Background Given that access to healthcare is less challenging in urban India, evidence shows that affordable government healthcare services are underutilized by the vulnerable and disadvantaged groups. There are emerging studies on healthcare seeking behavior in the context of short-term morbidities and communicable diseases that attempted to understand this gap of underutilization of government healthcare services, but similar studies are rare in the context of non-communicable diseases (NCDs) and associated chronic conditions. Given the urban health system is ill- prepared and ill-equipped to deliver NCD services, it is important to understand how the vulnerable and disadvantaged groups seek healthcare for chronic conditions. This article investigates the care-seeking practices of these individuals living in a low-income neighborhood and care-seeking pathways for chronic conditions. Methods The study is conducted at Kadugondanahalli—a low-income neighborhood with the presence of a recognized slum, in Bengaluru city. A total of twenty in-depth interviews are conducted with individuals diagnosed with non-communicable chronic conditions. Participants were selected through purposive and snowball sampling method. The data is collected between January 2020 to June 2021. Results The study participants practice a wide range of care-seeking practices based on the management of comorbidity and multimorbidity, recognizing the symptoms and severity, experiences of family members, belief, and purchase and consumption of medicines. These practices clearly highlighted not only the nuances of non-adherence to the long-term treatment and medications, but it also strongly influences the care-seeking behavior, which in turn make the care-seeking continuum very complex. The care-seeking continuum attempted each of the components (i.e. the screening, diagnosis, treatment, and control) of NCD care cascade but participants often failed to do screening on time, delayed diagnosis, and did not meet the treatment goals, leading to their conditions becoming further uncontrolled due to the care-seeking practices they practice. These practices delayed not only the diagnosis but also the completion of each component of the care cascade. Conclusion This study emphasizes strengthening of the health system in addressing the individual and community level practices, that significantly affect the entire care-seeking continuum, in the sustained monitoring and adherence to the treatment of chronic conditions.
Background National survey data provides information regarding undernutrition among children under 5 years of age, but there is a big gap in data on school-age children, despite evidence that hunger and malnutrition significantly affect learning outcomes and are critically linked to social determinants such as caste, class and gender. The present paper is based on the study 'Do we know what they eat and why? A study on school-level dietary adequacy and impact of cultural beliefs on dietary choice', examining the prevalence of malnutrition and their associated social determinants among school-going children in three districts of Karnataka. Methods Our study population consisted of government primary school children (both boys and girls) attending grade 1-5 in HD Kote taluk (Mysore), Shorapur (Yadgir) and North block (Mandya), Karnataka. We applied a cross-sectional design. Sample size was 5,340 children from 100 schools across three districts. Schools were randomly selected. Children not present on the day of examination were excluded from the study. A structured questionnaire was used for data collection. Study variables were height and weight of the children, plus their gender, caste and age. Ethical approval was taken from relevant authority. Findings Nutritional outcomes were measured using WHO references for 5-19 years: BMI-for-age (underweight) and height-for-age (stunting). Overall 29.7% of the children were underweight and 26.2% stunted. The distribution of underweight was similar across the districts but stunting was significantly higher at Yadgir (34%).
BackgroundClimate change as social determinant threatens human health through its effect on undernutrition and food insecurity. In Karnataka, climate change is dramatically affecting agriculture after the year 2000 by declining trend of rainfall and rise in temperature, resulting in decrease in yield and increase in cost of cultivation. At the same time, poverty and indebtedness are the most important factors leading to migration, and are associated with malnutrition and poor health status. The present study investigates climate change as a cause of migration and as determinant of health and nutrition of migrant children.MethodsBetween June and September 2015, we conducted semi-structured interviews with mothers of migrant families from two construction colonies, having children aged 0–19 years and attending migrant labourer school in Bangalore urban. Of a purposeful sample of 77 households, all mothers were interviewed and 140 children underwent anthropometric examination. Primary data were causes of migration, mother and children nutritional outcome, gender, social class, socio-demographic factors, illness profile, information on maternal & child health, and access to health services. Informed consent from the respondent was obtained.FindingsAbout 74% of the migrant households live below the poverty line. Of the total, 96% belongs to either Scheduled Castes (19%), or Muslim (21%), Other Backward Castes (19%) and Schedules Tribes (6%). Rural-to-urban is the main migration pattern (94%), with 75% of the migrants originating from North-East Karnataka. Availability of only agricultural work in rural areas is the main driver of migration as perceived by most of the respondents. More in detail, the expressed causes of migration are: (i) for agricultural land holders (70%): no, insufficient or too much rain affecting agricultural production, irregular income because of seasonal agricultural work, financial shortage for cultivation; (ii) for non-agricultural land holders (5%): low paid agri-labourer work, few income opportunities, high temperature disallowing pleasant living, floods due to heavy rains; (iii) for non-land holders (25%): no land and no other income opportunities, having to pay back debt borrowed for marriage, and extreme hot and cold.Using WHO measures, child nutrition status was measured:(a) Weight-for-height: <-3sd: 8%; <-2sd: 9%; >-2sd: 83%(b) Weight-for-age: <-3sd: 18%; <-2sd: 21.1%; >-2sd: 60.9%(c) Height-for-age: <-3sd: 22.1%; <-2sd: 25%; >-2sd: 52.9%(d) BMI-for-age: <-3sd: 5%; <-2sd: 9.3%; >-2sd: 85.7%Of the mothers, 24.7% was underweight. Child malnutrition was significantly higher among children with underweight mothers. Boys are more malnourished than girls, and younger ones more than older; 65% of children die at birth.Fever, cold and body-ache were reported among the major health issues in last 30 days. Few respondents reported to have pneumonia and viral flu in children. Utilisation of government health services was low because of restricted access, limited time and non-availability of caregi...
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