Background TB is a preventable and treatable disease. Yet, successful treatment outcomes at desired levels are elusive in many national TB programs, including India. We aim to identify risk factors for unfavourable outcomes to TB treatment, in order to subsequently design a care model that would improve treatment outcomes among these at-risk patients. Methods We conducted a cohort analysis among TB patients who had been recently initiated on treatment. The study was part of the internal program evaluation of a USAID-THALI project, implemented in select towns/cities of Karnataka and Telangana, south India. Community Health Workers (CHWs) under the project, used a pre-designed tool to assess TB patients for potential risks of an unfavourable outcome. CHWs followed up this cohort of patients until treatment outcomes were declared. We extracted treatment outcomes from patient’s follow-up data and from the Nikshay portal. The specific cohort of patients included in our study were those whose risk was assessed during July and September, 2018, subsequent to conceptualisation, tool finalisation and CHW training. We used bivariate and multivariate logistic regression to assess each of the individual and combined risks against unfavourable outcomes; death alone, or death, lost to follow up and treatment failure, combined as ‘unfavourable outcome’. Results A significantly higher likelihood of death and experiencing unfavourable outcome was observed for individuals having more than one risk (AOR: 4.19; 95% CI: 2.47–7.11 for death; AOR 2.21; 95% CI: 1.56–3.12 for unfavourable outcome) or only one risk (AOR: 3.28; 95% CI: 2.11–5.10 for death; AOR 1.71; 95% CI: 1.29–2.26 for unfavourable outcome) as compared to TB patients with no identified risk. Male, a lower education status, an initial weight below the national median weight, co-existing HIV, previous history of treatment, drug-resistant TB, and regular alcohol use had significantly higher odds of death and unfavourable outcome, while age > 60 was only associated with higher odds of death. Conclusion A rapid risk assessment at treatment initiation can identify factors that are associated with unfavourable outcomes. TB programs could intensify care and support to these patients, in order to optimise treatment outcomes among TB patients.

Background: TB is a preventable and treatable disease. Yet, successful treatment outcomes at desired levels are elusive in many national TB programs, including India. We aim to identify risk factors for unfavourable outcomes to TB treatment, in order to subsequently design a care model that would improve treatment outcomes among these at-risk patients. Methods: We conducted a cohort analysis among TB patients who had been recently initiated on treatment. The study was part of the internal program evaluation of a USAID-THALI project, implemented in select towns/cities of Karnataka and Telangana, south India. Community Health Workers (CHWs) under the project, used a pre-designed tool to assess TB patients for potential risks of an unfavourable outcome. CHWs followed up this cohort of patients until treatment outcomes were declared. We extracted treatment outcomes from patient’s follow-up data and from the Nikshay portal. The specific cohort of patients included in our study were those whose risk was assessed during July and September, 2018, subsequent to conceptualisation, tool finalisation and CHW training. We used bivariate and multivariate logistic regression to assess each of the individual and combined risks against unfavourable outcomes; death alone, or death, lost to follow up and treatment failure, combined as ‘unfavourable outcome’. Results: A significantly higher likelihood of death and experiencing unfavourable outcome was observed for individuals having more than one risk (AOR: 4.19; 95% CI: 2.47-7.11 for death; AOR 2.21; 95% CI: 1.56-3.12 for unfavourable outcome) or only one risk (AOR: 3.28; 95% CI: 2.11-5.10 for death; AOR 1.71; 95% CI: 1.29-2.26 for unfavourable outcome) as compared to TB patients with no identified risk. Male, a lower education status, an initial weight below the national median weight, co-existing HIV, previous history of treatment, drug-resistant TB, and regular alcohol use had significantly higher odds of death and unfavourable outcome, while age >60 was only associated with higher odds of death. Conclusion: A rapid risk assessment at treatment initiation can identify factors that are associated with unfavourable outcomes. TB programs could intensify care and support to these patients, in order to optimise treatment outcomes among TB patients.

Suicidal deaths in a region reflect the socio-economic status and intellectual health status of that population. Suicidal deaths are preventable health hazards. A six year retrospective research from January 2005 to December 2010 was conducted at A. J. Institute of Medical Sciences and Research Centre, Mangalore, India, one of the leading tertiary health care centre of southern part of Karnataka. Among fifty six suicidal death cases reported during the period from January 2005 to December 2010, thirty six were males and twenty females. Majority of suicidal deaths were found in the age group of 21 to 30years. Maximum numbers of victims (38) were from the rural background. The maximum number of suicidal deaths (60.71%) was among the married persons. The most common mode of committing suicide in our study was Poisoning. Suicidal deaths can be curtailed by the collective efforts of the family members and other social groups and more importantly change in the frame of mind of the people to acclimatize to all the intricate situations in life.

Introduction:The incidence of unnatural deaths is found to be persistently increasing. Pattern of unnatural deaths is a reflection of the prevailing social set up and mental health status of the population. Aim: This retrospective and prospective study was undertaken to analyze the various aspects related to unnatural deaths autopsied at A. J. Institute of Medical Sciences & Research Centre, Mangalore which is tertiary health care teaching hospital catering the healthcare needs of rural population of coastal Karnataka and Northern districts of Kerala. Materials and Methods: Materials for the present retrospective and prospective study consists of unnatural deaths autopsied at

Background India’s National Strategy to ‘End TB by 2025’ aims to reduce unfavourable TB treatment outcomes. There is need for innovative approaches to improve TB treatment outcomes. Methods Under a USAID-THALI, Community Health Workers using a pre-designed tool assessed TB patients in three states in south India for risks of non-adherence and risk of unfavourable outcomes. We examined whether those with identified risk had higher levels of two unfavourable treatment outcomes; death and unfavourable outcome including death, lost to follow up and failure, as compared to no risk. Bivariate and multivariate logistic regression was used to assess each of the individual risks and the combined risk, for experiencing death or unfavourable outcome as described earlier, after initiation of TB. Results A significantly higher likelihood of death and experiencing unfavourable outcomes was observed for individuals having one risk (AOR: 3.28; 95% CI: 2.11-5.10 for death; AOR 1.71; 95% CI: 1.29-2.26 for unfavourable outcome) and more than one risk (AOR: 4.19; 95% CI: 2.47-7.11 for death; AOR 2.21; 95% CI: 1.56-3.12) as compared to TB patients with no identified risk. In addition to the risk characterisation, TB patients with initial weight below the national median weight were 2.1 times and 2.0 times more likely to die and experience unfavourable outcomes, as compared to patients with initial weight equal to the median or higher. Conclusion The results of our analysis point to the need for a ‘differentiated care model’, beginning with a risk and needs assessment and continuing with tailored care and support for TB patients, based on their identified risk. While all TB patients require a minimum package of care and support there are a substantial proportion who require more specific interventions and services in order to successfully complete their treatment. We identified a number of important risk factors that could be predictive of an unfavourable outcome and which could be used by TB programs in order to optimize patient treatment outcomes.