Health Seeking Behaviour of People in a Malaria Endemic Village of Odisha, India: An In-Depth Study

Despite the existing intensive efforts to improve rural based health care structure (infrastructure and man-power), the proportion of malaria morbidity and mortality remains high in rural Odisha, India. The incidence of malaria may vary substantially between hamlets in villages and within an individual community, even in malaria endemic area. The present study was conducted to analyze the factors responsible for local variations in the incidence of malaria in order to identify the potential control measures. Factors shown to be associated with local protection against malaria includes house construction materials, house design, and activities inside or outside adjacent living room. The present study was designed to assess the personal protection measures which are needed to see if new malaria control tools can be identified not only for individual characteristics, but also community-level factors that determine people's decision to opt for treatment at home or at available health facilities in the locality. INTRODUCTION Despite the considerable increase in funds under National Vector Borne Disease Control Programme (NVBDCP) to control malaria, the disease has been frequently reported and is the main cause of morbidity and mortality in the state of Odisha in India (WHO). Current malaria control interventions in Odisha include early diagnosis and prompt treatment with effective anti-malarial drugs, preventive measures such as the use of insecticide-treated nets (ITNs) and indoor residual spraying (IRS), and malaria epidemic preventive measures such as distribution of ITNs and spray of DDT. However, these interventions have not been effectively utilized by the target groups in rural areas in Odisha. The coverage and proper utilization of most promising malaria preventive measure, ITNs, in the rural areas is also limited by lack of sustainable distribution and issues related to replacement of free nets, seasonality of malaria, and poor knowledge of the community with regard to the link between mosquitoes and malaria (Kassie et *Address for Communication: Regional Medical Research Centre (RMRC) , lCMR, Chandrasekharpur, Bhubaneswar, Odisha. The Oriental Anthropologist, Vol. 18, No. 2, 2018, Pages 341-360 © OICSR, Allahabad Corresponding Author E-mail : mahendra74iips@gmail.com 342 Mahendra Panda, Amarendra Mahapatra and K. C. Satapathy al., 2014). Several studies have demonstrated compliance to malaria treatment and prevention strategies depends substantially on social, behavioural and cultural factors that affect understanding of the causes, the relationship between mosquitoes and the disease, diagnosis, treatment and practices about prevention by people in the locality (Kengeya-Kayondo et al., 1994; Tanner and Vlassoff, 1998). In addition, factors such as vulnerability, economic constraints, inadequacy or unavailability of appropriate health services, and other related factors play an important role in explaining health seeking behaviour of the people (Ahorlu and Dunyo, 1997). Studies in the past were mainly carried out in areas of stable malaria transmission due to the overwhelming burden of the disease, however, there has been an increased need to understand perception and practices of the community about the disease, particularly health and treatment seeking behaviours in areas of seasonal transmission frequently exposed to malaria epidemics (Espino, 1997; Ahorlu and Nuwaha, 2004). It has been acknowledged that the success of malaria control in an endemic village depends on the understanding of the local socio-cultural factors affecting people's perceptions of causes and modes of transmission of the disease, health seeking behaviour and practices of malaria prevention measures. Therefore, understanding the local perceptions and practices of villagers is of utmost relevance to enhance community's potential to deal with village-based malaria interventions. This particular study was carried out in a rural community to examine people's perceptions and practices related to malaria transmission, symptoms/ recognition, treatment, prevention, and treatment seeking behaviour in an area of seasonal malaria transmission. The purpose of this study was to generate information that might support to design suitable malaria control program and implement appropriate interventions to control malaria in a better way. METHODOLOGY Study setting and population The study was conducted in October-November 2002 and 2003 and again 2016-2017 in Chabripalli Village in Bolangir District in Odisha. The people are predominantly agricultural labour/farmers belonging to the scheduled tribe: Binjhal/Binjhal an ethnic group. Malaria transmission in the district is seasonal and epidemic type, peaking from September to December. Severe malaria epidemics occurred in the area in 2000, 2001. Sample size estimation and sampling methods In the village a total 167 villagers including mothers/ caretakers of children under five years of age were interviewed by house-to-house visits. For the qualitative research, the participants of the focus group discussions (FGDs) and in-depth interviews were The Oriental Anthropologist Health Seeking Behaviour of People in a Malaria Endemic Village of Odisha, India :An In-Depth Study 343 purposively selected through discussions with Community Leaders (Gate-Keeper) and informants (Key Informants) in the village. Data collection A structured questionnaire was designed in English, translated into the local language (i.e., Odia). Information on the socio-demographic characteristics of all the villagers including pregnant and lactating mothers in the village and their knowledge, perceptions and practices related to malaria transmission, symptoms, treatment and preventive methods were collected. In addition, history of malaria morbidity during the previous three months and related practices of treatment seeking behaviour were collected through qualitative research technique. The qualitative data were used to supplement, cross check and further explore the quantitative findings. Data analysis The quantitative data were entered to SPSS version 20 statistical software package (SPSS, Chicago, IBM, USA) for analysis. Descriptive statistics such as frequencies are used for the analysis of the quantitative data. The FGDs and in-depth interviews from the different groups were transcribed and analyzed manually along the major themes of the study. Verbatim transcriptions of FGDs and in-depth interviews, translated into English. The findings from the individual interviews and FGDs were presented in an integrated manner. Where appropriate, quotes that best explained the perceptions and practices of the mothers about malaria were identified and used in parallel with the quantitative findings to elaborate more on the insights of the perceptions and practices of the community. Ethical considerations This study was reviewed and approved by the Ethical Clearance Committee of the RMRC (ICMR), Bhubaneswar. Verbal consent was obtained from all respondents who participated in the study after explaining the purpose and objectives of the study in the local language. The respondents were informed about their right either not to participate, not to answer any question or all of the questions. RESULTS Background characteristics of the respondents Table 1 summarizes the demographic and socio-cultural characteristics of the study population. It was found that almost half (49.1 %) of Household head (HH) were male followed by 29.9% women and rest were adult members from whom information had been collected. Majority of villagers (79.6%) belongs to Tribe Binjhal. It was seen that The Oriental Anthropologist 344 Mahendra Panda, Amarendra Mahapatra and K. C. Satapathy people have taken less interest on education of their children (44.3%) though there is a Lower Primary School available in the Village. Majority of people (50.9%) engaged in agricultural work and daily labour work (35.3%). The average number of persons per household was ranging from 2 to 6 in the village. The dwelling houses were Huts (41.9%), made out of Un-Burnt Bricks, Mud & Poles, thatch/straw (Khapara) (47.3%), Timber, Stone, mud and bamboo poles, Straw (35.3%). Most (87.4%) of the study households did not have a toilet facility at the time of the study. Firewood (49.1%), Cow dung/Straw (31.7%) is the main type of fuel used for cooking. The main source of drinking water included Tube well (56.3%), open well (31.7%) and other sources (5.4%). The quality of water of Tube-Well is not good as described by majority women in the village. Firewood and water fetching work in this Community is exclusively done by the women and adolescent girls. Majority of HH reported in the village (65.9%) that they do not possess any electrical/ electronic equipment. There is a trend of migration among villagers as 51.5% respondents reported their family members working outside as migration labour in Brick Klein in different parts of the country. Domestic bird namely "Country Chicken" are being reared and accommodated inside the living room by constructing a separate shed (25.7%) or keeping temporary basket (21.0%) inside the living room as reported by respondent in the village. The reason for keeping chicken shed inside the living room was reported as safety of Chicken (8.4 %) and non availability of space (16.8 %) and majority mentioned that it is their habit pattern (40.7 %). Similarly 19.2% respondent used front side living room as Cow-shed in the village. This peculiar form of living pattern is in existence since time immemorial in the village as reported by Villagers in the Key informants during interview and also in Focus Group Discussion. "Majority of Households in our Village have constructed either Bhaddi (kuchha stair) or Kukkuda ghar (Chicken Shelter) or Baunsa dolli (Chicken basket) inside the living room for keeping Chicken. We prefer Country Chicken (Dessi Kukuda as they are sacred and useful for