Personal concept of chronic illness in rural population-identifying myths and beliefs

Background: The morbidity of Chronic Renal Failure (CRF) is not only physical but also psychological and social. The study aimed at identifying whether there was any mythological belief in being afflicted with such a chronic illness and the personal concept of a chronic illness. Therefore patients with chronic renal failure were selected for the study.  Methods: The study includes two different groups of patients, 25 per group examined at two different places at two different points of time. The two groups attended different hospitals in their local areas. Patients who were suffering from chronic renal failure were examined and selected for the study. In both groups results were obtained based on questions designed to get information on four themes: their economic status, their status of work, their dependency status and their personal concept of the illness. All the patients belong to rural areas and have had less than formal education or no education at all.Results: The most important finding in this study was a belief expressed in five patients (Two males and three female). They believed that indulging in sex in their marital life itself was a cause of the illness. One other female patient who had a bad obstetric history felt that her illness was due to the number of abortions she had.Conclusion: In a country like India especially in rural India where people believe in alternative medicine, magico-religious methods of native healers, it is difficult to convince people to go for a counselling service. They have to be provided such a service after the initial physical treatments have been started. It is essential that a service of such kind is provided free of cost at any level, even in a primary health centre. Where possible it is necessary to use diagnostic tools to designate severity of the problem. Otherwise personal ideas about illness that marital life has caused the disease can reflect adversely on the harmony and quality of life of patients. This study has enough potential to conduct more such studies to identify outcomes of chronic illnesses and design interventions accordingly.

'I am on treatment since 5 months but I have not received any money': coverage, delays and implementation challenges of 'Direct Benefit Transfer' for tuberculosis patients - a mixed-methods study from South India.

Background: In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India's national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives: To assess the coverage and implementation barriers of DBT among TB patients notified during April-June 2018 and residing in Dakshina Kannada, a district in South India. Methods: This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results: Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67-173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion: DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action

Are they there yet? Linkage of patients with tuberculosis to services for tobacco cessation and alcohol abuse – a mixed methods study from Karnataka, India

Abstract Background Tobacco use and alcohol abuse are associated with higher risk of tuberculosis (TB) infection, progression to active TB and adverse treatment outcomes among patients with TB. Revised National Tuberculosis Control Programme (RNTCP) treatment guidelines (2016) require the documentation of tobacco and alcohol use among patients with TB and their linkage to tobacco and alcohol abuse treatment services. This study aimed to assess the extent of documentation of tobacco and alcohol usage data in the TB treatment card and to explore in-depth, the operational issues involved in linkage. Methods A convergent parallel mixed methods study was conducted. All new TB treatment cards of adult patients registered under RNTCP between January and June 2017 in Dakshina Kannada district were reviewed to assess documentation. Document review was done to understand the process of linkage (directing patients to tobacco and alcohol abuse treatment services). In-depth interview of health care providers (n = 7) and patients with TB (n = 5) explored into their perspectives on linkage. Results Among 413 treatment cards reviewed, tobacco use was documented in 322 (78%), of whom 86 (21%) were documented as current tobacco users. Sixteen (19%) out of these 86 patients were linked to tobacco cessation services. Alcohol usage status was documented in 319 (77%) cards of whom 71(17%) were documented as alcohol users. Eleven (16%) out of these 71 patients were linked to alcohol abuse treatment services. The questions in the treatment card lacked clarity. Guidelines on eliciting history of substance abuse and criteria for linkage were not detailed. Perceived enablers for linkage included family support, will power of the patients and fear of complications. Challenges included patient’s lack of motivation, financial and time constraints, inadequate guidelines and lack of co-ordination mechanisms between TB programme and tobacco/alcohol abuse treatment services. Conclusion Documentation was good but not universally done. Clear operational guidelines on linkage and treatment guidelines for health care providers to appropriately manage the patients with comorbidities are lacking. Lack of coordination between the TB treatment programme and tobacco cessation as well as alcohol treatment services was considered a major challenge in effective implementation of the linkage services