Understanding patients' mobility for treatment seeking in India.

Healthcare systems worldwide are grappling with the challenge of providing high-quality healthcare in the face of evolving disease patterns. India, like many other countries, faces a significant treatment gap for various curable impairments, non-communicable diseases (NCDs), and cardiovascular diseases (CVDs). To address their healthcare needs, individuals often relocate in search of better treatment options. However, no studies were conducted to understand the spatial mobility. This paper explores the determinants of spatial mobility for treatment in India using data from NSS 75th round (2017-2018). A total of 64,779 individual medical cases of different diseases were taken into consideration for our analysis. Fixed effect and multinomial regression models were used to understand diseases specific mobility for treatment. It was found that those with CVDs, NCDs, and disabilities are more prone to travel outside their district for medical care. Rural and economically disadvantaged individuals also tend to travel further for treatment. The key factors impacting treatment-seeking mobility include insurance coverage, hospital quality, cost of medicine, and cost of X-rays/surgeries. The study highlights the need for improved policies to address the gap between healthcare needs and infrastructure in India, with a focus on prioritizing the development of local healthcare facilities for disabilities, NCDs, and CVDs.

First Report of Anopheles annularis s.l., An. maculatus s.s., and An. culicifacies s.l. as Malaria Vectors and a New Occurrence Record for An. pseudowillmori and An. sawadwongporni in Alipurduar District Villages, West Bengal, India.

A comprehensive entomological survey was undertaken in Alipurduar District, West Bengal, from 2018 to 2020 and in 2022. This study was prompted by reported malaria cases and conducted across nine villages, seven Sub-Centres, and three Primary Health Centres (PHCs). Mosquitoes were hand-collected with aspirators and flashlights from human dwellings and cattle sheds during the daytime. Both morphological and molecular techniques were used for species identification. Additionally, mosquitoes were tested for Plasmodium parasites and human blood presence. Mosquito species such as An. barbirostris s.l., An. hyrcanus s.l., An. splendidus, and An. vagus were morphologically identified. For species like An. annularis s.l., An. minimus s.s., An. culicifacies s.l., and An. maculatus s.s., a combination of morphological and molecular techniques was essential. The mitochondrial cytochrome c oxidase gene subunit 1 (CO1) was sequenced for An. annularis s.l., An. maculatus s.s., An. culicifacies s.l., An. vagus, and some damaged samples, revealing the presence of An. pseudowillmori and An. fluviatilis. The major Anopheles species were An. annularis s.l., An. culicifacies s.l., and An. maculatus s.s., especially in Kumargram and Turturi PHCs. Plasmodium positivity was notably high in An. annularis s.l. and An. maculatus s.s. with significant human blood meal positivity across most species. Morphological, molecular, and phylogenetic analyses are crucial, especially for archived samples, to accurately identify the mosquito fauna of a region. Notably, this study confirms the first occurrence of An. pseudowillmori and An. sawadwongporni in West Bengal and implicates An. maculatus s.s., An. culicifacies s.l., and An. annularis s.l. as significant vectors in the Alipurduar region.

Social capital and well-being of the elderly 'left-behind' by their migrant children in India.

BACKGROUND: The study aims to examine the association between individual forms of social capital and the well-being of the elderly 'left-behind' parents and to determine if there is a gender difference within the possible relationship. METHODS: This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents 'left-behind' by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample's characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents' health outcomes. RESULTS: This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882-3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034-1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations. CONCLUSION: Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.

Exposure to indoor air pollution and the cognitive functioning of elderly rural women: a cross-sectional study using LASI data, India.

BACKGROUND: The majority of people in rural developing counties still rely on unclean and solid fuels for cooking, putting their health at risk. Adult and elderly women are most vulnerable due to prolonged exposure in cooking areas, and Indoor Air Pollution (IAP) may negatively impact their health and cognitive function. This study examines the effect of IAP on the cognitive function of middle-aged and elderly rural women in India. METHODS: The study utilized the data from the Longitudinal Ageing Study in India (LASI 2017-18, Wave-1). Bivariate analysis and multilevel linear regression models were applied to show the association between IAP and the cognitive abilities of rural women and results from regression were presented by beta coefficient (ß) with 95% confidence interval (CI). Confounding factors such as age, education, health risk behaviours, marital status, monthly per capita consumption expenditure (MPCE), religion etc. were adjusted in the final model. RESULTS: The study found that 18.71 percent of the rural women (n = 3,740) lived in Indoor Air Pollution exposed households. IAP was significantly found to be associated with the cognitive functional abilities among the middle and older aged rural women. Middle and older aged rural women exposed to IAP had lower cognitive functional abilities than non-exposed women. Comparing to the non-exposed group, the cognitive score was worse for those exposed to IAP in both the unadjusted (ß = -1.96; 95%CI: -2.22 to -1.71) and the adjusted (ß = -0.72; 95%CI: -0.92 to -0.51) models. Elderly rural women from lower socioeconomic backgrounds were more likely to have cognitive impairment as a result of IAP. CONCLUSION: Findings revealed that IAP from solid fuels could significantly affect the cognitive health of elderly rural women in India, indicating the need for immediate intervention efforts to reduce the use of solid fuels, IAP and associated health problems.

Trends and determinants in the utilization of maternal healthcare services in West Bengal, India: Findings from the 3rd and 4th round National Family and Health Survey.

BACKGROUND: Proper utilization of recommended healthcare services during the pregnancy is considered as critically important for better pregnancy outcomes, as well as a good health status of the mother. OBJECTIVE: The aim of the current study was to trace the trend in progress, and what are factors associated with the attendance at four Antenatal Care (ANC) visits, receive full ANC and institutional delivery in the study area. RESEARCH DESIGN/SETTING: The study has used a cross-sectional secondary data of the 3rd and 4th round National Family and Health Survey (NFHS) for India conducted in 2005-06 and 2015-2016 respectively. For West Bengal, a total of 6794 in 2005-06 and 17,668 in 2015-2016 ever-married women aged 15-49 who had experienced at least one live birth in the past five years preceding the survey were covered in this study. To analyze the data, the chi-square test was performed as it allows researcher to assess the association between outcome variables and independent variables. The univariate descriptive and multivariate statistical tools have been applied to analyse the data in this study. RESULTS: Our study indicated that the progress rate in attending at least four antenatal care visits, institutional delivery considerably good, but a noticeable gap exists across the different socio-economic groups. The coverage of full ANC services has remained very poor and unchanged over the decade. It was concluded that the wealth status of the households significant predictor of the attendance at least four ANC visits, full ANC and Institutional delivery in West Bengal. Other statistically significant socio-economic and demographic factors include level of women education, age of women, exposure to mass media, place of residence, and number of parities of birth. CONCLUSION: The present study suggests that the increasing strength in the coverage of all maternal healthcare services could be a significant focus during the program implementation in West Bengal. For strengthening and ascertaining the universal coverage of maternal healthcare services, there is an urgent need to reduce socioeconomic inequity in uses of the recommended maternal healthcare services. Moreover, our study found that the socio-economic and demographic factors play a significant role in utilization of maternal healthcare services. Thus the promotion of women education, empowerment and autonomy, and the frequent social marketing of government schemes and programs on maternal healthcare through the various types of mass media should be the unique future steps for achieving the universal coverage of maternal service in West Bengal.

Determinants of hand-hygiene practices in India: reflections from the 76th round National Sample Survey, 2018.

This paper studies the differences and determinants of handwashing practices in India and identifies sections of the population with poor handwashing practices who are relatively more vulnerable during the COVID-19 pandemic. We have used the data from the recent National Sample Survey (NSS, 76th round) for India (2018). Bivariate and logistic regression analyses have been performed to predict the determinants of handwashing practices across states and socio-economic groups. Levels of education of the household head, Usual Monthly Per Capita Expenditure (UMPCE) of the household, access to water (other than drinking water) resources and sanitation facilities, and the availability of water with soap in and around latrines are major socio-economic and demographic factors that impact handwashing practices. Higher access to principal sources of water for drinking and other purposes, access to bathrooms and latrines with soap, and the availability of water in or around latrines increase the likelihood of handwashing among the people. Universal handwashing across different sections of the population will be effective to prevent further infection. The available data help us to identify the vulnerable sections of the population which are towards the lower end of the handwashing compliance spectrum. The policymakers can outline specific planning and strategy implementation for them.