|Year : 2021 | Volume
| Issue : 4 | Page : 164-172
An observational study to assess the demographic status and health-seeking behavior of SC women and children in Bhubaneswar Block of Odisha
P Binitha1, Kshirod K Ratha2, Banamali Das2, Sarada Ota3, Kishor A Gavali4, Mrithyunjaya M Rao2
1 National Ayurveda Research Institute for Panchakarm, Cheruthuruthy, Kerala, India
2 Central Ayurveda Research Institute for Hepatobiliary Disorders, Bhubaneswar, Odisha, India
3 Central Council for Research in Ayurvedic Sciences, New Delhi, India
4 Regional Ayurveda Research Institute for Endocrine Disorders, Jaipur, Rajasthan, India
|Date of Submission||24-Jul-2021|
|Date of Decision||15-Feb-2022|
|Date of Acceptance||16-Feb-2022|
|Date of Web Publication||29-Apr-2022|
Kshirod K Ratha
Central Ayurveda Research Institute for Hepatobiliary Disorders, Bhubaneswar, Odisha
National Ayurveda Research Institute for Panchakarma, Cheruthuruthy, Kerala
Source of Support: None, Conflict of Interest: None
BACKGROUND: The Scheduled Castes (SC) population of Odisha constitutes 17.3% of the total population of the state and is one of the most vulnerable groups with regard to health care due to the non-availability of affordable and quality health services. Reproductive health literacy is relatively poorer in adolescents and women, which impacts their reproductive health. OBJECTIVE: The core objectives of the study were to determine the socioeconomic status, living conditions, educational status, dietetic habits, lifestyles, and healthcare-seeking behavior of SC women and children, promote awareness regarding lifestyle and health, and also provide healthcare services at their doorsteps. MATERIALS AND METHODS: The study was conducted from January to December 2019 in the SC population-dominated areas of the Khurdha district of Odisha. The requisite information was documented by door-to-door visits from respondents who provided their consent for participation in the study, through a structured format. Awareness was created to the respondents through distribution of Information, Education, and Communication materials and public lectures. Ayurveda healthcare services were provided as per the initial screening, presence of risk factors, and presenting complaints, if any. The data gathered were analyzed through descriptive statistical assessment, i.e., measures of frequency and position of the data. RESULTS: A total of 5041 people were surveyed, including females and children only. Among these, 2758 were women of reproductive age and 2283 were children. Of the 2283 children, 1186 were male and 1097 were female. The causes of gynecological diseases in SC women are poor living conditions, environmental factors, poor hygiene, improper care during menstrual cycles, a faulty lifestyle, and a low socioeconomic status. The health indices were found to have improved due to the implementation of various women-centric welfare schemes by the government and institutional delivery. CONCLUSION: The Reproductive and Child Health program is pivotal for improving the health outcomes of the deprived and unreached segment of the SC women’s population. Supplementation of comprehensive and holistic health care through Ayurveda advocacy is sustainable and can improve health outcomes and reduce mortality and morbidity.
Keywords: Child health, Khurdha, reproductive and child health indicators, reproductive health
|How to cite this article:|
Binitha P, Ratha KK, Das B, Ota S, Gavali KA, Rao MM. An observational study to assess the demographic status and health-seeking behavior of SC women and children in Bhubaneswar Block of Odisha. J Res Ayurvedic Sci 2021;5:164-72
|How to cite this URL:|
Binitha P, Ratha KK, Das B, Ota S, Gavali KA, Rao MM. An observational study to assess the demographic status and health-seeking behavior of SC women and children in Bhubaneswar Block of Odisha. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Aug 13];5:164-72. Available from: http://www.jrasccras.com/text.asp?2021/5/4/164/344407
| Introduction|| |
Background and rationale
Women and children are important constituents of any society. From the reproductive and child health (RCH) perspective, this group is vulnerable and at greater risk. Despite the commendable work done in this field by the government and NGOs, the health of the mother and child is still considered at great risk. This situation is graver for the women and children of the SC/ST community. The male and female ratio of the SC population in Odisha is 1000:1013. The literacy level of the total SC population is 69.02%. Male literacy rates are 79.21% and female literacy rates are 58.76%. A UN report says that the average Dalit woman in India dies 14.6 years younger than women from higher castes. Health literacy is the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.
A woman’s caste in India increases her exposure to mortality because of poor sanitation and inadequate health care. The condition of SC women in India needs more attention. The World Health Organization defines health as a “state of complete physical, mental, social, and spiritual well-being and not just the absence of disease and infirmity.” Generally, women and children are vulnerable groups, and it increases manifold in the case of SC women. Proper nutrition, appropriate pregnancy care, care during delivery, postnatal care, and care for other gynecological problems, sanitation, and immunization of SC women and children may help to reduce morbidity and mortality. The Government of India is taking steps to resolve these issues through schemes such as National Health Mission, Pradhana Mantri Surakshit Matritva Abhiyan, Janani Suraksha Yojana, Pradhana Manthri Matritva Vandana Yojana, Swadhar Greh, Ayushman Bharat, Pradhana Mantri Jan Arogya Yojana, etc.
Ayurveda, the ancient tradition of Indian systems of medicine, has sustained the population for centuries, with effective cures and remedies for numerous conditions, including those relating to women and children, with minimal side effects. As an apex body of research in Ayurveda, CCRAS is providing healthcare services and creating awareness for the maintenance and promotion of health of SC communities through Ayurvedic approaches through its different institutes across the country under the program Schedule Caste Sub-plan (SCSP). This program is aimed at achieving a status in which women will be able to regulate their fertility, go through their pregnancy and childbirth safely, have a successful outcome of pregnancy, and thus lead to the survival and well-being of the mother and child.
Considering the strength of Ayurveda in the management of health-related problems of women and children, the Council has also decided to extend its activities, especially for women and children, under the SCSP program with the aim of providing mother and child healthcare awareness and medical services in the SC-dominant community. The goals include researching the socioeconomic status, living conditions, educational status, dietary habits, lifestyles, and healthcare-seeking behavior of SC women and children, raising awareness about Ayurvedic concepts such as Swasthavrita, Pathyapathya, and Sadavritta for health promotion and maintenance and providing primary healthcare services at their doorsteps through Ayurveda, particularly to women and children from the SC community, in order to reduce mortality and morbidity.
| Materials and Methods|| |
This is an observational study.
Five villages of Khurdha district of Odisha were selected for study purposes, viz., Basuaghai, Chandaka, Dadha, Dhauli, and Kalarangha which were with the majority of the SC population and were easy to access from the institute.
The study was conducted between January 2019 and December 2019 with the approval of the Institutional Ethics Committee.
About 5041 women of reproductive age (13–50 years) and children below 12 years belonging to the SC population residing in these areas were selected.
The method used was convenient sampling data collection method.
A descriptive statistical method was used. Measures of frequency and position of data were also used.
Data collection method
Before the initiation of the study, the Sarpanch/Gram Panchayat members and other local authorities of these areas were informed about the project, viz., beneficiaries and benefits and the mode of implementation of the project. The works were carried out with the permission of the village authorities. A team consisting of an Ayurveda physician, a social worker, and a multi-tasking staff visited the area. A tour schedule was planned before the initiation of the work, depending on the population size of the area. The survey was executed through doorstep visits to every household. Each member of the household was interviewed with a close-ended questionnaire for the demographic data, whereas an open-ended questionnaire was used for the documentation of lifestyle and disease-related information. The collected information includes (i) village/area information, (ii) house information such as type of house, ventilation, drinking water source, drinking water purification method, toilet facilities, method of vector-borne disease prevention, drainage facility, etc., (iii) socio-demographic data, viz., age, sex, marital status, education, occupation, dietary habits, addiction, etc., (iv) personal health information of women, such as menstrual history, obstetrical history, contraceptive history, and so on; and (v) health-related information of children, such as immunization status, school-going status, any recurring common childhood infections, such as respiratory/gastrointestinal/dermatological infections, and whether or not growth and development are appropriate for age. Hemoglobin and random sugar estimation were also performed during the survey on a case-to-case basis.
Through behavior change counseling and providing Information, Education, and Communication (IEC) materials, awareness regarding the Ayurvedic concept of Dincharya (daily regimen), Ritucharya (seasonal regimen), and Pathyapathya (do’s and don’ts) for the prevention of diseases and promotion of health was increased. After the stipulated number of visits to the selected areas, patients were informed to visit the institute for further follow-up and other health-related checkups as per requirement, and a health card was issued to each registered patient for this purpose.
Structured questionnaires were used to document the demography, lifestyle, and health-related information of the respondents.
As it was an observational study, qualitative data have been presented in number and pages.
| Observations and Results|| |
Sociodemographic data of 5041 SC population (2758 women, 1186 male children and 1097 female children) and clinical data of 1980 patients were also collected in the designed data collection format [Table 1].
The data of basic house facilities of 1425 houses were collected through a door-to-door survey. As per the survey, the majority of the surveyed houses (95%) were of the pukka type (houses made of wood, cement, and iron rods) without adequate ventilation (69%) and drainage facilities (55%) [Table 2]. A majority of the population (69%) used non-purified water from the hand pump for drinking purposes. Though LPG facilities were available in the majority of houses, firewood was used mainly for cooking purposes. Toilet facilities are available in the majority of the houses (99%). About 69% of the houses do not use any prevention method against vector-borne diseases, and 31% use normal nets for preventing vector-borne diseases. An open drainage facility is seen in most of the houses.
Demographic status of SC women of age 13–50 years
It was observed that the majority of the respondents were literate (79%), and the number of childhood marriages was also small [Table 3]. Around 41% attained education up to the primary school level, 25% up to the middle school level, and only 3% of the surveyed population studied up to graduation. There was no one in the age group of 13–18 years addicted to any noxious substances. The majority of the respondents (89%) used contemporary biomedicine for any ailments, and very few of them (5.5%) reported using Ayurveda medicines for their diseases. Community-based traditional or folk medicines were the second choice for illness, and 6% have reported it. The majority of women in the age group between 13 and 18 years (96%) have regular cycles without any associated complaints. Reduced menstrual flow is seen in the majority of the surveyed women in the age group of 36–50 years, but it was not presented as a health complaint. The majority (77%) use sanitary napkins and married women were aware of the use of contraceptives. Eighty-one women in the perimenopausal period complained of irregular cycles. No other major complaints were noted in the total surveyed population [Table 4]. Here, among the surveyed population, the majority of the surveyed women were unskilled labors (45.6%). Only 3.1% were skilled laborers. Around 285 (28%) of females were found to be housewives, and 94% of women in the age group of 13–18 years were found to be students. More than 99% of surveyed women were following a non-vegetarian diet. Less than 10% of surveyed women were addicted to pan (betel) or tobacco. Not a single woman among those surveyed in the age group of 13–18 years was addicted to any of the given addictions or to any noxious substances.
|Table 4: Data on the menstrual history of women between the ages of 13 and 50 years|
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Only six pregnancies were reported in the age group of 13–18 years, and all were vaginal deliveries conducted at hospitals without any complications. Hospital delivery tendency has increased nowadays and is 100% in the age group of 13–18 years [Table 5]. A total of 4760 pregnancies were recorded among the surveyed women. Of these, 27 were aborted. Medical termination of pregnancy was not recorded among the surveyed population. The abortion percentage was only 0.56%. About 99.6% were reported as normal delivery. About 54.5% of the deliveries were in institutions/hospitals, and home delivery was reported in 45.5% of the cases. A total of 16 cesarean sections were recorded among the surveyed women, and 99.4% of deliveries were term deliveries.
About 975 pregnancies were documented in the age group of 19–35 years, among which 2.8% were reported to be aborted. Approximately 96% of the pregnancies were normal deliveries, among which 87% were conducted at hospitals and 13% at home itself. Only nine were born by cesarian section, which is only 0.9% of total pregnancies in this age group. More than 50% of total pregnancies in the age group 36–50 of years were delivered in the home and only 6 (less than 1%) were lower segment Caesarian section. It is observed that Swetapradara (leukorrhea) was found as the most prevalent gynecological disease among the surveyed women. Dysmenorrhea was complained about by 70 patients and was successfully treated with Ayurvedic medicines [Table 6]. As the majority of the female population covered comes under the age group 36–50 years, the predominant disease was Vata vyadhi (joint disorders), i.e., around 30% of the total cases.
School-going status, immunization status, and recurrent infection status of surveyed children below 12 years
It has been observed that the majority of the children (77%) were vaccinated as per the immunization schedule, though a few have been reported to have completed the vaccination slightly later than the schedule. The average age for the initiation of school was reported as 6 years. Only 30% of children less than 6 years of age are sent to preschools by their parents. Respiratory tract infections (33%) and skin diseases (29%) were the most common illnesses in children. For the common illnesses affecting children, they resort to modern medicine, and very few prefer Ayurveda or homoeopathic medicines.
As per the survey, no one among the children prefers to take their traditional medicine for such complaints. Very few children were affected by delayed growth. Only 8% had a height below the normal level according to their age. Only 9.5% of children had weights below the normal weight according to their age. Developmental delay was not observed among the surveyed population [Table 7].
|Table 7: School-going status, immunization status, and recurrent infection status of surveyed children below 12 years (n = 2283)|
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| Discussion|| |
Environmental factors and demographic profiles also have a pivotal role in the health of people in any country. However, as matter of physiological difference, it can be claimed that women and children are the most vulnerable groups in the population regarding the effect of environmental and demographic factors. Therefore alternately, it can be said that the factors that may influence the healthy reproductive life of a woman and normal growth of the children need to be maintained. Survey studies can bring information of the health influencing demography-related factors and thus have their unique way to contribute in adopting preventive strategies. The present study is an attempt to assess the demographic status and health-seeking behavior of SC women and children in Bhubaneswar Block of Odisha. The present location has poor economic conditions and thus seemed more suitable to study factors which can influence health of women and children in the study area. SC population was chosen as it is one of the cast categories which has fallen behind and still attempting to progress. The result of health-seeking behavior of such SC populations may highlight the requisites which can be considered for further strategies-related development of rural as well as economically backward population.
The observation indicates that in terms of the state of basic housing facilities in the villages in question, inadequate drainage and ventilation were reported to be the most critical concerns. The availability of closed and open drainage facilities in the houses has been improved up to 14% and 31% in the surveyed area, respectively; however, it is less when compared with that of the entire country, i.e., 18.1% and 45%.,, Various government schemes, such as the PM Awas Yojana Gramin (PMAY-G), Biju Pucca Ghar Yojana (BPGY), Khani Ancha Pucca Ghar Yojana, and Nirman Shramik Pakka Ghar Yojana (NSPGY), have contributed significantly to this improvement. Even though there has been an improvement in the drainage facilities in houses, additional measures need to be undertaken to further improve drainage facilities and ventilation of houses, thereby preventing diseases such as fever and respiratory tract infections, which are found to be most common diseases among children in the studied area.
Improper water purification methods were also found to be a major problem among the surveyed population. It is estimated that contaminated water and a lack of basic sanitation and hygiene every year claim the lives of more than 1.2 million children under 5 years from diarrhea., Majority of the studied population (69%) is reported to be using non-purified water for drinking. This may be the reason for recurrent respiratory tract infections and gastrointestinal diseases in children. Proper awareness about water purification methods and their implementation can be recommended for the prevention of the occurrence of recurrent respiratory tract infections in children of the study location.
The most prevalent gynecological complaint found was leucorrhoea. Lack of proper personal hygiene, polluted surroundings, lack of proper care during menstrual cycles, and lack of proper case according to changes in environmental factors can be claimed as the causes behind the manifestation of diseases such as leukorrhea and Yoni Kandu (vaginal itching). Regular village cleaning and vigilance program related to gynecological care may be needed to be arranged to overcome such situations. The majority of surveyed women were married (72%) and according to the survey, women in the studied region usually get married after 18 years of age. Only a very few women under the age of 18 were observed to be married. This indicates that nowadays, child marriage is not much promoted in the SC population of Khurdha. The increased literacy rate (79%) among women in recent years might be attributed to the reduced rate of childhood marriage.
The total female literacy of Odisha was found to be 81.6% as per 2011 census. The literary rate found in the present survey is 79% of the total surveyed women which was reported up to 60% in the survey conducted in 2011. No illiterate women were found in the age group of 13–18 years. The observation indicates 19% increase in literacy rate among SC women, which is a considerable positive change. However, in a study conducted in 2016, the graduate women percentage of Khurdha district was found to be 3.29%. Majority of women in the age group of 13–18 years in the studied area reported their education to be in the level of middle school (51%). This observation represents that even though literacy rate is increased by 19%, the higher education level is not found to be improved. The non-availability of higher education centers in the rural area and poor economic condition to support the cost of higher education may be major factors responsible for the low higher education rate. Here a need can be presented to establish higher education centers at rural areas. The educational status of surveyed children was found satisfactory as per the study. Working status of women in the studied area improved from 19% to 62%. The improvement may be due to increased literacy rate of women along with work-related reservation policies for SC population created by the government such as selection for ASHA workers.
In addition to chewing tobacco, betel leaf or betel nut is mostly found among village women in India. The addiction status of women in the survey indicates that nowadays women are aware of the health hazards associated with the addiction. The treatment choice of a majority of respondents is contemporary biomedicine, followed by local health tradition. The availability of primary healthcare (PHC) centers which utilize contemporary biomedicine may be the reason for the observation. Here a necessity can be expressed regarding establishment of PHC working under Ayurveda expert and with facility of required common Ayurveda medicines. This may help in promotion of Indian traditional medicine and may also contribute to increasing general health status of rural population. Such attempt may also reduce the burden on PHCs along with creation of employment opportunities for Ayurveda professionals. The obstetrical status observed in the survey showed that a good proportion of the SC population (88.6%) in the age group of 19–35 years in the surveyed areas reported hospitalized child birth deliveries. In contrast, the proportion of birth delivery at home in the age group of 36–50 years is observed as 54%. Here it can be interpreted that after first normal delivery, women in villages may prefer delivery at home. Government schemes such as the Odisha Mamatha Yojana and Janani Suraksha Yojana played a pivotal role in improving the rate of hospitalized birth deliveries. It is pertinent to note that, irrespective of their vulnerable status, the majority of the women completed their pregnancy term and very few abortions were reported. By analyzing the data nowadays, most women are doing the antenatal care regularly in the hospital. Pregnancy and delivery were regularly monitored by health volunteers such as ASHA and Anganwadi workers in the surveyed areas. Therefore, further involvement of ASHA and Anganwadi workers may be done to ensure 100% hospitalized delivery rate in rural areas.
Apart from the survey, the study helped to generate awareness on Ayurvedic concepts such as Swasthavrita (healthy lifestyle), Pathyapathya (dietary and behavioral do’s and don’ts), Sadavitta (personal care), etc. for promotion and maintenance of health and provision of primary healthcare services at their doorsteps through Ayurveda. especially to women and children of SC community to reduce the mortality and morbidity. Such Ayurveda concepts are individual-based and non-medicinal regiments thus these are cost-free. Hence, awareness regarding such Ayurveda health measures needs to be undertaken specially for improving the health of rural and economically poor population. During the survey, attempt was made for such awareness by giving lectures and distributing IEC materials in the areas.
| Conclusion|| |
The demographic status and health-seeking behavior of SC women and children in Bhubaneswar Block of Odisha have showed positive outcome of various development schemes initiated by the government. However, the goal is yet to be achieved completely. In the studied area, it is needed to further improve the water drainage and ventilation facilities. Awareness activities related to gynecological care are also needed to be undertaken more frequently. Ayurveda principles and medicines can help in increasing health improvement rate at rural area; therefore it is need of hour to include Ayurveda treatment modalities in health centers.
Limitation of the study
This study was conducted on a limited population over a limited period of time. To validate the study findings and to reach the root cause of the observed issues, condition-specific objective-based long-term studies involving a majority of the SC population are required.
The authors are grateful to Director General, CCRAS for his constant inspiration and guidance to undertake this program and also thankful to the State Government of Odisha for extending permission to conduct the survey. Special thanks are due to the AMHCP RCH survey team of CARIHD, Bhubaneswar, Odisha who conducted the survey tirelessly in various villages/areas. The authors offer special thanks to the public of these villages/areas for their active involvement and cooperation during the survey.
| References|| |
Scheduled Castes Population—Census 2011. Available from: https://www.census2011.co.in/scheduled-castes.php
. [Last accessed on February 14, 2022].
Demographic Profile of Scheduled Tribes of Odisha, 1961–2011. Available from: https://repository.tribal.gov.in/bitstream/123456789/73776/1/SCST_2018_book_0016.pdf
. [Last accessed on February 14, 2022].
Institute of Medicine (US) Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. In: Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Washington, DC: National Academies Press (US); 2004.
Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets. Available from: https://apps.who.int/iris/handle/10665/68754
. [Last accessed on February 14, 2022].
Census of India 2011 Odisha. District Census Handbook Khordha, Series 22, Part XII-B. Bhubaneswar: Directorate of Census Operations Odisha; 2011. p. 358.
Houses, Household Amenities and Assets Data 2001–2011—Visualizing Through Maps. Available from: https://censusindia.gov.in/2011-common/nsdi/houses_household.pdf
. [Last accessed on February 14, 2022].
Houselisting and Housing Census Data Highlights—2011. Available from https://censusindia.gov.in/2011census/hlo/hlo_highlights.html?drpQuick=anddrpQuickSelect=andq=Census+Drainage+facilities+in+households
. [Last accessed on February 14, 2022].
Census of India 2011 Odisha. District Census Handbook Khordha, Series 22, Part XII-B. Bhubaneswar: Directorate of Census Operations Odisha; 2011. p. 374.
Census of India 2011 Odisha. District Census Handbook Khordha, Series 22, Part XII-B. Bhubaneswar: Directorate of Census Operations Odisha; 2011. p. 370.
Esrey SA, Potash JB, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 1991;69:609-21.
Census of India 2011 Odisha. District Census Handbook Khordha, Series 22, Part XII-B. Bhubaneswar: Directorate of Census Operations Odisha; 2011. p. 25.
Sadhana S. Status of higher education for women in Odisha: An inter district analysis. IOSR J Human Social Sci 2016;21:1-10.
Census of India 2011 Odisha. District Census Handbook Khordha, Series 22, Part XII-B. Bhubaneswar: Directorate of Census Operations Odisha; 2011. p. 26.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]