Public Health Action最新文献_第2页

India's private sector engagement model improved TB notification and drug uptake. 印度的私营部门参与模式改善了结核病通报和药物摄取。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0018

S Gupta, S K Mattoo, R Rao, P Manickam, K Selvaraj, K Soundappan, A R Singh, K Mehta, S Shanmugasundaram, U B Singh

{"title":"India's private sector engagement model improved TB notification and drug uptake.","authors":"S Gupta, S K Mattoo, R Rao, P Manickam, K Selvaraj, K Soundappan, A R Singh, K Mehta, S Shanmugasundaram, U B Singh","doi":"10.5588/pha.26.0018","DOIUrl":"10.5588/pha.26.0018","url":null,"abstract":"Settings: Since 2018, India's National Tuberculosis Elimination Programme has adopted a patient-provider support agency (PPSA) model to engage the private sector using domestic resources.Objective: To evaluate the effectiveness of the PPSA model for private-sector TB notifications, care services, and treatment success in 42 districts across six Indian states and to explore enablers and challenges of PPSA implementation.Design: A mixed-methods study. We performed interrupted time-series analysis using the segmental regression model to quantify level and monthly changes in private sector TB indicators before (2019-2021) and after PPSA implementation (2021-2024) and interviewed stakeholders regarding enablers and challenges of PPSA implementation.Results: PPSA initiation significantly increased private-sector TB notification rates (immediate change) from 43.5 in 2019 to 72.7 per 100,000 in 2021 and sustained till 2024. Similarly, number of private facilities notifying TB increased from 1,040 to 1,858 and prescription of free fixed dose combination drugs by private providers increased from <1% to 14%. These gains were not accompanied by improvements in other TB care services and treatment success. Stakeholders offered insights and reasons for these variations.Conclusion: The PPSA model improved notification and drug uptake and will require strengthening of quality-of-care services for future scale-up.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"177-182"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gaps in access and trust: essential medicine availability, affordability, and barriers to generic medicine use. 获取和信任方面的差距：基本药物的可得性、可负担性和使用仿制药的障碍。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0033

R Sathiyamoorthy, P R Naik, J Cherian, M H Rao, V Dwarakanathan, V A, P Thekkur

{"title":"Gaps in access and trust: essential medicine availability, affordability, and barriers to generic medicine use.","authors":"R Sathiyamoorthy, P R Naik, J Cherian, M H Rao, V Dwarakanathan, V A, P Thekkur","doi":"10.5588/pha.26.0033","DOIUrl":"https://doi.org/10.5588/pha.26.0033","url":null,"abstract":"Setting: Selected public health facility pharmacies, private pharmacies, and Jan Aushadhi Kendras (JAKs) outlets dispensing generic medicines in four districts of Tamil Nadu, India.Objective: To compare essential medicine availability, affordability, and knowledge on generic medicines among clients across pharmacy types. Additionally, to explore barriers to the use of generic medicines.Design: A concurrent mixed-methods study with a quantitative cross-sectional assessment of the availability of 50 essential medicines in 70 pharmacies and structured interview of 1,750 clients. Eight focus group discussions with clients and 24 in-depth interviews with health care providers to qualitatively explore barriers.Results: The median number of essential medicines available in private pharmacies (43) was higher than that in public pharmacies (30) and JAKs (29) (P < 0.001). The medicine purchase was unaffordable (expenditure >6USD) for 92% of clients in JAKs and 98% of private pharmacies. Knowledge of generic medicine was low among clients attending public (24%) and private (31%) pharmacies. Barriers to generic medicine use included unavailability of medicines, concerns about effectiveness, and suboptimal marketing.Conclusion: JAKs have to address the unavailability of medicines, high unaffordability, and barriers to utilisation by expanding their drug baskets, further reducing costs, and implementing strategies to build trust in generic medicines.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"195-201"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Food support for tuberculosis care: coverage, outcomes, and implementation lessons from the Ni-kshay Mitra scheme in India. 粮食支持结核病治疗：印度Ni-kshay Mitra计划的覆盖面、结果和实施经验教训。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0031

P Chavda, R Patel, K Mehta, K C Prajitha, K Davara, K Shah, J Tankariya, H Nakshiwala, N Panchal, S Nayak, A M V Kumar

{"title":"Food support for tuberculosis care: coverage, outcomes, and implementation lessons from the Ni-kshay Mitra scheme in India.","authors":"P Chavda, R Patel, K Mehta, K C Prajitha, K Davara, K Shah, J Tankariya, H Nakshiwala, N Panchal, S Nayak, A M V Kumar","doi":"10.5588/pha.26.0031","DOIUrl":"https://doi.org/10.5588/pha.26.0031","url":null,"abstract":"Setting: Vadodara City (Gujarat, India) has a mixed public-private tuberculosis (TB) care landscape. Since 2022, the city has implemented 'Ni-kshay Mitra' scheme, where individuals and organisations voluntarily 'adopt' persons with TB (PwTB) and provide food kits (distributed at monthly camps) during treatment.Objective: To assess coverage (received at least one kit) and effectiveness of Ni-kshay Mitra on treatment outcomes, and explore implementation facilitators, barriers, and solutions from the stakeholders' perspective.Design: Explanatory mixed-methods study: quantitative cohort analysis of secondary programme data followed by qualitative interviews and focus group discussions with donors (n = 3), programme staff (n = 18), and PwTB (n = 35).Results: Among 2,068 PwTB notified between January and June 2025, 1,238 (60%) consented to the scheme, 666 (32%) received ≥1 food kit, and 68 (3%) received complete package (≥6 kits). Median kits received were 2 (interquartile range: 2-4). Unsuccessful treatment outcomes were 7% (2022, pre-scheme) and 6% (2023, post-scheme), not statistically significant. Donor non-availability and opportunity costs of attending camps were the major barriers; presence of dedicated non-profit organisations was a key facilitator.Conclusion: Coverage of Ni-kshay Mitra remains suboptimal, largely due to donor participation gaps, possibly explaining limited effectiveness on outcomes. Strengthening donor engagement and alternate delivery models are essential to enhance reach and effectiveness.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"209-215"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The pre-hospital pulse: high responsiveness, deployment, and utilisation of ambulance services in India. 院前脉搏：印度救护车服务的高响应性、部署和利用。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0028

M Moonis, V Madhur, S Yadvinder, K Anil, S A Parray, P Thekkur, K Rakesh, K Niraimathi, Z Rony, A Grover

{"title":"The pre-hospital pulse: high responsiveness, deployment, and utilisation of ambulance services in India.","authors":"M Moonis, V Madhur, S Yadvinder, K Anil, S A Parray, P Thekkur, K Rakesh, K Niraimathi, Z Rony, A Grover","doi":"10.5588/pha.26.0028","DOIUrl":"https://doi.org/10.5588/pha.26.0028","url":null,"abstract":"Background: India's National Ambulance Service, a key component of the public health system, operates through 102, 108, and 112 hotline networks.Objective: To assess ambulance performance in terms of responsiveness, deployment, and utilisation. A descriptive study was conducted using ambulance records from two large states in India, Punjab and Haryana, from January to December 2025.Results: Of 626,372 hotline calls (72% from rural areas), 97% resulted in ambulance deployment, and 92% were utilised for patient transfers. 91% of ambulances reached the pickup location within 30 min (response time) and 67% transported patients to health facilities within 60 min (call-to-drop time). Median distance travelled by ambulance (parking to drop location) was 32 km (interquartile range 17-58). In Punjab, 50% of call-to-drop times were within 60 min, while in Haryana this was 74%. There were notable interdistrict variations in call-to-drop times. The most common reasons for hotline calls were maternal and obstetric conditions (37%), medical emergencies (27%), and trauma or accidents (17%). Inter-facility transfers accounted for 61% of ambulance utilisation.Conclusion: Our study demonstrates that ambulance services perform at a high level and provide substantial public health value. However, opportunities remain to further strengthen performance, particularly in reducing call-to-drop times.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"188-194"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Digital tools not enough; quality control-linked incentives are needed for tuberculosis active case finding. 数字工具还不够；需要与质量控制相关的激励措施来促进结核病的主动病例发现。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0015

H Abdullah, H D Shewade, P Manickam, K Gupta, M S Ambiya, R S Dhakad, K Sharma, S Nag, M Shahnawaz, R Nagar

{"title":"Digital tools not enough; quality control-linked incentives are needed for tuberculosis active case finding.","authors":"H Abdullah, H D Shewade, P Manickam, K Gupta, M S Ambiya, R S Dhakad, K Sharma, S Nag, M Shahnawaz, R Nagar","doi":"10.5588/pha.26.0015","DOIUrl":"10.5588/pha.26.0015","url":null,"abstract":"Background: Low yield of tuberculosis (TB) active case finding (ACF) in routine health systems is a concern. Following identification of high-risk villages/wards guided by annual digital household survey (captured in Community Health Integrated Platform [CHIP]), the health system utilised the ACF module of CHIP for an ACF cycle (December 2025 to January 2026) in Udaipur district, Rajasthan, India. Despite advocating the recommendations from a recently concluded national-level TB ACF evaluation, sputum collection and transport and quality control-lined incentives were not implemented.Objectives: To document the reported and estimated (after telephonic data cross-verification by investigators) scale, quality, and yield of ACF, based on a longitudinal descriptive study using secondary data.Result: Of 1.3 million high-risk populations, 70.6% (scale) were reportedly screened. With 44 (0.6% test positivity) reported ACF-detected TB, the number needed to screen (NNS) was 21,082 (quality) and yield was 0.7% (total ACF-detected TB divided by [0.5% × total high-risk population]). The estimated scale was 35% (n = 457,240) and one out of 44 was confirmed to be ACF-detected (estimated NNS = 457,240, estimated yield <0.1%). Similar suboptimal results were observed in 33% villages/wards that were multidimensionally poor as per CHIP and additional 21% villages/wards identified as high-risk through local mapping.Conclusion: Suboptimal ACF yield reveals digital tools alone are insufficient.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"183-187"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quality improvement package for severe tuberculosis triage in Tamil Nadu, India. 印度泰米尔纳德邦严重结核病分诊质量改进方案。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0023

A Jeyakumar, S Kalaiselvi, D Nair, R Vijayaprabha, K Gayathri, D Kabir, J M Melfha, T Bhatnagar, R Srinivasan, M Balusamy, S Shanmugasundaram, Alicia Catherine, N Nithya, R Venkateshwar, A Frederick, H D Shewade

{"title":"Quality improvement package for severe tuberculosis triage in Tamil Nadu, India.","authors":"A Jeyakumar, S Kalaiselvi, D Nair, R Vijayaprabha, K Gayathri, D Kabir, J M Melfha, T Bhatnagar, R Srinivasan, M Balusamy, S Shanmugasundaram, Alicia Catherine, N Nithya, R Venkateshwar, A Frederick, H D Shewade","doi":"10.5588/pha.26.0023","DOIUrl":"10.5588/pha.26.0023","url":null,"abstract":"Setting: Tamil Nadu Kasanoi Erappila Thittam (TN-KET) is a statewide differentiated tuberculosis (TB) care initiative to reduce TB deaths involving triaging for severe illness at diagnosis and referral of severely ill for appropriate inpatient care (2022-2025). Eleven out of 30 districts did not reduce their TB death rates despite achieving the target process indicators.Objective: To assess the implementation fidelity and effect of a quality improvement (QI) package to improve triage coverage and quality in the select 11 districts of Tamil Nadu.Design: A quasi-experimental pre-post study was conducted between October 2024 to February 2025 (pre-QI) and June to December 2025 (post-QI). The QI package was introduced in poorly performing districts. Data were extracted from Ni-kshay and TB SeWA (e-tools of the TB programme and TN-KET, respectively), supplemented by independent triage audits.Results: Integrating the QI package within TN-KET achieved high fidelity. The extent of missing triage data reduced from 38% to 12%, and median delays in entry of triage details reduced from 13 to 9 days and early TB deaths reduced from 3.7% to 3.3%.Conclusion: The QI package improved documentation and timeliness of triage assessment, contributing to modest reductions in early TB deaths. District-level supervision and triaging at diagnosis for early admission will sustain the reduced death rate.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"168-171"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevalence of major risk factors for tuberculosis in COVID-19 active case-finding camps in India. 印度COVID-19活跃病例发现营地中结核病主要风险因素的流行情况。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0025

S Arunachalam, T Chandra, A Basu, M Gandhi, S Shrivastava, A Shekhawat, M Singh, A Khanna, S Mannan

{"title":"Prevalence of major risk factors for tuberculosis in COVID-19 active case-finding camps in India.","authors":"S Arunachalam, T Chandra, A Basu, M Gandhi, S Shrivastava, A Shekhawat, M Singh, A Khanna, S Mannan","doi":"10.5588/pha.26.0025","DOIUrl":"10.5588/pha.26.0025","url":null,"abstract":"Background: TB) remains a major public health challenge in India, driven by undernutrition, diabetes, alcohol use, and tobacco exposure. Under the Global Fund-supported COVID-19 Response Mechanism (C19RM), we implemented integrated active case finding (ACF) and risk screening to estimate the prevalence of key risk factors among individuals with TB. We assessed their combined influence on detection yield, and examined state-wise variation in TB and non-communicable disease (NCD) comorbidity patterns.Methods: This cross-sectional analysis included 17,288 C19RM-supported ACF camps across 11 states. Screening combined digital chest X-ray, molecular diagnostics, and NCD risk assessment, including anthropometry, self-reported diabetes and hypertension, opportunistic blood sugar testing, and self-reported tobacco and alcohol use. Multivariable logistic regression estimated adjusted odds ratios (aORs) for TB diagnoses.Results: Among 1,383,058 individuals screened, 11,012 TB cases were identified (0.8% yield). Undernutrition (BMI <18.5 kg/m2) accounted for 40% of cases and showed the strongest association (aOR 3.89). Alcohol (aOR 1.62) and tobacco use (aOR 1.51) were independently associated with TB, while diabetes showed an inverse adjusted association despite 10% prevalence. Interaction analyses indicated higher TB odds with coexisting risk factors, with geographic clustering observed.Conclusion: Integrated TB-NCD screening revealed clustering of nutritional, behavioural, and metabolic risks, supporting risk-prioritised ACF strategies.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"270-274"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Feasibility of tuberculosis drug-induced liver injury screening under programme settings in Southern India. 在印度南部规划环境下结核药物性肝损伤筛查的可行性。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0022

M Natarajan, M Verma, K M Akshaya, G Manohar, V Rathinam, S Ramalingam, M Kaleeswari, K Ganesan, R Gouroumourty, D Vasudevan, S Anandakrishnan, A Ramachandran, P M Ramesh, A Frederick

{"title":"Feasibility of tuberculosis drug-induced liver injury screening under programme settings in Southern India.","authors":"M Natarajan, M Verma, K M Akshaya, G Manohar, V Rathinam, S Ramalingam, M Kaleeswari, K Ganesan, R Gouroumourty, D Vasudevan, S Anandakrishnan, A Ramachandran, P M Ramesh, A Frederick","doi":"10.5588/pha.26.0022","DOIUrl":"10.5588/pha.26.0022","url":null,"abstract":"Background: Anti-TB drug-induced liver injury (AT-DILI) is an important treatment-related adverse event. The National TB Elimination Programme (NTEP) recommends baseline liver function testing (LFT), but systematic follow-up monitoring remains fragmented.Objective: To assess the operational feasibility of implementing a screening cascade among persons with TB (PwTB) at high risk for AT-DILI within routine NTEP services.Methods: Co-designed implementation research was conducted in three districts of Tamil Nadu between July and December 2025 among adults with drug-sensitive tuberculosis (TB). Persons at high risk were identified using predefined criteria. Feasibility was assessed in implementation terms, focusing on coverage of risk assessment, adherence to the screening cascade, and timeliness of follow-up testing and clinical action.Results: Of 2,258 PwTB, 52.3% (n = 1,158) were at risk for AT-DILI. Among them, 71.2% (n = 840) underwent baseline LFT testing and 53.9% (n = 637) completed follow-up LFT within 30 days. Eighteen PwTB developed AT-DILI (1.5% incidence under programme conditions) reflecting burden with incomplete follow-up rather than true population burden.Conclusion: Implementation of an AT-DILI screening cascade within routine NTEP services was partially feasible. Risk identification was operationally achievable, but baseline and follow-up testing remained suboptimal. Gaps in follow-up monitoring and documentation highlight the need for strengthened supervision, accountability, and system support before wider scale-up.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"156-161"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multimodal melphalan delivery: improved safety and outcomes with autologous myeloma transplant in India. 在印度，多模式给药：自体骨髓瘤移植提高了安全性和结果。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0046

A Joy, A Philip, R Muralikrishnan, K Niraimathi, R Zachariah, P Thekkur, A Doshi, M P Arya, K Ajith, V Hari, V Rajan, M O Lissy, R Chandran, V A Anoop, L Abraham, P S Alwyn, A A Alex, S Cyriac

{"title":"Multimodal melphalan delivery: improved safety and outcomes with autologous myeloma transplant in India.","authors":"A Joy, A Philip, R Muralikrishnan, K Niraimathi, R Zachariah, P Thekkur, A Doshi, M P Arya, K Ajith, V Hari, V Rajan, M O Lissy, R Chandran, V A Anoop, L Abraham, P S Alwyn, A A Alex, S Cyriac","doi":"10.5588/pha.26.0046","DOIUrl":"https://doi.org/10.5588/pha.26.0046","url":null,"abstract":"Background: High-dose melphalan-based autologous stem cell transplantation (ASCT) remains a cornerstone of treatment in multiple myeloma but causes severe gastrointestinal toxicity in up to 50% of patients due to mucosal injury.Objective: To mitigate this, we assessed a multimodal approach of combined oral cryotherapy, extended duration of melphalan infusion (1 h compared to bolus), and upright patient positioning during administration.Design: A cohort study using hospital patient records to evaluate the safety and outcomes of this approach at a tertiary hospital in South India, from January 2017 to March 2026.Results: Among 47 patients undergoing ASCT, 4% had grade 3 (severe) mucositis, 15% experienced grade 3 diarrhoea, and one patient had severe vomiting. No grade 4 (life threatening) or grade 5 (fatal) gastrointestinal toxicities were observed. Total parenteral nutrition was required in 4% patients. The median duration of stay in the transplant unit was 14 days. There was no post-transplant mortality within 1 year. Relapse-free survival at 1 year was 88%, and relapse was significantly associated with high-risk cytogenetics.Conclusion: Multimodal melphalan delivery is feasible, with manageable toxicity and low rates of severe adverse events, while maintaining excellent short-term outcomes. Further multicentric evaluation and wider adoption is warranted.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"216-221"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiological trends in tuberculosis during a technical assistance project, Lusaka, Zambia, 2018-2021. 2018-2021年，赞比亚卢萨卡，技术援助项目期间结核病流行病学趋势。

IF 1.6

Public Health Action Pub Date : 2026-08-24 eCollection Date: 2026-08-01 DOI: 10.5588/pha.26.0029

S Daka, M Ota, S Hirao, G Samungole

{"title":"Epidemiological trends in tuberculosis during a technical assistance project, Lusaka, Zambia, 2018-2021.","authors":"S Daka, M Ota, S Hirao, G Samungole","doi":"10.5588/pha.26.0029","DOIUrl":"10.5588/pha.26.0029","url":null,"abstract":"Setting: Five health facilities in Lusaka, Zambia.Objective: An observational study to describe activities of a technical assistance project in 2019-2021 with baseline epidemiological indicators in 2018.Results: The number of presumptive tuberculosis (TB) cases at the five sites significantly rose from 7,063 in 2018 to 48,250 in 2021 with a total diagnosis of 9,642 cases of all types of TB and 4,747 cases of bacteriologically positive TB in the 4 years. The percentage of the bacteriologically positive cases among the presumptive TB ones varied from 8.2% to 11.3% in facilities. The proportion of bacteriologically positive TB among the presumptive TB cases at five sites declined from 14.1% in 2018-2019 to 8.3% in 2020-2021 (P < 0.001). Treatment success rates maintained high over 85% in four facilities, whereas in the other improved significantly. The 'not evaluated' rates of treatment outcomes dropped from 7.0% at all the facilities in 2018-2019 to 1.0% in 2020. During the project, three GeneXpert and a digital X-ray machines were installed in the facilities.Conclusion: Investment in TB, particularly in diagnostic tools, and training of health care workers, coupled with close monitoring of health workers and community volunteers, can greatly improve core TB indicators.","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"16 3","pages":"288-292"},"PeriodicalIF":1.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0