Under-five child mortality and associated factors among tribal populations from a South Indian district.

This paper reports child mortality and associated factors among tribal (indigenous) populations from a South Indian district. In India, 104 million people belonged to 705 tribal groups, constituting 8.6% of India's population. Of the 705 tribal groups, 75 were classified as particularly vulnerable tribal groups (PVTG). The present study aims to report the under-five child mortality among the tribal (both PVTG and non-PVTG) population in Visakhapatnam district, a district with a higher concentration of tribes in the Indian state of Andhra Pradesh. Four sub-districts were selected to conduct a cross-sectional study to understand health and health-seeking behavior, including maternal and child health. Socio-demographic details and obstetric history were collected through a pre-tested, interviewer-administered questionnaire from mothers with a child aged up to one year. These 277 mothers gave birth to 632 liveborn children, out of which 56 children died within 12 months. Multiple logistic regression revealed that living in villages with no health facility, woman-headed households, younger age at first childbirth and mother' aged 30 years or above were significantly associated with mothers experiencing child death. Implementation of home-based neonatal care is crucial in the vulnerability context of the tribes due to socioeconomic conditions and remote habitation. Health educational interventions to address early marriages leading to teenage pregnancies are needed immediately. This disaggregated analysis of under-five mortality and associated factors among the tribes highlights the need for population-specific interventions and improving infrastructural facilities like all-weather roads and improved access to quality healthcare services in addition to the overall socio-economic development.

Community engagement to control dengue and other vector-borne diseases in Alappuzha municipality, Kerala, India.

Introduction Vector-borne diseases (VBDs) are a serious threat in many Indian states, including Kerala. Community-based decentralized planning and engagement are effective strategies that can make positive behavioral changes to control VBDs. Methods This community-based implementation research was conducted during November 2016 - October 2018 in Alappuzha municipality in Kerala, India. It was conducted in two phases. In the first phase, formative research was conducted to know the community's profile and perceptions and thus to plan and develop an appropriate intervention. Baseline data on some entomological indicators were also collected. These data were used to assess the impact of the intervention by comparing with the post-intervention data. In the second phase, an intervention through the community's engagement was implemented in selected wards. The activities included the formation of community committees and the vector control and source reduction activities with the community engagement and inter-sectoral coordination. Results The intervention resulted in a positive change among the community to engage in vector control activities. These efforts along with inter-sectoral coordination resulted in successfully implementing vector source reduction activities. In both wards, pre- and post-intervention entomological data (house index: 16.7 vs 6.0 and 64.2 vs. 8.6; container index: 24.8 vs. 12.1 and 37.7 vs. 18.1; and Breteau index: 21.3 vs. 7.3 and 47.7 vs. 8.6) revealed a considerable vector source reduction. Conclusion The findings of this study suggest considering and including community engagement in public health policy as the main thrust to control VBDs.

Birth preparedness and determinants of birth place among migrants living in slums and slum-like pockets in Delhi, India.

OBJECTIVE: The objective of this paper is to report birth preparedness and place of birth and its determinants among recent- and settled- migrant households living in slums of Delhi. METHODS: In a cross-sectional survey, 458 migrant mothers with a child aged below one year of age were identified. Socio-demographic details, data on the place of childbirth, antenatal care (ANC) and birth preparedness in terms of planning for home birth or hospital birth, transport, saving money, knowledge of danger signs were collected through interviewer-administered pretested questionnaire. Logistic regression was carried out for the determinants of hospital birth. RESULTS: The present study migrants are characterised by younger ages, low educational attainment, low incomes and represented by socioeconomically disadvantaged communities. They mainly relied on government healthcare services for maternal care. ANC seeking was not satisfactory with 16% of women with no ANC; 46% receiving 1-3 visits; and only 23% of women reported health worker visited them at home. 59% of the births took place at hospitals. Having ANC visits (Adjusted Odds Ratio (AOR) for having 4 or more ANC visits = 5.252), planning for hospital birth (AOR = 6.114), plan for transport (AOR = 1.989), mass media exposure (listening to radio; AOR = 2.871) and knowledge of danger signs (AOR = 3.872) resulted in significant chances of hospital birth. CONCLUSION: Migrant women are at the risk of utilizing the services to a less extent. The health systems need to take measures to mitigate the disadvantage due to migration through specific strategies to make them inclusive and outreach to the poor migrants.

Antenatal care service utilization in tribal and rural areas in a South Indian district: an evaluation through mixed methods approach.

BACKGROUND: Maternal and child healthcare is one of the eight basic components of primary healthcare. Poor access and utilization of antenatal care (ANC) services continue to contribute to high maternal mortality and morbidity; and the services of primary healthcare are amenable for evaluation. AIM: To report the utilization of ANC services by women living in tribal and rural areas in the district of Visakhapatnam, Andhra Pradesh, India. MATERIALS AND METHODS: Both qualitative and quantitative methods were used in the study. Quantitative data on ANC were collected from women having a child aged less than a year (n=380) through a structured interview schedule. The qualitative data were collected through indepth interviews with key informants in the villages (n=12). RESULTS: The study reports higher utilization of ANC compared with the national average of India. A greater proportion of women living in tribal areas utilize the services from governmental sources (92%), whereas approximately 54% of the rural women seek services (paid services) from private practitioners. Health workers' visits match with the utilization of government health services. CONCLUSION AND RECOMMENDATIONS: The study showed relatively higher utilization of ANC services than the national average, but at the same time, child deliveries at home, which were mostly conducted by untrained elderly women, were also high. This gap is indicative of the target-oriented approach where quantity rather than the quality takes priority. In addition, the literacy levels of women, socioeconomic conditions and distance to the health facilities also played a role. To improve utilization and access, community health needs assessment has to be made, along with attempts to develop community participation.

Dowry deaths: a neglected public health issue in India.

This paper appraises the public health burden of mortality in India caused by the practice of dowry and examines the association of some demographic and socio-economic factors with dowry deaths and dowry-related suicides. The paper is based on the data available on the public domains of the National Crime Records Bureau (NCRB), third National Family Health and Survey-2005-06, Planning Commission of India and Census of India 2001. In 2007, the total number of dowry deaths and dowry-related suicides reported in India were 8093 and 3148, respectively. There was a 74% increase in dowry-related deaths from1995 to 2007, while there was a 31% increase in the reporting of dowry-related suicides. Occurrence of dowry deaths has significant association with some demographic and socio-economic variables. The data reveal that the status of women is undesirable, and the burden of mortality and related morbidity is enormous. There should be a national injury surveillance system and reliable estimates of dowry-related homicides. However, available information can be used to design and implement some counter-measures to prevent dowry-related violence and deaths. The study warrants the undertaking of research to give insights into circumstances and triggers of such violence, the healthcare seeking of these victims, bottlenecks in seeking health care and reporting to the police.

Association of alcohol consumption and blood pressure in some low socioeconomic groups from Andhra Pradesh, India.

The present paper examines the relationship of alcohol consumption with blood pressure (BP) levels and hypertension prevalence. Data on BP, alcohol consumption and anthropometry were obtained from a cross sectional sample of 1316 adult men and women of six low socioeconomic groups belonging to four different ethnic groups from Visakhapatnam district of Andhra Pradesh, India. Considerable proportions of respondents reported the consumption of alcohol. Some groups recorded higher levels of systolic and diastolic BP among alcohol drinkers than non-drinkers, and in others it was reverse. There was no uniform association between alcohol consumption and hypertension prevalence, though the combined data revealed a higher prevalence of hypertension among non-drinker men and drinker women. The present study population was a heterogeneous group in terms of alcohol consumption, and many of them were occasional drinkers. The study revealed no consistent association of alcohol consumption with blood pressure. The study opines that it is necessary to take measures to reduce the prevalence of alcohol consumption, as it was an underlying social problem and, though not directly associated with blood pressure; and alcohol consumption has been demonstrated as a major risk factor for cardiovascular diseases.

Clinicians' attitude on mass drug administration under the program to eliminate lymphatic filariasis: a qualitative study from Orissa, India.

The global program to eliminate lymphatic filariasis (LF) is currently based on mass drug administration (MDA) with annual single dose of antifilarials. In India, the MDA is implemented by primary health centers (PHC) of the district health system. The aim of the present study was to explore the attitudes of clinicians working at PHC level in three districts of Orissa, India. The data are obtained from interviews of 50 clinicians (35 from PHCs and 15 private). Only 11 PHC clinicians and 1 private clinician opined that the elimination of LF is possible through MDA of diethylcarbamazine (DEC); and 40% PHC and 87% private clinicians strongly felt that the elimination is not feasible through MDA and that the yearly single dose of DEC was not efficacious. The remaining clinicians were unable to comment on the feasibility and efficacy of MDA. The indifferent attitudes arise from lack of knowledge or erroneous beliefs. A good understanding of the program through reorientation and rigorous training should be emphasized to make the MDA successful.

Sexual risk behaviour among migrant tribals living in urban slums of an eastern Indian city: implications on the spread of HIV.

This paper reports the sexual risk behaviour among migrant tribal community living in an eastern Indian city. The age at marriage is very low in this community and 54% of women had first intercourse before the age of 15 years with the mean of 15.8 years and it is 19.5 years for men. Pre and extramarital relations, including multi-partnered sex is prevalent. Safe sexual practices are not reported and the risk perception is very low. High prevalence of behavioral risk factors leaves a potential risk for rapid spread of human immunodeficiency virus (HIV) both in slums as well as in remote tribal areas.