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    Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study

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    Authors
    Siddaiah, Archana
    Ahmed, Mohammad Naseer
    Kumar, Ajay M. V.
    D’Souza, George
    Wilkinson, Ewan
    Maung, Thae Maung
    Rodrigues, Rashmi
    Publication Date
    2019-02-05
    Submitted date
    2018-05-08
    
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    Abstract
    Objectives India contributes approximately 25% of the ‘missing’ cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India’s private sector, few are notified to the public healthcare system. India’s TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study in a private hospital to assess the proportion notified and factors affecting TB notifications. We explored barriers and probable solutions to TB notification qualitatively from health provider’s perspective. Study setting Private, tertiary care, teaching hospital in Bengaluru, South India. Methodology This was a mixed-methods study. Quantitative component comprised a retrospective review of hospital records between 1 January 2015 and 31 December 2017 to determine TB notifications. The qualitative component comprised key informant interviews and focus groups to elicit the barriers and facilitators of TB notification. Results Of 3820 patients diagnosed and treated, 885 (23.2%) were notified. Notifications of sputum smear-positive patients were significantly more likely, while notifications of children were less likely. Qualitative analysis yielded themes reflecting the barriers to TB notification and their solutions. Themes related to barriers were: (1) basic diagnostic procedures and treatment promote notification; (2) misconceptions regarding notification and its process are common among healthcare providers; (3) despite a national notification system other factors have prevented notification of all patients; and (4) establishing hospital systems for notification will go a long way in improving notifications. Conclusions The proportion of patients with TB notified by the hospital was low. A comprehensive approach both by the hospital management and the national TB programme is necessary for improving notification. This includes improving awareness among healthcare providers about the requirement for TB notifications, establishing a single notification portal in hospital, digitally linking hospital records to Nikshay and designating one person to be responsible for notification.
    Citation
    BMJ Open, volume 9, issue 2, page bmjopen-2018-023910
    Publisher
    BMJ Publishing Group
    URI
    http://hdl.handle.net/10034/621846
    Type
    article
    Description
    From BMJ via Jisc Publications Router
    History: received 2018-05-08, rev-recd 2018-10-31, accepted 2018-11-05, ppub 2019-02, epub 2019-02-05
    Publication status: Published
    Funder: Swedish Research Council
    Funder: Department for International Development, FundRef: http://dx.doi.org/10.13039/501100000278
    Funder: Welcome trust/ DBT Alliance
    Funder: La Fondation Veuve Emile Metz-Tesch, Luxumberg
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    Chester Medical School

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