Impact of involvement of non-formal health providers on TB case notification among migrant slum-dwelling populations in Odisha, India

• Published in: PloS one 2018-05, Vol.13 (5), p.e0196067-e0196067
• Main Authors: Dutta, Ambarish, Pattanaik, Sarthak, Choudhury, Rajendra, Nanda, Pritish, Sahu, Suvanand, Panigrahi, Rajendra, Padhi, Bijaya K, Sahoo, Krushna Chandra, Mishra, P R, Panigrahi, Pinaki, Lekharu, Daisy, Stevens, Robert H
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; Care and treatment; Diagnosis; Ecology and Environmental Sciences; Ghettos; Health aspects; Health care; Health facilities; Industrial areas; Intervention; Medical diagnosis; Medical personnel; Medicine; Medicine and Health Sciences; Microscopy; Migrant labor; Migrants; People and Places; Physical Sciences; Populations; Practice; Public health; Research and Analysis Methods; Research projects; Slums; Time series; Tuberculosis; Urban areas; Urban poor
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0196067

Migrant labourers living in the slums of urban and industrial patches across India make up a key sub-population so far controlling Tuberculosis (TB) in the country is concerned. This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India. This marginalized community usually seeks early-stage healthcare from "friendly neighbourhood" non-formal health providers (NFHPs). Because, RNTCP has limited capacity to involve the NFHPs, an implementation research project was conceived, whereby an external partner would engage with the NFHPs to enable them to identify early TB symptomatics from this key sub-population who would be then tested using Xpert MTB/RIF technology. Diagnosed TB cases among them would be referred promptly to RNTCP for treatment. This paper aimed to describe the project and its impact. Adopting a quasi-experimental before-after design, four RNTCP units from two major urban-industrial areas of Odisha were selected for intervention, which spanned five quarters and covered 151,400 people, of which 30% were slum-dwelling migrants. Two similar units comprised the control population. The hypothesis was, reaching the under reached in the intervention area through NFHPs would increase TB notification from these traditionally under-notifying units. RNTCP notification data during intervention was compared with pre-intervention era, adjusted for contemporaneous changes in control population. The project detected 488 Xpert+ TB cases, of whom 466 were administered RNTCP treatment. This translated into notification of additional 198 new bacteriologically positive cases to RNTCP, a 30% notification surge, after adjustment for 2% decline in control. This meant an average quarterly increase in notification of 41.20(20.08, 62.31; p