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Background: Delay in diagnosis and treatment enhances tuberculosis (TB) transmission and mortality. Understanding causes for delay can help in TB elimination by 2025, the stated goal of India. Objectives: Estimate diagnostic and treatment delay in Ernakulam district of Kerala, identify associated factors, and determine health-seeking behavior and knowledge regarding TB among new pulmonary TB patients. Materials and Methods: Community-based cross-sectional study among the new pulmonary TB patients registered under Revised National TB Control Program. Patients interviewed in-person and data collected using pretested semi-structured questionnaire. Descriptive statistics expressed as frequency, percent, interquartile range, median, and mean. The Chi?square test was used to assess statistical significance (P < 0.05) of association. Backward conditional method logistic regression done using variables with P < 0.2 in univariate analysis and adjusting for possible confounders. Results: Two hundred and twenty-nine patients interviewed and the median patient, health-care system, and treatment delay were 25 days, 22 days, and 1 day, respectively. While the patient delay (>30 days) and treatment delay (>2 days) were seen in 47.6% and 41% of patients, respectively, health?care system delay was seen in 79.9% of the patients. Choosing pharmacy for initial treatment (adjusted odds ratio [aOR] = 5.217), unskilled occupation (aOR = 3.717), female gender (aOR = 3.467), previously not heard about TB (aOR = 3.410), and lower education level (aOR = 2.774) were the independent predictors of the patient delay. Visiting two or more doctors (aOR = 5.855) and initially visiting a doctor of undergraduate qualification (aOR = 3.650) were the independent predictors of health?care system delay. The diagnosis in private sector (aOR = 8.989), not being admitted (aOR = 3.441), and age above 60 years (aOR = 0.394) was the independent predictors of treatment delay. Conclusion: Initial treatment from pharmacy, consulting multiple physicians, and diagnosis by private sector cause significant delay in diagnosis and treatment of pulmonary TB.
ABSTRACT
Background: Voluntary non-remunerated blood donation is the key strategy to ensure availability of safe blood. India is facing shortage of 2.5 million units of blood annually and voluntary donation rate is only 50%. The present study was conducted in a fully literate district of India to assess the attitude and practice of blood donation and various associated beliefs. Methodology: This cross-sectional community based study was conducted in Cheranalloor Panchayat of Ernakulam. A total of 202 respondents selected using multi-stage sampling between 18 and 60 years of age were interviewed. Data was analyzed using computer. Results & Conclusion: 25.2% respondents ever donated blood which correlated with knowledge level (r=0.233) or attitude level (r=0.225). The major reasons for blood donation were for relatives (39.2%), in emergency for others (35.3%) and as voluntary donation (6.4%). Among non-willing, reasons cited for not willing to donate blood were ill health (46.9%), old age (25.8%) and fear of blood (16.6%). Attitude towards blood donation is low in this literate area. Proper information regarding blood donation needs to be conveyed to the community.
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Background. Making tobacco cessation a normative part of all clinical practice is the only way to substantially reduce tobacco-related deaths and the burden of tobacco-related morbidity in the short term. This study was undertaken because information on receptivity to integrate tobacco control education in the medical curriculum is extremely limited in low- and middle-income countries. Methods. From five medical colleges (two government) in southern India, 713 (men 59%) faculty and 2585 (men 48%) students participated in our cross-sectional survey. Information on self-reported tobacco use and readiness to integrate tobacco control education in the medical curriculum was collected from both the faculty and students using a pretested structured questionnaire. Multiple logistic regression analysis was done to find the associated factors. Results. Current smoking was reported by 9.0% (95% CI 6.6–12.1) of men faculty and 13.7% (CI 11.8–15.9) by men students. Faculty who were teaching tobacco-related topics [odds ratio (OR) 2.29; 95% CI 1.65–3.20] compared to those who were not, faculty in government colleges (OR 1.69; CI 1.22–2.35) compared to those in private colleges and medical specialists (OR 1.79; CI 1.23–2.59) compared to surgical and non-clinical specialists were more likely to be ready to integrate tobacco control education in the medical curriculum. Non-smoking students (OR 2.58; CI 2.01–3.33) compared to smokers, and women students (OR 1.80; CI 1.50–2.17) compared to men were more likely to be ready to integrate a tobacco control education in the curriculum. Conclusion. Faculty and students are receptive to introduce tobacco control in the medical curriculum. Government faculty, medical specialists and faculty who already teach tobacco-related topics are likely to be early introducers of this new curriculum.
Subject(s)
Cross-Sectional Studies , Curriculum , Education, Medical , Faculty, Medical , Female , Humans , India , Male , Smoking , Smoking Cessation , Students, Medical/psychologyABSTRACT
Background & objectives: Cervical cancer has a major impact on woman's lives worldwide and one in every five women suffering from cervical cancer belongs to India. Hence the objectives of this study were to find the knowledge of women regarding cervical cancer, to determine screening practices and determinants, and to identify factors for non screening. Methods: A cross-sectional study was conducted in Vypin Block of Ernakulam District, Kerala, India where four of the seven Panchayats were randomly chosen. Households were selected by systematic random sampling taking every second house in the tenth ward of the Panchayat till at least 200 women were interviewed. Thus, 809 women were interviewed from four Panchayats. Results: Mean age of the study population was 34.5 + 9.23 yr. Three fourths of the population (74.2%) knew that cervical cancer could be detected early by a screening test. Majority of respondents (89.2%) did not know any risk factor for cervical cancer. Of the 809 women studied, only 6.9 per cent had undergone screening. One third of the population were desirous of undergoing screening test but had not done it due to various factors. These factors related to knowledge (51.4%) such as no symptoms, not being aware of Pap test, not necessary, etc. This was followed by resource factors (15.1%) like no time, no money, etc. and psychosocial factors (10.2%) included lack of interest, fear of procedure, etc. Independent predictors for doing Pap test included age >35, having knowledge of screening for cervical cancer and Pap test (P<0.05). Interpretation & conclusions: Specific knowledge on cervical cancer screening is a critical element in determining whether a woman will undergo Pap test in addition to making cancer screening facilities available in the primary health centre.