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Kumar P, Srivastava S, Chauhan S, Patel R, Marbaniang SP, Dhillon P. Factors associated with gynaecological morbidities and treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India. PLoS One 2021; 16:e0252521. [PMID: 34086759 PMCID: PMC8177445 DOI: 10.1371/journal.pone.0252521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Gynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India. METHODOLOGY The study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10-19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables. RESULTS Overall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (β: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (β: 0.09; CI: 0.00, 0.19). The adolescents who had 8-9 (β: 0.17; CI: 0.05, 0.29) or ten and above years of education (β: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (β: -0.09; CI: -0.17, -0.01) than urban counterparts. CONCLUSION Multi-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.
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Affiliation(s)
- Pradeep Kumar
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | - 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
| | - Preeti Dhillon
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
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Ortayli N, Ringheim K, Collins L, Sladden T. Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD). Contraception 2014; 90:S22-31. [PMID: 25023474 DOI: 10.1016/j.contraception.2014.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/22/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite being recognized as an important challenge at the 1994 International Conference on Population and Development (ICPD), sexually transmitted ınfections (STIs) other than HIV are one of the most neglected dimensions of sexual and reproductive health. STIs, often undiagnosed and untreated, have especially harmful consequences for women and their neonates. PROGRESS SINCE ICPD During the last two decades, substantial knowledge and experience have accumulated in behavior change programming during the global response to the HIV epidemic which can also be used for prevention of STIs. There has been progress in development and implementation of vaccines against certain STIs such as hepatitis B and the human papilloma virus. Development of a rapid, point-of-care test for syphilis has opened the door to control this infection. CHALLENGES The estimated annual incidence of non-HIV STIs has increased by nearly 50% during the period 1995-2008. The growth in STIs has been aggrevated by a combination of factors: lack of accurate, inexpensive diagnostic tests, particularly for chlamydia and gonorrhea; lack of investment to strengthen health systems that can deliver services for diagnosis and management of STIs; absence of surveillance and reporting systems in the majority of countries; political, socioeconomic and cultural barriers that limit recognition of STIs as an important public health problem; and failure to implement policies that are known to work. RECOMMENDATIONS Governments, donors and the international community should give higher priority to preventing STIs and HIV; fully implementing behavior change interventions that are known to work; ensuring access of young people to information and services; investing in development of inexpensive technologies for STI diagnosis,treatment and vaccines; and strengthening STI surveillance, including of microbial resistance.
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Affiliation(s)
| | | | - Lynn Collins
- 330 East 38th Street, Apt 21B, New York, NY 10016, USA
| | - Tim Sladden
- 330 East 38th Street, Apt 21B, New York, NY 10016, USA
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Care Seeking Behaviour and Barriers to Accessing Services for Sexual Health Problems among Women in Rural Areas of Tamilnadu State in India. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2014; 2014:292157. [PMID: 26316973 PMCID: PMC4437401 DOI: 10.1155/2014/292157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/23/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
Background. Sexually transmitted infections (STIs) may be either asymptomatic or symptomatic. Regardless of the presence or absence of symptoms all STIs can lead to major complications if left untreated. Objective. To assess the care seeking behaviour and barriers to accessing services for sexual health problems among young married women in rural areas of Thiruvarur district of Tamil Nadu state in India. Methods. A community based cross-sectional study was conducted in 28 villages selected using multistage sampling technique for selecting 605 women in the age group of 15–24 years during July 2010–April 2011. Results. The prevalence rate of reproductive tract infections (RTIs) and STIs was observed to be 14.5% and 8.8%, respectively, among the study population. Itching/irritation over vulva, thick white discharge, discharge with unpleasant odor, and frequent and uncomfortable urination were most commonly experienced symptoms of sexual health problems. Around three-fourth of the women received treatment for sexual health problems. Perception of symptoms as normal, feeling shy, lack of female health workers, distance to health facility, and lack of availability of treatment were identified as major barriers for not seeking treatment for RTIs/STIs. Conclusion. Family tradition and poor socioeconomic conditions of the family appear to be the main reasons for not utilizing the health facility for sexual health problems. Integrated approach is strongly suggested for creating awareness to control the spread of sexual health problems among young people.
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Khan N, Kausar R, Flach C, Howard L. Psychological and gynecological morbidity in women presenting with vaginal discharge in Pakistan. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17542863.2011.579710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kostick KM, Schensul SL, Jadhav K, Singh R, Bavadekar A, Saggurti N. Treatment seeking, vaginal discharge and psychosocial distress among women in urban Mumbai. Cult Med Psychiatry 2010; 34:529-47. [PMID: 20533080 DOI: 10.1007/s11013-010-9185-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Vaginal discharge (safed pani in Hindi, meaning "white water") is one of the leading symptoms for which women in India seek care. Treatment-seeking for safed pani is disproportionately high among poor women, representing a physical, emotional and financial burden for low-income families. Safed pani is only rarely indicative of a reproductive tract or sexually transmitted infection. The discrepancy between symptom reports and observed pathology has led some researchers to characterize safed pani as a culturally based expression of more generalized negative life situation. Data are drawn from two prevention intervention studies (2002-2006 and 2007-2012) conducted in economically marginal communities in Mumbai. Results show that husbands as problem generators and spousal abusers and women's greater perceived empowerment and reported tension are significantly associated with safed pani. These results provide the basis for identifying women at greater risk for psychosocial distress and providing supports at the locations at which they seek treatment.
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Affiliation(s)
- Kristin M Kostick
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1912, USA.
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Symptoms of Reproductive Tract Infections and Mental Distress among Women in Low-Income Urban Neighborhoods of Beirut, Lebanon. J Womens Health (Larchmt) 2009; 18:1701-8. [DOI: 10.1089/jwh.2008.0962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sudha S, Morrison S, Zhu L. Violence against women, symptom reporting, and treatment for reproductive tract infections in Kerala state, Southern India. Health Care Women Int 2007; 28:268-84. [PMID: 17364985 DOI: 10.1080/07399330601180164] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this article we examine factors associated with women's self-reports of reproductive ill health symptoms and factors associated with seeking and receiving treatment for the symptoms. We focus on indicators of women's societal position, especially empowerment (indicated by experience of and attitudes toward violence against women), autonomy, and education. We used data from the National Family Health Survey-2 from Kerala state in Southern India. Based on our results we suggest that violence against women, whether actually experienced or internalized as acceptance of its justification, is associated with increased ill health symptoms, and the acceptance of violence is associated with decreased chance of treatment. Women's higher formal education appeared to reduce treatment seeking for reproductive ill health, perhaps due to the stigma associated with sexually transmitted disease (STD) in this cultural setting. Women's work participation had no significant impact, nor did indicators of women's economic and personal autonomy.
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Affiliation(s)
- S Sudha
- Department of Human Development and Family Studies, University of North Carolina at Greensboro, Greensboro, North Carolina 27402-6170, USA.
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Kielmann K. Theorizing health in the context of transition: the dynamics of perceived morbidity among women in peri-urban Maharashtra, India. Med Anthropol 2002; 21:157-205. [PMID: 12126274 DOI: 10.1080/01459740212903] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In international health, transition models that project global trends in fertility, morbidity, and mortality have been challenged for their underlying assumptions about modernization and the inability to capture inequities in the distribution of health and health services, the resurgence of infectious diseases and an apparent rise in perceived morbidity. The evidence that individuals' perceived morbidity rarely corresponds to biomedical measures of health status prompts questions regarding the relationship of epidemiologic transitions to shifts in ways of recognizing, representing, and responding to health and illness. In both international and national health policy and research, the discursive parameters of "women's health" in India largely reflect the logic of transition models and rarely consider how women themselves see "health" and its determinants, the dynamics of women's perceived morbidity, and women's response to changes in local medical discourse and practice. Drawing on survey and ethnographic data collected during 1996-97 in a peri-urban community located near the city of Pune in Maharashtra, Western India, I examine the context and content of intergenerational differences in perceived morbidity among women. Among these women, perceived morbidity is an important gauge of the conceptual health transition taking place in urbanizing areas of India, and, potentially, it tells us far more about social change and its impact on health than do statistical representations and models.
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Affiliation(s)
- Karina Kielmann
- Health Policy Unit, London School of Hygiene and Tropical Medicine, University of London, UK.
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Koenig M, Shepherd M. Alternative study designs for research on women's gynaecological morbidity in developing countries. REPRODUCTIVE HEALTH MATTERS 2001; 9:165-75. [PMID: 11765393 DOI: 10.1016/s0968-8080(01)90103-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although community-based studies are considered to be the 'gold standard' for research on gynaecological morbidity among women, there is growing appreciation of the significant challenges to successfully undertaking such studies in developing countries. In this review, the constraints to undertaking community-based studies are discussed and alternative study designs are evaluated. Our review suggests that these alternative designs have both limitations as well as strengths compared to community-based designs. An important limitation concerns possible selection bias in the populations studied and the extent to which findings can be generalized to the broader population. Important advantages include higher feasibility, lower respondent refusal rates especially for medical procedures, lower costs, and potentially a more direct link between research and utilization. We conclude that the alternative study designs considered provide researchers with an expanded array of tools for investigating the issue of women's gynaecological morbidity in developing countries.
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Affiliation(s)
- M Koenig
- Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD 21205, USA.
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Boonmongkon P, Nichter M, Pylypa J. Mot luuk problems in Northeast Thailand: why women's own health concerns matter as much as disease rates. Soc Sci Med 2001; 53:1095-112. [PMID: 11556778 DOI: 10.1016/s0277-9536(00)00404-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this paper, we consider women's illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major women's reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant women's health concern in rural Northeast villages. Women's embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, women's responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of women's self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how women's concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to women's own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on women's health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.
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Affiliation(s)
- P Boonmongkon
- Center for Health Policy Studies, Faculty of Social Sciences and Humanities, Mahidol University, Nakornpathom, Thailand
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Harlow SD, Campbell OM. Menstrual dysfunction: a missed opportunity for improving reproductive health in developing countries. REPRODUCTIVE HEALTH MATTERS 2000; 8:142-7. [PMID: 11424262 DOI: 10.1016/s0968-8080(00)90016-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The field of population has undergone a paradigm shift to a broader focus on reproductive health, which recognises women's self-perceived health needs. Investigations in various countries reveal that menstruation is a primary concern of women. Yet sparse attention has been paid to understanding or ameliorating women's menstrual complaints. We propose including the management of menstrual complaints as part of reproductive health programming. Next steps should include further quantitative and qualitative research to understand the prevalence, determinants and consequences of menstrual dysfunction; developing appropriate protocols and low-cost interventions for diagnosis and treatment of menstrual morbidity and training of health care workers in resource-scarce settings; and developing educational interventions to facilitate women's understanding of normal menstrual function and variability as well as of the types, causes and appropriate treatments for menstrual dysfunction.
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Affiliation(s)
- S D Harlow
- Department of Epidemiology, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.
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Patel V, Oomman N. Mental health matters too: Gynaecological symptoms and depression in South Asia. REPRODUCTIVE HEALTH MATTERS 1999. [DOI: 10.1016/s0968-8080(99)90004-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Measuring reproductive health is problematic. Awareness of the problems needs to be raised both among those collecting and those using data on reproductive health. This paper discusses two major measurement questions--one related to ascertainment and the other to attribution. The first question is to what extent the observed levels and patterns of reproductive health outcomes in women are valid as opposed to artefacts of the data sources and the data collection methods? The second question is can lack of evidence of effectiveness for any reproductive health intervention ever confidently be separated into no effects vs an inability to measure effects? Determining the effectiveness of health interventions is notoriously difficult. Reproductive health may not be a case for special pleading in the competition for scarce resources, but equally it should not be a case for special standards of proof of the effectiveness of interventions--standards which have not indeed been met by many other, and yet unquestioned, health care priorities. "What works" in reproductive health should in fact be judged from at least four different perspectives: from that of women and their families, health professionals, the scientific community, and national and international policy-makers.
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Affiliation(s)
- W J Graham
- Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, Aberdeen University, UK.
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