Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

BACKGROUND: Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. METHODS: The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. RESULTS: Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. CONCLUSIONS: In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities often cause residents to bypass them in favour of tertiary hospitals or private sector facilities. Families follow a complex selection process, mediated by their ability to mobilise economic and social resources, and a concern for positive experiences of health care and outcomes. Health managers must ensure quality services, a functioning regulatory mechanism, and monitoring of provider behaviour.

Fundamental approach in the management of Drava Bahula Amlapitta with Bhringaraja (Eclipta alba).

The disease Amlapitta has been selected for the clinical trials because it presents two type of manifestations depending upon the involvement of Agni (Ushnagunadhikya) and Jala (Dravagunadhikya) Mahabhuta. The present research work was focused at Drava Guna, with an aim to assess the efficacy of a drug with quality of Ruksha and Ushna predominance like Bhringaraja in treating Amlapitta with Pitta Drava Guna Vriddhi. Randomized open clinical trials were conducted on 22 patients of Amlapitta who were screened on the basis of clinical findings and allocated in to two groups. The criteria for selection were the signs and symptoms of Dravagunadhikya Amlapitta, irrespective of sex, religion, etc. Group A consisting of 15 cases received the trial drug Bhringaraja tablet (4 Tab. two times, 1 tablet=500 mg) and 7 cases in Group B received rice powder tablet as a placebo (4 Tab. two times, 1 tablet=500 mg) for 4 weeks. Special scoring pattern was adopted for the assessment of Amlapitta. Routine pathological tests such as blood, urine, stool, etc. were also carried out. In Group A, 55.33% patients showed marked improvement, whereas moderate improvement was observed in 26.67% patients. Complete cure was found in 06.67% of the patients and mild improvement in the chief complaints was observed in 13.33% patients. All the selected symptoms showed statistically significant results (P<0.01) except the Vidbheda in treated Group A, while in Group B, all symptoms showed statistically insignificant results except the Utklesha and Amlodgara. Total effect of the therapy showed statistically significant effect of the test drug. These results support the hypothesis.