1

GENETIC DISORDER

Protection Provided by Haemoglobinopathies in Uncomplicated

and Severe P. falcipa= rum Malaria- A Cohort Study

Objective

To observe the protective effect, in t= erms of malarial episode and parasitemia, of common haemoglobinopathies i.e. sic= kle haemoglobin, a-thalassaemia, = b-thalassaemia trait etc. and Duffy antigens in = mild (P. falciparum) and severe malaria (cerebral malaria).

During active fever survey, a total of 1355 blo= od slides were collected from individuals having fever or history of fever at = the time of survey. Six hundred ninety eight persons were positive for malaria parasite (SPR-51.5). Proportion of = P. falciparum infection was 89%. Overall malaria infection was significant= ly more among younger age groups (<14 yrs) than adult age group of 14+ year= s (= c²=3D60.0, p< 0.00001) (Table 1.1.1). Blood sample for analysis of haemoglobinopath= ies was collected from 246 persons. Sickle cell trait was 12.8% and G-PD defici= ency was 4.1%.

The study is in progress.

Apha Thalassamia in Re= lation to Common Haemoglobinopathies

in some Tribes of Madh= ya Pradesh

Objective

To correlate the variation in sickle haemoglobi= n to the other haemoglobinopathies like b-thalassaemia, a-thalassaemia and G-6-PD deficiency in Kol, Gon= d, Pradhan, Bharia and Baiga populations of Madhya Pradesh

Findings

Prevalence of haemoglobinopathies and G-6-PD deficiency in tribes Kol of district Satna, Gonds of district Shahdol and Pradhan and Baiga of district Dindori vary a lot and are given in figure 1.2.1. Sickle haemoglobin is very high (30%) in Pradhan of district Dindori and it was moderate (about 15%) in Baiga and Gond tribes. Prevalence of heat unstable haemoglobin was about 2%= in all the tribes except Pradhan in which it was 5% (Figure 1.2.1).

Fig 1.2.1: Prevalence of haemoglobinopathies

among four different tribal populations

= a-thalasaemia type II was done for samples of Ba= iga, Kol, Gond and Pradhan tribes. Deletional form of a-thalassaemia type-II is very high in all the f= our tribes. (Fig 1.2.2). Highest prevalence of alpha thalassaemia (85%) was found in Baiga tribe followed by Gond (24.4%), Kol (30%) and Pradhan (52%). The gene frequency of = a gene was high in the four tribal population vi= z. Kol- 0.5278, Baiga 0.7465, Pradhan 0.3636 and Gond 0.6036. Such high frequency of = a-thalassaemia type II as found in Baiga tribe is rarely reported from any indigenous population of the world. -= a^3.7 deletional allele is more common compared to -a^4.2 deletional allele in all the four tribes. The distribution of -= a gene was not following the Hardy-Weinberg Law = for the natural distribution of gene in the population. The proportion of (-= a/-a) homogygous alpha thalassaemia II was more at the cost of heterozygotes for = all the four population but it was more pronounced in Baiga tribe. From the deviated values of Hardy-Weinberg’s Law it appears that (-= a/-a) homozygous alpha thalassaemia II is having advantageous selection (may be against malaria) in all the four population (Allen, 1997).

Fig 1.2.2: Prevalence of deletional form of alp= ha thalassaemia type II

among four different tribal populations

Presence of alpha thalassaemia does not cause any clinical sig= ns symptoms in the person but it causes mild microcytic anaemia or lowering of haemoglobin. The alpha thalassaemia is stated to provide protection against severe from of malaria and it also lower the clinical severity of sickle ce= ll disease. In the present study there was no significant difference in the CBC profile of the four tribes. Hence the three category of alpha thalassaemia = of all the four tribes were grouped together. The homozygousity of the alpha thalassaemia lowers the haemoglobin level and other haematological paramete= rs (Table 1.2.1).

Anaemia is common in all the four tribes. Highest level (78.3%= ) of anaemia was found in Kol tribe followed by Pradhan (71.2%), Gond (65%) and Baiga (62.8%). Most of anaemic person (75%) falls under mild category (Hb <12 gm/dl). Person under severe anaemic category (Hb 7.0 gm/dl) were 1% = to 2.5%. The anaemia was more common in children (below 12 years) and adult females (Table 1.2.2).

&= nbsp; The mean haematological parameters of the four tribal populations for adult mal= es and females, and children are given table 1.2.3. The mean haemoglobin levels are inconsistent with the data on prevalence of anaemia in the tribal populations, i.e. higher level of mean Hb in male group as compared to fema= le and children groups. The mean value of MCV and MCH for female and male grou= ps are in lower range, i.e. less than 72 fl and 25 pg respectively, suggesting that there is wide spread of hypochromic and microcytic anaemia in these groups.

COMMUNICABLE DISEASES

Epidemiology of viral hepatitis in tribal populations of Orissa,

Madhya Pradesh/Chhatisgarh and Jharkhand, India

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Objectives

<= span style=3D'font-family:Arial;mso-fareast-font-family:Arial;color:black'>1.&n= bsp; To determine the prevalence of antibodies to hepatitis A= and hepatitis E viruses.

<= span style=3D'font-family:Arial;mso-fareast-font-family:Arial;color:black'>2.&n= bsp; To determi= ne the prevalence of hepatitis B, C and delta viruses.

<= span style=3D'font-family:Arial;mso-fareast-font-family:Arial;color:black'>3.&n= bsp; To assess = the risk factors for transmission of hepatitis viruses.

<= span style=3D'font-family:Arial;mso-fareast-font-family:Arial;color:black'>4.&n= bsp; To determi= ne the circulating genotypes of HBV & HCV and prevalence of pre-core and basal core promoter mutants of HBV.

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Methodology

This is an ICMR task force study being undertaken among primitive tribal communities in different parts of the country. The primiti= ve tribes in Madhya Pradesh and Chhattisgarh are covered by the centre. All the seven primitive tribes in Madhya Pradesh and Chhattisgarh have been covered under the study viz. Baigas, Bharias, Saharias in Madhya Pradesh and Abujhmarias, Hill Kowas, Kamars and Birhors in Chhatisgarh. The study methodology involves collection of demographic and socio-cultural informati= on from the households and information on risk factors from the study individu= als using a structured questionnaire. A written informed consent was obtained f= rom all the participants. The blood samples were collected from the study population; plasma/serum separated on site, aliquoted and transported to the laboratory maintaining the cold chain. Serology for HAV, HBV and HCV was conducted by using commercial ELISA kits. HBV genotyping was carried out at National Institute of Virology, Pune. Polymerase Chain Reaction (PCR) was employed to detect HBV DNA and for genotyping.

Findings

A tot= al of 1223 subjects were screened in the study. The prevalence of hepatitis B was higher in males (80.5%) as compared to females (19.5%). The prevalence of hepatitis C was higher in females (53%) as compared to males (47%). Table 2= .1.1 shows the age wise distribution of hepatitis markers.The overall HBV preval= ence was found in the range of 3 -4 % in all the age groups. The anti-HCV preval= ence was higher in the age group of 20-50 yrs (8%).Tribe wise seroprevalence of hepatitis markers is shown in Figure 2.1.1. The prevalence of HBsAg varies between 0.6% - 10% in these tribes. The prevalence of Anti HBs and Anti HCV= has been found to be ranging between 5-33% and 1-14.4% respectively. High Anti = HCV prevalence was found in Bharia tribe (14.4%). Molecular studies of HBV isol= ates indicated a predominance of genotype D in the region.

Table 2.1.1: Age-wise distribution of hepatitis markers

Viral markers	Percent positive
<20yr	20-50yr	>50yr
H= BsAg	4% (209)	3% (756)	4% (238)
A= nti-HBc	18% (195)	26% (727)	43% (220)
A= nti-HAV	89% (205)	99% (745)	98% (233)
A= nti-HCV	6% (205)	8% (745)	7% (229)
A= nti-HEV	31% (197)	50% (723)	52% (219)
A= nti HBsAg	8% (206)	11% (738)	14% (227)

Values in parentheses are number of sample tested=

Fig 2.1.1: Seroprevalence of viral hepatitis among the primitive tribes

Molecular Epidemiology= of Community Acquired Staphylococcus aureus Strains from Primitive Trib= es of Madhya Pradesh

Objectives

1. &n= bsp; Prevalence= and characterization of CA-MRSA

2. &n= bsp; Genotyping= of MRSA strains

Findings

Bha= ria: In Bharia tribe 248 swabs collected, S.aureus was detected in 22 (8.8%) specimens. Of these 4 (1.6%) were methicillin resistant. =

Sah= aria: Total of 288 swabs were collected, of these 9 (3.1%) were S.aureus and 4 of t= he strains were methicillin resistant. The genes mecA and femA were also detected from the strains.

= &nb= sp; =

3D"Text

mec A<= /span>

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femA

Band showing gene mecA and femA<= /span>

Lane 2 – 7: samples

Lane 8: DNA mark= er

Health and Nutritional Profile of Baiga Tribe

of Balaghat District, Madhya Pradesh=

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Objectives

A= ssess health and nutritional status of Baiga tribe of Balaghat District.

Findings

About 1191 individuals of different age group from 436 households in 22 villages were surveyed. All the households belonged to Hindu religion (100%) with 95% of = the households were living in kachha houses. The average family size was= 5 and 70% of the families had children with birth order of 5 and above. All t= he Baigas were marginal land holders and maximum landholdings were non-irrigat= ed. Labour and collection of forest products were major occupation (89.1%). A t= otal of 41% populations were illiterate, 21.6% had primary education and 11.8% w= ere educated upto middle school. More than 81% households uses tube well as sou= rce of drinking water and 3% uses stream water. Only 1.6% households had sanita= ry latrine. A total of 8.5% households possessed separate kitchen and about one third of houses were electrified. Only 47.7% households had ‘Deend= ayal card’ and 27.1% preschool children were benefited by ‘Ba= lshakti Yojana’.

Over all acute respiratory infection (8.6) was the most common morbidity followed by fever (most likely due to malaria) (7.4%), scabies (2.4%), cataract in elderly population (1.7%) and dysentery (0.8%). Among w= omen prevalence of pelvic inflammatory disease was 2.6% (Table 4.2.1).

The mean anthropometric measurements were lower than those of = all age & sex matched values for other tribal children of MP as well as NCHS standards. The proportion of underweight (<-2SD) preschool children was about 65.9%, while severe underweight (<-3Sd) was 35.4%. The extent of stunting (<-2SD) was about 49.6%, while about 28.8% of were severely stu= nted (<3SD). Wasted (<-2SD) were 42.3% and severe wasted (<Median -3SD)= was 10.7% (Table 4.2.2). Among adult population about 55.8% males and 62.9% of = the females (Table 4.2.3) had chronic energy deficiency (BMI <18.5).

Cereals formed the bulk of Baiga diet. Consumption of protecti= ve foods such as pulses, flesh food, milk, fruits, oil and fats were grossly inadequate. As a result the intake of micronutrients was much below the recommended level in all the age groups.

None of the children up to 6 year exhibited signs of Kwashiork= or while the prevalence of Marasmus was about 0.8%. The prevalence of Bitot’s spot, a sign of vitamin A deficiency and angular stomatitis indicative of B complex deficiency was about 1.0 % and 0.9% respectively.

Utilization of health services was poor. About 76.9% pregnant/lactating women did not receive any antenatal care. Only 54% women have received II dose of TT injection during their antenatal period. In the last 24 month 72% deliveries took place at home, majority being carried out= by trained Dais. Only 18% women had post natal care visited by ANM & AWW. = The detail analysis is in progress

Table 4.2.1: Prevalence (%) of General Morbidity &

Nutritional Deficiency Signs (n=3D1197)

General Morbidity

(%)

Nutritional Deficiency

(%)

Malaria Fever

ARI

Dysentery

Scabies

Cataract

PUS

Multiple Boil

PID

7.4

8.6

1.2

2.4

1.7

1.9

0.7

2.6

Marasmus

Night Blindness

Conjunctival Xerosis

Bitot Spot

Angular stomatitis

Dental carriers

Goiter

0.8

0.1

3.5

1.0

0.9

0.8

0.6

Table: 4.2.2: Distribution (%) of 1-5 years chi= ldren

according to SD classification (n=3D226)

Variables	<-3SD	-3SD to 2SD	-2SD to-1SD	-1SD to Median	>=3DMedian
Weight for Age	35.4	30.5	24.8	6.6	2.7
Height for Age	28.8	20.8	21.7	15.5	13.3
Weight for Height	10.7	31.6	39.6	13.8	4.4

Table 4.2.3: Distribution (%) of Adult Male &am= p; Female

according to BMI classification (n=3D691)<= /o:p>

BMI <= o:p>	<16 CED III	16-17 CED II	17-18.5 CED- I	18.5-20 Low wt Normal	20-25 Normal	25-30 Obese I	>=3D30 Obese II
Male	5.3	18.5	32.0	29.0	14.9	0.3	nil
Female	13.4	15.2	34.3	23.7	11.9	1.5	nil
Total	9.8	16.6	33.3	26.0	13.2	1.0	nil

&= nbsp;

Health= and Nutritional Profile of Baiga Tribe

of Din= dori District, Madhya Pradesh

Objective

To study the health and nutritional status of Baiga’s of Dindori district.

Findings

So far a total of 611 individuals of different ages from 273 households in 12 villages were surveyed. All households belonged to Hindu religion, and 88.6% households were living in kachha houses, while 8.1% were semi puc= ca and only 3.3% were pucca. About 59% of the households had open well = as source of drinking water, while about 20% use stream water for drinking. On= ly 1.1% of the households had sanitary latrine. A total of 40% of households possessed separate kitchen and about fifty percent houses were not electrif= ied. Only 68% households had ‘Deendayal card’ and 61.2% presc= hool children were benefited in ‘Balsakti Yojna’.<= /span>

Fever due to malaria was the most common morbidity (17.6%) followed by acute respiratory infection (5.6%), dysentery (1.5%) and goiter (0.7%). The prevalence of cataract in elderly population was 5.1%.&n= bsp; None of the children exhibited signs of Kwashiorkor, while the prevalence of Marasmus was about 1.5% (Table 4.3.1). The prevalence of Bitot’s spot, a sign of vitamin A deficiency and that of angular stomatitis indicative of B complex deficiency was about 1.3 % and 1.1% respectively. The proportion of preschool children with underweight (<-2= SD) was about 60.2%, while that severe underweight (<3SD) was 25% (Table 4.3.2). The extent of stunting (<-2SD) was about 44.8% while about 17.4% of were severely stun= ted. Wasted (<-2SD) was 27.1% and severe wasted (<Median -3SD) was 6%. Amo= ng adults about 47.5% males and 48.7% of the females had chronic energy defici= ency (BMI <18.5) (Table 4.3.3).

Cereals for= med the bulk of Baigas diet while millets (maize & vargu) also consumed in = the form of ‘Pej’. The intake of Cassia tora (chakoda leaves) was very common in the daily diet. The consumption of proactive foods such = as milk, green leafy vegetables, fruits, oil and fats were grossly inadequate. Regarding utilization of health-care services, more than 52% women did not receive any antenatal care. Only 62 % women had received II dose of TT injection. In the last 24 month 87% deliveries took place at home, majority being carried out by trained Dais. Only 25% women had post natal care visit= ed by ANM & AWW. The study is in progress.

Table 4.3.1: Prevalence (%) of Major Morbidities &

Nutritional Deficiency disorders

General Morbidity (n=3D611)=	(%)	Nutritional Deficiency (n=3D611)	(%)
Scabies=	3.0	Marasmus	1.5
Fever	17.6	Conjunctival Xeros= is	0.8
Dysentery	1.5	Bitot’s Spot=	1.3
ARI	5.6	Angular stomatitis=	1.0
Cataract	5.5	Cheilosis	0.6
Peptic ulcer Syndr= ome	1.0	Goiter<= /span>	0.7
Multiple furunculo= sis	0.3

Table: 4.3.2: Distribution (%) of 1-5 years chi= ldren

According to SD classification (n=3D165)

Variables	<-3SD	-3SD to 2SD	-2SD to-1SD	-1SD to Median	>=3DMedian
Weight for Age	24.9	34.7	26.0	9.8	4.6
Height for Age	30.1	17.9	26.0	11.6	14.5
Weight for Height<= o:p>	5.4	20.5	45.8	16.3	12.0

Table 4.3.3: Distribution (%) of Adult Male &am= p; Female

according to BMI classification (n=3D329)<= /o:p>

= BMI	<16 CED III	16-17 CED II	17-18.5 CED- I	18.5-20 Low wt normal	20-25 normal	25-30 Obese I	>=3D30 Obese II
Male	5.0	13.3	29.2	27.5	22.5	2.5	nil
Female	10.5	10.0	28.2	27.8	22.5	1.0	nil
Total	8.5	11.2	28.6	27.7	22.5	1.5	nil

&= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; <= /p>

Health and Nutritional Profile of Bh= aria Tribe of Patalkot Valley, Chhindwara District, Madhya Pradesh

Objectives<= span style=3D'font-family:Arial;mso-fareast-font-family:"MS Mincho";color:blue'>=

The main objective of the study is to assess the health and nutritional status of the Bharia tribe of Patalkot Valley.

Findings

About 570 individuals of different age groups and gender from 230 households were cov= ered for clinical examination and anthropometry. Information on food and nutrient intake was collected from 74 households. A total 262 male & females were covered for estimation of Hemoglobin, while with our best efforts we could collect only 79 stool samples from the school going children for identifica= tion of intestinal parasites. Most of the people lives in kachha houses (79.1%) followed by semi pucca (19.6%). About 42% of Bharia populati= on was absolutely illiterate, 26.5% had primary education, 24.9% had middle le= vel, 3.5% had high school level and only 2.4% had college level education. A tot= al of 58.3% households use open well for drinking water and 20.9% depend on tu= be wells. Another 21.7% households were consuming unsafe drinking water from streams. Only 2.2% households had sanitary latrines.

During the survey, scabies (21%) was found to be the most common morbidity (Plate 1), while 9.8% population were suffering from fever, 9.6% had upper respiratory tract infection and 2.5% had dysentery. Other general morbidities observed = were UTI, Cataract, Jaundice, Bronchitis, Hypertension, TB, Dermatitis, Multiple boil and in low proportion. According to JNC-VII criteria, prevalence of st= age II hypertension (SBP >160 mmHg and DBP >100 mmHg) was about 2.8%. The overall prevalence of anemia among male was about 89.8% with 37% having moderate and 2.8% with severe anemia (Table 4.4.1). H. Nana (20.2%) was the commonest parasite followed by Entamoeba histolytica (17.7%), Ascaris lumbricoides (16.4%) and <= /span>Ancylostoma duod= enale (15.2%) found in the stool (Table 4.4.2)

The prevale= nce of clinical cases of Protein Energy Malnutrition such as Kwashiorkor in pre-sc= hool children was absent and only 0.2% cases of Marasmus was seen. In the school= age children the prevalence of Vitamin A deficiency in the form of Conjunctival xerosis (3.3%) and Bitot’s Spot (1.8%) was high. The overall prevalen= ce of goiter was found in 2.6% cases confined to older women over 40 years. The distribution of height and weight of male and female are presented in Fig 4= .4.1 & 4.4.2. Bharias were found to be lighter and shorter as compared to the NCHS standard as well as Rural Madhya Pradesh children. <= /p>

The proportion of children with underweight (<Median - 2SD) was about 53.7%, while that of severe underweight (<Median - 3SD) was 13.9%. The extent of stunting (<Median -2SD) among pre-school children was 44.8%, while that of severely stunting (<Median -3SD) was 17.4%. The wasting of pre-school children was about 32.2% (<Me= dian - 2SD), while 7% was severally wasting (<Median - 3SD). No significant s= ex difference was observed in the prevalence of wasting. About 42% of the males and 48% of the females had Chronic Energy Deficiency (CED< 18.5) = (Table 4.4.= 3).

The staple diet was a low calorie dense prepara= tion made by boiling millet flour such as maize, vargu and samai with a large quantity of water adding salt called Pej. The average daily intake of cereal and millets was 483 gm which was higher = than RDA. The consumption of pulses and green leafy vegetables was 30gm and 26.6= gm respectively. The consumption of protective food such as fruits, milk & milk products, oil and fat were much lower than recommended level.

The average energy and protein intake was 1895 = kcal and 46.7 g per CU/ per day. Though the cereals and millets intake was high = but energy level was low. This might be due to low calorie of coarse grain mill= ets intake. The intake of all micronutrient was lower than RDI, only thiamin in= take was better due to higher intake of cereals. The mean intake of calcium and = iron was 124 mg and 16.9 mg respectively, while the mean intake of vitamin C 28.1 mg, carotene 1153 µg, thiamin 1.0 mg and riboflavin was 0.7 mg.

Inspite of 90% women are aware of “Jan= ani Suraksa Yojana” only 10% could avail such facility. The reasons submitted by them are: home delivery is convenient (55.9%), hospital is far away and lack of proper transportation (35%). Similarly only 15% of the respondents availed “Ladli Laxmi Yojana” another 15% were not aware about this scheme and 70% did not avail the facility. About 87% deliveries were carried out by trained Dai.

Only 57% children received BCG within one month= of birth, while DPT 1^st dose was 63% and II dose was 24.1%. However= 83% children received Oral Polio Vaccine. More than 50% of the pregnant women d= id not receive any antenatal care and only 62% women received Tetanus Toxoid injection.

Table 4.4.1: Prevalence (%) of Major Morbidities & Nutritional Deficiency

disorders among B= haria tribes of Patalkot valley (n=3D570)

General Morbidity (n=3D570)	P= ercentage	Nutritional&= nbsp; Deficiency Disorders (n=3D570)	P= ercentage
Scabies=	20.9	Emaciation	0.4
Fever	9.8	Marasmus	0.2
Dysentery	2.5	Conjunctival Xeros= is	3.3
ARI	9.6	Bitot’s Spot=	1.8
Cataract	1.4	Angular stomatitis=	1.2
PUS	3.2	Cheilosis	1.1
Multiple Boil=	2.1	Goiter<= /span>	2.6

<= /span>

Table 4.4.2: Perce= nt Distribution of worm infestation

among Bharia child= ren of Patalkot = Valley

<= /span>

O= rganism	N= umber	%=
E. Histolytica=	14	17.7
E.= Coli	10	12.6
An= cylostoma duodenale	12	15.1
Ascaris	13	16.5
Giardia	11	13.9
H. Nana	16	20.2
E. Vermicularis	3	3.8
Total	79	100

Table 4.4.3: Percent distribution of anemia acc= ording to Hemoglobin

level among Bharias of Patalkot valley (n=3D 26= 2)

G= rades of Anaemia (Hb level)	S= ex
M= ale (n=3D108)	F= emale (n=3D154)	T= otal (= n=3D262)
Normal (>12g/dl= )	10.2=	3.2<= o:p>	6.1<= o:p>
Mild (10-12g/ dl)	50.0=	29.9=	38.2=
Moderate (7-10g/dl= )	37.0=	65.6=	53.8=
Severe (<7g/dl)=	2.8<= o:p>	1.3<= o:p>	1.9<= o:p>

Fig 4.4.2: Comparison of Height of Bharia child= ren (Female) with rural NNMB

Behaviour and Vulnerability to Reproductive

Morbidity among the Tribal Youths: A= Study

among the Sahariyas of Madhya Prades= h

Objectives

The study endeavours to understand the social risk factors along with knowledge, attitude, behaviour and practice about various reproductive and sexual matt= ers among tribal youths in the context of emerging diseases- RTI/STI/HIV/AIDS. = This in-depth study will help in tribe specific micro-planning.

Findings

The thematic analyses of the discussion are men= tioned as: Barring very few most of them had no knowledge of sexually transmitted infection (STI) or other reproductive morbidities. Though many of them have heard about AIDS from TV and radio but are unaware of its proper routes of transmission. They have a feeling that it can be cured but only by a trained doctor. However, none of them have seen any individual suffering from the H= IV infection. Some of them mentioned that AIDS is caused by transfusion of infected blood and also from infected mother to child. Syphilis a STI was mentioned by few. While trying to venture in to their knowledge on sexualit= y, almost half of the participants agreed that masturbation, night wetting and pre-mature ejaculation is not a disease, while others have different opinio= ns. Almost all of them mentioned that pre-marital sexual contacts are common am= ong the Sahariya males. Most of them argued that it is male who is more respons= ible for STI. Further they opined that higher coital frequency makes individual vulnerable to STI. Condom is known to them but they decline to use it with = the view that it reduces the sexual pleasure. Half of the participants are awar= e of safe period. They mentioned that though it is not openly accepted in the Sahariya society but youths do mix freely in the place of occupation and ot= her places during feast and fairs and thus have ample scope for sexual indulgen= ce. The in-depth interview with parents, teachers, village leaders and health providers do express concern about the changing behavioural pattern of the Sahariya youths in the present context and their vulnerability to unwanted pregnancy and STI. Matrix ranking was done to assess the popularity of government health system in the Saharia locality and it was found that vill= age medicine man and private health providers are usually preferred during heal= th problems particularly related to reproductive health. The matrix ranking of responses related to non utilization of health services in the village Ghatigaon is shown below in figure 5.2.1.

Fig 5.2.1: Reasons for non utilization of Govt.= health

services (Matrix ranking), N=3D37

There was demand both from the youths and others close to them for educating youths on different aspects of sexual and reproductive health and providing such health services at easy reach. The matrix ranking of responses on pr= eferred media to get sexual and reproductive health information is shown in figure 5.2.2. The qualitative information generated helped in the preparati= on of survey instrument for the second phase of study (the quantitative survey) and same is going to start soon.

Fig 5.2.2: Preferred media to get sexual and reproductive

health information (= Matrix ranking), N=3D48

Community participation for matrix ranking at Village Gathigaon



Focus group discussions (FGD) at village Paniyar

Determinants of utilization of Mater= nal Health Care

Services among Baiga Primitive Tribe= in M.P.

O= bjectives

1.&n= bsp;     To determine the utilization/practices of maternal health care services.
2.&n= bsp;     To study the know= ledge, perceptions regarding maternal health services.

Findings

A total populati= on of 709 out of 142 households was covered in nine villages in Bajag block of Dindori district. One hundred and thirty eight ever married women were interviewed to know the level of health care utilization by them. Average household size was 5 persons and most of the population lived in nuclear families (81%). The source of drinking w= ater is important because waterborne diseases including diarrhea and dysentery a= re prevalent in tribal areas. It has been found that about 29% of households w= ere using drinking water from stream/river. In order to determine the maternal health care utilization out of 138 women, 106 experienced maternity during last five year. Out of them 67(63.2%) women had received antenatal checkup. The main source of ANC were ANM/Nurse (46.2%) followed by Govt. do= ctor (6.6%) and another 6.6% received ANC from private doctors (Fig 5.3.1). The average age at delivery of first birth was found to be 18.4 years. Most of = the women delivered at home (93.4%). About three-fourth of the deliveries were assisted by untrained Dai, while 16% by trained Dai and 9.4% by ANM and LHV= .

&nb= sp;           Desp= ite increasing efforts to prevent early marriages in tribal population, substan= tial numbers of people continue to practice child marriage, which carry immense health and social disadvantages. Knowledge regarding maternal health care services was reported by 43(31.1%) women indicating that the majority of them were not aware of any such servi= ces. Further a small number of ever married women (12.3%) knew about the danger signs of pregnancy complications (Fig 5.3.2) and is an again matter of conc= ern.

The study is under progress.

Figure 5.3.1: Sources of antenatal care

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Figure 5.3.2: Women’s knowledge about danger signs of Pregnancy

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