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Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries’ regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study’s findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.

Background:There are multiple risk factors during adolescence, which become precursors of various diseases and injuries inflicting high morbidity, mortality, and disability. There are several gaps in adolescent health research in India; one among them is that programs targeting adolescent health are constrained by the absence of rigorous interventional research informing interventions for improving adolescent health. This study aims to document the effectiveness of intervention on adolescent health and knowledge change on the risk factors among adolescents in one of the selected districts in Gujarat, India.Methods:This was an interventional study with quasi-experimental design executed in one of the blocks of Gujarat. Baseline was conducted in 2013–2014 followed by intervention and the end line during 2016–2017. A structured validated questionnaire after pilot testing was executed to collect information on sociodemographic profile, nutrition status, menstrual hygiene practices, reproductive and sexual health, substance abuse, program awareness and utilization, and empowerment through life skills of adolescents in baseline and end line survey. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp).Results:This study documented increased awareness regarding anemia, knowledge about STD and HIV/AIDS, reduced addiction to tobacco, improved practices during menstrual hygiene and engagement with adolescent services/schemes in the intervention site.Conclusion:This study concludes that evidence-based interventions lead to increase in knowledge and practices; however, some improvements have also been documented in the nonintervention site. Therefore, changes due to interventions could not be attributed completely for improving adolescent health. Further long term interventional studies are required to develop a robust evidence on improving health of adolescents in India.

Water, sanitation and hygiene (WASH) is important to improve and maintain the quality of health care services. Improving and managing WASH services require strong and consistent monitoring mechanisms to measure progress and direct efforts where needs are greatest. Although several tools are available to assess WASH in health care facilities (HCFs), there is always a dilemma among the program managers to select an appropriate tool for the assessment of WASH. Thus, it was aimed to perform a descriptive review of all available WASH assessment tools and assist in reaching a consensus for an optimal tool to assess WASH in HCFs. For this descriptive review, PubMed, ScopeMed and Google Scholar were used to search all available tools for the assessment of WASH. All the tools available online since 1991 till July 2018 were included in the review. Globally, nine different WASH assessment tools were retrieved. The majority of them have their self-limitations on the basis of 11 selected indicators and were examined in all the retrieved tools. There are variability and overlapping components within the specific tools. Very few survey instruments including human resource (HR), supply, budget, patient/staff satisfaction and documentation for appropriateness of WASH were found to be neglected. The majority of instruments were based on the subjective assessment of WASH validating with microbiological surveillance and photo documentation. The descriptive review suggests that various tools are available for the assessment of WASH but none of them seem to be complete with all indicators and to have consensus for the elements. Therefore, there is a need to develop a robust and comprehensive tool for the assessment of WASH in HCFs.

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