Practice Patterns of Audiologists Involved in Assessment and Management of Vestibular Disorders: An Indian Cross-Sectional Survey.

BACKGROUND: As the incidence of vestibular disorders continues to rise, the role of the audiologists in assessing and providing effective intervention has become increasingly important. To date, there have been no studies investigating the practice patterns of Indian audiologists towards the assessment and management of vestibular disorders. METHOD: An electronic survey consisting of 29 questions across demographics, vestibular assessment, and management emailed to 704 members of the Indian Speech and Hearing Association (ISHA). Additionally, the questionnaire was circulated to audiologists through social media groups. The participants were provided with a two weeks' time limit for completing the survey. RESULTS: 704 participants were contacted to take part in the survey, and only 243 responses were received resulting in a 34.66 % response rate. Among the 243 participants who responded, 127 participants were currently not involved in the assessment and/or management of vestibular disorders in India. The responses were analyzed descriptively according to each section of the questionnaire. The study also sheds light on vestibular assessment, rehabilitation trends, and perceived barriers/facilitators among Indian audiologists. CONCLUSION: We observed major discrepancies between practice patterns of audiologists in India. Like any other developing nation, India has challenges of its own. Proper planning in terms of resource allocation is needed to address the barriers in access to instrumentation, and limited workforce.

Gender bias in hospitalization financing from borrowings, selling of assets, contribution from relatives or friends in India.

BACKGROUND: Studies from India have documented gender differentials in hospitalization financing. Much of this work focused either on children or adults, but not across age-groups. No research to date has focused on gender differentials in case of catastrophic hospitalization expenditures. This study assesses gender differentials in distressed financing (borrowing, selling of assets, contributions from relatives or friends) for hospitalization in cases of catastrophic expenditures for hospitalization in India, for young, adult and older adult patients. METHODS: We conducted a cross-sectional analysis of India's 2017-18 National Sample Survey, which collected data on hospitalization and expenditures. We used multivariable probit regression and adjusted marginal effects to assess the associations between gender and the use of distressed financing for catastrophic hospitalization expenditures. Models were stratified by age, and run both with and without sample selection. Secondary analyses assessed gender differentials in the use of distressed financing for hospitalization in case of health insurance cover or not. RESULTS: Multivariable sample selection-adjusted probit regression shows that in households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization of young or older females was 10% points lower than their male counterparts. In households which did not incur severe catastrophic hospitalization expenditures, there was no significant gender differential in use of distressed financing for hospitalization for any age group. In households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization was lower for older females than for older males irrespective of health insurance cover. CONCLUSION: There appears to be a clear gender discrimination in distressed financing of hospitalization costs among younger and older individuals in households that incurred severe catastrophic hospitalization expenditures in India. Health systems should consider how to otherwise support necessary hospitalization financing for girls and older women.

What Explains the Decline in Neonatal Mortality in India in the Last Three Decades? Evidence from Three Rounds of NFHS Surveys.

Identifying the factors that have contributed to recent declines in neonatal mortality in India may help determine which policies and programs are most likely to facilitate further reductions. We use data from the 1992-93, 2005-06, and 2015-16 National Family Health Surveys (NFHS) to examine trends in neonatal mortality in India. We use multivariable decomposition to estimate the contribution of different factors to the change in neonatal mortality in India in the last three decades. When limited to most recent births in the 1-47 months preceding the surveys, 70 percent of the decline in neonatal mortality from 1992-2016 is due to changes in utilization of maternal- and child-care program factors and distribution of household, mother's, and child's characteristics. Improvement in "mother's schooling" and increase in utilization of "at least two tetanus toxoid injections" contributed the most followed by the increase in use of "at least three antenatal-care visits" and "clean fuel for cooking." The change in distribution of "birth order" also contributed significantly to the decline in neonatal mortality. Change in the benefits of "access to improved water," "delivery in a medical facility," and "mother's schooling" has led to a decline of 3 points, 2 points, and 1 point, respectively. More investments in maternal- and child-health programs (including family planning) and providing clean fuel for cooking are likely to pay higher dividends.

Epidemiological investigation and management of bloody diarrhea among children in India.

BACKGROUND: The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context. METHODS: We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years. FINDINGS: The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics. CONCLUSION: The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Oral problems and associated risk indicators in adults in the Russian Federation, India, and China.

BACKGROUND: Oral problems, known as a neglected epidemic, have become prevalent in Brazil, the Russian Federation, India, China, and South Africa (BRICS) countries in last decade. The objective of the study is to examine the prevalence and associated risk indicators of oral problems in adults in the Russian Federation, India, and China in BRICS countries. METHODS: We used data from the first round of the Study of Global AGEing and Adult Health (SAGE), conducted by WHO in 2007-10 in selected BRICS countries. Oral problems are defined as if an adult had any mouth and/or teeth related problems including swallowing problems in last 1 year of the survey. We estimated the mean age of adults who had oral problems and used a t-test for comparing it by sex of adults. We determined the prevalence of oral problems in adults. We designed a hierarchical conceptual model to identify associated risk indicators with oral problems. Finally, we applied a multivariable binary logistic regression model based on a conceptual model to examine associated socioeconomic and demographic, behavioral and nutritional risk indicators and systemic diseases - diabetes, hypertension, and angina pectoris/angina with oral problems in adults. RESULTS: The mean age of adults who had oral problems is lowest in India (57 years; SD: 15) and highest in China (65 years; SD: 11). However, it does not vary by sex of adults except India. The prevalence of oral problems is highest in the Russian Federation (35%) and lowest in China (9%). Adults with body mass index (BMI) less than 25 kg/m2, age 45 years or more, diabetes, hypertension, and angina pectoris/angina have a higher risk of oral problems. Females and adults using alcohol are also more likely to have oral problems in selected countries. CONCLUSIONS: The study concludes that females, adults using alcohol and those having any systemic disease are at higher risk of oral problems in the Russian Federation, India, and China. A one-third of adults had oral problems in particularly, in the Russian Federation; thus there is an urgent need to formulate oral policy and program, which the country currently lacks in.

Prevalence and socio-demographic correlates of alcohol consumption: Survey findings from five states in India.

AIM: To investigate the association between socio-demographic characteristics and alcohol consumption in India. METHODS: Analytical data were derived from household surveys conducted by the study team that included 6088 adults in five states of India (male = 3803, female = 2285). The sample was a cross-sectional selected through stratified multistage sampling design. The survey collected data on socio-demographic characteristics of the respondents as well as the pattern of alcohol consumption. Multivariate logistic regression models were fitted to investigate the socio-demographic association with both alcohol consumption and types of alcoholic beverages consumed (distilled spirits, country liquor, home-brewed). RESULTS: More than one-third of the sample respondents (38.6%, 95%CI = 29.2-48.8%) reported to be current drinkers and approximately one-fifth (21.7%, 95%CI = 4.2-31.7%) were heavy drinkers and 7.4% (95%CI = 4.6-11.6%) were heavy episodic drinkers. In multivariate analyses, age greater than 50 years (OR = 0.70, 95%CI = 0.56-0.86), being female (OR = 0.08, 95%CI = 0.06-0.09), schooling greater than 12 years (OR = 0.61, 95% CI = 0.50-0.75), owning land (OR = 0.74, 95%CI = 0.65-0.86), and living in pucca house (OR = 0.85, 95% CI = 0.74-0.98) were negatively associated with current drinking status. Higher income (OR = 1.30, 95%CI = 1.08-0.57) and living in urban areas (OR = 1.54, 95%CI = 1.33-1.78) were positively associated with current drinking status. CONCLUSIONS: Substantial differences in the socio-demographic correlates of alcohol consumption and types of alcoholic beverages exist in India. It is recommended that intervention and prevention strategies to curb alcohol consumption should include drinkers' characteristic.

Trends in inequality in length of life in India: a decomposition analysis by age and causes of death.

BACKGROUND: Studies dealing with trends in inequality in length of life in India are rare. Studies documenting the contribution of age and causes of death to the inequality in length of life are more limited. OBJECTIVE: The study aims to examine the trends in inequality in length of life in India and 15 major states of India and to decompose the inequality in length of life into the contributions of age and causes of death. METHOD: We use life table Gini coefficient (G0) to measure the inequality in length of life. We use the formulae developed by Shkolnikov, Andreev, and Begun (DR 8(11):305-358, 2003) to decompose the differences between Gini coefficients by age and cause of death. RESULT: The G0 for men has declined from 0.32 in 1981 to 0.19 in 2011. For women, G0 has decreased from 0.31 in 1981 to 0.22 in 2011. Mortality decline in the age group 0-1 year has contributed most to the decrease in G0. In contrast, mortality decline in 60+ has tended to increase the G0. The state-wide variations in the age-specific contributions to decrease in G0 were stark. The contribution of noncommunicable diseases to the male-female gap in G0 has increased between 1990 and 2010. Injuries at ages from 20 to 39 years also contributed to the male-female difference in G0 in 2010. CONCLUSION: Future studies must analyze inequality in life expectancy for assessing the performance of societies regarding length of life. CONTRIBUTION: This is the first study that provides compelling evidence on inequality in length of life in India and its major states.

Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE.

BACKGROUND AND OBJECTIVES: The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. DATA AND METHODS: The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. RESULTS AND CONCLUSIONS: Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.