Frequency and determinants of health care utilization for symptomatic reproductive tract infections in rural Indian women: A cross-sectional study

Abstract

IntroductionThe public health burden of reproductive tract infections (RTIs) among women in rural areas of low-income countries is poorly addressed because health care seeking for treatment of RTIs is inadequate. There are gaps in knowledge about whether low care seeking behavior stems from challenges in accessing health care versus women's recognition of and response to RTI-specific disease symptoms. We aim to identify determinants of care seeking behavior and analyze the difference in utilization of health care resources in response to symptoms of an RTI versus non-RTI disease symptoms in rural India. This will aid in the design of interventions that promote RTI care seeking behavior.MethodsOur analysis uses data from a cross-sectional, population-based surveillance survey among rural, non-pregnant women in Odisha, India, from 2013–2014 (n = 3,600). We utilized bivariate logistic regression to determine the degree that certain determinants are associated with a woman’s likelihood to seek RTI treatment, and chi-Squared tests to assess for differences in health care resources used for non-RTI versus RTI symptoms.ResultsMarried women were significantly more likely to seek health care for RTI symptoms (Odds Ratio (OR) = 1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between RTI health care seeking with education level, belief about whether symptoms can be treated, or poverty. The majority (73.8%) of women who did not seek treatment for RTI symptoms reported not seeking treatment because they did not know treatment was needed. Women utilized formal health care providers at a higher rate in response to RTI symptoms than in response to their most recent symptoms of any kind (p = 0.003).ConclusionsCommunity-based reproductive health education interventions are needed to increase health care seeking behavior for RTIs in rural Indian women. Interventions should target unmarried women and focus on both sexual health education and access to care.

Factors associated with gynaecological morbidities and treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India

“…However, this study found that the treatment for gynaecological morbidities was lower among adolescent girls in rural areas than in urban areas. Previous studies align with our study in reporting lower treatment-seeking for gynaecological morbidities among rural girls [ 46 ]. In rural areas, stigma related to gynaecological morbidities may be one reason for the lower treatment of gynaecological morbidities among adolescents [ 47 ].…”

“…Moreover, in rural areas, health care services may be too far from home [ 47 ]. In rural areas, most married women and adolescent girls do not seek treatment as they did not feel that treatment was needed [ 46 ].…”

Gender inequities in treatment-seeking for sexual and reproductive health amongst adolescents: Findings from a cross-sectional survey in India

“…It is unclear why the proportion of unmarried adolescents who reported symptoms of genital infections was slightly higher (approximately 7–10%) than similar surveys amongst unmarried young women ( Kinkor et al, 2019 ; Sabarwal & Santhya, 2012 ). Self-reports of genital symptoms vary across settings in India, and are generally poorly correlated with clinical diagnosis ( Kaida et al, 2018 ; Kerubo et al, 2016 ; Koenig, Jejeebhoy, Singh, & Sridhar, 1998 ).…”

“…For the third and fourth analyses, we first used bivariate logistic regression to report unadjusted odds ratios, drawing from the conceptual frameworks above and the literature on RTI/STIs amongst adolescents in India ( Kinkor et al, 2019 ; Nagarkar & Mhaskar, 2015 ; Sabarwal & Santhya, 2012 ). We examined several factors in both models: location; state; religion; caste; household wealth index quintile; currently in school; highest level of education attained; mother's education; engaged in paid work in the last 12 months; decision-making; mobility; have any savings; exposure to mass media; peer network; self-efficacy; witnessed domestic violence; discussed SRH issues with parents; received any information on SRH in school/community; awareness of RTI/STIs and history of premarital sex.…”

“…32–46; Prasad et al, 2005 ). Few community-based studies have estimated the prevalence of infections amongst unmarried adolescents ( Kinkor, Padhi, Panigrahi, & Baker, 2019 ; Sabarwal & Santhya, 2012 ). Moreover, most community-based research on SRH services in India has focused on girls, with relatively less research on the prevalence of ailments or treatment-seeking patterns amongst boys ( Sivakami & Rai, 2019 , pp.…”