ObjectiveWe assessed uptake of isoniazid preventive therapy (IPT) among child contacts of smear-positive tuberculosis (TB) patients and its implementation challenges from healthcare providers’ and parents’ perspectives in Bhopal, India.MethodsA mixed-method study design: quantitative phase (review of programme records and house-to-house survey of smear-positive TB patients) followed by qualitative phase (interviews of healthcare providers and parents).ResultsOf 59 child contacts (<6 years) of 129 index patients, 51 were contacted. Among them, 19 of 51 (37%) were screened for TB and one had TB. Only 11 of 50 (22%) children were started and 10 of 50 (20%) completed IPT. Content analysis of interviews revealed lack of awareness, risk perception among parents, cumbersome screening process, isoniazid stock-outs, inadequate knowledge among healthcare providers and poor programmatic monitoring as main barriers to IPT implementation.ConclusionNational TB programme should counsel parents, train healthcare providers, simplify screening procedures, ensure regular drug supply and introduce an indicator to strengthen monitoring and uptake of IPT.

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BackgroundPre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014).MethodsStudy was conducted under the Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all registered TB cases in Bhopal district that met the presumptive MDR-TB criteria (eligible for DST) in 2014. In quarter 1, Line Probe Assay (LPA) was used if sample was smear/culture positive. Quarter 2 onwards, LPA and Cartridge-based Nucleic Acid Amplification Test (CbNAAT) was used for smear positive and smear negative samples respectively. Pre-diagnosis attrition was defined as failure to undergo DST among patients with presumptive MDR-TB (as defined by the programme).ResultsOf 770 patients eligible for DST, 311 underwent DST and 20 patients were diagnosed as having MDR-TB. Pre-diagnosis attrition was 60% (459/770). Among those with pre-diagnosis attrition, 91% (417/459) were not identified as ‘presumptive MDR-TB’ by the programme. TAT [median (IQR)] to undergo DST after eligibility was 4 (0, 10) days. Attrition was more than 40% across all subgroups. Age more than 64 years; those from a medical college; those eligible in quarter 1; patients with presumptive criteria ‘previously treated – recurrent TB’, ‘treatment after loss-to-follow-up’ and ‘previously treated-others’; and patients with extra-pulmonary TB were independent risk factors for not undergoing DST.ConclusionHigh pre-diagnosis attrition was contributed by failure to identify and refer patients. Attrition reduced modestly with time and one factor that might have contributed to this was introduction of CbNAAT in quarter 2 of 2014. General health system strengthening which includes improvement in identification/referral and patient tracking with focus on those with higher risk for not undergoing DST is urgently required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2191-6) contains supplementary material, which is available to authorized users.

Background: Chemicals that are commonly used for artificial ripening and to increase the shelf life of fruits and vegetables are ethylene, ethane, calcium carbide, and ethephon. The present study was conducted to study the effect of ethephon on the morphometry of rat liver. Methods:Ethephon was administered by oral gavage tube to 10 adult Wistar albino rats at a dose of 200 mg/kg body weight/day for 14 days. Ten controls were maintained. The animals were sacrificed within 24 h of administering the last dose by perfusion with formal saline under anesthesia. Liver was dissected and processed for paraffin embedding. Histomorphometric studies were done on randomly selected sections of the liver and the data obtained were tabulated and statistically analyzed. Results:In the experimental rats, the hepatocytes had a mean long and short diameter of 15.02 ± 4.20 and 12.08 ± 3.02 µm, respectively. In the control animals, the mean long and short diameters were found to be 16.5 ± 3.59 and 13.9 ± 3.59 µm, respectively. The nucleus of the hepatocytes had a mean long and short diameter of 5.08 ± 1.93 and 5.08 ± 1.93 µm, respectively, in the ethephon-treated rats and 6.15 ± 1.72 and 6.05 ± 1.68 µm, respectively, in the control animals. The decrease in diameters of the hepatocytes and their nuclei was statistically significant. At some sites, the parenchyma showed pyknotic nucleus and inflammatory infiltrations. There was a statistically significant increase in the diameters of the central vein and sinusoids. Dilatation of the bile canaliculi was seen in between the hepatocytes. Conclusion: The plant growth regulator, insecticide, and fruit ripener, ethephon, caused inflammatory and degenerative changes in the liver with associated cholestasis, probably suggestive of toxic hepatitis. (Biomed J 2015;38:421-427)