Cost of hospitalisation for non-communicable diseases in India: are we pro-poor?

Objectives: To estimate out-of-pocket (OOP) expenditure due to hospitalisation from NCDs and its impact on households in India.

Methods: The study analysed nationwide representative data collected by the National Sample Survey Organisation in 2014 that reported health service utilisation and healthcare-related OOP expenditure by income quintiles and by type of health facility (public or private). The recall period for inpatient hospitalisation expenditure was 365 days.

Médecins Sans Frontières' Clinical Guidance mobile application: analysis of a new electronic health tool.

Many health care workers lack access to clinical support tools in rural and resource-limited settings. To address this gap, the Médecins Sans Frontières (MSF) Clinical Guidelines manual was converted into a static mobile health reference application (app) entitled MSF Guidance. The app's utility and growth was examined, and within 6 months of its launch 150 countries had downloaded the app, with demonstrated retention among new and existing users.

China's 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan?

Background: The China's 1-3-7 strategy was initiated and extensively adopted in different types of counties (geographic regions) for reporting of malaria cases within 1 day, their confirmation and investigation within 3 days, and the appropriate public health response to prevent further transmission within 7 days. Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan. This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time.

Ebola: lessons learned and future challenges for Europe.

The Ebola virus epidemic has topped media and political agendas for months; several countries in west Africa have faced the worst Ebola epidemic in history. At the beginning of the disease outbreak, European Union (EU) policies were notably absent regarding how to respond to the crisis. Although the epidemic is now receding from public view, this crisis has undoubtedly changed the European public perception of Ebola virus disease, which is no longer regarded as a bizarre entity confined in some unknown corner in Africa.

Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research.

The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; non-payment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stockouts due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities.

Origin of malaria cases: a 7-year audit of global trends in indigenous and imported cases in relation to malaria elimination.

Background: Countries in the different stages of pre-elimination, elimination, and prevention of reintroduction are required to report the number of indigenous and imported malaria cases to the World Health Organization (WHO). However, these data have not been systematically analysed at the global level.

Objective: For the period 2007 to 2013, we aimed to report on 1) the proportion of countries providing data on the origin of malaria cases and 2) the origin of malaria cases in countries classified as being in the stages of pre-elimination, elimination and prevention of reintroduction.

Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes.

Setting: Seventeen rural public health facilities in Western Kenya that introduced three models of integrated care for tuberculosis (TB) and human immunodeficiency virus (HIV) patients.

Objective: To assess the uptake and timing of cotrimoxazole preventive therapy (CPT) and antiretroviral treatment (ART) as well as anti-tuberculosis treatment outcomes among HIV-infected TB patients before (March-October 2010) and after (March-October 2012) the introduction of integrated TB-HIV care.

Design: A before-and-after cohort study using programme data.

Diabetes mellitus and tuberculosis: programmatic management issues.

In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation.

Ethics approval: a challenge for public health researchers in India.

There is increasing impetus, interest and opportunity for people working in public health programmes in India to carry out operational research (OR) around relevant programme issues and then publish that in peer-reviewed publications. These published researches are valuable in analysing, documenting and advocating for locally generated evidence to inform policy and practice. Ethics review and approval is an essential step in the process of OR but is often viewed as a barrier rather than a prerequisite of good practice in OR.

Mass treatment to eliminate tuberculosis from an island population.

Setting: The global target of tuberculosis (TB) elimination by 2050 requires new approaches. Active case finding plus mass prophylactic treatment has been disappointing. We consider mass full anti-tuberculosis treatment as an approach to TB elimination in Kiribati, a Pacific Island nation, with a persistent epidemic of high TB incidence.

Management of previously treated tuberculosis patients in Kalutara district, Sri Lanka: how are we faring?

Setting: District Chest Clinic, Kalutara, Sri Lanka.

Objectives: To determine the coverage of culture and drug susceptibility testing (CDST), delays in CDST, treatment initiation, obtaining CDST results and treatment outcomes of previously treated tuberculosis (TB) patients.

Design: Retrospective cohort study involving review of records and reports.

Cohort analysis of antenatal care and delivery outcomes in pregnancy: a basis for improving maternal health.

Cohort analysis has been the cornerstone of tuberculosis (TB) monitoring and evaluation for nearly two decades; these principles have been adapted for patients with the human immunodeficiency virus/acquired immune-deficiency syndrome on antiretroviral treatment and patients with diabetes mellitus and hypertension. We now make the case for using cohort analyses for monitoring pregnant women during antenatal care, up to and including childbirth. We believe that this approach would strengthen the current monitoring and evaluation systems used in antenatal care by providing more precise information at regular time intervals.

Research to policy and practice change: is capacity building in operational research delivering the goods?

Objectives: Between 2009 and 2012, eight operational research capacity building courses were completed in Paris (3), Luxembourg (1), India (1), Nepal (1), Kenya (1) and Fiji (1). Courses had strict milestones that were subsequently adopted by the Structured Operational Research and Training InitiaTive (SORT IT) of the World Health Organization. We report on the numbers of enrolled participants who successfully completed courses, the number of papers published and their reported effect on policy and/or practice.

Optimal evidence in difficult settings: improving health interventions and decision making in disasters.

Martin Gerdin and colleagues argue that disaster health interventions and decision-making can benefit from an evidence-based approach Please see later in the article for the Editors' Summary.

Measles in the Democratic Republic of Congo: an urgent wake-up call to adapt vaccination implementation strategies.

All countries in Africa have made a commitment to eliminate measles by 2020. This is laudable, as measles elimination will have a crucial impact on reducing childhood mortality. An important operational challenge is the resurgence of measles outbreaks in a number of countries; one of the main reasons for this is that many children are being missed by vaccination programmes.

Self-administered treatment for tuberculosis among pastoralists in rural Ethiopia: how well does it work?

Objectives: In the Somali Regional State, Ethiopia, where most of the population are pastoralists, conventional TB treatment strategies based on directly observed treatment (DOT) at health facilities are not adapted to the mobile pastoralist lifestyle and treatment adherence is poor. From a rural district, we report on treatment outcomes of a modified self-administered treatment (SAT) strategy for pastoralists with TB.

Methods: A descriptive cohort study was carried out between May 2010 and March 2012.

Countrywide audit of multidrug-resistant tuberculosis and treatment outcomes in Mongolia.

Setting: Eighteen treatment units for multidrug-resistant tuberculosis (MDR-TB) in Mongolia.

Objective: To determine the total number of MDR-TB cases detected, their resistance patterns, the proportion and characteristics of cases starting treatment, the delay between diagnosis and treatment initiation, and the relation between treatment outcomes and drug resistance.

Design: Retrospective cohort study using routine programme data.

A 'one-stop shop' approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?

Setting: Prevention of mother-to-child transmission (PMTCT) programme, Mpilo Hospital antenatal clinic, Zimbabwe.

Objective: Before and after the introduction of a one-stop shop approach and task-shifting of antiretroviral treatment (ART) to midwives in the PMTCT programme, 1) to compare ART uptake and 2) to determine socio-demographic and other characteristics associated with non-initiation of ART post integration.

Design: Before and after cohort study.

Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review.

The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM.