Treatment for Illness
Usually tribal people do not always get their ailments medically treated and checked and sometimes resort to self-medication and home remedies or do not take any medical care. Studies conducted on health seeking behaviour do support this view. A study conducted on women’s health-seeking behavior by Prasad et al (1999)(- cited in Oommen 2000) highlighted that two-thirds of the women who reported gynecological symptoms did not seek any treatment. Another study conducted in the rural areas of Rajasthan
supported this view because of the people who reported illness, 54 percent did not seek treatment (Oomman, 2000). The NSS 60th round data on medical treatment for different illness gives a different picture. Data provided in Table-7 indicate that over 80 percent of the people who reported sickness had taken medical treatment. This was true in case of most of the background variables and also for different diseases. However, when we look at the data by type of treatment it shows that a majority of the people have taken treatment from private health care facilities. This may be mainly because in tribal areas several nongovernmental organizations are working. Secondly, government health programmes, have created awareness about usefulness of allopathic medicines among tribals.
Table -7 : Percentage Distribution of Non-Hospitalized Illness by Source of Treatment and Background Variables
|Background Variables||Treatment Taken||Source of Treatment|
|Less than 1 hectare||81.7||18.3||27.7||72.3|
|1 -4 hectares||78.8||21.2||27.4||72.6|
|Above 5 hectares||82.9||17.1||6.6||93.4|
|Widowed / divorced / separated||68.2||31.8||27.2||72.8|
There are a few studies conducted in India regarding the type of health care facilities used during their sickness (NCAER 1992; Duggal and Amon !989). These studies show that people relied more on private sector both in urban and rural areas. About 55 percent of the cases were treated by private practitioners while the 38 to 39 percent of the cases, the households depended on the services of Government facilities. The reason for less number of people using government health facilities were mainly because of the distance of health care facilities and quality of services available at the government health facility (Mutharayappa 2005).
Cost of Treatment
The National Sample Survey 60th round also collected data on expenditure incurred for medical treatment for each hospitalisation and also for non-hospitalisation during the reference period. In addition, other expenses also were recorded separately along with medical expenses. Medical expenses included expenditure on medicines, bandages, plaster etc. fee paid for medical and paramedical services, charges for diagnostic test, charges for operations therapy, ambulance, cost of oxygen and blood, etc. The other expenses comprised all expenses relating to the treatment of ailments incurred by an ailing member of the household other than the medical expenditure. This category of expenditure included transport charges, lodging charges, attendant charges and personal medical appliances purchased during the reference period. Data given in Table 8 show the medical expenditure and non-medical expenditure incurred for non hospitalisation treatment during the reference period. The table provides separate estimates for male and female patients in rural and urban areas and by background variables. It is clear from the data that on an average a higher amount was spent for non-hospitalisation treatment of an ailing person in the urban areas than in the rural areas. And, comparatively higher amount was spent for males than for females.
Table 8: Cost of Treatment for Illness by Background Variables (in Rs.)
|Cost of Non-hospitalised
Treatment (15 Days)
|Less than 1 hectare||398.96||59.56||458.52|
|Above 5 hectares||407.80||63.01||470.81|
There were some problems in recording the ccost of illness. For instance, the doctor’s fee was not always mentioned by the respondents separately because sometimes doctors also dispensed medicines. For the patients, the payments to the doctor could not be differentiated in a large number of cases. Only in cases where doctors did not dispense medicines and charged only consultation fees, it had been recorded separately. For the rest, fees and medicines were combined. Also, purchase of medicines from a pharmacy shop had been included in the cost of illness. Another problem in recording health care cost was that respondents never considered other subsidiary cost as health expenditure. For instance, expenditure on rituals for an illness was never perceived by the respondents as cost incurred for treatment of an ailment. It was very difficult to elicit costs of rituals, bribes, diet, temple offerings and domiciliary “poojas”, “langars” (community kitchen) carried out for the sole purpose of alleviating the suffering of a sick person. Unless specifically asked for those, information on these costs were unreported.
Studies conducted on cost of treatment had indicated that the per capita health expenditure increased as class status (income) moved up. The NCAER (1992) study reveals that household expenditure per illness episode was Rs.123 and Rs.139 for the low income classes in urban and rural areas respectively. Against this, expenditure incurred by the high income class was Rs.226 in urban areas and Rs.195 in rural areas. NCAER (1992), while providing data for household expenditure per illness episode for non-hospitalised illnesses for the year 1992, also highlighted the rural-urban and income differentials. Doctor’s fees and also cost of medicines constituted the major item of expenditure in both rural and urban areas. However, transport was an important item of expenditure in rural areas. A study conducted in Jalgaon district of Maharashtra on health expenditure estimated that per capita out of pocket expenditure on health was about Rs.175 which constituted 7-8 percent of the household’s consumption expenditure (Duggal and Amin, 1989).
Factors Affecting Morbidity – A Discussion
Morbidity is the result of either complications due to lifestyle behaviours or occupational hazards or infections due to environmental impact. WHO has categorized health problems such as tuberculosis, heart complications, hypertensive disorders, anemia, hepatitis, high blood pressure and diabetes mellitus as chronic morbidity (WHO 2001). The major cause of tuberculosis and heart disease is the lifestyle of persons, viz. smoking and consumption of alcohol. A study conducted on tuberculosis patients in rural Aligarh indicated that tuberculosis among smokers was 33 per 1,000 population and for non-smokers it was 7 per 1,000 population (Khan 2006). Similarly, studies conducted on alcohol related morbidity examined the impact of alcohol consumption on coronary heart disease and other diseases and indicated that 40 ml of pure alcohol consumption every day lead to diabetes mellitus, Ischemic stroke, liver cancer, malignant neoplasms and neuro-psychiatric conditions (Murry et al. 2000: WHO 2001).
Anemia is mentioned to be the major cause of maternal morbidity and aggravating complications of pregnancy, such as eclampsia, ante-partum hemorrhage (Jejeebhoy 2000). Germs from unwashed hands or unsterilezed instruments entering the genital tract during delivery cause sepsis. Some of the community-based studies indicate that as high as 90 percent of the pregnant women planned to deliver at home with the help of a dai, family member or ANM. Mutharayappa and Prabhuswamy (2003) have opined that most of the deliveries conducted at home under unhygienic conditions caused sepsis to women. A study conducted on causes of death reported that sepsis accounted for 13 percent of maternal deaths in India (Government of India 1993).
Occupational hazards are mentioned to be responsible for increasing morbidity conditions. A study conducted on welders of unorganized sectors in Baroda city observed that smoke and fumes were common among welders which lead to physical hazards and respiratory problems. Out of the 126 welders studied, 44 percent were suffering from respiratory disease (Vimesh and Majumdar 2004). Asthma was a chronic respiratory disease that affected the functioning of lungs. Asthma was often mistaken for tuberculosis due to the similarity of symptoms. The number of persons who had asthma was estimated to be over 1,600 per 100,000 among both women and men in India (IIPS and Marco International 2007). Although there was a strong reason to believe that air pollution played an important role in causing asthma, it was difficult to document evidence suggesting that this was the primary reason. The prevalence of asthma among traffic police personnel in Bangalore was 26 percent compared to 14 percent among non-traffic police personnel, indicating 85 percent higher risk of developing asthma among them (Paramesh 2001). It has been reported in a number of surveys as well as in clinical studies that smoking was associated with airway hyper-responsiveness. The association was stronger among the elderly or associated with those having longer life-time exposure to cigarettes (Murthy and Sastry 2005).
Diabetes is a chronic and non-infectious disease. Studies conducted on diabetes mellitus have shown that Indians have a greater risk for developing type 2 diabetes and related metabolic abnormalities in comparison to other ethnic groups in the world (Mohan Sandeep et al 1986: Mohan Sandeep et al 2007). This was because firstly Indians had lower prevalence of obesity as defined by body mass index (BMI). Therefore, Indians tended to have greater waist circumference and waist to ratios, thus, had a greater degree of central obesity (Mohan Sandeep et al 2007). Secondly, Indians had more abdominal and visceral fat for any given body mass index (Raji et al 2001 cited in Mohan et al 2007) and for any given body fat they have higher insulin resistance (Chandalia et al 1999 cited in Mohan et al, 2007). Moreover, they had lower levels of protective tissue and greater levels of adipose tissue metabolites (Mohan et al 2007). Studies on neonates suggested that Indian babies were born smaller but relatively fatter as compared to Caucasian babies and were referred to as the “thin fat Indian baby” (Mohan etal 2007). A recent study confirms this finding and says that the “thin fat phenotype” in neonates persisted in childhood and could be a forerunner of the diabetogenic adult phenotype disease (Krishnaveni et al 2005). These findings suggest that Indians were more prone to diabetes and related metabolic abnormalities. Genetic factors that determine body fat distribution and glucose metabolism have to be fully elucidated for better understanding of the biochemical and molecular mechanisms behind the aetiopathogenesis of diabetes (Mohan et al 2007). Epidemiological studies conducted on diabetic patients indicate that macro-vascular and micro-vascular complications caused significant morbidity and mortality among people. A study conducted in Chennai urban area shows that the prevalence of coronary artery disease was 21 percent among diabetic patients in comparison to 9 percent among other patients having normal glucose tolerance (Mohan etal2001 cited in Mohan etal2007).
This study has shown that female morbidity was higher than male morbidity among tribes in Karnataka. One possible suggestion that could be made here is that better outreach services through paramedics, are needed for making a special effort to cover women’s health. As the age advances the rate of morbidity reduces and in old age the morbidity increases. The age-wise morbidity pattern both in rural and urban areas was somewhat less similar with the 60 years and above age group people having the highest prevalence rate, followed by the 0-14 year age group. Class differentials show that affluent classes had significantly a higher morbidity than the poor both in rural and urban areas.
Various types of diseases suffered by the individual members were non-infectious diseases such as cardiovascular disease, diabetes, joints and bone disorder, respiratory ailments, neurological disorder and cancer. These diseases accounted for about 50 percent of the hospitalized illness reported by the respondents. Over three-fourth of the respondents who were sick reported that they had taken medical treatment from the private health care.
As expected, the average household expenditure for non-hospitalization was higher among urban households than among the rural households. This is perhaps because in urban areas access to health care facilities is better and hence, the households belonging to higher income groups spent much more than their rural counterparts on medical treatment for illness. In terms of differentials in the expenditure for hospitalization the difference is higher in the case of literates, people living in pucca houses and land owning households.
Albala, C. (1995), “Epidemiological Transition in Latin America, the case of Chile”, Public Health, 9 (6).
Caldwell, J.C. (1990), “Introductory Thoughts on Health Transition”, in Caldwell, et.al, (eds), What We Know about Health Transition; Cultural, Social and Dehaviourial Determinants of Health,, Canberra, Australian National University, 1993, pp.25.
Chandalia, M. and Abate N, Garg (1999), “A Relationship between Generalized and Upper Body Obesity to Insulin Resistance in Asian Indian Men”, Journal of Clinical Endocrinol Meta-bolics, 84
Crews, D.E. (1987), “Multiple Causes of Death and the Epidemiological Transition in American Samoa”, Florida, Centre for the Study of Population, Florida State University.
Duggal, Ravi and Suchetha, Amin (1989), “Cost of Health Care; A Household Survey in an Indian District”, Bombay, The Foundation for Research in Community Health.
Duraisamy, P. (2001), “Health Status and Curative Health Care in Rural India”, Working Paper Series No. 78, New Delhi, National Council of Applied Economic Research (NCAER). Government of India (1993), “Survey of Causes of Death”, Annual Report, Series 3, No.26, New Delhi. Office of the Registrar General.
Government of India (2005), “Report of the National Commission on Macroeconomic Health (Burden of Disease in India)”, New Delhi, Ministry of Health and Family Welfare. International Institute for Population Sciences (UPS) and ORC Macro, (2001), National Family Health Survey (NFHS-2) 1998-99 Karnataka, Mumbai.
International Institute for Population Sciences (UPS) and Macro International. (2007). National Family Health Survey (NFHS-3), 2005-06, India, Volume I. Mumbai, UPS Jejeebhoy, S. (2000), “Safe Motherhood in India: Priorities for Social Science Research”, In Women’s Reproductive Health in India, Radhika Ramasubban and Shireen J Jejeebhoy (eds), New Delhi, Rawat publications.
Khan, Q.H. (2006), “Epidemiology of Pulmonary Tuberculosis in Rural Aligarh”, Indian Journal of Community Medicine, 31(1).
Krishnaveni, G.V., J.C. Hill, S.R. Veena, S.D. Leary, J. Saperia, and K.J. Chachyamma (2005), “Truncal Adiposity is Present at Birth and in Early Childhood in South Indian Children”, Indian Pediatrics, Vol.42.
McNamara, R. (1982), “Demographic Transition Theory” In J A Rose (ed), International
Encyclopaedia of Population, Vol.1, Free Press. Mercer, A. (1990), “Disease, Mortality and Population in Transition; Epidemiological- Demographic Change in England Since the Eighteenth Century as Part of a Global Phenomenon”, Leicester, England, Leicester University Press.
Mohan V. Sharp P.S. Cloke H.R. Burrin J.M. Schumer B. and Kohner E.M. (1986), “Serum Immunoreactive Insulin Responses to a Glucose Load in Asian Indian and European Type 2 (Noninsulin-Dependent) Diabetic Patients and Control Subjects” Diabetologia, 29.
Mohan, S. Sandeep, R. Deepa, B. Shah and C. Varghese (2007), “Epidemiology of type 2 diabetes: Indian scenario” Indian Journal of Medical research, 125 (3), March.
Murray, C.L. and Lopez, A. (1996), The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020″, Volume 1. World Health Organisation, Geneva
Murthy K.J.R. and J.G. Sastry, (2005), “Economic Burden of Asthma”, National Commission Macroeconomic Health (Burden of Disease in India), Ministry of Health Ministry of Health and Family Welfare, Government of India, New Delhi, September.
Mutharayappa, R. and P. Prabhuswamy, (2003), “Factors and Consequences of Home Deliveries; A Study in Rural Karnataka”, Journal of Health Management, No.5, 1,
Mutharayappa, R. (2005), “A Study of Maternal Health Services in Three Districts of Karnataka”, Journal of Indian Anthropological Society, Vol. 40, No. 1.
National Council of Applied Economic Research (NCAER), (1992), Household Survey of Medical Care, New Delhi, NCAER.
Omran, A.R. and J.A. Ross, (eds) (1982), “Epidemiological Transition Theory”, in International Encyclopaedia of Population, Free Press, New York.
Panikar, P.G.K. (1984), “Fertility Decline in Kerala; Social Justice Hypothesis”, Economic and Political Weekly, 19 (13).
Panikar, P.G.K. (1999), “Health Transition in Kerala”, Discussion Paper No. 10, Kerala Research Programme on Local Level Development, Thiruvananthapuram, Centre for Development Studies.
Paramesh, H. (2001), Air pollution and Child Health, Academy Today, January.
Prata, P.R. (1992), “The Epidemiological Transition in Brazil”, Cadernos De Sande Republica, 8(2).
Reis, C.S. (1978), “Demographic and Epidemiological transition in Africa”, Tropical Doctor, 8(4).
Shariff, Abusale (1995), ‘Health Transition in India’, Working Paper No.57, New Delhi,
National Council of Applied Economic Research. Sunder, Rama-mani and Abhilasha, Sharma(2002), “Morbidity and Utilisation of Health Services; A Survey Urban Poor in Delhi and Chennai”, Economic and Political Weekly, November 23.
Vimesh Jani and V.S. Majumdar, (2004), “Prevalence of Respiratory Morbidity Among
Welders in Unorganized Sector of Baroda City”, Indian Journal of Occupational and Environmental Medicine, 8 (1), January-April.
World Health Organization (WHO), (2001), International Classification of Functioning, Disability and Health. Geneva: WHO.