Farmers’ suicides in the Vidarbha region of Maharashtra, India: a qualitative exploration of their causes

Background: To explore the various perceived reasons for farmers’ suicides in the Vidarbha region of Maharashtra, their common factors, and to suggest solutions. METHODS: The present formative research was undertaken in the 23 villages surrounding the Anji Primary Health Centre, located in the Vidarbha region of Maharashtra, India. A triangulation of free list and pile sort exercises was used. The data was analyzed by Anthropac 4.98.1/X software. This was followed by a semi-structured focus group discussion. To increase the validity of the results, these findings were presented to the participants and later they were circulated to the 26 farmers’ clubs in the villages for comment and discussion during their monthly, village-based meetings. RESULTS: Farmers perceived debt, addiction, environmental problems, poor prices for farm produce, stress and family responsibilities, government apathy, poor irrigation, increased cost of cultivation, private money lenders, use of chemical fertilizers and crop failure as the reasons for farmers’ suicides. Participants suggested solutions such as self-reliance and capacity building among farmers, a monitoring and support system for vulnerable farmers, support and counseling services, a village-level, transparent system for the disbursement of relief packages. CONCLUSIONS: Farmers’ suicides in Vidarbha are caused by the complex interplay of social, political and environmental constraints. Hence, a comprehensive intervention to ensure self-reliance and capacity building among farmers in modern farming techniques , monitoring and support system for vulnerable farmers, a village-level, transparent system for disbursement of relief packages is required to prevent farmer suicides in the near future. Apart from this, there is a need to strengthen the National Mental Health Program at primary health care level to offer support and counseling to vulnerable farmers in rural area

Intention to quit tobacco and Perceptions About Enhanced Pictorial Warnings on Tobacco Products Among Male College Students in Puducherry- Mixed-Methods Study

Background: Framework Convention on Tobacco Control (FCTC) recognized pictorial health warnings on tobacco products as a powerful public health intervention tool to communicate health risks and to bring about a behavioral change like quitting and reduction in tobacco consumption Objectives: To explore the perceptions on pictorial warnings on tobacco products and to find out the prevalence of ever and current tobacco product users, influencing factors and barriers in intention to quit tobacco among male college students. Material and Methods: An Exploratory Mixed-Method study [Two Focus Group Discussions (FGDs) among students followed by survey among 450 male college students] was carried out in an engineering college in Puducherry during December 2016- February 2017. Results: As perceived by the students, the new pictorial warnings when compared to the old ones had better precision of pictures, convey the message better and elicit fear among the users. Out of 450 participating students, 57 (12.7%) students were ever users and 39 (8.7%) were current users of tobacco. Among current users, 30 (76.9%) has intention to quit the habit. Out of 450 students, 184 (41.1%) students have noticed the pictorial warnings and 111 (24.7%) of them stated that it will encourage users in quitting. Conclusion: Though the new pictorial warnings bring a sense of fear on initiators, it fails to create an impact on chronic users. Majority of the current users has intention to quit tobacco and would like to follow a healthy lifestyle

Postmenopausal bleeding among rural women in Tamil Nadu, India: Mixed methods study

Introduction: Postmenopausal bleeding (PMB) is a common and early symptom of cervical and endometrial cancer. Its early detection can improve the cure rate and reduces mortality. Objectives: The objective of the study is to find out the prevalence and determinants of PMB in a rural community setting and the reasons for not undergoing cervical cancer screening among postmenopausal women. Materials and Methods: A sequential exploratory mixed methods study where qualitative (group interviews) phase followed quantitative (survey) phase in the community. The survey was undertaken among the representative sample of 1,530 postmenopausal women in 34 villages of Villupuram district, Tamil Nadu. Data were collected by house-to-house survey. Analysis: Bivariate and multivariate analysis was done using SPSS 24 software package. Results: The prevalence of PMB was found to be 1.8%. Only 5.6% women had undergone screening. The majority did not go for screening due to lack of awareness, or they did not have any symptoms or feared about negative results. Occupation (daily wage laborers), use of oral contraceptive pills at least for 1 year, recurrent abortions (> three abortions), reproductive tract infection (more than 10 episodes in lifetime), abdominal obesity (increased waist–hip ratio), and underweight were identified as significant risk factors for PMB. Conclusion and Recommendations: Nearly 2% of women have PMB, and most of the factors identified as determinants are preventable. Cervical cancer screening rate was poor among the respondents and lack of awareness was stated as the major reason for it. Hence, the promotion of healthy lifestyles and contraceptives in early reproductive life and awareness for the need of early screening is recommended

An Evaluation of Community-Based Action Research Program for Medical Undergraduates in Rural Pondicherry

Objective: To obtain the learners’ reaction to a community-based action research program in a rural setting of Pondicherry. Methods: Both quantitative (post-then-pre rating) and qualitative (response to open ended questions) feedback from 125 medical students exposed to this program was obtained. Mean values were calculated for pre and post self-rating on skills acquired by the students in retro-pre feedback. The content analysis of the qualitative data was undertaken. Results: There was significant improvement in their perceived abilities to follow basic steps in carrying out research such as – problem identification, literature search, drafting a proposal, preparation of questionnaire, data collection, analysis and its reporting. Our approach could contribute to development of cognitive, social-emotional and vocational domains of the students. Conclusions: Overall, our community-based action research program is taking a shape and getting mainstreamed in the exiting curriculum. It could sensitize students to basic steps in research and contributed to their cognitive, social-emotional and vocational development. Further work is needed to increase its scope and intensity to achieve the development of cultural, moral and ethical domains

Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Objectives: (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. Materials and Methods: This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. Results: Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01–1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03–1.82). Conclusions and Recommendations: Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood

Household Environmental Risk Factors for Fall in Older People (≥ 65 Years) in Rural Pondicherry

Background: Most households in rural India have potential environmental hazards for fall among older people. There is limited information available on magnitude of these factors in our context. Objective: To assess the potential environmental risk factors for fall in and around the rural households of older people. Methods: The cross sectional survey was done in 14 villages of Primary Health Care Centre (PHC) Thirubhuvanai, Pondicherry. Representative samples of 570 houses were observed for risk factors using pre-designed and pre-tested checklist, which was carried out by trained post-graduates in Community Medicine. Environmental factors such as the type of house, presence of stairs without support, unstable furniture, adequate lighting arrangement, presence/use of latrine, supports in the toilet and bathroom were observed. Frequencies of variables were obtained by using SPSS (Version 24.0). Results: Out of 570 houses, 285(50%) houses were pucca and 340 (59.6%) houses had cemented floor. Unstable furniture was present in 203 (59.4%) houses. Among houses, the latrine was present in 333 (58.4%) houses, where toilet was in use in 284 (85.2%) whereas 315 (94.3%) houses didn’t have any support in their latrine. Bathroom was present in 338 (59.3%) houses and only 11 bathrooms (3.2%) had support. Majority of the houses had adequate lighting in living room and toilets; however, it was relatively low in the kitchen. Conclusion: Majority of households had potential environmental risk factors. Interventions at household level are required to minimize these risk factors. The results of this study indicate the need for environmental inspection and hazard reduction measures in their houses

How Does Seating Arrangement Matter While Teaching in Small Groups?

A circular seating arrangement is best suited for small group discussions