall health system. This information is vital for policy makers and planners to allocate adequate budget to the programme

Tuberculosis control programme - Is it pro poor?

Background: TB is a complex socio economic problem that impedes human development and traps the poorest and most marginalized in a vicious circle of disease and poverty. India accounts for 30% of all TB cases in the world. Objective: This paper is focusing on whether the TB programme is outreaching the poorer segment ofthe community. We did a prospective study to assess the economic indices (SLI) of TB patients registered under government TB control programme of Tamil Nadu. This data was compared with that of the National Family Health Survey (NFHS) data of the community Methods: A semi-structured and pretested schedule was used for data collection. Information elicited through the interview included demographic and socio-economic characteristics such as employment, income, assets of the patient and family. Based on the information collected, standard of living index (SLI) was measured using the NFHS definition and classified as High, medium or low SLI. Results: A total of 980 TB patients were registered during the study period of which 896 (91 %) patients were interviewed for this study. The economic status and SLI of the community compared with that of TB patients registered under the programme was as follows: people owning assets in the form of agriculture land 40%, 15%, owning a house 92%, 74% and livestock 36%, 14% no of persons sharing a room more than 5 persons per room 9%, 28%. The distribution of SLI in the community was low in 51 %, medium in 40% and high in 8% as compared to the distribution of SLI of TB patients where low SLI was observed in 64%, medium in 32% and high in 4%. Conclusion: This study clearly shows that two thirds of TB patients who have access to the TB programme were poor and meets the health need of the most vulnerable segment of the population

Costs to patients with tuberculosis treated under DOTS programme

Background: The economic burden of TB in India is enormous as TB perpetuates and exacerbates poverty. Revised National Tuberculosis Control Programme (RNTCP) based on DOTS strategy is currently being implemented in India. The purpose of this study is to estimate the costs incurred by tuberculosis patients treated under RNTCP in a district in Tamilnadu where services are decentralized for diagnosis and treatment. Method: In all, 455 patients registered under RNTCP between June and December 2000, in Tiruvallur district were interviewed to collect the following information: Demographic, socio-economic characteristics of patients, expenditure incurred due to illness and effect of illness on employment. Based on the data collected, various costs (direct medical, nonmedical, indirect and total costs incurred on account of tuberculosis before and during treatment) were estimated. In addition Standard of Living Index (SLI) was calculated for patients. Results: Of 455 patients, 62% had low SLI. The median direct, indirect and total costs for 343 patients who successfully completed treatment were as follows: pre treatment direct costs were Rs 340, during treatment direct costs Rs 100; more than 50% of patients did not incur any indirect costs in both pre treatment and during treatment periods and overall total costs were Rs 1398. About 12% of patients lost more than 60 workdays and after completing treatment, 88% returned to work. Conclusion: For patients registered under RNTCP in Tiruvallur district in Tamilnadu, the findings that the total patient costs were Rs 1398/- and also the patients returned to work early establishes the economic benefits to patients treated under DOTS and lend support to rapid expansion of DOTS programme, particularly in low-income countries

Perceptions on tuberculosis and its cure among the government welfare sector providers in Chennai, city, South India

Objective - To study the perceptions on cure regarding tuberculosis (TB) among the employees working in Adi dravidar and Tribal Welfare department, Government of Tamil Nadu. Design - An interview schedule was used to collect the socio-economic characteristics of the respondents and the data on their knowledge on symptoms, cause, mode of infection, diagnosis, treatment for TB and their perceptions on cure were collected. Results - Among the 71 employees working in the Tamil Nadu government welfare origination, only ninety two percent of them have heard of the disease called TB. Forty three percent reported that cough as the main symptom, 37% reported TB was caused by germs. Out of 97% who were aware there was treatment available for TB, only 72% reported TB was curable. Disappearance of symptoms (12%) and feeling alright (25%) were perceived as the cure of TB. Only 26% reported completing the treatment for the prescribed period as cure of TB. Misconceptions reported on cure of TB were abstaining from smoking (95%), from alcohol (89%) from sex (17%) and tobacco (98%). Conclusions - This study suggests for strengthening the need to educate the community in general and the other government sector in specific on symptoms and cure of TB

Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. METHODS The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. FINDINGS In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [-5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [-5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. INTERPRETATION The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. FUNDING Bill & Melinda Gates Foundation

EFFECT OF GYMNEMA SYLVESTRE METHANOLIC EXTRACT ON PANCREATIC PUTRESCINE LEVELS AGAINST ALLOXAN-INDUCED DIABETIC RATS

Objective: Gymnema sylvestre, a rare herb with significant medicinal values widely used as a naturopathic treatment for diabetes. This study demonstrates the antidiabetic potential and changes in the levels of pancreatic putrescine in G. sylvestre treated experimental rat models.Methods: Phytochemical analysis was carried out for methanolic leaf extract of G. sylvestre (GSME). Further, antidiabetic property and putrescine levels in alloxan-induced diabetic Wister albino rats were analyzed by high-performance liquid chromatography method.Results: The GSME (500 mg/kg b/w) was administered daily up to 15 days in diabetic rats against standard drug metformin (500 mg/kg b/w). At the end of the experiments, the increased body weights were noted in the diabetic control groups, while there was reduction in blood glucose level, total protein, liver glycogen, glutathione, glutathione peroxidase, and blood catalase, respectively.Conclusion: GSME at the dose of (500 mg/kg b/w) brings about significant beneficial effects in various physiological parameters and level of putrescine altered during diabetic manifestations, and these effects are quite comparable with the standard drug, metformin

Observations on whale shark Rhineodon typus (Smith) caught at Pamban, Palk Bay and Gulf of Mannar

A male whale shark Rhineodon typus of 688 cm in total length caught in a No.4 gill net was landed on 20-01 -2001 at Pamban light house landing centre. The whale shark was estimated to weigh around 1.5 tonnes

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

Risk Factors for Non-adherence to Directly Observed Treatment (DOT) in a Rural Tuberculosis Unit, South India

Objective: To identify risk factors for non-adherence of tuberculosis (TB) patients to DOT. Methods: Retrospective study of TB patients by logistic regression analysis to identify risk factors for non-adherence. Results: Of the 1666 patients interviewed, 1108 (67%) adhered and 558 (33%) did not adhere to DOT. Of 558 patients, the risk factors associated with non-adherence were illiteracy (39%), difficulty in accessing health facility (57%), and nongovernment DOT centre (43%). Conclusion: Patients should be educated about tuberculosis and importance of DOT. All DOT centres, including Nongovernment DOT centres, should be made more accessible and patient-friendly