Reproductive health needs and care seeking behaviour of pavement dwellers of Calcutta.
ABSTRACT An unabated growth of street dwellers in the city of Calcutta is reported to be due to twin reasons like, migration of rural poor people as well as uncontrolled fertility among these poor settlers of the city. A community-based study on reproductive health, fertility and related care seeking behaviour was studied among a sample of women of child bearing age living on streets of Calcutta. Besides, the quite common conditions like leucorrhoea (28.5%), menstrual irregularities (12.3%), infertility (2.5%) and STDs (1.3%) were also reported. But most of these illnesses (three-fourth) were uncared for, and the remaining one-fourth sought treatment from govemment institutions, private agencies or even from untrained practitioners (quacks). The reproductive behaviour of street dwelling women was characterised by early marriage, teenage pregnancies, and scarce use of contraceptives (32%) as well as frequent abortions (2.8%). Very few pregnant women received adequate antenatal care (3.8%). Coverage of tetanus toxoid immunisation (68.5%) and proper iron and folic acid supplementation (16.7%) were also poor. Whereas, antenatal care was received mostly from government health institutions (71%), home delivery (ie, on street) was a common practice and conducted mostly by untrained birth attendants (51.8%).
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ABSTRACT: It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. This paper is an attempt to assess untreated reproductive morbidities and to study factors affecting treatment-seeking behavior among ever married women of urban slums. We selected 1,046 women of the reproductive age group (15-49 years) using two-stage cluster sampling for a community-based, cross-sectional study. From this sample, 593 responses reporting reproductive morbidity were analyzed for treatment-seeking behavior and its correlates. Information was collected on demographics, socioeconomic status, self-reported reproductive morbidity, and treatment-seeking patterns, along with reasons for not utilizing available health services, all using a pretested, structured interview schedule. Univariate and multivariate analyses were done in SPSS 15.0. In our sample, 57% of women had at least one reproductive morbidity; of these, only one third sought health care. Women belonging to the Scheduled Castes/Scheduled Tribes caste group (OR = 3.92, 95% CI 1.44-10.64), at a distance of more than 2 km from a health facility (OR = 2.67, 95% CI 1.28-5.58), and whose duration of illness was more than 1 year (OR = 14.44, 95% CI 3.66-56.87) accessed fewer reproductive health services compared to their counterparts. The present study found that a lower sense of need, the cost of care, and societal barriers were the reasons for not seeking care. Providers' poor attitudes, poor quality of services, and long waiting times were found to be the reasons for not utilizing health facilities. The determinants for accessing reproductive health care were resources available at the household level, social factors, the availability of services, and behaviors related to health. Government facilities remained underutilized.Journal of Urban Health 03/2010; 87(2):254-63. · 1.89 Impact Factor
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ABSTRACT: The study objective was to ascertain the extent to which the need for primary health care services among street-dwellers is being met through existing facilities. This community-based cross-sectional study was conducted in Dhaka city over a 12-month period from June 2007 to May 2008. The study population included ever-married females and males aged 15-49 years. Data for the study were collected through a community survey and exit interviews. Both bivariate and multivariate analyses were done. Seventy-two per cent of female and 48% of male street-dwellers interviewed were sick at the time of data collection. Twenty-one per cent of deliveries were conducted on the street. Eighty-nine per cent of the street-dwellers reported that their children aged less than 5 years had more than one symptom associated with acute respiratory infection during the last 2 weeks. Thirty-seven per cent of the females and 34% of the males interviewed reported that their accompanied children had diarrhoea. A few street-dwellers sought services for their health problems, and most went to the nearest pharmacy and to mobile clinics run by a non-governmental organization at night. Eighty-eight per cent of the female and 88% of the male street-dwellers used open space for their defecation. The street-dwellers are extremely vulnerable in terms of their health needs and health-care-seeking behaviours. There is no health service delivery mechanism targeting this marginalized group of people. Although the health, nutrition and population sector programme of Bangladesh designed programmes to ensure equitable essential services to all, this marginalized group of people was not targeted. The Ministry of Health and Family Welfare and private sectors should, thus, should focus future programmes to meet the needs of this extremely vulnerable group. Mobile and static clinics at night for street-dwellers may be potential programmes. Action research to assess the effectiveness of programmes is essential before large-scale implementation.Health Policy and Planning 07/2009; 24(5):385-94. · 3.06 Impact Factor
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ABSTRACT: BACKGROUND: In almost every major urban city, thousands of people live in overcrowded slums, streets, orother public places without any health services. Bangladesh has experienced one of thehighest rates of urban population growth in the last three decades compared to the nationalpopulation growth rate. The numbers of the urban poor and street-dwellers are likely toincrease at least in proportion to the overall population growth of the country. The streetdwellersin Bangladesh are extremely vulnerable in terms of their health needs andhealthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanismtargeting this marginalized group of people. This study, therefore, assessed the effectivenessof two models to provide primary healthcare (PHC) services to street-dwellers. METHODS: This study of experimental pre-post design tested two models, such n as static clinic andsatellite clinics, for providing PHC services to street-dwellers in the evening throughparamedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitativetechniques were used for collecting data. Data were analyzed comparing before and after theimplementation of the clinics for the assessment of selected health and family-planningindicators using the statistical t-test. Services received from the model l and model 2 clinicswere also compared by calculating the absolute difference to determine the relativeeffectiveness of one model over another. RESULTS: The use of healthcare services by the street-dwellers increased at endline compared tobaseline in both the model clinic areas, and the difference was highly significant (p < 0.001).Institutional delivery among the female street-dwellers increased at endline compared tobaseline in both the clinic areas. The use of family-planning methods among females alsosignificantly (p < 0.001) increased at endline compared to baseline in both the areas. CONCLUSIONS: As the findings of the study showed the promise of this approach, the strategies could beimplemented in all other cities of Bangladesh and in other countries which encounter similarproblems.Health Research Policy and Systems 06/2012; 10(1):19. · 1.86 Impact Factor