Background : In March 2018, the Government of India launched a direct benefit transfer (DBT) scheme to provide nutritional support for all tuberculosis (TB) patients in line with END TB strategy. Here, the money (@INR 500 [~8 USD] per month) is deposited electronically into the bank accounts of beneficiaries. To avail the benefit, patients are to be notified in NIKSHAY (web-based notification portal of India’s national TB programme) and provide bank account details. Once these details are entered into NIKSHAY, checked and approved by the TB programme officials, it is sent to the public financial management system (PFMS) portal for further processing and payment. Objectives : To assess the coverage and implementation barriers of DBT among TB patients notified during April–June 2018 and residing in Dakshina Kannada, a district in South India. Methods : This was a convergent mixed-methods study involving cohort analysis of patient data from NIKSHAY and thematic analysis of in-depth interviews of providers and patients. Results : Of 417 patients, 208 (49.9%) received approvals for payment by PFMS and 119 (28.7%) got paid by 1 December 2018 (censor date). Reasons for not receiving DBT included (i) not having a bank account especially among migrant labourers in urban areas, (ii) refusal to avail DBT by rich patients and those with confidentiality concerns, (iii) lack of knowledge and (iv) perception that money was too little to meet the needs. The median (IQR) delay from diagnosis to payment was 101 (67–173) days. Delays were related to the complexity of processes requiring multiple layers of approval and paper-based documentation which overburdened the staff, bulk processing once-a-month and technological challenges (poor connectivity and issues related to NIKSHAY and PFMS portals). Conclusion : DBT coverage was low and there were substantial delays. Implementation barriers need to be addressed urgently to improve uptake and efficiency. The TB programme has begun to take action.

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BackgroundTobacco use and alcohol abuse are associated with higher risk of tuberculosis (TB) infection, progression to active TB and adverse treatment outcomes among patients with TB. Revised National Tuberculosis Control Programme (RNTCP) treatment guidelines (2016) require the documentation of tobacco and alcohol use among patients with TB and their linkage to tobacco and alcohol abuse treatment services. This study aimed to assess the extent of documentation of tobacco and alcohol usage data in the TB treatment card and to explore in-depth, the operational issues involved in linkage.MethodsA convergent parallel mixed methods study was conducted. All new TB treatment cards of adult patients registered under RNTCP between January and June 2017 in Dakshina Kannada district were reviewed to assess documentation. Document review was done to understand the process of linkage (directing patients to tobacco and alcohol abuse treatment services). In-depth interview of health care providers (n = 7) and patients with TB (n = 5) explored into their perspectives on linkage.ResultsAmong 413 treatment cards reviewed, tobacco use was documented in 322 (78%), of whom 86 (21%) were documented as current tobacco users. Sixteen (19%) out of these 86 patients were linked to tobacco cessation services. Alcohol usage status was documented in 319 (77%) cards of whom 71(17%) were documented as alcohol users. Eleven (16%) out of these 71 patients were linked to alcohol abuse treatment services. The questions in the treatment card lacked clarity. Guidelines on eliciting history of substance abuse and criteria for linkage were not detailed. Perceived enablers for linkage included family support, will power of the patients and fear of complications. Challenges included patient’s lack of motivation, financial and time constraints, inadequate guidelines and lack of co-ordination mechanisms between TB programme and tobacco/alcohol abuse treatment services.ConclusionDocumentation was good but not universally done. Clear operational guidelines on linkage and treatment guidelines for health care providers to appropriately manage the patients with comorbidities are lacking. Lack of coordination between the TB treatment programme and tobacco cessation as well as alcohol treatment services was considered a major challenge in effective implementation of the linkage services.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3913-8) contains supplementary material, which is available to authorized users.

Background: Antenatal care services including supplementary nutrition services are the essential services for reducing maternal mortality. As per National Family Health Survey (NFHS) 4 data, 62% pregnant mothers received supplementary nutrition in Karnataka state and only 49.4% received health and nutrition education. Study was conducted to assess utilization of antenatal services with special reference to supplementary nutrition and advice on nutrition.Methods: A cross sectional study was conducted among the mothers admitted in obstetrics and gynecology department of Yenepoya Medical College Hospital. All the 140 mothers admitted during August and September 2017 for safe confinement of pregnancy were enrolled in this study and data was collected using semi-structured questionnaire. SPSS software version 22 was used for data analysis. Descriptive statistics was expressed in terms of frequencies and percentages. Chi square test was used to study the factors association with utilization of antenatal services.Results: Of the 140 participants, most of them i.e. 38.6% were in 25-30 years age group. The mean age was 46 years. Only 86 mothers (61.42%) received supplementary nutrition of whom only 53 (37.85%) had consumed it. Utilization of antenatal services was 100% with respect to minimum antenatal visits, routine laboratory investigations and TT immunization. Awareness about Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was very poor (5%). Educational status of mother was found to be associated with utilization of supplementary nutrition (p=0.026).Conclusions: Utilization of routine antenatal services was reported to be very good. Efforts should be made to improve utilization about supplementary nutrition and awareness about nutrition education.

Objective: The aim of this project is to find out the prevalence of overweight and obesity in the high school children in selected schools of Mangalore and Manipal and also to study the association of obesity with different factors like Age, Sex, Physical activity etc. Methods: Cross sectional Study which included 500 participants from 10 selected schools in Udupi and D.K districts. 50 students were rd included from each school on the basis of 1 in 5 choosing every 3rd student. In schools with lesser attendance all were included. Following which they were explained the details about the study. Then their height and weight were recorded using standard measurements and the data was collected using the questionnaire. Results: The overall prevalence of obesity and overweight was found to be 2.6% and 3.0% respectively. Prevalence was found to be higher in males, those studying in private schools, staying in nuclear family, consuming fried foods-aerated drinks regularly and in those who do not exercise regularly. Conclusions: Childhood obesity is a major public health problem globally because of changes in lifestyle.