Menstrual Hygiene Practices and Constraints in Availing Government Sanitary Pad Provision among Adolescents in Rural Puducherry: A Mixed Method Study.

CONTEXT: Although free and subsidized sanitary pads are provided by the government, proportion of adolescents availing this service remains low. AIMS: The aim of the study was to determine the proportion of adolescent girls availing supply of sanitary napkins from a rural health training center (RHTC) in Puducherry; to assess the level of satisfaction with government supply; and to identify reasons for not accessing the same. SUBJECTS AND METHODS: The mixed-method cross-sectional study done in July 2017 included 240 adolescent girls living in the RHTC service area of a tertiary care institute. Quantitative data were collected house to house with a pretested semi-structured questionnaire and qualitative data from a focused group discussion. RESULTS: Sanitary pads were used by all of the participants who achieved menarche. Of them, 87 (40.2%) used pads purchased outside and 127 (58.8%) used both government supply and private purchase. Reasons for not availing government supply were insufficient quantity and low quality, lack of information about the government provision, and accessibility issues. CONCLUSIONS: Ensuring better quality and adequate quantity of sanitary pads supplied by the government along with increased awareness about the government provision can increase the utilization of the same by rural adolescents.

Prevalence of Food Insecurity at Household Level and Its Associated Factors in Rural Puducherry: A Cross-Sectional Study.

BACKGROUND: Malnutrition is a consequence of food insecurity. Food insecurity in India became a public health problem due to explosive population growth and widening gap between rich and poor. It also has a detrimental effect on factors related to health and social well-being of the family. OBJECTIVES: The study was conducted to determine the prevalence of food insecurity at household level in rural population and factors associated with it. SUBJECTS AND METHODS: A community-based cross-sectional study was conducted among the households of rural Puducherry. The adult females in the households were interviewed with a pretested semi-structured questionnaire in which, along with sociodemographic factors, food insecurity was assessed using the Household Food Insecurity Access Scale. Univariate and multivariate logistic regression analysis was done to identify the factors associated with food insecurity. RESULTS: Out of 299 households that were assessed for food insecurity, 31.7% (95% confidence interval [CI]: 26.6-37.4) had food insecurity. Out of 95 households with food insecurity, 51 (17%), 37 (13%), and 7 (2%) had severe, moderate, and mild food insecurity, respectively. In univariate analysis, the presence of children in the family, using below poverty line ration card, and socioeconomic status were significantly associated with food insecurity. In multivariate analysis, socioeconomic status was significantly associated with food insecurity (rate ratio: 3.59; P < 0.001 [95% CI: 1.68-7.67]). CONCLUSIONS: One in three families experienced the food insecurity, and it was more among households with children. It has to be addressed to prevent nutrition-related disorders in community, particularly in children.

Costs incurred and determinants of out-of-pocket payments for child delivery care in India: Evidence from a nationally representative household survey.

In India, out-of-pocket (OOP) expenditure on health care services has been showing an increasing trend. The cost and willingness to pay determines the use of facility-based maternal health services. Hence, the current study was done to find the costs and determinants of OOP payments on childbirth care in India. We analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from the Demographic Health Survey (DHS) program. Stratification and clustering in the sample design were accounted for by using the "svyset" command. Out of 43 507 women, 26 916 (61.9%) had incurred OOP expenditure during their most recent institutional delivery. The average OOP expenditure for delivery care was INR 5985 ($93.3) with median cost being INR 1000 ($15.6). About 80% of women who had OOP expenditure reported that they handled the financial situation by utilizing the money in their bank/savings account. Determinants of OOP expenses were the age of mother, education, religion, state of residence, number of antenatal visits place of delivery, and mode of delivery (P < .05). Out-of-pocket expenditure for accessing care is one of the key determinants of service utilization which, if not addressed by the health system, can deter women from having institutional deliveries in the future.

Health information needs assessment among self-help groups and willingness for involvement in health promotion in a rural setting in Puducherry: A mixed-method study.

BACKGROUND: Health promotion is the process of enabling people to increase control over their own health. Community involvement in social and environmental interventions tends to improve people's health and quality of life. Self-help groups (SHGs) primarily focus on microfinancing, thereby acting as a catalyst in bringing backward society to the mainstream. They possess huge potential to influence the health of the community. OBJECTIVE: The objective of the study is to assess the willingness among SHGs for the involvement in health promotion activities and to assess their health information needs. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted during September 2017 in rural Puducherry. All 86 SHGs in four selected villages were covered, and their leaders were interviewed using a structured questionnaire on functioning of SHGs and their health information needs. Willingness for health promotion activities was rated on an interest scale (1-100). RESULTS: Among the 86 heads of SHGs interviewed, 81 SHGs (94.1%) were registered. They were mainly involved in microfinancing. Health information needs expressed were cancer detection (45%), diabetes (60%), hypertension (56%) and vector-borne diseases (63%). When asked to rate their willingness on an interest scale for health promotion activities, nearly 64% showed a great interest (i.e., score > 60). Majority were willing to work for noncommunicable disease-related activities such as provision of drugs (86%) and for screening of various cancers (84%). CONCLUSION: This study has shown that majority of SHG members have expressed willingness for the involvement in health-related activities, thereby can be utilized as an important resource for health promotion in rural areas.

Patient and Provider's Experience and Perspective in Addressing Barriers to Medication Adherence Among Noncommunicable Disease Patients in Rural Puducherry, South India-A Qualitative Study.

BACKGROUND: Trend in morbidity and mortality due to noncommunicable diseases (NCDs) is rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status. OBJECTIVES: To examine the barriers in drug adherence among NCD patients in rural Puducherry. METHODS: This qualitative study includes in-depth and key informant interview conducted among 6 NCD patients and 4 health-care providers. Interviews were audio-recorded, and transcript was prepared in verbatim format. Thematic content analysis was done to derive the categories and themes. RESULTS: Major barriers for nonadherence to medications found were stress, substance abuse, forgetfulness, lack of family support, and high case load of health facilities. Corrective measures suggested to address the barriers were to provide health education to patients and family members, awareness campaigns in community, and health education sessions at the clinic. CONCLUSION: Psychological factors such as stress, social isolation, and negligence are major barriers for drug adherence. Health education session at community and health system is needed to improve the adherence.

Assessment of the WHO Health Promoting Schools Framework among schools in selected villages of rural Puducherry, South India - a mixed method study.

BACKGROUND: The health of children and adolescents can be promoted through schools as they spend most of their time in school. The Health Promoting Schools (HPS) framework provides a set of policies to be followed in schools for improving the health status of school-going children and adolescents. The current study was done to assess this framework among schools in rural Puducherry. METHODS: Key informant interviews were done with the teachers under the six World Health Organisation (WHO) HPS framework domains to develop an observation checklist for the assessment of schools in the study area. After the survey, in-depth interviews were conducted as an approach to explore the existing health promotion activities, facilitating or hindering factors in the implementation of health promotion framework and suggestions for improving the same. RESULTS: A quantitative survey on nine schools showed that almost all the schools were lacking in domains such as health promotion policy, behaviour counselling and mental and social support. Physical education, facilities and policies for nutrition and community collaboration exist in only some of the schools. Qualitative interviews also showed similar findings and most of the teachers suggested to include training for general health emergencies and behaviour counselling. CONCLUSION: The current study showed that most of the schools were lacking in almost all the domains under the HPS framework. Hence, stakeholders at all levels should be made aware of this framework and develop a strategy for uniform implementation of it in all the schools in the region.

Preference for Private Sector for Vaccination of Under-Five Children in India and Its Associated Factors: Findings from a Nationally Representative Sample.

BACKGROUND: Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public-private partnership (PPP) model. METHODS: We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015-16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. RESULTS: Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7-10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. CONCLUSION: Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.

Prevalence and associated factors for social phobia among school-going adolescents in a rural area of Puducherry, South India.

BACKGROUND: The World Health Organisation has reported that mental disorders are one of the leading causes of disability worldwide. Social phobia is one such mental disorder that can have significant impact on the livelihood of adults if not detected at an early stage. There have been very few studies done on social phobia among adolescents in South India. Hence, this study was done to determine the prevalence of social phobia and factors associated with it among the school-going adolescents in rural Puducherry. METHODOLOGY: A community-based cross-sectional study was conducted among 1018 school going adolescents from December 2017 to January 2018 in rural Puducherry. Information on socio-demographic characteristics was collected by a pre-tested semi-structured questionnaire and social phobia was assessed using the validated Social Phobia Inventory (SPIN) questionnaire. RESULTS: Among 1018 participants, 738 (72.5%) belonged to early adolescence (10-13 years); 520 (51.1%) were boys; 557 (54.7%) were studying in a middle class; 931 (91.5%) were Hindus; 978 (96.1%) had siblings.The prevalence of social phobia among adolescents was found to be 22.9% (95% CI: 20.4-25.5%). The prevalence of mild social phobia was 18% [95% confidence interval (CI): 15.7-20.4%], moderate social phobia was 4% (95% CI: 2.9-5.4%), severe social phobia was 0.7% (95% CI: 0.3-1.3%) and very severe social phobia was 0.2% (95% CI: 0.03-0.64%). Higher age, female gender, lack of counselling services and specialist visits at school were found to be determinants of social phobia. CONCLUSION: The current study showed that one in every five adolescents was at risk of developing social phobia. Health education for students, teachers and family members needs to be given to make them aware of the importance of social phobia.

Awareness and practices of menstrual hygiene among females of reproductive age in rural Puducherry - a mixed method study.

BACKGROUND: Menstruation is a physiological process. Unfortunately, there is substantial lacuna in knowledge related to menstrual hygiene among females. OBJECTIVES: To assess the awareness and prevailing practices of menstrual hygiene, prevalence of symptoms related to genito-urinary tract infection, and the factors influencing menstrual hygiene practices, among women of reproductive age in rural Puducherry. METHODOLOGY: The study was conducted in March 2017 in rural Puducherry adopting a mixed-methods approach. A pre-tested semi-structured questionnaire was used for a quantitative survey among 357 women of reproductive age. Qualitative data was collected through focused group discussions (FGDs). RESULTS: The mean age of the participants was 28.25 + 9.25 years. Thirty-three percent of the respondents had menstrual knowledge prior to menarche. A total of 90.8% were aware that menstruation is a physiological process. The majority of respondents 94.1%, used sanitary napkins as absorbents during menstruation and 60.7% of them changed it 3 times a day. Regarding the method of disposal, 47.6% participants threw it into the routine waste and 43.8% burnt it after use. Among 8.9% of cloth users 62.5% used a new cloth for each cycle and 37.5% of respondents washed and reused the cloth. Satisfactory cleaning of external genitalia was practised by 62.2%. Only 11.2% respondents had symptoms related to genito-urinary tract infection. From FGDs it was observed that the several socio-cultural factors and taboos restrict them from practising safe menstrual hygiene practices. CONCLUSION: Our study has revealed that most of the females are still unaware of menstrual hygienic practices which suggest the need for appropriate health intervention measures to be implemented for their well-being.

Screening for red flag symptoms of cancer: A community-based cross-sectional study from urban Puducherry, India.

BACKGROUND: Patients with cancer often delay seeking medical advice in developing countries. In India, only 20%-30% of cancers are being diagnosed in Stages I and II. Screening for red flag symptoms of cancer can be used to identify high-risk individuals in the community. METHODOLOGY: A community-based cross-sectional study was conducted in February 2017 among 302 participants in one of the service areas of Jawaharlal Institute of Postgraduate Medical Education and Research urban health center selected by universal sampling. Data on the presence of red flag symptoms of cancer (persistent cough, persistent change in bowel/bladder habits, nonhealing ulcer, persistent difficulty in swallowing, unexplained weight loss, unexplained lump, persistent unexplained pain, unexplained bleeding, and change in the appearance of mole) and presence of risk factors were collected through interviews. The collected data were entered using EpiData version 3.0. RESULTS: The mean (standard deviation) age of the study participants was 44 (11) years and 50.6% of them were male. At least one red flag symptom of cancer was present in 22 (7.3%) individuals; 9 (2.8%) had unexplained pain, 4 (1.3%) had change in bowel habits, 4 (1.3%) had change in bladder habits, 3 (1%) had cough, 3 (1%) had nonhealing ulcer, 2 (0.6%) had unexplained bleeding, 1 (0.3%) had difficulty in swallowing, 1 (0.3%) had weight loss, 1 (0.3%) had lump, and 1 (0.3%) had change in the appearance of mole. CONCLUSION: Screening for red flag symptoms of cancer is an easy tool that can be used in the community to identify high-risk individuals, which will facilitate early diagnosis of cancer.