Background: Treatment delays increase adverse treatment outcome of tuberculosis (TB). It is necessary to identify reasons behind such delays in different phases of anti-TB treatment (ATT). Objective: To study treatment seeking behavior (TSB) and risk factors for treatment delays among TB patients. Materials and Methods: New smear positive (NSP) pulmonary TB patients initiated on category one regimen of directly observed treatment short course (DOTS) at 24 DOTS centers (N = 156) in E-ward of Mumbai Municipal Corporation (MMC) were interviewed using pre-tested semi-structured schedule, which was designed to elicit the TSB and factors associated with treatment delays. Results: Median duration of cough with expectoration before consulting a provider was 8 weeks (min = 1, max = 96 weeks). Risk factors for patient delay were age <45 years, living without family. Mean provider delay was 17.91 (SD = 18.026, range = 7-99 days). First approach to the private sector for the treatment was associated with provider delay. Mean delay to start continuation phase (CP) was 18.46 days (SD = 16.292) (min = 4 days, max = 67 days). Delay to go for sputum microscopy, to collect reports, delay in reporting, supposed that treatment is completed as felt better were the reasons to delay to start CP. It was associated with migration, smoking, alcoholism, living away from family, social stigma involving hiding the disease from spouse and relatives. Conclusion: Risk factors identifi ed for treatment delays were age <45 years, lack of family support, fi rst approach to the private sector, migration, addictions and social stigma. Strengthening Revised National TB Control Program by operational research to involve the private sector, improving transfer procedures for migrants, creating public awareness to remove stigma and transport of patients and/or their sputum samples from DOTS centers to microscopy centers may be considered to decrease treatment delays. Abstract Access this article onlineWebsite: www.ijmedph.org
Perceptions and practices of smokeless tobacco use in the form of mishri among rural women above 10 years of age in Pune, Maharashtra, India Background: Tobacco use in different forms has become a growing public health problem. It contributes to increased non communicable disease burden. Females tend to use smokeless tobacco in various forms. Material and methods: It was a cross sectional study conducted in the fi eld practice area of Rural Health Training Centre of Dr. D Y Patil Medical College, Pimpri, Pune. Pretested, semistructured proforma was used to collect the information regarding the age of initiation and reasons for its use and other parameters of mishri use after taking informed consent from women >10 years of age . At the end of the study all the subjects were given active education in group setting. Results: Total 256 rural women were studied. 59.8% were <45 yrs, majority were Hindu, married and housewives. 50.4% belonged to joint families, 46.1% from nuclear families. Majority (55%) were from socioeconomic class II and III. 38% initiated its use from 11 to 20 yrs, 49% left it on teeth for a duration of less than 5 minutes, 38% of them used the amount as 1 tsf per day while another 37% used the amount as 1-2 tsf of mishri per day. 45.3% gave reasons for initiation of mishri as to clean teeth. Reasons for continuing use were noted as experienced a kick, gave energy, relieved tension, etc. Positive correlation was observed between quantity of mishri used at a single time and age as well as with duration of use (r = 0.258, P < 0.001 and r = 0.335, P < 0.001 respectively). Conclusion: There is a need to make the rural women aware about hazardous effects of use of mishri through health education sessions to wean them out of this addiction. Abstract Access this article onlineWebsite: www.ijmedph.org
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