Harsh Shah

Introduction: Tuberculosis (TB) remains a leading cause of death globally. India aims to eliminate TB by 2025; however, persistently high mortality rates suggest critical failures in early intervention, particularly among vulnerable populations. This study examined the clinical, social, and system factors associated with accelerated mortality among notified persons with TB (PwTB) in Western India. Methods: A cross-sectional study was conducted in six districts of Gujarat, India, during 2023–2024 using Community-Based Verbal Autopsy (CBVA) among relatives of 149 deceased PwTB. Sociodemographic, clinical, and TB care cascade data were collected, and a retrospective time-to-event analysis was performed. A Cox proportional hazards model was used to assess the factors associated with a shorter time from diagnosis to death. Results: Majority of deceased belonged to 26–50 years age group (40%), with a high male predominance (81.9%). Nearly half (48.3%) had comorbidities, and 65.8% had a history of addiction. A substantial median delay of approximately five weeks was observed between symptom onset and treatment initiation. Following a confirmed diagnosis, the majority of deaths (nearly 80%) occurred within the first 16 weeks. A comparable trend was noted after the start of treatment, with about 78% of fatalities occurring within 15 weeks. In the adjusted Cox regression model, key population status (HR = 1.5, p = 0.01), presence of comorbidities (HR = 2.0, p < 0.001), and drug-resistant tuberculosis (HR = 1.7, p = 0.003) were independently associated with a shorter time from diagnosis to death. Discussion: The findings highlighted the convergence of clinical complexity, social vulnerability, and persistent system constraints that shorten survival, even after treatment initiation. Strengthening early case diagnosis, integrating comorbidity management, improving health system responsiveness, and implementing targeted strategies for vulnerable populations are critical. A systematic TB Death Surveillance and Response System (TBDSR), integrating facility-, community-based reviews, and digital reporting, would provide actionable insights to inform timely intervention and support progress towards TB elimination in India and other high-burden settings.

Background Hypertension remains a significant global health challenge, affecting approximately 1.4 billion adults aged 30–79 worldwide. In India, the age-standardised prevalence is 28.1%, and blood pressure (BP) control remains suboptimal. Therapeutic inertia, the failure to initiate or intensify treatment when therapeutic goals are unmet, is recognised as a key contributor to uncontrolled hypertension. In this study, we aimed to understand the prevalence and factors contributing to therapeutic inertia in hypertension management within primary care settings in Chittoor, with a focus on shared decision-making (SDM). Methods A convergent parallel mixed-methods design was adopted. The quantitative strand involved 104 adults with uncontrolled hypertension attending primary care facilities. Data on sociodemographic variables, cardiovascular risk factors, consultation and treatment details, and SDM were collected through a structured questionnaire. The qualitative strand included in-depth interviews with nine patients and eight medical officers. Findings from both strands were integrated and triangulated with field observations. Results The prevalence of therapeutic inertia was 76.9%. Patients aged under 60 years (AOR = 4.36; 95% CI: 1.13–16.90) and those with borderline or mildly elevated blood pressure (AOR = 4.81; 95% CI: 1.38–16.70) had greater odds of inertia. In contrast, illiteracy (AOR = 0.23; 95% CI: 0.05–0.99), the presence of comorbidities (AOR = 0.18; 95% CI: 0.04–0.79), and higher SDM scores (AOR = 0.93; 95% CI: 0.88–0.99) were associated with lower odds. The participants with inertia had significantly lower mean SDM scores (20.36 vs. 28.4, p = 0.003). Thematic analysis highlighted seven key drivers: patient beliefs and perceptions, reluctance to adopt lifestyle changes, fragmented care and conflicting advice, provider caution and clinical judgement, poor follow-up and adherence, workforce constraints in outreach programmes, and limited SDM. Conclusions Therapeutic inertia is highly prevalent within India’s primary healthcare system, resulting from a complex interplay of factors at the patient, provider and system levels. Limited engagement in shared decision making, particularly regarding hypertension, has been consistently associated with increased inertia. Strengthening provider capacity, enhancing patient engagement and incorporating SDM into routine clinical practice could help reduce inertia and improve hypertension management outcomes in primary care settings.

Background: Passive smoking is a major public health concern in India, increasing second-hand smoke exposure. College students often lack awareness of their health risks. This study evaluated a self-instructional module (SIM) to improve knowledge and examined demographic influences among degree college students in Udaipur, India. Methodology: A cross-sectional intervention study involved 50 participants aged 18–25 from a western Indian city. A 30-item questionnaire assessed knowledge in health effects and prevention domains. Pre-test scores were recorded, followed by a bilingual SIM intervention, with post-test scores collected after 1 week. Paired t -tests evaluated knowledge gains (H ₁ ), and Chi-square tests analysed demographic associations (H ₂ ). Results: The SIM increased mean knowledge scores by 44.6% (9.71 - 23, P < 0.001), supporting H ₁ , with the largest gains in prevention (5.4). High scores (≥21/30) rose from 4% to 62%. Pre-test knowledge was significantly associated with gender, education and prior smoke exposure ( P < 0.05), supporting H ₂ . Conclusion: The SIM effectively enhanced knowledge, supporting its integration into India’s National Tobacco Control Programme. Targeted interventions and digital SIM delivery could further reduce exposure.

Background: Tuberculosis (TB) remains a global health challenge, with India being severely affected. Despite efforts like the End TB Strategy and the National Strategic Plan for TB Control, the burden persists, necessitating innovative approaches such as the Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA). This study aims to assess the implementation and reach of PMTBMBA nutritional support, examining factors that influence its uptake among persons with TB (PwTB) and Ni-kshay Mitra: a voluntary donor to PwTB. Materials and Methods: Aggregated data variables from the records and registers of Ni-kshay Portal were analyzed for the duration of September 2022 to May 2023. It examined the nutritional support coverage under PMTBMBA initiative and outcomes of PwTB and uptake of scheme among Ni-kshay Mitra. Results: The PMTBMBA showed 51% Ni-kshay Mitra supported, with varying levels of support provision across the states. Notably, 9.6% of PwTB documented with receipt of benefits during initial months, with better coverage in certain states. Most of the Ni-kshay Mitra distributed nutritional support, and analysis demonstrated a significant association between Ni-kshay Mitra support and improved treatment outcomes. This finding was confirmed through Chi-square analysis ( P < 0.001, OR = 2.2) and regression analysis, showing that PwTB without support are significantly more likely to have unfavorable outcomes (Exp (B) =1.671). Conclusion: The PMTBMBA represents a crucial initiative in India’s TB control efforts, integrating comprehensive support for PwTB. However, challenges in volunteer engagement and geographical disparities highlight the need for targeted strategies and equitable nutritional support allocation. The study underscores the importance of community involvement and nutritional support in enhancing TB treatment outcomes, emphasizing the program’s potential to drive progress toward TB elimination.

Background Tuberculosis (TB) continues to pose a serious threat to the public health system in India. Although the National Tuberculosis Elimination Program (NTEP) is providing a wide range of interventions from early diagnosis to complete treatment to reduce morbidity and mortality from TB, adverse drug reactions (ADR) remain a challenge in treatment adherence and completion. Methods An observational cross-sectional study was conducted in selected districts of Gujarat state. A total of 593 reported TB patients were recruited with an adjusted unified distribution based on the type of cases, site of diseases, and service facility through a simple random sampling method. A semi-structured questionnaire tool was used to collect socio-demographic, clinical, and ADR-related data from the TB patients. Data was analyzed for the frequency, percentage, chi-squared, and adjusted odds ratio to find the association between the variables. Results The majority of the study participants were male (87.2%), aged 15 to 60 (57.8%), daily laborers (22.4%), and married (64.2%). Over 75% of individuals had pulmonary TB, with 87% having experienced their first episode, 83% being new cases, and 44.7% having a history of addiction. ADR with mild symptoms was reported by more than a quarter (29%) of TB patients during the intensive phase (77%). The association between ADR experience and drug susceptibility was significant (p<0.005) and drug-resistant TB patients experience two times more ADRs than drug-sensitive TB patients (OR 2.04). Binomial logistic regression was carried out to describe the association between various variables and occurrence of ADRs. Conclusion The study highlighted a need to enhance health care providers’ capacity and program structure for managing ADRs among TB patients. In order to completely eliminate TB across the country, it also emphasized the attention for a holistic and all-encompassing strategy for managing TB patients at the field level.

Introduction: The private sector plays an important role in tuberculosis (TB) elimination by providing access to quality TB care services like diagnosis and treatment, advocacy for preventive measures, innovation to address challenges in TB elimination, vaccines etc. The study aims to understand the perspectives of private practitioners on patients’ TB care cascade to reinforce existing interventions by assuring the quality of care to TB patients. Methods: The study utilized a qualitative design through in-depth interviews of private practitioners and was conducted in Ranchi and Purbi Singhbhum District of Jharkhand State from March-August 2021. The pilot-tested, semi-structured, open-ended interview guide questionnaire collected information from private practitioners on various aspects of the TB care cascade. The data from the provider interviews were transcribed into multiple codes and themes on the TB program. An inductive analysis was carried out with a focus on content credibility to eliminate bias. Ethical approval was received from the Institutional Ethics Committee of the Indian Institute of Public Health Gandhinagar (IIPHG), India. Written consent was taken from the private practitioners involved in the study. Result: In-depth interviews of 17 private practitioners reveal various factors contributing to delays in TB care cascades, especially delay in access to TB diagnosis and TB Care, delay in providing treatment once after diagnosis and poor adherence to the TB treatment. According to the perception of private practitioners, there was an array of client, provider and system side factors affecting the TB care cascade gaps positively and negatively. Positive aspects mainly emerged from interviews: strong governance, consistent supply chain management, innovative PPP models and financial schemes reducing out-of-pocket expenditure (OOPE). Various factors affecting the TB care cascade negatively include awareness among the patient, socio-economic status, approach and decision-making power of providers, adverse effects of drugs, staff capacity building, etc. Conclusions: Engaging private practitioner in TB elimination efforts is critical to achieving global targets and reducing the burden of TB. The study helps to determine geography-specific barriers and facilitators of the TB care cascade to achieve the aim of providing universal access to TB healthcare with the inclusion of private practitioners.

Background: Globally, occupational hazards are a concern, especially in waste management. With 31.2% of its population in urban areas, India is confronted with escalating waste management challenges. People worldwide generate about two-thirds of a kilogram of waste daily. Effective solid waste management is crucial due to population growth, changing waste patterns, and rapid urbanisation. It profoundly impacts environmental, resident, and worker health. Rag picking is an informal profession undertaken by a marginalised population of the society, which involves collecting waste from trash cans, streets, and household waste. To assess the burden and the pattern of morbidity, and the occupational factors associated with it, as well as their health-seeking behaviour, the present study was carried out among women rag pickers in Mumbai, India. Methodology: A cross-sectional descriptive study was conducted through a mixed-method approach in Mumbai's Chembur and Govandi areas, focusing on women rag pickers aged 15 to 49 years. The research was conducted over a period of three months, during which a total of 150 female rag pickers from individual families were identified and included in the study through purposive sampling. The structured questionnaires gathered quantitative data on socio-demographics, health-seeking behaviour, morbidity, and monthly expenses. The qualitative data were collected through focus group discussions with rag pickers, analysing themes related to rag picking as occupational preference and substance usage factors. Ethical approval from the institute and informed consent from each participant were obtained prior to data collection. Results: Among the cohort of 150 women rag pickers, 67.3% were aged between 15 and 30 years, with 82% belonging to the lower socio-economic class. A notable 43.4% of these women engaged in significant tobacco use, primarily through oral consumption, while about 56.7% of their family members exhibited high substance use, including pan, tobacco, and alcohol. In terms of health-seeking behaviour, 51% refrained from seeking treatment for minor ailments, 29% resorted to home remedies or self-medication, and 20% sought care at hospitals. A morbidity analysis over the past three months revealed prevalent health issues, informing potential interventions. Examination of monthly expenditure patterns unveiled an average income of 9000 INR (130 USD), with a significant 61% allocation towards food and grocery expenses. Qualitative insights indicated that the preference for rag picking was driven by limited alternatives and substance use was influenced by peers and served as a means to cope with stress. These findings underscore distinct health-seeking behaviours, and the unique needs of women rag pickers, providing valuable guidance for targeted policies to enhance their well-being. Conclusion: These findings underscore the need for targeted interventions to improve the well-being and socio-economic conditions of women rag pickers in India. Universal healthcare coverage, community-based initiatives, and social inclusion are vital for addressing their unique challenges and enhancing their quality of life.

Background: Achieving the target for eliminating tuberculosis (TB) in India by 2025, 5 years ahead of the global target, critically depends on strengthening the capacity of human resources as one of the key components of the health system. Due to the rapid updates of standards and protocols, the human resources for TB health care suffer from a lack of understanding of recent updates and acquiring necessary knowledge. Objective: Despite an increasing focus on the digital revolution in health care, there is no such platform available to deliver the key updates in national TB control programs with easy access. Thus, the aim of this study was to explore the development and evolution of a mobile health tool for capacity building of the Indian health system’s workforce to better manage patients with TB. Methods: This study involved two phases. The first phase was based on a qualitative investigation, including personal interviews to understand the basic requirements of staff working in the management of patients with TB, followed by participatory consultative meetings with stakeholders to validate and develop the content for the mobile health app. Qualitative information was collected from the Purbi Singhbhum and Ranchi districts of Jharkhand and Gandhinagar, and from the Surat districts of Gujarat State. In the second phase, a participatory design process was undertaken as part of the content creation and validation exercises. Results: The first phase collected information from 126 health care staff, with a mean age of 38.4 (SD 8.9) years and average work experience of 8.9 years. The assessment revealed that more than two-thirds of participants needed further training and lacked knowledge of the most current updates to TB program guidelines. The consultative process determined the need for a digital solution in easily accessible formats and ready reckoner content to deliver practical solutions to address operational issues for implementation of the program. Ultimately, the digital platform named Ni-kshay SETU (Support to End Tuberculosis) was developed to support the knowledge enhancement of health care workers. Conclusions: The development of staff capacity is vital to the success or failure of any program or intervention. Having up-to-date information provides confidence to health care staff when interacting with patients in the community and aids in making quick judgments when handling case scenarios. Ni-kshay SETU represents a novel digital capacity-building platform for enhancing human resource skills in achieving the goal of TB elimination.