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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 2  |  Page : 69-72

Patterns of utilization of maternal and child health care among tribals of H D Kote Taluk Mysore


1 Public Health Researcher, Jawaharlal Nehru University, New Delhi, India
2 Department of Community Medicine, JSS Medical College and Hospital, Mysore, India
3 Researcher, Swami Vivekananda Youth Movement, Sargur, India

Date of Submission20-Oct-2020
Date of Decision15-Dec-2020
Date of Acceptance16-Dec-2020
Date of Web Publication24-Mar-2021

Correspondence Address:
Dr. Kavita Yadav
Public Health Researcher, Jawaharlal Nehru University, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_139_20

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  Abstract 


Background: Maternal and child health (MCH) care services utilization is an important issue in the tribal area. It is very important to understand the pattern of utilization so as enable the policymakers to take initiatives to make the service provision more acceptable to the tribal population of India. Methodology: A community-based study was conducted in the tribal area of H D Kote taluk Mysore. Of 16 Primary Health Centers, five centers which cover nearly 50% of the population were chosen for the study. All the mothers who resided in those areas and delivered during January 2013 to December 2013, were chosen for study, which came to 215. Those who had migrated to areas outside our study area and those who were not found in home during data collection home visit were left out. Hence, the final sample size came to be 165. Results: Majority of mothers (74.5%) had antenatal registration done in the first trimester. Nearly 36.4% of mothers had <3 antenatal check-up visits, 26.7% had 3–5 visits, and 32.7% of mothers had >5 visits. About 95.2% of mothers had received two Tetanus toxoid injections, 3% had one injection, and 1.8% had no injections. About 42.4% of mothers had consumed >100 iron and folic acid (IFA) tablets, 27.3% had 75–100 tablets, 13.3% had 50–75 tablets, and 14.5% had <50 tablets, whereas 2.4% did not consume the IFA tablets. Conclusion: MCH care services utilization in the chosen tribal area was found to be satisfactory. It is a good sign as this reflects on the success of the reach of the government programs aimed at improving the mother and child health conditions in the tribal population.

Keywords: Maternal and child health care, service utilization, tribal health


How to cite this article:
Yadav K, Narayana Murthy M R, Prasad M, Kulkarni P. Patterns of utilization of maternal and child health care among tribals of H D Kote Taluk Mysore. Indian J Med Spec 2021;12:69-72

How to cite this URL:
Yadav K, Narayana Murthy M R, Prasad M, Kulkarni P. Patterns of utilization of maternal and child health care among tribals of H D Kote Taluk Mysore. Indian J Med Spec [serial online] 2021 [cited 2021 Jun 24];12:69-72. Available from: http://www.ijms.in/text.asp?2021/12/2/69/311869




  Introduction Top


India is home to world's second-largest tribal population. There are 635 tribes and it constitutes approximately 8.6% of the total Indian population.[1] These are the marginalized communities who live mostly in hilly terrains and away from civilization. Due to this isolation, and living in hard to reach places, they are often victim of lack of access to proper healthcare. This is further worsened by lack of awareness regarding the health-care services being offered by the government. This eventually leads to higher maternal mortality rates and child mortality rates among the tribal population. It is well known and widely accepted that the use of maternal health services reduces maternal morbidity and mortality.[2],[3] There are many national programs aimed at reducing maternal mortality and morbidity. However, despite the existence of these national programs for improving maternal and child health (MCH), maternal mortality and morbidity continue to be at higher side, at an unacceptable level. There are multiple reasons for this situation. Early marriage, malnutrition, illiteracy, ignorance, lack of health services, and unavailability of transport facilities are the major contributors. One of the most important reasons for the same is nonacceptance or nonutilization/underutilization of maternal health care services, especially among the tribal population. Therefore, the present study is carried out to assess the utilization of maternal health care services in remote tribal areas of HD Kote and to understand the root cause behind the reasons of the utilization/nonutilization of MCH care services. Understanding the pattern of utilization of MCH care services would further enable the concerned departments to address those concerns and take initiatives to make the service provision more acceptable to the tribal population of India.


  Methodology Top


This cross-sectional community-based study was carried out in H D Kote taluk with a population of 275,160. Among these, the tribal population is scattered in haadis (tribal hamlet) which are 119 in number. There were 16 Primary Health Centers covering the tribal population of 19,964. Out of these 16 Primary Health Centers, five centers, namely, B. Matakari, D. B Kuppe, N Belthur, Dadadahalli, and Badagalapura which cover nearly 50% of tribal population and are also reached by the program Vatsalya Vahini (reproductive and child health initiative of SVYM) were selected. Then from the selected Primary Health Centers catering to tribal hamlets, all the mothers who delivered during January 2013 to December 2013, were chosen for the study, which came to 215. Those mothers who had migrated to areas outside our study area and those who were not found in home during data collection home visit were excluded.

After obtaining approval from the Institutional Ethical Committee, JSS Medical College, Mysore, and Institutional Review Board, Swami Vivekananda Youth Movement, we conducted a study in the above-mentioned area. All the chosen mothers were interviewed personally using a pretested semi-structured proforma, with the help of health workers in respective areas. Before interview, a written consent was obtained from each participant in the local language Kannada.

Data collection were done from July 2014 to December 2014. Those houses found locked on first visit, were given second visit after 1 week. And if still found locked or mother was missing, then they were excluded from the study. Hence, the total sample size came to 165. The nonresponse rate was found to be 23.26%. Data analysis was done using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.


  Results Top


In the present study, a total of 165 mothers were interviewed. Majority of the mothers (59.3%) were in the age group of 20–24 years. About 26.7% of mothers belonged to the group of 25–29 years and rest 14% belonged to 15–19 years age group. 82.4% of mothers were married before the age of 19 years and rest 15.8% were married during 20–24 years. About 80.6% of mothers were working as coolie or daily wager, whereas 17.6% were homemakers and rest 1.8% were involved in other activities such as honey collection. All the mothers were Hindu by religion. They were further divided into, four castes, namely., Jenu Kuruba (66.1%), Kadu Kuruba (15.2%), Yeravas (12.1%), and Soligas (6.7%). Majority of the mothers (80%) were literate, at least having primary school education, whereas literacy rate among husbands was comparatively low (64.8%). About 66.7% of mothers had delivered in private hospital, 12.7% of mothers had delivered in government hospital, and 20.6% of mothers had delivered in home.

[Table 1] depicts that majority of mothers (74.5%) had antenatal registration done in the first trimester, 14.5% had in the second trimester, 7.3% had in the third trimester, and 3.6% of mothers did not have a registration. About 36.4% of mothers had <3 antenatal check-up visits, 26.7% had 3–5 visits, and 32.7% of mothers had >5 visits [Figure 1].
Figure 1: Mothers utilizing full antenatal care services

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Table 1: Distribution of study participants according to antenatal services received

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About 95.2% of mothers had received two tetanus toxoid injections, 3% had one injection and 1.8% had no injections. About 42.4% of mothers had consumed >100 iron and folic acid (IFA) tablets, 27.3% had 75–100 tablets, 13.3% had 50–75 tablets, and 14.5% had <50 tablets, whereas 2.4% did not consume the IFA tablets.

Awareness regarding various aspects of pregnancy

[Table 2] depicts that about 98.2% of mothers had information about place of delivery danger signs, complications of pregnancies, and delivery kit. About 97.6% of mothers had information about supplementary food and 69.7% had consumed supplementary diet for 4–6 months, 29.1% of mothers had it for nearly 3 months. About 98.8% of mothers had the exclusive breastfeeding counseling but only 97.6% of mothers practiced it.
Table 2: Awareness among the study participants

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Post-natal care received

[Table 3] depicts that About 89.6% of mothers received check-up within 48 h of delivery, 97.6% of mothers practiced exclusive breastfeeding, and 95.1% of mothers had got their child immunized.
Table 3: Postnatal care

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Beneficiary status of government schemes

About 84.2% of mothers had postnatal care at hospital and rest 15.8% did not receive it. Nearly 56.4% of mothers were beneficiary of all three schemes, 9.1% of mothers received 2 scheme benefits. About 9.1% of mothers got only one scheme benefit out of three schemes run by the government, namely, Madilu kit, Janani Suraksha Yojana, and Prasuti Aarieke.


  Discussion Top


In the present study, it was found that 74.5% of mothers had registered their pregnancy in the first trimester, 14.7% registered in the second trimester, and 7.3% registered in the third trimester, and 3.6% of mothers had not registered at all, which is similar to the findings of study conducted by Babu et al.[4] where 74% of mothers had registered their pregnancy in the first trimester. Deb, in her study[5] reported that 52.4% tribal population of East Khasi Hills had registered their pregnancy in the first trimester itself, and 45.3% of mothers registered in the second trimester. Our study shows comparatively higher antenatal care (ANC) registration among the tribal population but when compared to the urban population the proportion comes down gradually. This may be due to the migration of the tribal population at regular intervals.

In the present study, it was found that 59.4% of mothers had three or more ANC visits and 36.4% of mothers had <3 visits, and 4.2% of mothers did not have any visit. In a study done in tribal areas of Andhra Pradesh, it was found that 32.1% of mothers had more than 3 visits and 41.75% of mothers had 2–3 visits and 13.4% had only one ANC visit.[6] Our study reported higher ANC registration in the first trimester, however, when compared to a study conducted in rural area there were 83.1% of mothers with three or more ANC visits, 15.9% had two ANC visits and one percent had single ANC visit.[7] There are varied levels of ANC visit data across India in different populations, namely., rural and urban slums; however, an approximate 60% of mothers having three ANC visits in tribal areas is an encouraging number. In the present study, it was found that 95.2% of mothers had received two injections, 3% received only one injection, and 1.8% of mothers did not receive any injection which is in line with the findings of study conducted by Babu et al.[4] and Deb[5] where 97% of tribal mothers had two TT injections and 83.3% of mothers had received complete TT vaccination in the Tribal Population of East Khasi Hills (Meghalaya). In another study done in Maharashtra tribal population, the percentage of TT immunization was found to be 82.38%.[8] On the contrary, study done in Meghwal in a remote tribal village of Udaipur district, it was found that 42% of mothers were still unaware about the TT injections.[8] Our study reports relatively higher numbers which maybe attributed to the tireless workers of the Vatsalya Vahini program running in the study area.

In the present study, it was found that 42.4% of mothers had consumed >100 tablets, 27.3% of mothers had consumed 76–100 tablets and 13.3% of mothers had consumed 50–75 tablets, 14.5% of mothers had taken <50 tablets, and 2.4% mothers had not consumed any tablets. However, other studies in tribal areas[4],[5],[9] reported higher IFA tablet consumption, namely., 93%, 79.8%, and 68.5%. The main reason cited for not consuming IFA tablets was that the mothers did not like taking any tablets.

In the present study, it was found that 98.2% of mothers had information about the place of delivery, danger signs, complications of pregnancies, and delivery kit and 97.6% of mothers had information about supplementary food and 69.7% had consumed supplementary diet for 4–6 months, 29.1% of mothers had it for nearly 3 months.

In our study, 98.8% of mothers had the exclusive breastfeeding counseling but only 97.25% of mothers practiced it. About 95.2% of mothers had got immunization of child done. These findings are somewhat similar to the findings of a study which reported that 71.2% of children were fully immunized in Andhra Pradesh tribes.[6]

In another study,[8] it was found that 62% of mothers were still unaware about child immunization. Our study report higher numbers which may be attributed to the regular counseling by ASHA workers who visit houses crossing difficult terrains.

The overall ANC service utilization was found to be 67% in our study. This is quite high when compared to study conducted in Madhya Pradesh[10] where the overall ANC service utilization was found to be 39.5% only. In another study conducted in Kodagu,[11] the ANC utilization rates were found to be 58% which is comparable to our study.


  Conclusion Top


MCH care services utilization in the chosen tribal area was found to be satisfactory. Although the data are 6 years old, it represents the success of the reach of the government programs aimed at improving the mother and child health conditions in the tribal population. It may not be generalizable to the current situation. Good ANC care utilization is known to improve the rates of institutional deliveries along postnatal care utilization which in turn would result in a healthier nation as envisioned by various national programs.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Statistical Profile of Scheduled Tribes in India, 2013. Ministry of Tribal Affairs, Statistical Division. Government of India. Available from: https://www.tribal.nic.in. [Last accessed on 2020 Oct 15].  Back to cited text no. 1
    
2.
Vora KS, Mavalankar DV, Ramani KV, Upadhyaya M, Sharma B, Iyengar S, et al. Maternal health situation in India: A case study. J Health Popul Nutr 2009;27:184-201.  Back to cited text no. 2
    
3.
Kesterton AJ, Cleland J, Sloggett A, Ronsmans C. Institutional delivery in rural India: The relative importance of accessibility and economic status. BMC Pregnancy Childbirth 2010;10:30.  Back to cited text no. 3
    
4.
Babu G, Ramachandra S, Garikipati U, Mahapatra T, Mahapatra S, Narayana S, Pant H. Maternal Health Correlates of Neonatal Deaths in a Tribal Area in India. Int J Epidemiol 2012;10. Available from: https://www.researchgate.net/publication/236866097_Maternal_health_correlates_of_neonatal_deaths_in_a_tribal_area_in_India. [Last accessed on 2021 Jan 30].  Back to cited text no. 4
    
5.
Deb R. Utilization of services related to safe motherhood among the tribal population of east Khasi hills (Meghalaya): An overview. Ethno Med 2011;2:137-41.  Back to cited text no. 5
    
6.
Mallikharjuna Rao K. Utilization of reproductive and child health services in tribal areas of Andhra Pradesh. Reproductive and child health services in Andhra Pradesh. Tribes Tribals 2008;2:35-41.  Back to cited text no. 6
    
7.
Rudramma J. Utilization of Antenatal, Intranatal and Postnatal Care Services by Mothers in Rural Field Practice Area of JNMC: A Cross-sectional Study (MD Thesis). Belgaum, Karnataka: K.L.E University.  Back to cited text no. 7
    
8.
Kumar A, Sharma S, Sharma CP, Meghwal SC. A Study to assess the level of living and awareness andpractices regarding MCH Care in a remote tribal village of Udaipur district. Nat J Community Med 2013;4:318-20.  Back to cited text no. 8
    
9.
Sachiri SM, Rekha R. Ante natal care services utilization, delivery practices and factors affecting them in tribal area of North Maharashtra. Indian J Community Med 2011;36:287-291.  Back to cited text no. 9
    
10.
Sharma A, Thakur PS, Tiwari R, Sharma R. Utilization of antenatal care services in tribal area of Madhya Pradesh: A community based cross sectional study. Int J Community Med Public Health 2019;6:2465-71.  Back to cited text no. 10
    
11.
Udayar S, Parveen M. Study of awareness and utilization pattern of antenatal care services among tribal women of the reproductive age group in Kodagu district, Karnataka. Int J Med Sci Public Health 2020;9:1-6.  Back to cited text no. 11
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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