High Under-five Mortality Rate in Rural Madhya Pradesh, Time to Identify High-Risk Districts Using National Family Health Survey-4 Data with Comparison to Low Under-five Mortality Rate in Rural Tamil Nadu, India.

BACKGROUND: India had highest number of under-five deaths, 1.2 million deaths out of 5.9 million (2015). As per the results from the first phase of National Family Health Survey (NFHS-4), 2015-2016, under-five mortality rate was highest in rural area of Madhya Pradesh (MP), 69/1000 live birth as compared to urban areas, 52/1000 live birth. The objective of the study was to identify potentially high-risk districts (HRD). METHODS: This study was carried out from the secondary data of 50 districts of MP State which was available from NFHS-4 with information from 49,164 households. Scoring method was used to identify HRD by comparing variables related to maternal and child health care of rural MP with rural Tamil Nadu. RESULTS: Eleven HRDs were identified with poor maternal and child health care along with high women's illiteracy and high percentage of child marriages in women. Indore division had 3 topmost HRD, Alirajpur, Jhabua, and Barwani followed by Rewa division with 2, Singrauli and Sidhi along with Sagar division. CONCLUSIONS: HRDs should be considered for targeted interventions using the strategies for reducing under-five mortality rate in rural MP.

The need to focus on medical education in rural districts of India.

Background: . Globally, India has the highest number of medical colleges followed by Brazil and China. The density of physicians in rural India was 3 per 10 000 population against 13 per 10 000 in urban areas. Worldwide, studies show that medical schools play an important role in overcoming the shortage of physicians locally. Hence, we studied the distribution of medical colleges in India and reviewed the shortage of established and new medical colleges in rural districts with the year 2000 as baseline. Methods: . We used the database of the Medical Council of India as on 27 April 2017; and Census 2011 data, based on the percentage of rural/urban population, for the classification of districts (rural/urban). All the 640 districts were included with 1210.9 million population. Results: . Of the 480 rural districts in India, only 132 (27.5%) had a medical college. Jharkhand, Jammu and Kashmir and Arunachal Pradesh had no medical colleges in rural districts. Madhya Pradesh, Uttar Pradesh, Bihar, Assam, Punjab, Uttarakhand, Haryana and Rajasthan had <30% of rural districts with a medical college. Of the 286 new medical colleges established since 2000 in India, 130 (45.5%) were in rural districts with uneven distribution with lower percentage of new medical colleges in states with predominance of rural population. Conclusion: . There is an overall shortage of medical colleges in rural districts of India. Paradoxically, the trend of uneven rural-urban distribution continues among the newly opened medical colleges as well.

Gender equality in India hit by illiteracy, child marriages and violence: a hurdle for sustainable development.

INTRODUCTION: Gender equality is fundamental to accelerate sustainable development. It is necessary to conduct gender analyses to identify sex and gender-based differences in health risks. This study aimed to find the gender equality in terms of illiteracy, child marriages and spousal violence among women based on data from National Family Health Survey 2015-16 (NFHS-4). METHODS: This was a descriptive analysis of secondary data of ever-married women onto reproductive age from 15 states and 3 UTs in India of the first phase of NFHS-4. Gender gap related to literacy and child marriage among urban and rural area was compared. RESULTS: In rural area all states except Meghalaya and Sikkim had the significantly higher percentage of women's illiteracy as compared to male. Bihar and Madhya Pradesh had higher illiterate women, 53.7% and 48.6% as compared to male, 24.7% and 21.5% respectively (P < 0.000). Child marriages were found to be significantly higher in rural areas as compared to urban areas in four most populated states. CONCLUSION: There is a gender gap between illiteracy with women more affected in rural areas with higher prevalence of child marriages and poor utilization of maternal health services. Also, violence against women is showing an upward trend with declining sex-ratio at birth.

Sputum smear grading and treatment outcome among directly observed treatment-short course patients of tuberculosis unit, Jagdalpur, Bastar.

INTRODUCTION: Tuberculosis (TB) is a major global health problem. In 2014, worldwide, 1.5 million deaths were reported from TB. The study was planned to assess sputum smear grading and treatment outcome among TB patients attending tuberculosis unit (TU), Jagdalpur of Bastar district in Chhattisgarh. MATERIALS AND METHODS: It was a record-based analysis for the year 2014 data from TU, Jagdalpur, Bastar of Chhattisgarh. STATISTICAL ANALYSIS USED: Data entry and analysis were done using STATA/SE 14.1 software. RESULTS: Out of total registered 496 TB patients in 2014, 207 were sputum smear positive with 83 (40.1%) having 3 + and 14 (6.8%) having scanty sputum grading. The percentage of successfully treated was lowest, 71.4% in scanty followed by 1+ (80.2%), compared to 84.1% in sputum smear negative (P = 0.02335). Overall rate of unfavorable outcome was 16.9%. Factors associated with unfavorable outcome were age more than 40 years (P = 0.01894), male gender (P = 0.06722), and retreatment cases (P = 0.0001136). Death rate was higher (6.6%) among patients of Category II. Higher default rate in new smear positive (8.3%), new smear negative (7.8%), and retreatment (16.7%) was noted. CONCLUSIONS: Overall rate of unfavorable outcome was higher in patients with scanty and 1+sputum grading. Age more than 40 years, male sex, and retreatment category were factors associated with unfavorable outcome.