Study on obesity and Influence of dietary factors on the weight status of an adult population in Jamnagar city of Gujarat: A cross-sectional analytical study

<b>Background:</b> Obesity has reached epidemic proportions globally and is a major contributor to the global burden of chronic diseases. Dietary factors are the major modifiable factors through which many of the external forces promoting weight gain act. <b>Objectives:</b> The objectives were to find the prevalence of overweight and obesity in the urban population of Jamnagar and to explore the effect of dietary factors on the weight status of the people. <b>Materials and Methods:</b> A cross-sectional study was conducted among the adult population of Jamnagar city. Cluster sampling technique was used to select study samples. Data were collected in a prestructured questionnaire by interviewing subjects through house-to-house visits. Data were analyzed in Epi Info and appropriate statistical methods were used. <b>Results:</b> The prevalence of overweight and obesity was found to be 22.04&#x0025; and 5.20&#x0025;, respectively. Overweight was more prevalent in females than males. The prevalence rose with an increase in age up to 60 years. Among dietary factors, the total calorie intake and habit of snacking had a positive association with weight gain (<i>P</i> &lt; 0.05). The mean intake of oil was more and the mean intake of vegetables was less among overweight subjects than nonoverweight subjects (<i>P</i> &lt; 0.05). <b>Conclusion:</b> The prevalence of overweight and obesity in the urban population in Jamnagar was found to be 22.04&#x0025; and 5.20&#x0025;, respectively. Total calorie intake as well as composition of diet was the important dietary factor affecting weight gain

Assessment Of Long-Term Outcome Among New Smear Positive Pulmonary TB Patients Treated with Intermittent Regimen Under RNTCP – A Retrospective Cohort Study

Background: Under the Revised National TB Control Programme (RNTCP) of India, treatment of TB is given as thrice weekly regimen following WHO recommended DOTS strategy and the success of treatment is largely declared based on completeness and bacteriological conversion. Once the patient is declared as cured or treatment completed, they are not followed up under the programme unless they come to the health system again with symptoms. Present study was conducted to assess status of patients at 2 years after successful anti-TB treatment under DOTS and to explore any potential impact of treatment irregularity on long term outcome Methods: In this retrospective cohort study, all new smear positive (NSP) pulmonary TB cases declared as cured or treatment completed from were included in the study. They were interviewed, after 24 months from date of declaration of successful treatment, using semi-structured questionnaire. Patient TB treatment card and Tuberculosis registers were also used to collect desired information. Results: A total of 657 out of 706 successfully treated NSP TB patients were included in the study. Out of these, 326 (49.6%) patients had any interruption during their treatment. The average number of doses missed during intensive phase and continuation phase was 7.5 and 11.9 respectively. Average duration of any interruption during treatment was 6.5 days. No significant difference was observed in proportion of treatment interrupters and non-interrupters across demographic variables except for a higher proportion of treatment interruption in patients enrolled from urban district. Out of 657 subjects, 71 (10.85%) had relapse of TB. Another 39 (5.9%) patients died due to TB. These unfavourable outcomes were not significantly different among treatment interrupters and treatment non-interrupters. Conclusion: After being successfully treated, the new smear positive pulmonary TB patients had a very high proportion of relapse of TB. Treatment non-adherence was not significantly associated with long term unfavourable outcomes

A Study on Status of Empowerment of Women in Jamnagar District

Background: Empowerment of women is important for decision making in relation to health seeking, family planning, nutrition and economic issues, for her as well as for the family. Aim: To assess the level of empowerment of women in Jamnagar district. Settings and design: A cross sectional study was designed in rural and urban areas of Jamnagar district. Material and methods: An open-ended questionnaire was used for data collection on parameters relating to women empowerment through house-to-house survey. Statistical analysis: Chi-square was used. Results: Mean age of participants was 30.74 ± 7.65 years, 14.77% were illiterate, majority of women were housewives, 28.86% were not involved in decision regarding their marriage and 14.09% were not involved in household decisions. About quarter had no say in financial matters of family and 57% didn’t hold any bank account. The condition was worse for rural and urban slum women. 21% of the women had experienced some kind of domestic violence, which was higher in case of urban women. About one fifth of the women had no role in decisions related to reproductive health viz; spacing and of number of children, methods of family planning. Conclusion: one fifth of the women had no say regarding the reproductive issues and similarly a quarter had no participation in financial decisions. One in every five (21.47%) had faced domestic violence in some form. Education, employment had a positive impact on status of women in relation to empowerment

A Community Level KAP Study on Mosquito Control in Jamnagar District

Background: The vectors borne diseases poses an immense public health concern and are major impediments in the path of socio-economic development. Objective: To assess domestic environment as well as community level KAP on mosquito control measures in Jamnagar district. Methods & statistics: It was a cross-sectional survey of 450 household by a pre-tested proforma analyzed by Microsoft excel office 2007. It was carried out in urban, urban slum and rural areas of Jamnagar district. Results: Rural domestic environment was favorable for mosquito breeding. Most of the respondents were unaware about the places where mosquito bred. The knowledge regarding vector, routes and symptoms of malaria was good, while majority were unaware about types of malaria and other mosquito borne diseases. Active malaria surveillance activity was totally lacking in urban area (94%), while it was very poor in rural and slum area. The preferred treatment providers in the community neither screened malaria nor imparted health education about mosquito control. 56% of the respondents were practicing at least one personal protective and larvae control measure, but less efficient one. Conclusion: Community participation in term of KAP regarding vector control is deficient at places & needs to be addressed for effective mosquito control

Private Doctors’ Perspective towards “Patient First” in TB Diagnostic Cascade, Hisar, India

TB diagnosis has been simplified in India following advances in available diagnostic tools. This facilitates private doctors’ “patient first” approach toward early diagnosis; however, costs remain high. India’s NTEP established a TB diagnostic network, which is free for patients and incentivizes private doctors to participate. Drawing from this context led to the design and implementation of the One-Stop TB Diagnostic Solution model, which was conducted in the Hisar district, Haryana, allowing specimens from presumptive TB patients from private doctors to be collected and tested as per NTEPs diagnostic algorithm. A subset of data pertaining to private doctors was analyzed for the project period. Qualitative data were also collected by interviewing doctors using a snowball method to capture doctors’ perception about the model. Out of 1159 specimens collected from 60 facilities, MTB was detected in 32% and rifampicin resistance was detected in 7% specimens. All specimens went through the diagnostic algorithm. Thirty doctors interviewed were satisfied with the services offered and were appreciative of the program that implements this “patient centric” model. Results from implementation indicate the need to strengthen private diagnostics through a certification process to ensure provision of quality TB diagnostic services

Engaging with the private healthcare sector for the control of tuberculosis in India: cost and cost-effectiveness

Background The control of tuberculosis (TB) in India is complicated by the presence of a large, disorganised private sector where most patients first seek care. Following pilots in Mumbai and Patna (two major cities in India), an initiative known as the ‘Public–Private Interface Agency’ (PPIA) is now being expanded across the country. We aimed to estimate the cost-effectiveness of scaling up PPIA operations, in line with India’s National Strategic Plan for TB control.Methods Focusing on Mumbai and Patna, we collected cost data from implementing organisations in both cities and combined this data with models of TB transmission dynamics. Estimating the cost per disability adjusted life years (DALY) averted between 2014 (the start of PPIA scale-up) and 2025, we assessed cost-effectiveness using two willingness-to-pay approaches: a WHO-CHOICE threshold based on per-capita economic productivity, and a more stringent threshold incorporating opportunity costs in the health system.Findings A PPIA scaled up to ultimately reach 50% of privately treated TB patients in Mumbai and Patna would cost, respectively, US$228 (95$564 (95% uncertainty interval (UI): 409 to 775) per DALY averted. In Mumbai, the PPIA would be cost-effective relative to all thresholds considered. In Patna, if focusing on adherence support, rather than on improved diagnosis, the PPIA would be cost-effective relative to all thresholds considered. These differences between sites arise from variations in the burden of drug resistance: among the services of a PPIA, improved diagnosis (including rapid tests with genotypic drug sensitivity testing) has greatest value in settings such as Mumbai, with a high burden of drug-resistant TB.Conclusions To accelerate decline in TB incidence, it is critical first to engage effectively with the private sector in India. Mechanisms such as the PPIA offer cost-effective ways of doing so, particularly when tailored to local settings

What would it cost to scale-up private sector engagement efforts for tuberculosis care? Evidence from three pilot programs in India.

BackgroundPrivate providers dominate health care in India and provide most tuberculosis (TB) care. Yet efforts to engage private providers were viewed as unsustainably expensive. Three private provider engagement pilots were implemented in Patna, Mumbai and Mehsana in 2014 based on the recommendations in the National Strategic Plan for TB Control, 2012-17. These pilots sought to improve diagnosis and treatment of TB and increase case notifications by offering free drugs and diagnostics for patients who sought care among private providers, and monetary incentives for providers in one of the pilots. As these pilots demonstrated much higher levels of effectiveness than previously documented, we sought to understand program implementation costs and predict costs for their national scale-up.Methods and findingsWe developed a common cost structure across these three pilots comprising fixed and variable cost components. We conducted a retrospective, activity-based costing analysis using programmatic data and qualitative interviews with the respective program managers. We estimated the average recurring costs per TB case at different levels of program scale for the three pilots. We used these cost estimates to calculate the budget required for a national scale up of such pilots. The average cost per privately-notified TB case for Patna, Mumbai and Mehsana was estimated to be US$95, US$110 and US$50, respectively, in May 2016 when these pilots were estimated to cover 50$91 and US$101, respectively. In comparison, the national TB program's budget for 2015 averages out to$150 per notified TB case. The total annual additional budget for a national scale up of these pilots was estimated to be US$267 million.ConclusionsAs India seeks to eliminate TB, extensive national engagement of private providers will be required. The cost per privately-notified TB case from these pilots is comparable to that already being spent by the public sector and to the projected cost per privately-notified TB case required to achieve national scale-up of these pilots. With additional funds expected to execute against national TB elimination commitments, the scale-up costs of these operationally viable and effective private provider engagement pilots are likely to be financially viable

Feasibility of decentralised deployment of Xpert MTB/RIF test at lower level of health system in India.

BackgroundXpert MTB/RIF is an automated cartridge-based nucleic acid amplification test that has demonstrated its potential to detect tuberculosis and rifampicin resistance with high accuracy. To assist scale-up decisions in India, a feasibility assessment of Xpert MTB/RIF implementation was conducted within microscopy centres of 18 RNTCP TB units.MethodsAs part of programme-based demonstration of Xpert MTB/RIF implementation, we recorded and analysed association between key implementation factors and the ability of test to produce valid results. Factors contributing to test failures were analysed from GeneXpert software data which provides 'failure codes' and causes for test failures.ResultsFrom March'12 to January'13, total 40,035 suspects were tested by Xpert MTB/RIF, and 39,680 (99.1%) received valid results (Cumulative: 37157 (92.8%) on first attempt, 39410 (98.4%) on second attempt, 39637 (99.0%) on third attempt and 39680 (99.1%) on more attempts). Overall initial test failure was 2,878 (7.2% (4%-17%)); of these, 2,594 (90.1%) were re-tested and produced valid results. Most frequent reason of test failure was inadequate sample processing or equipment malfunction (3.9%). Other reasons included power failure (1.1%), cartridge integrity/component failure (0.8%), device-computer communication error (0.5%), and temperature-related errors (0.08%). Significant variation was observed in failure rates both across instruments and over time; furthermore, substantial variation was observed in failure rate in two cartridges lots.ConclusionInstallation required minimal infrastructure modifications and concerns about adequacy of human resources under public sector facilities and temperature extremes proved unfounded. Under routine conditions, Xpert MTB/RIF provided 99.1% valid results in TB suspects with low overall failure rates (7.2% initial failure, 0.9% final failure); devices provided valuable real-time feedback on reasons for test failure, which were used for rapid corrective action. High modular replacement (32%) and inter-lot cartridge performance variation remain sources of concern, and warrant close monitoring of failure rates as a key quality indicator