The association of religion with maternal and child health outcomes in South Asian countries.

OBJECTIVE: Theological beliefs play an important role in cultural norms and could impact women's prenatal and postpartum decisions in South Asia, which has a high burden of disease in children and pregnant women. The aim of this study is to identify any associations religion may have in affecting a woman's decision-making ability, and how that in turn affects maternal and child health, at a group level in multiple South Asian countries. STUDY DESIGN: Cross-sectional study utilizing secondary data analysis. METHODS: We used Demographic and Health Surveys (DHS) between 2014 and 2018 in Afghanistan, Bangladesh, India, Maldives, Myanmar, Nepal, and Pakistan. Not every country's survey asked about religion, so we imputed these results based on Census data. We assessed maternal and child health through a composite coverage index (CCI), which accounts for family planning, attendance of a skilled attendant at birth, antenatal care, BCG vaccinations, 3 doses of diphtheria-tetanus-pertussis vaccine, measles vaccine, oral rehydration therapy, and seeking care if the child has pneumonia. The relationship between religion, women's empowerment, and CCI was assessed through linear regression models. RESULTS: The sample included 57,972 mothers who had children aged 12-23 months. CCI is observed to be affected by family income, in addition to religion and country. CCI was higher in Hindus (2.8%, 95% CI: 2.4%, 3.1%) and Buddhists (2.0%, 95% CI: 1.2%, 2.9%) than Muslims. Mother's age, education, income, decision-making autonomy, and attitude towards beatings were all related to CCI. In a model stratified by religion, age, education, and income were significant predictors of CCI for both Muslims and non-Muslims, but were more impactful among Muslims. CONCLUSION: Though multiple imputation had to be used to fill in gaps in religion data, this study demonstrates that maternal and child health outcomes continue to be a concern in South Asia, especially for Muslim women. Given the importance of religious beliefs, utilizing a simple indicator, such as the CCI could be helpful for monitoring these outcomes and provides a tangible first step for communities to address gaps in care resulting from disparities in maternal empowerment.

Causality assessment of serious and severe adverse events following immunization in India: a 4-year practical experience.

BACKGROUND: India has implemented the World Health Organization's revised Causality Assessment Protocol for adverse events following immunization (AEFI). We describe the number and types of serious/severe AEFIs, including deaths. RESEARCH DESIGN AND METHODS: Analysis of causality classification of reported serious/severe AEFIs from 1 January 2012 to 7 January 2016 was done. Classification includes (A) consistent with causal association to immunization; (B) indeterminate; (C) coincidental association; or (D) unclassifiable. We present descriptive statistics across each category. RESULTS: Analysis of causality assessment completed for 1037 reports of serious AEFIs: 499 (48%) were causally associated, 84 (8%) were indeterminate, 323 (31%) were coincidental, and 131 (13%) were unclassifiable. Of the 499 reports in the A category, the events were causally linked to vaccine product for 189 (18%), to immunization error for 135 (13%), and to immunization anxiety for 175 (17%). Among 279 reported deaths, more than half (55%; n = 153) were coincidental events and 37% were unclassifiable. CONCLUSIONS: Causality assessment of AEFI cases is an important component of vaccination programs and post-marketing surveillance of vaccines. Field reporting and investigation of AEFIs can be improved for many severe or serious reports, most of which are not causally linked to the vaccination program.

Burden of Diabetes Related Complications Among Hypertensive and Non Hypertensive Diabetics: A Comparative Study.

BACKGROUND: Diabetes and hypertension are the conditions with overlapping risk factors and complications. Objective of present study was to compare the burden of complications of diabetes among hypertensive and non hypertensive diabetes individuals. MATERIALS AND METHODS: This cross-sectional study was conducted at Saveetha medical college and hospital, Chennai, India. A total of 100 diabetics having hypertension and 50 non-hypertensive diabetic patients were enrolled on the basis of purposive sampling. Information about sociodemograpic characteristics, general health, health distress, diabetes symptoms, communication with physician, healthcare utilization and lifetime occurrence of diabetes related complications. Mean, standard deviation and median of continuous variables and proportion of categorical variables were recorded. RESULTS: Average age of the hypertensive diabetes patients (M=57; SD=11) was higher than non hypertensive diabetes patients (M=52; SD=11) which was statistically significant (p=.009). Diabetic neuropathy was reported by 45% of the hypertensive and 38% of the non-hypertensive diabetics. Mean self reported general health score was higher among hypertensive diabetic participants (M=3.4; SD=1) in comparison to non hypertensive diabetic participants (M=3; SD=1) and it was found statistically significant (p=.03) indicating towards poor self health perception among hypertensive's. Results of the study have shown that the proportion of participants who have prepared any list of questions before visiting doctor's clinic (fairly often to always) was significantly higher among hypertensive diabetics (30%) in comparison to non-hypertensive diabetics (14%). CONCLUSION: The proportion of participants reporting diabetes neuropathy and retinopathy was higher among hypertensive diabetics in comparison to non hypertensive diabetics.

Evaluation of Dietary Choices, Preferences, Knowledge and Related Practices Among Pregnant Women Living in An Indian Setting.

INTRODUCTION: Healthy and nutritious diet is very essential component of Antenatal care along with clinical advice. The objective of this study was to understand the dietary choices, preferences, knowledge and related practices among pregnant women living in an Indian setting. MATERIALS AND METHODS: Hundred pregnant women were enrolled in this cross-sectional study. Information about Socio-demographic profile, food item price and approach during inflation, nutrition related knowledge, attitude and practices and 24 hour dietary recall was acquired. RESULTS: Majority of the participants (87%) reported regular antenatal care visits and intake of iron and folic acid tablets. Eighty two percent of the participants were acquainted with standardized marks on food items and 64% of them reported checking of these marks before purchasing. Thirty two percent of the participants did not know about balanced diet. Fifty eight percent of the participants felled in fair category of dietary recall final scores. CONCLUSION: There is still vast room for improvement of the nutritional status of pregnant women as none of the participants were able to achieve excellent status on 24 hour food record scoring sheet.

Assessment of burden of depression during pregnancy among pregnant women residing in rural setting of chennai.

INTRODUCTION: Depression during perinatal period leads to adverse pregnancy outcome and of child growth. Our study aimed to examine the burden of antenatal depression and associated risk factors among pregnant women living in rural settings of Chennai, a southern state of India. MATERIALS AND METHODS: A pilot cross-sectional study was conducted in the rural settings of Chennai, one of the Southern States of India during August through September 2013. Hundred pregnant women who agreed to participate were enrolled in this study. Edinburg postnatal depression scale was used to assess the depression level of the study participants. Information was also gathered about socio-demographics, obstetric and disease history, social support and marital satisfaction was gathered. Descriptive analysis was performed using univariate statistics to report means and standard deviations for the continuous variables and frequency distribution for the categorical variables. RESULTS: Majority of the participants (65%) had scored 13 or higher on the Edinburg Depression Scale reflecting high likelihood of depression. Majority of the participants (66%) had been bothered due to low feeling, depressed or hopelessness during the previous month. Enriched marital satisfaction scale (p=.025) had shown significant association with Edinburg depression scale. CONCLUSION: Pregnancy is very crucial period not only for mother but whole family. This study has shown very high frequency of depression among the participants. There is a need for a longitudinal study to design interventions that can address emerging burden of antenatal depression among pregnant women living in rural settings.

Urban rural comparisons of polycystic ovary syndrome burden among adolescent girls in a hospital setting in India.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is a multifaceted disorder characterized by varying clinical presentations. OBJECTIVE: The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. METHODS: A pilot cross-sectional study was conducted for a period of one month (August-September 2013) at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, n = 63) and rural (50%, n = 63) settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. RESULTS: Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements). Majority of the individuals with PCOS had an average age of 16 (SD = 2) (P = .02) years with an average age of menarche 12 years (SD = 1). CONCLUSION: The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants.

Perceptions of online lifestyle counseling among individuals living in rural India.

The burden of lifestyle related chronic diseases have increased in recent times. The objective of this pilot study was to explore perceptions about using online lifestyle counseling services among individuals living in rural settings in India. A pilot convenient sample of 100 individuals living in rural settings of Chennai with age 18 years and above was enrolled for the study. Information was gathered about socio-demographic characteristics, health behavior, current disease status; familiarity with technology and perceptions about online lifestyle counseling. The average age of the individuals was 34 years (SD=15). More than half of the individuals had access to computers at home and workplace. Individuals indentified various barriers for unable to obtain lifestyle counseling. Nearly 47% of the individuals were interested in obtaining online lifestyle counseling. There is an urgent need for evaluating the role of an online lifestyle counseling intervention among individuals living in rural settings.

Association between socio-demographics and alcohol dependence among individuals living in an Indian setting.

BACKGROUND: Alcohol use is on the rise worldwide and urgent steps are required to curb this growing burden of alcohol consumption. Alcohol drinking leads to serious social, physical and mental consequences. OBJECTIVE: The objective of this pilot study is to examine association between socio-demographics and severity of alcohol dependence among individuals obtaining treatment at alcohol de-addiction center. METHODS: This pilot cross sectional study was conducted in September 2013 in South India. A convenient sample of 100 participants was enrolled. Individuals aged 30 years and above, receiving treatment from de-addiction center and providing written informed consent were eligible for the study. A modified version of previously validated questionnaires was used for gathering information on socio-demographic characteristics, severity of alcohol dependence (using Alcohol Dependent Scale [ADS] and Short Alcohol Dependence Data questionnaire [SADD]), motivational incentives for alcohol quitting and challenges faced while quitting alcohol. RESULTS: All participants were males with mean age of 43 years (SD = 6.5 years). Significant association was seen between ADS and annual income (p = 0.001), education (p = 0.001), occupation (p < 0.0001) and work timing (p < 0.0001). Similar results were seen with SADD scores. Family support (100%) and health (60%) were reported to be the most important motivating factors for quitting alcohol. DISCUSSION: Results showed an urgent need of interventions that are family centered and focus on unskilled, less educated individuals having high work stress. Public health interventions should not only be home based, but should also include worksite awareness initiatives. A national policy is needed to promote alcohol quitting and to bring awareness regarding the consequences of alcohol consumption on individual's life.

Water and sanitation hygiene knowledge attitude practice in urban slum settings.

BACKGROUND: Access to improved drinking water, sanitation and hygiene is one of the prime concerns around the globe. This study aimed at assessing water and sanitation hygiene-related attitude and practices, and quality of water in urban slums of south Delhi, India. METHODOLOGY: This pilot cross sectional study was performed during July 2013 across four urban slums of South Delhi. A convenient sample of 40 participants was enrolled. A modified version of previously validated questionnaire was used to gather information on socio-demographics, existing water and sanitation facilities and water treatment practices. Water quality testing was additionally performed using hydrogen sulphide (H2S) vials. RESULTS: Average age of participants was 36 years (SD=10). 83% of the participants perceived gastrointestinal tract infection as the most important health problem. 75% of the participants did not use any method for drinking water treatment. 45% of the participants consumed water from privately-owned tube well/ bore well. Water shortage lasted two days or more (50%) at a stretch with severe scarcity occurring twice a year (40%). Females aged 15 years and above were largely responsible (93%) for fetching water from water source. 45% of the participants had toilets within their households. 53% of drinking water samples collected from storage containers showed positive bacteriological contamination. DISCUSSION: There is an urgent need to develop family centered educational programs that would enhance awareness about water treatment methods that are cost effective and easily accessible.