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: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018. Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers' perspective. Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted 'presumptive TB': any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes. Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision. Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

There is a huge gap between the awareness and utilization of AFHC services. The reasons for non-utilization were poor awareness and misconceptions about the clinic. Training of health staffs on communication skills, and supportive supervision could improve the utilization.

Background:Nutritional status of the elderly population has become an important issue but often gets neglected. Both undernutrition and over nutrition are important public health priorities in this vulnerable group.Objectives:To determine the prevalence of malnutrition and factors associated with it among elderly population in rural Puducherry using mini-nutritional assessment (MNA) questionnaire.Materials and Methods:A community-based cross-sectional study was conducted among 279 elderly population between November and December 2016 in four villages of rural Puducherry, India. Information on sociodemographic characteristics and nutritional status of the elderlies were collected using validated MNA questionnaire. Body mass index was used to report obesity based on Asia-Pacific guidelines.Results:Among 279 participants, 178 (63.8%) were in the age group of 60–70 years, 190 (68.1%) were females, and 208 (74.6%) had no formal-education. Prevalence of malnutrition among elderly was found to be 17.9% (95% CI: 13.7–22.7) and about 58.8% (95% CI: 52.9–64.4) were at risk of malnutrition which was assessed using MNA questionnaire. Prevalence of obesity was found to be 32.5% (95% CI: 27.3–38.3) and 38.4% had inadequate fruits and vegetables intake. About 250 (89.6%) are living independently according to ADL score.Conclusion:Both undernutrition and over nutrition are important health issues to be considered among elderly population in this area. Primary healthcare strengthening to address and prevent this health issue by balanced dietary practices may improve their nutritional status, thereby enhancing their quality of life.

Background: India contributes to one-third of rabies death globally. Despite the efforts taken by government, Rabies incidence in India has been constant for over a decade. Hence, there is need to assess the awareness and treatment-seeking behaviour which will help to plan strategies to prevent rabies related deaths. The objective of the study was to assess the awareness about rabies among general population and to determine the treatment-seeking behaviour and adherence to anti-rabies vaccine among victims of dog-bite in rural PuducherryMethods: Community based cross-sectional study was conducted during November 2016 in rural Puducherry. 386 individuals were covered in four villages. Information on socio-demographic characteristics and awareness regarding rabies, treatment-seeking behaviour and adherence to anti-rabies vaccine among dog-bite victims was collected using pre-tested questionnaire.Results: Among 386 participants, 244 (63.2%) were in the age group 31-60 years, 259 (67.1%) were females, 103 (26.7%) had no formal-education. About 68% were found to have adequate knowledge regarding rabies but only 49.5% were aware of local wound-management and 237 (61.4%) showed a positive attitude towards vaccination following scratches/lick over abraded skin. Among 27 (6.9%) with history of dog-bite in last one-year, 17 (62.9%) had taken first-aid measures. All 27 (100%) had visited hospital out of which 24 (88.8%) adhered to vaccination schedule.Conclusions: Although two-thirds of the study populations were found to have adequate knowledge regarding rabies, half of them had no knowledge regarding first-aid measures. Although all dog bite victims visited hospital, some did not adhere to the schedule mainly due to negligence. Hence, there is need to create awareness regarding wound management and post-exposure immunization.