Principal Investigator Dr. Nerges Mistry
Co-Investigator Dr. YatinDholakia
Budget team Ms. Akshaya Patil, Dr. Chinmay Oak
Funder Bombay Community Public Trust, BCPT
Duration 7 months (January 2013- July 2013)
Budget Rs.4.20 Lakhs
Mumbai houses 12% of the population of Maharashtra state, but accounts for 22% of notified cases of Tuberculosis (TB). A fast growing urban metropolis Mumbai has higher levels of MDR-TB, than in other states (24%–30% of new cases and 11%–67% of treated case). There has also been emergence of Extremely Drug Resistant TB (XDR-TB) and Total Drug resistant TB (TDR-TB). The rising incidence drug resistant TB cases in Mumbai necessitates measures for active case finding and treating identified cases successfully.
Being an airborne infection, the risk of transmission of TB is high in overcrowded, poorly ventilated settings. Malnourished individuals, people living with HIV/AIDS, Diabetes mellitus, elderly persons and children are at increased risk of infection due to poor immunity. Due to the inherent susceptibility of their residents TB prevalence is expected to be high in correctional facilities like prisons and congregate settings like old age homes, shelter homes, orphanages, etc. However not much is known about the actual prevalence of TB amongst the population of congregate or correctional settings in India. Following a comprehensive literature review prior to conducting the study it was noted that very limited information is available about the probable threats and risk of TB transmission amongst congregate settings in India. There are currently no policies or guidelines in the country for prevention or control of TB in congregate settings.
This study was therefore done in collaboration with the Municipal Corporation of Greater Mumbai (MCGM) as a collective step towards understanding the existing control and preventive measure for TB in various congregate settings across the urban metropolitan Mumbai.
The Foundation of Medical Research (FMR) conducted an assessment of tuberculosis detection and care in 33 congregate settings and 2 Correctional facilities in Mumbai between the period of January 2013 and June 2013.
It is crucial to build linkages between congregate facilities and public health system, and to advocate the significance of early TB detection and treatment to the managerial staff of congregate settings. There is need to setup protocols for comprehensive TB detection, care and follow-up of patients in these settings. Strengthen the documentation and notification system in order to understand the actual burden of tuberculosis in these set-ups. There is a need for India to develop guidelines and formulate policies for control of TB in congregate settings.
An action plan to carry out the proposed strategies was prepared and shared by FMR with the DTO’s.
The DTO’s of wards in which the participating facilities were located were contacted by FMR about 2 months after the initial stakeholder meetings and sharing of action plan. This was to obtain feedbacks on activities conducted towards sensitization and screening of facility staff and residents. FMR also contacted all the facilities that had agreed to be a part of the study, to get their feedback on any visits by their respective ward DTO’s. After a poor response during the first round of communication (September 2013) with the DTO’s, a much more positive response in terms of activities conducted at the participating facilities was received from the DTO’s during the second round of communication in April 2014.
We are currently collating all the feedback and responses received from both the DTO’s and facilities that had participated in the study. DTO’s and facilities that have not responded yet will be contacted again. This will be done before a review appraising the various activities implemented by DTO’s and feedback from participating facilities is prepared and circulated to all the key stake holders.
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