Based on WHO guidance, all forms of asbestos are a health risk. In India, the mining of asbestos has been stopped, but chrysotile (a type of asbestos) is still imported and processed in large quantities. Chrysotile is mainly used for asbestos-cement roofing, and the manufacturers claim its use to be safe. We sought to understand the Indian Government's position on the use of asbestos. To do so, we have analysed the replies of the executive wing of the Indian Government to questions on asbestos in the Indian Parliament. This revealed that, despite a mining ban, the government has defended the import, processing and continued use of asbestos.
{"title":"Analysis of the Indian Government's position on the use of asbestos and its health effects.","authors":"R Singh, A L Frank","doi":"10.5588/pha.23.0013","DOIUrl":"https://doi.org/10.5588/pha.23.0013","url":null,"abstract":"<p><p>Based on WHO guidance, all forms of asbestos are a health risk. In India, the mining of asbestos has been stopped, but chrysotile (a type of asbestos) is still imported and processed in large quantities. Chrysotile is mainly used for asbestos-cement roofing, and the manufacturers claim its use to be safe. We sought to understand the Indian Government's position on the use of asbestos. To do so, we have analysed the replies of the executive wing of the Indian Government to questions on asbestos in the Indian Parliament. This revealed that, despite a mining ban, the government has defended the import, processing and continued use of asbestos.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9714190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G Kurbaniyazova, F Msibi, H Bogati, M Kal, A Sofa, E Abdi Djama, P Mozi, F Hossain, P Blasco, L Sannino
Setting: Papua New Guinea (PNG) has one of the world's highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.
Objective: To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.
Design: A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019-2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.
Results: Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7-19.3), as were PEC sessions (OR 4.3, 95% CI 2.5-7.2).
Conclusion: By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals' needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.
环境:巴布亚新几内亚是世界上结核病发病率最高的国家之一。在偏远省份,由于基础设施不足和地形复杂,患者很难获得结核病治疗,因此必须采用多种有针对性的结核病治疗模式。目的:评估PNG背景下自我给予治疗(SAT)、家庭支持治疗和社区直接观察治疗(DOT)的治疗效果。设计:对2019-2020年两个地点360名患者常规收集的数据进行回顾性描述性分析。根据风险因素(依从性或默认)为所有患者分配治疗模式,并提供患者教育和咨询(PEC)、家庭咨询和交通费。对每个模型的治疗结束结果进行评估。结果:药物敏感结核病(DS-TB)的治疗成功率总体良好:SAT治疗为91.1%,家庭支持治疗为81.4%,DOT治疗为77%。SAT与有利结果密切相关(OR 5.7, 95% CI 1.7-19.3), PEC疗程也是如此(OR 4.3, 95% CI 2.5-7.2)。结论:通过在确定治疗交付模式时考虑危险因素,三组患者均获得了良好的治疗效果。针对个人需求和风险因素量身定制的多种治疗管理模式,是一种可行、有效、以患者为中心的护理模式,适用于交通不便、资源有限的环境。
{"title":"TB treatment using family members, treatment supporters and self-administered therapies in rural Papua New Guinea.","authors":"G Kurbaniyazova, F Msibi, H Bogati, M Kal, A Sofa, E Abdi Djama, P Mozi, F Hossain, P Blasco, L Sannino","doi":"10.5588/pha.22.0062","DOIUrl":"https://doi.org/10.5588/pha.22.0062","url":null,"abstract":"<p><strong>Setting: </strong>Papua New Guinea (PNG) has one of the world's highest TB incidence rates. It is difficult for patients to access TB care in remote provinces due to insufficient infrastructure and challenging terrain, making varied, targeted delivery models for treating TB necessary.</p><p><strong>Objective: </strong>To assess treatment outcomes using self-administered treatment (SAT), family-supported treatment and community-based directly observed therapy (DOT) via treatment supporter (TS) in the PNG context.</p><p><strong>Design: </strong>A retrospective, descriptive analysis of routinely collected data from 360 patients at two sites in 2019-2020. All patients were assigned a treatment model based on risk factors (adherence or default) and offered patient education and counselling (PEC), family counselling and transportation fees. End-of-treatment outcomes were assessed for each model.</p><p><strong>Results: </strong>Treatment success rates among drug-susceptible TB (DS-TB) were good overall: 91.1% for SAT, 81.4% for family-supported treatment and 77% for DOT patients. SAT was strongly associated with favourable outcomes (OR 5.7, 95% CI 1.7-19.3), as were PEC sessions (OR 4.3, 95% CI 2.5-7.2).</p><p><strong>Conclusion: </strong>By considering risk factors when determining their treatment delivery model, strong outcomes were seen in all three groups. Multiple modes of treatment administration, tailored to individuals' needs and risk factors, is a feasible, effective, patient-centred care model for hard-to-reach, resource-limited settings.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9717160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Iyer, Z Ndlovu, J Sharma, H Mansoor, M Bharati, S Kolan, M Morales, M Das, P Issakidis, G Ferlazzo, N Hirani, A Joshi, P Tipre, N Sutar, K England
Background: Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India.
Methods: Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below.
Results: Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119.
Conclusions: Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.
{"title":"Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB.","authors":"A Iyer, Z Ndlovu, J Sharma, H Mansoor, M Bharati, S Kolan, M Morales, M Das, P Issakidis, G Ferlazzo, N Hirani, A Joshi, P Tipre, N Sutar, K England","doi":"10.5588/pha.22.0041","DOIUrl":"https://doi.org/10.5588/pha.22.0041","url":null,"abstract":"<p><strong>Background: </strong>Phenotypic drug susceptibility testing (pDST) for <i>Mycobacterium tuberculosis</i> can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India.</p><p><strong>Methods: </strong>Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below.</p><p><strong>Results: </strong>Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (<i>n</i> = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119.</p><p><strong>Conclusions: </strong>Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9711944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G Buonomo, C Acuña-Villaorduna, V Poongothai, M Dharmalingam, C Cintron, M Dauphinais, S P Babu, L M Locks, S Sarkar, P Salgame, N S Hochberg, S Lakshminaryanan, P B Narasimhan, P Sinha
Undernutrition is the leading risk factor for TB infection and death in India. We undertook a micro-costing analysis of a nutritional intervention for household contacts of people living with TB in Puducherry, India. We found that the total 6-month food cost for a family of four was USD4/day. We also identified several alternative regimens and cost-lowering strategies to encourage wider adoption of nutritional supplementation as a public health tool.
{"title":"A micro-costing analysis of nutritional support for persons with TB and their families in India.","authors":"G Buonomo, C Acuña-Villaorduna, V Poongothai, M Dharmalingam, C Cintron, M Dauphinais, S P Babu, L M Locks, S Sarkar, P Salgame, N S Hochberg, S Lakshminaryanan, P B Narasimhan, P Sinha","doi":"10.5588/pha.22.0058","DOIUrl":"10.5588/pha.22.0058","url":null,"abstract":"<p><p>Undernutrition is the leading risk factor for TB infection and death in India. We undertook a micro-costing analysis of a nutritional intervention for household contacts of people living with TB in Puducherry, India. We found that the total 6-month food cost for a family of four was USD4/day. We also identified several alternative regimens and cost-lowering strategies to encourage wider adoption of nutritional supplementation as a public health tool.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10015533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C Ugwu, U Chukwulobelu, E Okeke, C Igboekwu, A Onyima, V Ibeziako, C Ebede, U Orjiagu, V Unamba
Setting: In July 2019, the Anambra State (south-east Nigeria) TB Control Programme implemented the integration of TB case-finding with the polio vaccination campaign with the support of the WHO.
Objective: To improve TB case-finding from communities leveraging already existing polio structures.
Design: Vaccination teams were trained to ask for symptoms of TB in each household and to document details of people presumed to have TB. Community TB workers subsequently tracked those identified for subsequent sample collection. We report the numbers detected, and the proportion of wards that reported people with TB. Regression analyses were used to estimate the relationship between ward characteristics and reporting. Odds ratios (ORs) with associated 95% confidence intervals (CIs) are also reported.
Results: Of 281 people with presumptive TB, 32 were diagnosed with TB; 21% (70/330) of wards identified at least one presumptive, while 5% (18/330) of the people were identified with TB. Peri-urban slums were most likely to identify presumptives (adjusted OR [aOR] 11.52, 95% CI 1.62-81.79), while Riverine areas were most likely to identify a person with TB (aOR 3.59, 95% CI 1.16-11.01).
Conclusion: Integrating community TB case-finding into house-to-house vaccination campaigns can boost case detection. This approach proved effective in areas perennially underserved by routine healthcare services.
背景:2019年7月,在世卫组织的支持下,阿南布拉州(尼日利亚东南部)结核病控制规划将结核病病例发现与脊髓灰质炎疫苗接种运动结合起来。目的:利用现有的脊髓灰质炎结构改善社区的结核病病例发现。设计:疫苗接种小组接受了培训,询问每个家庭的结核病症状,并记录推定患有结核病的人的详细情况。社区结核病工作人员随后对确定的病例进行追踪,以便随后进行样本收集。我们报告了检测到的数字,以及报告结核病患者的病房比例。回归分析用于估计病区特征与报告之间的关系。比值比(ORs)和相关的95%置信区间(CIs)也被报道。结果:在281例推定结核病患者中,32例被诊断为结核病;21%(70/330)的病房确定了至少一种推定,而5%(18/330)的人被确定患有结核病。城市周边的贫民窟最有可能发现推定结核病患者(调整后的OR [aOR] 11.52, 95% CI 1.62-81.79),而河流地区最有可能发现结核病患者(aOR 3.59, 95% CI 1.16-11.01)。结论:将社区结核病病例发现纳入挨家挨户的疫苗接种运动可以促进病例发现。事实证明,这种做法在常规保健服务长期不足的地区是有效的。
{"title":"Integrating TB screening into house-to-house polio vaccination campaigns.","authors":"C Ugwu, U Chukwulobelu, E Okeke, C Igboekwu, A Onyima, V Ibeziako, C Ebede, U Orjiagu, V Unamba","doi":"10.5588/pha.22.0055","DOIUrl":"https://doi.org/10.5588/pha.22.0055","url":null,"abstract":"<p><strong>Setting: </strong>In July 2019, the Anambra State (south-east Nigeria) TB Control Programme implemented the integration of TB case-finding with the polio vaccination campaign with the support of the WHO.</p><p><strong>Objective: </strong>To improve TB case-finding from communities leveraging already existing polio structures.</p><p><strong>Design: </strong>Vaccination teams were trained to ask for symptoms of TB in each household and to document details of people presumed to have TB. Community TB workers subsequently tracked those identified for subsequent sample collection. We report the numbers detected, and the proportion of wards that reported people with TB. Regression analyses were used to estimate the relationship between ward characteristics and reporting. Odds ratios (ORs) with associated 95% confidence intervals (CIs) are also reported.</p><p><strong>Results: </strong>Of 281 people with presumptive TB, 32 were diagnosed with TB; 21% (70/330) of wards identified at least one presumptive, while 5% (18/330) of the people were identified with TB. Peri-urban slums were most likely to identify presumptives (adjusted OR [aOR] 11.52, 95% CI 1.62-81.79), while Riverine areas were most likely to identify a person with TB (aOR 3.59, 95% CI 1.16-11.01).</p><p><strong>Conclusion: </strong>Integrating community TB case-finding into house-to-house vaccination campaigns can boost case detection. This approach proved effective in areas perennially underserved by routine healthcare services.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162365/pdf/i2220-8372-13-1-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N Beyene, A L Sitotaw, E G Telila, H A Gebre, N B Alemu, R Burny, C Cox, J Soka, B Tegegn, L Wassie, K Bobosha, T Agizew
Although detection of drug-susceptible TB by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling-trained African giant pouched rats has been known for more than a decade, the detection of drug-resistant TB (DR-TB) using rats has never been explored before. We present what we believe to be the first report on rifampicin-resistant TB (RR-TB) detected using Xpert® MTB/RIF Ultra, comparably identified by rats sniffing sputum samples from presumptive TB patients: 88% of RR-TB detected using Ultra were identified by the rats. Further evaluation of the usefulness of rats for large-scale DR-TB contact triage testing is needed, especially in low- and middle-income countries, where resources are limited.
{"title":"The use of rats to detect drug-resistant TB.","authors":"N Beyene, A L Sitotaw, E G Telila, H A Gebre, N B Alemu, R Burny, C Cox, J Soka, B Tegegn, L Wassie, K Bobosha, T Agizew","doi":"10.5588/pha.22.0059","DOIUrl":"https://doi.org/10.5588/pha.22.0059","url":null,"abstract":"<p><p>Although detection of drug-susceptible TB by Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling-trained African giant pouched rats has been known for more than a decade, the detection of drug-resistant TB (DR-TB) using rats has never been explored before. We present what we believe to be the first report on rifampicin-resistant TB (RR-TB) detected using Xpert® MTB/RIF Ultra, comparably identified by rats sniffing sputum samples from presumptive TB patients: 88% of RR-TB detected using Ultra were identified by the rats. Further evaluation of the usefulness of rats for large-scale DR-TB contact triage testing is needed, especially in low- and middle-income countries, where resources are limited.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162364/pdf/i2220-8372-13-1-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9485209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P S Rakesh, S Nair, R Kamala, M S Manu, S K Mrithunjayan, M J Valamparampil, V Raman Kutty, R Sadanandan
Setting: The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination.
Objective: To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala.
Design: 1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff.
Results: LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement.
Conclusion: LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.
{"title":"Local government stewardship for TB elimination in Kerala, India.","authors":"P S Rakesh, S Nair, R Kamala, M S Manu, S K Mrithunjayan, M J Valamparampil, V Raman Kutty, R Sadanandan","doi":"10.5588/pha.22.0037","DOIUrl":"https://doi.org/10.5588/pha.22.0037","url":null,"abstract":"<p><strong>Setting: </strong>The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination.</p><p><strong>Objective: </strong>To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala.</p><p><strong>Design: </strong>1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff.</p><p><strong>Results: </strong>LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement.</p><p><strong>Conclusion: </strong>LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983805/pdf/i2220-8372-13-s1-44.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9518609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K C Prajitha, V Babu, A Rahul, M J Valamparampil, P R Sreelakshmi, S Nair, R P Varma
Background: The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala.
Methods: This study used a qualitative descriptive approach built on the advocacy paradigm. The stakeholders who were involved in decision-making and the representatives of local self-government who had real-time experience and had handled the challenges were identified using purposive sampling. Seven key informant interviews (KIIs) and nine in-depth interviews (IDIs) were conducted.
Results: Findings indicate that decentralisation had enabled the state to effectively deal with the outbreaks and the pandemic. The survey revealed four major themes: decision-making, engagement level, people-centric action, and difficulties. Two to four categories have emerged for each theme.
Conclusion: The study results highlight the importance of human resources and service delivery as balancing factors during public health emergencies in any developing nation with limited resources. Given that very few nations have the healthcare infrastructure and resources necessary to cater to the healthcare needs of the whole population, decentralisation should be reinforced.
{"title":"Combatting emerging infectious diseases from Nipah to COVID-19 in Kerala, India.","authors":"K C Prajitha, V Babu, A Rahul, M J Valamparampil, P R Sreelakshmi, S Nair, R P Varma","doi":"10.5588/pha.22.0024","DOIUrl":"https://doi.org/10.5588/pha.22.0024","url":null,"abstract":"<p><strong>Background: </strong>The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala.</p><p><strong>Methods: </strong>This study used a qualitative descriptive approach built on the advocacy paradigm. The stakeholders who were involved in decision-making and the representatives of local self-government who had real-time experience and had handled the challenges were identified using purposive sampling. Seven key informant interviews (KIIs) and nine in-depth interviews (IDIs) were conducted.</p><p><strong>Results: </strong>Findings indicate that decentralisation had enabled the state to effectively deal with the outbreaks and the pandemic. The survey revealed four major themes: decision-making, engagement level, people-centric action, and difficulties. Two to four categories have emerged for each theme.</p><p><strong>Conclusion: </strong>The study results highlight the importance of human resources and service delivery as balancing factors during public health emergencies in any developing nation with limited resources. Given that very few nations have the healthcare infrastructure and resources necessary to cater to the healthcare needs of the whole population, decentralisation should be reinforced.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983808/pdf/i2220-8372-13-s1-32.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Krishnan, R P Varma, R Kamala, R Anju, K Vijayakumar, R Sadanandan, P K Jameela, K S Shinu, B Soman, R M Ravindran
Introduction: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care.
Methods: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema.
Results: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed.
Conclusion: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.
{"title":"Re-engineering primary healthcare in Kerala.","authors":"A Krishnan, R P Varma, R Kamala, R Anju, K Vijayakumar, R Sadanandan, P K Jameela, K S Shinu, B Soman, R M Ravindran","doi":"10.5588/pha.22.0033","DOIUrl":"https://doi.org/10.5588/pha.22.0033","url":null,"abstract":"<p><strong>Introduction: </strong>In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based (<i>'Aardram'</i>) initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care.</p><p><strong>Methods: </strong>The study adopted an exploratory approach using qualitative methods: key informant interviews (<i>n</i> = 8), in-depth interviews (<i>n</i> = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema.</p><p><strong>Results: </strong>The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of <i>'Aardram'</i> primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed.</p><p><strong>Conclusion: </strong>Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983803/pdf/i2220-8372-13-s1-19.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9770521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
People previously treated for TB are at a higher risk of rifampicin-resistant or multidrug-resistant TB (RR/MDR-TB). Uganda's recent RR-TB estimates were not updated, including during the COVID-19 pandemic. Using programmatic data (2012-2021), we report on the distribution and trends in RR-TB among people previously treated for bacteriologically confirmed pulmonary TB (BC-PTB) across six TB clinics in Kampala, Uganda. The RR-TB prevalence between 2012 and 2015 was 0% (95% CI 0-2.3). The prevalence rose significantly in recent years to 7.0% (95% CI 4.4-10.8) between 2016 and 2021 (P < 0.001). RR-TB is increasing among people previously treated for BC-PTB in Kampala; surveillance for RR-TB should be enhanced.
以前接受过结核病治疗的人患耐利福平或耐多药结核病(RR/MDR-TB)的风险较高。乌干达最近的耐药结核病估计数没有更新,包括在2019冠状病毒病大流行期间。利用规划数据(2012-2021年),我们报告了乌干达坎帕拉6家结核病诊所中曾接受细菌学确诊肺结核(BC-PTB)治疗的患者中耐药结核病的分布和趋势。2012年至2015年间,RR-TB患病率为0% (95% CI 0-2.3)。近年来,患病率在2016年至2021年间显著上升至7.0% (95% CI 4.4-10.8) (P < 0.001)。在坎帕拉以前接受过BC-PTB治疗的人群中,RR-TB正在增加;应加强对耐药结核病的监测。
{"title":"Increase in rifampicin resistance among people previously treated for TB.","authors":"J Izudi, F Bajunirwe, A Cattamanchi","doi":"10.5588/pha.22.0047","DOIUrl":"https://doi.org/10.5588/pha.22.0047","url":null,"abstract":"<p><p>People previously treated for TB are at a higher risk of rifampicin-resistant or multidrug-resistant TB (RR/MDR-TB). Uganda's recent RR-TB estimates were not updated, including during the COVID-19 pandemic. Using programmatic data (2012-2021), we report on the distribution and trends in RR-TB among people previously treated for bacteriologically confirmed pulmonary TB (BC-PTB) across six TB clinics in Kampala, Uganda. The RR-TB prevalence between 2012 and 2015 was 0% (95% CI 0-2.3). The prevalence rose significantly in recent years to 7.0% (95% CI 4.4-10.8) between 2016 and 2021 (<i>P</i> < 0.001). RR-TB is increasing among people previously treated for BC-PTB in Kampala; surveillance for RR-TB should be enhanced.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162363/pdf/i2220-8372-13-1-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9432025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}