Investigating gynaecological morbidity in India: Not just another KAP survey

Reproductive Health Matters

Volumn 6, Issue 11, 1998, Pages 84-97

  Koenig, Michael ^a   Jejeebhoy, Shireen ^b   Singh, Sagri ^b   Sridhar, S ^b  

^a FORD FOUNDATION   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL EXAMINATION; EPIDEMIOLOGICAL DATA; FEMALE; GYNECOLOGIC DISEASE; HUMAN; INDIA; MAJOR CLINICAL STUDY; MORBIDITY; POVERTY; PREVALENCE; PRIORITY JOURNAL; REPRODUCTION; SEXUAL BEHAVIOR; SOCIAL BEHAVIOR;

EID: 0032462616     PISSN: 09688080     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0968-8080(98)90085-4     Document Type: Article

References (36)

1. Dixon-Mueller R, Wasserheit J, 1991. The Culture of Silence: Reproductive Tract Infections among Women in the Third World. International Women's Health Coalition, New York.
2. Germain A, Holmes KK, Piot P et al. 1992. Reproductive Tract Infections: Global Impact and Priorities for Women's Reproductive Health. Plenum Press, New York.
3. The studies are by SEARCH in rural Maharashtra; Child-in-Need Institute (CINI) in rural West Bengal; Streehitakarini in Bombay; Baroda Citizens Council in Baroda, Gujarat; Indian Institute of Management, Bangalore, in rural and urban Karnataka; SEWA-Rural in rural Gujarat; and URMUL Trust in rural Rajasthan. Two other studies in rural Gujarat were either discontinued or under way at the time of writing. See notes 23 and 31.
4. Bang RA, Bang AT, Baitule M et al. 1989. High prevalence of gynaecological diseases in rural Indian women. Lancet. 8629(14 January):85-88.
5. Bhatia JC, Cleland J, Bhagavan L et al. 1997. Gynaecological morbidity in south India. Studies in Family Planning. 28(2):95-103.
6. Oomman NM, 1996. Poverty and Pathology: Comparing Rural Rajasthani Women's Ethnomedical Models with Biomedical Models of Reproductive Behavior. PhD thesis. Johns Hopkins University.
7. Latha K, Kanani SJ, Maitra N et al. 1997. Prevalence of clinically detectable gynaecological morbidity in India: results of four community-based studies. Journal of Family Welfare. 43(4):8-16.
8. Younis N, Khattab H, Zurayk H et al. 1993. A community study of gynaecological and related morbidities in rural Egypt. Studies in Family Planning. 24(3):175-86.
9. Wasserheit JN, Harris JR, Chakraborty J et al. 1989. Reproductive tract infections in a family planning population in rural Bangladesh. Studies in Family Planning. 20(2):69-80.
10. Brabin L, Kemp J, Obunge OK et al. 1995. Reproductive tract infections and abortion among adolescent girls in rural Nigeria. Lancet. 8945 (4 February): 300-04.
11. Bulut A, Filippi V, Marshall T et al. 1997. Contraceptive choice and reproductive morbidity in Istanbul. Studies in Family Planning. 28(1):35-43.
12. These were undertaken in Maharashtra, Bombay, West Bengal, Karnataka and Rajasthan.
13. Although this information was not reported separately in the Maharashtra study, it is evident that the overall level of clinically diagnosed morbidity in this study also exceeded 70 per cent of all women.
14. The Maharashtra study, for example, reported that only 8 per cent of women respondents had ever undergone a gynaecological examination. See note 4.
15. Bang R, Bang A, 1994. Women's perceptions of white vaginal discharge: ethnographic data from rural Maharashtra. Listening to Women Talk about Their Health. Gittelsohn J et al. (eds). Har-Anand Publications, New Delhi.
16. Streehitakarini, 1995. Gynaecological diseases and perceptions about them in a Bombay slum area. (Unpublished report.)
17. Bang R, Bang A, 1996. A community study of gynaecological disease in Indian villages: some experiences and reflections. Learning about Sexuality. Zeidenstein S, Moore K (eds). Population Council, New York.
18. Council for Social Development, unpublished results.
19. Even with these factors, it is possible that the higher prevalence estimates in the later rounds represent significant underestimates of true levels of gynaecological morbidity, given the absence or low levels of reported conditions, such as prolapse or dysuria.
20. In a study in Istanbul, for example, while 81 per cent of the women reported experiencing one or more symptoms associated with reproductive morbidity when interviewed by a physician, the corresponding figure when interviewed at home by an interviewer was 65 per cent. See Bulut A, Yolsay N, Filippi V et al. 1995. In search of truth: comparing alternative sources of information on reproductive tract infection. Reproductive Health Matters. 6 (Nov):31-39.
21. Since this study population was comprised largely of self-selected clinic attenders who would be expected to volunteer information more readily, an even larger gap between unprompted and prompted responses might be expected among the general population of women.
22. Bhattacharya S, 1994. Gynaecological morbidities among women in West Bengal. Child-in-Need Institute. (Unpublished report.)
23. Preliminary results from a separate study in Gujarat indicate that only 46 per cent of sampled women consented to undergo a clinical examination. See Visaria L, 1997. Gynaecological morbidity in rural Gujarat: some preliminary findings. Gujarat Institute of Development Research. (Unpublished paper.)
24. This was only possible in studies which fielded their surveys of self-reported morbidity among all sampled women prior to and separately from the clinical examination, or who returned to interview a representative sample of women who refused the clinical component.
25. See Bhatia JC, Cleland J, 1995. Self-reported symptoms of gynaecological morbidity and their treatment in south India. Studies in Family Planning. 26(4):203-16. The Karnataka analysis was based on data from a larger cross-sectional survey.
26. Parikh I, Taskar V, Dharap N et al. 1996. Gynaecological morbidity among women in a Bombay slum. Streehitakarini. (Unpublished paper.)
27. Zurayk H, Khattab H, Younis N et al. 1995. Comparing women's reports with medical diagnoses of reproductive morbidity conditions in rural Egypt. Studies in Family Planning. 26(1):14-21.
28. Filippi V, Marshall T, Bulut A et al. 1997. Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul. Tropical Medicine and International Health. 2(1):47-56.
29. Graham W, Ronsmans CCA, Filippi VGA et al. 1995. Asking Questions about Women's Reproductive Health in Community-based Surveys: Guidelines on Scope and Content. London School of Hygiene and Tropical Medicine, Maternal and Child Epidemiology Unit Publication No 6, April.
30. The field data collection costs, exclusive of data entry and management, from an ongoing clinic-based study of gynaecological morbidity in Maharashtra are estimated at roughly US$50 per respondent. Arundhati Char, personal communication, 1998. The percase costs for community-based studies of gynaecological morbidity are likely to be substantially higher.
31. For a discussion of this issue, see Khanna R, 1997. Dilemmas and conflicts in clinical research on women's reproductive health. Reproductive Health Matters. 9(May):168-73.
32. See, for example, Hopcraft M, Verhagen AR, Ngigi S et al. 1973. Genital infections in developing countries: experience in a family planning clinic. Bulletin of the World Health Organization. 48:581-86.
33. For a discussion of diagnostic techniques, see Morse SA, Moreland AA, Holmes KK, 1996. Atlas of Sexually Transmitted Diseases and AIDS. Mosby-Wolfe, London.
34. See Measham AR, Heaver RA, 1996. India's Family Welfare Program: Moving to a Reproductive and Child Health Approach. World Bank, Washington DC.
35. Government of India. n.d. Reproductive and Child Health Programme. Ministry of Health and Family Welfare, New Delhi.
36. It has been estimated that India presently spends roughly US$0.60 per capita on maternal and child health and family planning services, against the World Bank's recommended level of US$5.40 per capita for low-income developing countries. See [34] above, p. 51.