IMPORTANCE The high household costs associated with tuberculosis (TB) diagnosis and treatment can create barriers to access and adherence, highlighting the urgency of achieving the World Health Organization's End TB Strategy target that no TB-affected households should face catastrophic costs by 2020.OBJECTIVE To estimate the occurrence of catastrophic costs associated with TB diagnosis and treatment and to identify socioeconomic indicators associated with catastrophic costs in a setting where TB control strategies have been implemented effectively. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, 455 patients with TB in the Chennai metropolitan area of South India who were treated under the TB control program between February 2017 and March 2018 were interviewed. Patients were interviewed by trained field investigators at 3 time points: at the initiation of treatment, at the end of the intensive phase of treatment, and at the end of the continuation phase of treatment. A precoded interview schedule was used to collect information on demographic, socioeconomic, and clinical characteristics and direct medical, direct nonmedical, and indirect costs. Data analysis was performed from August 2018 to November 2019. MAIN OUTCOMES AND MEASURES Direct, indirect, and total costs to patients with TB.Catastrophic costs associated with TB were defined as costs exceeding 20% of the household's annual income. A binary response model was used to determine the factors that were significantly associated with catastrophic costs. RESULTSOf 455 patients with TB interviewed, 205 (53%) were aged 19 to 45 years (mean [SD] age, 38.4 [16.0] years), 128 (33%) were female, 72 (19%) were illiterate, 126 (33%) were employed, and 186 (48%) had a single earning member in the family (percentages are based on the 384 patients who were interviewed through the end of the continuation phase of treatment). Sixty-one percent of patients (234 patients) had pulmonary smear positive TB. The proportion of patients with catastrophic costs was 31%. Indirect costs contributed more toward catastrophic cost than did direct costs. Multivariate logistic regression analysis found that unemployment (adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) and higher annual household income (Rs 1-200 000, adjusted odds ratio, 0.4; 95% CI, 0.2-0.7; P = .004; Rs >200 000, adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) were associated with a decreased likelihood of experiencing catastrophic costs. CONCLUSIONS AND RELEVANCEDespite the implementation of free diagnostic and treatment services under a national TB control program, TB-affected households had a high risk of catastrophic (continued) Key Points Question What are the costs incurred by patients with tuberculosis (TB) throughout the treatment period in a resource-poor country such as India, where diagnostic testing and TB treatment are provided free of charge? Findings In this cross-sectional study of 455 individuals with TB, despite the implementation of free diagnostic and treatment services un...

Background To measure and compare economic burden at the household level for tuberculosis (TB) patients who were detected through active case finding (ACF) and passive case finding (PCF) in rural areas. Methods This study was conducted in the Thiruvallur district from October 2016 to March 2018. TB patients diagnosed through ACF were included in this study. For the comparison, patients diagnosed through ACF were recruited in the ratio of 1:2 from the same study area during the same period. Costs between the groups were compared and a multiple regression model was used to identify factors associated with catastrophic costs due to TB. Results Of the 336 individuals, 110 were diagnosed through ACF and 226 through PCF. A total of 29% of patients diagnosed through PCF and 9% of patients diagnosed through ACF experienced catastrophic costs due to TB. The multiple logistic model shows that catastrophic costs due to TB had a significant association with higher income status (adjusted odds ratio [aOR] 4.91 [confidence interval {CI} 2.39 to 10.08]; p&lt;0.001), alcohol use (aOR 2.78 [CI 1.33 to 5.81]; p=0.007), private as a first point of care (aOR 3.91 [CI 2.01 to 7.60]; p&lt;0.001) and PCF (aOR 3.68 [CI 1.62 to 8.33]; p=0.002). Conclusions Findings highlight that ACF significantly averted catastrophic costs due to TB among patients. ACF as a strategy could ensure financial protection of TB patients and limit their risk of poverty.

Supravesical hernia is an unusual type of hernia. It is of two types: internal and external [Skandalakis JE, Gray SW, Burns WB, Sangmalee U, Sorg JL. Internal and external supravesical hernia. Am Surg 1976 Feb;42(2):142-6]. We are reporting a case of internal supravesical hernia, in a 62-year-old gentleman to call attention to the entity, as a rare cause of intestinal obstruction.

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Patient-completed questionnaires can be used to obtain a more accurate history than junior doctors for most patients admitted with acute abdominal pain.

PurposeThe purpose of this paper is to analyse the complaints received from surgical patients and provide suggestions to reduce them.Design/methodology/approachThe authors conducted a retrospective study of 100 complaints received from surgical patients over a two‐year period between January 2004 and December 2005. Data was obtained through the complaints department and summaries of all the complaints were analysed.FindingsThere were 47 males and the median age was 58 years (range 13‐92). Of complaints, 44 per cent were received from outpatients and 56 per cent from inpatients. The main reasons for complaints from outpatients were appointment delays or cancellations (54.6 per cent), followed by clinical treatment (20.5 per cent), communication issues (13.6 per cent), attitude of staff (9.1 per cent) and miscellaneous (2.25 per cent). For inpatients, the main reasons were clinical treatment (39.3 per cent) followed by delay in admission/investigations (25 per cent), communication (17.9 per cent), attitude of staff (10.7 per cent) and miscellaneous (7.1 per cent). The outpatients complain mostly about administrative problems whereas inpatients complain about clinical care. Communication problems and staff attitude are the next most common in either setting. Providing patients with clear patient information about admission, treatment and waiting times would help to reduce complaints.Originality/valueThe paper shows that adopting an empathetic approach to patients and understanding their concerns and anxieties would improve patient satisfaction.