Thresholds of Morbidity among Women in a Peri-Urban Community of Maharashtra,                India: Conceptual and Methodological Issues

Kielmann, Karina; Bentley, Margaret E.

doi:10.1177/13591053030085005

Cited by 14 publications

(14 citation statements)

References 27 publications

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“…In the survey, tracking both insured and uninsured women allowed the intervention to be examined from a community perspective, rather than solely for the insurance program. The claims data were not compromised by survey fatigue, attrition, recall errors or other limitations of self–reporting morbidity and hospitalisation that may have affected the household survey [ 34 – 39 ]. Lastly, the use of process and mixed methods data in addition to our randomised trial allowed us to examine its context, intended mechanisms and implementation gaps [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of community health worker–led education on women’s health and treatment–seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

Desai¹,

Mahal²,

Sinha³

et al. 2017

Journal of Global Health

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BackgroundA community–based health insurance scheme operated by the Self–Employed Women’s Association in Gujarat, India reported that the leading reasons for inpatient hospitalisation claims by its members were diarrhoea, fever and hysterectomy – the latter at the average age of 37. This claims pattern raised concern regarding potentially unnecessary hospitalisation amongst low–income women.MethodsA cluster randomised trial and mixed methods process evaluation were designed to evaluate whether and how a community health worker–led education intervention amongst insured and uninsured adult women could reduce insurance claims, as well as hospitalisation and morbidity, related to diarrhoea, fever and hysterectomy. The 18–month intervention consisted of health workers providing preventive care information to women in a group setting in 14 randomly selected clusters, while health workers continued with regular activities in 14 comparison clusters. Claims data were collected from an administrative database, and four household surveys were conducted amongst a cohort of 1934 randomly selected adult women.Results30% of insured women and 18% of uninsured women reported attending sessions. There was no evidence of an intervention effect on the primary outcome, insurance claims (risk ratio (RR) = 1.03; 95% confidence interval (CI) 0.81, 1.30) or secondary outcomes amongst insured and uninsured women, hospitalisation (RR = 1.05; 95% CI 0.58, 1.90) and morbidity (RR = 1.09; 95% CI 0.87, 1.38) related to the three conditions. The process evaluation suggested that participants retained knowledge from the sessions, but barriers to behaviour change were not overcome.ConclusionsWe detected no evidence of an effect of this health worker–led intervention to decrease claims, hospitalisation and morbidity related to diarrhoea, fever and hysterectomy. Strategies that capitalise on health workers’ role in the community and knowledge, as well as those that address the social determinants of diarrhoea, fever and the frequency of hysterectomy – such as water and sanitation infrastructure and access to primary gynaecological care – emerged as areas to strengthen future interventions.

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Section: Discussionmentioning

confidence: 99%

The effect of community health worker–led education on women’s health and treatment–seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

Desai¹,

Mahal²,

Sinha³

et al. 2017

Journal of Global Health

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“…It directly contrasted with women's prescriptions for regular food consumption as a basis of preventative health and the passion they had for the food they enjoyed. Following Kielmann and Bentley, I believe not eating should be considered as a “biocultural marker” of “perceived morbidity complexes that are intricately tied to women's lives and reflect the continuity between mental, physical and social health in this setting” (Kielmann and Bentley :534). Thus, I concentrate the rest of the discussion on exploring the significance of what appetite loss in this urban setting might mean for women's mental, physical, and social health.…”

Section: Discussionmentioning

confidence: 99%

Marital Distress and the Failure to Eat: The Expressive Dimensions of Feeding, Eating, and Self‐care in Urban South Asia

Snell‐Rood

2015

Med Anthropol Q

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This article examines appetite loss among married women living in a Delhi slum. Research has shown that through feeding, women in South Asia gain domestic authority and become part of the families into which they marry. I use observations and interviews collected over 14 months in one poor urban community to explore the social dimensions of feeding and abstaining from eating in a context of marital and food insecurity. Results show that women report appetite loss in response to domestic violence, the stress of marital fights, and fears about the dissolution of their marriages. In other instances, women report that they forget to eat because of dedication to caregiving or refuse to eat because of their husbands' failure to attend to their needs. In the context of this research, I show that food insecurity research would benefit from considering the kinship and gender politics involved in feeding and eating behaviors.

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“…Rather, it is generalized, chronic illness conditions that raised the threshold for perceiving a condition of 'serious' morbidity and result in longer patient delays. The gap between perceived and clinically relevant symptoms has been well-documented in India [22,24,31] and South-East Asia [32,33]. Especially among the poor, acknowledgement of an illness as an abnormal state of being - and one that deserves care - is a function of affordability.…”

Section: Discussionmentioning

confidence: 99%

What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

Pradhan

Kielmann

Gupte³

et al. 2010

BMC Public Health

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BackgroundIndia's Revised National Tuberculosis Control Programme (RNTCP) is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India.MethodsWe conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays.ResultsForty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as non-serious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme.ConclusionA proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for understanding the barriers to reaching public health programmes.

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Thresholds of Morbidity among Women in a Peri-Urban Community of Maharashtra, India: Conceptual and Methodological Issues

Cited by 14 publications

References 27 publications

The effect of community health worker–led education on women’s health and treatment–seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

The effect of community health worker–led education on women’s health and treatment–seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

Marital Distress and the Failure to Eat: The Expressive Dimensions of Feeding, Eating, and Self‐care in Urban South Asia

What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

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