Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3-93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.

Background: The population of elderly people aged ≥60 years is increasing worldwide and is projected to reach 1.5 billion by 2050. In India, the elderly people constitute 8.1% of the total population. Malnutrition is highly prevalent in the elderly population due to various diseases and impairments.Methods: A cross-sectional study was carried out amongst 209 elderly people from February 2018 to April 2018. A questionnaire was used to collect data related to socio-demographic characteristics, Mini Nutritional Assessment (MNA) and regarding medication use, comorbidity, use of a walking aid, smoking and alcohol consumption. The MNA tool was used for the assessment of nutrition status. For an assessment of functional status, the activities of daily living scale and instrumental activities of daily living scale were used. Descriptive analysis and Chi-square test were used to present the data.Results: The average MNA score was 23.5 (SD=4.3, range: 7-30) and that of BMI was 23.8 (SD=3.9, range: 15.6-38.9). Of 209 study participants, 9.1% were malnourished, 32.5% were at risk of malnutrition and remaining 58.4% were having normal nutritional status. The possible predictors of malnutrition were older age, lower education level, staying single, unemployed, low income and less than three meals daily.Conclusions: The overall prevalence of malnutrition was found to be 9.1% but the proportion of elderly people at risk of malnutrition was relatively high. Diagnosis and treatment of elderly people at high risk for malnutrition based on the findings of this study may improve functional status and prognosis of elderly people.

Background: A high level of awareness of tuberculosis (TB) is very important for its prevention and control in the community. Objective: To study the knowledge, attitude, and practices regarding TB and the effect of sociodemographic characteristics. Materials and Methods: A cross-sectional study was conducted of all patients with new smear-positive pulmonary TB diagnosed between January 2012 and June 2013 at RNTCP clinic. The information was collected with reference to knowledge, attitude, and practices regarding TB (its signs and symptoms, mode of spread, cause, investigations, treatment, and prevention). Bivariate and logistics regression were applied to study the effect of sociodemographic characteristics on knowledge, attitudes, and practices regarding TB. Result: A total of 122 patients with a mean age of 29.9 years were included in the study. Persistence cough (48.4%) was the most common symptom known, 87% were aware that TB could spread to others with 56.6% being aware of airborne transmission. Misconceptions such as casual contact as a route of spread were observed. Females and those without secondary education were less aware of various aspects of TB. Of all, 32% stated government health facility as a place of choice for treatment of TB. A low knowledge score was significantly associated with young age group (P = 0.037), less education (P < 0.001), and low income (P = 0.027). A low attitude and practice score was significantly associated with less education (P = 0.002), low income (P = 0.008), and nuclear family (P = 0.008). Conclusion: The study participants had good knowledge of TB but there were several misconceptions regarding the cause of TB that need to be clarified. Community-based programs on TB awareness need to be increased among young people and less educated groups.

The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described India’s response to combat the pandemic during the initial months (from 17 January to 20 April 2020). India issued travel advisories and implemented graded international border controls between January and March 2020. By early March, cases started to surge. States scaled up movement restrictions. On 25 March, India went into a nationwide lockdown to ramp up preparedness. The lockdown uncovered contextual vulnerabilities and stimulated countermeasures. India leveraged existing legal frameworks, institutional mechanisms and administrative provisions to respond to the pandemic. Nevertheless, the cross-sectoral impact of the initial combat was intense and is potentially long-lasting. The country could have further benefited from evidence-based policy and planning attuned to local needs and vulnerabilities. Experience from India offers insights to nations, especially LMICs, on the need to have contextualised pandemic response plans.

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