RESUMO
Background: The accredited social health activist (ASHA) is a link between community and health systems, so her services are very crucial for attainting universal health coverage. Comprehensive understanding of the demotivating factors, affecting the work efficacy of ASHA workers in the tribal areas, will not only help us in framing new ideas for providing them a positive work environment but also in retaining these health providers in their current job and increase their productivity and efficiency. Objectives: The study aims to find out the challenges and demotivating factors that ASHA workers face while implementing their responsibilities in tribal areas and frame recommendations based on study findings. Materials and Methods: An observational cross-sectional study conducted in a tribal area falling within the scope of a primary health care (PHC) center affiliated to a medical college. A semi-structured interview schedule was utilized to interview trained ASHA workers to understand the practical in-field challenges while implementing duties. Results: About 63% of ASHA workers were satisfied working in the tribal area. However, the major causes of de-motivation were community resistance (71.7%), less/irregular incentives (69.5%), transportation problems (52.2%), workload and stress (56.5%), and lack of training (23.9%). Family support and cooperation by auxiliary nurse midwife/multipurpose worker and other health-care staff in referral units were satisfactory for ASHAs in tribal areas. Conclusion: Most of the ASHA workers of the tribal area were satisfied with their job responsibilities, but timely activity-based incentives for the ASHA workers and regularity in their monthly salary and more community awareness about ASHA can motivate ASHA workers and increase their efficiency in providing PHC.
RESUMO
Background: About 304 million persons are living in the known endemic areas and are exposed to the risk of filariasis. About 22 million persons are harboring microfilaria in their blood and 16 million persons show clinical manifestations. The objective of the study was to study the prevalence of lymphatic filariasis in a tribal area.Methods: A community based cross sectional study was carried out. Night blood smears were obtained between 9-11.30 pm by finger prick method and thick smears were prepared and usual staining procedure was performed. 451 people out of (enumerated) 565 could be covered excluding infants. Diethyl carbamazine (DEC) provocative test was performed the next day by administering 100 mg DEC orally and collecting blood sample after one hour with usual method. DEC could be administered to only 200 individuals in spite of utmost efforts to ensure cooperation.Results: Out of 451 persons examined, 20 (4.4%) were showing clinical manifestations. Overall microfilaria rate was 14.4%. Total endemicity rate was 17.3%. The lowest number of microfilaria was seen in 5 in 20 cumm of blood while the highest count was 78 in the 20 cumm of the blood. 13 smears (20%) showed that microfilaria count was in the range of 41-50. Maximum average infestation rate was 33.3 per 20 cumm of the blood. The most prominent clinical manifestation seen was hydrocele in males constituting 35% of the total clinical cases.Conclusions: The prevalence of filariasis in this tribal area was high. Mf rate was 14.4%. Endemicity rate was 17.3%. Hydrocele was the commonest clinical manifestation.
RESUMO
Background & objectives: Malaria is a major public health problem in many states of the country, particularly, in Madhya Pradesh where both Plasmodium vivax and P. falciparum are endemic. Although many studies have been conducted to investigate risk factors for malaria, but only a few have examined household and socio-economic risk factors. The present study was, therefore, undertaken to explore the relationship of different socio-demographic, socio-economic and behavioural risk factors with malaria prevalence in tribal areas of Madhya Pradesh, India. Methods: This study was undertaken in all 62 villages of Bargi Primary Health Centre from May 2005 to June 2008. These villages comprised 7117 households with an average family size of five members. fortnightly fever surveys were conducted in all villages to assess prevalence of malaria infection in the community. The distinct univariate and multivariate logistic regression models were fitted on the data set. Results: The important socio-demographic risk factors like age of household head, social group, occupation and family size; socio-economic factors like type of walls of house, place of drinking water source, irrigated land, cash crop; and behavioural variables like place of sleeping, use of bed nets, etc. were found significantly associated with malaria in univariate analyses. in multivariate analyses only social groups, family size, type of walls of house, and place of sleeping had strong significant association with prevalence of malaria. Interpretation & conclusions: The study shows that in tribal areas where people are living in poor quality of houses with no proper use of preventive measures, malaria is firmly established. We conclude that community based interventions which bring improvement in standard of living, access to healthcare facilities and health awareness, will have a significant impact on malaria prevention in these areas.
RESUMO
Aims: The study was conducted to obtain information about place and mode of child delivery and compare unsafe deliveries between tribal and non-tribal areas. Study Design: This was a retrospective study with the follow up of registered pregnant women in the Primary Health Centers (PHC). Place and Duration of Study: The study was conducted in the PHCs of the State of Maharashtra, India. They were divided into two groups, tribal and non-tribal. The study was carried out in 2009-10. Method: A format was prepared to obtain details of delivery of children by women. The Auxiliary Nurse Midwives filled the format for all the pregnant women registered during calendar year 2008, through house to house visits in their respective areas. Results: More than one million pregnancies were registered. There were 21.88% home deliveries, of which 6.96% were not attended by a skilled birth attendant. About 5% of the babies were delivered through Cesarean section. The proportion of home deliveries (46.79%) and the absence of a skilled birth health professional (16.19%) were significantly higher in tribal areas. Even in institutional deliveries, interventional assistance was offered to lesser extent in these areas. The relative risk of undergoing unsafe delivery was 3.25 (95%, C.I. 3.20-3.29) in tribal PHCs. The district wise analysis Original Research Article British Journal of Medicine & Medical Research, 4(27): 4570-4581, 2014 4571 also supported the findings that home deliveries and overall unsafe deliveries were more in tribal districts. Conclusion: The study concludes that substantial number of women from tribal areas is exposed to unsafe deliveries.
RESUMO
Pregnancy related complications are among the leading causes of death and disability for women aged 15-49 in India. The National Rural Health Mission (NRHM) is contributing to the various health needs still the antenatal care utilization and neonatal practices are very poor especially in the tribal pockets of Maharashtra. Our aim was to assess the impact of close supervision and support intervention (CSSI) among primigravidae as compared to non-intervened primigravidae. Community based interventional study done in the tribal rural health training centre (RHTC) which is field practice area of tertiary health care institute.Total of 120 registered primigravidae mothers were enrolled in the study and were divided into two groups interventional group (N=30) and non- interventional group (N= 90).The CSSI was given to interventional group. Only 57 (42.50%) & 59(49.17%) women had taken two doses of TT immunization and ≥100 IFA tablets respectively. Regular CSSI helped to increase the ANC visits 25(83.33%), helped to confine delivery either at the RHTC or private hospital 29(96.70%).Maximum mothers i.e. 17(90%) and 30(100%) initiated breast feeding within 1 hour and fed colostrums to their baby respectively.
RESUMO
Background: In an attempt to make primary health care services available, especially, to the poorest and most vulnerable segments of rural & tribal society, JSY forms a crucial component of the NRHM. JSY is a safe motherhood intervention initiated to reduce maternal and neo-natal mortality and increasing institutional deliveries in them. Objective: 1) To assess awareness about Janani Suraksha Yojana (JSY) among ANC registered women. 2) To establish association of socio-demographic factors with awareness about Janani Suraksha Yojana (JSY). Methods: A cross sectional study was conducted in Primary Health Centre, Khardi of Thane district of Maharashtra during the period of Oct. 2010. A total of 110 ANC registered women were interviewed using pre-designed questionnaire. Results were analyzed by using SPSS version-15. Chi-square test was applied and p < 0.05 was considered as statistically significant. Results: More than half of the women (52.7%) were aware about this governmental scheme & only 17.24% of them were able to answer the correct name of the scheme. They obtained this knowledge mainly from the ANMs (58.6%), AWWs (22.4%) and ASHAs (17.2%). About 54.5% women had the knowledge about the components of JSY. Poor socioeconomic class, backward caste (SC/ST) & skilled/unskilled type of occupation were found to be significantly associated with the presence of knowledge about JSY. Conclusion: As the awareness and knowledge in our study group was less compared to other studies, there is a need to intensify the efforts to increase awareness and knowledge about JSY.