Impact Of Involvement Of Non Formal Health Providers On Tb-Books Pdf

Impact of involvement of non formal health providers on TB
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NFHP involvement in TB case notification, Competing interests Although SS worked for TB Results. REACH funding arm of the STOP TB Partnership, the agency that funded the project but he neither The project detected 488 Xpert TB cases of whom 466 were administered RNTCP treat. had any role on the funding decision nor any ment This translated into notification of additional 198 new bacteriologically positive cases. special influence on the analysis of the project to RNTCP a 30 notification surge after adjustment for 2 decline in control This meant. results and preparation of the manuscript RHS,was involved in monitoring and evaluation of the. an average quarterly increase in notification of 41 20 20 08 62 31 p 0 001 cases The. project but he did not have any special influence increase was immediate evident from the rise in level in the time series analysis by 50 42. on the analysis and preparation of the manuscript 10 28 90 55 p 0 02 cases. This does not alter our adherence to PLOS ONE,policies on sharing data and materials. Conclusion, Engagement with NFHPs contributed to an increase in TB notification to RNTCP from key.
under reached slum dwelling migrant populations,Introduction. Tuberculosis TB is considered a major public health problem in India with almost 3 million. people developing this infectious disease every year in the country and as many as half a mil. lion Indians succumbing to it annually 1 Despite country wide implementation for more. than a decade of the Revised National Tuberculosis Control Programme RNTCP which is. based on the internationally acclaimed and recommended DOTS strategy India is yet to. reduce its TB burden substantially let alone eliminate this dreadful scourge 1 2 The basic. tenets of RNTCP include diagnosing majority of the TB cases early in the course of their dis. eases and treating them appropriately and completely This is to ensure that majority of the. affected individuals suffer for a relatively shorter period and they do not continue to spread. the infection to other uninfected individuals in the community This has the potential to decel. erate the infection disease cycle and subsequently reduce the TB burden in the society For. this RNTCP primarily depends on voluntary presentation of the TB patients at the local des. ignated health facilities which are overwhelmingly housed within the public health system of. the country and very few within the private clinics 3 Patients who initially seek care from pri. vate healthcare providers or health workers are also sometimes referred to the RNTCP desig. nated facilities, Individuals who present for care at RNTCP facilities are then diagnosed by conventional. sputum microscopy and also chest x rays and other tests if necessary which are provided free. of cost to the care seekers One of the major barriers to the decline of TB burden in India is. some sections of its population remain largely under reached at least in the initial stages of. their diseases to the programme 4 5 In TB policy parlance these groups are referred to as. key populations those with limited access to quality TB services though the services are. offered free by the national TB programmes 6 7, Migrant labourers constitute such an under reached key population in India 7 8 These are. the people who mostly migrate from villages to the burgeoning Indian urban centres and its. industrial patches They mostly find employment in the low skill low wage jobs in the infor. mal sector which has a sizeable presence in the Indian towns and cities These marginalized. people end up living in the overcrowded slums the likes of which are rapidly proliferating in. the urban and industrial landscape of modern India 9. When individuals from this vulnerable group seek healthcare they often find it difficult to. navigate the channels of the public health system of their adopted places This is mainly due to. PLOS ONE https doi org 10 1371 journal pone 0196067 May 23 2018 2 16. NFHP involvement in TB case notification, their unfamiliarity with the city health system Moreover the unsuitable location and timing. of the public health facilities in these urban areas often impose substantial access and opportu. nity costs in the form of transportation costs and wage losses on these predominantly impover. ished masses 10, The high end formal private healthcare system which often has a large footprint in the.
Indian cities is mostly out of reach of these poor people because of their prohibitively steep. user fees Hence the sick members of these poor migrant communities often gravitate to. the friendly neighbourhood non formal health providers NFHPs 11 the likes of which. include small medicine shop owners chemists and pharmacists of drug stores practitioners. of alternative systems of medicine unqualified practitioners of allopathic medicine and. members of various community based health organizations The NFHPs mainly prescribe. medicines mostly allopathic for symptomatic relief of the care seekers presenting to them. These NFHPs not only operate within or close to these slums but also provide services at. friendly hours and frequently offer flexi payment options 12 to suit the capacity of their. poor clients But the lack of formal medical training of the NFHPs often lead to inappropri. ate management of grave medical conditions of their clients thereby compounding their suf. ferings 13, Naturally those who develop TB in these communities TB being considerably more com. mon in urban India 1 also often present initially to their neighbourhood NFHPS frequently. with symptoms of prolonged cough These patients seek symptomatic relief or suggestions. early in the course of their diseases when their TB symptoms are yet to become too severe to. raise alarm in both the sufferers as well as their untrained providers The NFHPS mostly pro. vide inappropriate management to these care seeking early TB symptomatics which may. include injudicious prescription of antibiotics also as they are hardly aware of the diagnostic. and treatment protocols of RNTCP 14 This not only prolongs the sufferings of their TB. patients by delaying their actual diagnosis and treatment initiation as evidence shows 11 but. also enables protracted transmission of infection in the community This fuels the TB epidemic. in these overcrowded environments 8 However some of these poor patients somehow ulti. mately manage to find their way to the RNTCP system 15 after much suffering when their. symptoms become too severe to ignore, Unfortunately the TB programmes worldwide 16 including RNTCP hardly ever. engaged with the NFHPS The public private partnership initiatives of RNTCP were also. mostly directed to the involvement of formally trained medical practitioners albeit many. poor patients present to these NFHPs as their first port of call 17 This insufficient. engagement of RNTCP with this sizeable yet important non formal healthcare sector has. further been compounding the access issues of this key population leading to many TB. patients in these communities remaining under reached 16 All these factors perhaps. underpin the low notification of diagnosed TB cases from many Indian cities notwithstand. ing a higher burden of TB in urban India because many of these cities have substantially. large under reached populations, Therefore a project was conceived whereby a local public health academic institute. would facilitate establishment of linkage between the slum dwelling migrant communities. and RNTCP The project planned to engage with the NFHPs on behalf of RNTCP with an. overarching aim to identify the TB patients emerging from these under reached communi. ties through these providers and lead them to the standardized RNTCP regimen as early in. the course of their diseases as possible The objective of our manuscript is to describe the. project and assess its impact using primarily the evaluation framework of the project and. routine programme data so that its successful components can be identified for future. PLOS ONE https doi org 10 1371 journal pone 0196067 May 23 2018 3 16. NFHP involvement in TB case notification,Populations and study design. Two intervention sites Bhubaneswar city and Jajpur town in Odisha state were selected. because these two areas are among those with the highest concentration of slum dwelling. migrant labourer population in the state the primary target of the project Bhubaneswar is. the rapidly growing capital city of this eastern Indian state The industrial corridor of Jajpur. district in Odisha harbours many large to small scale ferro alloy factories These two interven. tion sites are similar in nature in terms of migrant labourers residing in slums that dots these. two areas extensively as well as the care seeking practices of these communities The total pop. ulation of the intervention area hereinafter is called the Evaluation Population EP. The control area that did not receive any intervention from the project but was only used. for comparison consisted of Cuttack city and its outskirts Cuttack a city located 25 kilo. metres away from Bhubaneswar shares similar characteristics with the intervention area It. being the commercial hub of the state also traditionally attracts many migrant labourers to the. numerous commercial and industrial establishments situated in and around the city as well as. the informal service sector allied to them Therefore many slums emerge and continue to pro. liferate also in Cuttack and its outskirts where these migrant communities reside The total. population of the control area is hereinafter referred to as the Control Population CP Histor. ically both the intervention and the control areas experienced low TB case notification to. RNTCP notification failing to attain 50 of the estimated annual incident cases let alone the. prescribed 90 needed to effect a significant decline of TB 18. The demographic and other relevant characteristics of the intervention and control areas. are described in Table 1, We used a quasi experimental before after design with a control group to analyse the.
results of intervention which is frequently employed to evaluate such population level initia. tives or events 19 20,Intervention, In addition to the routine passive case detection services provided by RNTCP the project. engaged in the intervention area with almost all the Non formal Health Providers NFHP. Table 1 The characteristics of intervention and control areas. Intervention area Control area,Bhubaneswar site Jajpur site Cuttack city and. Number of Basic Management Units BMUs providing TB services 2 2 2. Number of designated microscopy centres providing TB diagnostic services 4 4 6. Number of peripheral health institutions or treatment centres providing RNTCP treatment services 6 6 8. Total population 2014 850 000 664 000 1 411 000, Proportion of total population who are mainly migrant labourers dwelling in slums in these areas Approximately Approximately Approximately 35. Average baseline new smear positive case notification rate per 100 000 population per year 1st 37 4 41 2 19 7. quarter 2011 to 3rd quarter 2014, The total population of the intervention area is known as the evaluation population EP 1 514 000 and that of the control area is known as the control population. CP 1 411 000, This was the target population of the project in the intervention area.
The estimated new smear positive case incidence is 85 per 100 000 population per year So the baseline annualized new smear positive case detection rate case. notification estimated incidence was 50 in all the areas. https doi org 10 1371 journal pone 0196067 t001, PLOS ONE https doi org 10 1371 journal pone 0196067 May 23 2018 4 16. NFHP involvement in TB case notification, who were embedded within and were providing services to the target population The project. was administered by Asian Institute of Public Health a public health academic institute based. in Bhubaneswar Odisha The project enlisted n 539 enrolled n 447 and then engaged. with the NFHPs n 431 from the target population in September 2014 The project staff. experienced in working with community based organizations and providers used persuasion. and one to one personal engagement with the NFHPs to motivate them to participate in the. project The NFHPS were trained by the project staff to identify the presumptive TB cases. also known as TB symptomatics from their clientele using presence of cough for two weeks. or more as the primary screening criterion as suggested in the Technical Guidelines for. RNTCP The NFHPs were also trained to collect quality sputum samples from these sympto. matics promptly either at their clinics or at the patients homes The NFHPs were also pro. vided supportive supervision by the project staff at regular intervals either through personal. visits or telephonic contacts to monitor the quality of the operations and also to sustain their. morale No NFHP dropped out from the project, The field network of the project transported the samples collected from the NFHP identi. fied suspects to two project laboratories one established at each intervention site Both. laboratories were equipped with Xpert MTB RIF technology a cartridge based nucleic acid. amplification CBNAAT test with 90 sensitivity and specificity 21 22 This technology. simultaneously detects Mycobacterium tuberculosis and resistance to the most important first. line anti TB drug Rifampicin RIF from just one sample of . mal sector which has a sizeable presence in the Indian towns and cities These marginalized people end up living in the overcrowded slums the likes of which are rapidly proliferating in the urban and industrial landscape of modern India 9 When individuals from this vulnerable group seek healthcare they often find it difficult to

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