Academic journal article Journal of Health Population and Nutrition

Gender Differences in Healthcare-Seeking during Common Illnesses in a Rural Community of West Bengal, India

Academic journal article Journal of Health Population and Nutrition

Gender Differences in Healthcare-Seeking during Common Illnesses in a Rural Community of West Bengal, India

Article excerpt

INTRODUCTION

Inequalities in gender, in one form or the other, with considerable regional differences, are ubiquitously present and all-pervasive (1-5). In health, these are manifested in differences in mortality (6-9). Discrimination and gender gaps have been observed even in early years of life (10-12). Girls, aged less than five years, in India show steadily high mortality compared to boys (10,11). Although overall sex ratio in India has improved from 927 to 933 in the last decade, it declined from 945 to 927 in children aged less than six years (11). Besides, other discriminatory treatment-seeking practices probably contribute to this (13-17). Relatively fewer studies have been undertaken in western part of India (13), whereas there is a lack of information from eastern part of India. In western India and Bangladesh, cross-sectional surveys of practitioners and care providers reported discriminatory care-seeking for boys and girls (13,14). Differences in intra-household resource allocation have also been reported from many developing countries (18-20).

Since acute respiratory infections (ARIs), diarrhoea, and fever are the common childhood illnesses (21-23), these are chosen to study home management and treatment-seeking by a longitudinal follow-up of 719 children aged less than five years for a one-year period. The findings can help identify the prevailing practices, which may be useful in planning effective health-education intervention at the community level.

MATERIALS AND METHODS

Operational definitions

Acute respiratory infection (ARI): Acute infection of the respiratory tract, as judged by clinical features based on the guidelines of the World Health Organization (21), lasting for less than 30 days.

Diarrhoea: Passage of three or more loose or watery stools in the past 24 hours or passage of stools with blood or mucus in a young child. For young breastfed infants, change in the consistency of stool was considered a case of diarrhoea.

Fever: Any child reported hot by mother and on measuring axillary temperature [greater than or equal to] 37.5[degrees]C. This includes fever episodes with and without rashes.

Home practices: Locally-prevalent practices included the following:

For diarrhoea: Frequent feeding of child, including breast-feeding, administration of home fluids, and appropriate use of oral rehydration solutions (ORS).

For ARI: Frequent feeding of child, including breastfeeding, use of traditional remedies of cough, e.g. ginger, honey, herbal extract, etc., and covering the child to keep him/her warm.

For fever: Frequent feeding, increased fluid and water administration.

Qualified professionals: Registered medical practitioners of both allopathic and homeopathic systems.

Money spent: Direct expenditure on treatment-seeking, including doctor's fee and cost of medicines. In the case of multiple sources, it included total treatment cost but did not include travel expenses and loss of wages due to illness of child.

Time lag: Since onset of illness, i.e. recognition of first symptom by mothers/care provides and treatment-seeking. It was recorded in days and hours and later converted into hours. In the case of multiple treatment sources, time lag since onset to first treatment contact (initial source) was taken.

Distance covered: Approximate distance (km) travelled by a child for treatment-seeking. In the case of multiple treatment sources, the most distal distance was recorded.

Study area

The study was conducted in a cluster of four villages, situated 10 km from Kolkata (Calcutta), which constitute the test site of the National Institute of Cholera and Enteric Diseases (NICED), India. The area has 1,500 families with a total population of 7,000.

In the area, a community-based surveillance of all children aged less than five years for diarrhoea, ARI, and fever has been carried out with the help of locally-resident female surveillance workers. …

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