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
BACKGROUND: Nipah is an emerging zoonotic disease that is transmitted through contaminated food or directly between people. Recently, Nipah virus infection was confirmed in Kochi, Kerala, making it the fourth outbreak reported in India. However, due to its good epidemic response, the health system of Kerala was able to control it in a timely manner. OBJECTIVE: To qualitatively analyse the response of the health system of Kerala in controlling the Nipah outbreak (2019) by identifying the enabling factors and the challenges faced by it. METHODS: A qualitative study was conducted using grounded theory approach. Key informant interviews were conducted till data saturation was reached. The audio recorded data was translated, transcribed and was manually coded and thematically analysed. RESULTS: The major enablers for its apt response were identified to be effective communication, good line of control, effective division of work, intersectorial coordination, strong leadership, political commitment, resilient public private partnership and support groups, past experiences in disaster management, quick procurement of medicines and availability of lab facilities. On the other hand, the challenges identified were initial confusions, lack of standard operating procedures/guidelines for epidemic management, complacency, lack of effective zoonotic surveillance, media management and community participation. CONCLUSION: This study attributes the success of the outbreak response to the strong leadership and political commitment. In order to prevent recurrences in the future, there is a need to build a resilient health system through capacity building and further strengthening of the surveillance system.
ABSTRACT
The coexistence of raised blood pressure (BP) in people with type 2 diabetes mellitus (T2DM) is a major contributor to the development and progression of both macrovascular and microvascular complications. The aim of our study was to determine the prevalence of uncontrolled BP and its associated factors in persons with T2DM in a district in Kerala. METHODS: The study was conducted in Ernakulam district in Kerala, and a total of 3,092 individuals with T2DM were enrolled after obtaining consent. Those with a BP "above or equal to 140 mmHg" and/or "above or equal to 90 mmHg" were thus considered to have uncontrolled BP. If the BP was equal or >140 and/or 90 mmHg, a repeat reading was taken after 30 min and the average of the two was considered. Basic demographic details were enquired along with electronic measurement of BP, HbA1c estimation and screening for diabetic retinopathy, peripheral arterial disease (PAD), and peripheral neuropathy. Quantitative and qualitative variables were expressed as mean (SD) and proportions, respectively. The model for determinants of uncontrolled BP was developed adjusting for age, gender, education, duration of diabetes, occupation, body mass index (BMI) and clustering effect. RESULTS: The mean age of the study population was 59.51 ± 9.84 years. The mean duration of T2DM was found to be 11.3 ± 6.64 years. The proportion of uncontrolled HTN adjusted for clustering was 60% (95% CI 58 and 62%). Among them, only one in two persons (53.3%) had a history of hypertension. Age >60 years [adjusted odds ratio (aOR) 1.48, 95% CI 1.24, 1.76; p < 0.001], unemployment (aOR 1.33, 95% CI 1.01, 1.75; p < 0.01), duration of diabetes > 11 years (aOR 1.42, 95% CI 1.19, 1.68; p < 0.001), and BMI ≥23 (aOR 1.33, 95% CI 1.10, 1.59; p < 0.002) were found to be independent determinants of high BP levels when adjusted for the aforementioned variables, gender, education, and cluster effect. The association between complications, such as peripheral neuropathy, PAD, and retinopathy showed a higher risk among those with uncontrolled BP. Retinopathy was 1.35 times more (95% CI 1.02, 1.7, p < 0.03), PAD was 1.6 times more (95% CI 1.2, 2.07, p < 0.001), and peripheral neuropathy was 1.5 (95% CI 1.14, 1.9, p < 0.003) times more compared to their counterparts. CONCLUSION: Target BP levels were far from being achieved in a good majority of the persons with T2DM. To reduce further macrovascular and microvascular events among people with T2DM, effective awareness and more stringent screening measures need to be employed in this population.
