ROBERT L. PARKER, S. MOIN SHAH, C. ALEX ALEXANDER and. ALFRED K. NEUMANN
S E L F - C A R E IN R U R A L A R E A S O F I N D I A A N D N E P A L *
ABSTRACT. Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar,better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.
In most societies self-medication or treatment in the home by family members and friends is a c o m m o n occurrence during illnesses and pregnancies. This self or family care may range from minimal adjustments in: diet or activities to the use of modern drugs such as antibiotics. So integral are most of these practices to the patterns of everyday living that they are often ignored in discussions and studies of health care systems. In recent years, however, there has been a surge of interest in self-care as an alternative or supplement to the formal health care system (Levin, Katz, and Hoist 1 9 7 6 : 1 9 - 2 9 ) . Although historically treatment in the home has probably always existed as the one source of health care consistently available to individuals, it is gaining popular exposure now in developed countries as one answer to the increasingly complex health care system which frequently fosters dependence on the providers of services. A recent Louis Harris poll taken in the U.S. indicated that people found "enormously appealing" the possibility of reducing hospital and doctor care by taking better care of themselves and being rewarded with lower health insurance premiums (Knudson 1978 :A-8). In planning primary health care services for less developed countries, self-care is being proposed as a potent resource that should be considered along
Culture, Medicine and Psychiatry 3 (1979) 3-28. 0165-005X/79/0031-0003502.60. Copyright © 1979 by D. Reidel Publishing Co., Dordrecht, Holland, and Boston, U.S.A.
4
ROBERT L. PARKER ET AL.
with other approaches for improving health and primary health care coverage (Kleinman 1978a). One model of the health care process visualizes delegating as many as possible of the various functions and tasks of health services from highly trained professionals who now perform them to health workers with less training, or to sick individuals and their families (Department of International Health 1976:9-19). This looks at the process from the provider's or planner's perspective and explicitly calls for decisions as to where in the spectrum of self-care to specialty care a given activity should occur based on considerations of efficiency and effectiveness. From the viewpoint of the villagers, however, effective self-care may offer increased control over their own lives and reduction in the feelings of helplessness or fatalism, both of which support the important attitudes of self-reliance and community level cooperation so important for true development. These,arguments are attractive and call for serious consideration of the possible approaches that might be taken to encourage appropriate self-care. For those interested in pursuing the possibilities of self-care, one of the first problems encountered is the lack of a consistent definition of what is meant by 'self-care'. Levin has proposed a broad working definition which states that self-care is a "process whereby a lay person functions on his/her own behalf in health promotion and prevention and in disease detection and treatment at the level of the primary health resource in the health care system" (Levin, Katz, and Holst 1976:10). It is clear that as research and development projects begin to multiply in the area of self-care, very specific definitions will be required that will assist in delineating the various dimensions of who provides the care (individuals, families, friends, community); what is done (change in activity, diet, life style; use of herbs, patent medicines, prescription medicines); whether the care involves health promotion, prevention, or cure; and when it is used in the disease process or care sequence. At present, however, very little is even known about the actual frequency of use of self-care, let alone the more detailed dimensions of self-care suggested above. This is particularly true for less developed countries, but it is also a glaring gap in the health services research literature of developed nations. Assumptions have been made that ill individuals probably treat themselves if they do not seek care from health practitioners or some health care facility. Thus, by using studies such as those by White et al. (1961) and Hulka et al. (1972), the exclusive use of self-care during episodes of illness can be inferred to be as high as 67 to 75 percent in the United Kingdom and the United States. Similar conclusions could be reached for India and Nepal where utilization of various private practitioners or government services by sick persons was found to be between 25 to 40 percent (Department of International Health 1976:71- 72; Directorate of Health and Family Planning 1973:5-6; and Tribhuvan University 1977:35-38), thus'leaving the balance to self-care. Relatively few studies were found which reported attempts to measure self-care
SELF-CARE IN RURAL AREAS OF INDIA AND NEPAL
5
activities directly. Estimates have been made by Levitt in England that as many as 75 percent of symptoms are treated by patients themselves without seeing a doctor (1976:95). A survey carded out for the Federal Drug Administration in the U.S. by National Analysts, Inc. (1972) found that individuals who had ever used self-medication for common ailments such as colds and upset stomachs were as high as 56 percent of the total sampled population. In addition, approximately 12 percent of these self-care medicators reported having continued self-care over two weeks without seeking professional help. Current or continuous use of medications such as vitamins and tonics or laxatives was reported by 15 to 26 percent of the respondents. In a study of a rural county in Florida, Murphee and Barrow reported that over 31 percent of the respondents claimed they used patent medicines daily, while 11 percent stated they still used folk remedies, although infrequently (1970). An international comparative study of health care in six developed countries reported by Kohn and White (1976:233) ascertained the use of nonprescribed medicines over a two-day period. Exclusive use of these medicines ranged from a low of 8 percent of the surveyed population in Yugoslavia to over 25 percent in North America and England. Combined use of nonprescribed and prescribed medicines involved an additional 2 to 10 percent of the population. Another study in England by Dunnell and Cartwright (1972:13-18) reported that 55 percent of individuals over 21 years of age had taken some medication during a 24-hour period and 80 percent had taken medications during a two-week period. Over the two weeks about 67 percent of individuals took nonprescribed medicines. Taking of medicines was somewhat less in children, with 55 percent receiving any medication and 48 percent receiving nonprescribed medicines during the twoweek period. Nichter has reported a study he carried out in South India in which he estimated that during a one-week period 10-12 percent of villagers took home remedies or ready-made medicines, maintained special diets, or performed special rituals at home for one or more ailments (1978). In addition, he found that over 45 percent of a group of villagers who consulted a practitioner for an acute illness during the same one-week period had used home remedies or special diets before the consultation. Preference for initial use~of self-care was shown to vary according to specific symptoms or recognized disease entities. An in-depth study of 115 families in Taiwan by Kleinman (1978b) revealed that 93 percent of all illness episodes during one month were first treated within the family setting. However, 73 percent of all ill individuals continued to use only self or family care. Kleinman's def'mition of self care included diets, special foods, first aid materials, exercise, massage, and medications. Looking specifically at non-prescription or patent medicines he found that 83 percent of illness episodes during one month involved the use of such items. Athough primarily limited to two culturally traditional urban districts in
6
ROBERT L. PARKER ET AL.
Taipei, Kleinman's study has been able to characterize home care used by individuals and fafiailies in considerable detail including variations related to age, sex, social class, illness involved, type of care, and the hierarchy of resort to other types of care. Because of the differences in the types of self-care measured, the recall period involved and the questions that were asked, it is difficult to know whether the differences noted in the studies summarized above reflect actual variations in patterns of self-care. Certainly the variations within the international comparative study which was carried out in a similar fashion in each country indicate that use of nonprescription medications can vary as much as three-fold between different health care or cultural settings. Additional well standardized studies are needed in order to better understand the complex activities that are grouped under the topic of self-care and how these activities are related to the multiple factors specific to a given area including the availability of alternate health care resources. This paper reports on a unique group of surveys carried out in India and Nepal that collected data on self-care as part of an overall assessment of health problems and the use of health care services in rural communities. Although not specifically designed to study the phenomenon of self-care in depth they present an opportunity to examine more carefully than previously possible certain quantitative aspects of self-care and home treatment in rural areas of two developing countries. DATA SOURCES AND METHODS Published and unpublished data from four separate but inter-related studies carded out in India and Nepal between 1966 and 1977 form the basis of the findings in this paper. The Functional Analysis Project (FAP) of the Department of International Health, The Johns Hopkins University, School of Hygiene and Public Health, was the first of the studies in this group (Department of International Health, 1976; and Department of International Health, 1967). Data from this project include surveys during a feasibility study period in Punjab (North India) and Kerala (South India) in 1966-1967, and surveys during the definitive study period of 1968-1969 in Punjab and Karnataka (previously the South Indian state of Mysore). In 1972 the second study in this series was carried out by the Punjab Directorate of Health and Family Planning in another area of Punjab (FAPHS) with the assistance of staff members from the previous Functional Analysis Project (Directorate of Health and Family Planning 1973). In 1973-1974 similar survey methods were again used in two projects in Punjab (FANS) (Department of International Health 1975; and Kielmann, Taylor, and Parker 1978). The latter were prospective field studies by the Department of
SELF-CARE IN RURAL AREAS OF INDIA AND NEPAL
7
International Health in collaboration with the Indian Council of Medical Research measuring the impact of health services, nutrition supplementation and family planning services on the health and health care patterns in villages. Finally, data from one published (Tribhuvan University 1977) and two as yet unpublished surveys that were part of studies carried out in three districts in Nepal by the Institute of Medicine of Tribhuvan University in 1976-1977 provide the fourth set of findings. All four studies includedas part of their protocol sample household interviews that elicited the following information about each member of the household for a two-week recall period immediately preceding the interview: 1. Occurrence of any symptoms or complaints, either perceived as an illness by the respondents or elicited by the interviewers using specific probes; 2. The duration of symptoms or complaints and any associated reduction in normal activities; 3. Use of any health service or practitioner by respondents with symptoms or complaints; 4. The reasons for not using health services or practitioners which included statements that "home treatment was adequate"; and 5. Whether recourse was made to self-care or care by family and friends. The wording of the questions designed to elicit the use of such care differed in each of the surveys. In the FAP feasibility study the use of self-care was asked as part of one question covering all types of treatment ranging from self-care to practitioner care. In the FAPHS and FANS surveys information about self-care was only asked of those who did not seek care from health services or practitioners and was part of the question designed to ascertain reasons for not consulting practitioners or health services. In the FAP definitive surveys and the Nepal studies a separate question specifically worded to determine the use of self-care was asked independently from questions ascertaining the use of practitioners or health services. The use of different types of practitioners, health services, or self-care for the antenatal, delivery and postnatal period by women giving birth during the year prior to the interview was ascertained in each household surveyed. In addition to general demographic data, information was also collected in some of the surveys about the individuals providing self-care, the type of care provided, the expenditures associated with self-care, and the relative availability of government or project services as measured by distance or access to these services. All the surveys were cross-sectional in nature except for a subgroup of households in t h e 1968-1969 FAP survey which were interviewed fortnightly throughout one full year. Sampling criteria were different for each of the studies, but all households selected were from rural villages in each of the study areas. Details of the study designs, sampling framework, and the specific
8
ROBERT L. PARKER ET AL.
survey methodologies used are available in the publications referred to above. FINDINGS The number of individuals identified in each survey that utilized self or home treatment for an illness during the two-week recall period is summarized in Table I. In addition, the table includes the total population surveyed, the number o f persons who were ill (except in survey B) and those that sought some form o f professional health care (traditional or modern) for the illness. Data from the F A P feasibility study (A and B) provided information about total self-care, 1 b u t it was not possible to identify how much may have overlapped with other types of care. The FAPHS and FANS surveys (E and F ) identified only self-care that was used when there was no other type of care. The remainder o f the survey data permitted separation o f self-care into that used exclusively and that used along with other sources of care during the two-week recall period. The proportion o f the population that was identified as being ill ranged from 18 to 39 percent and the rate o f consultation o f professional health care services b y ill individuals was TABLE I Summary of the Total Population in each Survey, Total Number of I11 Individuals, and Number of 111 Individuals Using Self-Care or Professional Health Care Services During a two Week Period Survey FAP - India 1966-67
1968-69
Nepal FANS India (F)
Hills (G)
Terai (H)
North (A)
South (B)
North (C)
Totalpopulation sampled
2,958
3,119
31,217" 29,147" 4,430
14,259
5,832
5,963
Persons ill (Percent of Total)
538 (18.2)
-
8,367 (26.8)
6,348 (21.8)
1,196 (27.0)
5,290 (37.1)
2,278 (39.1)
1,605 (26.9)
No. using only self-care
-
-
1,931
2,172
314
918
368
253
433
324
Total no. using self-care
South (D)
FAPHS India (E)
136
184
2,360
2,661
No. receiving 243 professional care (Percent of In) (45.2)
375
2,628
1,984
-
(31.4)
(31.3)
-
478
2,224
456
462
(40.0)
(42.0)
(20.0)
(28.8)
*Approximately 85 percent of this number represents 'person-fortnights' from the longitudinal study. Actual individuals totaled 5,883 in the North and 5,975 in the South. Person-fortnights were used so that cross-sectional and longitudinal data could be combined.
SELF-CARE
IN RURAL
AREAS
OF INDIA
= , i i
....., .
9
AND NEPAL Percent Using 0nly Self-Care Percent Uslng
Self-Care
.I " A l o n e or i n C o m b i n a t i o n WithProfesslonal
Care
4541.9 i
40-
35-
28,,2J ~
30-
25.3 H
\\
\\
25-
fi
23.1
20-
% -%
\ ". \1
20.2
. o
o
N
I~1~.~'1-
S E L F - C A R E IN R U R A L A R E A S O F I N D I A A N D N E P A L *
ABSTRACT. Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar,better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.
In most societies self-medication or treatment in the home by family members and friends is a c o m m o n occurrence during illnesses and pregnancies. This self or family care may range from minimal adjustments in: diet or activities to the use of modern drugs such as antibiotics. So integral are most of these practices to the patterns of everyday living that they are often ignored in discussions and studies of health care systems. In recent years, however, there has been a surge of interest in self-care as an alternative or supplement to the formal health care system (Levin, Katz, and Hoist 1 9 7 6 : 1 9 - 2 9 ) . Although historically treatment in the home has probably always existed as the one source of health care consistently available to individuals, it is gaining popular exposure now in developed countries as one answer to the increasingly complex health care system which frequently fosters dependence on the providers of services. A recent Louis Harris poll taken in the U.S. indicated that people found "enormously appealing" the possibility of reducing hospital and doctor care by taking better care of themselves and being rewarded with lower health insurance premiums (Knudson 1978 :A-8). In planning primary health care services for less developed countries, self-care is being proposed as a potent resource that should be considered along
Culture, Medicine and Psychiatry 3 (1979) 3-28. 0165-005X/79/0031-0003502.60. Copyright © 1979 by D. Reidel Publishing Co., Dordrecht, Holland, and Boston, U.S.A.
4
ROBERT L. PARKER ET AL.
with other approaches for improving health and primary health care coverage (Kleinman 1978a). One model of the health care process visualizes delegating as many as possible of the various functions and tasks of health services from highly trained professionals who now perform them to health workers with less training, or to sick individuals and their families (Department of International Health 1976:9-19). This looks at the process from the provider's or planner's perspective and explicitly calls for decisions as to where in the spectrum of self-care to specialty care a given activity should occur based on considerations of efficiency and effectiveness. From the viewpoint of the villagers, however, effective self-care may offer increased control over their own lives and reduction in the feelings of helplessness or fatalism, both of which support the important attitudes of self-reliance and community level cooperation so important for true development. These,arguments are attractive and call for serious consideration of the possible approaches that might be taken to encourage appropriate self-care. For those interested in pursuing the possibilities of self-care, one of the first problems encountered is the lack of a consistent definition of what is meant by 'self-care'. Levin has proposed a broad working definition which states that self-care is a "process whereby a lay person functions on his/her own behalf in health promotion and prevention and in disease detection and treatment at the level of the primary health resource in the health care system" (Levin, Katz, and Holst 1976:10). It is clear that as research and development projects begin to multiply in the area of self-care, very specific definitions will be required that will assist in delineating the various dimensions of who provides the care (individuals, families, friends, community); what is done (change in activity, diet, life style; use of herbs, patent medicines, prescription medicines); whether the care involves health promotion, prevention, or cure; and when it is used in the disease process or care sequence. At present, however, very little is even known about the actual frequency of use of self-care, let alone the more detailed dimensions of self-care suggested above. This is particularly true for less developed countries, but it is also a glaring gap in the health services research literature of developed nations. Assumptions have been made that ill individuals probably treat themselves if they do not seek care from health practitioners or some health care facility. Thus, by using studies such as those by White et al. (1961) and Hulka et al. (1972), the exclusive use of self-care during episodes of illness can be inferred to be as high as 67 to 75 percent in the United Kingdom and the United States. Similar conclusions could be reached for India and Nepal where utilization of various private practitioners or government services by sick persons was found to be between 25 to 40 percent (Department of International Health 1976:71- 72; Directorate of Health and Family Planning 1973:5-6; and Tribhuvan University 1977:35-38), thus'leaving the balance to self-care. Relatively few studies were found which reported attempts to measure self-care
SELF-CARE IN RURAL AREAS OF INDIA AND NEPAL
5
activities directly. Estimates have been made by Levitt in England that as many as 75 percent of symptoms are treated by patients themselves without seeing a doctor (1976:95). A survey carded out for the Federal Drug Administration in the U.S. by National Analysts, Inc. (1972) found that individuals who had ever used self-medication for common ailments such as colds and upset stomachs were as high as 56 percent of the total sampled population. In addition, approximately 12 percent of these self-care medicators reported having continued self-care over two weeks without seeking professional help. Current or continuous use of medications such as vitamins and tonics or laxatives was reported by 15 to 26 percent of the respondents. In a study of a rural county in Florida, Murphee and Barrow reported that over 31 percent of the respondents claimed they used patent medicines daily, while 11 percent stated they still used folk remedies, although infrequently (1970). An international comparative study of health care in six developed countries reported by Kohn and White (1976:233) ascertained the use of nonprescribed medicines over a two-day period. Exclusive use of these medicines ranged from a low of 8 percent of the surveyed population in Yugoslavia to over 25 percent in North America and England. Combined use of nonprescribed and prescribed medicines involved an additional 2 to 10 percent of the population. Another study in England by Dunnell and Cartwright (1972:13-18) reported that 55 percent of individuals over 21 years of age had taken some medication during a 24-hour period and 80 percent had taken medications during a two-week period. Over the two weeks about 67 percent of individuals took nonprescribed medicines. Taking of medicines was somewhat less in children, with 55 percent receiving any medication and 48 percent receiving nonprescribed medicines during the twoweek period. Nichter has reported a study he carried out in South India in which he estimated that during a one-week period 10-12 percent of villagers took home remedies or ready-made medicines, maintained special diets, or performed special rituals at home for one or more ailments (1978). In addition, he found that over 45 percent of a group of villagers who consulted a practitioner for an acute illness during the same one-week period had used home remedies or special diets before the consultation. Preference for initial use~of self-care was shown to vary according to specific symptoms or recognized disease entities. An in-depth study of 115 families in Taiwan by Kleinman (1978b) revealed that 93 percent of all illness episodes during one month were first treated within the family setting. However, 73 percent of all ill individuals continued to use only self or family care. Kleinman's def'mition of self care included diets, special foods, first aid materials, exercise, massage, and medications. Looking specifically at non-prescription or patent medicines he found that 83 percent of illness episodes during one month involved the use of such items. Athough primarily limited to two culturally traditional urban districts in
6
ROBERT L. PARKER ET AL.
Taipei, Kleinman's study has been able to characterize home care used by individuals and fafiailies in considerable detail including variations related to age, sex, social class, illness involved, type of care, and the hierarchy of resort to other types of care. Because of the differences in the types of self-care measured, the recall period involved and the questions that were asked, it is difficult to know whether the differences noted in the studies summarized above reflect actual variations in patterns of self-care. Certainly the variations within the international comparative study which was carried out in a similar fashion in each country indicate that use of nonprescription medications can vary as much as three-fold between different health care or cultural settings. Additional well standardized studies are needed in order to better understand the complex activities that are grouped under the topic of self-care and how these activities are related to the multiple factors specific to a given area including the availability of alternate health care resources. This paper reports on a unique group of surveys carried out in India and Nepal that collected data on self-care as part of an overall assessment of health problems and the use of health care services in rural communities. Although not specifically designed to study the phenomenon of self-care in depth they present an opportunity to examine more carefully than previously possible certain quantitative aspects of self-care and home treatment in rural areas of two developing countries. DATA SOURCES AND METHODS Published and unpublished data from four separate but inter-related studies carded out in India and Nepal between 1966 and 1977 form the basis of the findings in this paper. The Functional Analysis Project (FAP) of the Department of International Health, The Johns Hopkins University, School of Hygiene and Public Health, was the first of the studies in this group (Department of International Health, 1976; and Department of International Health, 1967). Data from this project include surveys during a feasibility study period in Punjab (North India) and Kerala (South India) in 1966-1967, and surveys during the definitive study period of 1968-1969 in Punjab and Karnataka (previously the South Indian state of Mysore). In 1972 the second study in this series was carried out by the Punjab Directorate of Health and Family Planning in another area of Punjab (FAPHS) with the assistance of staff members from the previous Functional Analysis Project (Directorate of Health and Family Planning 1973). In 1973-1974 similar survey methods were again used in two projects in Punjab (FANS) (Department of International Health 1975; and Kielmann, Taylor, and Parker 1978). The latter were prospective field studies by the Department of
SELF-CARE IN RURAL AREAS OF INDIA AND NEPAL
7
International Health in collaboration with the Indian Council of Medical Research measuring the impact of health services, nutrition supplementation and family planning services on the health and health care patterns in villages. Finally, data from one published (Tribhuvan University 1977) and two as yet unpublished surveys that were part of studies carried out in three districts in Nepal by the Institute of Medicine of Tribhuvan University in 1976-1977 provide the fourth set of findings. All four studies includedas part of their protocol sample household interviews that elicited the following information about each member of the household for a two-week recall period immediately preceding the interview: 1. Occurrence of any symptoms or complaints, either perceived as an illness by the respondents or elicited by the interviewers using specific probes; 2. The duration of symptoms or complaints and any associated reduction in normal activities; 3. Use of any health service or practitioner by respondents with symptoms or complaints; 4. The reasons for not using health services or practitioners which included statements that "home treatment was adequate"; and 5. Whether recourse was made to self-care or care by family and friends. The wording of the questions designed to elicit the use of such care differed in each of the surveys. In the FAP feasibility study the use of self-care was asked as part of one question covering all types of treatment ranging from self-care to practitioner care. In the FAPHS and FANS surveys information about self-care was only asked of those who did not seek care from health services or practitioners and was part of the question designed to ascertain reasons for not consulting practitioners or health services. In the FAP definitive surveys and the Nepal studies a separate question specifically worded to determine the use of self-care was asked independently from questions ascertaining the use of practitioners or health services. The use of different types of practitioners, health services, or self-care for the antenatal, delivery and postnatal period by women giving birth during the year prior to the interview was ascertained in each household surveyed. In addition to general demographic data, information was also collected in some of the surveys about the individuals providing self-care, the type of care provided, the expenditures associated with self-care, and the relative availability of government or project services as measured by distance or access to these services. All the surveys were cross-sectional in nature except for a subgroup of households in t h e 1968-1969 FAP survey which were interviewed fortnightly throughout one full year. Sampling criteria were different for each of the studies, but all households selected were from rural villages in each of the study areas. Details of the study designs, sampling framework, and the specific
8
ROBERT L. PARKER ET AL.
survey methodologies used are available in the publications referred to above. FINDINGS The number of individuals identified in each survey that utilized self or home treatment for an illness during the two-week recall period is summarized in Table I. In addition, the table includes the total population surveyed, the number o f persons who were ill (except in survey B) and those that sought some form o f professional health care (traditional or modern) for the illness. Data from the F A P feasibility study (A and B) provided information about total self-care, 1 b u t it was not possible to identify how much may have overlapped with other types of care. The FAPHS and FANS surveys (E and F ) identified only self-care that was used when there was no other type of care. The remainder o f the survey data permitted separation o f self-care into that used exclusively and that used along with other sources of care during the two-week recall period. The proportion o f the population that was identified as being ill ranged from 18 to 39 percent and the rate o f consultation o f professional health care services b y ill individuals was TABLE I Summary of the Total Population in each Survey, Total Number of I11 Individuals, and Number of 111 Individuals Using Self-Care or Professional Health Care Services During a two Week Period Survey FAP - India 1966-67
1968-69
Nepal FANS India (F)
Hills (G)
Terai (H)
North (A)
South (B)
North (C)
Totalpopulation sampled
2,958
3,119
31,217" 29,147" 4,430
14,259
5,832
5,963
Persons ill (Percent of Total)
538 (18.2)
-
8,367 (26.8)
6,348 (21.8)
1,196 (27.0)
5,290 (37.1)
2,278 (39.1)
1,605 (26.9)
No. using only self-care
-
-
1,931
2,172
314
918
368
253
433
324
Total no. using self-care
South (D)
FAPHS India (E)
136
184
2,360
2,661
No. receiving 243 professional care (Percent of In) (45.2)
375
2,628
1,984
-
(31.4)
(31.3)
-
478
2,224
456
462
(40.0)
(42.0)
(20.0)
(28.8)
*Approximately 85 percent of this number represents 'person-fortnights' from the longitudinal study. Actual individuals totaled 5,883 in the North and 5,975 in the South. Person-fortnights were used so that cross-sectional and longitudinal data could be combined.
SELF-CARE
IN RURAL
AREAS
OF INDIA
= , i i
....., .
9
AND NEPAL Percent Using 0nly Self-Care Percent Uslng
Self-Care
.I " A l o n e or i n C o m b i n a t i o n WithProfesslonal
Care
4541.9 i
40-
35-
28,,2J ~
30-
25.3 H
\\
\\
25-
fi
23.1
20-
% -%
\ ". \1
20.2
. o
o
N
I~1~.~'1-
