Banuru Muralidhara Prasad

Cost of hospitalisation for non‐communicable diseases in India: are we pro‐poor?

To estimate out‐of‐pocket (OOP) expenditure due to hospitalisation from NCDs and its impact on households in India.

Status of Tuberculosis Services in Indian Prisons

INTRODUCTION Prisons are known to be a high risk environment for tuberculosis (TB) due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. India has nearly 1400 prisons housing 0.37 million inmates. However, information on, availability of diagnostic and treatment services for TB in the prison settings is limited. This study examined the availability of TB services in prisons of India. Simultaneously, prison inmates were screened for tuberculosis. METHOD The study was conducted in 157 prisons across 300 districts between July-December 2013. Information on services available and practices followed for screening, diagnosis and treatment of TB was collected. Additionally, the inmates and prison staff were sensitised on TB using interpersonal communication materials. The inmates were screened for cough ≥2 weeks as a symptom of TB. Those identified as presumptive TB patients (PTBP) were linked with free diagnostic and treatment services. RESULTS Diagnostic and treatment services for TB were available in 18% and 54% of the prisons respectively. Only half of the prisons screened inmates for TB on entry, while nearly 60% practised periodic screening of inmates. District level prisons (OR, 6.0; 95% CI, 1.6-22.1), prisons with more than 500 inmates (OR, 52; 95% CI, 1.4-19.2), and prisons practising periodic screening of inmates (OR, 2.7; 95% CI, 1.0-7.2) were more likely to diagnose TB cases. 19% of the inmates screened had symptoms of TB (cough ≥2 weeks) and 8% of the PTBP were diagnosed with TB on smear microscopy. CONCLUSION The TB screening, diagnostic and treatment services are sub-optimal in prisons in India and need to be strengthened urgently.

Lessons learnt from active tuberculosis case finding in an urban slum setting of Agra city, India ☆

Active case finding (ACF) is recognized as one of the key strategies to reach the missing 3 million cases in high tuberculosis (TB) burden countries. In India, we conducted ACF as a pilot project to assess its operational feasibility in four slums of Agra city in 2012 and covered 3940 households (in 14 wards) with a population of 21,870. Trained community volunteers visited households with an intention to provide information on TB and refer those with cough ≥2 weeks for sputum smear examination. Volunteers identified 8 persons with cough of ≥2 weeks by asking the first or the main respondent of the household. However, by directly asking (or probing) all available members of the household, they identified 374 persons with cough of ≥2 weeks. All 382 persons with cough of ≥2 weeks were referred for sputum smear examination. While 40% of those referred reached health facilities for sputum examination on their own, 60% had to be accompanied by the community volunteers to the health facility for sputum smear examination by Ziehl-Neelsen staining method. Eventually, seven persons were found to be sputum smear positive. This study highlighted important aspects for implementing ACF: First, all household members have to be asked for TB symptoms and Second, mere referral for sputum examination is not enough and there is a need to support people to reach the health facility for sputum smear examination.

Data collection using open access technology in multicentre operational research involving patient interviews

Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis

ABSTRACT Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as ‘catastrophic’ if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US

Community health workers: a review of concepts, practice and policy concerns

4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [−0.15 (−0.32, 0.11)] and PCF [−0.06 (−0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [−0.60 (−0.81, –0.39)] and PCF [−0.58 (−0.78, –0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.