Journal Article > ResearchFull Text
Public Health Action. 2014 June 21; Volume 4 (Issue 2); 105-9.; DOI:10.5588/pha.13.0111
Abeygunawardena SC, Sharath BN, Van der Bergh R, Naik B, Pallewatta N, et al.
Public Health Action. 2014 June 21; Volume 4 (Issue 2); 105-9.; DOI:10.5588/pha.13.0111
SETTING
District Chest Clinic, Kalutara, Sri Lanka.
OBJECTIVES
To determine the coverage of culture and drug susceptibility testing (CDST), delays in CDST, treatment initiation, obtaining CDST results and treatment outcomes of previously treated tuberculosis (TB) patients.
DESIGN
Retrospective cohort study involving review of records and reports. All previously treated TB patients from January 2008 to June 2013 were included in the study.
RESULTS
Of 160 patients, 126 (79%) samples were sent for CDST; 79 (63%) were culture-positive and no multi-drug-resistant (MDR) TB cases were reported. Respectively 9% and 15% of patients experienced a delay in sending samples (median delay 21 days) and receiving CDST reports (median delay 71 days), while 20% experienced delays in initiating the retreatment regimen (median delay 11.5 days). The cohort recorded an 82% treatment success rate.
CONCLUSION
Of all retreatment patients, only 79% were tested for CDST and there were sizeable delays in sample transportation and treatment initiation. Possible ways forward to strengthen the programme are discussed.
District Chest Clinic, Kalutara, Sri Lanka.
OBJECTIVES
To determine the coverage of culture and drug susceptibility testing (CDST), delays in CDST, treatment initiation, obtaining CDST results and treatment outcomes of previously treated tuberculosis (TB) patients.
DESIGN
Retrospective cohort study involving review of records and reports. All previously treated TB patients from January 2008 to June 2013 were included in the study.
RESULTS
Of 160 patients, 126 (79%) samples were sent for CDST; 79 (63%) were culture-positive and no multi-drug-resistant (MDR) TB cases were reported. Respectively 9% and 15% of patients experienced a delay in sending samples (median delay 21 days) and receiving CDST reports (median delay 71 days), while 20% experienced delays in initiating the retreatment regimen (median delay 11.5 days). The cohort recorded an 82% treatment success rate.
CONCLUSION
Of all retreatment patients, only 79% were tested for CDST and there were sizeable delays in sample transportation and treatment initiation. Possible ways forward to strengthen the programme are discussed.
Journal Article > ResearchFull Text
BMC Complement Altern Med. 2016 August 17; Volume 16 (Issue 1); DOI:10.1186/s12906-016-1264-0
Bairy S, Kumar AMV, Raju MSN, Achanta S, Naik B, et al.
BMC Complement Altern Med. 2016 August 17; Volume 16 (Issue 1); DOI:10.1186/s12906-016-1264-0
With an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. 'Integrated Naturopathy and Yoga'(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients.
Journal Article > ReviewFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue 1); DOI:10.5588/pha.13.0024
Harries AD, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue 1); DOI:10.5588/pha.13.0024
Journal Article > ResearchFull Text
PLOS One. 2013 December 16; Volume 8 (Issue 12); e84255.; DOI:10.1371/journal.pone.0084255
Bhat PG, Kumar AMV, Naik B, Satyanarayana S, KG D, et al.
PLOS One. 2013 December 16; Volume 8 (Issue 12); e84255.; DOI:10.1371/journal.pone.0084255
BACKGROUND
Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children.
METHODS
A cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India.
RESULTS
Of 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed.
CONCLUSION
This study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India.
Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children.
METHODS
A cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India.
RESULTS
Of 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed.
CONCLUSION
This study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India.
Journal Article > ReviewFull Text
BMC Health Serv Res. 2015 September 17; Volume 15 (Issue 1); 389.; DOI:10.1186/s12913-015-1026-6
Zam K, Kumar AMV, Achanta S, Bhat PG, Naik B, et al.
BMC Health Serv Res. 2015 September 17; Volume 15 (Issue 1); 389.; DOI:10.1186/s12913-015-1026-6
BACKGROUND
There is an increasing trend of non-communicable diseases in Bhutan including Diabetes Mellitus (DM). To address this problem, a National Diabetes Control Programme was launched in 1996. There is anecdotal evidence that many patients do not visit the DM clinics regularly, but owing to lack of cohort monitoring, the magnitude of such attrition from care is unknown. Knowledge of the extent of this problem will provide a realistic assessment of the situation on the ground and would be helpful to initiate corrective actions. In this first country-wide audit, we thus aimed to determine among type 2 DM patients registered for care the i) pre-treatment attrition ii) one-year programme outcomes including retention in care, died and Lost-to-follow-up (LTFU, defined as not having visited the clinic at least once within a year of registration) iii) factors associated with attrition from care (death + LTFU) and iv) quality of follow-up care, measured by adherence to recommended patient-monitoring protocols including glycaemic control.
METHODS
A retrospective cohort study involving a review of records routinely maintained under the National Diabetes Control Programme. All type 2 DM patients registered between 1st January and 31st December 2012 in 18 district hospitals of Bhutan were included. Glycaemic control was defined as glycosylated haemoglobin of <7% or [Fasting Blood Sugar of <130 mg/dl and, Post-prandial Blood Sugar of <180 mg/dl].
RESULTS
Of 350 registered DM patients (52% female, median age 55 years), 63(18%) were LTFU before treatment initiation (pre-treatment attrition). Of the remaining 287 individuals who started treatment, 226(79%) were retained in care while 61(21%) either died or were LTFU. Glycaemic control was achieved in 85(38%) patients retained in care. Between 7 and 98% of monitoring parameters had missing data.
CONCLUSION
Nearly one-third of DM patients were LTFU and there were short comings in monitoring. Qualitative research is urgently needed to find out the reasons for high attrition. Given the high political commitment by the Royal Government of Bhutan, the findings provide ample grounds for instituting corrective measures and propelling DM care further. It is time to do better!
There is an increasing trend of non-communicable diseases in Bhutan including Diabetes Mellitus (DM). To address this problem, a National Diabetes Control Programme was launched in 1996. There is anecdotal evidence that many patients do not visit the DM clinics regularly, but owing to lack of cohort monitoring, the magnitude of such attrition from care is unknown. Knowledge of the extent of this problem will provide a realistic assessment of the situation on the ground and would be helpful to initiate corrective actions. In this first country-wide audit, we thus aimed to determine among type 2 DM patients registered for care the i) pre-treatment attrition ii) one-year programme outcomes including retention in care, died and Lost-to-follow-up (LTFU, defined as not having visited the clinic at least once within a year of registration) iii) factors associated with attrition from care (death + LTFU) and iv) quality of follow-up care, measured by adherence to recommended patient-monitoring protocols including glycaemic control.
METHODS
A retrospective cohort study involving a review of records routinely maintained under the National Diabetes Control Programme. All type 2 DM patients registered between 1st January and 31st December 2012 in 18 district hospitals of Bhutan were included. Glycaemic control was defined as glycosylated haemoglobin of <7% or [Fasting Blood Sugar of <130 mg/dl and, Post-prandial Blood Sugar of <180 mg/dl].
RESULTS
Of 350 registered DM patients (52% female, median age 55 years), 63(18%) were LTFU before treatment initiation (pre-treatment attrition). Of the remaining 287 individuals who started treatment, 226(79%) were retained in care while 61(21%) either died or were LTFU. Glycaemic control was achieved in 85(38%) patients retained in care. Between 7 and 98% of monitoring parameters had missing data.
CONCLUSION
Nearly one-third of DM patients were LTFU and there were short comings in monitoring. Qualitative research is urgently needed to find out the reasons for high attrition. Given the high political commitment by the Royal Government of Bhutan, the findings provide ample grounds for instituting corrective measures and propelling DM care further. It is time to do better!
Journal Article > ResearchFull Text
BMC Health Serv Res. 2017 August 22; Volume 17 (Issue 1); DOI:10.1186/s12913-017-2511-x
Choun K, Achanta S, Naik B, Tripathy JP, Thai S, et al.
BMC Health Serv Res. 2017 August 22; Volume 17 (Issue 1); DOI:10.1186/s12913-017-2511-x
Over the last decade, the availability and use of mobile phones have grown exponentially globally and in Cambodia. In the Sihanouk Hospital Centre of Hope(SHCH) in Cambodia about half of all tuberculosis patients referred out to peripheral health facilities for TB treatment initiation or continuation were lost to contact after referral ranging from 19 to 69% between 2008 and 2013. To address this, we implemented a mobile phone-based patient tracking intervention. Here, we report the number and proportion of referred TB patients who could be contacted through a mobile phone and retained in care after the introduction of mobile phone tracking.
Journal Article > ResearchFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S34-7.; DOI:10.5588/pha.13.0022
Naik B, Kumar AMV, Satyanarayana S, Suryakant MD, Swamy NMV, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S34-7.; DOI:10.5588/pha.13.0022
SETTING
Seventeen peripheral health institutions (PHI) in Kolar district (population: 0.5 million), South India.
OBJECTIVE
To assess the feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) at peripheral level.
DESIGN
From January to September 2012, all TB patients were assessed for DM. Those with unknown DM status were screened for the disease (free of charge) by trained laboratory technicians at each PHI, using a glucometer supplied by the national programme on a capillary blood sample. Those with fasting blood glucose (FBG) ≥ 126 mg/dl (≥7 mM) were diagnosed as DM-positive.
RESULTS
Of 362 TB patients, 358 (99%) were assessed for DM and 62 (17.1%) had the diseases-53 (14.6%) had a previous history of DM and 9 (2.9%) were newly diagnosed. All new DM patients were enrolled into DM care. Higher DM prevalence was found among TB patients aged ≥40 years, smokers and those with smear-positive pulmonary TB. To detect a new case of DM, the number needed to screen (NNS) among TB patients was 40.
CONCLUSION
Screening of TB patients for DM was feasible and effective in a peripheral setting. The availability of trained laboratory technicians and free services at every PHI made the intervention feasible. The study has contributed towards a national policy decision in this regard.
Seventeen peripheral health institutions (PHI) in Kolar district (population: 0.5 million), South India.
OBJECTIVE
To assess the feasibility and results of screening patients with tuberculosis (TB) for diabetes mellitus (DM) at peripheral level.
DESIGN
From January to September 2012, all TB patients were assessed for DM. Those with unknown DM status were screened for the disease (free of charge) by trained laboratory technicians at each PHI, using a glucometer supplied by the national programme on a capillary blood sample. Those with fasting blood glucose (FBG) ≥ 126 mg/dl (≥7 mM) were diagnosed as DM-positive.
RESULTS
Of 362 TB patients, 358 (99%) were assessed for DM and 62 (17.1%) had the diseases-53 (14.6%) had a previous history of DM and 9 (2.9%) were newly diagnosed. All new DM patients were enrolled into DM care. Higher DM prevalence was found among TB patients aged ≥40 years, smokers and those with smear-positive pulmonary TB. To detect a new case of DM, the number needed to screen (NNS) among TB patients was 40.
CONCLUSION
Screening of TB patients for DM was feasible and effective in a peripheral setting. The availability of trained laboratory technicians and free services at every PHI made the intervention feasible. The study has contributed towards a national policy decision in this regard.
Journal Article > ResearchFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S38-42.; DOI:10.5588/pha.13.0037
Nair SA, Kumari AK, Subramonianpillai J, Shabna DS, Kumar SM, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S38-42.; DOI:10.5588/pha.13.0037
SETTING
Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India.
OBJECTIVE
To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs.
DESIGN
A descriptive study: TB patients diagnosed during March-September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ≥ 126 mg/dl was diagnosed as new DM.
RESULTS
Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17-6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes.
CONCLUSION
As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs.
Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India.
OBJECTIVE
To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs.
DESIGN
A descriptive study: TB patients diagnosed during March-September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ≥ 126 mg/dl was diagnosed as new DM.
RESULTS
Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17-6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes.
CONCLUSION
As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs.
Journal Article > ResearchFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S18-22.; DOI:10.5588/pha.13.0032
Prakash BC, Ravish KS, Prabhakar B, Ranganath TS, Naik B, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue 1); S18-22.; DOI:10.5588/pha.13.0032
SETTING
Tuberculosis (TB) and diabetes mellitus (DM) clinics at Bowring and Lady Curzon Hospital, a tertiary care centre in Bangalore, India.
OBJECTIVE
To assess the feasibility and results of TB-DM bidirectional screening.
METHODS
A descriptive study conducted from 1 March to 30 September 2012, in which all TB patients were assessed for DM and vice versa. Fasting blood glucose values of ≥126 mg/dl and 110-125 mg/dl were considered as DM and pre-diabetes, respectively.
RESULTS
Of 510 TB patients, 32 (6.3%) had been previously diagnosed with DM. Screening among the remaining 478 patients yielded 15 (2.9%) with pre-diabetes and 15 (2.9%) newly diagnosed cases of DM. A higher prevalence of DM was found among patients aged ≥40 years, patients with pulmonary TB and smokers. Of the 47 TB-DM patients, 45 were enrolled in DM care. Of 1670 DM patients followed up in DM clinics, 45 already had TB. Among the remaining 1625 patients screened, 152 (9%) had symptoms suggestive of TB; two of these were found to have the disease.
CONCLUSION
Bidirectional screening for DM and TB is feasible and produces a high yield for DM among TB patients. The yield of TB among DM patients was low and needs future research using new, improved TB diagnostic tools.
Tuberculosis (TB) and diabetes mellitus (DM) clinics at Bowring and Lady Curzon Hospital, a tertiary care centre in Bangalore, India.
OBJECTIVE
To assess the feasibility and results of TB-DM bidirectional screening.
METHODS
A descriptive study conducted from 1 March to 30 September 2012, in which all TB patients were assessed for DM and vice versa. Fasting blood glucose values of ≥126 mg/dl and 110-125 mg/dl were considered as DM and pre-diabetes, respectively.
RESULTS
Of 510 TB patients, 32 (6.3%) had been previously diagnosed with DM. Screening among the remaining 478 patients yielded 15 (2.9%) with pre-diabetes and 15 (2.9%) newly diagnosed cases of DM. A higher prevalence of DM was found among patients aged ≥40 years, patients with pulmonary TB and smokers. Of the 47 TB-DM patients, 45 were enrolled in DM care. Of 1670 DM patients followed up in DM clinics, 45 already had TB. Among the remaining 1625 patients screened, 152 (9%) had symptoms suggestive of TB; two of these were found to have the disease.
CONCLUSION
Bidirectional screening for DM and TB is feasible and produces a high yield for DM among TB patients. The yield of TB among DM patients was low and needs future research using new, improved TB diagnostic tools.