title: Health system frailties in tuberculosis service provision in Russia: an analysis through the lens of formal nutritional support.
abstract: OBJECTIVE
  The aim of this study was to describe health system challenges faced by tuberculosis (TB) treatment facilities in Russia through an analysis of formal institutional dietary provisions to patients in an inpatient facility that provides care for poor patients.
  
  
  METHODS
  Analysis of formal dietary provisions by institutions and financing data from TB hospitals in Samara Oblast, Russia.
  
  
  RESULTS
  Formal dietary provision for inpatients with TB has fallen substantially in recent years. In a hospital providing inpatient care for the poorest patients with fewest social support networks, this has been very pronounced. The likely reason for this is that financial support for other budget lines, principally salaries, has required protection.
  
  
  CONCLUSIONS
  Formal institutional nutritional support in institutions providing care for the poorest patients with TB is unlikely to be enhancing the speed of recovery, or reducing the duration of infectiousness. Furthermore, the role that hospital may have played in the past in enabling patients to regain weight lost before admission may have been limited by reductions in formal financing. Reductions in state provision of food for patients may serve as an important illustration of wider TB control system frailties in the Russian Federation.
authors.affiliation: ECOHOST, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. richard.coker@lshtm.ac.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Coker
authors.forename: B
authors.initials: B
authors.lastname: Dimitrova
authors.forename: F
authors.initials: F
authors.lastname: Drobniewski
authors.forename: Y
authors.initials: Y
authors.lastname: Samyshkin
authors.forename: J
authors.initials: J
authors.lastname: Pomerleau
authors.forename: G Y
authors.initials: GY
authors.lastname: Hohlova
authors.forename: N
authors.initials: N
authors.lastname: Skuratova
authors.forename: S
authors.initials: S
authors.lastname: Kuznetsov
authors.forename: I
authors.initials: I
authors.lastname: Fedorin
authors.forename: R
authors.initials: R
authors.lastname: Atun
mesh_terms: D002017:Budgets / Q000639:trends; D016208:Databases, Factual; D004045:Dietary Services / Q000191:economics* / Q000592:standards; D017721:Hospital Costs / Q000639:trends; D006765:Hospitals, Convalescent / Q000191:economics*; D006779:Hospitals, Public / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D009747:Nutritional Physiological Phenomena; D018529:Nutritional Support / Q000191:economics* / Q000592:standards; D011203:Poverty; D012426:Russia; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000178:diet therapy / Q000191:economics*