Hospitalization & health expenditure in Odisha: Evidence from National Sample Survey (1995-2014).

Background & objectives: Financing healthcare services through out-of-pocket payments is common in India. Household impoverishments due to health expenditure can be daunting, especially among the economically vulnerable households. This study investigated hospitalization and patient's health expenditure in Odisha State in India. Methods: The national sample survey data were used to assess hospitalization and patient's health expenditure over two time periods (1995 and 2014). Disease classification was made following International Classification of Diseases 10th revision (ICD-10). The hospitalization rate and health expenditure were estimated for infectious, cardiovascular, non-communicable, disability and other diseases. Andersen model was used to examine the determinants of healthcare expenditure. Results: Findings of the study revealed that hospitalization in Odisha increased nearly three folds and health expenditure by more than two times between 1995 to 2014. While the hospitalization for other diseases remained consistently higher, health expenditure for disability was the highest and it increased three times within the last two decades. The socio-economic and demographic divides in the hospitalization rate and health expenditure were evident. Interpretation & conclusions: Our analysis indicated that predisposing factors such as age and marital status played an important role in hospitalization whereas, enabling factors likely determined the health expenditure. There is a need to recognize the unique vulnerabilities of older population, widowed and health financial mechanism for disability-related illness.

Marriage practices, decision-making process and contraception use among young married men in rural Odisha, India.

Research on sexual and reproductive health including contraception use has predominantly focussed on women's behaviour. Much less is known about men's behaviour. We investigated the links between marriage practices and decision-making about contraception use among young married men in rural Odisha. This cross-sectional study used a mixed methods design. Data were collected through household surveys and in-depth interviews. Study findings revealed that over half of men were ill prepared for marriage and lacked understanding about what it would entail. Familiarity and communication between spouses were higher in self-arranged marriages and this contributed considerably to contraception use, while negative attitudes and lack of access to contraceptive supply and counselling hindered it. Many young men shied away from seeking contraception services at community level since the majority of frontline health workers providing such services were female. Findings reinforce the need for health system change to actively engage and involve young married men in decision-making about contraception use as well as to introduce male frontline health workers who can reach out to young men on SRH issues.

INTIMATE PARTNER VIOLENCE AND UNINTENDED PREGNANCY AMONG ADOLESCENT AND YOUNG ADULT MARRIED WOMEN IN SOUTH ASIA.

This study examined the relationship between Intimate Partner Violence (IPV) and unintended pregnancy among young women in South Asia using Demographic and Health Survey data from India (2005-2006), Bangladesh (2007) and Nepal (2011). The respondents were adolescent and young adult married women aged 15-24 years who had at least one childbirth in the five years preceding the survey. Bivariate and stepwise multivariate logistic regression analyses were performed to assess the relationship between IPV and unintended pregnancy. Thirty-eight per cent of the respondents in India, 52% in Bangladesh and 28% in Nepal reported having experienced physical or sexual IPV. Those who reported physical or sexual IPV had higher odds of unintended pregnancy (1.36 in India and 1.99 in Bangladesh). The findings indicate that IPV is a risk factor for unintended pregnancy among adolescent and young adult married women. Along with violence prevention programmes, a more responsive and youth-friendly health system needs to be in place to provide health care services to young women in these countries.

Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey.

BACKGROUND: India is rapidly undergoing an epidemiological transition with a sudden change in the disease profile of its population. It is important to understand the changing nature of the burden of disease across the states of India for adequate policy intervention. METHODS: We analyzed the trend and pattern of self-reported morbidity across states of India using three rounds of (52nd, 60th and 71st) National Sample Survey Organization (NSSO) data. Descriptive analysis was carried out to understand the prevalence of self-reported morbidity variation over a period of two decades (1995-2014) and multivariate analysis was performed to identify the significant determinants of various types of self-reported morbidities. RESULTS: The results indicated an increasing trend of infectious disease, Cardio Vascular Diseases (CVDs) and Non-Communicable Diseases (NCDs) over the last two decades (1995-2014). CVDs increased by a whopping eight-fold and the NCDs increased by three times during this period. A higher prevalence of self-reported morbidity was observed among the elderly and female, particularly in the urban locality. The growing incidence of CVDs and NCDs, especially among the elderly were reported from Kerala, Tamil Nadu, Punjab and West Bengal. CONCLUSIONS: The already constrained public health system in India is likely to face serious challenges with a double burden of communicable and non-communicable diseases. An effective and responsive public health system needs to be in place to make health care services available for NCDs and CVDs at the primary level. In order to ameliorate caregiving, the involvement of family will be critical. Informing the people inculcate healthy habits may be an effective health promotion measure.

Menstrual hygiene practices and its association with reproductive tract infections and abnormal vaginal discharge among women in India.

OBJECTIVE: The objective was to explore the determinants of menstrual hygienic practices and its effect on Reproductive Tract Infections (RTI) among ever married women in India. METHODS: District Level Household and Facility Survey-3 (DLHS) India data have been used in the study. The respondents constituted ever married women (N = 577,758) in the age group of 15-49. Bivariate and multivariate techniques were employed using IBM SPSS statistics 20. Individual effects of socio economic, demographic and gynecological factors on menstrual hygienic practices, RTIs and abnormal vaginal discharged respectively were calculated using binary logistic regression. RESULTS: A meager 15% of women used sanitary pad/locally prepared napkins during menstruation in India. Both RTI and Vaginal discharge were positively related with non-use of hygienic methods. The women who used unhygienic method during menstruation were more likely to have any symptom of RTI (OR = 1.046, p < 0.001, CI = 1.021-1.071) and vaginal discharge (OR = 1.303, p < 0.001, CI = 1.266-1.341). CONCLUSION: The reason for the symptoms of RTI may be diverse and not only limited to the unhygienic menstrual practices although this may be one of the reasons causing reproductive morbidity. Awareness, affordability and privacy are some of the major concerns that need immediate attention to promote the use of sanitary pad during the time of menstruation. Establishing relation between menstrual practices and RTI is in its initial stage of investigation and hence needs further research.