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Aguzzi A, Frost CJ, Singh T, Benson LS, Gren LH. Exploring the preferences of traditional versus Western medicine in the Spiti Valley region of India: A qualitative approach. DIALOGUES IN HEALTH 2024; 5:100185. [PMID: 39021532 PMCID: PMC11253261 DOI: 10.1016/j.dialog.2024.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/28/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024]
Abstract
Background Traditional healing practices are prevalent in rural and mountainous areas of India where Western medicine is not accessible. WHO guidelines recommend integration of traditional and Western medicine to meet rural primary care needs. We explored three dimensions of rural patients' decision-making and satisfaction with their medical care: pregnancy-related concerns, pediatric care for children under five, and acute injuries. Methods We conducted a qualitative study using a phenomenological approach in India's Spiti Valley between August and October 2023. Sixteen individuals, age 18 years and older, participated in one-on-one interviews. The interviews were transcribed from Hindi into English, reviewed for accuracy by a native speaker, and imported into Dedoose software. Data were analyzed using inductive coding. Findings Multiparous women aged 35-44 were concerned about pregnancy complications, leading them to choose Western medicine despite access and cost barriers. Pediatric illness requiring urgent care at night was a concern for women with children under five. Those in the injuries group reported having to travel for care beyond basic first aid. Overall, concerns were about limited access to some services locally, as well as costs of travel, medical procedures, and medications when services were obtained beyond the local area. Interpretation All participants considered their traditional healer their first point of contact for medical care. A number of Western medical services were not available locally. These findings suggest a need to strengthen access to and integration of Western and traditional medical care in rural settings in India.
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Affiliation(s)
- Annica Aguzzi
- University of Utah, Department of Family & Preventive Medicine, Division of Public Health, 375 Chipeta Way A, Salt Lake City, UT 84108, United States of America
| | - Caren J. Frost
- University of Utah, College of Social Work, 395 1500 East, Salt Lake City, UT 84112, United States of America
| | - Tejinder Singh
- University of Utah, Department of Family & Preventive Medicine, Division of Public Health, 375 Chipeta Way A, Salt Lake City, UT 84108, United States of America
| | - L. Scott Benson
- University of Utah, Department of Family & Preventive Medicine, Division of Public Health, 375 Chipeta Way A, Salt Lake City, UT 84108, United States of America
| | - Lisa H. Gren
- University of Utah, Department of Family & Preventive Medicine, Division of Public Health, 375 Chipeta Way A, Salt Lake City, UT 84108, United States of America
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Kar R, Wasnik AP. Determinants of public institutional births in India: An analysis using the National Family Health Survey (NFHS-5) factsheet data. J Family Med Prim Care 2024; 13:1408-1420. [PMID: 38827686 PMCID: PMC11141982 DOI: 10.4103/jfmpc.jfmpc_982_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 06/04/2024] Open
Abstract
Background Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India. Method We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch's t-test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike's Information Criterion (AIC) and adjusted R2 values to identify the best-fit model. Results We find no significant difference between urban and rural areas (P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India. Conclusion Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.
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Affiliation(s)
- Rohan Kar
- Doctoral Researcher, Marketing Area, Indian Institute of Management Ahmedabad. Gujarat, India
| | - Anurag Piyamrao Wasnik
- Doctoral Researcher, Innovation and Strategy, Beedie School of Business, Simon Fraser University (SFU), Vancouver, Canada
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Ray A, Samra T, Mahajan V, Singla K, Naik BN, Joshi B, Ashok V, Suri V, Singh M, Ghosh A, Puri GD. Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study. J Family Med Prim Care 2022; 11:6478-6486. [PMID: 36618233 PMCID: PMC9810863 DOI: 10.4103/jfmpc.jfmpc_551_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients. Materials and Methods Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021. Results In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS). Conclusions The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.
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Affiliation(s)
- Ananya Ray
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Varun Mahajan, Assistant Professor, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
| | - Karan Singla
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B Naveen Naik
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharti Joshi
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vighnesh Ashok
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Regassa LD, Tola A, Weldesenbet AB, Tusa BS. Prevalence and associated factors of home delivery in Eastern Africa: Further analysis of data from the recent Demographic and Health Survey data. SAGE Open Med 2022; 10:20503121221088083. [PMID: 35342629 PMCID: PMC8949735 DOI: 10.1177/20503121221088083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: The current study aimed to determine the magnitude of home delivery and its associated factors in East Africa using data from the Demographic and Health Survey. Methods: We pooled data from the Demographic and Health Survey of the 11 East African countries and included a total weighted sample of 126,107 women in the study. The generalized linear mixed model was fitted to identify factors associated with home delivery. Variables with adjusted odds ratio with a 95% confidence interval, and p value < 0.05 in the final generalized linear mixed model were reported to declare significantly associated factors with home delivery. Result: The weighted prevalence of home delivery was 23.68% (95% confidence interval: [23.45, 23.92]) among women in East African countries. Home delivery was highest in Ethiopia (72.5%) whereas, it was lowest in Mozambique (2.8%). In generalized linear mixed model, respondent’s age group, marital status, educational status, place of residence, living country, wealth index, media exposure, and number of children ever born were shown significant association with the home delivery in the East African countries, Conclusion: Home delivery varied between countries in the East African zone. Home delivery was significantly increased among women aged 20–34 years, higher number of ever born children, rural residence, never married, or formerly married participants. On the contrary, home delivery decreased with higher educational level, media exposure, and higher wealth index. Wide-range interventions to reduce home delivery should focus on addressing inequities associated with maternal education, family wealth, increased access to the media, and narrowing the gap between rural and urban areas, poor and rich families, and married and unmarried mothers.
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Affiliation(s)
- Lemma Demissie Regassa
- Epidemiology and Biostatistics Department, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Assefa Tola
- Epidemiology and Biostatistics Department, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Adisu Birhanu Weldesenbet
- Epidemiology and Biostatistics Department, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Biruk Shalmeno Tusa
- Epidemiology and Biostatistics Department, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
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Shah S, Desai S, Desai T, Szkwarko D, Desai G. Trends and risk factors in tribal vs nontribal preterm deliveries in Gujarat, India. AJOG GLOBAL REPORTS 2021; 1:100026. [PMID: 36277462 PMCID: PMC9563542 DOI: 10.1016/j.xagr.2021.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although risk factors of preterm deliveries across the world have been extensively studied, the trends and risk factors of preterm deliveries for the population of rural India, and specifically tribal women, remain unexplored. OBJECTIVE The aim of this study was to assess and compare the preterm delivery rates among women from a rural area in Gujarat, India, based on socioeconomic and clinical factors. The second aim of the study was to assess and identify predictors or risk factors for preterm deliveries. STUDY DESIGN This was a retrospective medical record review study investigating deliveries that took place at the Kasturba Maternity Hospital in Jhagadia, Gujarat, from January 2012 to June 2019 (N=32,557). We performed odds ratio and adjusted odds ratio analyses of preterm delivery risk factors. Lastly, we also considered the neonatal outcomes of preterm deliveries, both overall and comparing tribal and nontribal mothers. RESULTS For the study period, the tribal preterm delivery rate was 19.7% and the nontribal preterm delivery rate was 13.9%; the rate remained consistent for both groups over the 7-year study period. Adjusted odds ratios indicated that tribal status (adjusted odds ratio, 1.16; 95% confidence interval, 1.08–1.24), maternal illiteracy ((adjusted odds ratio, 1.29, 95% confidence interval, 1.18–1.42), paternal illiteracy (adjusted odds ratio, 1.27; 95% confidence interval, 1.15–1.410), hemoglobin <10 g/dL (adjusted odds ratio, 1.41; 95% confidence interval, 1.32–1.51), and a lack of antenatal care (adjusted odds ratio, 2.15; 95% confidence interval, 1.94–2.37) are significantly associated with higher odds of preterm delivery. The overall stillbirth rate among tribal women was 3.06% and 1.73% among nontribal women; among preterm deliveries, tribal women have a higher proportion of stillbirth outcomes (11.77%) than nontribal women (8.86%). CONCLUSION Consistent with existing literature, risk factors for preterm deliveries in rural India include clinical factors such as a lack of antenatal care and low hemoglobin. In addition, sociodemographic factors, such as tribal status, are independently associated with higher odds of delivering preterm. The higher rates of preterm deliveries among tribal women need to be studied further to detail the underlying reasons of how it can influence a woman's delivery outcome.
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Affiliation(s)
- Shital Shah
- Warren Alpert Medical School of Brown University, Providence, RI (Ms Shah)
- Corresponding author: Shital Shah, MPA.
| | - Shrey Desai
- Society for Education Welfare and Action (SEWA) Rural, Jhagadia, Gujarat, India (Drs S Desai, T Desai, and G Desai)
| | - Tushar Desai
- Society for Education Welfare and Action (SEWA) Rural, Jhagadia, Gujarat, India (Drs S Desai, T Desai, and G Desai)
| | - Daria Szkwarko
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI (Dr Szkwarko)
| | - Gayatri Desai
- Society for Education Welfare and Action (SEWA) Rural, Jhagadia, Gujarat, India (Drs S Desai, T Desai, and G Desai)
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Patel R, Marbaniang SP, Srivastava S, Kumar P, Chauhan S. Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality. BMC Public Health 2021; 21:1785. [PMID: 34600528 PMCID: PMC8487549 DOI: 10.1186/s12889-021-11779-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To promote institutional delivery, the Government of India, through the Janani Suraksha Yojana (JSY) program, gives monetary reward to all pregnant women who give birth at the government or private health center. Despite providing cash assistance, a higher number of women are still preferring delivering at home. Therefore, this study sought to determine the prevalence of home births and identifying the factors influencing women's choice of home deliveries. METHODS Data from the National Family Health Survey (NFHS) conducted during 2005-06 and 2015-16 were used in the study. The respondents were women 15-49 years; a sample of 36,850 and 190,898 women in 2005-06 and 2015-16 respectively were included in the study. Multivariate logistic regression was used to determine the factors influencing home delivery. Income-related inequality in home delivery was quantified by the concentration index (CI) and the concentration curve (CC), and decomposition analysis was used to examine the inequality in the prevalence of home deliveries. RESULTS The prevalence of home deliveries has reduced from 58.5% in 2005-06 to 18.9% in 2015-16. The odds of delivering babies at home were lower among women who had full ANC in 2005-06 [AOR: 0.34; CI: 0.28-0.41] and in 2015-16 [AOR: 0.41; CI: 0.38-0.45] and were higher among women with four or higher parity in 2005-06 [AOR: 1.70; CI: 1.49-1.92] and in 2015-19 [AOR: 2.16; CI: 2.03-2.30]. Furthermore, the odds of delivering babies at home were higher among rural women and were lower among women with higher education. It was found that the value of CI increased from - 0.25 to - 0.39 from 2005-06 to 2015-16; this depicts that women delivering babies at home got more concentrated among women from lower socio-economic status. CONCLUSION There is a need to promote institutional deliveries, particular focus to be given to poor women, women with higher parity, uneducated women, and rural women. ANC is the most concurring contact point for mothers to get relevant information about the risks and complications they may encounter during delivery. Therefore, effort should be directed to provide full ANC. Targeted interventions are called for to bring improvements in rural areas.
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Affiliation(s)
- Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Strong P Marbaniang
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India.
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