ABSTRACT
Objectives: The coronavirus disease 2019 (COVID-19) pandemic affected routine healthcare services across all spectra, and tuberculosis (TB) care under the National Tuberculosis Elimination Program have been affected the most. However, evidence available at the community level is minimal. The clinical features, care cascade pathway, and treatment outcomes of TB patients pre- and during/post-COVID-19 pandemic lockdown in a rural community health block in northern India were assessed and compared.Materials and Methods: This was a retrospective cohort study that included all patients diagnosed with TB and initiated treatment under programmatic settings between January 1 and June 30, 2020, in a rural TB unit in northern India. The periods from January 1 to March 23 and March 24 to June 30 were marked as pre-lockdown and during/post-lockdown, respectively.Results: A total of 103 patients were diagnosed and treated for TB during the study period. A significantly higher proportion of pulmonary TB cases were reported during/post-lockdown (43, 82.7%) compared to that pre-lockdown (32, 62.7%), and a higher diagnostic delay was noted during/post-lockdown (35, 81.4%). Through adjusted analysis, patients diagnosed during/post-lockdown period (adjusted risk ratio [aRR], 0.85; 95% confidence interval [CI], 0.73–0.98) and previously treated (aRR, 0.77; 95% CI, 0.60–0.995) had significantly lower favorable treatment outcomes.Conclusions: The symptom and disease (pulmonary/extrapulmonary) pattern have changed during/post-lockdown. The care cascade delays are still high among TB patients, irrespective of the lockdown status. Lockdown had a significant adverse impact on the outcomes of TB treatment.
ABSTRACT
Background: Psychiatric disorders are highly prevalent and also the leading causes of disability worldwide. Because of multiple factors playing as barriers in help seeking many people who might benefit from the treatment do not obtain it. Data regarding common mental disorders is even more lacking. Methods: Present study was undertaken to assess various treatment barriers affecting help seeking behavior in 156 patients of “neurotic, stress related and somatoform disorders” who were assessed on various tools. The study sample was divided in Aware and Unaware group on the basis of their awareness about psychiatric disorder at the time of onset/initial stages of illness. Results: Inability to recognize patient’s behavioral problem by family members and lack of treatment facility/ resource were important barrier to care. Prevalent nonscientific etiological belief (e.g. supernatural phenomenon, a form of worry or tension) in society also delayed treatment seeking. The observations of present study have helped in revealing the barriers in treatment seeking for patients of neurotic and stress related disorders. Raising awareness about these disorders in community and making psychiatric easily accessible to general population will be helpful in overcoming these barriers.