ObjectivesThis study aimed to assess the coverage and explore enablers and challenges in implementation of direct benefit transfer (DBT) cash incentive scheme for patients with tuberculosis (TB).DesignThis is a mixed methods study comprising a quantitative cohort and descriptive qualitative study.SettingThe study was conducted in City TB Centre, Vadodara, Western India.ParticipantsWe used routinely collected data under the National TB Programme (NTP) on patients with TB notified between April and September 2018 and initiated on first-line anti-tuberculosis treatment (ATT) to assess the coverage of DBT. We interviewed NTP staff and patients to understand their perceptions.Primary and secondary outcome measuresThe study outcomes are receipt of DBT (primary), time to receipt of first instalment of DBT and treatment outcome.ResultsAmong 1826 patients, 771 (42.2%) had received at least one instalment. Significantly more patients from the public sector had received DBT (at least one instalment) compared with those from private sector (adjusted relative risk (adjRR)=16.3; 95% CI 11.6 to 23.0). Among public sector patients, 7.3% (49/671) had received first instalment within 2 months of treatment initiation. Median (IQR) time to receipt of first instalment was 5.2 (3.4, 7.4) months. Treatment in private sector, residing outside city limits and being HIV non-reactive were significantly (p<0.001) associated with longer time to receipt. Timely and sufficient fund release, adequate manpower and adequate logistics in TB centre were the enablers. Inability of patients to open bank accounts due to lack of identity/residence proof, their reluctance to share personal information and inadequate support from private providers were the challenges identified in implementation.ConclusionDuring the early phase of DBT implementation, the coverage was low and there were delays in benefit transfer. Facilitating opening of bank accounts for patients by NTP staff and better support from private providers may improve DBT coverage. Repeat assessment of DBT coverage after streamlining of implementation is recommended.

Background: In 2016, the National AIDS Control Programme (NACP) in Gujarat, India implemented an innovative intervention called ‘M-TRACK’ (mobile phone reminders once every week for four weeks after diagnosis and electronic patient tracking tool) to reduce pre-treatment loss to follow-up (LFU) among people living with HIV (PLHIV) in Vadodara district while other districts received standard of care. Objectives: To assess the effectiveness of M-TRACK in reducing pre-treatment LFU (proportion of diagnosed PLHIV not registering for HIV care by four weeks after diagnosis) and to explore the implementation enablers and challenges from health care providers’ and PLHIV perspective. Methods: An explanatory mixed-methods study design was used wherein the quantitative phase (cohort study with two groups: Vadodara district exposed to M-TRACK and Rajkot district as unexposed) was followed by a qualitative phase (descriptive study involving group interview with 16 health care providers, personal interviews with two programme managers and telephonic interviews with 16 PLHIV). Data were collected during October 2016 to February 2017. Results: During the pre-M-TRACK period (July–September 2016), the LFU proportion was similar [13% (25/191) in Vadodara; 15% (21/141) in Rajkot (p = 0.8)]. During the M-TRACK period (October–December 2016), LFU decreased to 4% (9/209) in Vadodara (exposed), whereas it remained similar at 16% (18/113) in Rajkot (unexposed) district (p = 0.02). PLHIV exposed to M-TRACK had an 80% lower risk of LFU (aRR 0.2; 95% CI: 0.1–0.5) compared with standard care, after adjusting for socio-demographics, time and clustering at district level. During interviews, M-TRACK was welcomed by both PLHIV and the counsellors. The latter felt it saved time by obviating the need for home visits and helped in documentation. Inconvenience of using landline phone available at the health facility, lack of budgets for reimbursement of mobile call expenses and internet connectivity problems were the key implementation challenges. Conclusion: M-TRACK was highly effective in reducing the gap between diagnosis and treatment. It may be considered for scale-up after addressing the challenges noted.

Breastfeeding during early childhood is vital for survival, growth and development. It confers from physiological to psychological benefits to both child and mother. Breastfeeding also helps to protect children against a variety of acute and chronic disorders. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life with early initiation and continuation of breastfeeding for 2 years or more together with nutritionally-adequate, safe, age-appropriate complementary feeding starting at 6 months. 1 Breast feeding is a universal phenomenon in India, but breast feeding practices are far from optimal because they are influenced by socioeconomic factors, cultural background, psychological status, religious values, illiteracy, ignorance, lack of access to antenatal and ABSTRACT Background: Early and exclusive breastfeeding (EBF) is recognized as one of the most effective interventions for child survival particularly to address childhood morbidity and mortality. In spite of the countless benefits, the prevalence of EBF in India, according to the NFHS-3 (2005-2006), at 6 months was only 46.4%. Constraints to EBF are breastfeeding problems, delivery by caesarean section, perceived or real breast milk insufficiency, resumption of official work by the mother, and cultural practices. The objective of the study was to assess current breastfeeding practices of mothers having children less than 6 months of age and to assess the correct positioning, attachment and effective suckling as practiced by these mothers. Methods: An observational, cross-sectional study was done in urban field practice area of a medical college in Central Gujarat from August 2015 to September 2015. Thirty two mother-infant units were observed for baby"s position, attachment and effective suckling using standard IMNCI guideline. Data thus collected were analysed using Microsoft Excel. Results: Out of the criteria for correct attachment, only two children fulfilled all 4 criteria which were classified as having "good attachment". The assessment for proper positioning revealed that only around 13% infants fulfilled all 4 criteria for good positioning. Almost half of the infants were suckling effectively. Conclusions: Based on the findings of the study, it is recommended that each mother should be observed for mother"s and infant"s positioning and attachment at the onset of breastfeeding and if needed given counselling on correct breastfeeding practices.

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