Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India.

BACKGROUND: Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. METHODS: This was a cross-sectional descriptive mixed-methods study. RESULTS: Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. CONCLUSION: Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.

Tuberculosis retreatment outcomes and associated factors: a mixed-methods study from Puducherry, India.

Setting: Four Tuberculosis (TB) Units in the Union Territory of Puducherry in India. Objectives: To identify factors associated with unfavourable outcomes among retreatment TB cases in Puducherry. Design: The study had a mixed-methods design in which routinely reported TB data from retreatment TB cases registered during 2014 and 2015 were used for the quantitative part; the qualitative phase comprised interviews and focus group discussions with health care providers. Results: Among the 392 retreatment cases, 297 (75.8%) had favourable outcomes. Outcome for previous treatment such as loss to follow-up (LTFU) (adjusted relative risk [aRR] 1.6, 95%CI 1.1-2.4, P = 0.001), treatment failure (aRR 1.7, 95%CI 1.04-2.8, P = 0.03) and pre-treatment weight <40 kg (aRR 1.8, 95%CI 1.3-2.5, P = 0.001) had increased risk for unfavourable outcomes. Health care providers reported that alcoholism, lack of family support, job-related issues and lack of access to trained staff for injections were some of the reasons for unfavourable outcomes. Providing incentives, nutritional supplements and early retrieval of the LTFU cases were some of the suggestions to reduce unfavourable outcomes. Conclusion: Outcome of previous treatment and low pre-treatment weight of the patient affected retreatment outcomes. Health professionals and workers highlighted social and health system-related factors. Commitment at all levels on the part of health care providers and addressing their concerns can improve retreatment outcomes.

Contexte : Quatre unités tuberculose (TB) dans le territoire de Puducherry en Inde.Objectif : Identifier les facteurs associés à des résultats défavorables parmi les cas de retraitement de TB à Puducherry.Schéma : Schéma à méthodes mixtes dans lequel les données TB recueillies en routine relatives aux cas de retraitement de TB enregistrés en 2014 et 2015 ont été utilisés de manière quantitative. L'aspect qualitatif a été basé sur des entretiens et des discussions en groupe focal avec les prestataires de soins de santé.Résultats : Parmi les 392 cas de retraitement, 297 (75,8%) ont eu un résultat défavorable. Les résultats du traitement précédent comme les pertes de vue (LTFU) (risque relative ajusté [RRa] 1,6 ; IC95% 1,1­2,4 ; P = 0,001), un échec du traitement (RRa 1,7 ; IC95% 1,04­2,8 ; P = 0,03) et un poids avant traitement <40 kg (RRa 1,8 ; IC95% 1,3­2,5 ; P = 0,001) ont majoré le risque de nouveau résultat défavorable. Les prestataires de soins de santé ont rapporté que l'alcoolisme, l'absence de soutien familial, des problèmes professionnels et l'absence d'accès à du personnel formé pour les injections ont été parmi les causes de résultats défavorables. On a suggéré de réduire ces problèmes, notamment en fournissant des incitations et des suppléments nutritionnels et en recherchant rapidement les LTFU.Conclusion : Les résultats du traitement précédent et un faible poids avant le traitement ont affecté les résultats du retraitement. Le personnel de santé a attribué ce fait à des facteurs sociaux et liés au système de santé. L'engagement à tous les niveaux des prestataires de soins de santé et le fait de répondre à leurs préoccupations peuvent améliorer les résultats du retraitement.

Marco de Referencia: Cuatro unidades de tuberculosis (TB) en Puducherry, que es un Territorio de la Unión en la India.Objetivos: Reconocer los factores que se asocian con los desenlaces desfavorables en los casos de retratamiento de la TB en Puducherry.Método: Fue este un estudio con diseño de método mixtos; en el análisis cuantitativo se utilizaron los datos corrientes de notificación de los casos de retratamiento de la TB registrados en el 2014 y el 2015 y en la fase cualitativa se realizaron entrevistas y sesiones en grupos de opinión con los proveedores de atención de salud.Resultados: De los 392 casos en retratamiento, 297 (75,8%) alcanzaron desenlaces favorables. Se observó que el riesgo aumentado de desenlaces desfavorables se asociaba con el desenlace del tratamiento anterior como la pérdida durante el seguimiento (LTFU) (riesgo relativo ajustado [RRa] 1,6; 95%CI 1,1­2,4; P = 0,001), el fracaso terapéutico (RRa 1,7; 95%CI 1,04­2,8; P = 0,03) y con un peso <40 kg antes de iniciar el tratamiento (RRa 1,8; 95%CI 1,3­2,5; P = 0,001). Los profesionales de salud refirieron el alcoholismo, la falta de apoyo familiar, los problemas relacionados con el trabajo y la falta de acceso a personal capacitado para las inyecciones como algunas de las razones de los desenlaces desfavorables y sugirieron la provisión de incentivos, los suplementos nutricionales y la recuperación rápida de los casos LTFU como estrategias para corregirlos.Conclusión: El desenlace de un tratamiento anterior y el bajo peso del paciente antes de iniciar el tratamiento afectan el desenlace de los casos de retratamiento de la TB. Los profesionales y los trabajadores de salud atribuyeron estos resultados a factores sociales y factores relacionados con el sistema de salud. La participación de los proveedores de atención de salud a todos los niveles y la respuesta a sus inquietudes contribuirán a mejorar los desenlaces del retratamiento de la TB.

Unsymmetrical tetrasubstituted ureas from tertiary carbamoylimidazole: activation by AlMe3.

An efficient and general method for the synthesis of unsymmetrical tetrasubstituted ureas from carbamoylimidazole is described. The conversion is achieved by the concurrent quarternization of the imidazole nitrogen and activation of amines with AlMe(3).