Background: Nutritional status of the elderly population has become an important issue but often gets neglected. Both undernutrition and over nutrition are important public health priorities in this vulnerable group. Objectives: To determine the prevalence of malnutrition and factors associated with it among elderly population in rural Puducherry using mini-nutritional assessment (MNA) questionnaire. Materials and Methods: A community-based cross-sectional study was conducted among 279 elderly population between November and December 2016 in four villages of rural Puducherry, India. Information on sociodemographic characteristics and nutritional status of the elderlies were collected using validated MNA questionnaire. Body mass index was used to report obesity based on Asia-Pacific guidelines. Results: Among 279 participants, 178 (63.8%) were in the age group of 60–70 years, 190 (68.1%) were females, and 208 (74.6%) had no formal-education. Prevalence of malnutrition among elderly was found to be 17.9% (95% CI: 13.7–22.7) and about 58.8% (95% CI: 52.9–64.4) were at risk of malnutrition which was assessed using MNA questionnaire. Prevalence of obesity was found to be 32.5% (95% CI: 27.3–38.3) and 38.4% had inadequate fruits and vegetables intake. About 250 (89.6%) are living independently according to ADL score. Conclusion: Both undernutrition and over nutrition are important health issues to be considered among elderly population in this area. Primary healthcare strengthening to address and prevent this health issue by balanced dietary practices may improve their nutritional status, thereby enhancing their quality of life.

Objectives: We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design: A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting: National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants: Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures: We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results: The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion: TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.

Background: The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018. Objective: To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers’ perspective. Methods: We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted ‘presumptive TB’: any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes. Results: Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision. Conclusions: The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.

To compare clinical, radiological and haematological manifestations among newly diagnosed smear positive tuberculosis patients between Group I (Elderly >60 yrs) and Group II (Younger age between 13 and 60 years). This was a hospital-based cross-sectional study conducted at the out-patient department of pulmonary medicine, between March 2014 and December 2017. There were 61 patients in Group I (Elderly > 60 yrs) and 110 patients in Group II (Younger age between 13 and 60 years). Continuous variables were compared using student’s t-test and Mann-Whitney test. Chi square test and Fischer test was used for analysing categorical variables. All statistics were two-tailed, and a p-value of 0.05 was considered to be statistically significant. The mean age for Group I (Elderly >60 yrs) was 65 ± 2 years and for the Group II (Younger age between 13 and 60 years) was 40 ± 1 years. There was a statistically significant association of cavitation with infiltrates (p = 0.007) in younger age group. Bilateral multiple zone (48, 64.86%) involvements were commonly observed in both the age groups. There was no significant difference between two groups with regard to haematological and clinical parameters. We did not find any difference in the presentation of tuberculosis in both the groups. Radiologically, there was more of cavitating lesion in younger age group. So, they should be isolated and followed up at regular intervals.

Background: Access to health care among tribes is a significant challenge. Traditional healers have acted as a major resource for healthcare provision since the earliest ages of humanity. Efforts to create an entry point through them require a detailed understanding of their role, beliefs, and treatment approaches. This study aimed to capture the role of traditional healers in improving access to health care and their practices from the perspectives of the community, health care providers and traditional healers. Methods: This study was part of an implementation research project aimed at improving access to healthcare among the tribal population in Maharashtra in 2021. In-depth interviews with traditional healers and health care providers were conducted by trained field assistants in participant’s homes and facilities. An interview guide with open-ended questions explored perceptions of disease, treatment approaches, reasons for preference and challenges in utilizing public health facilities. With consent, interviews were audio recorded, verbatim transcripts prepared, and three independent reviewers inductively coded the data, and emerging themes were identified. Results: A total of 32 health care providers, 24 key informants, and nine traditional healers participated. All traditional healers interviewed were men aged 40–65 years with experience ranging from four to 35 years. Many practice a healing as a part-time job, attributed disease to black magic and lifestyle factors. Dietary restrictions, purgation, and topical herbal medicines were common treatment approaches. They claimed their role as the first point of contact for healthcare, a health guide, an escorting agent, and a link between the tribal Community and the health system. Round-the-clock availability, convenient time, affordability, and respectful attitudes were reasons they were preferred. Lack of awareness, economic vulnerability, preference for private services, and limited trust in the public health system were shared as reasons for poor utilization of services from public facilities. Health care providers viewed health seeking from traditional healers as illegal and a deterrent to timely care. Conclusion: With their close geographical and cultural association, and credible and affordable service provision, traditional healers can act as an entry point to improve health access among the tribal population and achieve universal health coverage.