Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms

A methodological review of patient healthcare-seeking journeys from symptom onset to receipt of care

BACKGROUND

For many diseases, early diagnosis and treatment are more cost-effective, reduce community spread of infectious diseases and result in better patient outcomes. However, healthcare-seeking and diagnoses for several diseases are unnecessarily delayed. For example, in 2022, 3 million and 5.6 million people living with tuberculosis (TB) and HIV, respectively, were undiagnosed. Many patients never access appropriate testing, remain undiagnosed after testing or drop out shortly after treatment initiation. This underscores challenges in accessing healthcare for many individuals. Understanding healthcare-seeking obstacles can expose bottlenecks in healthcare delivery and promote equity of access. We aimed to synthesise methodologies used to portray healthcare-seeking trajectories and provide a conceptual framework for patient journey analyses.

DESIGN/METHODS

We conducted a literature search using keywords related to "patient/care healthcare-seeking/journey/pathway analysis" AND "TB" OR "infectious/pulmonary diseases" in PubMed, CINAHL, Web of Science and Global Health (OVID). From a preliminary scoping search and expert consultation, we developed a conceptual framework and honed the key data points necessary to understand patients' healthcare-seeking journeys, which then served as our inclusion criteria for the subsequent expanded review. Retained papers included at least three of these data points.

RESULTS

Our conceptual framework included five data points and seven related indicators that contribute to understanding patients' experiences during healthcare-seeking. We retained 66 studies that met our eligibility criteria. Most studies (56.3%) were in Central and Southeast Asia, explored TB healthcare-seeking experiences (76.6%), were quantitative (67.2%), used in-depth, semistructured or structured questionnaires for data collection (73.4%). Healthcare-seeking journeys were explored, measured and portrayed in different ways, with no consistency in included information.

CONCLUSIONS

We synthesised various methodologies in exploring patient healthcare-seeking journeys and found crucial data points necessary to understand challenges patients encounter when interacting with health systems and offer insights to researchers and healthcare practitioners. Our framework proposes a standardised approach to patient journey research.

Influencing factors of patients' behavior of healthcare seeking: a meta-analysis in China

Objectives

Understanding patient's healthcare seeking behavior (BHS) and identifying the determinants influencing BHS can optimize the allocation of medical resources and enhance the efficacy of healthcare systems. The purpose of this study is to identify the influencing factors of patients' BHS and to assess the extent and variation in their impact on BHS.

Methods

Drawing upon the Anderson Behavioral Model of Health Service Utilization, we summarized the factors influencing patients' BHS into three categories, and examined empirical journal articles published from 2010 to 2023 using meta-analysis. In addition, the Bayesian analysis of variance was introduced to explore the influence of moderators.

Results

A total of 39 empirical journal articles were finally identified for meta-analysis. Ten out of the thirteen factors have a significant and positive influence on BHS, with the exception of trust in medical institutions (z = 0.176, p = 0.077), health record (z = 1.942, p = 0.052), and medical expenses (z = 0.1846, p = 0.065). The results of moderating effect analysis indicate that there is a significant difference in the impact of age (p < 0.001), education level (p < 0.05), family income (p < 0.001), medical insurance (p < 0.001), illness severity (p < 0.01), and healthcare service reputation (p < 0.001) on BHS.

Conclusion

There is a positive and significant influence of the antecedent variables (self-rated health, distance to medical facilities, illness severity, age, family income, education level, marital status, medical insurance, awareness of hierarchical healthcare, health record, and healthcare service reputation) on BHS. Furthermore, the influences of family income, medical insurance, and illness severity on BHS in developed areas are stronger than that in underdeveloped areas, while the influences of age, education level, and healthcare service reputation on BHS in underdeveloped areas are stronger than that in developed areas.

Bridging Gaps in Tuberculosis Control: A Culturally Competent Approach for Tribal Populations in India

Tuberculosis (TB) remains a major health challenge in India, with a significant burden among tribal populations. These communities experience disproportionately high TB prevalence due to factors such as geographical isolation, socio-economic challenges, and cultural practices, further worsened by malnutrition, overcrowded living conditions, and limited awareness. Despite efforts under national programs aimed at eliminating TB, various socio-cultural and logistical barriers continue to impede progress in tribal regions. This discussion underscores the need for culturally sensitive healthcare approaches to effectively address these challenges. A structured framework focusing on cultural awareness, knowledge, sensitivity, and competence is recommended to develop tailored interventions. Key strategies include training healthcare workers to understand tribal customs, creating accessible educational materials, involving tribal leaders in stigma-reduction efforts, and integrating traditional practices with modern healthcare systems. To achieve impactful outcomes, it is essential to enhance healthcare infrastructure, implement customized awareness campaigns, address underlying socio-economic issues, and leverage technology for better outreach and adherence. Real-world examples from tribal regions illustrate both advancements and ongoing gaps in TB care. A collaborative effort among various stakeholders is crucial to bridge healthcare disparities and empower tribal communities in the fight against TB, ultimately contributing to the national goal of its elimination while improving the overall well-being of these populations.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

The potential of digital health interventions to address health system challenges in Southeast Asia: A scoping review

Objective

The World Health Organization (WHO) Southeast Asian region, comprising a quarter of the global population, faces significant healthcare challenges influenced by diverse economic and social conditions. The objective of this study is to map the Digital Health Intervention (DHI) functionalities across the nine axes of the healthcare system challenges (HSCs) model; we use WHO's DHIs classification framework and the Health System Challenges model. Our study findings help identify the gaps in the potential of the existing DHIs in addressing health system challenges in low- and middle-income countries.

Methods

Using SCOPUS, EMBASE and PUBMED databases, a scoping review was conducted to identify the existing DHIs in the Southeast Asia region and map the DHIs with the HSCs related to availability, information, utilization, quality, accountability, efficiency, equity, cost and acceptability.

Results

Out of 278 studies, 337 DHI functionalities were identified. A majority of the identified DHIs address challenges related to information (35.6%), availability (34.7%) and utilization, while less than 10% of the DHIs address challenges related to quality (8.9%), accountability (5%) and efficiency (3.9%) in the health system.

Conclusion

Most of the existing DHIs in SEA region address challenges related to availability of services and lack of information, while they fall short in addressing challenges related to quality of services, efficiency, and accountability. Acknowledging the inter-linkages across the health system challenges, this gap identification may well guide future investments and planning in DHIs.

A qualitative analysis to identify the issues of tuberculosis management in tribal areas of Rajasthan

BACKGROUND

Tuberculosis (TB) is a disease with social issue. Tribal people are disproportionately affected by TB. There is a scarcity of data on issues of TB management among the tribal groups of India. The objective of this study was to get in-depth understanding of the issues hindering TB management among the tribal communities of Rajasthan, India.

METHODS

We conducted qualitative study involving in-depth interviews with purposively selected healthcare service providers of the selected tribal areas of Rajasthan. Beside this, in-depth interviews and focus group discussions were also conducted among the purposively selected tribal people of these tribal areas. Data was collected using predesigned interview guides and a focus group discussion guide in their local setting in the local language. Information obtained were transcribed and translated into English language before analysing. Translated data was then coded and thematically organized. Inductive coding was used to identify emerging themes and sub-themes relevant to issues that occur during TB management.

RESULTS

Several locally relevant issues were identified which negatively affected TB management in tribal areas of Rajasthan, India. Substance abuse, lack of awareness, discriminative behaviour, poor accessibility, exposure to mine dust, economic burden, migration, lack of training, irregular disbursement of incentive and staff behaviour emerged as major issues.

CONCLUSION

This study identified the issues which hamper TB management in tribal population of Rajasthan, India. Result of this study can be useful in designing a tribal-centric approach to adequately manage TB among tribal population of Rajasthan.

Estimating and Explaining the Differences in Health Care Seeking by Symptom Burden Among Persons With Presumptive Tuberculosis: Findings From a Population-Based Tuberculosis Prevalence Survey in a High-Burden Setting in India

Background

There is a lack of research evidence on the quantitative relationship between symptom burden and health care seeking among individuals with presumptive tuberculosis (TB).

Methods

Data were derived from a cross-sectional population-based TB survey conducted between February 2021 and July 2022 in 32 districts of India. Eligible and consented participants (age >15 years) underwent TB symptom screening and history elicitation. Fairlie decomposition analysis was used to estimate the net differences in health care seeking due to varied symptom burden-from 1+ burden (>1 symptom) to 4+ burden (>4 symptoms)-and decomposed by observable covariates based on logit models with 95% CIs.

Results

Of the 130 932 individuals surveyed, 9540 (7.3%) reported at least 1 recent TB symptom, of whom 2678 (28.1%; 95% CI, 27.1%-28.9%) reportedly sought health care. The net differences in health care seeking among persons with symptom burden 1+ to 4+ ranged from 6.6 percentage points (95% CI, 4.8-8.4) to 7.7 (95% CI, 5.2-10.2) as compared with persons with less symptom burden. The presence of expectoration, fatigue, and loss of appetite largely explained health care seeking (range, 0.9-3.1 percentage points [42.89%-151.9%]). The presence of fever, cough, past TB care seeking, weight loss, and chest pain moderately explained (range, 5.3%-25.3%) health care seeking.

Conclusions

Increased symptom burden and symptoms other than the commonly emphasized cough and fever largely explained health care seeking. Orienting TB awareness and risk communications toward symptom burden and illness perceptions could help address population gaps in health care seeking for TB.

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

BACKGROUND

India accounts for about one-quarter of people contracting tuberculosis (TB) disease annually and nearly one-third of TB deaths globally. Many Indians do not navigate all care cascade stages to receive TB treatment and achieve recurrence-free survival. Guided by a population/exposure/comparison/outcomes (PECO) framework, we report findings of a systematic review to identify factors contributing to unfavorable outcomes across each care cascade gap for TB disease in India.

METHODS AND FINDINGS

We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches of PubMed, Embase, and Web of Science from January 1, 2000 to August 14, 2023 were conducted. We identified articles evaluating factors associated with unfavorable outcomes for each gap (reported as adjusted odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons for these outcomes (reported as proportions), with specific quality or risk of bias criteria for each gap. Findings were organized into person-, family-, and society-, or health system-related factors, using a social-ecological framework. Factors associated with unfavorable outcomes across multiple cascade stages included: male sex, older age, poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) health services. People previously treated for TB were more likely to seek care and engage in the diagnostic workup (Gaps 1 and 2) but more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable treatment outcomes (Gap 4), especially those who were lost to follow-up during their prior treatment. For individual care cascade gaps, multiple studies highlighted lack of TB knowledge and structural barriers (e.g., transportation challenges) as contributing to lack of care-seeking for TB symptoms (Gap 1, 14 studies); lack of access to diagnostics (e.g., X-ray), non-identification of eligible people for testing, and failure of providers to communicate concern for TB as contributing to non-completion of the diagnostic workup (Gap 2, 17 studies); stigma, poor recording of patient contact information by providers, and early death from diagnostic delays as contributing to pretreatment loss to follow-up (Gap 3, 15 studies); and lack of TB knowledge, stigma, depression, and medication adverse effects as contributing to unfavorable treatment outcomes (Gap 4, 86 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and TB recurrence (Gap 5, 14 studies). Limitations include lack of meta-analyses due to the heterogeneity of findings and limited generalizability to some Indian regions, given the country's diverse population.

CONCLUSIONS

This systematic review illuminates common patterns of risk that shape outcomes for Indians with TB, while highlighting knowledge gaps-particularly regarding TB care for children or in the private sector-to guide future research. Findings may inform targeting of support services to people with TB who have higher risk of poor outcomes and inform multicomponent interventions to close gaps in the care cascade.

A Cross-Sectional Study on Motor and Sensory Nerve Functions in Women Newly Diagnosed and Untreated for Hypothyroidism in a Tribal Area of Odisha, India

Introduction: Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. The tribal population, characterized by distinct lifestyles and dietary habits, may experience unique influences on their growth and development. Aim: This study aimed to compare nerve conduction in newly diagnosed and untreated tribal women affected by hypothyroidism with euthyroid tribal women. Methods:A cross-sectional study was conducted in southern Odisha, India, spanning from April 2020 to January 2021. Forty-five newly diagnosed hypothyroid tribal women were enlisted from the outpatient department of general medicine as the case group. Additionally, 45 age-matched apparently healthy euthyroid tribal women were included as the control group. The subjects' height and weight were measured by an expert clinician. Nerve conduction (motor and sensory) study on both extremities (left and right side) were conducted for all participants in the human physiology laboratory. Results:The mean age of participants was 48.13±12.12 years in the case group and 47.18±12.2 years in the control group. In hypothyroid tribal women, a significant decrease in conduction velocity was observed in the majority of motor nerves (right median [p = .03], left median [p = .02], left ulnar [p = .04], right posterior tibial [p = .001], left posterior tibial [p = .0001]) and sensory nerves (right median [p =.005], right ulnar [p = .02], right sural [p = .001], and left sural [p = .02]). Conclusion:In newly diagnosed cases of hypothyroidism in tribal women, there is a risk of neuropathy that impacts both motor and sensory neurons. Therefore, it is crucial to initiate early diagnosis and immediate treatment to prevent additional neurological damage.

A Cross-Sectional Study on Motor and Sensory Nerve Functions in Women Newly Diagnosed and Untreated for Hypothyroidism in a Tribal Area of Odisha, India

Introduction: Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. The tribal population, characterized by distinct lifestyles and dietary habits, may experience unique influences on their growth and development. Aim: This study aimed to compare nerve conduction in newly diagnosed and untreated tribal women affected by hypothyroidism with euthyroid tribal women. Methods:A cross-sectional study was conducted in southern Odisha, India, spanning from April 2020 to January 2021. Forty-five newly diagnosed hypothyroid tribal women were enlisted from the outpatient department of general medicine as the case group. Additionally, 45 age-matched apparently healthy euthyroid tribal women were included as the control group. The subjects' height and weight were measured by an expert clinician. Nerve conduction (motor and sensory) study on both extremities (left and right side) were conducted for all participants in the human physiology laboratory. Results:The mean age of participants was 48.13±12.12 years in the case group and 47.18±12.2 years in the control group. In hypothyroid tribal women, a significant decrease in conduction velocity was observed in the majority of motor nerves (right median [p = .03], left median [p = .02], left ulnar [p = .04], right posterior tibial [p = .001], left posterior tibial [p = .0001]) and sensory nerves (right median [p =.005], right ulnar [p = .02], right sural [p = .001], and left sural [p = .02]). Conclusion:In newly diagnosed cases of hypothyroidism in tribal women, there is a risk of neuropathy that impacts both motor and sensory neurons. Therefore, it is crucial to initiate early diagnosis and immediate treatment to prevent additional neurological damage.

Rural-Urban Inequities in Tuberculosis-Related Practices in Equatorial Guinea

BACKGROUND

Tuberculosis (TB) is one of the leading causes of mortality from a single infectious disease agent. Equatorial Guinea is a country with high estimated TB incidence in 2021 (275 cases per 100,000 population) and low TB case detection (42%). Early diagnosis and prompt treatment are crucial for TB control. Failure to seek adequate health care increases the disease's transmission and leads to poor treatment outcome, the mortality, even for easily manageable conditions. Information regarding community management of TB and treatment-seeking patterns in Equatorial Guinea is rare. The aim of this study was to explore differences in TB health-seeking behaviour among urban and rural population TB cases in Equatorial Guinea and the factors associated with this behaviour.

METHODS

A national cross-sectional study of 770 household caregivers was conducted in 2020 in Equatorial Guinea using multistage stratified sampling. The 284 caregivers that reported having had a TB case in their family were included in this study. A practice index was created. Poisson regression with robust variance was performed with the practices index as dependent variable to assess the factors associated with the health-seeking behaviour.

RESULTS

Most of the cases (65%) have had good TB health-seeking practices. However, 23.2% of TB cases reported having abandoned treatment before 6 months. A higher probability of having good TB practices was observed with being women, aged and living in rural area. Those who were TB cases themselves have heard about TB on the radio, and had high knowledge about TB, hand also good practices.

CONCLUSIONS

Disparities in tuberculosis health-seeking behaviour between rural and urban populations highlight the challenges existing in the fight against this infectious disease. The National Tuberculosis Control Program has to reinforce the health system needs to strengthen the follow-up of TB patients taking into account the population at risk of inappropriate TB behaviour.

TRIAL REGISTRATION

Not applicable.

Improving measurement of tuberculosis care cascades to enhance people-centred care

Care cascades represent the proportion of people reaching milestones in care for a disease and are widely used to track progress towards global targets for HIV and other diseases. Despite recent progress in estimating care cascades for tuberculosis (TB) disease, they have not been routinely applied at national and subnational levels, representing a lost opportunity for public health impact. As researchers who have estimated TB care cascades in high-incidence countries (India, Madagascar, Nigeria, Peru, South Africa, and Zambia), we describe the utility of care cascades and identify measurement challenges, including the lack of population-based disease burden data and electronic data capture, the under-reporting of people with TB navigating fragmented and privatised health systems, the heterogeneity of TB tests, and the lack of post-treatment follow-up. We outline an agenda for rectifying these gaps and argue that improving care cascade measurement is crucial to enhancing people-centred care and achieving the End TB goals.

The Tribal Health System in India: Challenges in Healthcare Delivery in Comparison to the Global Healthcare Systems

The tribal health system in India faces unique challenges in comparison to non-tribal health in the nation and global healthcare systems. The tribal health issues are distinct due to the diverse socio-cultural practices, rituals, customs, and languages of the tribal communities. Despite commendable efforts, there are several obstacles that hinder the successful delivery of healthcare services to these underserved populations. These challenges include geographical remoteness and limited infrastructure, language, and cultural barriers; scarcity of healthcare professionals; socioeconomic disparities; and the need for cultural sensitivity and integration of traditional healing practices. Overcoming these challenges requires collaborative efforts between the government, medical specialists, and the indigenous tribes themselves. By addressing these obstacles, it is possible to enhance the accessibility, quality, and cultural appropriateness of healthcare services for tribal groups, leading to improved health outcomes and reduced health inequalities.

Behavioral deviations: healthcare-seeking behavior of chronic disease patients with intention to visit primary health care institutions

BACKGROUND

Although primary health care (PHC) has been proven to be effective in preventing and treating chronic diseases, the visits rate of PHC institutions is still not ideal. Some patients initially express a willingness to visit PHC institutions but end up seeking health services at non-PHC institutions, and the reasons for this behavior remain unclear. Therefore, the objective of this study is to analyze the factors that contribute to behavioral deviations among chronic disease patients who originally intended to visit PHC institutions.

METHODS

Data were collected from a cross-sectional survey among chronic disease patients with original intention to visit PHC institutions in Fuqing City, China. The analysis framework was guided by Andersen's behavioral model. Logistic regression models were employed to analyze the factors affecting the behavioral deviations among chronic disease patients with a willingness to visit PHC institutions.

RESULTS

A total of 1,048 individuals were finally included and about 40% of the participants with the original willingness to seek care from PHC institutions finally chose non-PHC institutions in their subsequent visits. The results of logistic regression analyses indicated that at the predisposition factor level, older participants (aOR_60-69 = 0.602, P < 0.01; aOR_70-75 = 0.475, P < 0.01) were less likely to have behavioral deviations. At the enabling factor level, compared to those covered by Urban Employee Basic Medical Insurance (UEBMI) and not reimbursed, those covered by Urban-Rural Resident Basic Medical Insurance (URRBMI) (aOR = 0.297, P < 0.01), and those answering that reimbursement from medical institutions was convenient (aOR = 0.501, P < 0.01) or very convenient (aOR = 0.358, P < 0.001) were less likely to have behavioral deviations. At the need factor level, participants who visited PHC institutions due to illness last year (aOR = 0.348, P < 0.001) and with polypharmacy (aOR = 0.546, P < 0.01) were less likely to have behavioral deviations compared to those without the visit of PHC institutions and not taking polypharmacy, respectively.

CONCLUSIONS

The deviations between the original willingness of PHC institution visits and subsequent behavior among chronic disease patients were associated with a number of predisposing, enabling, and need factors. Developing the health insurance system, strengthening the technical capacity of PHC institutions, and steadily developing a new concept of orderly healthcare-seeking behavior among chronic disease patients, will help promote their access to PHC institutions as well as improve the effectiveness of the tiered medical system for chronic disease care.

Trends in Tuberculosis Mortality Across India: Improvements Despite the COVID-19 Pandemic

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has had significant health implications across the globe. India is a country that has faced a double burden of COVID-19 and tuberculosis (TB) since 2020. There is a need to understand the impacts of COVID-19 on tuberculosis control programs in India. Therefore, our study aimed to determine the changes in TB mortality across India between 2019 and 2021.

METHODS

In our study, we described trends in TB and COVID-19 cases reported across India. Next, we compared death totals for TB between 2019, 2020, and 2021 in India at the national and state level. We considered total TB deaths, as well as deaths by TB for tribal populations, and for those living with human immunodeficiency virus (HIV). Percent changes were calculated.

RESULTS

In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decrease during this time period. While total deaths increased in 2021 compared to 2020, decreases did occur in 2021 compared to 2019. Deaths by TB for individuals living with HIV decreased by 16.0% across India. At a national level, there was a notable rise in TB deaths among tribal populations, though this was not universal across states.

CONCLUSION

While the majority of the world has seen an increase in new TB cases and TB deaths annually since the start of the COVID-19 pandemic, there have instead been decreases in India during this time period. More research is required to understand the factors that have led to this decrease in TB deaths. Furthermore, additional allocation of resources is required to better support vulnerable populations in states where TB death totals have increased, especially among tribal populations.

Respiratory viruses among ethnic Nicobarese during COVID-19 pandemic

Background

Acute respiratory infections (ARIs) and severe acute respiratory illness (SARI) are public health burdens globally. The percentage of non-SARS CoV-2 respiratory viruses among patients having ARI and SARI who visit Car Nicobar's hospital settings is undocumented. Changes in the epidemiology of other respiratory viruses during COVID19 pandemic is being reported worldwide.

Methods

Inpatient and outpatient settings at BJR hospital, Car Nicobar Island, India, were used to conduct prospective monitoring for ARI and SARI among Nicobarese tribal members. The patients with ARI and SARI were enlisted in BJR hospital from June 2019 to May 2021. At the ICMR-NIV in Pune, duplex RT-PCR assays were used to test the presence of respiratory viruses. The prevalence of non- SARS CoV-2 respiratory viruses was measured by comparing here between pandemic and pre-pandemic periods.

Results

During the COVID19 pandemic, Influenza A (H3N2) and rhinovirus were predominantly reported non-SARS CoV-2 respiratory viruses while Human metapneumovirusand influenza A (H1N1)pdm09were most commonly reported in the prepandemic period. This result indicates the altered circulation of non-SARS CoV-2 during pandemic.

Conclusions

A considerable proportion of respiratory infection was correlated with respiratory viruses. Prevalence of non-SARS CoV-2 respiratory viruses was high at the time of infection when compared with pre-pandemic period, at Car Nicobar Island. This study enlightened the change in circulation of other respiratory viruses among the indigenous Nicobarese tribes. Clinicians and allied medical staff should be more prudent of these respiratory infections.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07435-x.

Willingness to seek medical care for tuberculosis and associated factors among the elderly population in Shenzhen: a cross-sectional study

OBJECTIVES

This study was aimed to assess the willingness of elderly people to seek medical care for tuberculosis (TB) and the associated influencing factors.

DESIGN

A cross-sectional study.

SETTING

A multistage random survey was conducted in Bao'an District of Shenzhen in China.

PARTICIPANTS

A total of 1200 elderly people aged 65 or above were recruited for the study and completed a structured questionnaire between September and October 2019.

MAIN OUTCOME MEASURES

Descriptive and binary logistic stepwise regression analyses were conducted to analyse the characteristics of elderly individuals, their willingness to seek medical care for TB and associated factors.

RESULTS

Among the final 1123 respondents, 943 (84.0%) were willing to seek medical care if they discovered suspicious TB symptoms. Binary logistic stepwise regression analysis indicated that respondents whose family annual income per capita was 50 000-100 000¥ (OR=2.56, 95% CI: 1.44 to 4.54, p<0.01) and who had positive attitudes (≥3 scores: OR=3.10, 95% CI: 1.90 to 5.05, p<0.01) or practices (≥4 scores: OR=3.13, 95% CI: 1.82 to 5.39, p<0.01) towards TB were more willing to seek medical care for TB.

CONCLUSIONS

Willingness to seek medical care for TB in the elderly population can be improved according to the determinants.

A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China

Background

Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB.

Methods

We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al.

Results

Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment.

Conclusions

We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.

Graphic abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00906-4.