Using photovoice to understand the context of cervical cancer screening for underserved communities in rural India.

Cervical cancer is the second most common cancer diagnosed among women in India and current estimates indicate low screening rates. To implement successful population-based screening programs, there is an urgent need to explore the social and cultural beliefs among women residing in underserved communities. An innovative, community-based participatory approach called photovoice was used with 14 women aged between 30-51 years, residing in rural and tribal villages around Mysore, Karnataka, India. Each participant was trained in photovoice techniques, provided with a digital camera, and asked to photo document their everyday realities that could influence their intentions to undergo cervical cancer screening. Over 6 months, participants took a total of 136 photos and participated in 42 individual interviews and two group discussions. These data helped identify specific beliefs prevalent in the target population and were organized according to the Integrated Behavior Model. Some women reported a lack of perceived susceptibility to cervical cancer whereas others mentioned the fatal nature of cancer as a disease and believed that no screening exam could prevent death if they were destined to get cancer. Husbands, mothers-in-law, and their peers in the community had an important influence on the social identity of women and influenced their intentions to participate in the screening exams. Seeking healthcare was associated with an economic burden, not only in terms of out-of-pocket expenses for healthcare services but also in missing daily labor wages or taking unpaid leave from work to seek healthcare when they were asymptomatic. Several action steps were proposed including: identifying community liaisons or champions, repeated community activities to raise awareness of cervical cancer, and educating men and other family members about women's health issues. Study findings can conceptually help design and develop educational efforts for mobilizing women to undergo screening and inform future research to help understand disparities.

A community-based, cross-sectional study of hrHPV DNA self-sampling-based cervical cancer screening in rural Karnataka, India.

OBJECTIVE: To examine the feasibility of implementing a high-risk HPV (hrHPV) DNA-based screening program for cervical cancer and the prevalence of hrHPV DNA-positive women in a community setting in rural India. METHODS: A cross-sectional study was conducted at the community level in the Hunsur taluk of the Mysore district from January to August 2016. Cervical cancer screening was conducted with self-collected vaginal samples that were analyzed using the Hybrid Capture 2 (HC2) assay (Qiagen, USA). RESULTS: The majority of participants were aged 30-39 years, with no formal schooling, from a lower caste, and lived below an annual household income of US$1499. After group health education and one-on-one counseling, a total of 473 women underwent self-sampling. Of these, 36 (7.6%) were positive for hrHPV and only 24 (66.6%) underwent follow-up diagnostic triaging. Cancer was detected in two women, who were referred to appropriate healthcare facilities for further treatment. CONCLUSION: Implementation of hrHPV DNA-based screening tests using self-sampling can be feasible in rural settings in India. However, substantial resources are required for providing health education and one-on-one counseling to inform asymptomatic women about the benefits of testing and, more importantly, to improve compliance with follow-up.

Determinants of exclusive breastfeeding in rural South India.

BACKGROUND: While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India. METHODS: This cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor medicine or oral rehydration solution, between birth and 6 months and was assessed at six months postpartum. RESULTS: We surveyed mothers who delivered in rural Mysore taluk between 2008 and March 2011. A total of 1292 mothers participated in the study. The overall breastfeeding rate at six months postpartum was 74.9% and the EBF rate was 48.5%. Factors associated with EBF included higher maternal age (Adjusted Odds Ratio[aOR] 1.04; 95% Confidence Interval [CI] 1.00, 1.09), lower maternal education (aOR1.56, 95% CI 1.10, 2.21), and 7-10 antenatal visits (aOR 1.57; 95% CI 1.09, 2.27). The most common reason for non-exclusive breastfeeding was the mother's feeling that she did not have enough milk (23.7%). Infants that were not exclusively breastfed were most commonly fed formula/animal milk (42.6%) or castor oil/ghee (18.4%). CONCLUSIONS: Less than half of the mothers in our sample reported exclusive breastfeeding in a rural region of Karnataka, India in the first six months, a rate lower than national and state level rates. Future interventions should evaluate whether antenatal education can improve breastfeeding outcomes. The only modifiable factor was number of antenatal visits. Breastfeeding education should be emphasized at every antenatal visit so that even mothers with fewer than 7-10 antenatal visits can learn the best techniques and benefits of breastfeeding.

Suboptimal Breastfeeding Practices among Women in Rural and Low-Resource Settings: a Study of Women in Rural Mysore, India.

BACKGROUND: Breastfeeding rates are progressively increasing worldwide while optimal breastfeeding practices are lagging behind, especially in rural and low resource settings like India. OBJECTIVES: This study estimated the prevalence of and factors associated with suboptimal breastfeeding practices among mother-infant dyads in rural southern India. METHODS: This is a cross-sectional analysis of data collected in Mysore District from 2008-2011 from 1294 mother-infant dyads. All women answered an interviewer-administered survey, which included maternal, infant, and sociodemographic information and breastfeeding-related characteristics. Logistic regressions were conducted to determine factors associated with suboptimal breastfeeding practice. FINDINGS: About 20% (n = 281) of mothers reported delayed initiation of breastfeeding. Mothers who were unsatisfied with the infant's gender had higher odds of delayed breastfeeding (adjusted odds ratio [AOR]: 1.42, 95% confidence interval [CI]: 1.00, 2.00). Odds of delayed initiation were significantly lower among mothers who received 7-10 antenatal checkups (AOR: 0.59, 95% CI: 0.41, 0.87) and assistance during breastfeeding (AOR: 0.73, 95% CI: 0.57, 0.95). About half (51.4%) the sample did not breastfeed exclusively for the first 6 months. Older age was associated with lower odds of nonexclusive breastfeeding (AOR: 0.95, 95% CI: 0.92, 1.00). Compared with mothers with no education, mothers with primary education (AOR: 1.94, 95% CI: 1.35, 2.79) or more than primary education (AOR: 1.58, 95% CI: 1.10, 2.26) had higher odds of nonexclusive breastfeeding. CONCLUSIONS: Optimal breastfeeding practices were influenced by a multitude of factors, including maternal age, education, number of antenatal checkups, receiving assistance with breastfeeding, and satisfaction with the infant's gender. Health promotion efforts should focus on encouraging mothers to attend antenatal care visits. Early antenatal education and counseling should include breastfeeding education in early antenatal visits. Further research should examine how to mitigate the effect of gender preference on initiation of breastfeeding.

Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India.

BACKGROUND: In rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients. METHODS: From 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1. RESULTS: During the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested. CONCLUSIONS: Patient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities.

Erratum to "Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India".

[This corrects the article DOI: 10.1155/2013/971458.].

Increasing Antenatal Care and HIV Testing among Rural Pregnant Women with Conditional Cash Transfers to Self-Help Groups: An Evaluation Study in Rural Mysore, India.

Background. We describe a one-year evaluation study comparing SCIL intervention of mobile provision of integrated ANC/ HIV testing with an enhanced (SCIL+) intervention of community mobilization strategy providing conditional cash transfers (CCT) to women's SHG for identifying and accompanying pregnant women to mobile clinics. Methods. Twenty pairs of villages matched on population, socioeconomic status, access to medical facilities, and distance from Mysore city were divided between SCIL and SCIL+ interventions. The primary study outcome was the proportion of total pregnancies in these villages who received ANC and HIV testing. Results. Between April 2011 and March 2012, 552 pregnant women participated in SCIL or SCIL+ interventions. Among women who were pregnant at the time of intervention delivery, 181 of 418 (43.3%) women pregnant at the time of intervention delivery received ANC in the SCIL arm, while 371 of 512 (72.5%) received ANC in the SCIL+ arm (P < 0.001); 175 (97%) in the SCIL and 366 (98.6%) in the SCIL+ arm consented to HIV testing (P < 0.001). HIV prevalence of 0.6% was detected among SCIL clinic, and 0.9% among attending SCIL+ clinic attendees. Conclusion. Provision of CCT to women's microeconomic SHG appears to significantly increase uptake of ANC/HIV testing services in rural Mysore villages.