• I have heard about it for the first time from you! Implementation of tobacco control law by police personnel in India.

      Ahuja, N; Kathiresan, J; Anand, T; Isaakidis, P; Bajaj, D (International Union Against Tuberculosis and Lung Disease, 2018-12-21)
      Setting and Objetives: Police personnel, alongside other key stakeholders, are responsible for implementing the Cigarettes and Other Tobacco Products Act (COTPA) in India. This study aimed to assess knowledge and attitudes about COTPA among police personnel and explore enablers and barriers in implementing it. Design: This convergent parallel mixed-methods study used a self-administered questionnaire (quantitative) and key informant interviews (qualitative). Of 300 police personnel across all eight police stations in Daman, 155 participated. Quantitative data were analysed using descriptive statistics and the χ2 test. Qualitative data from in-depth interviews of six key informants from all coordinating departments were analysed thematically. Results: Overall, 63.2% of responders were aware of any tobacco control law in India, and only 12.9% were trained in its implementation. One person had conducted inspections for COTPA compliance in the last 12 months. The majority (78.1%) of the police personnel, and significantly more tobacco non-users than users (81.2% vs. 52.9%, P = 0.016), felt that enforcing anti-tobacco regulations is one of their most important functions. Perceived benefits of the act and formal authority to act were the two main enablers of COTPA implementation. Lack of awareness and coordination, competing priorities, concentration of authority with higher-ranking officials and evasion of the law by retailers and the public hampered effective implementation of the law. Conclusion: Knowledge about the COTPA was average and implementation poor. Sensitisation and training of implementers, systematic transparent reporting and creating awareness among public are recommended for effective implementation.
    • "I Wasted 3 Years, Thinking It's Not a Problem": Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study

      Muthuvel, T; Govindarajulu, S; Isaakidis, P; Shewade, HD; Rokade, V; Singh, R; Kamble, S (Public Library of Science, 2017-01-12)
      Worldwide, leprosy is one of the major causes of preventable disability. India contributes to 60% of global leprosy burden. With increasing numbers of leprosy with grade 2 disability (visible disability) at diagnosis, we aimed to determine risk factors associated with grade 2 disability among new cases and explore patients and providers' perspectives into reasons for late presentation.
    • Infective endocarditis in Ethiopian children: a hospital based review of cases in Addis Ababa

      Moges, T; Gedlu, E; Isaakidis, P; Kumar, A; Den, R V; Khogali, M; Mekasha, A; Hinderaker, S G (African Field Epidemiology Network, 2015-01-28)
    • Influence of the 2014-2015 Ebola Outbreak on the Vaccination of Children in a Rural District of Guinea

      Camara, B; Delamou, A; Diro, E; El Ayadi, A; Béavogui, A; Sidibé, S; Grovogui, F; Takarinda, K; Kolié, D; Sandouno, S; Okumura, J; Baldé, M; Van Griensven, J; Zachariah, R (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: All health centres in Macenta District, rural Guinea. Objective: To compare stock-outs of vaccines, vaccine stock cards and the administration of various childhood vaccines across the pre-Ebola, Ebola and post-Ebola virus disease periods. Design: This was an ecological study. Results: Similar levels of stock-outs were observed for all vaccines (bacille Calmette-Guérin [BCG], pentavalent, polio, measles, yellow fever) in the pre-Ebola and Ebola periods (respectively 2760 and 2706 facility days of stock-outs), with some variation by vaccine. Post-Ebola, there was a 65-fold reduction in stock-outs compared to pre-Ebola. Overall, 24 facility-months of vaccine stock card stock-outs were observed during the pre-Ebola period, which increased to 65 facility-months of stock-outs during the Ebola outbreak period; no such stock-out occurred in the post-Ebola period. Apart from yellow fever and measles, vaccine administration declined universally during the peak outbreak period (August-November 2014). Complete cessation of vaccine administration for BCG and a prominent low for polio (86% decrease) were observed in April 2014, corresponding to vaccine stock-outs. Post-Ebola, overall vaccine administration did not recover to pre-Ebola levels, with the highest gaps seen in polio and pentavalent vaccines, which had shortages of respectively 40% and 38%. Conclusion: These findings highlight the need to sustain vaccination activities in Guinea so that they remain resilient and responsive, irrespective of disease outbreaks.
    • Integration of tobacco cessation and tuberculosis management by NGOs in urban India: a mixed-methods study

      Gupte, HA; Zachariah, R; Sagili, KD; Thawal, V; Chaudhuri, L; Verma, H; Dongre, A; Malekar, A; Rigotti, NA (International Union Against Tuberculosis and Lung Disease, 2018-06-21)
    • Intensified Tuberculosis Case Finding among Malnourished Children in Nutritional Rehabilitation Centres of Karnataka, India: Missed Opportunities

      Bhat, P G; Kumar, A M V; Naik, B; Satyanarayana, S; Kg, D; Nair, S A; MD, S; Heldal, E; Enarson, D A; Reid, A J (Public Library of Science, 2013)
      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.
    • Intensive-Phase Treatment Outcomes among Hospitalized Multidrug-Resistant Tuberculosis Patients: Results from a Nationwide Cohort in Nigeria

      Oladimeji, O; Isaakidis, P; Obasanya, O J; Eltayeb, O; Khogali, M; Van den Bergh, R; Kumar, A M V; Hinderaker, S G; Abdurrahman, S T; Lawson, L; Cuevas, L E (Public Library of Science, 2014-04)
      Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.
    • Intermittent Preventive Treatment and Bed Nets Uptake Among Pregnant Women in Kenya

      Karoki, SM; Kariuki, L; Owiti, PO; Takarinda, KC; Kizito, W; Edwards, JK; Ogutu, O; Waqo, E (African Journals Online, 2016-10)
    • International Non-Governmental Organizations' Provision of Community-Based Tuberculosis Care for Hard-To-Reach Populations in Myanmar, 2013-2014

      Soe, KT; Saw, S; van Griensven, J; Zhou, S; Win, L; Chinnakali, P; Shah, S; Mon, MM; Aung, ST (BioMed Central, 2017-03-24)
      National tuberculosis (TB) programs increasingly engage with international non-governmental organizations (INGOs), especially to provide TB care in complex settings where community involvement might be required. In Myanmar, however, there is limited data on how such INGO community-based programs are organized and how effective they are. In this study, we describe four INGO strategies for providing community-based TB care to hard-to-reach populations in Myanmar, and assess their contribution to TB case detection.
    • Is Adjunctive Naturopathy Associated with Improved Glycaemic Control and a Reduction in Need for Medications Among Type 2 Diabetes Patients? A Prospective Cohort Study from India

      Bairy, S; Kumar, AM; Raju, M; Achanta, S; Naik, B; Tripathy, JP; Zachariah, R (BioMed Central, 2016-08-17)
      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.
    • Is there a correlation between malaria incidence and IRS coverage in western Zambezi region, Namibia?

      Mumbengegwi, DR; Sturrock, H; Hsiang, M; Roberts, K; Kleinschmidt, I; Nghipumbwa, M; Uusiku, P; Smith, J; Bennet, A; Kizito, W; Takarinda, K; Ade, S; Gosling, R (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Setting: A comparison of routine Namibia National Malaria Programme data (reported) vs. household survey data (administrative) on indoor residual spraying (IRS) in western Zambezi region, Namibia, for the 2014-2015 malaria season. Objectives: To determine 1) IRS coverage (administrative and reported), 2) its effect on malaria incidence, and 3) reasons for non-uptake of IRS in western Zambezi region, Namibia, for the 2014-2015 malaria season. Design: This was a descriptive study. Results: IRS coverage in western Zambezi region was low, ranging from 42.3% to 52.2% for administrative coverage vs. 45.9-66.7% for reported coverage. There was no significant correlation between IRS coverage and malaria incidence for this region (r = -0.45, P = 0.22). The main reasons for households not being sprayed were that residents were not at home during spraying times or that spray operators did not visit the households. Conclusions: IRS coverage in western Zambezi region, Namibia, was low during the 2014-2015 malaria season because of poor community engagement and awareness of times for spray operations within communities. Higher IRS coverage could be achieved through improved community engagement. Better targeting of the highest risk areas by the use of malaria surveillance will be required to mitigate malaria transmission.
    • The journey to antiretroviral therapy in Karnataka, India: who was lost on the road?

      Shastri, S; Sathyanarayna, S; Nagaraja, S B; Kumar, A M V; Rewari, B; Harries, A D; Zachariah, R (International AIDS Society, 2013)
      One important operational challenge facing antiretroviral treatment (ART) programmes in low- and middle-income countries is the loss to follow-up between diagnosis of human immunodeficiency virus (HIV) and initiation of ART. This is a major obstacle to achieving universal access to ART. This study from Karnataka, India, tried to measure such losses by determining the number of HIV-positive individuals diagnosed, the number of them reaching ART centres, the number initiated on ART and the reasons for non-initiation of ART.
    • Knockdown and recovery of malaria diagnosis and treatment in Liberia during and after the 2014 Ebola outbreak

      Dunbar, NK; Richards, EE; Woldeyohannes, D; Van den Bergh, R; Wilkinson, E; Tamang, D; Owiti, P (International Union Against Tuberculosis and Lung Disease, 2017-06-21)
      Setting: The malaria-endemic country of Liberia, before, during and after the 2014 Ebola outbreak. Objective: To describe the consequences of the Ebola outbreak on Liberia's National Malaria Programme and its post-Ebola recovery. Design: A retrospective cross-sectional study using routine countrywide programme data. Results: Malaria caseloads decreased by 47% during the Ebola outbreak and by 11% after, compared to the pre-Ebola period. In those counties most affected by Ebola, a caseload reduction of >20% was sustained for 12 consecutive months, while this lasted for only 4 consecutive months in the counties least affected by Ebola. Linear regression of monthly proportions of confirmed malaria cases-as a proxy indicator of programme performance-over the pre- and post-Ebola periods indicated that the malaria programme could require 26 months after the end of the acute phase of the Ebola outbreak to recover to pre-Ebola levels. Conclusions: The differential persistence of reduced caseloads in the least- and most-affected counties, all of which experienced similar emergency measures, suggest that factors other than Ebola-related security measures played a key role in the programme's reduced performance. Clear guidance on when to abandon the emergency measures after an outbreak may be needed to ensure faster recovery of malaria programme performance.
    • Knowledge, Access and Utilization of Bed-Nets Among Stable and Seasonal Migrants in an Artemisinin Resistance Containment Area of Myanmar

      Phyo Than, W; Oo, T; Wai, K; Thi, A; Owiti, P; Kumar, B; Deepak Shewade, H; Zachariah, R (BioMed Central, 2017-09-14)
      Myanmar lies in the Greater Mekong sub-region of South-East Asia faced with the challenge of emerging resistance to artemisinin combination therapies (ACT). Migrant populations are more likely than others to spread ACT resistance. A vital intervention to reduce malaria transmission, resistance spread and eliminate malaria is the use of bed nets. Among seasonal and stable migrants in an artemisinin resistance containment region of Myanmar, we compared a) their household characteristics, b) contact with health workers and information material, and c) household knowledge, access and utilization of bed nets.
    • Leprosy Trends at a Tertiary Care Hospital in Mumbai, India, From 2008 to 2015

      Muthuvel, T; Isaakidis, Pe; Shewade, HD; Kattuppara, L; Singh, R; Govindarajulu, S (Co-Action Publishing, 2016-11-23)
      Leprosy remains an important cause of preventable disabilities. After the advent of multidrug therapy, new leprosy cases have come down dramatically. Despite this achievement, India, which contributes 60% of the global leprosy burden, faces some challenges to eliminate the disease, including active transmission in the community and delayed diagnosis of leprosy patients.
    • Linkage Between Diagnosis and Treatment of Smear-Positive Pulmonary Tuberculosis in Urban and Rural Areas in Kyrgyzstan

      Kulzhabaeva, A; Nabirova, D; Usenbaev, N; Denisiuk, O; Zachariah, R (The World Health Organization, 2016-03)
    • Low Mother-to-Child HIV Transmission Rate But High Loss-to-Follow-Up Among Mothers and Babies in Mandalay, Myanmar; A Cohort Study

      Kyaw, K; Oo, M; Kyaw, N; Phyo, K; Aung, T; Mya, T; Aung, N; Oo, H; Isaakidis, P (Public Library of Science, 2017-09-08)
      Loss-to-follow-up (LTFU) throughout the Prevention of Mother-To-Child Transmission (PMTCT) cascade remains one of the major threats to the success of PMTCT programs. In this study, we aimed to determine the mother-to-child transmission rate in a programmatic setting and to determine factors associated with LTFU among enrolled mothers and unfavorable outcomes among HIV-exposed babies which includes being HIV positive, death and LTFU.
    • Low uptake of preventive interventions among malaria cases in Swaziland: towards malaria elimination

      Makadzange, K; Dlamini, N; Zulu, Z; Dlamini, S; Kunene, S; Sikhondze, W; Owiti, P; Geoffroy, E; Zachariah, R; Mengestu, TK (International Union Against Tuberculosis and Lung Disease, 2018-04-25)
      Settings: Swaziland is striving to achieve sustainable malaria elimination. Three preventive interventions are vital for reaching this goal: 1) effective household utilisation of long-lasting insecticide nets (LLINs), 2) indoor residual spraying (IRS), and 3) provision of chemoprophylaxis for those travelling to malaria-endemic areas. Objectives: To assess the uptake of preventive intervention among confirmed malaria cases. Design: A longitudinal study using nation-wide programme data from 2010 to 2015. Data on malaria cases from health facilities were sourced from the Malaria Surveillance Database System. Results: Of a total 2568 confirmed malaria cases in Swaziland, 2034 (79%) had complete data on case investigations and were included in the analysis. Of 341 (17%) individuals who owned LLINs, 169 (8%) used them; 338 (17%) had IRS and 314 (15%) slept in sprayed structures. Of 1403 travellers to areas at high malaria risk, 59 (4%) used any form of malaria prevention, including chemoprophylaxis. Conclusion: The uptake of all three key malaria prevention interventions is low, and could threaten the progress made thus far toward malaria elimination. Efforts to improve this situation, including qualitative research to understand the reasons for low uptake, are urgently needed.
    • Malaria profiles and challenges in artemisinin resistance containment in Myanmar

      Nwe, TW; Oo, T; Wai, KT; Zhou, S; van Griensven, J; Chinnakali, P; Shah, S; Thi, A (BioMed Central, 2017-04-25)
      This study examined evolving malaria profiles from January, 2010 to December, 2014 to evaluate achievements and challenges of implementing measures to prevent and control spread of artemisinin resistance in Myanmar.
    • Management and Treatment Outcomes of Patients Enrolled in MDR-TB Treatment in Viet Nam

      Phuong, NTM; Nhung, NV; Hoa, NB; Thuy, HT; Takarinda, KC; Tayler-Smith, K; Harries, AD (International Union Against Tuberculosis and Lung Disease, 2016-03-21)
      The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009.