Suchismita Mishra

Mass drug administration under the programme to eliminate lymphatic filariasis in Orissa, India: a mixed-methods study to identify factors associated with compliance and non-compliance

The present study aimed to identify the factors responsible for compliance and non-compliance of mass drug administration (MDA) under the programme to eliminate lymphatic filariasis (LF) from Orissa, India. It was based on both quantitative (through household MDA coverage survey) and qualitative data (through semi-structured interviews with heads of compliant and non-compliant households) collected during an MDA held in November 2005 in two districts of Orissa. In these districts, 83% of the eligible population received the drug (coverage) and only 49.5% people actually consumed the drug (compliance). Seventeen percent of the population did not even receive the drug. The predominant reason for not receiving the drug at household level was that the drug distributor did not visit the household, while the fear of adverse reactions is the predominant reason for not consuming it. The qualitative data revealed that the major contributor to taking the drug was the awareness that drug protects them from LF. Motivation by health workers was another reason for compliance. In many endemic areas, the issues related to non-compliance were taken casually during implementation. Hence, it is imperative to make the programme more efficient by addressing the issues linked to low compliance.

Primary Healthcare Services Among a Migrant Indigenous Population Living in an Eastern Indian City

This paper reports the accessibility and utilization of the healthcare services among a migrant indigenous community inhabiting slums of an eastern Indian city. It is based on data collected through semi-structured interviews conducted with heads of the households. The results indicated that the services of health personnel by visiting households are rare and the service provision was very poor. For curative services, the people heavily depend on private practitioners, including unqualified practitioners, by spending large proportions of their earnings. Due to migration, this community becomes more vulnerable to low utilization of healthcare services. This study warrants evolving a system of healthcare to cater the needs of vulnerable migrant groups in urban areas of India.

Use of an inclusive-partnership strategy in urban areas of Orissa, India, to increase compliance in a mass drug administration for the control of lymphatic filariasis

Abstract In India, the programme to eliminate lymphatic filariasis, which is largely based on mass administrations of diethylcarbamazine, has, in terms of coverage and compliance, been generally much less successful in urban areas than in rural communities. An innovative strategy to make the programme more effective in urban settings, largely based on an inclusive partnership and community participation, has recently been developed. An evaluation of the strategys implementation in Orissa, which employed both quantitative and qualitative methods of data collection, revealed significantly higher coverage and compliance in an urban area where the strategy had been implemented than in a similar urban area where there had been no such intervention. Application of this strategy in other urban settings in general, and in small towns in particular, is recommended in India.

Household Livelihood and Coping Mechanism During Drought among Oraon Tribe of Sundargarh District of Orissa, India

Abstract The present study attempted to report the livelihood and coping strategies at the household level during drought among Oraon tribe living in Sundargarh district of Orissa. The study is based on both quantitative and qualitative data collected from households and key-informants in the community. These data were based on the livelihood and coping strategies during the drought and lean period during the year 2002. The scanty of rainfall due to irregular monsoon in the current Kharif crop season (2002) has resulted in massive crop failure and subsequent acute drought condition. During this period, the Oraons of this area have implemented a range of livelihood and coping strategies to reduce their vulnerability. The present study reports some rituals that followed by Oraons to appease, the Lord lndra (the god of rain). In addition, some social support system to cope up during drought also existed in this tribe. At household level, reduction of food consumption and change in the pattern of food consumption are important strategies to cope up with low resources. Majority of people in this area changed their occupation, as agriculture is failed due to drought. Also many households either sold or mortgaged their lands and household assets. Some of the people, including young children migrated temporarily to other places for livelihood. Various studies from other drought prone areas were reviewed and discussed briefly in the light of present study results.

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.