Ailing and treatment seeking behavior of schedule tribes of Madhya Pradesh, India

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1 STUDENT SECTION Ailing and treatment seeking behavior of schedule tribes of Madhya Pradesh, India Sarda Prasad Research Scholar, Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, India ABSTRACT The highest percentages of tribes are living in North East region of India and in Madhya Pradesh in the central India. This study is based on the NSSO 60 th round data, with the two objectives Tribal s ailing and hospitalization pattern and treatment seeking behavior of ailing Madhya Pradesh and India. Result shows that around 7% of Indian tribes were ailing 15 days before the survey and about 10% of them were hospitalized during 365 days before the survey. Rural tribes were more ailing and went to hospital for treatment than urban tribes. Odds ratio show that rural, male, old-aged, educated up to primary, not in labor force, currently married, and Hindu tribes were more likely to be hospitalized in Madhya Pradesh. Odds ratio also depicts that the household that have no drainage, used water from tube well and hand pump were more likely to be ailing. Key words: Ailing, hospital and scheduled tribe, hospitalization, treatment Introduction Development of any country depends upon the mass of that country. Educated and rich person are morally and physically handicap and poors are the active agent of development in India (Vivekanand). Madhya Pradesh (MP) is one of the poorest states in India with over 37% of its total population of 60 million living below the poverty line. Scheduled castes (SCs) and scheduled tribes (STs), two of the most marginalized groups, constitute 35% of the population and account for 60% of the poor. Gender-based discrimination is reflected in the unequal sex ratio (916/1000) against an already worrying national average (of 933/1000 in 2001) and lower human development indicators for women. Despite progress in recent years, Madhya Pradesh still has among the high rates of maternal and infant mortality of all states in India. Total fertility rate and incidence of vector-borne and communicable diseases are also much higher than average. Access this article online Quick Response Code: Website: DOI: / Recently published national statistics (National Family Health Survey [NFHS 3]) indicated that Madhya Pradesh had the highest rates of under nourishment in children under 3 years (60%) in the country (Government of Madhya Pradesh, [1] 2007). The tribal lives in the naturally bound region/area. They known people of god/nature, castes of forests, vanvasi (inhabitants of forest), pahari (hill dwellers), adimjati (original commumity/primitive people), adivasi (first settlers), janjati (folk people), anusuchit janjati (schedule tribes), and so on. [2] Tribes are the human beings, who are totally or partially close to the nature. Their belief, customs, food habit, living standards, etc., are natural and totally or partially different from other communities of India. All the states of India have tribes except Punjab, Haryana, and Delhi. Their health status and other socioeconomic status vary from state to state and region to region. Health status and treatment behavior are also affected by education and socioeconomic factors. The highest percentages of tribes are living in North east region of India, and in Madhya Pradesh in central India. In Madhya Pradesh, the most population strongest tribe community is Gonds and their group is called Koiter (Vidyarthi and Rai, [2] 1985). Other tribe groups are Kamars, Korkus, Haibas, Kols in Madhya Pradesh. Their economy is non-market-oriented and exist barter system. But now, it is changing rapidly with the change Correspondence: Dr. Sarda Prasad, 207 Census Data Centre (CDC), JNU Convention Centre, New Delhi spkjnu@gmail,com 156

2 of global market and liberalization and many tribal development programs implemented in the various parts of India. The tribal political associations are of various kinds and incorporate individuals, elders, families, a clan group, a village, and a tribal territory. The political characteristics of tribals may broadly be looked at through their social organization. They are-political association based on village as unit, clan lineage, and group villagers of a territory. The first and foremost characteristic is the clan and lineage. Clanship is politically more significant. The tribal of India is practically by religion a Hindu. Figure 1 indicates population of STs increasing in India from 1995 to 2001 in census of India. Health status, health indicator and medical facilities in ST areas Health is a function of medical care, socioeconomic, and political development of any society. The WHO defines health as a state of complete mental, physical, and social well-being. Figures in Table 1 indicate that in Madhya Pradesh, all important health indicators are higher than India s average in terms of maternal mortality rate and infant mortality rate and institutional delivery. These indicators are basic and foremost important for all the population. In the context of medical facilities in ST areas, in India, is somewhat good but not sufficient. Sukai [3] reported that about 15, 15, and 18% Primary health center, subcenter, and Integrated Child Development Schemes, respectively, available in all India level [Table 2]. Poor health is positively correlated to social variables. Health status of the tribal women is reflected by its sex ratio, female literacy, women-child ratio, and age at marriage, fertility, mortality, maternal and child care practices, and women are more vulnerable to diseases that afflict population. [4] He again reported that tribals have strong belief on supernatural god for their health, calamities, dog bites, and snack bites, etc. Indian Council of Medical Research (ICMR, 2003) [5] report reveals that the wide spread poverty, illiteracy, malnutrition, absence of safe drinking water and sanitary conditions, poor maternal and child health services, ineffective coverage of national health and nutritional services, etc., have been found, as possible contributing factors of dismal health condition prevailing among the primitive tribal communities of the country. Bacillary tuberculosis (TB) prevalence is about 2 times higher among tribal males than females, and it increased with age in central parts of India (Madhya Pradesh). [6] Most of the tribes in Andhra Pradesh in practiced traditional Figure 1: Population of schedule tribes in India Table 1: Health indicator in MP, 2007 MP/India MMR/100,000 IMR/1000 Institution delivery (%) MP All India Source: NFHS-3, MP = Madhya Pradesh, MMR = Maternal mortality rate, IMR = Infant mortality rate Table 2: Medical facilities in ST areas in India, 1996 Medical center Total number Number in ST areas Percentage Primary health center 21, Health sub-centers 132,778 20, ICDS projects ( ) Source: Sukai; 3] ST = Scheduled tribe; ICDS = Integrated Child Development Schemes medicines such as herbals and psychological treatments (Varadarajan, [7] et al., 2010). Gupta [8] (Date Not Stated) studied Hemoglobinopathies in form of sickle hemoglobin and b-thalassemia are common in Central India and are important from clinical and disease burden point of view. These disorders are more common in STs and SCs as compared to other endogamous groups of Central India. There is heterogeneity in the distribution of these lethal genes in the area. In the some endogamous groups like Jharia, Mehra in SC group and Pradhan, Panika, Barela, Bhilala in ST group, sickle hemoglobin has high prevalence and b-thalassemia is very low or absent. In some primitive tribes like Saharia, Hill Korba, Kamar, sickle hemoglobin is either absent or with low prevalence but b-thalassemia is common. Kate [9] survey also showed that in every village, there are at least one or two patients suffering from sickle cell disease. Das et al. [10] reported that among tribes the child mortality under five is high, poverty is the main cause of poor health, and tribal children are dying more than other community in India. The above research studies showed the major health problems of the tribal communities are the high 157

3 incidence of maternal mortality and morbidity. Lack of sufficient supply of food, poor environmental condition, and personal hygiene result in high levels of reproductive tract infections. The above studies have been done in the limited areas. The comparative study of factors influencing of ailing and hospitalization in Madhya Pradesh and India is not done so far. Therefore, this study indicates the broader issues of health of tribal population of Madhya Pradesh and India. Objectives To study the factors influencing ailing and hospitalization pattern. To study the disease pattern and use of hospital. Conceptual framework The ailing and hospitalization influenced by various factors. These factors are related to demographic, social, household, and economic. To study these factors, I have developed a conceptual framework. The Figure 2 shows the relationship between factors affecting diseases and hospitalization. The incidence of the diabetes mellitus is high in the urban population in India (Balasubramanian [11] et al., 2007). The Schedule Tribes children 5-9 years age had high TB infection in Andhra Pradesh (Chadha [12] et al., 2007). The poor people are more vulnerable to TB because of living and working condition. I have taken household characteristic to examine whether type of structure, availability of latrine, drainage facility, and source of drinking water and treatment of the water, energy for cooking in the household are influencing hospitalization and how it related to demographic and social factors in terms of the disease pattern and hospitalization. In India, most of the persons are suffering from attacks of amoebiasis, giardiasis, and other infective diarrheas that are attributable to socio economic and environmental conditions such as poor sanitation and contaminated drinking water. The accident and violence, and suicide were interpersonal and family problems and financial difficulties was reported by Manoranjithan et al. [13] To examine the effects of the indoor pollution created by source of energy for cooking on health is the major issue for the household factors which influence ailing and hospitalization. Most of the Indian population are using their everyday household energy needs depend on inefficient and highly polluting solid fuels, particularly biomass, liquefied petroleum gas (LPG), and gobar gas. The consequence of this indoor air pollution is a chief cause of morbidity especially among children and women (Sharma [14] et al., 2004). Data source The survey of the NSSO [15] 60 th round conducted in 2004, related to Morbidity and Health Care. Information related to morbidity, problems of aged persons, utilization of health care services and expenditure on medical treatment, hospitalization, health schemes, nature of ailment, duration of hospitalization, and medical services were collected in the survey. These data provide an opportunity to examine the ailing and hospitalization in Madhya Pradesh and India. The data were collected using schedule number 25.0 during surveys. This schedule contains many blocks. Household factors information provides block-3 and demographic particulars of household members are given in block-4. The particulars of medical treatment received as inpatient of a hospital 365 days before survey is in block-7. These blocks have been merged for the purpose of the study. In this study, variables have selected, ailments for which the patients were hospitalized during the last 365 days preceding the date of survey. Particulars of these ailments and their treatment as inpatients in hospitals during the reference period were collected in block 7 in the questionnaire. Study variable There are two response variables (dependent variables). They are follows: Ailing 15 days before the survey (No = 0 and Yes = 1, recoded). Hospitalization 365 days before the survey (No = 0 and Yes = 1, recoded). Figure 2: A conceptual framework for ailing and hospitalization in India The following predictor variables (independent variables) are considered in the study-demographic factors (age, sex, and residence) social (religion, social group, and marital status) household (type of structure, source of drinking water, water treated, types of latrine, drainage facility, energy for fuel, and others) and economic factors (education, activity status, land holding) health (ailments, ailing, type of hospital). 158

4 Methodology The data have been analyzed with the help of SPSS software 12 and 16 version. NSS data have been exported into SPSS format for the purpose of study. The univariate, bivariate, and binary logistic regression have been analyzed. In logistic regression, the variables were highly correlated, have removed those variables from the analysis. Results and Discussion Results are univariate, bivariate, and binary logistic given following Background information of Tribes The tribes consist of about 8% of total India population, mostly in Madhya Pradesh, Maharashtra, Orissa, Bihar, Andhra Pradesh, West Bengal, and Gujarat (Indian Census, 2001). Figures in Table 3 indicate marital status of people is more or less same in Madhya Pradesh and India. More than half of the tribal population is never married and <6% were widow/divorced and separated, and remaining were currently married. In terms of education level among the STs, Madhya Pradesh shows lower than national level of education. There were numbers of education level in the original data; I have clubbed these levels into three categories for the purpose of study. As expected, more than half (58%) of STs were illiterate, but it is lower than national level (67%). About one-fourth were educated up to primary. At national level, Madhya Pradesh shows better in position in education level. In working status, it is disheartening that more than half of the STs population were not in labor force, and it was higher than national level. There were <3% (2.8) in Madhya Pradesh and <2% (1.8) in India, STs were in the salaried job and about one fifths of them were self-employed and casual worker. The not in labor force categories, student consists of the highest percentage than others. I have clubbed into not labor force those are not working. A vast majority of the STs population belong to Hindu community. The Hindu STs were lower in Madhya Pradesh (88%) than in India (99%). Majority of them possessed land holding were less than one hectare and about one thirds having more than one hectare land holding in Madhya Pradesh and in India. Table 3 further shows that STs in Madhya Pradesh (23%) is in the better position in terms of pucca (cemented) house structures than in national level (15%). In Table 3: Background information of STs of MP and India Characteristics MP India Marital status Never married Currently married Widow/divorced and separated Education level Illiterate Up to primary level Middle and above Working status Self-employed Salaried Casual Seeking Not in labor Religion Hindu Others Land holding ha ha House structure Pucca Others Toilet availability in household Latrine No latrine Drainage in household Open Covered No drainage Source of drinking water Bottled and tap water Tube well and hand pump Others Source of energy for cooking Firewood and chips LPG Others Total (n) 78,378,098 11,675,588 Whether water treated before drinking Type of water treatment Boiling Filter Cloth screen Others Total (n) 20,440,214 2,632,209 Source: NSSO; ST = Scheduled tribe, MP = Madhya Pradesh, LPG = Liquefied petroleum gas others, categories of household consist of kutcha, semikutcha, hut, etc., and majority of them living in other than pucca house. In the Madhya Pradesh, about 13% of the household of tribes have toilet facilities whereas at national level it was <3%, and vast majority of them 159

5 have not toilet in the households. Few of them have covered drainage system in the household. In drainage system, Madhya Pradesh is in the better position as compared to India level. There were 78% and 82% household of tribes have not drainage system in Madhya Pradesh and India, respectively. More than 50% of tribal s households in Madhya Pradesh and India used tube well and hand pump as source of drinking water. Schedule tribes community of Madhya Pradesh is better in position in terms of using safe drinking water such as bottled and tap water, and >19% of household used bottled water, whereas at national level it was only 8%. Almost all the household of tribes were using firewood and chips as source of energy for cooking in both study areas. There were about 5% of household of tribes in Madhya Pradesh is used LPG, whereas it was only 2% at all India level household of tribes. About one fourths of the STs Households treated water before drinking and most of them used cloth screen as type of water treatment and few of them used filter. In Madhya Pradesh, the use of filter (8.5%) is lower than national level use of the same (15%). It is good that STs of Madhya Pradesh used boiling (18%) as type of water treatment which is more reliable and cheap and easy methods, whereas it was <1% at national level. Health-related information about the STs in Madhya Pradesh and India In the survey, information on ailments (illness or injury that is a deviation from the state of physical and mental well-being) has been collected by means of three questions. The respondents were asked whether a household member was ailing 1 day, 15 days, and 365 days prior to the survey. The ailment pattern among the STs can be, therefore, measured in terms of 2 times references; viz., 15 and 365 days before the survey. Data for the time reference of 15 days also includes hospitalization of persons. Details regarding hospitalization are recorded for those household members who were ailing a year before the survey. The results of survey, given in Table 4, show that ailing and hospitalization among the STs population is lower than other social group in Madhya Pradesh and India. At national level, about 9% of the population were ailing 15 days before the surveys, whereas it was in Madhya Pradesh about 6%. Among the STs at national and in Madhya Pradesh, the ailing percentage is lower than other social group, and it was about 6% at national level and in the state Madhya Pradesh There was almost same percentages of STs were ailing 15 days before the survey. In the case of hospitalization, 2.4% of the population of India were hospitalized during 365 days before the survey, whereas it was 2.0% in the Madhya Pradesh And these percentages of hospitalization among STs were 1.5% and 1.2% in India and Madhya Pradesh, respectively. The figures in the Table 4 suggest us that ailing percentages were higher than hospitalization. It also indicates that most of them treated ailments in the household or any traditional methods rather than hospital treatment. In the 21 st century, people were not using hospital for the treatment of ailments. There were many reasons such as high cost of treatment, high rush in the hospitals, not believing in doctors. Data indicate that trend of use of private hospital is increasing, due to above reasons, not only STs, but all sect of the population of India. Disease pattern As mentioned, the survey contains detailed information on hospitalization and we have used these data for analyzing disease pattern among the labor force. A total of 42 ailments is listed in the survey. According to the high prevalence of these diseases, I have sorted out top 10 diseases for the purpose of study. Table 5 shows the disease pattern among the general population and the STs population in India and Madhya Pradesh. The prevalence of diarrhea/dysentery is higher at national level among all Table 4: Ailing and hospitalization Ailing and India MP hospitalization Total STs Total STs Ailing 15 days before the survey Hospitalized during days Total (n) 958,921,633 78,378,097 59,673,936 11,675,587 ST = Scheduled tribe, MP = Madhya Pradesh Table 5: Top diseases in India and MP Diseases India MP Total STs Total STs Diarrhea/dysentery Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/ urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/ throat ail Bronchial asthma Others Total 21,271,225 11,559,368 1,079,260 1,069,

6 the population and the STs population. But, in Madhya Pradesh, the high prevalence of deadly disease malaria among the general as well as STs population. Figure 3 also indicates that among STs population in India and Madhya Pradesh diarrhea/dysentery, Malaria, gynecological disorders, gastritis disease prevalence is higher than other diseases. It is interesting to note that the prevalence of heart disease and bronchial asthma is completely absent among the STs population of the Madhya Pradesh. But, it is disheartening that about 15% of the STs population were suffered from deadly disease of malaria. It is expected because, majority of studies reveals that STs population living condition is more poor and living in the forest areas, and near to open water body, where mosquitoes breeding is high. In India, there are 29 states and 6 union territories (UTs). These states and UTs are clubbed into six regions. The North region includes Jammu and Kashmir, Himachal Pradesh, Punjab, Haryana, Delhi, Rajasthan, and Chandigarh. In the Central region Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chhattisgarh are included. Bihar, Jharkhand, Orissa, and West Bengal form the eastern region while Arunachal Pradesh, Assam Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, and Tripura are in the northeastern region. The Western region contains Goa, Gujarat, Maharashtra, Daman and Diu and Dadra and Nagar Haveli. Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, Lakshadweep, Pondicherry, and Andaman and Nicobar Island in the Southern region. It is very surprising results shown in Figure 4, the persons of the southern parts of India suffered from all type of diseases except malaria disease than other parts of Indian population, whereas malaria and kidney diseases were high prevalence in the western parts of India, followed by eastern region. Figure 3: Disease pattern in India and M.P. among scheduled tribes Figure 4: Disease pattern in India by region Among the STs population of India, the disease pattern was high among the Western, Southern, and eastern region of India, followed by North and Northeast region population. The results in the Figures 5 show that maximum numbers of STs population of western part of India suffered from the bronchial asthma, kidney diseases. The higher number of STs of southern parts of India suffered from heart disease and gynecological disorders followed by neurological disorders. Some of the diseases were not high prevalence among the males, for example gynecological disorders. And variation of disease pattern among the rural and urban, and male and female was found. The results in Table 6 show the disease pattern among the STs by residence and sex. All of the rural males (100%) of the Madhya Figure 5: Disease pattern in India by region among scheduled tribes 161

7 Pradesh suffered from the heart disease, kidney disease, cataract, and respiratory diseases, whereas female were suffered from gynecological disorders and gastritis diseases in the same residence. At national level, these diseases were high prevalence among the male and female in the rural areas. It is surprising results that the heart disease, kidney disease, cataract, and respiratory diseases among STs males and females gynecological disorders and gastritis were absent completely among the urban residents in Madhya Pradesh. The prevalence of bronchial asthma was high among the males in India, but this disease is absent in the Madhya Pradesh in both residences. In the rural residence, malaria is high prevalence among the females (60%), whereas in the urban (34%) residence, it was reverse results in the Madhya Pradesh and India. Rural males were suffered from neurological disorders higher than females, but in the urban areas, females were higher than males in the Madhya Pradesh and India. The results in Table 7, reveals disease pattern among STs in Madhya Pradesh and India by residence and age. Table 6: Disease pattern among STs in MP and India by residence and sex Disease Rural Urban Male Female Male Female MP India MP India MP India MP India Diarrhea/dysentery Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/throat ail Bronchial asthma Total (n) 51, ,759 51, , , ,766 MP = Madhya Pradesh, ST = Scheduled tribe Table 7: Disease pattern among STs in MP and India by age group and residence Disease/age group MP India MP India MP India Diarrhea/dysentery Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/throat ail Bronchial asthma Total rural (n) 25, ,895 66, ,540 11,802 98,826 Diarrhea/dysentery Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/throat ail Bronchial asthma Total urban (n) , , ,483 MP = Madhya Pradesh 162

8 Disease patterns are not the same among all the age group of population in both residences. Diarrhea was more prevalent in the Madhya Pradesh and India among the working age (15-59 years) population of STs in rural residents, but it was high in the Madhya Pradesh than at national level. Among the children (0-14 years), this disease in the rural residence of Madhya Pradesh was lower (<2%) than that of India (36%) in the same age group. All the working age STs population were suffered from gynecological disorders and gastritis. And all old age (60+) STs of Madhya Pradesh were suffered from the heart diseases and followed by neurological (93%) and respiratory diseases (89%). The Madhya Pradesh was not reported bronchial asthma in any age groups, but it was present at all India level among all age group STs population. Urban STs population of Madhya Pradesh was reported only four disease out of top ten diseases. These are malaria (45%), neurological disorders (60%) among children, diarrhea (100%), malaria (55%) prevalence among the working age STs and cataract (100%) and Neurological disorders (40%) among the old age population. Children of STs at national level more suffered from the Bronchial asthma (80%) and old age group also reported same disease (16%). All the STs who were residing in the urban areas those were working age group were suffered from the diarrhea and all the older age people reported cataract in Madhya Pradesh. At national level of STs population of working age group reported high prevalence of gynecological disorders (99%), gastritis (93%), respiratory (91%) and malaria (82%), and diseases of kidney (79%), whereas older age STs reported as expected response of cataract (81%). Disease pattern also varies among the marital status of the population. In the survey, marital status were listed number of categories such as currently married, never married, widow, separated/divorced. I have grouped into two categories, that is, currently married and others. Results in the Table 8 suggest that all the currently married STs in both residences were suffered from gynecological disorders, heart disease, diarrhea, and cataract. Rural residents tribal of the Madhya Pradesh who were currently married, almost all of them suffered from gynecological disorders and heart diseases followed by gastritis (96%) and cataract (89%), whereas urban residents of Madhya Pradesh of same marital status group, all of them were reported diarrhea, cataract, followed by malaria (34%). Currently married STs population at national level were suffered from gynecological disorders in both residence. The STs population who were other than currently married, most of them suffered from the disease of Malaria in the Madhya Pradesh (99%) and in India (61%) in rural areas. There were all the other marital status group of STs population reported neurological disorders in the Madhya Pradesh urban area and in the rural area this disorder have been reported by 73% of them. Majority of the STs of Madhya Pradesh and India were belongs to the Hindu community. The figures in the Table 9 indicate that all the STs in Madhya Pradesh who were living in the rural area were Hindu and all of them have been suffered from all types of the diseases. But, those Hindu who were living in the urban areas all of them were suffered from malaria, neurological disorders, and cataract, but, those were other religious community; all of them reported that they have been suffered from the diarrhea/dysentery. This pattern of disease at all India level is also shown in the Table 9. Use of hospital for the treatment A general belief with regard to hospital usage is that most people prefer to use private hospital, even if the cost of private hospitals tends to be high. Government hospitals are not preferred due to poorer quality of their services, even though this service is provided a low cost. The public hospital is basically good for the majority, Table 8: Disease pattern among STs in MP and India by marital status and residence Disease/marital status Rural Urban Currently married Others Currently married Others MP India MP India MP India MP India Diarrhoea/dysentery Gynaecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/throat ail Bronchial asthma Total rural urban (n) 59, ,482 44, , , ,894 ST = Scheduled tribe, MP = Madhya Pradesh 163

9 Table 9: Disease pattern among STs in MP and India by religion and residence Disease/religion Rural Urban Hindu Others Hindu Others MP India MP India MP India MP India Diarrhea/dysentery Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/urinary system Malaria Neurological disorders Cataract Respiratory including ear/nose/throat ail Bronchial asthma Total rural urban (n) 103, , ,957 10, , ,226 ST = Scheduled tribe, MP = Madhya Pradesh the poorest of poor or low-income household member in society and it is better and cheaper than private hospital. Most of the population in India using private hospital due to many reasons like-better treatment and quick results, whereas in public hospitals there is heavy rush, lack of sufficient doctors, and lack of faith of population in terms of the hospital services, rude behavior of the medical staff, lack of sanitations etc. Private hospital provides proper clinical services and standard of health care. In India, a large proportion of the population is poor and cannot afford the high tech medical treatment of the private hospital. At the time of independence, it is said that 15% of the people used to go to the private sector hospitals, but now the World Bank has found that 80% of the people go to the private sector first and not to the public sector ( worldbank.org). The above statements indicate that private hospital is costlier than public hospital; the poor cannot afford the cost of treatment in the private hospitals. The results of survey also indicated in the Table 10a that STs were used public hospital for the treatment of ailments. Results in Table 10b clearly indicate that most of rural residents STs went for the treatment in the public hospital for all the types of the disease, whereas this was the reverse results for the urban residents in the Madhya Pradesh The treatment of Heart diseases, cataract all the STs of rural residents went to public hospital followed by for the treatment of gynecological disorders and diarrhea. They went to private for the treatment only for gastritis and kidney diseases. But, all the urban residents went to public hospital for the treatment of diarrhea and malaria, and they used private for the treatment of the cataract followed by for the neurological disorders (60%). Table 10a: Utilization of health centre by types Type of hospital India MP Total STs Total STs Public hospital and dispensary Private hospital Total (n) 22,926,102 1,175,322 1,161, ,379 ST = Scheduled tribe, MP = Madhya Pradesh Table 10b: STs uses of hospital for the treatment of disease by residence in MP Disease Type of hospital Public Private Total (n) Diarrhea/dysentery ,331 Gynecological disorders Heart diseases Gastritis/gastric or peptic ulcer Diseases of kidney/ urinary system Malaria ,528 Neurological disorders Cataract Respiratory including ear/nose/throat ail Total rural ,696 Diarrhea/dysentery Malaria Neurological disorders Cataract Total urban ,523 ST = Scheduled tribe, MP = Madhya Pradesh Odds Ratios for ailing and hospitalization by STs in Madhya Pradesh The logistic regression shows the net effect of the independent variables on the dependent variables. In this case, all the two dependent variables namely: Ailing 164

10 15 days before the survey and hospitalization during 365 days have dichotomous ( yes and no ) values and thus binary logistic is model of the choice. The odds ratios of logistic regression are indicated in Table 11. Working age group of males of STs living in rural areas were more likely to be ailing 15 days before the survey than children and females living in the same residence in the Madhya Pradesh. Older age people were less likely to be ailing 15 days before the survey, but they were 18 times more likely to be hospitalized during 365 days before the survey than children. The persons those were age group of years were more likely to be ailing and hospitalized than reference category. Among the marital status category, currently married people were more likely to be ailing and hospitalization than never married people, whereas widow/divorced and separated were less likely to be ailing and hospitalization than never married people. The other than Hindu STs were more likely to be ailing, but less likely to be hospitalized than Hindu STs Communities. The members of household those have covered and no drainage, used tube well and hand pump water for drinking, used LPG for cooking, were less likely to be ailing than those who have open drainage, used bottled and tap water, and used firewood and chips for cooking. The members of household those have no drainage in the household, used tube well and hand pump water for drinking, and used other source of energy for cooking were more likely to be hospitalized during 365 days before the survey. Education increases knowledge and change the positive attitudes toward scientific means. The odds ratios in Table 11 show that middle and above educated person and working as salaried were more likely to be ailing than illiterate and self-employed, but, they were less likely to be hospitalized. The people who were primary educated and not in labor force categories were more likely to be hospitalized than illiterate and selfemployed person among the STs of Madhya Pradesh. The overall conclusion is that all the factors were influences ailing and hospitalization among the STs in Madhya Pradesh. I could not analyzed odds ratio for STs at national due to the multi-collinearity between the dependent and independent variables. Conclusions Notwithstanding progress in recent years, Madhya Pradesh still has among the highest rates of maternal Table 11: Odds ratio for hospitalized and ailing for STs, MP Factor Ailing 15 DbS Hospitalised 365 DbS Exp(b) Significant Exp(b) Significant Demographic factor Residence Rural Urban Sex Male Female Age Social factor Marital status Never married Currently married Widow/divorced and separated Religion Hindu Others Household factor Drainage Open Covered No drainage Drinking water Bottled and tap water Tube well and handpump Others Energy for cooking Firewood and chips LPG Others Economic factor Education level Illiterate Upto primary level Middle and above Activity status Self-employed Salaried Casual Not in labour DbS = Days before survey, ST = Scheduled tribe, MP = Madhya Pradesh, LPG = Liquefied petroleum gas. Reference category and infant mortality of all states in India. Total fertility rate and occurrence of vector-borne and communicable diseases are also much higher than average. Recently 165

11 available national statistics NFHS 3 indicated that Madhya Pradesh had the highest rates of under nourishment in children less than 3 years (60%) in the country (Government of Madhya Pradesh, 2007). ICMR report reveals that the wide spread poverty, illiteracy, malnutrition, absence of safe drinking water and sanitary conditions, poor maternal and child health services, ineffective coverage of national health and nutritional services, etc., have been found, as possible contributing factors of dismal health condition prevailing among the primitive tribal communities of the country. Among the STs at national level and in Madhya Pradesh, the ailing percentage is lower than other social group, and it was about 6% at national level and in the state Madhya Pradesh. There was almost same percentages of STs were ailing 15 days before the survey. In the case of hospitalization, 2.4% of the population of India were hospitalized during 365 days before the survey, whereas it was 2.0% in the Madhya Pradesh. And these percentages of hospitalization among STs were 1.5% and 1.2% in India and Madhya Pradesh. respectively. Among STs population in India and Madhya Pradesh. diarrhea/dysentery, Malaria, gynecological disorders, gastritis disease prevalence is higher than other diseases. It is interesting to note that the prevalence of heart disease and bronchial asthma is completely absent among the STs population of the Madhya Pradesh. But, it is disheartening that at present about 15% of the STs population were suffered from deadly disease of malaria. It is expected because, majority of studies reveals that STs population living condition is more poor and living in the forest areas, and near to open water body, where mosquitoes breeding is high. The STs were used public hospital for the treatment of ailments. Working age group of males of STs living in rural areas were more likely to be ailing 15 days before the survey than children and females living in the same residence in the Madhya Pradesh. Among the marital status category, currently married people were more likely to be ailing and hospitalization than never married people, whereas widow/divorced and separated were less likely to be ailing and hospitalization than never married people. The other than Hindu STs were more likely to be ailing, but, less likely to be hospitalized than Hindu STs Communities. The members of household those have covered and no drainage, used tube well and hand pump water for drinking, used LPG for cooking, were less likely to be ailing than those who have open drainage, used bottled and tap water, and used firewood and chips for cooking. The educated person and working as salaried were more likely to be ailing than illiterate and self-employed, but, they were less likely to be hospitalized. References 1. 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Available from: centre%27s_publications/nsth_06/nsth06_ 15.RB.Gupta.pdf. [Last accessed on 2010 Nov 23]. 9. Kate SL. Health Problems of Tribal Population Groups from the State of Maharashtra Available from: edu/india_scd.html. [Last accessed on 2010 Nov 23]. 10. Das MB, Kapoor S, Nikitin D. A Closer Look at Child Mortality among Adivasis in India. Policy Research Working Paper Available from: Adivasi_ChildMortality2010.pdf. [Last accessed on 2010 Nov 17]. 11. Balasubramanian R, Ramanathan U, Thyagarajan K, Ramachandran R, Rajaram K, Bhaskar D, et al. Evaluation of an intermittent six-month regimen in new pulmonary tuberculosis patients with diabetes mellitus. Indian J Tuberc 2007;54: Chadha VK, Kumar P, Satyanarayana AV, Chauhan LS, Gupta J, Singh S, et al. Annual risk of tuberculous infection in Andhra Pradesh, India. Indian J Tuberc 2007;54: Manoranjitham S, Charles H, Saravanan B, Jayakaran R, Abraham S, Jacob KS. Perceptions about suicide: A qualitative study from southern India. Natl Med J India 2007;20: Sharma RC, Joshi V, Dixit AK, Yadav S, Fotedar R, Anand K, et al. Assessment of Impact of Environmental Pollution on Human Health in the City of Jodhur, Rajsthan Available from: in/annual/ /dmrc/ar45_4e.pdf. [Last accessed on 2010 Nov 23]. 15. National Sample Survey Organization. Morbidity, Health Care and the Condition of the Aged. 60 th Round (Jan-June 2004). New Delhi: National Sample Survey Organization; Cite this article as: Prasad S. Ailing and treatment seeking behavior of schedule tribes of Madhya Pradesh, India. Ann Trop Med Public Health 2014;7: Source of support: Nil, Conflicts of Interest: None declared. 166

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