The need to focus on medical education in rural districts of India.

Background: . Globally, India has the highest number of medical colleges followed by Brazil and China. The density of physicians in rural India was 3 per 10 000 population against 13 per 10 000 in urban areas. Worldwide, studies show that medical schools play an important role in overcoming the shortage of physicians locally. Hence, we studied the distribution of medical colleges in India and reviewed the shortage of established and new medical colleges in rural districts with the year 2000 as baseline. Methods: . We used the database of the Medical Council of India as on 27 April 2017; and Census 2011 data, based on the percentage of rural/urban population, for the classification of districts (rural/urban). All the 640 districts were included with 1210.9 million population. Results: . Of the 480 rural districts in India, only 132 (27.5%) had a medical college. Jharkhand, Jammu and Kashmir and Arunachal Pradesh had no medical colleges in rural districts. Madhya Pradesh, Uttar Pradesh, Bihar, Assam, Punjab, Uttarakhand, Haryana and Rajasthan had <30% of rural districts with a medical college. Of the 286 new medical colleges established since 2000 in India, 130 (45.5%) were in rural districts with uneven distribution with lower percentage of new medical colleges in states with predominance of rural population. Conclusion: . There is an overall shortage of medical colleges in rural districts of India. Paradoxically, the trend of uneven rural-urban distribution continues among the newly opened medical colleges as well.

Sputum smear grading and treatment outcome among directly observed treatment-short course patients of tuberculosis unit, Jagdalpur, Bastar.

INTRODUCTION: Tuberculosis (TB) is a major global health problem. In 2014, worldwide, 1.5 million deaths were reported from TB. The study was planned to assess sputum smear grading and treatment outcome among TB patients attending tuberculosis unit (TU), Jagdalpur of Bastar district in Chhattisgarh. MATERIALS AND METHODS: It was a record-based analysis for the year 2014 data from TU, Jagdalpur, Bastar of Chhattisgarh. STATISTICAL ANALYSIS USED: Data entry and analysis were done using STATA/SE 14.1 software. RESULTS: Out of total registered 496 TB patients in 2014, 207 were sputum smear positive with 83 (40.1%) having 3 + and 14 (6.8%) having scanty sputum grading. The percentage of successfully treated was lowest, 71.4% in scanty followed by 1+ (80.2%), compared to 84.1% in sputum smear negative (P = 0.02335). Overall rate of unfavorable outcome was 16.9%. Factors associated with unfavorable outcome were age more than 40 years (P = 0.01894), male gender (P = 0.06722), and retreatment cases (P = 0.0001136). Death rate was higher (6.6%) among patients of Category II. Higher default rate in new smear positive (8.3%), new smear negative (7.8%), and retreatment (16.7%) was noted. CONCLUSIONS: Overall rate of unfavorable outcome was higher in patients with scanty and 1+sputum grading. Age more than 40 years, male sex, and retreatment category were factors associated with unfavorable outcome.