Maharashtra Association of Anthropological Sciences

We analyzed the healthcare access and quality (HAQ) index for surgically amenable causes, its progress since 1990, and the gap compared to non-surgical HAQ across 204 countries and territories in 2019 for children (up to 14years) and overall populations. The Global Burden of Disease 2019 study provided mortality-to-incidence ratios and risk-standardized death rates for 32 causes with preventable mortality. Of these, 14 (18) and 9 (17) causes were considered surgical (non-surgical) for the overall population and children, respectively. We constructed composite indices ranging from 0 (worst) to 100 (best) using the adjusted Mazziotta Pareto index methodology. The ratio of surgical HAQ in 2019 to that in 1990 noted a change over time. Surgical-to-non-surgical HAQ ratio gave the relative gap in 2019. Ratios >1 depicted improvement over time or better-performing surgical care systems. In 2019, the overall surgical HAQ varied from 18.00 for the Central African Republic to 98.25 for Canada. The child surgical HAQ index varied from 39.87 for Chad to 99.41 for San Marino. For both surgical HAQ indices, 202 countries noted progress from 1990 to 2019. Only 31 countries (15.2%) had greater surgical HAQ index values than their non-surgical counterparts. The child surgical HAQ index lagged non-surgical for 61.28% of countries. Low-income countries had limited progress in surgical HAQ indices since 1990 and lagged behind the non-surgical HAQ index in 2019 the most. These findings are valuable for global evaluations, policymaking, and advocacy for investing in surgical care.

BackgroundChronic obstructive pulmonary disease (COPD) is a significant public health concern, and inhalation therapy is a critical component of its management. However, using an inhaler is challenging, especially for patients with COPD, who are often elderly and experience reduced dexterity, visual and cognitive impairment, and difficulty synchronizing inhalation with dose actuation. Synchrobreathe® is an easy-to-use, breath-actuated inhaler that releases medication during inhalation, addressing these challenges. Although its use in asthma is well documented, evidence in COPD is limited.MethodsThis prospective, multicenter, observational study carried out during August 2021 and August 2022 evaluated the clinical outcomes of the budesonide/formoterol combination (BUD/FORM) delivered through Synchrobreathe® in patients with COPD in India. The primary endpoint was disease control, that is, change from baseline in COPD Assessment Test (CAT) score at 12 weeks. Secondary endpoints included changes in CAT and modified Borg Dyspnea Scale (mBDS) scores and device usability. Adverse events were monitored over 12 weeks.ResultsIn the study population (N = 250), significant reductions from baseline were observed in mean CAT (−6.56 ± 0.33; p < 0.001) and mBDS (−1.60 ± 0.09; p < 0.0001) scores at 12 weeks. Almost all (98%) patients were satisfied with Synchrobreathe® and preferred it over their previous inhalers. No significant adverse events were reported.ConclusionBUD/FORM delivered through Synchrobreathe® significantly improved CAT and mBDS scores, with no reported serious adverse events in patients with COPD. Its simple usage makes it an effective option for this patient population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-025-00522-w.

Background In 2018, the World Health Organisation (WHO) released interim guidelines, advising a change of regimens to dolutegravir-based first- and second-line antiretroviral therapy (ART), based on which, in 2021, the National Aids Control Organisation (NACO) updated its guidelines to include the tenofovir+ lamivudine + dolutegravir (TLD) regimen as a first line of therapy for all people living with HIV (PLHIV) and second- and third-line regimens to dolutegravir-based regimens. Considering this change of regimen, the adverse drug reaction (ADR) profiling and longitudinal prescription pattern of antiretroviral and concomitant medications in adult patients at the ART centre of a tertiary care hospital were assessed in this study. Methods Ninety-seven PLHIV out of all the patients who attended the ART centre from September 2021 to July 2022 were enrolled and followed up for six months. The ADRs that occurred during this period were collected along with details of prescription patterns and analyzed by descriptive statistics. Causality assessment for ADR was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Results Seventy-eight percent (n=76 out of 97) of patients experienced at least one ADR, and 128 ADRs were seen in 97 patients. The most common ADRs were increased alkaline phosphatase (39.0%, n=128), dyslipidaemia (12.5%, n=128), and nephrotoxicity (10.1%, n=128). The drug most suspected of causing ADRs was dolutegravir (27.5%, n=342). The most common therapeutic regimen was TLD (71.2%, n=97). The most prescribed drug was lamivudine (30.6%, n=1183). The most prescribed concomitant medication was cotrimoxazole (15%, n=312). Conclusions Dolutegravir-based regimens have been implemented for PLHIV in a phased-out manner from previous non-dolutegravir-based ART regimens, which is in line with the recent NACO guidelines. However, it has also led to an increase in dolutegravir-associated ADRs like increased alkaline phosphatase, dyslipidaemia, and nephrotoxicity. Continuous monitoring of prescriptions and ADRs can add to our knowledge regarding their use and ADRs.

To understand patients' challenges in adhering to treatment for MDR-TB/HIV co-infection within the context of their life circumstances and access to care and support. Qualitative study using in-depth interviews with 12 HIV/MDR-TB co-infected patients followed in a Médecins Sans Frontières (MSF) clinic in Mumbai, India, five lay caregivers and ten health professionals. The data were thematically analysed along three dimensions of patients' experience of being and staying on treatment: physiological, psycho-social and structural. By the time patients and their families initiate treatment for co-infection, their financial and emotional resources were often depleted. Side effects of the drugs were reported to be severe and debilitating, and patients expressed the burden of care and stigma on the social and financial viability of the household. Family caregivers were crucial to maintaining the mental and physical health of patients, but reported high levels of fatigue and stress. Médecins Sans Frontières providers recognised that the barriers to patient adherence were fundamentally social, rather than medical, yet were limited in their ability to support patients and their families. The treatment of MDR-TB among HIV-infected patients on antiretroviral therapy is hugely demanding for patients, caregivers and families. Current treatment regimens and case-holding strategies are resource intensive and require high levels of support from family and lay caregivers to encourage patient adherence and retention in care.

IntroductionIn low resource settings, the vast majority of ‘Person/people Living with HIV’ (PLHIV/s) and inadequate healthcare delivery systems to meet their treatment and care needs, caregivers play a vital role. Home based caregivers are often unrecognized with limited AIDS policies and programs focusing on them. We explored the perceptions and norms regarding care being provided by family caregivers of PLHIVs in India.MethodologyA community based qualitative study to understand the issues pertaining to home based care for PLHIV was conducted in urban settings of Pune city, in Maharashtra, India. Eight Focus Group Discussions (FGDs) among men, women and peer educators were carried out. A total of 44 in-depth Interviews (IDIs) with PLHIVs (20) and their caregivers (24), were conducted using separate guides respectively. Data was analyzed thematically.ResultsHome based care was perceived as economically viable option available for PLHIVs. ‘Care’ comprised of emotional, adherence, nursing and financial support to PLHIV. Home based care was preferred over hospital based care as it ensured confidentiality and patient care without hampering routine work at home. Women emerged as more vital primary caregivers compared to men. Home based care for men was almost unconditional while women had no such support. The natal family of women also abandoned. Their marital families seemed to provide support. Caregivers voiced the need for respite care and training.DiscussionGender related stigma and discrimination existed irrespective of women being the primary family caregivers. The support from marital families indicates a need to explore care and support issues at natal and marital homes of the women living with HIV respectively. Home based care training and respite care for the caregivers is recommended. Gender sensitive interventions addressing gender inequity and HIV related stigma should be modeled while designing interventions for PLHIVs and their family caregivers.

A rural tuberculosis (TB) Unit (population 350 794) in Pune district, Maharashtra State, India. To develop a 'model' partnership between rural private medical practitioners (PMPs) and the Revised National Tuberculosis Control Programme (RNTCP). A partnership was developed between 100 PMPs in the study area and the district health and tuberculosis staff through facilitation by a non-governmental organisation (NGO). Participatory research methods were used to plan and implement the partnership. The process of creation and implementation of the partnership was analysed using quantitative and qualitative research methods. The partnership contributed to 30% of the cases detected in the TB Unit over a 5-month period. Six months after withdrawal of the NGO, referrals from the private sector to the RNTCP were continuing to a lesser extent, but there was a breakdown of the communication and documentation systems. The project highlights the importance of organisational and individual commitment to these partnerships, the key roles of the District Health Officer and the District Tuberculosis Officer in guiding and supporting these initiatives from the public sector, the potential role of process and outcome 'indicators' in monitoring partnerships and the important role of NGOs as intermediaries and facilitators.