Health needs, access to healthcare, and perceptions of ageing in an urbanizing community in India: a qualitative study.

BACKGROUND: India's elderly population is rising at an unprecedented rate, with a majority living in rural areas. Health challenges associated with ageing, changing social networks and limited public health infrastructure are issues faced by the elderly and caregivers. We examined perceptions of health needs of the elderly across local stakeholders in an urbanizing rural area. METHODS: The qualitative study was conducted among participants in the Andhra Pradesh Children and Parents Study (APCAPS) site in Rangareddy district, Telangana. We collected data using focus group discussions and interviews among communities (n = 6), health providers (n = 9) and administrators (n = 6). We assessed stakeholders' views on the influence of urbanization on health issues faced and interventions for alleviating these challenges. We used a conceptual-analytical model to derive themes and used an inductive approach to organizing emerging codes as per a priori themes. These were organized as per thematic groups and ranked by different authors in order of importance. Bronfebrenner's theory was used to understand stakeholder perspectives and suggest interventions within four identified spheres of influence - individual, household, community and services. RESULTS: Stakeholders reported frailty, lack of transport and dependence on others as factors impacting health access of the elderly. Existing public health systems were perceived as overburdened and insensitive towards the elderly. Urbanization was viewed positively, but road accidents, crime and loneliness were significant concerns. Interventions suggested by stakeholders included health service outreach, lifestyle counseling, community monitoring of healthcare and engagement activities. CONCLUSIONS: We recommend integrating outreach services and lifestyle counseling within programs for care of the elderly. Community institutions can play an important role in the delivery and monitoring of health and social services for the elderly

Menstrual hygiene management and waste disposal in low and middle income countries — a review of the literature

Menstrual hygiene management (MHM) has gained some attention and several literature reviews have been published. However, both original papers and reviews tend to focus on absorbent access and use and not on the disposal of menstrual waste. This review aims to fill a gap in the water, sanitation and hygiene (WASH) sector by bringing a focus specifically on menstrual hygiene safe disposal in low- and middle-income countries (LMIC). We reviewed published literature since 2002 on menstrual hygiene with a focus on menstrual waste management and menstrual absorbent disposal in LMIC. Database searches were conducted of both peer reviewed literature and grey literature, in addition to hand searching of references of relevant earlier literature reviews. In total 152 articles and reports were identified and 75 met the inclusion criteria and was included in the final review. Existing polices on MHM was also reviewed with a focus on India and South Africa. The review showed that disposal of menstrual waste is often neglected MHM and sanitation value chains, leading to improper disposal and negative impacts on users, the sanitation systems and the environment. Findings call for further research to gain better understandings of MHM waste streams, disposal behaviors, absorbent materials and waste management technologies to deliver health, safety, mobility and dignity for women and girls

Constrained choices? Understanding the help seeking behavior of unmarried young women for sexual and reproductive health needs in a Mumbai slum

Thesis (D.P.H.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Background: Young unmarried women living in Indian slums are vulnerable to adverse reproductive and sexual health (SRH) outcomes including menstrual problems and poor menstrual hygiene, unwanted pregnancies and STIs, and sexual violence. Their vulnerability to preventable SRH conditions is heightened by their partial and incorrect knowledge of SRH issues, unfavorable societal attitudes towards women, and a paucity of relevant and accessible health services. Objective: This study aims to understand how young unmarried women living in a slum in Mumbai, India perceive and seek help for their sexual and reproductive health needs; identify the sources of help available to them and the challenges mothers and health care providers face in providing help; and propose an intervention plan to enhance the SRH of these young women. Methods: Interviews and focus group discussions were conducted with young unmarried women ages 15-24 years, mothers of young unmarried women, health care providers, and senior staff from non-governmental organizations to understand varying perceptions of young women's SRH needs and help seeking experiences. The data were analyzed using NVivo Version 8. Findings: Young unmarried women perceived menstrual problems, the inability to negotiate romantic relationships, and daily sexual harassment as the main SRH concerns they face, as they significantly interfere with their daily routine and cause emotional distress. Young women's ability and willingness to seek help to address these needs is influenced by a culture of silence that surrounds women's SRH, excessive scrutiny and blaming by the community, and restrictions on their mobility and interactions with peers. The findings underscored the role of mothers as gatekeepers who greatly influence young women's perceptions of SRH and their ability to seek help. Implications: Existing interventions need to be expanded to address young women's need for emotional and social support, and to involve significant gatekeepers such as mothers in promoting the health and wellbeing of young unmarried women in slum communities. This dissertation recommends intervention strategies to enhance the capacity of mothers to recognize, understand, and address their teenage daughters' needs for information, emotional support, and access to essential clinical and social services

Quality and Sustainability of Toilets: A Rapid Assessment of Technologies Under Swachh Bharat Mission - Gramin

With an aim to ensure open defecation free (ODF) India by 2019, Swachh Bharat Mission has been progressing at a rapid pace. Since its start in October 2014, over four crore toilets have been constructed across rural India. Lakhs of villages and hundreds of districts are being declared ODF across the country. However, there are concerns that the rapid top-down implementation focused on construction targets might have come about at the expense of the quality of the implementation. One key aspect within that would be the toilet technology choice and quality of the toilets built, which would affect the sustainability

Additional file 1: of A review of measures of women’s empowerment and related gender constructs in family planning and maternal health program evaluations in low- and middle-income countries

Evaluation papers included in systematic review. (DOCX 27 kb

Gender counts: A systematic review of evaluations of gender-integrated health interventions in low- and middle-income countries

As a result of new global priorities, there is a growing need for high-quality evaluations of gender-integrated health programmes. This systematic review examined 99 peer-reviewed articles on evaluations of gender-integrated (accommodating and transformative) health programmes with regard to their theory of change (ToC), study design, gender integration in data collection, analysis, and gender measures used. Half of the evaluations explicitly described a ToC or conceptual framework (n = 50) that guided strategies for their interventions. Over half (61%) of the evaluations used quantitative methods exclusively; 11% used qualitative methods exclusively; and 28% used mixed methods. Qualitative methods were not commonly detailed. Evaluations of transformative interventions were less likely than those of accommodating interventions to employ randomised control trials. Two-thirds of the reviewed evaluations reported including at least one specific gender-related outcome (n = 18 accommodating, n = 44 transformative). To strengthen evaluations of gender-integrated programmes, we recommend use of ToCs, explicitly including gender in the ToC, use of gender-sensitive measures, mixed-method designs, in-depth descriptions of qualitative methods, and attention to gender-related factors in data collection logistics. We also recommend further research to develop valid and reliable gender measures that are globally relevant

Additional file 1: Table S1. of Health needs, access to healthcare, and perceptions of ageing in an urbanizing community in India: a qualitative study

Differences in characteristics of urbanicity across villages in the study. (DOCX 61 kb