Changes in socio-economic inequality in nutritional status among children in EAG states, India.

OBJECTIVE: The primary purpose of this study is to examine changes in socio-economic inequality in nutritional status (stunting and underweight) among children in Empowered Action Group (EAG) states. DESIGN: The study is based on the most recent two wave's cross-sectional data from the National Family Health Survey (NFHS) conducted in 2005-2006 (NFHS-3) and 2015-2016 (NFHS-4). The study used height-for-age (stunting) and weight-for-age (underweight) of children as anthropometric indicators. SETTING: EAG states including Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh in India. PARTICIPANTS: The study includes a total of 11 858 (NFHS-3) and 92 630 (NFHS-4) children under 5 years of age. RESULT: The socio-economic inequality in stunting remained unchanged in all EAG states. At the same time, the inequality in underweight decreased during 2005-2016. On decomposing, the factors contributing to socio-economic inequality revealed that household wealth index, mother's education and mother's nutritional status were the largest contributors to stunting (47 %, 24 % and 8 %) and underweight (51 %, 21 % and 16 %), respectively, in 2015-2016. CONCLUSION: The study concluded the socio-economic inequality in underweight among children under 5 years of age increased over the years in EAG states in India. Altogether, household wealth index, mother's education and mother's nutritional status contributed to nearly 80 % to inequality in stunting and 90 % to inequality in underweight in 2015-2016. Hence, efforts should be made to minimise the socio-economic inequality in the nutritional status of children, particularly in EAG states in India.

Deaths during pregnancy, childbirth and puerperium: Exploring causes, context and evidence from Eastern India.

AIM: The study was aimed to identify the specific reasons and circumstances of maternal deaths in West Bengal. METHODS: The present study is a retrospective study of 317 maternal deaths, conducted between November 2013 and October 2015 at two major referral hospitals of eastern India, West Bengal. The frequencies, proportions, measures of central tendency and dispersion were used to describe the data. The data were analyzed using the statistical software spss version 20.0. ArcGIS 10.1 was also employed to show the distributional pattern of maternal deaths. RESULTS: The overall maternal mortality ratio was estimated as 561 per 100 000 live births. Eclampsia or hypertensive disorders of pregnancy contributed to one-third (33.1%, n = 105/317) of maternal deaths. The maternal deaths were more common (41%) among women belonging to the age group of 20-24 years and primiparous (36.9%) group. The average distance for traveling to reach the final hospital was 47.37 km. Approximately, three-fourths (72.2%) of maternal deaths were in the post-partum period. Half of the women (50.5%) sought medical care after 12 hrs of developing complications. The majority of the cases (80.1%) were referred and about 45% of patients had a cesarean section. CONCLUSION: The result suggests there was a shift in causes of maternal deaths from hemorrhage to eclampsia. Establishment of separate eclampsia units at lower-level health facilities may be a more plausible pathway to prevent eclampsia-related maternal deaths in West Bengal.

Supported motherhood? An examination of the cultural context of male participation in maternal health care among tribal communities in India.

In many cultural settings worldwide, within families, men tend to be responsible for important choices relating to the allocation of household resources and care-seeking behaviour that directly impact on the health of women and newborns. This study examines the extent of male participation in antenatal care (ANC), delivery, postnatal care (PNC), household chores and providing food to wives among tribal communities in India. In addition, health care providers' views on male participation in maternal health were examined. Primary data were collected from 385 men aged 15-49 from rural Gadchiroli District in Maharashtra, India. Interviews of 385 men whose wives had delivered a child within the previous 2 years were conducted between November 2014 and March 2015. Bivariate and multivariate analyses were done. The results showed that the tribal men's participation in maternal health care was minimal. Around 22% of the men reported accompanying their wives to ANC, 25% were present at the time of delivery of their children and 25% accompanied their wives to PNC. Participation in household work, and support for wives in other ways, were slightly better. The main reason given by men for not participating in maternal health care was that they didn't think it was necessary, believing that all maternal health issues were women's concern. Health care providers among these tribal communities in India should encourage men to participate in issues related to maternal health care.

What he knows about her and how it affects her? Husband's knowledge of pregnancy complications and maternal health care utilization among tribal population in Maharashtra, India.

BACKGROUND: Husbands' knowledge and awareness of pregnancy complications have a positive impact on their wives' utilization of maternal health care services. In this study, we examined whether husbands' knowledge and awareness of pregnancy complications can serve as determinants of maternal health service utilization among wives from the tribal population. METHODS: This cross-sectional study was conducted in the rural Gadchrioli district of Maharashtra, India, during November 2014-March 2015. This study included a representative population-based sample of 385 men whose wives had given birth in last 2 years at the age of 15-49 years. A multistage sampling strategy was adopted to select the respondents. Univariate, bivariate, and binary logistic regression analyses were applied to examine the association between men's knowledge and maternal health service utilization. RESULTS: The result revealed that an increase in husbands' education level increased the wives' utilization of antenatal (ANC) care services. The type of tribe also contributed to significant differences in ANC utilization (OR: 2.64; 95% CI: 0.847-8.24). Regarding standard of living, husbands who were poor were 22% less likely than husbands in the rich category to report the utilization of ANC by their wives. Men with partial or complete knowledge of pregnancy, childbirth, and postpartum complications were more likely to utilize all maternal health services by their wives. CONCLUSIONS: The wives are of men who aware of complications during pregnancy and childbirth are more likely to use maternal health services. Therefore, educating and empowering men about pregnancy complications will contribute to the reduction in maternal and neonatal deaths.

Praying until death: revisiting three delays model to contextualize the socio-cultural factors associated with maternal deaths in a region with high prevalence of eclampsia in India.

BACKGROUND: A disproportionately high proportion of maternal deaths (99 percent) in the world occur in low and middle income countries, of which 90 percent is contributed by Sub-Saharan Africa and South Asia. This study uses the effective "Three Delays" model to assess the socio-cultural barriers associated with maternal mortality in West Bengal, India. METHODS: It was a retrospective mixed methods study, which used facility-based as well as community-based approaches to explore factors associated with maternal deaths. We reviewed 317 maternal death cases wherein a verbal autopsy technique was applied on 40 cases. The Chi-square test (χ2) and multivariable logistic regression model were employed to accomplish the study objectives. RESULTS: The delay in seeking care (Type 1 delay) was the most significant contributor to maternal deaths (48.6 percent, 154/317). The second major impacting contributor to maternal deaths was the delay in reaching first level health facility (Type 2 delay) (33.8 percent, 107/317), while delay in receiving adequate care at the health facility (Type 3 delay) had a role in 18.9 percent maternal deaths. Women staying at long distance from the health facilities have reported [AOR with 95 % CI; 1.7 (1.11-1.96)] higher type 2 delay as compared to their counterparts. The study also exhibited that the women belonged to Muslim community were 2.5 times and 1.6 times more likely to experience type 1 and 2 delays respectively than Hindu women. The verbal autopsies revealed that the type 1 delay is attributed to the underestimation of the gravity of the complications, cultural belief and customs. Recognition of danger signs, knowledge and attitude towards seeking medical care, arranging transport and financial constraints were the main barriers of delay in seeking care and reaching facility. CONCLUSIONS: The study found that the type-1 and type-2 delays were major contributors of maternal deaths in the study region. Therefore, to prevent the maternal deaths effectively, action will be required in areas like strengthening the functionality of referral networks, expand coverage of healthcare and raising awareness regarding maternal complications and danger signs.

Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India.

BACKGROUND: Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015-16, the fourth National Family Health Survey (NFHS-4) - a cross-sectional survey - collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30-49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. METHODS: Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. RESULTS: In India as a whole, 6 % of women aged 30-49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). CONCLUSION: The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45-49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy.

Age, gender and socioeconomic patterns of awareness and usage of e-cigarettes across selected WHO region countries: evidence from the Global Adult Tobacco Survey.

OBJECTIVES: The study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries. DESIGN: Cross-sectional. SETTING: 14 countries. PARTICIPANTS: Surveyed population ≥15 years selected through multi-stage cluster sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: We selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017. RESULTS: Awareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia . CONCLUSIONS: E-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.

Spatial modeling of child malnutrition attributable to drought in India.

OBJECTIVES: Indian agriculture is mostly dependent on monsoon. Poor and irregular rainfall may result in crop failure and food shortage among the vulnerable population. This study examined the variations in drought condition and its association with under age 5 child malnutrition across the districts of India. METHODS: Using remote sensing and National Family Health Survey (NFHS-4) data, univariate Moran's I and bivariate local indicator of spatial autocorrelation (LISA) maps were generated to assess the spatial autocorrelation and clustering. To empirically check the association, we applied multivariate ordinary least square and spatial autoregressive models. RESULTS: The study identified highly significant spatial dependence of drought followed by underweight, stunting, and wasting. Bivariate LISA maps showed negative spatial autocorrelation between drought and child malnutrition. Regression results suggest agricultural drought is substantially associated with stunting. An increasing value of drought showed statistical association with the decreasing (ß = - 8.251; p value < 0.05) prevalence rate of child stunting across India. CONCLUSIONS: This study provides evidence of child undernutrition attributable to drought condition, which will further improve the knowledge of human vulnerability and adaptability in the climatic context.