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.

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.