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The aim of the study was to explore the care-seeking pathway of rural women living with rheumatoid arthritis (RA) and attending a tertiary health-care facility in Odisha, India.
RA is the third leading chronic health condition and causes severe pain and immense psychosocial stress. The prevalence of RA is three to four times higher in women than in men. Furthermore, in India, women delay care seeking due to the prevailing sociocultural norms. Women report more severe symptoms and greater disability; however, there is a lack of information on their care-seeking pathways.
We conducted 113 in-depth interviews among RA patients those who visited specialists at the outpatients’ Department of Rheumatology, SCB Medical College Hospital, a tertiary care hospital in Cuttack, Odisha, India. The grounded theory approaches were used for data analysis.
The key findings included physical pain and psychosocial stress in relation to RA, cultural issues in relation to RA, mapping of the health-care providers for RA, the first point of cares and changes in care-seeking pathways, the perceived challenge for seeking health-care, and coping strategies of patients and social supports. This study explored that the RA patients seek care from multiple providers – untrained, trained and specialist without any gatekeeping. However, the primary health centers were the first point of care for maximum patients due to accessibility and affordability. Furthermore, follow-up care is significant to prevent complication among RA patients; the primary health centers are the gateway for keeping RA patients. Hence, the availability of RA trained providers at primary health center including interprofessional care, such as physiotherapy providers, and proper referral system is essential to convalesce care-seeking pathways.
This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants.
In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice.
A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form – designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers.
A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics – cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.
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