Adopting a model of antimicrobial stewardship program to anti-tubercular treatment stewardship: A single-centre experience from a private tertiary care hospital in South India.

Tuberculosis (TB) remains a significant public health challenge in Low- and Middle-Income Countries (LMIC). Inappropriate use of Anti-Tubercular Treatment (ATT) undermines treatment efficacy and could contribute to drug resistance. While antimicrobial stewardship programs (AMSP) are well established, anti-tubercular treatment stewardship programs (ATTSP) in private hospitals do not have an established model.

Distribution and bioaccumulation status of polycyclic aromatic hydrocarbons (PAHs) in Veraval coastal waters using copepods as bio-indicators.

The study investigates the pollution characteristics of 16 priority PAHs, accumulated in copepods from a major fishing harbour and its adjacent coastal waters of Veraval, west coast of India. The total PAH accumulation is in the range of 922.16-27,807.

Airborne Infection Control Practices in Homes for the Aged in the Context of Tuberculosis Elimination.

Background: National Strategic Plan to End tuberculosis (TB) in India 2020-2025 aims to prevent the emergence of TB in susceptible populations. Airborne infection control (AIC) practices in high-risk settings like homes for the aged (HFA) will be essential to achieve this.

Objective: The objective is to assess the AIC practices (AICPs) in HFA in the Kollam district in Kerala, India.

Ensuring universal access to quality care for persons with presumed tuberculosis reaching the private sector: lessons from Kerala.

Background: More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with the private health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them.

Prevalence of tuberculosis in homes for the aged and orphanages of a district in Kerala, India.

Background: India accounts for one fourth of the TB burden globally. One of the objectives of the National Strategic Plan is to achieve 90% notification rate of all TB cases. Screening of high risk groups is one of the important components towards achieving this objective.

Occurrence, sources and risk assessment of polycyclic aromatic hydrocarbons in the coral reef waters of the Lakshadweep Archipelago, Arabian Sea.

The compound effects of anthropogenic disturbances on global and local scales threaten coral reef ecosystems of the Arabian Sea. The impacts of organic pollutants on the coral reefs and associated organisms have received less attention and are consequently less understood. This study examines the background levels, sources, and ecological implications of polycyclic aromatic hydrocarbons (PAHs) in the coral reef ecosystems of Lakshadweep Archipelago.

Hypertension in urban slums of southern India: Burden, awareness, health seeking, control and risk factor profile.

Introduction: Hypertension is the leading risk factor for global disease burden. Inequalities in health among urban poor and non-poor is a matter of concern. The current study was done to estimate the prevalence of hypertension and to describe the health seeking and risk factor profile of people with hypertension in the urban slums of Kochi, Kerala, India.

Local government stewardship for TB elimination in Kerala, India.

Setting: The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination.

Objective: To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala.

Prevalence of Tuberculosis Infection among Adults of Thiruvananthapuram District of Kerala as Measured by Interferon Gamma Release Assay - A Cross-Sectional Study.

Background: To achieve the goals of the end tuberculosis (TB) strategy, strategies for management of TB infection (TBI) have to be expanded. The first step to devise policies is to understand the distribution and determinants of TBI in the community. The objectives of the study were to estimate the prevalence of TBI using Interferon Gamma Release Assay (IGRA) and its determinants among the adult population of Thiruvananthapuram district, Kerala.

Health system resilience: Ensuring TB services during COVID-19 pandemic in Kerala, India.

COVID-19 pandemic has affected TB case detection and continuity of care globally. Kerala, the southern Indian state has experienced a reduction in TB notification during second and third quarter of 2020. Through (1) causal analysis (2) meticulous planning and establishment of systems (3) locally customised guidelines (4) better management of resources (5) integration with other programs and (6) good partnership with private sector, Kerala was able to catch up the TB notification and ensure that TB services remain intact even during the COVID-19 pandemic.

Diagnostic and treatment delay among new pulmonary tuberculosis patients in Southern India: A cross-sectional study.

Background: Delay in diagnosis and treatment enhances tuberculosis (TB) transmission and mortality. Understanding causes for delay can help in TB elimination by 2025, the stated goal of India.

Objectives: Estimate diagnostic and treatment delay in Ernakulam district of Kerala, identify associated factors, and determine health-seeking behavior and knowledge regarding TB among new pulmonary TB patients.

STEPS - a patient centric and low-cost solution to ensure standards of TB care to patients reaching private sector in India.

Background: More than half of the TB patients in India seek care from the private sector. Two decades of attempts by the National TB Program to improve collaboration between the public and private sectors have not worked except in a few innovative pilots. The System for TB Elimination in Private Sector (STEPS) evolved in 2019 as a solution to ensure standards of TB care to every patient reaching the private sector.

Together let us confront it: An outbreak investigation of hepatitis B in Pathanamthitta district, Kerala.

Introduction: Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus (HBV). The established routes of transmission are from mother to infant, sexual contact, and exposure to blood or body fluids. Though HBV is preventable by vaccine and robust infection control practices, outbreaks of HBV infection do occur in India.

Implementing the Epidemic Diseases Act to combat Covid-19 in India: An ethical analysis.

Many states in India have invoked the provisions of the Epidemic Diseases Act, 1897, as a major tool in the fight against the Covid-19 pandemic. The current review attempts to discuss the ethical challenges in implementation of the Epidemic Diseases Act, 1897, to combat Covid-19 in India. Implementation of the Act in India has exposed its major limitations.

TB patient support systems in Kerala: A qualitative analysis.

Introduction: Tuberculosis (TB) is one of the leading causes of death due to infectious diseases in the world. Kerala a southern state in India aims to eliminate TB in the near future. In order to achieve its goal Kerala is providing various social support services to TB patients to ensure their smooth transition as they pass through the treatment cascade.

Population Attributable Risk of Tuberculosis Vulnerabilities in Kerala, India.

Background: A robust disaggregated understanding of the determinants of tuberculosis (TB) in each local setting is essential for effective health system and policy action to control TB.

Objectives: The objective of the study was to identify population attributable risk (PAR) for TB disease based on the locally available evidences for Kerala, India.

Methods: Systematic review was done for risk factors of TB in the state.

Social stigma associated with TB and HIV/AIDS among Kudumbashree members: A crosssectional study.

Introduction: TB and HIV/AIDS are the two major public health problems. Stigma and discrimination has an enormous impact on the sufferers. The impact is felt at home, in workplace, and at the institutions.

Ocular adverse events in drug sensitive TB patients on daily fixed dose combination anti-TB drugs: A record review study from Kerala, India.

Background: Government of India's Revised National TB Control Programme (RNTCP) has begun implementing daily fixed dose combination (FDC) anti-TB treatment regimen for drug sensitive TB patients in which ethambutol is given for six months. Prolonged ethambutol use is known to cause ocular adverse drug events (ADE).

Objectives: To assess the magnitude of ocular ADEs in adult drug sensitive TB patients initiated on daily FDCs and to describe the demographic and clinical profile of patients with ocular ADEs.

Lung Health Care pilot project trims patient pill load and antibiotic prescription in primary health care settings in Kerala, India.

Introduction: Kerala, the southern Indian state piloted Lung Health Care Project (LHCP) which is a locally adopted version of WHO recommended Practical Approach to Lung health (PAL). The current study assessed the impact of the project on the prescribing practices of doctors and consumption of antibiotics and other drugs.

Methods: This study compared performance of primary health care institutions with regard to drug prescriptions and consumptions before and after the implementation of the project.