ObjectiveTo quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation.DesignExplanatory mixed-methods design.SettingA rural population of 1.02 million in the Samastipur district of Bihar, India.ParticipantsBased on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1).Outcome measuresProportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation.ResultsA total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system.ConclusionFinding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.
During radiometric investigation at Mawlait, significant uranium mineralisation (0.024-0.22%U 3 O 8 ) was located mainly within the small pegmatite (garnet bearing quartzofeldspathic rock), which are locally segregated within migmatite at Umiang River section. Pink granite and granite gneisses are the dominant lithounits of the study area showing fertile character and spotty radioactivity at several places. Radioactivity in these rocks is mainly contributed by discrete uraninite grains along with some zircon and xenotime. Granites are peraluminous, low-Ca in nature and their geochemical signatures suggest derivation from a felsic source. Discriminant diagrams using Rb, Nb and Y indicate 'within plate' to 'volcanic arc' nature of the rock. The uraniferous pegmatitic veins within migmatite appear to have formed due to localised metamorphic segregation during late stage of anatexis. Petromineralogical and geochemical studies suggest that the uranium mineralisation in granitic-pegmatitic rocks of the area is mainly syn-magmatic type.
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