Particularly Vulnerable Tribal Groups Research Articles

A Study of the Baiga Women's Tradition of Tattoos, Modernization of this Art and Situation of Tattoo Industry in India

The Polynesian term "Ta," which signifies hitting something, or the Tahitian word "tatau," according to some anthropologists, may be the source of the word "tattoo." It is "to mark something." Since before the start of the Christian era (CE), tattooing—a kind of bodily modification—has been ingrained in the cultures of many indigenous tribes worldwide. It is also demonstrated by anthropological evidence of various tattoo designs from various cultures that tattooing originated independently in many parts of the world. For various tribes across the nation, getting tattoos has always been an essential aspect of daily life. Tattoos are considered an essential component of the culture and history of the Baiga tribe's women. With the tribal people of Central India, tattooing, sometimes referred to locally as "Godna," is a common form of body art that has deep cultural significance. In this work, the importance of tattoo culture among the women of the Baiga tribe in central India is discussed and examined. This study aims to provide an overview of the Baiga tribe the Particularly Vulnerable Tribal Groups (PVTGs) of Central India. It also explains the tattooing process, from the development of the indelible ink to the tattoo artist's application of the ink into the skin's dermis layer. At present, this art has been modernized to a great extent and the tattoo industry has become a major identity all over the world. At the same time, it has spread to many states in India as well. There are immense possibilities of development in this field in the future.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

INTEGRATING TRADITIONAL INDIGENOUS PRACTICES AND MODERN MEDICINE FOR ENHANCED TRIBAL WELL-BEING

The Particularly Vulnerable Tribal Groups (PVTGs) of Tamil Nadu inhabit the remote hilly regions of the Nilgiris District, fostering a deep reliance on Traditional Medicine over the past decades. Advancements in healthcare systems like road accessibility and the Tribal Mobile Outreach Services (TMORS) have brought modern medicine to the doorstep. It is still a matter of fact to be analysed whether or not these services cater to the unique needs of the tribal communities. The realm of study surrounds the tribal hamlets of Kotagiri where a blend of traditional and modern medicine exists within the healthcare system. However, the absence of a formal integrated structure poses various challenges. The study utilises a qualitative method through interviews and observations. The study aims to assess the prevalence and utilisation of traditional medicine while examining the availability and feasibility of Modern medicine in the tribal communities. Furthermore, it seeks to explore the distinctive barriers and challenges in integrating traditional and modern medicine. The study proposes a strategy to enhance public health and address emergencies within the tribal community as the primary focus is on enhancing the tribal healthcare system to meet the distinctive needs with a tailored framework which contributes to a more effective and cohesive healthcare system. KEYWORDS: PVTGs, Traditional Medicine, Modern Medicine, Integrated Healthcare System, Public Health

Individualized Homeopathic and Organopathic Supportive Management of Sickle Cell Disorder: A Case Series of Six Patients from a Particularly Vulnerable Tribal Group in India.

Sickle cell disorder (SCD) is a hereditary blood disease characterized by an abnormality in the oxygen-carrying protein hemoglobin present in red blood cells. Genetic abnormality causes these cells to become sickle-shaped, with shorter lifespan. Vaso-occlusive crisis is a major symptom of SCD: it is a sudden and severe episode of pain, and occurs when sickle-shaped cells block blood flow. This blockage can lead to tissue damage, inflammation and pain. This case series aims to observe the clinical outcomes from prescribing individualized homeopathic medicines along with organopathic supportive medicine in the management of SCD through the analysis of case studies of six patients from a particularly vulnerable tribal group (PVTG) in India that manifests genetic predisposition for the disease. The patients were administered individualized homeopathic and organopathic supportive medicines, after a comprehensive door-to-door survey and subsequent screening, conducted between October 2020 and May 2023 in the Dindori and Mandla districts of the central Indian state, Madhya Pradesh. Clinical symptoms, laboratory parameters including hemoglobin, along with scores from a visual analogue scale (VAS) for pain and from the World Health Organization Quality of Life (WHOQoL) Questionnaire, were determined. Individualized homeopathic and organopathic supportive management led to improvements in clinical symptoms for all six patients. Laboratory test results showed a statistically significant increase in hemoglobin level associated with treatment. The VAS for pain indicated decreased pain frequency and severity. WHOQoL scores also improved, indicating enhanced well-being for each patient. No adverse effects were reported during treatment. This study suggests that individualized homeopathic medicine and organopathic supportive management have a beneficial role in managing SCD and may be valuable in the context of PVTGs in India. To establish a more comprehensive understanding of its efficacy, further studies should involve larger cohorts to allow for a thorough evaluation, including comparative analyses with standard therapies.

To leave no one behind: Assessing utilization of maternal newborn and child health services by all the 13 particularly vulnerable tribal groups (PVTGs) of Odisha, India.

Indigenous tribal people experience lower coverage of maternal, newborn and child healthcare (MNCH) services worldwide, including in India. Meanwhile, Indian tribal people comprise a special sub-population who are even more isolated, marginalized and underserved, designated as particularly vulnerable tribal groups (PVTGs). However, there is an extreme paucity of evidence on how this most vulnerable sub-population utilizes health services. Therefore, we aimed to estimate MNCH service utilization by all the 13 PVTGs of the eastern Indian state of Odisha and compare that with state and national rates. A total of 1186 eligible mothers who gave birth to a live child in last 5years, were interviewed using a validated questionnaire. The weighted MNCH service utilization rates were estimated for antenatal care (ANC), intranatal care (INC), postnatal care (PNC) and immunization (for 12-23-month-old children). The same rates were estimated for state (n = 7144) and nationally representative samples (n = 176843) from National Family Health Survey-5. The ANC service utilization among PVTGs were considerably higher than national average except for early pregnancy registration (PVTGs 67% versus national 79.9%), and 5 ANC components (80.8% versus 82.3%). However, their institutional delivery rates (77.9%) were lower than averages for Odisha (93.1%) and India (90.1%). The PNC and immunization rates were substantially higher than the national averages. Furthermore, the main reasons behind greater home delivery in the PVTGs were accessibility issues (29.9%) and cultural barriers (23.1%). Ours was the first study of MNCH service utilization by PVTGs of an Indian state. It is very pleasantly surprising to note that the most vulnerable subpopulation of India, the PVTGs, have achieved comparable or often greater utilization rates than the national average, which may be attributable to overall significantly better performance by the Odisha state. However, PVTGs have underperformed in terms of timely pregnancy registration and institutional delivery, which should be urgently addressed.

How healthy is the health budget of Amrit Kaal: 2023-24?

Political will is the key to public health policy-making and a major driving force for the attainment of Universal Health Coverage (UHC) in any nation. To achieve UHC, the Indian government laid down National Health Policy in 1983 and updated it in 2002 and recently in 2017. This recent policy emphasized increasing healthcare spending and economic growth. In the current budget, there is an increment in the share of GDP of 0.34% from the previous year's allocation, but still staggering for the envisaged 2.5% to achieve UHC. Enthusiastic announcements of opening 157 new nursing colleges, a separate programme for eliminating sickle cell anemia by 2047, and Centers of excellence establishment for pharma companies for promoting research and development and focusing on Particularly Vulnerable Tribal Groups (PVTGs) are the few overarching and new highlights in the current budget. But, in a country so huge and varied in terms of its needs in every sector, the announcements in the financial budget speech taking India forward in becoming a "shining star" is a matter of debate. This is an attempt to review the budget for this financial year in the healthcare sector and what it means: is the country willing to build a self-driven healthcare sector in the Amrit Kaal with strong public finances and a robust financial sector through "efforts by all"?

Towards an improved involvement of parents in educating girls: a study on Particularly Vulnerable Tribal Groups in India

ABSTRACT Parental involvement in educating children remains a crucial first step in building an informed citizen. It becomes a routine matter for children to follow the footsteps of educated parents. However, for the first-generation learners, e.g. particularly vulnerable tribal groups (PVTGs), it is an arduous task because they belong to the least developed communities in India, with poverty and illiteracy forming the base of their existence. This paper examines the extent of involvement PVTG parents have in educating their daughters and identifies ways for improvement. Findings based on this original study suggest that the parents realise involvement, but their knowledge of involvement differs from the general population and the Western context. Hence, the study proposes four types of Cs to integrate their involvement: Concern, Communication, Condition, and Cooperation.

Ethnobotanical Exploration on PVTG, The Chenchu Tribe of Srisailam Forests in Nallamala Hills of Eastern Ghats in India With Special Reference to Anti Venom Tool, The Herbal Necklace For Snake Bite.

The medicinal plants are the local heritage with global importance. The plants are important source in the preparation of ethno medicine and play a significant role in the survival of ethnic people worldwide. Snake bite is a severe medical, social, and economic problem in many parts of the world. In India a range of medicinal plants are used as antidote for snake bite used either singly or in combination with other agents. The present study makes an effort to document the indigenous knowledge regarding herbal remedies for snake bite practiced by the Deva Chenchus of Srisailam forests of Nallamala hills of Eastern Ghats in India. During the ethnobotanical explorations carried out during 2021 to 2022 an interesting cultural practice by the Particularly Vulnerable Tribal Group (PVTG), the Deva Chenchu ethnic tribe was observed for documentation of Indigenous knowledge . The males of native Chenchu tribe sport a herbal necklace as their identity as well as antidote to snakebite. The medicinal plants of herbal necklace are identified. Further studies are required to evaluate efficacy for the anti venom properties of the herbal necklace.

Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts

ObjectiveTo report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India. MethodsCross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility). ResultsOnly 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother’s education, health worker’s home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home. ConclusionPVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health.

Attitude and determinants of contraceptive use among the Juang tribe: A cross-sectional study in Odisha, India

BackgroundIn India, Scheduled Tribes (STs) often have the lowest performance across various health measures, including contraceptive use. The condition of the Particularly Vulnerable Tribal Groups (PVTGs) is perceived to be worse. This study assesses attitudes and determinants of contraceptive use among the Juang tribe, a PVTG residing in Odisha, India. MethodsData from a cross-sectional mixed-method research with a three-stage sampling design that was carried out in 2020–2021 were utilized for this study. The analysis was based on quantitative data from 360 currently married women aged 15–49 years, and qualitative interviews with women and men (12 Focus group discussions and 12 Key-Informant Interviews). Binary logistic regression was used to assess the determinants of contraceptive use among Juang women. ResultsTwo-thirds of Juang women had low/moderately favorable attitudes towards contraceptive method use. Thirty-four percent of women were using any contraceptive methods. The adjusted odds ratio (AOR) of using contraception was low among the women aged 15–24 years (AOR = 0.38; 95 % CI: 0.19–0.73), illiterate (AOR = 0.11; 95 % CI: 0.06–0.20), married below 18 years (AOR = 0.38; 95 % CI: 0.18–0.77), and not exposed to mass media (AOR = 0.34; 95 % CI: 0.18–0.65) than their respective counterparts. ConclusionsAmong the Juang tribe, the use of contraception is limited and influenced by socio-cultural factors, including existing gender norms. Illiteracy, marriage below 18, younger age, and non-exposure to mass media are significantly associated with the non-use of contraception. Results suggest strengthening and expanding the family planning program outreach, especially among the young, illiterate Juang women.

Health issues of the indigenous communities with special reference to the Particularly Vulnerable Tribal Groups (PVTGs) of Odisha: a review

As India is a country in epidemiological transition, the indigenous populations agonise from a dual burden of illnesses, including undernutrition, infectious diseases and lifestyle-related issues like hypertension, obesity and diabetes. Few concrete efforts have been made to understand these emerging public health problems with emphasis on the indigenous populations living in this country. This review paper focuses on the epidemiological transition, prevalence of communicable and non-communicable diseases, nutritional status, dual burden of malnutrition and the availability, acceptability and accessibility of the health care services among the tribal communities with special emphasis on the Particularly Vulnerable Tribal Groups (PVTGs) of Odisha. This study is based on the review of published articles in different online databases using search engines like Google Scholar, Pub Med, INFLIBNET, JSTOR. A total of 195 articles published during the period from 1956 to 2022 were reviewed. The review is focussed on the indigenous populations living in the Indian state of Odisha. Migration and urbanization are the leading causes of epidemiological transition among them. The health scenario in terms of nutritional status, disease burden and availability of health care facilities of Odisha was found to be far behind the national average. Compared to other groups, the situation of the PVTGs of this state is the worst. The review suggests more action-oriented ground level research with targeted goals that would address the health needs of the indigenous populations at a micro level.

Role of information sources in carrying government reproductive health scheme to tribal women in India: A case study among women belonging to Koraga community.

To improve the health status of its people irrespective of their socio and economic status, the government will design various schemes. In taking the government schemes effectively to the target group, the role of information sources is crucial. For the study purpose, Koraga community residing in and around Udupi-a district of Karnataka State, which has earned a name not only for its mythological significance but also for its culture of having their women empowered is considered. In the present study, role of information sources in taking the Janani Shishu Kalyan Yojana planned towards improving the pre- and post-natal health of women to reduce maternal death is considered. The results of the study enable us to understand the preference and dependency of the target group on various sources regarding the information received. Since the government-proposed health schemes should reach the target group to bring in a better health index which is one of the SDGs set for 2030, this study gains importance. The study intends to examine the role of information sources in educating the women, particularly those belonging to Koraga community, who fall under the particularly vulnerable tribal groups (PVTG) category among the tribals of India about the government schemes earmarked for safe motherhood. It was conducted in the colonies designated for Koraga community near Udupi of Karnataka using a questionnaire. Based on the results obtained from the pilot study, a final questionnaire was prepared and was personally demonstrated among Koraga women during the month of January 2020. Data were collected from 117 women belonging to Koraga community. SPSS version 17.0 software, Microsoft Word and Excel were used in data handling and analysis. The results obtained out of the study reveal that among the sources, the respondents consider doctors as dependable sources followed by ASHA/Anganwadi workers. The target group is not aware of the nomenclature of the scheme nor the benefits to expect, but they are receiving medical support during their pre- and post-natal period. The governments may initiate schemes for the benefit of the public, but the schemes will become successful only when the desired information reaches the target group. The study intended to examine the role of information sources in educating the women particularly those belonging to Koraga community and found that the dependency of the target group on various sources of information regarding government projects is evident and should be further strengthened.

Ethno-medicinal plants used by the Baiga tribe of Maikal hills of Central India

The Baiga tribes considered as Particularly Vulnerable Tribal Groups (PVTGs), reside in the Maikal hills of central India and are rich in their culture and traditional knowledge. The Vaidya and Guniya are two types of health healers found among the Baiga tribal community. It is found that they have good skills in identifying the mediational plants. The present paper aims to explore the traditional healing system, and tribal indigenous knowledge system and identifies the ethno-medicine used by the Baiga tribes of the Maikal hills of central India. The three-pronged research methodology was adopted in the present study. (i) Desk review, (ii) FGDs, and (iii) personal interactions. Due to development intervention, many medicinal plants disappeared, and there is a need to document and encourage the new generation to continue medicinal practices. Their livelihood opportunities could be increased, and hidden treasury will be helpful to mainstream society for the protection of health care.

Menstrual health and hygiene among Juang women: a particularly vulnerable tribal group in Odisha, India

BackgroundMenstruation is a normal biological process that all women go through, yet it is shrouded in secrecy, taboos, and even stigma in many societies. Studies have shown that women from socially disadvantaged groups are more likely to have preventable reproductive health issues and have less understanding of hygienic menstrual practices. Therefore, this study aimed to provide an insight into the most sensitive issue of menstruation and menstrual hygiene practices among the women of the Juang tribe, recognized as one of the particularly vulnerable tribal groups (PVTG) in India.MethodsA cross-sectional study using a mixed-method approach was carried out among Juang women in Keonjhar district of Odisha, India. Quantitative data was gathered from 360 currently married women to assess practices associated with menstruation and its management. In addition, 15 focus group discussions and 15 in-depth interviews were conducted to explore the views of Juang women on menstrual hygiene practices, cultural beliefs, menstrual problems, and treatment-seeking behaviour. Inductive content analysis was used to analyse the qualitative data, while descriptive statistics and chi-squared tests were used to analyse quantitative data.ResultsMost Juang women (85%) used old clothes as absorbents during menstruation. Distance from the market (36%), lack of awareness (31%), and high cost (15%) were cited as the contributing factors to the low level of sanitary napkin usage. Around 85% of women were restricted from participating in religious activities, and 94% avoided social gatherings. Seventy-one percent of the Juang women experienced menstrual problems, while only one-third of them sought treatment for their problems.ConclusionHygienic practices during menstruation are far from satisfactory among Juang women in Odisha, India. Menstrual problems are common, and the treatment sought is insufficient. There is a need for awareness generation on menstrual hygiene, the adverse effects of menstrual problems, and the provision of low-cost sanitary napkins among this disadvantaged, vulnerable tribal group.

Assessment of Oral Health Status among the Kutia Kandha Tribe - A Particularly Vulnerable Group Residing in Kandhamal District, Odisha

Objective: In Odisha, the Kandha tribal group is numerically the most populous tribe. Among the several sections of the Kandha communities, two sub-sections, the Kutia Kandha and Dongria Kandha, have been identified as Particularly Vulnerable Tribal Groups (PVTGs). As a result, the study’s aim was to assess the oral health status of the Kutia Kandha tribe. Material and Methods: A cross-sectional survey was carried out among 850 Kutia Kandhas using a multistage randomised sampling method in the Tumudibandha Block of Kandhamal District. Data were collected using the World Health Organization (WHO) Oral Health Assessment Form, 2013. Numbers and percentages were analyzed using Microsoft Excel and Statistical Package for the Social Science (SPSS) package version 26.0. Comparisons between discrete and continuous data were done using the Chi-square test and ANOVA. A p-value of 0.05 was considered to be statistically significant. Results: The study population consisted of 850 subjects stratified into seven different age groups. The mean DMFT (permanent) and dmft (deciduous) scores of were 4.06±3.55 and 0.12±0.56 respectively. One hundred fifty-one (16.0%) subjects had bleeding. Three hundred and sixty-two (42.6%) subjects had pockets 4-6 mm and 276 (32.5%) had pockets more than 6 mm. Four hundred and seventy-six (56%) of the study participants had 4-5 mm of loss of attachment followed by 303 (35.6%) with 6-8 mm loss of attachment. Conclusion: The prevalence of caries and periodontal diseases was high. Due to a lack of knowledge about oral hygiene maintenance, proper health education should be provided to the Kutia Kandha tribals.

Smoking, betel quid chewing, and alcohol use among an indigenous primitive Tribal group in the Kerala State of India: Secondary analysis of a Tribal household survey

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India.Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households.Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use.Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

Hepatitis B virus infection among the tribal and particularly vulnerable tribal population from an eastern state of India: Findings from the serosurvey in seven tribal dominated districts, 2021-2022.

The Global Health Sector Strategy on viral hepatitis (2016-2021) endorsed by the World Health Assembly in 2016, called for the elimination of viral hepatitis as a public health threat by 2030. Odisha, an eastern state of India, has the third-highest percentage of tribal population in the country and limited information is available regarding the prevalence of HBsAg among them. The present study was undertaken to estimate the seroprevalence of hepatitis B surface antigen as well as HBV DNA almost after 12 years of the first prevalence study of HBsAg among the tribal community of Odisha. The present study attempted to estimate the prevalence of HBsAg among the 35 Scheduled tribal (ST) communities and 5 Particularly Vulnerable Tribal Group (PVTG) using the 2,737 number of sera collected as part of a statewide COVID-19 serosurvey, among the tribal populations of Odisha (residing in 7 districts) aged 6-75 years. HBsAg positivity ranged between 1.79 and 2.94% across various age groups. 42.9% of HBsAg positive individuals showed the presence of HBV DNA and the high viral load was 0.10 × 102-6.84 × 108 IU/mL, indicating a high potential to transmit the virus. The HBsAg positivity was 14.18 and 6.06% among the PVTGs, Kutia Khond and Paudi Bhuyan, who were first time surveyed for HBsAg prevalence. The present study documents the prevalence of HBsAg among the major tribal population residing in the eastern state of the country and highlights the need for a statewide survey of Hepatitis B infection and risk factors, coverage and impact of the Hepatitis B vaccination program introduced in 2010-2011 in Odisha among the ST and PVTG population of the state.

Development, validation & pilot testing of a questionnaire to assess healthcare seeking behaviour, healthcare service utilization & out-of-pocket expenditure of Particularly Vulnerable Tribal Groups of Odisha, India.

Assessing healthcare seeking behaviour (HSB), healthcare utilization and related out-of-pocket expenditures of Particularly Vulnerable Tribal Groups (PVTGs) of India through a prism of the health system may help to achieve equitable health outcomes. Therefore, this comprehensive study was envisaged to examine these issues among PVTGs of Odisha, India. However, there exists no validated questionnaire to measure these variables among PVTGs. Therefore, a study questionnaire was developed for this purpose and validated. Questionnaire was constructed in four phases: questionnaire development, validity assessment, pilot testing and reliability assessment. Nine domain experts face validated questionnaire in two rounds, followed by a single round of quantitative content validity. Next, the questionnaire was pretested in three rounds using cognitive interviews and pilot-tested among 335 and 100 eligible individuals for the two sections healthcare seeking behaviour (HSB-Q) and maternal and child healthcare service utilization (MCHSU-Q). Internal consistency reliability was assessed for de novo HSB-Q. On two rounds of expert-driven face validity, 55 items were eliminated from 200 items. Questionnaire showed moderate to high content validity (item-level content validity index range: 0.78 to 1, scale-level content validity index/universal agreement: 0.73; scale-level content validity index/average: 0.96 and multirater kappa statistics range: 0.6 to 1). During the pre-test, items were altered until saturation was achieved. Pilot testing helped to refine interview modalities. The Cronbach alpha and McDonald's omega assessing internal consistency of HSB-Q were 0.8 and 0.85, respectively. The questionnaire was found to be valid and reliable to explore healthcare seeking behaviour, maternal and child healthcare utilization and related out-of-pocket expenditure incurred by PVTGs of Odisha, India.

A community based study on haemoglobinopathies and G6PD deficiency among particularly vulnerable tribal groups in hard-to-reach malaria endemic areas of Odisha, India: implications on malaria control

BackgroundHaemoglobinopathies and G6PD deficiency are inherited disorders found mostly in malaria-endemic areas among different tribal groups of India. However, epidemiological data specific to Particularly Vulnerable Tribal Groups (PVTGs), important for planning and implementing malaria programmes, is limited. Therefore, the present community-based study aimed to assess the prevalence of haemoglobinopathies and G6PD deficiency among the 13 PVTGs found in the state of Odisha, reporting the maximum malaria cases in the country.MethodsThis cross-sectional study was conducted from July 2018 to February 2019 in 12 districts, home to all 13 PVTGs, in an estimated sample size of 1461, selected two-stage sampling method. Detection of haemoglobinopathies was done by the variant analyser. Screening of G6PD deficiency was carried out using DPIP method followed by quantification using spectrophotometry. The PCR–RFLP technology was used to determine variant of G6PD deficiency and haplotype analysis of sickle cell, while ARMS-PCR and GAP-PCR was used for detecting the mutation pattern in β-thalassaemia and α-thalassaemia respectively. The diagnosis of malaria was done by Pf-PAN RDT as point of care, followed by nPCR for confirmation and Plasmodium species identification.ResultsThe prevalence of sickle cell heterozygotes (AS) was 3.4%, sickle cell homozygous (SS) 0.1%, β-thalassaemia heterozygotes 0.3%, HbS/β-thalassaemia compound heterozygote 0.07%, HbS-α-thalassaemia 2.1%, G6PD deficiency 3.2% and malaria 8.1%. Molecular characterization of βS revealed the presence of Arab-Indian haplotype in all HbS cases and IVS 1–5 G → C mutation in all β-thalassaemia cases. In case of α-thal, αα/α-3.7 gene deletion was most frequent (38%), followed by αα/α-4.2 (18%) and α-3.7/α-3.7 (4%). The frequency of G6PD Orissa (131C → G) mutation was found to be 97.9% and G6PD Mediterranean (563C → T) 2.1%. Around 57.4% of G6PD deficient individuals and 16% of the AS were found to be malaria positive.ConclusionThe present study reveals wide spread prevalence of sickle cell anaemia, α-thalassaemia, G6PD deficiency and malaria in the studied population. Moderate to high prevalence of G6PD deficiency and malaria warrants G6PD testing before treating with primaquine (PQ) for radical cure of Plasmodium vivax. Screening and counselling for HbS is required for the PVTGs of Odisha.

Indigenous Knowledge Pertaining to Health, Illness and Healthcare Seeking Behaviour Among Tribes of Chhattisgarh, India: A Comparative Explanation

Tribal population in India constitutes about 8.6 percent of the country’s total population and there are 705 recognized scheduled tribes in the country out of which 75 are declared Particularly Vulnerable Tribal Groups (PVTGs). Tribals reside in the hilly terrains, dense forests in the remote areas perched away from the mainstream depending upon the forests for their routine needs. The interaction of tribal people with nature is intertwined with their indigenous knowledge system, the knowledge which is held by the members of a particular community and evolved through many years of regular experimentation. It is handed down through generations by the mode of cultural transmission. The characteristic feature of indigenous knowledge is that it serves the day to day needs of the tribals and some crises situation of life including health. Health is an inevitable prerequisite is influenced by some common beliefs, practices and customs in any society. Like every culture, tribals as well have their own beliefs and practices with respect to the concept of health, disease and illness. The present study is conducted among tribes of Surguja district of Chhattisgarh and lays emphasis on highlighting the perceptions pertaining to health &amp; illness and beliefs associated with their indigenous knowledge system.