ABSTRACT
Background: Among the different social groups in India, the tribes are the most vulnerable and socioeconomically deprived. The tribal population is distinct from the general population in terms of their unique cultural, traditional, and reproductive health practices. Therefore, the aim of the study was to conduct an exploratory analysis of the menstrual practices, fertility intentions and decision-making regarding family planning among various indigenous tribal women of Kerala. Methods: A qualitative study was conducted among the tribal women of Wayanad district using the grounded theory approach. Using purposive sampling 16 in-depth interviews, 6 key informant interviews and 2 focus group discussion (FGD) s were conducted. Interview guides were developed for in-depth interviews, key-informant interviews, and focus group discussion through extensive formative research with literature reviews and taking expert opinions. The interviews were conducted among women of reproductive age and their spouses hailing from Paniya and Kurichiya tribal groups in Kalpetta and Mananthavady areas of Wayanad district. Key informant interviews were also conducted among doctors, pharmacists, and community health workers. Results: The key findings of this study were the identification of a web of cultural practices pertaining to menstruation among persons of tribal origin. Unique traditional practices such as "Valayamapura" and "Thirandukalyanam" were reported and most of the women were keen to carry it forward. Fertility desires among couples were found to be not significantly influenced by any gender bias. Decision-making regarding family size were found to be on a mutual agreement between the spouses. The tribal women were aware of modern spacing methods, but preferred natural methods of contraception for temporary use and tubectomy as the permanent method. Non-contraceptive use of oral contraceptive pills (OCP) was prevalent, and the majority took it occasionally for postponement of menstruation to attend various social events. Conclusion: Menstruation-related myths and practices are prevalent and require educational interventions. More focus needs to be given to male sterilization as the permanent method of contraception. The study underscores the need to address gender inequalities and attitudes among tribal populations and to increase efforts to promote higher education among the tribes for busting cultural myths and practices.
ABSTRACT
OBJECTIVES: Primary objective was to determine an association between Atherosclerotic Cardiovascular Disease (ASCVD) and Framingham (FRS) risk scores with Syntax score(SS). Secondary objective was to determine sensitivity, specificity and discriminative ability of FRS and ASCVD risk scores in detecting Coronary Artery Disease (CAD) and predicting its severity. MATERIALS AND METHODS: This is a cross-sectional study carried out in the Comprehensive Health Clinic of Amrita Institute of Medical Sciences, Kochi, Kerala. Patients voluntarily visiting the clinic for a health check-up were referred to Cardiology based on a positive treadmill test result where they underwent a coronary angiogram. Secondary data on patients' demographics, prior history of cardiovascular diseases, investigations and interventional procedures was collected from the hospital registry. The risk scores were calculated using the data through online calculators. Analysis was carried out using SPSS. RESULTS: Chi-square analysis showed significant association between FRS and SS. Both FRS and ASCVD risk scores have good sensitivity for CAD while having good specificity for patients with high Syntax score (SS≥33). ROC curve showed that ASCVD risk score has a higher positive likelihood ratio than FRS for predicting CAD and high Syntax Score Patients. CONCLUSION: The study concludes that FRS and ASCVD risk scores are effective risk predicting models for CAD. FRS is a more sensitive risk score than ASCVD risk score in predicting CAD whereas ASCVD risk score has a higher ability to differentiate patients with CAD and high Syntax Score than FRS.
