Factors influencing the place of delivery in rural Meghalaya, India: A qualitative study

Background: In Meghalaya, only 51.4% expectant mothers go for any institutional delivery with a wide rural-urban gap causing morbidity and mortality in the mothers and the neonates. Objectives: The objective of this study is to find out the factors influencing the choice of the place of delivery in rural women. Methodology: The present qualitative cross-sectional study was conducted from October to December 2016 in Bhoirymbong community health center (CHC) and the area catered to by it. This CHC was selected by purposive sampling. Data collection methods included focused group discussions and in-depth interviews. The data were analyzed manually using thematic content analysis. Results: Most of the women in the study area opted for home delivery by traditional birth attendants (TBAs), on whose skills the community had strong faith. Financial constraints, fear of out-of-pocket expenditure, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were found to be important causes of this choice. Home delivery apparently offered the women privacy and the opportunity to attend to their household chores and older children. Illiteracy, increasing age, and parity were risk factors for home delivery. Perceived need for institutional delivery was low. Staff attitudes and unnecessary referrals had an impact on the choice of place of delivery. Conclusion: In the rural areas of this study, home deliveries are the preferred norm. The wide range of factors identified in this study for the preference of TBA and home deliveries could help policy makers and program implementers to adopt socially and culturally appropriate community-based interventions that can contribute to the reduction of maternal, fetal, and neonatal mortality and morbidity and increase service utilization

Early community-based teaching of medical undergraduates for achieving better working skills in the community

INTRODUCTION: It has been perceived that there is a lack of community exposure and active learning in the community for the first-year undergraduates in Community Medicine. This study is designed to evaluate an early community exposure given to the students to help overcome these lacunae. METHODOLOGY: In this study, the first-year students (n = 44) were provided an early community exposure and evaluated to understand their perceptions by a prevalidated, pre- and post exposure questionnaire. The community exposure was given to the students by allocating them families in community with designated tasks A core group of mentors monitored the students and scored the students on every visit. Attendance of students, scores marked by the mentors, and pre- and postexposure responses were used to evaluate the impact of community exposure. RESULTS: A total of 44 students were evaluated in this study. A total of 22 h (36.6%) were dedicated to community-based learning in the 1st year. A positive response was observed in the postexposure responses with regard to the understanding of the subject and interest in the subject in comparison to preexposure responses (P < 0.05). A statistically significant difference was observed in the first and final visit scores by the mentors with respect to communication skills, elicitation of history, team spirit, and attitude toward community (P < 0.00001). CONCLUSIONS: Students were exposed to the concept of community service and inculcated an interest in public health. Early community exposure of medical undergraduate students is important in developing better working skills in the community

Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance