Screening and management of depression among patients on TB treatment in Papumpare district, Arunachal Pradesh, India.

The TB-depression syndemic is a complex health condition. This study demonstrates a collaborative model to screen and manage depression among TB patients and understand the enablers and challenges from the healthcare workers perspective regarding its implementation. The PHQ-9 questionnaire was used to screen for depression and in-depth interviews among five healthcare workers were taken to explore its feasibility. Eight healthcare workers were trained for the screening that was carried out in two tuberculosis units of Papumpare district over a period of three months. Of 46 eligible patients screened, 43 (93.4%) screened positive for depression. Fifteen patients with moderate, moderately severe and severe depression were referred, of which five (33.3%) visited the psychiatric OPD. Two patients were diagnosed with clinical depression by a psychiatrist and started on treatment. The reasons for smaller number of patients being screened were time constraints, lack of manpower, lackadaisical attitude towards TB disease and patients' parents or guardians coming to take medicines. Enablers and challenges were explored under the heads of training, screening tool and PHQ-9 questionnaire, psychiatrist referral and counselling. This study demonstrates implementation of a feasible model for screening of depression among TB patients using the PHQ-9 questionnaire within programmatic settings using available resources.

Maternal and Child Health Training of Traditional Birth Attendants and Pregnancy Outcomes: A Systematic Review and Meta-analysis.

INTRODUCTION: In remote communities, maternal and child health is often compromised due to limited access to healthcare. Simultaneously, these communities historically rely greatly on traditional birth attendants (TBAs). However, optimal integration of these traditional methods with modern healthcare practices remains a topic of debate. We assessed the effect of maternal and child health training of traditional birth attendants on adverse pregnancy outcomes. METHODS: We conducted a systematic review and meta-analysis to answer the above research question. We independently screened studies using databases like PubMed, Scopus, and CENTRAL, extracted data, and assessed the study quality. Due to fewer original studies in this field, we considered both pre-post and between-group differences to assess the effect of differences. These were synthesised separately, assessed against a p-value function, and subjected to sensitivity analyses. RESULTS: We included six interventional studies. Training TBAs reduced the risk of perinatal mortality [0.69, 0.61-0.78] and 7-day neonatal mortality [0.65, 0.53-0.80] but not stillbirth [0.70, 0.39-1.26]. In randomized controlled trials, there is a lower risk of perinatal mortality [0.73, 0.67-0.79] and neonatal mortality [0.70, 0.62-0.80] but not stillbirth [0.81, 0.56-1.18] with trained traditional birth attendants. There are methodological concerns with most existing studies, including domains like allocation concealment. DISCUSSION: There is some evidence of the benefit of training TBAs, though of a low to very low certainty. Due to fewer studies, inconsistent estimates for different critical outcomes, and concerns with the existing studies, further well-designed studies can give more insights. They can also help optimize the contents of TBA training interventions. PROTOCOL: CRD42023412935 (PROSPERO).

A qualitative analysis to identify the issues of tuberculosis management in tribal areas of Rajasthan.

BACKGROUND: Tuberculosis (TB) is a disease with social issue. Tribal people are disproportionately affected by TB. There is a scarcity of data on issues of TB management among the tribal groups of India. The objective of this study was to get in-depth understanding of the issues hindering TB management among the tribal communities of Rajasthan, India. METHODS: We conducted qualitative study involving in-depth interviews with purposively selected healthcare service providers of the selected tribal areas of Rajasthan. Beside this, in-depth interviews and focus group discussions were also conducted among the purposively selected tribal people of these tribal areas. Data was collected using predesigned interview guides and a focus group discussion guide in their local setting in the local language. Information obtained were transcribed and translated into English language before analysing. Translated data was then coded and thematically organized. Inductive coding was used to identify emerging themes and sub-themes relevant to issues that occur during TB management. RESULTS: Several locally relevant issues were identified which negatively affected TB management in tribal areas of Rajasthan, India. Substance abuse, lack of awareness, discriminative behaviour, poor accessibility, exposure to mine dust, economic burden, migration, lack of training, irregular disbursement of incentive and staff behaviour emerged as major issues. CONCLUSION: This study identified the issues which hamper TB management in tribal population of Rajasthan, India. Result of this study can be useful in designing a tribal-centric approach to adequately manage TB among tribal population of Rajasthan.

The Legacy of Shanti Teresa Lakra and Its Impact on Public Health in the Andaman Islands.

In the Andaman and Nicobar Islands, Shanti Teresa Lakra, a committed Indian medical nurse, has made a major impact on public health. Lakra, who was born in Rangat on May 1, 1972, was motivated to become a nurse by her elder sister. Her work with the Onge tribe has earned her recognition, particularly in the wake of the 2004 tsunami that destroyed their settlements. Lakra has devoted her professional life to enhancing the health of these indigenous people and averting their extinction by working with particularly vulnerable tribal groups. When she started her work, there were just 78 Onge people living there. She worked constantly to improve healthcare and education, and in five years, the population grew to 100. Her effort required overcoming socioeconomic obstacles, linguistic limitations, and the tribe's initial apprehensions. Despite hazardous circumstances, Lakra helped by immunizing the Jarawa tribe during the COVID-19 outbreak. Her efforts have been recognized with prestigious awards, including the Florence Nightingale Award and the Padma Shri. Her legacy is marked by her empowerment of tribal communities, her role as a healthcare role model, and her advancements in public health in remote areas.

Prevalence of reproductive tract infection among tribal migrant women living in urban areas: a community-based cross-sectional study.

OBJECTIVES: The current study investigates the reproductive tract infections (RTIs) among tribal migrant women in urban areas of Gujarat, India. These groups of women face multiple challenges, including limited healthcare access, poor living conditions, and inadequate reproductive and child healthcare services. Therefore, the present study was conducted to assess the RTIs of tribal women living in urban areas. STUDY DESIGN: It was a community-based cross-sectional study. METHODS: It was conducted among the four municipal corporation areas in Gujarat. A sample of 592 women, who were in reproductive age (15-45 years) and belonging to tribal community and seasonally migrated to urban areas, were included for the study. RESULT: Almost 64% of the participants married before the legal age of 18, with 29% marrying before the age of 15. Furthermore, early pregnancy (at <18 years) was reported by 29% of the women. Approximately 22% of the women experienced reproductive health issues, with a prevalence of 13% for symptomatic RTIs, 8% for urinary tract infections (UTIs), and 8% for menstrual problems. Almost 58.4% of women with RTIs, 54.1% with UTIs, 48.9% with menstrual problems, and 46.1% with polycystic ovary syndrome were classified as underweight. However, this relationship was not statistically significant. CONCLUSION: The study revealed the 13% of the prevalence of RTIs among the migratory tribal women. It is matching with national-level community-based study of India National Family Health Survey. The current study explored that there is no association of nutrition and RTI. Also, it is required to plan a larger-level community-based study to understand overall reproductive health issues among all different group of women.

High non-use of contraception among tribal and non-tribal women in North-Eastern India: alarming but neglected.

Limited evidence exists about the contraception uptake in indigenous tribal groups of the north-eastern region of India. This study based on the National Family Health Survey (NFHS) IV (2015-2016) reports aimed to describe the pattern and factors associated with contraceptive non-use in the tribal women of the north-eastern part of India. The study was a cross-sectional analytical study based on secondary analysis of NFHS-IV data. All women in the age group of 15-49 years from the north-eastern part of India were included. Data were extracted and analysed using modified STATA-14 software. The association of socio-demographic and economic characteristics with contraceptive non-use was assessed using logistic regression. The inter-group differences of population characteristics for non-use contraceptives were assessed by modified Blinder-Oaxaca decomposition technique using 'Fairlie decomposition'. A total of 65,941 women were included, of whom 34,936 (52.9%) were tribal women. The proportion of contraceptive non-use was higher in tribal women. Tribal women with age at marriage above 30 years, Christian community, and women from Assam and Manipur state had higher odds of contraceptive non-use. The decomposition analysis showed that geographical variations, parity, and Christian religion contributed the most to contraceptive use disparity in the population. A huge gap was observed in contraceptive non-use among tribal and non-tribal women in the north-eastern part of India. The healthcare system must involve community representatives in designing context-specific community-based initiatives to increase the uptake of contraceptive use in these remote vulnerable communities.

Burden and Predictors of Anemia Among Pregnant and Lactating Females in a Rural Area in India With a High Tribal Population.

Introduction Nutritional anemia is a silent emergency particularly rampant in developing countries, especially among women of reproductive age group. This study was done with the objective to determine the prevalence and predictors of anemia among pregnant and lactating females in the Ormanjhi block of Ranchi district, Jharkhand. Methodology A community-based cross-sectional study was done on 388 pregnant and lactating females from July 2022 to June 2024 using a multi-stage cluster sampling technique. A pre-designed, pre-tested, semi-structured, interviewer-administered questionnaire containing different sections namely socio-demographic details, dietary history, menstrual history, obstetric history, antenatal history, medical history, behavioral history, and personal history was used. House-to-house visits were done for the collection of data. To estimate the prevalence, hemoglobin levels were analyzed using a digital hemoglobinometer. Results The overall prevalence of anemia among pregnant and lactating females was found to be 361 (93%) among 388 participants. Prevalence among pregnant females was 295 (92.76%) out of 318, and among lactating females, it was 66(94.28%) out of 70. The prevalence of anemia in the first trimester was 80 (80.45%) out of 87, 112 (94.91%) in the second trimester among 118, and 103 (91.15%) among 113 females in the third trimester. Conclusion There are concerns about stagnancy in the prevalence of anemia in pregnancy despite strong political commitments. A baseline data is generated from this study giving a clear picture of the exact prevalence and the predictors of anemia among pregnant and lactating females. This would help the policymakers to make warranted modifications imperative to improve the nutritional status of pregnant and lactating women and hence the children.

Cephalic Index Variation in the Indigenous Population of Tribal Districts in Himachal Pradesh.

Introduction The cephalic index (CI) is the most commonly used index to determine the race of an individual. It is calculated as the ratio of the breadth of the skull to the length of the skull multiplied by 100. The CI of an individual can be influenced by factors such as race, ethnicity, genetic predisposition, lifestyle choices, nutritional habits, environmental factors, and climatic conditions. Material and methods This study was carried out on 413 individuals in the tribal districts of Himachal Pradesh (Kinnaur, Spiti, and Lahaul), with 247 (59.8%) male and 166 (40.2%) female subjects. Measurements of the skull were taken using a spreading caliper. The CI was calculated using Hardlika's method and data were analyzed using IBM SPSS version 27 (IBM Corp., Armonk, NY, US). Results The head shapes of the majority of the tribal population of Himachal Pradesh are mesocephalic, with the mean CI for males and females being 78.90 and 79.81, respectively, without any significant difference. The mean CI of the overall population is 79.27. The majority population of the Kinnaur district is brachycephalic, while the Spiti and Lahaul populations are mesocephalic with females predominately brachycephalic and males predominately mesocephalic. Conclusion The Indigenous population of Himachal Pradesh is mesocephalic with females predominately brachycephalic.

There and back again: dynamics of temporary labor migration, insights from rural India.

Temporary labor migration is a household phenomenon among rural communities in India. This study seeks to understand the subjective experiences influencing the temporariness of labor migration among internal migrants in India by examining various factors such as migration conditions, motivation, migration arrangements, coping and adaptation strategies, and determinants of stay. To achieve this objective, the current qualitative study utilized 14 in-depth interviews and 2 focus group discussions to investigate the temporary nature of labor migration among internal migrants in India. Our findings reveal that migration decisions are rational choices made collectively at the household level, considering socio-economic outcomes. We also find that social networks and contractors facilitate migration arrangements and job connections, and migrants employ various strategies to reduce costs and cope with expenses in urban areas. However, migration destinations often fail to meet migrants' expectations, exposing them to low-wage employment and precarious working and living conditions, which are detrimental to their health. Limited housing and sanitation facilities further contribute to the challenges faced by migrants. Work conditions, including poor wages and high job demands, also affect their well-being. These findings highlight the need for improved support systems that address accommodation challenges, work conditions, and the overall welfare of labor migrants.

Skin diseases among the tribal population of Kerala: the challenges and way forward.

BACKGROUND: Kerala has a history of achievements in health through acting on the distal social determinants, but certain communities like tribals were pushed back from the stream of social development and health achievements. Subsequently, the lifestyle and the poor living conditions of tribes make them more prone to several diseases including skin diseases. However, neither the burden nor the situation of the same in the tribal population in several parts including Kerala is seldom assessed. MAIN BODY: The lack of awareness about the symptoms, complications, and management options as a part of the social backwardness has led to the concentration of certain diseases like Leprosy among the tribal community. In addition, the tribal population is under the threat of infectious diseases of public health significance like Leishmaniasis (CL). The tribal population owing to ignorance neglects the skin lesions or uses their local remedies. Tribes might have been using many local remedies for their issues, but the emerging skin diseases may not be amenable to local remedies and often impose significant public health concerns. Developing and maintaining an effectively functioning health system in these difficult-to-reach terrains is also a challenge. The pattern of skin diseases among tribals residing in environmentally sensitive localities is an indicator for the need for more social, economic and geospatial inclusion. Skin lesions of the tribal population should be kept under active surveillance activities through the integrated health information platform (IHIP) and it should follow a vigilant public health response if there are clusterings. A dedicated evidence-based system should be developed to diagnose and treat skin diseases of tribal people residing away from the availability of specialist care using local resources and community-level workers. CONCLUSION: The rampant skin diseases among tribals are the product of their unacceptable socio-economic status and living conditions. It could only improve through interventions focusing on social determinants of health. Improvements in the living conditions of tribals are sustainable long-term solutions, but such solutions should be coupled with medium-term and short-term strategies.

Social Determinants of Health, Tribal Payments, and Probability of Contracting COVID-19 in American Indian and Alaska Native Peoples.

Little is known about the relationships between demographic and economic social determinants of health and the probability of contracting COVID-19 in American Indian and Alaska Native (AI/AN) peoples. In addition, we do not know if and how tribal payments, unique to AI/AN peoples, are associated with the probability of contracting COVID-19. We surveyed 767 AI/AN patients of five geographically disparate health organizations that primarily served AI/AN peoples in urban settings between January and May of 2021. We used univariate modified Poisson regressions to estimate the influence of age, gender, household composition, education, household income, and tribal payments on risk of contracting COVID-19, with results presented as both risk and risk difference. Fifteen percent of the sample contracted COVID-19, and individuals who lived in households with two or more generations had an 11-percentage point elevated risk of contracting COVID-19 compared to those who lived alone. Twenty-seven percent of participants received tribal payments; receipt was associated with seven percentage points (change from 18% probability to 11% probability) lower risk of contracting COVID-19. Our findings showed interventions specifically designed to reduce the spread of COVID-19 in multigenerational households, and regular tribal payments may help improve health outcomes in urban AI/AN populations.

Dr. Ratan Chandra Kar: The Journey of the Jarawa Doctor.

 A distinguished physician Dr. Ratan Chandra Kar, born in 1954 in West Bengal, India, is known for his pivotal role in providing healthcare to the Jarawa tribe of the Andaman Islands. He began his service toward the Jarawa tribes in 1998, notably combating a devastating measles outbreak in 1999 that threatened the tribe's existence. Overcoming initial distrust, Dr. Kar earned the tribe's confidence through cultural respect and medical expertise, treating over a hundred patients at the peak of the epidemic. He had established a dedicated Jarawa Ward at Kadamtala Hospital, integrating their traditional practices with modern medicine. For his dedication, Dr. Kar received the Padma Shri in 2023, for contributing significantly to the tribe's growth from 255 to 260 individuals in 1998 to over 560 today. His work stands as a testament to the importance of culturally sensitive healthcare in preserving vulnerable indigenous communities.

Barriers and proposed solutions to at-home colorectal cancer screening tests in medically underserved health centers across three US regions to inform a randomized trial.

INTRODUCTION: At-home colorectal cancer (CRC) screening is an effective way to reduce CRC mortality, but screening rates in medically underserved groups are low. To plan the implementation of a pragmatic randomized trial comparing two population-based outreach approaches, we conducted qualitative research on current processes and barriers to at-home CRC screening in 10 community health centers (CHCs) that serve medically underserved groups, four each in Massachusetts and California, and two tribal facilities in South Dakota. METHODS: We conducted 53 semi-structured interviews with clinical and administrative staff at the participating CHCs. Participants were asked about CRC screening processes, categorized into eight domains: patient identification, outreach, risk assessment, fecal immunochemical test (FIT) workflows, FIT-DNA (i.e., Cologuard) workflows, referral for a follow-up colonoscopy, patient navigation, and educational materials. Transcripts were analyzed using a Rapid Qualitative Analysis approach. A matrix was used to organize and summarize the data into four sub-themes: current process, barriers, facilitators, and solutions to adapt materials for the intervention. RESULTS: Each site's process for stool-based CRC screening varied slightly. Interviewees identified the importance of offering educational materials in English and Spanish, using text messages to remind patients to return kits, adapting materials to address health literacy needs so patients can access instructions in writing, pictures, or video, creating mailed workflows integrated with a tracking system, and offering patient navigation to colonoscopy for patients with an abnormal result. CONCLUSION: Proposed solutions across the three regions will inform a multilevel intervention in a pragmatic trial to increase CRC screening uptake in CHCs.

Seroprevalence of Hepatitis C Virus Among Blood Donors in a Tribal-Preponderant Region of India.

INTRODUCTION: Hepatitis C is a global health burden with significant morbidity and mortality. It primarily affects the liver and causes acute hepatitis, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Common modes of transmission of hepatitis C virus (HCV) infection are blood transfusion, needlestick injury, and mother-fetus transmission, among which transmission, blood transfusion is one of the most important causes. Blood transfusion is one of the pillars in the management of patients that saves lives and improves morbidity. Blood donation in India is done by voluntary and replacement blood donors of both sexes. The aim of this study is to determine the seroprevalence of HCV among blood donors in the Jharkhand state, a tribal-preponderant region of India, and to see the trend over the years. MATERIAL AND METHODS: This is a nine-year retrospective observational study from 2015 to 2023 that screened for anti-HCV antibodies (third-generation kit: Abbott Diagnostics) using the chemiluminescence technique. RESULTS: In this study, in total, 249,461 units of blood were collected, of which the majority of donations were by male and replacement donors (RDs) comprising 230,757 (92.50%) and 188,047 (75.38%), respectively. The mean number of blood donations by replacement and male donors (MDs) was more than for voluntary donors (VDs) and female donors (FDs) (20894.11 ± 3041.71 RDs vs. 6823.77 ± 2332.96 VDs, p < 0.0001 and 25639.66 ± 2810.08 MDs vs. 2078.22 ± 828.16 FD, p < 0.0001), respectively. The overall prevalence of HCV was 0.63%, and all seropositive donors were male. CONCLUSION: Replacement blood donation contributes to the major part of blood donation and is primarily done by males in this tribal population-dominant region of India. Seroprevalence of HCV is high in the population of this part of India, and there is a constant or slightly upward trend in hepatitis C infection among individuals.

Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Introduction: Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. Methods: The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Results: Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Discussion: Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Provider's satisfaction with telemedicine services for tribals of Western Rajasthan: A qualitative analysis.

Background: There are significant barriers to healthcare access in tribal areas, even though for every 834 people, there is one public physician (registered allopathic and AYUSH doctors). More than 86% of hospital visits occur in rural areas. Furthermore, the bulk of them travel long distances to reach hospitals. A telemedicine center was established in the aspirational tribal district of Sirohi, Rajasthan, to provide accessible quality health care. Objective: To understand providers' attitudes and satisfaction with telemedicine services for tribal populations. Materials and Methods: This cross-sectional, mixed-method study enrolled consultants from various clinical departments of AIIMS Jodhpur (n = 23) who provide teleconsultations to the tribal population. Result: The mean score of the satisfactory index was 54.7 ± 22.04. The higher score is 87.4 regarding the ability to use the technology platform during teleconsultation. The lower score was 34.7 for video quality during teleconsultation at STHR. 91.3% found this a beneficial model for the tribal population. Consultants providing teleconsultations expressed that this model is a boon for tribal patients as a screening tool and will save time and money for improved accessibility. Conclusion: Positive indications of teleconsultation with a provider's utility, acceptability, and satisfaction. Most marginalized people can efficiently access all levels of (primary, secondary, or tertiary) health care from experts through telemedicine, which will broaden outreach in hard-to-reach or inaccessible tribal or rural areas.

Estimation of prakriti (body constitution) in women of Eastern Maharashtra tribal belt of central India featuring early and premature menopause.

Introduction: Prakriti (body constitution) is the essential fundamental of Ayurveda. In female physiology, it plays a crucial role in determining the age of menarche and menopause. Recent research has shown that early menopause occurs in tribal women. Vagbhata states that a kapha dosha pradhan prakriti female has a longer menstrual life [i.e., reproductive period] compared to the vata and pitta prakriti females. This study was done to estimate prakriti in females who attain early and premature menopause in the tribal population to provide optimal care for tribal women through primary and whole health systems. Materials and Methods: This cross-sectional questionnaire survey study was carried out in four villages of Nagpur district territory of Eastern Maharashtra, the central zone of India after seeking permission from IEC. A multistage sampling technique was used to select the 80%, and above tribal people, 169 married women who attained early or premature menopause were included. Post-menopausal women were selected for the study, and females with hysterectomy, secondary amenorrhea, and other major illnesses were excluded from the study. Data were collected by survey method with the help of a pre-validated questionnaire. Observation and Result: Out of 169 females 57.98% of females were of vata prakriti, 24.85% of females were of pitta prakriti, and 17.15% of females were of kapha prakriti. The prevalence of early or premature menopause of vata prakriti females is 57.98. Discussion: Vata dosha characteristics such as ruksha, laghu, sheeta, and khara in vata prakriti females lead to early or premature menopause. To avoid early or premature menopause in tribal females, ghee (ghrit) and milk can be included in dietary habits, lifestyle modification, and awareness counseling may prove beneficial. Conclusion: Early or premature menopause is observed largely in vata prakriti females of Nagpur district, Eastern Maharashtra, tribal zone of Central Inda.

Menstrual hygiene behaviour among the tribal married women aged 15 to 49 years: A cross-sectional study in a community development block of Paschim Bardhaman District, West Bengal.

Background: Menstrual hygiene management is integrally associated with reproductive health of women. Menstrual health and hygiene needs, particularly of tribal women still remain unmet for many reasons. Inappropriate menstrual behaviour leads to adverse health consequences. Objectives: This study aimed to ascertain the menstrual hygiene behaviour of tribal married women aged 15 to 49 years and its correlates. Methods: A descriptive cross-sectional study was conducted from May 2019 to April 2020 in the Barabani block of Paschim Bardhaman district, West Bengal. A calculated sample of 530 women was selected randomly from 10 tribal villages of the study area; they were interviewed through a pre-designed schedule for socio-demographic and menstrual hygiene behaviour characteristics. Menstrual hygiene management score was derived based on five essential components- hygienic absorbents, hygienic disposal of absorbents, frequency of changing of absorbents, cleaning of external genitalia and source of water for cleaning; menstrual hygiene behaviour was categorised as favourable and unfavourable. Bivariate and multivariable logistic regression was performed using SPSS v. 20. Results: All 530 women were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate. Sanitary pads were used by 43.8% of women; 63% practised indiscriminate throwing for disposal of absorbents; 86% practised appropriate changing of absorbents. Overall, 63% had favourable menstrual hygiene management behaviour, and the literacy status of women was found to be a significant predictor. Conclusion: Unfavourable menstrual practices are still widely prevalent among tribal women, mainly attributable to lack of knowledge. Awareness generation should be focused on improving those practices, which would also result in the improvement of general health conditions.

Contraceptive use, unmet need and its determinants among tribal married reproductive women: A community based observational study in a district of West Bengal.

Context: Reported literatures revealed the problems of access and misconceptions, low contraceptive usage and high unmet need for family planning among the tribes. Aims: Our aim was to find out the prevalence of contraceptive usage, unmet need and their determinants among tribal married reproductive women. Settings and Design: A community-based, observational, analytical research using cross-sectional design was conducted among 290 tribal women of the Nadia district of West Bengal. Subjects and Methods: After obtaining ethical clearance, an interviewer-administered pre-designed, structured proforma was used to collect information on socio-demographic attributes, marital history, contraceptives and fertility status, unmet needs and the reasons for not using contraceptives. Statistical Analysis Used: Bi-variate analysis was used to know the differences and a two-tailed significance test with a P value of 0.05 or less was considered statistically significant. Results: The present study revealed a high prevalence of teenage marriage (60.7%) and pregnancy (27.6%). Every one in six tribal women was illiterate. The contraceptive prevalence rate was 43.8%. Tubectomy (38.6%) was the most common method (38.6%) and unfelt need (19.6%) was the most common reason for non-use. Age, occupation of women, social class, living status, marital duration, number of living children and desire to have a future child were found to be associated with the current contraceptive use. Social class, number of living children, contraceptive awareness, source and place of availability, abortion history, opposition from family and husband, and husband participation all were significantly associated with the unmet need for family planning. Conclusion: In-depth counselling focusing on achieving a satisfactory level of awareness and acceptance of family planning methods may help to achieve reproductive health by reducing unmet needs.

Barriers and Opportunities for Tribal Access to Public Health Data to Advance Health Equity.

Public health authorities (PHAs), including Tribal nations, have the right and responsibility to protect and promote the health of their citizens. Although Tribal nations have the same need and legal authority to access public health data as any other PHA, significant legal challenges continue to impede Tribal data access.