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


Autoři: Mitchell A. Kinkor aff001;  Bijaya K. Padhi aff002;  Pinaki Panigrahi aff004;  Kelly K. Baker aff005
Působiště autorů: Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America aff001;  Asian Institute of Public Health, Bhubaneswar, Odisha, India aff002;  Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India aff003;  University of Nebraska Medical Center, Omaha, Nebraska, United States of America aff004;  College of Public Health, University of Iowa, Iowa City, Iowa, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225687

Souhrn

Introduction

The 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.

Methods

Our 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.

Results

Married 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).

Conclusions

Community-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.

Klíčová slova:

Behavior – Behavioral and social aspects of health – Health care providers – Health care utilization – Health education and awareness – India – Sexually transmitted diseases – Surveys


Zdroje

1. Hillier SL, Nugent RP, Eschenbach DA, Krohn MA, Gibbs RS, Martin DH, et al. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. The Vaginal Infections and Prematurity Study Group. The New England journal of medicine. 1995;333(26):1737–42. Epub 1995/12/28. doi: 10.1056/NEJM199512283332604 7491137.

2. Isik G, Demirezen S, Donmez HG, Beksac MS. Bacterial vaginosis in association with spontaneous abortion and recurrent pregnancy losses. J Cytol. 2016;33(3):135–40. doi: 10.4103/0970-9371.188050 27756985; PubMed Central PMCID: PMC4995870.

3. Leitich H, Bodner-Adler B, Brunbauer M, Kaider A, Egarter C, Husslein P. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol. 2003;189(1):139–47. Epub 2003/07/16. doi: 10.1067/mob.2003.339 12861153.

4. Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, et al. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. American Journal of Obstetrics and Gynecology. 2001;184(5):856–64. doi: 10.1067/mob.2001.113847 11303192

5. Taha TE, Hoover DR, Dallabetta GA, Kumwenda NI, Mtimavalye LA, Yang LP, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998;12(13):1699–706. doi: 10.1097/00002030-199813000-00019 9764791.

6. Patel V, Weiss HA, Mabey D, West B, D'Souza S, Patil V, et al. The burden and determinants of reproductive tract infections in India: a population based study of women in Goa, India. Sex Transm Infect. 2006;82(3):243–9. doi: 10.1136/sti.2005.016451 16731678; PubMed Central PMCID: PMC2564748.

7. Eschenbach DA, Davick PR, Williams BL, Klebanoff SJ, Young-Smith K, Critchlow CM, et al. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol. 1989;27(2):251–6. 2915019; PubMed Central PMCID: PMC267286.

8. Homayouni A, Bastani P, Ziyadi S, Mohammad-Alizadeh-Charandabi S, Ghalibaf M, Mortazavian AM, et al. Effects of probiotics on the recurrence of bacterial vaginosis: a review. J Low Genit Tract Dis. 2014;18(1):79–86. doi: 10.1097/LGT.0b013e31829156ec 24299970.

9. Kumar N, Behera B, Sagiri SS, Pal K, Ray SS, Roy S. Bacterial vaginosis: Etiology and modalities of treatment-A brief note. J Pharm Bioallied Sci. 2011;3(4):496–503. doi: 10.4103/0975-7406.90102 22219582; PubMed Central PMCID: PMC3249696.

10. Balamurugan S, Bendigeri N. Health Care-Seeking Behaviour of Women with Symptoms of Reproductive Tract Infections in Urban field practice area, Hubli, Karnataka. National Journal of Research in Community Medicine. 2012;1:123–77.

11. Sciences IIfP. District Level Household and Facility Survey (DLHS-3), 2007–08: India. IIPS Mumbai; 2010.

12. Nagarkar A, Mhaskar P. A systematic review on the prevalence and utilization of health care services for reproductive tract infections/sexually transmitted infections: Evidence from India. Indian J Sex Transm Dis AIDS. 2015;36(1):18–25. doi: 10.4103/0253-7184.156690 26392649; PubMed Central PMCID: PMC4555893.

13. Rani M, Bonu S. Rural Indian women's care-seeking behavior and choice of provider for gynecological symptoms. Stud Fam Plann. 2003;34(3):173–85. doi: 10.1111/j.1728-4465.2003.00173.x 14558320.

14. Sabarwal S, Santhya KG. Treatment-seeking for symptoms of reproductive tract infections among young women in India. Int Perspect Sex Reprod Health. 2012;38(2):90–8. doi: 10.1363/3809012 22832149.

15. Klebanoff MA, Schwebke JR, Zhang J, Nansel TR, Yu KF, Andrews WW. Vulvovaginal symptoms in women with bacterial vaginosis. Obstet Gynecol. 2004;104(2):267–72. doi: 10.1097/01.AOG.0000134783.98382.b0 15291998.

16. Ray K, Bala M, Bhattacharya M, Muralidhar S, Kumari M, Salhan S. Prevalence of RTI/STI agents and HIV infection in symptomatic and asymptomatic women attending peripheral health set-ups in Delhi, India. Epidemiology and infection. 2008;136(10):1432–40. Epub 12/17. doi: 10.1017/S0950268807000088 18081951.

17. Baker KK, Padhi B, Torondel B, Das P, Dutta A, Sahoo KC, et al. From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India. PLoS One. 2017;12(12):e0188234. doi: 10.1371/journal.pone.0188234 29206842; PubMed Central PMCID: PMC5716553.

18. Mbizvo EM, Msuya SE, Stray-Pedersen B, Sundby J, Chirenje ZM, Hussain A. Determinants of reproductive tract infections among asymptomatic women in Harare, Zimbabwe. Cent Afr J Med. 2001;47(3):57–64. doi: 10.4314/cajm.v47i3.8595 11961859.

19. Philip PS, Benjamin AI, Sengupta P. Prevalence of symptoms suggestive of reproductive tract infections/sexually transmitted infections in women in an urban area of Ludhiana. Indian journal of sexually transmitted diseases and AIDS. 2013;34(2):83–8. doi: 10.4103/0253-7184.120537 24339457.

20. Hargreaves JR, Morison LA, Gear JSS, Kim JC, Makhubele MB, Porter JDH, et al. Assessing household wealth in health studies in developing countries: a comparison of participatory wealth ranking and survey techniques from rural South Africa. Emerging themes in epidemiology. 2007;4:4–. doi: 10.1186/1742-7622-4-4 17543098.

21. Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D. What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review. PLOS ONE. 2013;8(2):e54978. doi: 10.1371/journal.pone.0054978 23405101

22. Ismail S, Shajahan A, Sathyanarayana Rao TS, Wylie K. Adolescent sex education in India: Current perspectives. Indian journal of psychiatry. 2015;57(4):333–7. Epub 2016/01/28. doi: 10.4103/0019-5545.171843 26816418; PubMed Central PMCID: PMC4711229.

23. Tripathi N, Sekher TV. Youth in India ready for sex education? Emerging evidence from national surveys. PLoS One. 2013;8(8):e71584. Epub 2013/08/21. doi: 10.1371/journal.pone.0071584 23951197; PubMed Central PMCID: PMC3739735.

24. Aggarwal AK, Duggal M. Knowledge of men and women about reproductive tract infections and AIDS in a rural area of north India: impact of a community-based intervention. Journal of health, population, and nutrition. 2004;22(4):413–9. Epub 2005/01/25. 15663174.

25. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC public health. 2013;13:847. Epub 2013/09/17. doi: 10.1186/1471-2458-13-847 24034792; PubMed Central PMCID: PMC3848754.

26. Gogia S, Sachdev HS. Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review. Bulletin of the World Health Organization. 2010;88(9):658–66b. Epub 2010/09/25. doi: 10.2471/BLT.09.069369 20865070; PubMed Central PMCID: PMC2930362.

27. Desai S, Mahal A, Sinha T, Schellenberg J, Cousens S. The effect of community health worker-led education on women's health and treatment-seeking: A cluster randomised trial and nested process evaluation in Gujarat, India. Journal of global health. 2017;7(2):020404. Epub 2017/09/30. doi: 10.7189/jogh.07.020404 28959438; PubMed Central PMCID: PMC5604097 form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no conflict of interest.

28. George A. Embodying Identity through Heterosexual Sexuality: Newly Married Adolescent Women in India. Culture, Health & Sexuality. 2002;4(2):207–22.

29. Prasad JH, Abraham S, Kurz KM, George V, Lalitha MK, John R, et al. Reproductive tract infections among young married women in Tamil Nadu, India. International family planning perspectives. 2005;31(2):73–82. Epub 2005/06/29. doi: 10.1363/3107305 15982948.

30. Joshi BN, Chauhan SL, Donde UM, Tryambake VH, Gaikwad NS, Bhadoria V. Reproductive health problems and help seeking behavior among adolescents in urban India. The Indian Journal of Pediatrics. 2006;73(6):509–13. doi: 10.1007/bf02759896 16816513

31. Sudha S, Morrison S, Zhu L. Violence against women, symptom reporting, and treatment for reproductive tract infections in Kerala state, Southern India. Health care for women international. 2007;28(3):268–84. Epub 2007/03/17. doi: 10.1080/07399330601180164 17364985.

32. Kojima N, Krupp K, Ravi K, Gowda S, Jaykrishna P, Leonardson-Placek C, et al. Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India. BMC infectious diseases. 2017;17(1):189–. doi: 10.1186/s12879-017-2282-3 28264668.

33. Krupp K, Madhivanan P, Karat C, Chandrasekaran V, Sarvode M, Klausner J, et al. Novel recruitment strategies to increase participation of women in reproductive health research in India. Global public health. 2007;2(4):395–403. doi: 10.1080/17441690701238031 19283635.

34. Madhivanan P, Krupp K, Hardin J, Karat C, Klausner JD, Reingold AL. Simple and inexpensive point-of-care tests improve diagnosis of vaginal infections in resource constrained settings. Tropical medicine & international health: TM & IH. 2009;14(6):703–8. Epub 2009/04/28. doi: 10.1111/j.1365-3156.2009.02274.x 19392745; PubMed Central PMCID: PMC3625926.

35. Dharmalingam A, Philip Morgan S. Women's Work, Autonomy, and Birth Control: Evidence From Two South Indian Villages. Population Studies. 1996;50(2):187–201. doi: 10.1080/0032472031000149296

36. Su Y-L, Reeve J. A Meta-analysis of the Effectiveness of Intervention Programs Designed to Support Autonomy. Educational Psychology Review. 2011;23(1):159–88. doi: 10.1007/s10648-010-9142-7


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