Tribal Setting Research Articles

Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B046.

Investigating tooth morbidity risks, prevalence, and interventions in tribal setting: a study protocol focused on the Irula community in Tamil Nadu

AimDentistry is uniquely positioned as a healthcare profession, distinguished from allied health or paramedical fields. It operates within a university-based structure, maintaining primary care responsibilities. Oral diseases impose a substantial worldwide health and economic burden, profoundly affecting the well-being of those affected. This cross-sectional study is centered on the Irula tribes in Tamil Nadu, India. Investigating the extent of tooth morbidity and loss, identifying possible risk factors, looking at oral hygiene habits, and evaluating the oral health-associated quality of life (OHRQoL) in this population are the main goals. As this population is at high risk for dental issues, promoting good oral hygiene becomes crucial. Indigenous populations, including the Irula tribes, have been underrepresented in research studies. The vulnerability of the Irula tribes is exacerbated by their remote locations, resulting in limited access to fundamental healthcare facilities.Materials and methodsThis study employs a cluster sampling approach, aiming to include 880 individuals aged 60 and above from Kancheepuram and Chengalpattu districts. The methodology encompasses a community-based questionnaire, clinical assessments utilizing standardized indices, and the assessment of the Oral Health-Related Quality of Life (OHRQoL). The Statistical Package for Social Services, version 20, will be used to analyze all of the data that has been gathered (SPSS).Categorical variables will undergo analysis, with descriptive statistics and frequency percentages computed.ConclusionThis study evaluates tooth morbidity and dentistry's role in screening chronic diseases like diabetes among the Irula tribes. It explores risk factors, oral hygiene practices, treatment seeking behavior, and oral health-related quality of life to gain a comprehensive understanding.

Interpersonal Challenges Faced By Community Health Officers at Health and Wellness Centres in Delivery of Comprehensive Primary Health Care in Tribal Setting of Gujarat: A Mixed Methods Study

Introduction: Multi skilling and expansion of the team members involved in operationalizing Sub-Health Centres (SHCs) to Sub-health Centres-Health and Wellness Centres (SHC-HWCs) in India tends to be a challenge. New roles are being assigned to Community Health Officer (CHO) in an exponential manner. Objective: To identify the team-based interpersonal challenges encountered by Community Health Officers (CHOs)in terms of human relations in professional forefront and extract probable solutions from them for overcoming these challenges. Method: It was a sequential type of mixed method done in two-step process, quantitative survey of the defined indicators at SHC-HWCs followed by group discussion among CHOs for qualitative data. Quantitative survey was aimed at finding utilization of services. (Triangulation of both the data) whereas qualitative survey was aimed at finding out interpersonal challenges faced for adequate service delivery. Authors targeted to collect data from all the SHC-HWCs (N=53) in Dahod block for quantitative and qualitative survey. Results: The service utilization related to Maternal health and child health; childhood and adolescent health were found in range of 90-95%, followed by community participation (70%). The qualitative analysis of data revealed that CHOs were overburdened by their superiors and perceived lack of co-operation, dedication, and accountability from fellow team members. Conclusion: Utilization of certain services like non-communicable diseases (NCD), palliative care, mental health was found to be suboptimal. Significant lack of motivation and coordination were possibly some of the contributors.

Community member perspectives on adapting the cascade of care for opioid use disorder for a tribal nation in the United States.

The Opioid Use Disorder (OUD) Cascade of Care is a public health model that has been used to measure population-level OUD risk, treatment engagement, retention, service and outcome indicators. However, no studies have examined its relevance for American Indian and Alaska Native (AI/AN) communities. Thus, we aimed to understand (1) the utility of existing stages and (2) the relative 'fit' of the OUD Cascade of Care from a tribal perspective. Qualitative analysis of in-depth interviews with 20 individuals who were knowledgeable regarding the treatment of OUD in an Anishinaabe tribal setting in Minnesota, USA. Community member roles included clinicians, peer support specialists and cultural practitioners, among others. Thematic analysis was used to analyze the data. Participants identified the key transition points of prevention, assessment, inpatient/outpatient pathways and recovery as relevant to their community. They re-imagined an Aanji'bide (Changing our Paths) model of opioid recovery and change that was non-linear; included developmental stage and individual pathways; and demonstrated resilience through connection to culture/spirituality, community and others. Community members living/working in a rural tribal nation in Minnesota, USA identified non-linearity and cultural connection as key elements to include in an Anishinaabe-centered model of opioid recovery and change.

Medicinal Herbal Knowledge and Identity in a Tribal Setting: Locally Specific Composite Wound Balm Formulas in Tunceli, Turkey

Medicinal Herbal Knowledge and Identity in a Tribal Setting: Locally Specific Composite Wound Balm Formulas in Tunceli, Turkey

A Cultural Responses to Entrepreneurial Activities in Pashtun Society of Pakistan

Entrepreneurship is playing a vital role in national socioeconomic development. Entrepreneurial endeavors are significantly influenced by culture. In this study, the cultural barriers to entrepreneurship in Pashtun tribal society are examined. The tribal society of the Pashtuns was used as a case study. To carry out this study, a qualitative research paradigm was employed. In-depth interviews were conducted with those involved in business activities. Respondents to the study were selected through a purposive sampling technique. The thematic analysis method was employed to investigate the social barrier to entrepreneurship in Pashtun tribal society. The results showed that, in contrast to the formation, business is not a socially respectable job in a tribal setting. Individuals in Pashtun society were reluctant to create businesses because of the negative attitudes certain people had regarding specific entrepreneurial endeavors. The information shows that Pakhtunwali, or Pashtun culture's moral code, hinders entrepreneurship in Pashtun society. It has hampered the process of socioeconomic development and people are reluctant to start entrepreneurial activities in Pashtun Society. The government must encourage young people to start their businesses and identify Pashtun society's cultural hubs that encourage commerce.

Exploring social tolerance in the light of identity markers within a heterogeneous population: a demographic study in a multi-tribal context

This study was designed to assess how primary identification markers affected social tolerance in a multi-tribal setting among a heterogeneous population. A sample of 312 participants was selected using the purposive sampling technique. A search of the literary documentation yielded three modalities of the dependent variable. Thus, data were collected from the Feeling Thermometer, Affirmative Action, and Multiculturalism scales. We assessed participants' levels of identification with identity markers to determine their impact on social tolerance. The findings suggest that measures of social tolerance are somewhat significantly influenced by Cameroonians' levels of affiliation with their key identity markers. However, tolerance decreases when tribal identity becomes stronger. Conversely, the effect of linguistic and religious identification forces on social tolerance varies depending on the object to be tolerated. These findings contribute to a better understanding of the determinants that influence social tolerance in a tribal setting.

Understanding health care seeking behavior in a tribal setting in West Bengal

Background:The health-related problems of the tribal population depend on their ecology and culture. Often the tribal people do not utilize the medical and preventive health services available to them. Health problems in tribal groups need special attention because many tribal communities are backward. The current study was planned to determine the healthcare-seeking behavior of the tribal population in India.Method:A descriptive, cross-sectional study, conducted by interviewing key respondents of each participating family.Result:Two-thirds of the key respondents were literate and half (53.8%) of the total households in the three villages had a per capita monthly income between Rupees 500-1499. More than half (57%) of all respondents preferred government institutions for moderate illness, and the rest equally opted for private practitioners and quacks. However, for emergencies, dog bites, and snake bites, all key respondents in the three study villages unanimously preferred government institutions. A significant population (38.5%) got their children delivered at home. The majority of illiterate respondents (86.1%) preferred government institutions for health care of under-five children, while 60% of literates expressed a similar view. The choice of government institutions as a source of health care was increasingly favored with decreasing per capita monthly household income.Conclusion:Traditional healers are no longer preferred among the tribal population but they are reluctant to avail them because of the loss of valuable time. Home delivery is still prevalent. With improving socioeconomic status, people are going further away from government services as private practitioners, and quacks take less time.

Abstract IA-49: Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system

Abstract Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and many AI/AN communities have worse lung cancer incidence rates, survival, and death compared to the general population. Although lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation, uptake of LCS has been slow in most healthcare systems. LCS implementation among AI/AN has not been studied before in detail. To address this knowledge and implementation gap, a multi-phase, 5-year “Tribally Engaged Approaches to Lung Screening" (TEALS) study was launched in 2019 in partnership with the Choctaw Nation of Oklahoma. The overarching goal of this project is to co-design and test an LCS implementation program. This presentation will discuss what is being learned about potential facilitators and barriers to implementing LCS in a tribal health care setting. Findings may be pertinent to other health systems serving tribal, rural or underserved populations. Citation Format: Zsolt J. Nagykáldi. Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-49.

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt for treatment of hydrocephalus in infants in a tribal population in India

Study design: Prospective long term follow-up study Background: Hydrocephalus remains a common cause of admission in pediatric neurosurgery units. Of the two prevalent modalities of treatment for hydrocephalus in infants, i.e. endoscopic third ventriculostomy and ventriculoperitoneal shunt, which one is a better option, especially in a tribal setting, is a matter of debate. Aim: To determine and compare the effectiveness of endoscopic third ventriculostomy versus ventriculoperitoneal shunt for the treatment of infants in a tribal population. Methods: A prospective follow-up study was carried out on 70 patients of hydrocephalus with age less than or equal to 12 months during a period of 7 years from August 2014 to June 2021. A detailed history, physical examination, and computed tomography scan were done in all the cases. Based on patient condition, aetiology and parents choice, 30 patients were treated by Endoscopic third ventriculostomy and 40 patients were treated by ventriculoperitoneal shunt. At enrolment, baseline clinical data were collected. Postoperative data were collected, including assessments of complications and treatment failures. Results: A total of 70 infants with hydrocephalus were enrolled in the study and out of them, 30 (42.86%) underwent ETV and 40 (57.14%) underwent VP shunt for the initial treatment of their hydrocephalus. The mean age of patients was 6.4±1.2 months with a range of 18 days to 342 days. Clinical improvement was shown in 76.67% and 70% in ETV and VP shunt groups respectively. No significant difference (p=0.53) was observed in clinical outcomes in both groups. In the 1 to 6 months of age group, 07 (30.43%) clinically improved patients were from the ETV group, while in the VP shunt group, 10 (35.71%) patients showed improvement. In the 7 to 12 months age group, 16 (69.57%) clinically improved patients were from the ETV group and 18 (64.29%) patients were from the VP shunt group (p=0.69). Association of treatment success with gender, term of gestation and aetiology of hydrocephalus was not statistical significant (p>0.05). Out of 70 patients with hydrocephalus, postoperative complications such as infection, CSF leak, haemorrhage and blockage was found in 09 (12.86%), 08 (11.43%), 05 (7.14%) and 08 (11.43%) patients respectively. A significant higher proportion of infection (p=0.043) and blockage (p=0.023) was found in the VP shunt group than in the ETV group. Conclusion: Treatment success was high in both procedures. VP shunt was found to be more successful than ETV in terms of clinical outcome in both age groups. However, the results were statistically insignificant. A significantly higher proportion of complications was found with VP shunt than ETV therefore greater benefits can be achieved using ETV. Thus for a tribal population, where patient compliance is poor and healthcare accessibility, as well as regular follow-up, is difficult, a procedure like ETV can be considered better than VP shunt.

Disrupting Intergenerational Poverty Through a Place-Based Education Initiative : A Review of Promise Neighborhoods in their First Decade

This study explains the complexities of attainment, implementation, and evaluation of the U.S. Department of Education's Promise Neighborhood (PN) initiative. PNs seek to disrupt intergenerational poverty through a place-based education initiative that creates a pipeline of health, social, and education resources within an economically distressed neighborhood in an urban, rural, or tribal setting. The PN implementation grantees manage a network of school-community partnerships aiming to support students from cradle to career. This study includes an analysis of the complexities of PN attainment with a focus on the PN grant awardees; the complexities of PN implementation with a focus on PN management and services; and lastly, the complexities of evaluation with a focus on the PN evaluation factors. Recommendations for the future of the PN initiative are discussed.

Abstract PO-019: Delivering cancer prevention programs to Latinx and Korean immigrant communities in Los Angeles through community partnerships and a culturally adapted Cancer 101 Cancer Education and Training Program

Abstract Latinx and Korean immigrants (LKI) in the United States are less likely to incorporate cancer prevention practices (CPP), such as undergoing recommended cancer screening, as compared to white counterparts. Currently lacking are comprehensive, culturally tailored cancer prevention programs for LKI communities. One method of targeting these inequities and increasing CPP is the Cancer 101 Cancer Education and Training Program (CETP). CETP was developed in collaboration with American Indians and Alaska Natives (AI/AN) of Washington state as a cancer education resource to improve cancer knowledge, introduce preventative practices in a tribal setting, and increase survival rates for community members. Participants demonstrated a significant change in knowledge, attitudes and behaviors towards CPP. Given the need to improve CPP among LKI, and the success associated with the AI/AN CETP, the purpose of this study was to explore the impact on CPP through a culturally tailored CETP for LKI communities. We developed partnerships with the leadership of faith-based organizations (FBOs) and federally qualified health centers (FQHCs) serving predominantly LKI populations in neighborhoods with a high concentrations of late-stage cancer diagnoses. We referenced the Center for Disease Control’s (CDC) Community Guide for strategies of implementing tailored cancer programs. We administered our Spanish and Korean language Cancer and Healthcare in Los Angeles Survey (CHILAS) to FBO members to gather baseline awareness and perceptions of CPP. CHILAS data highlighted critical components that were used to modify the CETP. We translated the newly adapted CETP into Spanish and Korean and used it to conduct cancer prevention workshops and organize cancer screening events with our partnered FBOs and FQHCs. Our results include the development of partnerships with 15 FBOs where 12,000 predominantly LKI worshipped, in neighborhoods with a high incidence of late-stage breast cancer diagnoses. The results from 2,100 CHILAS and demographics were used to tailor the CETP for the communities of interest. Using the adapted CETP and strategies from the CDC’s Community Guide, 8,000 congregants received CPP information from the pulpit. Over 2 years, we delivered 63 cancer prevention workshops for 3,000 attendees, with 600 individuals participating in additional organized cancer screening programs and 35 volunteers and navigators trained. Furthermore, participants enrolled in community-based studies including the All of Us research project. Adaptation and application of the Cancer 101 CETP for LKI communities was an effective tool in disseminating cancer awareness and providing accessible cancer screening in high-need neighborhoods. Community partnerships shaped the Cancer 101 CETP to be a tangible and culturally sensitive resource for the communities of interest. We plan to sustain and expand this initiative through the creation of a comprehensive tool kit and training program for community leaders. Citation Format: Zul Surani, Bianca Luna, Dong Hee Kim, Ergueen Herrera, Loraine Escobedo, Robert Haile. Delivering cancer prevention programs to Latinx and Korean immigrant communities in Los Angeles through community partnerships and a culturally adapted Cancer 101 Cancer Education and Training Program [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-019.

Water, sanitation and hygiene (WaSH) practices and diarrhoea prevalence among children under five years in a tribal setting in Palghar, Maharashtra, India.

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.

Natural resource valuation with a tribal perspective: a case study of the Penobscot Nation

ABSTRACTThe unique settings of tribal lands and preferences of tribal members can complicate the effective application of standard natural resource use valuation tools within these tribal settings. We present a study which utilised referendum format contingent valuation methods to value foregone tribal use of the dioxin-contaminated Penobscot River in Maine. The Penobscot Nation’s prior experience in using referendums to evaluate cash settlement offers provides a unique setting for this application. The valuation responses pass a scope test and are consistent with a priori expectations of economic theory as well as individual attitudes and beliefs. Implicit discount rates based on the valuation of two clean-up periods are plausible. The response model indicates that cultural motives are a significant basis of foregone use values. While each tribal setting presents unique characteristics and challenges, the presented application demonstrates how carefully applied standard valuation tools, when appropriately designed to account for and incorporate tribal history, settings, and perspective, can yield defensible estimates of resource valuation.

Voices from the dead: the uneasy case of indigenous cultural expression

PurposeTraditional cultural expression (TCE) includes music, dance, art, designs, names, signs and symbols, performances, ceremonies, architectural forms, handicrafts and narratives or many other artistic or cultural expressions [World Intellectual Property Office (WIPO)]. To constitute TCEs, the expressions must form part of the identity and heritage of a traditional or indigenous community and need to be passed down from generation to generation (Kuprecht, 2014). This paper aims to analyse the protection of TCE in Malaysia by focusing on the Mah Meri tribe. This paper examines copyright over TCE, recordation as a means of preserving a dying tradition and customary practices and native law.Design/methodology/approachInformation is drawn from personal discussions with the weavers and carvers of the Mah Meri tribe, and a focus group discussion with subject matter experts. As a way of comparison, a personal visit has been made to Sarawak Biodiversity Centre, Sarawak Native Courts, the Dayak Iban Association and Dayak Bidayuh Association.FindingsThe research found that copyright law has no specific provision for the protection of TCEs. Customary practices of the indigenous people and the native law of Sarawak have limited effect outside their traditional domain. Recordation and documentation of TCEs are the prime initiatives, but the documents or the recordings do not carry any legal status.Research limitations/implicationsThe research is limited only to the Mah Meri tribe with a comparison drawn to the Dayak Iban and Dayak Bidayuh tribe.Practical implicationsThe research examines the practical implications of copyright and recording and documentation of cultural expression in Malaysia.Social implicationsThe research sets to unearth and highlight the ideation process in a tribal setting and how that clashes with the formal creation setting in a modern intellectual property system.Originality/valueThis paper was presented at the IAITL Congress 2013. It also appeared in the Conference Proceedings edited by Slyvia Kieerkgard, but it has not been published in any journals.

Effect of household size on mental problems in children: results from the Norwegian Mother and Child Cohort study.

BackgroundMost people in industrialized societies grow up in core (parents only) families with few if any siblings. Based on an evolutionary perspective, it may be argued that this environment reflects a mismatch, in that the tribal setting offered a larger number of close affiliates. The present project examined whether this mismatch may have a negative impact on mental health.MethodsWe used data from the Norwegian Mother and Child Cohort Study (MoBa), which includes 114 500 children. The mothers were recruited during pregnancy and followed up with questionnaires as the infants grew older. Correlates between number and type of people living in the household and questions probing mental health were corrected for likely confounders.ResultsThe number of household members correlated with scores on good mental health at all ages tested (3, 5 and 8 years). The effects were distinct, highly significant, and present regardless of how mental issues were scored. The outcome could be attributed to having older siblings, rather than adults beyond parents. The more siblings, and the closer in age, the more pronounced was the effect. Living with a single mother did not make any difference compared to two parents. Girls were slightly more responsive to the presence of siblings than boys. Household pets did not have any appreciable impact.ConclusionA large household is associated with fewer mental problems in children.

Awareness of pubertal changes and reproductive health in adolescent girls: a comparative study

Background: Adolescent period is characterized by physical, psychological and behavioural changes and girls can show different reactions to these changes. Proper information can help them in handling these changes without any stress. Tribal females are a vulnerable population and lack health care facilities. Limited data is available on awareness of pubertal changes and reproductive health among tribal adolescent girls. Aims of the study were to study and compare the level of awareness about pubertal changes and reproductive health between tribal and urban adolescent girls. Methods: The study population consisted of 200 adolescent girls between 10-19 years age 100 each, from urban and tribal setting. A predesigned questionnaire, which consisted of questions designed to evaluate the awareness about pubertal changes and reproductive health was used for data collection. Data was analysed using SPSS software, student t test, Chi- square test and co-relation test. Results: Mean age of the study population was 13.76±1.2 years. Mean awareness of urban adolescent girls about pubertal changes and reproductive health was significantly greater than tribal adolescent girls. Awareness was more in older age and more literate adolescent girls. Conclusions: Information, education and communication (IEC) campaigns have to be strengthened to increase awareness on menstrual hygiene practices and sexually transmitted diseases among tribal adolescent girls as these are a vulnerable group.

Knowledge and practices of health care workers regarding needle - stick injury in a tribal setting of Rajnandgaon, Chhattisgarh, India

Background: Needle Stick Injuries (NSIs) in healthcare settings are a global issue. Percutaneous injuries, caused by needle sticks and other sharps, are a serious concern for all Health Care Workers and pose a significant risk of occupational transmission of blood borne pathogens. The incidence of NSI is considerably higher than current estimates, because of gross under reporting and hence a low injury rate should not be interpreted as a nonexistent problem. The present study was carried out to determine the occurrence of NSI among various categories of HCWs . Methods: The present prospective cross sectional study was carried out at the 400 bedded Government Medical College Hospital, Rajnandgaon, Chhattisgarh, India during period from November 2015 to August 2016. Out of total (180) study participants, 18 were doctors, 142 nurses and 20 lab technicians from different clinical departments/wards of the hospital. Data was collected by using a predesigned pretested questionnaire. The first part of the questionnaire contained information on background characteristics and second part contained the questions regarding knowledge and practices about NSI. Results: Out of 180 HCW, 149 (82.78%) were females and, 31 (17.22%) were males. Majority of the subjects were nurses (78.89%). 92.2% subjects were aware of the Needle Stick Injury (NSI). 85% of the subjects knew that certain diseases can be spread through NSI. Almost all of them were using disposable/auto disabled syringes and needles at the hospital. Re-capping of used needle was practiced by 35.5% subjects. 63.8% subjects gave history of NSI in the last one year. Most chances of getting NSI were found to be while working in the Obstetrics and Gynecology Department (29.4%). 68.9% of the study subjects were immunized completely against Hepatitis B . Conclusions: There was gap between the knowledge and use of preventive measures. There is a need to address this gap by organizing on job training, retraining at regular intervals, workshops for HCWs regarding hazards, preventive measures and post-exposure prophylaxis for NSIs. Preventing NSI should be an essential part of any blood borne pathogen prevention strategy in the work place.

Reasons for Refusing Cataract Surgery in Illiterate Individuals in a Tribal Area of Andhra Pradesh, India

Purpose: To assess the reasons for refusing cataract surgery in illiterate individuals in a tribal area of India.Methods: A prospective study evaluated 1046 subjects who had undergone screening in eye camps and included 398 of 492 referred subjects with cataract who refused to seek cataract surgery. Subjects were assessed to elicit general and specific reasons for non-compliance. Multiple logistic regression analysis was applied to determine the associations; p < 0.05 was considered significant.Results: Overall, 83% (329/398) of subjects reported that they could manage with their current vision. The five most common reasons they did not proceed with cataract surgery were: fear of losing current vision, work priority, lack of support systems, a dependency due to old age, and expenses required after surgery. Odds of seeking treatment were lower among unemployed subjects (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19–0.86; p = 0.01) and in patients with family income <1000 Indian rupees per month (OR 0.5, 95% CI 0.34–0.94; p = 0.02), and higher among those unilaterally blind (OR 10.8, 95% CI 3.3–35.6; p ≤ 0.01).Conclusion: In a tribal setting, 83% of individuals referred for cataract surgery did not proceed with surgery. Reasons given for non-compliance were not directly related to the surgery but focused on valid day-to-day difficulties anticipated to increase following surgery. Beyond accessibility and cost of surgery, other social and infrastructural factors need to be addressed to increase the uptake of cataract surgery.

Community Perception And Client Satisfaction About The Primary Health Care Services In A Tribal Setting Of Gujarat - India

This community based cross sectional study attempts to assess the community perception and client satisfaction of primary health care services provided by Primary Health Centre (PHC) of Panchmahal district of Gujarat to assess the awareness of the community about primary health care services and its utilization in a tribal area and to assess the client satisfaction of those who have utilized the services. This study was conducted from January 2009 to March 2009. For the community survey, two blocks were randomly chosen and the interview was carried out by house visits. For exit interviews, patients were selected randomly from those attending the primary health centre. A total of 479 interviews were conducted. It was seen that 82% were aware of the availability of primary health centre but more than two-thirds preferred quacks. Approximately two-thirds to three-fourths of the clients were satisfied with the primary health care services.