Résumé
Background & objectives: Despite various efforts by the Government of India, utilization of antenatal care (ANC) services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country. Methods: Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3) have been used. Bivariate and multivariate analyses (logistic regression model) were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members). Results: The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28%) and those women who visited health facility for pregnancy confirmation test (9-27%). Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001) except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01) and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06) except in Rajasthan, were more likely to avail complete ANC services than their counterparts. Interpretation & conclusions: The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on woman’s educational attainment of high school and above. In addition, the study highlighted the need to create awareness among both pregnant tribal women as well as her family members on the importance of early ANC care.
Résumé
A presente pesquisa objetivou construir um sistema de categorias de comportamentos observáveis de crianças com dificuldade de aprendizagem (DA), relacionado aos fatores afetivo-motivacionais, exibidos durante uma prova cognitiva de modalidade assistida. Observou-se e registraram-se os comportamentos de 10 crianças (8-10 anos) com DA, registradas em vídeo, executando uma prova assistida. Para registro cursivo desses comportamentos infantis, escolheu-se aleatoriamente uma fita por vez de 34 vídeos da atividade sendo realizada por 34 crianças até a repetição de comportamentos infantis e a diminuição da variabilidade comportamental nas situações observadas, totalizando 10 crianças observadas. Definiu-se 20 categorias, divididas em Facilitadoras e Não facilitadoras do desempenho, como Demonstrar impulsividade, Dar feedback e Pedir orientação. O nível de concordância foi calculado entre três juízes. Os resultados mostraram que 10 categorias alcançaram índices de fidedignidade acima de 70 por cento entre pelo menos dois juízes. Estas categorias são indicadas para avaliação dos aspectos afetivo-motivacionais em avaliação assistida, tais como Corrigir pergunta/resposta após dica/ajuda, Demonstrar querer interromper a tarefa e Reclamar/responder/ atender solicitação. Estudos futuros são sugeridos a fim de testar a aplicabilidade das categorias com baixos índices de concordância.
This research aimed to build a set of observed behaviors categories of children with learning disability related to affective-motivational factors exhibited during dynamic assessment. Ten children with learning disabilities aged 8-10 years old were videotaped while performing a dynamic testing and observation reports of these videotapes were made. In order to register these children behavior, one tape at a time was randomly chosen from 34 videotapes, which showed the task being performed by 34 children, until the moment when the behaviors started to repeat and the behavioral variability started to decrease, concluding 10 children observed. Twenty categories were defined, divided into Facilitating and Non-facilitating of child performance, for example: Showing impulsivity, Giving feedback, Asking for help. The level of agreement was calculated among three examiners. The results showed that 10 categories assessed by at least two examiners reached reliability of ratings higher than 70%. These categories are indicated to assess affective-motivational aspects in dynamic assessment, such as Correcting question/answer after hint/help; Showing willingness in stopping the task; and Complaining about answering/meeting requests. Future studies are suggested to test the applicability of the categories with low agreement ratings.