Gynaecological morbidities and health seeking behaviour of aged tribal women in Trivandrum district, Kerala, India

Abstract

Gynaecological morbidities is any condition, disease or dysfunction of the reproductive system that is not associated with pregnancy, which includes reproductive tract infections, cervical cell changes, prolapse, urinary tract infection, back pain due to osteoporosis. 1 The community based prevalence of these morbidities are influenced by demographic, social, cultural and behavioural factors. Women do not consider it as a significant health problem or hesitate to talk about it. The onset of the menopause not only signals the end of a woman's reproductive function but also the start of a new ABSTRACT Background: Gynaecological morbidities is any condition, disease or dysfunction of the reproductive system that is not associated with pregnancy which include reproductive tract infections, cervical cell changes, prolapse, urinary tract infection, back pain due to osteoporosis. The community based prevalence of gynaecological morbidities are influenced by demographic, social, cultural and behavioural factors. Geriatric gynaecological problem especially in tribal population has not received adequate attention in India. It is a fact that, health seeking behaviour forms an important component in formulating health programs as successful interventions depends on the accessibility and acceptability ,both of which relates to social factors. The objective of this study was to assess the gynaecological morbidities of aged (>60 years) tribal women in Trivandrum district living in various settlement areas and also to study their health seeking behavior. Methods: 11 panchayats were selected where the density of tribal population was high, and using cluster sampling method, a sample size of119 was arrived at, and these many women were included in this study out of the total of 2362 aged tribal women residing in Trivandrum. 12 camps were conducted in settlement areas during the period of one year of study. Socio-demographic, general health, and gynaecological examination was conducted and findings noted in a proforma. Results: 47.1% women had one or more coexistent gynaecological morbidities. 16% had clinical evidence of vaginitis, 9.2% had urinary tract infection, 12.6% had prolapse of some degree, 3.4% had cervical lesions. 80% of tribal women belonged to low socio economic status. 74.8% tribal women were anaemic. However around 80% had health seeking behaviour. The rest did not seek because of inaccessibility or shyness to discuss gynaecological morbidities. Conclusions: Aged trial women harbour considerable gynaecological morbidities. Inspite of having a very high level of health seeking behaviour it was noted in the current study that the prevalence of anaemia was very high. Therefore there is an urgent need to further improve health facilities and health care in these areas.

Health Seeking Behaviour among Tribes of India

“…Gonds (Rao et al 2012;Singh et al 2016), Paniyan (Vivek et al 2012;Gandhi et al 2017 ), Irula (Santosam and Samuel 2013), Kani (Nandha et al 2014), Koraga (Shirisha et al 2015), Garo, Khasi (Albert et al 2015), Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (Pathania and Katoch 2017), Kattunayakan and Bettakurumbas (Gandhi et al 2017), unnamed tribal people belonging to Udaipur district of Rajasthan (Kumar et al 2013), Gadchiroli district of Maharashtra (Sundarrajan et al 2013), Narmada district of Gujarat (Chandwani and Pandor 2015), Villupuram district of Tamil Nadu (Jayaprakash and Saravanan 2015), Kalyani district of West Bengal (Ghosh et al 2015), Anantnag district of Jammmu and Kashmir (Ahmad and Saravanan 2015), Integrated Tribal Development Agency (ITDA) villages of 9 states (Laxmaiah et al 2015) and Thiruvananthapuram district of Kerala (Babu et al 2016).…”

“…The reasons for health seeking behavior and for varied health problems reported among the tribal people were not uniform. Significant health problems include tuberculosis in Koya and Konda Reddy (Rajamma et al1996), sexually transmitted diseases in Gonds (Rao et al 2012), dental problems in Paniya Paniyan (Vivek et al 2012), institutional delivers in tribes of Udaipur, Rajasthan (Kumar et al 2013), malaria in tribes of Gadchiroli, Maharashtra (Sundarrajan et al2013) and tribes of Kalyani, West Bengal (Ghosh et al 2015), leishmaniasis in Kani (Nandha et al 2014), childhood diseases in tribes of Narmada district, Gujarat (Chandwani and Pandor 2015) and Gonds ), diarrhea in Koraga (Shirisha et al 2015, hypertension in tribes of ITDA villages of 9 states (Laxmaiah et al 2015), gynecological morbidities in tribes of Thiruvananthapuram, Kerala (Babu et al 2016), common ailments in Bhatara (Mahapatro and Kalla 2000), Gadoliya Lohars, Rabaris, Nayaks, Kanjars, Sansis, Nats and Kalbeliyas, (Sachdev 2012 Tribal people in India for their health problems take home remedies (Bhatara (49%) (Mahapatro and Kalla 2000); Irula (100%) (Santosam and Samuel 2013); Koraga (100%) (Shirisha et al 2015); Garo, Khasi (79%) (Albert et al 2015); visit private hospitals (Gadoliya Lohars, Rabaris, Nayaks, Kanjars, Sansis, Nats and Kalbeliyas (92%) (Sachdev 2012); tribes of Villupuram district, Tamil Nadu (9%) (Jayaprakash and Saravanan 2015); follow indigenous medicine (Koyas and Konda Reddy (6%) (Rajamma et al 1996); Paite (10%) (Guite and Acharya 2006); tribes of Villupuram district, Tamil Nadu (28%) (Jayaprakash and Saravanan 2015); Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (44%); approach traditional healers (Koyas and Konda Reddy (86%) (Rajamma et al 1996); tribes of Gadchiroli, Maharashtra (100%) (Sundarrajan et al 2013); Kani (100%) (Nandha et al 2014); Garo, Khasi (10%) (Albert et al 2015); Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (37.2%) (Pathania and Katoch 2017) and practice modern medicine/allopathy (Koyas and Konda Reddy (86%)…”

“…The following factors were identified as barriers for health seeking behavior among tribal populations in India: lack of awareness and infrastructures, inaccessibility of health care institutions, inconvenient out-patient timings, non-availability of doctor, lack of time for waiting the doctor, illtreatment by government hospitals staff, fear of losing daily earnings by the accompanying person, less time spending of doctor with patient, high price and ineffectiveness of allopathic medicine, need to travel long distances, absence or inconvenient transport facilities, firmly fixed cultural be-liefs, male-dominated society, more concern for the well-being of the male child, final word of the head of the family, dissatisfaction with the healthcare services, lack of accountability among health care personnel, religious misinterpretations, socioeconomic constraints, women's restricted movements, larger family size, illiteracy and shyness in case of sexually transmitted diseases and gynecological problems (Kumar et al 2013;Chandwani and Pandor 2015;Laxmaiah et al 2015;Mahapatro and Kalla 2000;Sachdev 2012;Vivek et al 2012;Santhosam and Samuel 2013;Gandhi et al 2017;Rao et al 2012;Babu et al 2016).…”

Obesity and Hypertension: A Cross-sectional Study among the Adult Individuals of Sonowal Kachari Tribe of Hatimora Village, Assam, India

“…In this report, studies on health seeking behavior on tribes spread in 14 states of India like Andhra Pradesh, Odisha, Rajasthan, Manipur, Kerala, Madhya Pradesh, Tamil Nadu, Gujarat, Karnataka, West Bengal, Jammu and Kashmir, Meghalaya and Himachal Pradesh were taken into consideration. These studies encompassed tribes such as Koyas, Konda Reddy (Rajamma et al1996), Bhatara (Mahapatro and Kalla 2000), Gadoliya Lohars, Rabaris, Nayaks, Kanjars, Sansis, Nats, Kalbeliyas (Sachdev 2012), Bhils (Jain and Agrawal 2005), Paite (Guite and Acharya 2006), Kuruchiyas (Nelson 2011), Gonds (Rao et al 2012;Singh et al 2016), Paniyan (Vivek et al 2012;Gandhi et al 2017 ), Irula (Santosam and Samuel 2013), Kani (Nandha et al 2014), Koraga (Shirisha et al 2015, Garo, Khasi (Albert et al 2015), Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (Pathania and Katoch 2017), Kattunayakan and Bettakurumbas (Gandhi et al 2017), unnamed tribal people belonging to Udaipur district of Rajasthan (Kumar et al 2013), Gadchiroli district of Maharashtra (Sundarrajan et al 2013), Narmada district of Gujarat (Chandwani and Pandor 2015), Villupuram district of Tamil Nadu (Jayaprakash and Saravanan 2015), Kalyani district of West Bengal (Ghosh et al 2015), Anantnag district of Jammmu and Kashmir (Ahmad and Saravanan 2015), Integrated Tribal Development Agency (ITDA) villages of 9 states (Laxmaiah et al 2015) and Thiruvananthapuram district of Kerala (Babu et al 2016).…”

“…The reasons for health seeking behavior and for varied health problems reported among the tribal people were not uniform. Significant health problems include tuberculosis in Koya and Konda Reddy (Rajamma et al1996), sexually transmitted diseases in Gonds (Rao et al 2012), dental problems in Paniya Paniyan (Vivek et al 2012), institutional delivers in tribes of Udaipur, Rajasthan (Kumar et al 2013), malaria in tribes of Gadchiroli, Maharashtra (Sundarrajan et al2013) and tribes of Kalyani, West Bengal (Ghosh et al 2015), leishmaniasis in Kani (Nandha et al 2014), childhood diseases in tribes of Narmada district, Gujarat (Chandwani and Pandor 2015) and Gonds (Singh et al 2016), diarrhea in Koraga (Shirisha et al 2015), hypertension in tribes of ITDA villages of 9 states (Laxmaiah et al 2015), gynecological morbidities in tribes of Thiruvananthapuram, Kerala (Babu et al 2016), common ailments in Bhatara (Mahapatro and Kalla 2000), Gadoliya Lohars, Rabaris, Nayaks, Kanjars, Sansis, Nats and Kalbeliyas, (Sachdev 2012), Bhils (Jain and Agrawal 2005), Paite (Guite and Acharya 2006), Kuruchiyas (Nelson 2011) (Rajamma et al 1996); Paite (10%) (Guite and Acharya 2006); tribes of Villupuram district, Tamil Nadu (28%) (Jayaprakash and Saravanan 2015); Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (44%); approach traditional healers (Koyas and Konda Reddy (86%) (Rajamma et al 1996); tribes of Gadchiroli, Maharashtra (100%) (Sundarrajan et al 2013); Kani (100%) (Nandha et al 2014); Garo, Khasi (10%) (Albert et al 2015); Kinners, Lahules, Spitians, Pangwalas, Gaddis and Gujjars (37.2%) (Pathania and Katoch 2017) and practice modern medicine/allopathy (Koyas and Konda Reddy (86%) (Rajamma et al1996); Bhatara (6%) (Mahapatro and Kalla 2000); Gadoliya Lohars, Rabaris, Nayaks, Kanjars, Sansis, Nats and Kalbeliyas (28%) (Sachdev 2012); Paite (56%) (Guite and Acharya 2006): tribes of Udaipur, Rajasthan (48%)…”