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Background National tuberculosis (TB) programmes in high-burden countries do not systematically assess severity at diagnosis followed by referral for inpatient care. Due to limited capacity, comprehensive assessment of all TB patients is not practical. In three districts of Gujarat (West India) in June 2021, we determined the feasibility of screening for severe illness by paramedical staff of public facilities and the burden of 'high risk for severe illness' at notification among adults (≥15 y of age) with TB. Methods In this cross-sectional study, the screening criteria for high risk for severe illness was the presence of any one of the following: body mass index (BMI) ≤14.0 kg/m2, BMI ≤16.0 kg/m2 with bilateral leg swelling, respiratory rate >24/min, oxygen saturation <94% or inability to stand without support. We summarized the feasibility indicators and burden using proportion (95% confidence interval [CI]) and median, as applicable. Results Of 626 notified adults, 87% were screened. The median time interval for screening was 3 d from notification and all indicators were collected in 97% of patients. The burden of high risk for severe illness was high, at 41.6% (95% CI 37.5 to 45.8). Conclusions High burden and feasibility (high coverage, acceptable time interval and minimal missing data) makes a strong case for routine screening of severe illness. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June–September 2012. Methods: We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child’s DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. Results: Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. Conclusion: DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. Trial Registration: Clinical Trials Registry–India, National Institute of Medical Statistics (Indian Council of Medical Research) [ABSTRACT FROM AUTHOR]

Background: Revised National TB Control Programme (RNTCP) in India recommends that all previously-treated TB (PT) patients are offered drug susceptibility testing (DST) at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes. Methods: This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January-June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively. We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out). Results: Of 5,829 PT patients, 5306(91%) were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113) TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50) after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV) were higher among INH-resistant patients (39%) as compared to INH-sensitive (29%). Conclusion: Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed urgently for further progress. [ABSTRACT FROM AUTHOR]

Background: Awareness towards tobacco hazards has increased with time but its role alone towards cessation is questionable. With widespread menace of tobacco in developing countries like India, not much tobacco chewing prevalence and their quitting patterns data are available in urban Saurashtra region. Objectives: 1. To find out prevalence of various forms of chewing tobacco and quitting attitudes in urban Jamnagar. 2. To study quitting patterns in relation with age of habit initiation, family background and habit duration. Materials and Methods: It was a cross-sectional study involving 2513 individuals as study population by 30-cluster sampling method. The study was carried out between June 2007 and March 2008. Pre-set, pre-tested questionnaire was used for interview purpose and the statistical analysis was done on proportion basis. Results: About 37.2% of study population was ever-tobacco-chewers; 32.9% of them were current-chewers and 4.3% were quitters. Approximately 28.4% of current-consumers were willing to quit. Mawa-masala (63.7%) and Gutka (57.6%) were preferred forms of chewing tobacco and 57.5% of the current-chewers chewed tobacco six to eight times a day. Tobacco initiation age between 20 and 30 years was commoner among quitters (84.2%), while a little younger in current-consumers (76.5%). About 58.3% quitters and 74.0% chewers showing willingness to quit had not consumed tobacco for more than five years, 63.8% of current-chewers had a family member consuming tobacco. With initiation of health problems, 72.2% subjects quit and 55.5% of them already knew about health hazards. Conclusions: Every 4 out of 10 residents was found to be exposed to chewing tobacco. With Mawa-masala and Gutka being the predominant forms, habit onset in late adolescence, years of consumption and family exposure seem to be hampering quitting. Awareness about tobacco hazards alone does not appear to be resulting in successful quitting. [ABSTRACT FROM AUTHOR]