Kusuma Ys

Antenatal care service utilization in tribal and rural areas in a South Indian district: an evaluation through mixed methods approach

BACKGROUNDnMaternal and child healthcare is one of the eight basic components of primary healthcare. Poor access and utilization of antenatal care (ANC) services continue to contribute to high maternal mortality and morbidity; and the services of primary healthcare are amenable for evaluation.nnnAIMnTo report the utilization of ANC services by women living in tribal and rural areas in the district of Visakhapatnam, Andhra Pradesh, India.nnnMATERIALS AND METHODSnBoth qualitative and quantitative methods were used in the study. Quantitative data on ANC were collected from women having a child aged less than a year (n=380) through a structured interview schedule. The qualitative data were collected through indepth interviews with key informants in the villages (n=12).nnnRESULTSnThe study reports higher utilization of ANC compared with the national average of India. A greater proportion of women living in tribal areas utilize the services from governmental sources (92%), whereas approximately 54% of the rural women seek services (paid services) from private practitioners. Health workers visits match with the utilization of government health services.nnnCONCLUSION AND RECOMMENDATIONSnThe study showed relatively higher utilization of ANC services than the national average, but at the same time, child deliveries at home, which were mostly conducted by untrained elderly women, were also high. This gap is indicative of the target-oriented approach where quantity rather than the quality takes priority. In addition, the literacy levels of women, socioeconomic conditions and distance to the health facilities also played a role. To improve utilization and access, community health needs assessment has to be made, along with attempts to develop community participation.

Health-related quality of life of elderly living in the rural community and homes for the elderly in a district of India. Application of the short form 36 (SF-36) health survey questionnaire.

The present investigation aimed to assess the health-related QoL (HRQoL) of elderly people living in two settings: (i) rural community and (ii) homes for the elderly in a district of South India. The data are drawn from elderly (>60xa0years of age) sampled from both settings. The short form 36-item health survey (SF-36) was administered to all respondents. The average scores for several domains, including total physical health, total mental health and overall health (total SF-36 score) were around 50, which can be interpreted as a moderate level of health-related QoL. Residents living in a home for the elderly scored better in all domains except for role-physical and role-emotional. Though univariate analysis revealed some associations between characteristics of elderly SF-36 scores, the multiple regression analysis indicated that working status yields a significant but negative coefficient for total SF-36 score among community dwelling elderly. The elderly report that their lives are better when they are staying in homes for the elderly. Hence, despite the socio-economic conditions, provision of a better and conducive environment by setting up more charity-based homes for the elderly may be one of the options for relative betterment of the QoL of the elderly, particularly those who are socially and economically deprived. Finally, the study warrants the need of normative values of SF-36 for various population groups in India.ZusammenfassungZiel dieser Untersuchung war es, die gesundheitsbezogene Lebensqualität („health-related quality of life“, HRQoL) älterer Personen in zwei Lebensumfeldern zu erfassen: (i) in der eigenen bäuerlichen Gemeinschaft und (ii) in Altenheimen eines Bezirks in Südindien. Die Daten stammen von älteren Personen (>60xa0Jahre) aus beiden Umgebungen. Zur Erhebung war allen Teilnehmern der „short form 36-item health survey“ (SF-36) zugestellt worden. Die durchschnittlichen Scores für mehrere Dimensionen, einschließlich der physischen, der mentalen und der alle Befindlichkeiten umfassenden Gesundheit (Gesamt-SF-36-Score) lagen bei ca. 50; dies kann als mittelmäßiger Grad der gesundheitsbezogenen Lebensqualität interpretiert werden. Menschen in Altenheimen erreichten höhere Werte in allen Dimensionen, mit Ausnahme der körperlichen und emotionalen Rollenfunktionen. Obwohl durch Varianzanalyse einige Beziehungen zwischen den bestimmte Eigenschaften der Älteren betreffenden SF-36-Scores hergestellt werden konnten, deuten die Ergebnisse der multiplen Regressionsanalyse darauf hin, dass der Arbeitsstatus der Befragten einen signifikanten, aber negativen Faktor für den Gesamt-SF-36-Score der in bäuerlicher Umgebung wohnenden Älteren darstellt. Das Leben der älteren Menschen in Altenheimen ist besser. Deswegen könnte die Bereitstellung einer besseren und förderlicheren Umgebung, trotz der sozioökomischen Bedingungen, in durch Wohltätigkeitseinrichtungen finanzierten Altenheimen eine der Optionen für eine relative Verbesserung der Lebensqualität älterer Menschen sein, insbesondere für solche, die sozial und finanziell benachteiligt sind. Ebenso rechtfertigt diese Studie die Notwendigkeit der Erhebung von Richtwerten des SF-36 für einzelne Populationsgruppen Indiens.

Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India

Background: In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care. Objective: To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India. Methods: A total of 175 households with a child aged 0–14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008. Results: Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child’s gender (female) (P = 0.05), mother’s education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure. Conclusion: Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.

Health-related quality of life of elderly living in the rural community and homes for the elderly in a district of India@@@Gesundheitsbezogene Lebensqualität älterer in der bäuerlichen Gemeinschaft und im Altenwohnheim lebender Personen in einem Bezirk Indiens: Application of the short form 36 (SF-36) health survey questionnaire@@@Anwendung der Kurzform des SF-36-Fragebogens zum Gesundheitszustand

The present investigation aimed to assess the health-related QoL (HRQoL) of elderly people living in two settings: (i) rural community and (ii) homes for the elderly in a district of South India. The data are drawn from elderly (>60xa0years of age) sampled from both settings. The short form 36-item health survey (SF-36) was administered to all respondents. The average scores for several domains, including total physical health, total mental health and overall health (total SF-36 score) were around 50, which can be interpreted as a moderate level of health-related QoL. Residents living in a home for the elderly scored better in all domains except for role-physical and role-emotional. Though univariate analysis revealed some associations between characteristics of elderly SF-36 scores, the multiple regression analysis indicated that working status yields a significant but negative coefficient for total SF-36 score among community dwelling elderly. The elderly report that their lives are better when they are staying in homes for the elderly. Hence, despite the socio-economic conditions, provision of a better and conducive environment by setting up more charity-based homes for the elderly may be one of the options for relative betterment of the QoL of the elderly, particularly those who are socially and economically deprived. Finally, the study warrants the need of normative values of SF-36 for various population groups in India.ZusammenfassungZiel dieser Untersuchung war es, die gesundheitsbezogene Lebensqualität („health-related quality of life“, HRQoL) älterer Personen in zwei Lebensumfeldern zu erfassen: (i) in der eigenen bäuerlichen Gemeinschaft und (ii) in Altenheimen eines Bezirks in Südindien. Die Daten stammen von älteren Personen (>60xa0Jahre) aus beiden Umgebungen. Zur Erhebung war allen Teilnehmern der „short form 36-item health survey“ (SF-36) zugestellt worden. Die durchschnittlichen Scores für mehrere Dimensionen, einschließlich der physischen, der mentalen und der alle Befindlichkeiten umfassenden Gesundheit (Gesamt-SF-36-Score) lagen bei ca. 50; dies kann als mittelmäßiger Grad der gesundheitsbezogenen Lebensqualität interpretiert werden. Menschen in Altenheimen erreichten höhere Werte in allen Dimensionen, mit Ausnahme der körperlichen und emotionalen Rollenfunktionen. Obwohl durch Varianzanalyse einige Beziehungen zwischen den bestimmte Eigenschaften der Älteren betreffenden SF-36-Scores hergestellt werden konnten, deuten die Ergebnisse der multiplen Regressionsanalyse darauf hin, dass der Arbeitsstatus der Befragten einen signifikanten, aber negativen Faktor für den Gesamt-SF-36-Score der in bäuerlicher Umgebung wohnenden Älteren darstellt. Das Leben der älteren Menschen in Altenheimen ist besser. Deswegen könnte die Bereitstellung einer besseren und förderlicheren Umgebung, trotz der sozioökomischen Bedingungen, in durch Wohltätigkeitseinrichtungen finanzierten Altenheimen eine der Optionen für eine relative Verbesserung der Lebensqualität älterer Menschen sein, insbesondere für solche, die sozial und finanziell benachteiligt sind. Ebenso rechtfertigt diese Studie die Notwendigkeit der Erhebung von Richtwerten des SF-36 für einzelne Populationsgruppen Indiens.