How Do Patients Who Fail First-Line TB Treatment but Who Are Not Placed on an MDR-TB Regimen Fare in South India?

SETTING: Seven districts in Andhra Pradesh, South India. OBJECTIVES: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). DESIGN: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. RESULTS: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success. CONCLUSION: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed

Are Tuberculosis Patients in a Tertiary Care Hospital in Hyderabad, India Being Managed According to National Guidelines?

A tertiary health care facility (Government General and Chest hospital) in Hyderabad, India

Strengthening diabetes retinopathy services in India: Qualitative insights into providers' perspectives: The India 11-city 9-state study.

CONTEXT: There is a lack of evidence on the subjective aspects of the provider perspective regarding diabetes and its complications in India. OBJECTIVES: The study was undertaken to understand the providers' perspective on the delivery of health services for diabetes and its complications, specifically the eye complications in India. SETTINGS AND DESIGN: Hospitals providing diabetic services in government and private sectors were selected in 11 of the largest cities in India, based on geographical distribution and size. METHODS: Fifty-nine semi-structured interviews conducted with physicians providing diabetes care were analyzed all interviews were recorded, transcribed, and translated. Nvivo 10 software was used to code the transcripts. Thematic analysis was conducted to analyze the data. RESULTS: The results are presented as key themes: "Challenges in managing diabetes patients," "Current patient management practices," and "Strengthening diabetic retinopathy (DR) services at the health systems level." Diabetes affects people early across the social classes. Self-management was identified as an important prerequisite in controlling diabetes and its complications. Awareness level of hospital staff on DR was low. Advances in medical technology have an important role in effective management of DR. A team approach is required to provide comprehensive diabetic care. CONCLUSIONS: Sight-threatening DR is an impending public health challenge that needs a concerted effort to tackle it. A streamlined, multi-dimensional approach where all the stakeholders cooperate is important to strengthening services dealing with DR in the existing health care setup

Qualitative (interview-based and ethnographic) data on health-seeking, health-care and medical pluralism in rural areas of Andhra Pradesh, India

What the data is: Qualitative (interview-based and ethnographic) data on health-seeking, health-care and medical pluralism in rural areas of Andhra Pradesh, India. How and why collected: Collected as phase 1 of a multi-disciplinary, multi-phase proof-of-concept project (TRUMP), whose purpose was to create a pilot model for a mobile phone application for the self-management of chronic illness in rural India. Data collection for this first phase, used in this publication, combined semi-structured interviews with patients, with key informants (including informal medical practitioners who were the subject of this paper), group discussions, fieldwork conversations, and observations. Fieldwork took place from January to June 2014, under the direction of Prof. Peter Phillimore (Newcastle) and Dr G.V.S. Murthy (IIPH Hyderabad), organised and coordinated by Dr Papreen Nahar (Newcastle) working with Drs Kannuri and Mikkilineni (then both IIPH Hyderabad). Data processing: Data were transcribed and translated from Telugu, and analysed manually to extract themes, such as those which underpin the analysis in this paper

Evaluation of Dakshata, a scale-up WHO SCC and mentoring-based program, for improving quality of intrapartum care in public sector in Rajasthan, India: repeated mixed-methods surveys

Abstract Background The Dakshata program in India aims to improve resources, providers’ competence, and accountability in labour wards of public sector secondary care hospitals. Dakshata is based on the WHO Safe Childbirth Checklist coupled with continuous mentoring. In Rajasthan state, an external technical partner trained, mentored and periodically assessed performance; identified local problems, supported solutions and assisted the state in monitoring implementation. We evaluated effectiveness and factors contributing to success and sustainability. Methods Using three repeated mixed-methods surveys over an 18-month period, we assessed 24 hospitals that were at different stages of program implementation at evaluation initiation: Group 1, training had started and Group 2, one round of mentoring was complete. Data on recommended evidence-based practices in labour and postnatal wards and in-facility outcomes were collected by directly observing obstetric assessments and childbirth, extracting information from case sheets and registers, and interviewing postnatal women. A theory-driven qualitative assessment covered key domains of efficiency, effectiveness, institutionalization, accountability, sustainability, and scalability. It included in-depth interviews with administrators, mentors, obstetric staff, and officers/mentors from the external partner. Results Overall, average adherence to evidence-based practices improved: Group 1, 55 to 72%; and Group 2, 69 to 79%, (for both p < 0.001) from baseline to endline. Significant improvement was noted in several practices in the two groups during admission, childbirth, and within 1 hour of birth but less in postpartum pre-discharge care. We noted a dip in several evidence-based practices in 2nd assessment, but they improved later. The stillbirth rate was reduced: Group 1: 1.5/1000 to 0.2; and Group 2: 2.5 to 1.1 (p < 0.001). In-depth interviews revealed that mentoring with periodic assessments was highly acceptable, efficient means of capacity building, and ensured continuity in skills upgradation. Nurses felt empowered, however, the involvement of doctors was low. The state health administration was highly committed and involved in program management; hospital administration supported the program. The competence, consistency, and support from the technical partner were highly appreciated by the service providers. Conclusion The Dakshata program was successful in improving resources and competencies around childbirth. The states with low capacities will require intensive external support for a head start

Characterising the fruit and vegetable environment of peri-urban Hyderabad, India

Low fruit and vegetable consumption is a key contributor to all forms of malnutrition. This qualitative study examined the perceptions of people living in peri-urban villages of Hyderabad, India, to characterise the sources of fruit and vegetables, the fruit and vegetable environment, and to inform future interventions to increase fruit and vegetable consumption. Health and food quality were primarily seen through a food safety lens and negative aspects were frequently attributed to increased pesticide use. Availability, price and affordability of fresh fruit and vegetables were important drivers of their acquisition and consumption. Promoting communal gardens may increase the availability of affordable fruit and vegetables, as would promoting cold storage facilities. Financial incentives would likely be effective in increasing consumption of fruit and vegetables

Treatment regimens and times of follow-up sputum smear examinations in the Indian Revised National Tuberculosis Control Programme.

<p>*In children, seriously ill sputum smear-negative Pulmonary Tuberculosis (PTB) includes all forms of sputum smear-negative PTB other than primary complex. Seriously ill extrapulmonary tuberculosis (EPTB) includes TB meningitis (TBM), disseminated TB, TB pericarditis, TB peritonitis and intestinal TB, bilateral extensive pleurisy, spinal TB with or without neurological complications, genitourinary TB, and bone and joint TB.</p><p>**Not seriously ill sputum smear-negative PTB includes primary complex. Not seriously ill EP-TB includes lymph node TB and unilateral pleural effusion.</p><p>***Prefix indicates month and subscript indicates thrice weekly.</p

Treatment outcomes and drug susceptibility patterns for first line anti-TB drugs amongst Patients who failed Category I and Category II anti-TB treatment and who did not receive an MDR-TB treatment regimen in Andhra Pradesh, India (July 08 to December 09).

<p>*S-Streptomycin, H-Isoniazid, E-Ethambutol, NTM-Non tuberculosis mycobacterium;</p>#<p>Chi square test;</p>§<p>Fisher exact test.</p>$<p>(In order to calculate ‘<i>p value</i>’ treatment success is compared with other outcomes.</p

Treatment outcomes of TB patients who failed a first line anti-TB treatment and were not placed on MDR-TB treatment regimens, Andhra Pradesh, India (July 08 to December 09).

<p>*Chi-square test,</p><p>**Fisher exact test.</p>$<p>(In order to calculate ‘<i>p value</i>’ treatment success is compared with other outcomes).</p

Definitions of treatment outcome.

<p>Definitions of treatment outcome.</p