Jagdish C. Bhatia

Self-reported symptoms of gynecological morbidity and their treatment in south India.

This article presents an analysis of self-reported symptoms of gynecological problems among 3,600 recent mothers in Karnataka State, India. Approximately one-third of all women reported at least one current symptom; the most common were a feeling of weakness and tiredness (suggestive of anemia); menstrual disorders; white or colored vaginal discharge (suggestive of lower reproductive tract infection); and lower abdominal pain and discharge with fever (suggestive of acute pelvic inflammatory disease). Obstetric morbidity, associated with the last live birth, was strongly predictive of current gynecological symptoms. Women who delivered their last child in a private institution were significantly less likely to report symptoms than were those who delivered at home or in a government hospital. Nonusers or users of reversible contraceptive methods were also less likely to report symptoms of morbid conditions than were sterilized women. These associations persisted in analyses controlling for potentially confounding economic and demographic characteristics, and have far-reaching policy implications.

Levels and causes of maternal mortality in southern India.

Most studies of maternal mortality are hospital based. However, in developing countries, where many such deaths take place in the home, hospital statistics do not reflect the true extent of maternal mortality. Furthermore, the socioeconomic and demographic factors and health behavior affecting maternal mortality are rarely known. A study conducted in 1986 in South India demonstrates a new approach to investigating maternal mortality that combines the collection of information from hospital and health-facility records, field surveys, and case-control studies. The findings from this study indicate that there were 7.98 maternal deaths per 1,000 live births. Approximately one-half of the deaths occurred in the home or on the way to the hospital. Maternal deaths accounted for 36 percent of mortality for women of reproductive age. Analysis reveals that many of these deaths were preventable and that significant differentials existed with regard to demographic, social, and behavioral factors between the cases of maternal deaths and the controls.

Levels and determinants of gynecological morbidity in a district of south India.

This article presents the results of an assessment of gynecological morbidity among 385 women with young children residing in a district of Karnataka State, South India. All three main modes of assessment (clinical examination, laboratory tests, and self-reports) reveal a high burden of reproductive tract infections. The two most common conditions, identified by laboratory tests, were bacterial vaginosis and mucopurulent cervicitis. Approximately one-fourth of the women had clinical evidence of pelvic inflammatory disease, cervical ectopy, and fistula. The contribution of sexually transmitted diseases to overall gynecological morbidity appears to be relatively modest; 10 percent were so diagnosed. Associated conditions of anemia and chronic energy deficiency were common. Severe anemia was found in 17 percent of cases and severe chronic energy deficiency in 12 percent. These results indicate that radical improvements in womens health in India will require far more than the diagnosis and treatment of reproductive tract infections.

Obstetric morbidity in south India: Results from a community survey

A sample of 3600 mothers with at least one pre-school age child were interviewed in detail about obstetric problems associated with their last confinement. About 10% reported one or more of the classic symptoms of pre-eclampsia; and 8% reported symptoms of potentially life-threatening conditions during delivery, most notably prolonged labour of over 18 hr. Disorders during the post-partum period were more common; 10% reported excessive bleeding, loss of consciousness or convulsions (all indicative of potentially serious conditions) and an additional 17% reported symptoms of infections. The level of health care received by women is described.

The contribution of reproductive ill-health to the overall burden of perceived illness among women in southern India

OBJECTIVE To investigate womens perceptions of the overall burden of illness among a sample of women in southern India. METHODS A community-based sample of 421 young married women in a subdistrict about 70 kilometres from Bangalore, Karnataka State, India, were interviewed monthly for one year. At each visit, information on the symptoms of all forms of illness they had experienced was elicited with the aid of a checklist. Details were obtained on the durations of episodes of illness and on health-seeking behaviour and costs. The symptoms were subsequently coded in accordance with the International Classification of Diseases (ICD-10). FINDINGS Reproductive ill-health accounted for half of all illness-days and for 31% of total curative health expenditure. The 1990 Global Burden of Disease study estimated that 27.4% of disability-adjusted life years (DALYs) lost in Indian women aged 15-44 years were attributable to reproductive ill-health. CONCLUSIONS Our study indicates that this dimension of morbidity, when measured in terms of womens subjective experiences, makes a larger contribution to the burden of illness than that suggested by the DALY approach. This lends justification to the high priority attached to reproductive ill-health in India.

Mothers’ Perceptions and Attitudes towards Maternal Morbidity in Rural West Bengal: Findings from Focus Group Discussions:

The determinants of maternal morbidity are now receiving considerable attention. A study on maternal (obstetric) morbidity was conducted in three districts of West Bengal, India, where focus group discussions (FGD) revealed women’s perceptions, knowledge and awareness of lacunae in the health system. Women’s perspectives culled through FGD need to be incorporated into health policy and administration to improve women’s reproductive healthcare and reduce mortality.