Browsing by Author "Sunil Kumar"

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    Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis
    (Glob. Health Action, 2018) Hemant Deepak Shewade; Vivek Gupta; Srinath Satyanarayana; Atul Kharate; K. N. Sahai; Lakshmi Murali; Sanjeev Kamble; Madhav Deshpande; Naresh Kumar; Sunil Kumar; Prabhat Pandey
    Background: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF (-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-058 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.
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    An insight on sampling, identification, quantification and characteristics of microplastics in solid wastes
    (Trends Environ. Anal. Chem., 2022) Palas Samanta; Sukhendu Dey; Debajyoti Kundu; Deblina Dutta; Rohit Jambulkar; Rahul Mishra; Apurba Ratan Ghosh; Sunil Kumar
    Microplastics (MPs) have attracted wide attention all over the world as a remarkable pollutant. While MPs are spreading throughout several complex environmental matrices, various experiments till date have been pre-liminary concentrate on aquatic ecosystems. Terrestrial sources namely solid waste-origin have remains unex-plored, although they contribute largely for aquatic microplastics origin. Simultaneously, terrestrial systems under human activity, like healthcare units, are likely to be polluted by various plastic ingredients. Solid waste MPs sources primarily include sanitary landfilling, food waste, wastewater treatment end-product (sludge), tire wear, textile washing and paint failure. These microplastics caused adverse impacts on ecosystem, environment, and health. Accordingly, the present study addressed solid waste MPs' occurrence and sources, identification, quantification, characterization, fate, and degradation pathways for developing comprehensive management strategies following the principles of circular economy. In particularly, this paper critically demonstrated solid waste MPs sources, solid waste MPs sampling followed by identification and quantification by adopting com-bined chemical (e.g., spectroscopy viz., Fourier transform infrared (FTIR) spectroscopy, and Raman spectros-copy), physical (e.g., microscopy such as transmission or scanning electronic microscopy, TEM or SEM) and thermal analyses. Additionally, the strengths and limitations of each analytical technique are discussed critically with practical aspect. Further, the MPs related national and international regulations or laws and their subse-quent relevance to solid waste MPs management with future challenges are discussed very critically. Finally, the outcomes of the review paper will be valuable to different stakeholders for effective policy implementation.