Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Acceptance of Annual Booster Doses of COVID-19 Vaccines Among Indian Healthcare Professionals: A Pan-India Cross-Sectional Survey.

Introduction The emergence of coronavirus disease 2019 (COVID-19) posed significant challenges to global health, leading to the declaration of a pandemic by the World Health Organization. Vaccination efforts have effectively reduced severe outcomes and mortality, but breakthrough infections and new variants are of concern. In response, annual booster doses of COVID-19 vaccines are being considered to maintain immunity. Healthcare professionals, as frontline workers, play a pivotal role in vaccination campaigns. This study explores their attitudes toward and willingness to accept annual COVID-19 booster doses in India. Methods A pan-India cross-sectional survey was conducted among healthcare professionals, including faculty, resident doctors, interns, and nursing staff, across Indian medical and nursing colleges. Convenience sampling was used to collect responses via an online questionnaire. The questionnaire assessed demographics, vaccine status, attitudes toward COVID-19 vaccination, and willingness to accept annual booster doses. Multivariate analysis was performed to identify predictors of booster dose acceptance. Results A total of 535 participants responded from 28 states and 8 union territories of India. Most were 34.2 years (± 11.1 SD), and 372 (69.5%) had taken Covishield (Serum Institute of India, Pune, India) as their primary vaccine. While 525 (98.1%) had taken the first dose and 518 (96.8%) of them had taken the second dose, only 333 (62.2%) had received a booster. Around 318 (60%) of healthcare professionals were willing to accept an annual booster dose. The mean attitude score toward annual booster doses was 75.4 (range: 28-111). Healthcare professionals' trust in government recommendations and medical experts significantly influenced their willingness to accept annual booster doses. Conclusion This study provides insights into the attitudes of healthcare professionals in India toward annual COVID-19 booster doses. At the same time, a significant proportion showed a willingness to accept boosters.

Stakeholder Analysis for Hypertension Management in the Context of the Indian Public Health System.

BACKGROUND: Hypertension (HTN) portends a significant public health burden in India and calls for multi-stakeholder action. OBJECTIVES: We aimed to analyze the role of key stakeholder constituencies implicated in managing HTN across different levels of care within the public health system in India, alongside the enablers and barriers for effective program implementation. METHODS: We reviewed 45 articles and policy documents, and 17 consenting stakeholder representatives scored the stakeholder constituencies for "power," "position" and "interest." They ranked enablers and barriers to noncommunicable disease programs in each of the six building blocks of the WHO Health System Strengthening Framework. Data were analyzed on Jamovi 2.2.2. RESULTS: Policymakers/program managers emerged as the most critical stakeholder in influencing policy implementation (score for power: 23.3 ± 8.5, position: 25.4 ± 6.9, and interest: 22.1 ± 8.3). Beneficiaries ranked lowest (power: 10 ± 5.1, position: 12.3 ± 4.5, and interest: 19.4 ± 4.2). Effective "on-ground" implementation ("service delivery") was the most important enabler (17.9 ± 3.3) as well as a barrier (17.6 ± 9.2). The health workforce (19.2 ± 4.8) emerged as a top barrier. CONCLUSION: To bring around impactful efficiency in the health system, provider-side interventions, especially those at the point of delivery, emerged as the need of the hour. Policymakers and program managers could lead using a top-down leadership and Governance Approach, focusing on deploying an adequately trained and motivated health workforce to deliver HTN services. For ensuring better performance of the health system for HTN care, the health workforce/seemed to be the "obligatory pivot." Health-care providers could serve as the "point of convergence" of efforts made by all the stakeholder constituencies.