Background:
Multidrug-resistant tuberculosis (MDR-TB) increases the risk of depression, lowers treatment compliance leading to poor outcomes.
Objectives:
To (1) document the prevalence of depression among MDR-TB cases registered at tuberculosis units (TUs) of Ahmedabad city and (2) assess determinants of depression.
Methodology:
Adult MDR-TB patients registered at all (23) TUs of Ahmedabad city, were studied using semi-structured questionnaire along with Gujarati translated version of the Hamilton Depression Rating Scale (HAM-D) to assess the severity of depression based on 17 items. The sample size at 95% level of significance, was 251. Probability proportional to size sampling was adopted for selecting participants from each of the 23 TUs. Proportions and odds ratio with confidence interval with probability value were calculated.
Results:
Of 251, only 185 (73.7%) cases could be contacted. Mortality proportion among selected cases was 18.7%. More than one-fifth (22%) had ≥1 comorbidity and 9.7% had another active TB case in the family. 161 (87.1) experienced ≥1 adverse event. Financial, social, or psychological stressors were reported by 22% of cases. Based on the HAM-D scale, 16.2% suffered from depression, determinants of depression by univariate analysis showed significant association with recent family issues, discrimination, financial/other troubling issues, and the presence of adverse drug event.
Conclusion:
MDR-TB cases are more vulnerable for developing depression as the prevalence was 16.2% among them. Hence, cases need to be monitored closely for depression at TU as well at community level.
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Background: Drug resistant tuberculosis (DR-TB), is usually associated with adverse socioeconomic and psychological outcomes. Such patients with co-morbid depression have lower treatment adherence and poor outcomes. Programmatic management of drug resistant tuberculosis (PMDT) guidelines recommend screening of DR-TB patients for mental illnesses at baseline and Follow-up (FU). The objectives were to explore perceptions and experiences of service providers about depression amongst MDR TB cases, review current strategies for screening for depression at Tuberculosis units (TUs) and recommend measures to address depression among MDR TB cases.Methods:This qualitative study was conducted across all TUs of Ahmedabad Municipal Corporation wherein 26 Key informant interviews (KIIs) were conducted using thematic guidelines and subsequently categorized in to subtheme for thematic analysis.Results: MOs had mixed experiences about encountering depression among MDR-TB cases, ranging from 1%-50%. Long duration and side effects of treatment, financial burden due to unemployment and societal stigma were contributory factors. Ensuring compliance was a major challenge. Counselling is an effective intervention for this but lack of counsellors in the program was another challenge. MOs stated that pre-treatment screening for depression is done at DR TB centre, but there is no structured, process. However, most of them don’t do subsequent follow up for depression.Conclusions:More counsellors need to be included in the program and a structured method needs to be devised for screening of depression among MDR TB patients. Both MO TUs and Counsellors need to be sensitized and trained for screening and monitoring depression amongst MDR TB in a systematic way.
Introduction: Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. Objectives: (1) Document utilization of RBSK services within a year of referral, (2) Assess reasons for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Method: Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) taking two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Results: Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; major reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. Conclusion: After referral by RBSK team, only half utilized the services. Among users, OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.
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