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Muralidhar K, Nishimura H, Coursey K, Krupp K, Jaykrishna P, Srinivas V, Madhivanan P. Knowledge and practice of family planning among pregnant tribal women in Southern India: an observational study. Contracept Reprod Med 2024; 9:2. [PMID: 38217011 PMCID: PMC10785510 DOI: 10.1186/s40834-023-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND There are over 700 Scheduled Tribes (ST) living in 30 Indian states. As with other indigenous groups across the world, Indian ST have some of the poorest infant and child health outcomes of any communities in India. A child born to an ST family is 19% more likely to die in the first month of life and has a 45 percent risk of dying in their first year compared with other Indian populations. Research suggests that early conception, high fertility, and low use of family planning methods are large contributors to these disparities. METHODS A cross sectional survey in Kannada was conducted among 303 pregnant tribal women in Mysore, India after obtaining informed consent. Univariate and multivariable analyses were carried out to determine the demographic and psychosocial factors associated with knowledge of contraceptive methods using Stata 14.0. RESULTS There was widespread knowledge about female sterilization, while only 39.3% of women reported hearing about one or more forms of temporary contraception, and 36.3% knew where to get them. The largest proportion of women had heard about copper-T (33.0%), followed by oral contraceptive pills (23.8%), condoms (11.9%), and injectables (4.6%). Only 2.7% of women reported ever using any form of temporary contraception. Results from the multivariable logistic regression indicated that knowledge of at least one form of temporary contraception was linked to higher age (adjusted odds ratio[AOR]: 1.09; 95% CI: 1.02, 1.17), greater number of years of marriage (AOR: 0.90; 95% CI: 0.85, 0.96), and last birth in a government facility (AOR: 3.67; 95% CI: 1.99, 6.82). CONCLUSIONS The study revealed poor knowledge and utilization of temporary contraceptive methods among a tribal population in rural Mysore, India. Interventions aiming to increase knowledge of contraceptive options are important for birth spacing in this population and should target younger women and those without contact with government health facilities.
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Affiliation(s)
- Kiranmayee Muralidhar
- Public Health Research Institute of India, Mysore, Karnataka, India.
- JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
| | - Holly Nishimura
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Coursey
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245209, Tucson, Arizona, 85724-5209, USA
| | | | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245209, Tucson, Arizona, 85724-5209, USA
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N Srinivas P, Seshadri T, Velho N, Babu GR, Madegowda C, Channabasappa Y, Majigi SM, Bhat D. Response to correspondence article on the research protocol titled Towards Health Equity and Transformative Action on tribal health (THETA) studyto describe, explain and act on tribal health inequities in India: A health systems research study protocol. Wellcome Open Res 2023; 8:155. [PMID: 37766856 PMCID: PMC10521096 DOI: 10.12688/wellcomeopenres.19190.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 09/29/2023] Open
Abstract
In this correspondence, we, co-authors and collaborators involved in the Towards Health Equity and Transformative Action on tribal health (THETA) study respond to a recent article published in Wellcome Open Research titled Correspondence article on the research protocol titled 'Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol' published in Wellcome Open Research in December 2019 In the first part, we provide overall clarifications on the THETA study and in the second part respond to specific comments by the authors of the aforementioned correspondence.
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Affiliation(s)
- Prashanth N Srinivas
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Tanya Seshadri
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | | | - Giridhar R Babu
- Indian Institute of Public Health, Bangalore, Karnataka, 560023, India
| | - C Madegowda
- Jilla Budakattu Girijana Abhivruddhi Sangha, Chamarajanagar, Karnataka, 571441, India
| | - Yogish Channabasappa
- Field station BR Hills, Institute of Public Health Bengaluru, Chamarajanagar, Karnataka, 571441, India
| | - Sumanth Mallikarjuna Majigi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysore, Karnataka, 570001, India
| | - Deepa Bhat
- Department of Anatomy, JSS Medical College, Mysore, Karnataka, 570015, India
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Nallala S, Ghosh U, Desaraju SS, Kadam S, Kadarpeta RR, Van Belle S. Why are they "unreached"? Macro and Meso determinants of health care access in hard to reach areas of Odisha, India. Int J Equity Health 2023; 22:2. [PMID: 36604683 PMCID: PMC9814452 DOI: 10.1186/s12939-022-01817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Reaching hard to reach populations is key to reduce health inequities. Despite targeted interventions, status of crucial public health indicators like neonatal and maternal mortality is still far from optimal. Complex interplay of social determinants can influence both communities and health care workers to effectively access each other. We argue that culturally sensitive and contextually relevant healthcare provision has potential to increase health care utilization by the vulnerable communities living in remote areas. METHODS The study is an exploratory case study using rapid ethnographic techniques to understand the interplay of social determinants in hard to reach areas of Odisha state, India. We used in-depth interviews, focus group discussion, participatory action research and key informant interviews as tools for data collection. The analysis of data has been guided by thematic analysis approach. RESULTS We found that there are further layers within the designated hard to reach areas and those can be designated as-i) extremely remote ii) remote and iii) reachable areas. Degree of geographic difficulties and cultural dynamics are deciding the 'perceived' isolation and interaction with health care providers in hard to reach areas. This ultimately leads to impacting the utilization of the facilities. At extremely remote areas, felt health needs are mainly fulfilled by traditional healers and ethno-medical practices. In reachable areas, people are more prone to seek care from the public health facilities because of easy accessibility and outreach. Being in middle people in remote areas, diversify health care seeking depending upon social (e.g. patient's gender) economic (e.g. avoid catastrophic expenditure) and health system (timely availability of health human resources, language barriers) factors. CONCLUSION Our research highlights the need to value and appreciate different worldviews, beliefs and practices, and their understanding of and engagement with the pluralistic health care system around them. Other than pursuing the 'mainstreaming' of a standardized health system model across hard to reach areas, strategies need to be adaptive as per local factors. To handle that existing policies need revision with a focus on culturally sensitive and contextual care provision.
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Affiliation(s)
- Srinivas Nallala
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
| | - Upasona Ghosh
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
| | - Shyama Sundari Desaraju
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
| | - Shridhar Kadam
- grid.415361.40000 0004 1761 0198Indian Institute of Public Health Bhubaneswar, Bhubaneswar, India
| | | | - Sara Van Belle
- grid.11505.300000 0001 2153 5088Institute of Tropical Medicine, Antwerp, Belgium
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Kumar R, Dumka N, Kotwal A. Correspondence article on the research protocol titled ' Towards Health Equity and Transformative Action on tribal health (THETA) study to describe, explain and act on tribal health inequities in India: A health systems research study protocol' published in Wellcome Open Research in December 2019. Wellcome Open Res 2023; 8:3. [PMID: 37840884 PMCID: PMC10568208 DOI: 10.12688/wellcomeopenres.18425.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 10/17/2023] Open
Abstract
Research on indigenous (Tribal) populations is a step towards understanding the various tribal health issues and challenges and paves the way for addressing these issues. However, such populations are categorised as vulnerable and marginalised according to National ethical guidelines by Indian council of medical research. Hence, adequate measures are needed to be ensured by researchers while undertaking any research involving tribal populations to safeguard the rights of research participants. The purpose of this correspondence is to initiate a discussion among the researchers to give due consideration to research ethics especially when the research is being conducted on vulnerable populations and take adequate safeguard measures as suggested by National ethical guidelines to protect the rights of study participants.
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Affiliation(s)
- Rajnesh Kumar
- Knowledge Management Division, National Health Systems Resource Centre, Delhi, Delhi, 110067, India
| | - Neha Dumka
- Knoiwledge Management Division, National Health systems resource centre, Delhi, Delhi, 110067, India
| | - Atul Kotwal
- National Health Systems Resource centre, National Health Systems Resource centre, Delhi, Delhi, 110067, India
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Wood LM, D’Evelyn SM, Errett NA, Bostrom A, Desautel C, Alvarado E, Ray K, Spector JT. "When people see me, they know me; they trust what I say": characterizing the role of trusted sources for smoke risk communication in the Okanogan River Airshed Emphasis Area. BMC Public Health 2022; 22:2388. [PMID: 36539797 PMCID: PMC9763808 DOI: 10.1186/s12889-022-14816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As wildfire smoke events increase in intensity and frequency in the Pacific Northwest, there is a growing need for effective communication on the health risks of smoke exposure. Delivery through a trusted source or intermediary has been shown to improve reception of risk communication messages. This is especially salient in rural and tribal communities who may be hesitant to trust information from state and federal agency sources. This study aims to identify and characterize trusted sources for smoke risk information in the Okanogan River Airshed Emphasis Area (ORAEA), a rural region of North Central Washington state that is heavily impacted by smoke from wildfires and prescribed fire. METHODS The research team conducted a qualitative study using data collected through key informant interviews and focus groups to assess the role of various sources and intermediaries in disseminating smoke risk information. We used a consensual coding approach in NVivo Qualitative Analysis Software to sort data into preliminary categories, which were grouped into themes using a thematic analysis approach. We used member checking and iterative feedback processes with local project partners throughout the project to ensure credibility of results. RESULTS Through the analysis, we identified three themes characterizing trusted sources for smoke risk communication in the ORAEA. These themes were: (1) local and tribal sources of information are perceived as more trustworthy than state and federal government sources, (2) trustworthiness is determined by an evaluation of multiple factors, in particular, perceived credibility, quality of information, and relationship with the source, and (3) conservative political ideology and perceived parallels with COVID-19 communication influence perception of trust. Within each theme, we identified several sub-themes, which contributed additional nuance to our analysis. CONCLUSION This study provides insights into which sources of information are trusted by rural and tribal community members in the ORAEA and why. Results from our study emphasize the importance of relationships and collaboration with local and tribal partners in smoke risk communication. In this paper, we discuss implications for state and federal agency practitioners and present recommendations for how to work with local and tribal partners on smoke risk communication.
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Affiliation(s)
- Leah M Wood
- Department of Global Health, University of Washington, Seattle, USA
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, USA
| | - Savannah M D’Evelyn
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA
| | - Nicole A Errett
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA
| | - Ann Bostrom
- Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle, USA
| | - Cody Desautel
- Confederated Tribes of the Colville Reservation Natural Resources Department, Nespelem, USA
| | - Ernesto Alvarado
- School of Environmental and Forestry Sciences, University of Washington, Seattle, USA
| | - Kris Ray
- Confederated Tribes of the Colville Reservation Natural Resources Department, Nespelem, USA
| | - June T Spector
- Department of Global Health, University of Washington, Seattle, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA
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Mahajan N, Kshatriya GK. Prevalence of metabolic syndrome and associated risk factors among tribal adolescents of Gujarat. Diabetes Metab Syndr 2020; 14:995-999. [PMID: 32622209 DOI: 10.1016/j.dsx.2020.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIM Metabolic syndrome is rising at an alarming rate in developing countries. In India, increasing influence of urbanization in the rural areas is responsible for transition in lifestyle and diet of the indigenous people. Therefore, this study aims to estimate the prevalence of metabolic syndrome and the associated risk factors among the adolescents of Kukana tribe of Valsad district, Gujarat. METHODS A cross-sectional study was conducted on 296 adolescents (128 boys and 168 girls) aged 14-19 years. Semi-structure interview schedule including demographic characteristics like age, sex, clan, native village was administered. Anthropometric measurements (height, body weight, waist circumference), systolic and diastolic blood pressure, biochemical tests were recorded. Data was entered in MS-Excel, and SPSS was used to analyse descriptive statistics (mean and standard deviations), frequencies and test of significance such t-test and chi-square. Prevalence of metabolic syndrome and associated risk factors was determined by National Cholesterol Education Program Adult Treatment Panel III modified for adolescents by Cook's criteria. RESULTS Overall prevalence of metabolic syndrome was estimated as 3.8%, with sex-wise prevalence found to be 3.9% and 3.6% in boys and girls, respectively. Low High-Density Lipoprotein Cholesterol was the most prevalent individual risk factor observed in the present study. CONCLUSION This study is the first study which assessed metabolic syndrome and its components in tribal adolescents in India. Tribal communities are susceptible a triple burden of diseases. Micro-level and grassroot community-based studies should be designed and carried out in tribal communities, in order to provide better healthcare deliveries.
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Affiliation(s)
- Nupur Mahajan
- Department of Anthropology, University of Delhi, India.
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Kshatriya GK, Acharya SK. Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals. Diabetes Metab Syndr 2019; 13:1105-1115. [PMID: 31336452 DOI: 10.1016/j.dsx.2019.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/21/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With the increased worldwide prevalence of hypertension among the underprivileged populations, fewerstudies have reported such risks among Indian tribes. In the context of high prevalence of undernutrition, no such study has examined hypertension among lean and underweight Indian tribal individuals separately. METHODS We selected total samples of 1066 adult males and 1090 adult females in 20-60 years age-group cross-sectionally to examine the status of hypertension and its risks among nine major tribes in three Indian states; separate analyses for lean and underweight tribal individuals were done. RESULTS Increased prevalence of hypertension (females, 14.2%; males, 9.3%) was observed among the tribes with the overall percentage of individuals at adversity (hypertensive + isolated hypertensive) at more than 20% (males 20.1%; females 26.5%). Age-group-wise prevalence showed a sharp rise in the prevalence of hypertension in the 40 + year individuals; additionally, this rise was alarming among females. Undernutrition was observed to be a potential risk factor as a remarkable prevalence of hypertension was observed among the undernourished (approximately 9%) and lean tribal participants (12%). Underweight females were observed to be at higher risk. Tribal statuses were observed to be alarming than the national trends due to their very low average BMI along with high average SBP. A curvilinear prevalence of hypertension was observed while comparing through both the nutritional extremes. CONCLUSION The increased prevalence and risks of hypertension in the background of lean and underweight status of Indian tribes indicates their epidemiological transition burdened with alarming cardio-metabolic health risks that warrant an early and consistent surveillance.
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Affiliation(s)
| | - Subhendu K Acharya
- National Institute of Epidemiology Social and Behavioural Sciences, Chennai, Tamilnadu, 600077, India.
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Kshatriya GK, Kumari A, Acharya SK. Comparing the ability of anthropometric indicators in determining the prevalence of hypertension among Indian tribes. Diabetes Metab Syndr 2019; 13:696-706. [PMID: 30641792 DOI: 10.1016/j.dsx.2018.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/11/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We compared the ability of the selected anthropometric indicators to best predict the prevalence of hypertension among the Indian tribes. METHODS A cross-sectional study was undertaken among 1431 adult participants (705 males and 726 females) between the ages of 20 and 60 years from six major tribes in India. Selected anthropometric indicators such as body mass index (BMI), waist-hip-ratio (WHR), waist-height-ratio (WHtR), percentage body fat (PBF), visceral fat (VF), minimum-waist-circumference (MWC) and sum-of-the-four skinfold thickness (SF4), along with the physiological parameters such as blood pressure were recorded. Discriminant analysis (DA) was performed to examine and compare the ability of the selected anthropometric indicators towards classifying hypertension among males, females and the total population. RESULTS Significant independent association was observed for hypertension and similar conditions within gender and selected age-group categories. The overall hypertension prevalence among the studied tribes was observed at 12.6%. Standardized function coefficients (SFCs) in discriminant analysis revealed PBF(0.89, 0.36, and 0.76 for overall, males, and females respectively) as the most powerful discriminator of hypertension. In addition, visceral fat (0.74, 1.46, and 0.58 for overall, males and females respectively) was observed to be the other significant indicator of hypertensive blood pressure. These exploratory findings for the first time indicate fat deposition, rather than body density alone, as an emerging physiological and metabolic risk among Indian tribes. CONCLUSION In the context of the highly prevalent chronic undernutrition, internal fat deposition is a major classifying factor of physiological and metabolic intolerance. It also indicates the increasing trend in lifestyle changes and the associated adversities among the Indian tribes.
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Affiliation(s)
| | - Anjali Kumari
- Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Subhendu K Acharya
- National Institute of Epidemiology, Social and Behavioural Sciences, Chennai, 600012, Tamil Nadu, India
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Modi D, Desai S, Dave K, Shah S, Desai G, Dholakia N, Gopalan R, Shah P. Cluster randomized trial of a mHealth intervention "ImTeCHO" to improve delivery of proven maternal, neonatal, and child care interventions through community-based Accredited Social Health Activists (ASHAs) by enhancing their motivation and strengthening supervision in tribal areas of Gujarat, India: study protocol for a randomized controlled trial. Trials 2017; 18:270. [PMID: 28599674 DOI: 10.1186/s13063-017-1998-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 05/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background To facilitate the delivery of proven maternal, neonatal, and child health (MNCH) services, a new cadre of village-based frontline workers, called the Accredited Social Health Activists (ASHAs), was created in 2005 under the aegis of the National Rural Health Mission in India. Evaluations have noted that coverage of selected MNCH services to be delivered by the ASHAs is low. Reasons for low coverage are inadequate supervision and support to ASHAs apart from insufficient skills, poor quality of training, and complexity of tasks to be performed. The proposed study aims to implement and evaluate an innovative intervention based on mobile phone technology (mHealth) to improve the performance of ASHAs through better supervision and support in predominantly tribal and rural communities of Gujarat, India. Methods/design This is a two-arm, stratified, cluster randomized trial of 36 months in which the units of randomization will be Primary Health Centers (PHCs). There are 11 PHCs in each arm. The intervention is a newly built mobile phone application used in the public health system and evaluated in three ways: (1) mobile phone as a job aid to ASHAs to increase coverage of MNCH services; (2) mobile phone as a job aid to ASHAs and Auxiliary Nurse Midwives (ANMs) to increase coverage of care among complicated cases by facilitating referrals, if indicated and home-based care; (3) web interface as a job aid for medical officers and PHC staff to improve supervision and support to the ASHA program. Participants of the study are pregnant women, mothers, infants, ASHAs, and PHC staff. Primary outcome measures are a composite index made of critical, proven MNCH services and the proportion of neonates who were visited by ASHAs at home within the first week of birth. Secondary outcomes include coverage of selected MNCH services and care sought by complicated cases. Outcomes will be measured by conducting household surveys at baseline and post-intervention which will be compared with usual practice in the control area, where the current level of services provided by the government will continue. The primary analysis will be intention to treat. Discussion This study will help answer some critical questions about the effectiveness and feasibility of implementing an mHealth solution in an area of MNCH services. Trial registration Clinical Trial Registry of India, CTRI/2015/06/005847. Registered on 3 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1998-0) contains supplementary material, which is available to authorized users.
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Brown SR, Joshweseoma L, Saboda K, Sanderson P, Ami D, Harris R. Cancer Screening on the Hopi Reservation: A Model for Success in a Native American Community. J Community Health 2016; 40:1165-72. [PMID: 26091896 DOI: 10.1007/s10900-015-0043-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
American Indian women have lower cancer survival rates compared to non-Hispanic White women. Increased cancer screening fostered by culturally sensitive education and community programs may help decrease this disparity. This study assesses the effectiveness of Hopi Cancer Support Services (HCSS) in maintaining high rates of breast and cervical cancer screening among Hopi women and evaluates the impact of participation in HCSS programs on colorectal cancer (CRC) screening. A population-based survey was conducted on the Hopi reservation in 2012 (n = 252 women). Frequency of breast, cervical, and colorectal cancer screenings, participation in HCSS programs and barriers to screening were evaluated. Unconditional multiple logistic regression estimated the independent effect of the HCSS program on CRC screening. Approximately 88 % of Hopi women 40+ reported ever having had a mammogram; 71 % did so within the past 2 years. Approximately 66 % of women 50+ were ever screened for colorectal cancer (FOBT and/or colonoscopy). Women who had their last mammogram through HCSS were 2.81 (95 % CI 1.12, 7.07) times more likely to have been screened for CRC. Breast and cervical cancer screening continues at a high rate among Hopi women and is substantially greater than that reported prior to the inception of HCSS. Furthermore, participation in programs offered by HCSS is strongly associated with increased colorectal cancer screening. This tribal health program (HCSS) has strongly influenced cancer screening among Hopi women and is a model of a tribally run cancer prevention program.
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Affiliation(s)
- Sylvia R Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, Tucson, AZ, 85724-5163, USA. .,Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Lori Joshweseoma
- Hopi Department of Health and Human Services, The Hopi Tribe, Kykotsmovi, AZ, USA
| | | | - Priscilla Sanderson
- Department of Health Sciences, College of Health and Human Services and Department of Applied Indigenous Studies, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Delores Ami
- Hopi Cancer Support Services, The Hopi Tribe, Kykotsmovi, AZ, USA
| | - Robin Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, Tucson, AZ, 85724-5163, USA.,Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Dehury RK, Chatterjee SC. Dissociated reality vis-a-vis integrative planning of AYUSH in Maternal Health Program: A situational analysis in Jaleswar block of Balasore district of Odisha, India. J Ayurveda Integr Med 2016; 7:124-31. [PMID: 27450758 DOI: 10.1016/j.jaim.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/15/2015] [Accepted: 11/14/2015] [Indexed: 11/23/2022] Open
Abstract
Mainstreaming of AYUSH and revitalization of local health traditions is one of the innovative components of the National Rural Health Mission (NRHM) in the state of Odisha, India. In this study, an attempt was made to assess the potential of collocating AYUSH to improve maternal health services in tribal dominated Jaleswar block of the Balasore district. In addition, the study aimed at unearthing the underlying challenges and constraints in mainstreaming AYUSH and linking it with the Maternal Health Program. Review of the policy documents and guidelines, both central and state government, was made to assess the implementation of AYUSH in Odisha. Primary data were collected through interviews with AYUSH doctors, district and block level health administrators, and tribal women. The study revealed the inadequacy of basic amenities, infrastructure, drugs, and consumables in the health centers for integrating AYUSH in the delivery of maternal health services. Analysis of the job chart and work pattern of AYUSH doctors showed underutilization of their specialized knowledge to treat patients. Lack of continued medical education, standard operating procedures for treatment and spatial marginalization made suboptimal utilization of AYUSH services. This is unfortunate given the fact that such regions are economically underdeveloped and already have a distinct orientation toward indigenous health systems. AYUSH, on account of its holistic approach and proven cost-effectiveness, could be a viable option for improving maternal health in the region. The study concluded that although there is huge scope for integrating AYUSH in Maternal Health Program under the ongoing NRHM, the full potential is yet to be exploited.
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