ABSTRACT
Introduction: Deaths, defaults, relapses, and treatment failures have made the control of TB difficult across the globe
Methodology: This study is a record-based follow-up of a cohort of patients registered under Revised National Tuberculosis Control Program in the year 2014 in Wardha Tuberculosis Unit, India. Data was collected from the records available at the District Tuberculosis Office
Results: Data of 510 patients was analyzed. The sputum conversion rate was 88%. The overall treatment success rate was 81.9%, and rates of any adverse outcome, deaths, defaults, failure, and shift to Category IV regimen were 32.60/100 person years at risk [PYAR], 16.88/100 PYAR, 11.12/100 PYAR, 3.45/100 PYAR, and 1.15/100 PYAR, respectively. The median times for the above outcomes were 81 days, 110 days, 66 days, 118 days, and 237 days, respectively. The cumulative probability of occurrence at 6 months of any adverse outcome, deaths, default, failure, and shift to Category IV regimen was 0.145, 0.056, 0.088, 0.002, and 0.004, respectively. On multivariate analysis, the determinant of any adverse outcome was age >45 years, whereas extrapulmonary disease was protective. The hazard of defaulting was also significantly higher in male patients and those aged >45 years
Conclusion: Appropriate interventions and program implementation to reduce the adverse treatment outcomes and interruptions will help in improving program performance
ABSTRACT
Objective: The study was undertaken to explore what and how first year medical undergraduates could learn about Community Medicine using a portfolio-based learning approach during the period of Social Service Camp in the village Pulai. Methods: Study participants were 65 first year medical undergraduates participating in Social Service Camp in the village Pulai, during 10 - 24 October 2008. The first step was to set Specific, Measurable, Actionable, Realistic and Time bound (SMART) learning goals focused on Community Medicine. These learning goals were to be achieved during the fifteen days and within the existing curriculum, using existing resources and opportunities. The portfolio based records of students who accomplished their learning objectives were subjected to qualitative content analysis. Results: Of 65 students, 41 (63.1%) completed and reflected on their portfolios. Methods adopted for learning were; interaction with community based groups (48.8%), interaction with allotted family members (43.9%), lectures series, role plays and demonstrations (36.6%), interactions with village level healthcare providers (31.7%) and journal exercises (26.8%). The portfolio based exercises were useful to 30 (46.2%) students to understand the social, economic and health problems of the villagers and their life style. Twenty four (36.9%) students said that it improved their communication skills. This exercise helped 11 (16.9%) students to explore weaknesses such as poor communication skills, poor knowledge of local language, inability to adjust in new environment. Conclusion: The Social Service Camp in the village Pulai offered opportunities for portfolio based leaning to medical undergraduates. The students learned about the major topics of primary health care through self-directed learning.