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Balla S, Sk MIK, Ambade M, Hossain B. Distress financing in coping with out-of-pocket expenditure for maternity care in India. BMC Health Serv Res 2022; 22:288. [PMID: 35241077 PMCID: PMC8892690 DOI: 10.1186/s12913-022-07656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background The cost of maternity care is seen as the barrier in utilizing maternity care, resulting in high maternal deaths. This study focuses on the distress financing and its coping mechanisms associated with maternity care expenditure in India so that corrective measures can be taken to reduce the burden of maternity care. Methods This study used the National Sample Survey (NSS) data conducted in 20,014–15 (71st round of NSS) and 2017–18(75th round of NSS). We define distress financing as use of formal borrowing, borrowing from friends or family or sale of asser to finance maternity care. Percentage of pregnant/delivered females using distress financing were calculated.. The present study also used multinomial logistic regression with 95% to understand the impact of socio-economic variables on distress financing and concentration index to measure the inequality in maternity care expenditure. Results This study found that the maternity care expenditure has decreased from the INR. 9379 in 2014–15 to INR. 7835 in 2017–18. The percentage of households using distress financing is higher among the poorest (13.2%). Almost 14% of the SC households experience distress financing. Among EAG + A states, particularly in Madhya Pradesh and Uttarakhand, the percentage of households are which experience a high level of distress financing increased from 8.9 to 18.3 and 0.7 to 8.1 from 2014–15 to 2017–18 respectively. The study finds that more urban households (37%) utilized insurance than rural households (26%). Among EAG + A states, 67.9 percent of households were dependent upon household savings, and it was 63.6 percent in the non-EAG states. The households with a high burden of maternity care expenditure were at higher risk of borrowing money to finance the cost of maternity as compared to use of savings/income for the same (relative risk (RR) (R: 2.59; P < 0.01; 95% CI: 2.15–3.13). Mothers belonging to the SC caste were at significantly higher risk (RR: 1.43; P < 0.1; 95% CI: 1.07–1.91). of using borrowings as compared to the use of income/savings. Mothers with college education were 50% more likely to use health insurance as compared to those with primary education. Conclusions The study found that even though many programs for maternity care services are there, the maternity care expenditure, particularly the delivery care expenses, is very high in many states. The study recommends that India should increase subsidized maternity care facilities to decrease catastrophic maternity expenditure among households.
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Affiliation(s)
- Shalem Balla
- International Institute for Population Sciences, Mumbai, 400 088, India
| | | | - Mayanka Ambade
- International Institute for Population Sciences, Mumbai, 400 088, India
| | - Babul Hossain
- International Institute for Population Sciences, Mumbai, 400 088, India
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Lucas IM, Barr ELM, Barzi F, Longmore DK, Lee IL, Kirkwood M, Whitbread C, Connors C, Boyle JA, Simon D, Goodrem A, Brown ADH, Oats J, McIntyre HD, Shaw JE, Maple-Brown L. Gestational diabetes is associated with postpartum hemorrhage in Indigenous Australian women in the PANDORA study: A prospective cohort. Int J Gynaecol Obstet 2021; 155:296-304. [PMID: 34328645 DOI: 10.1002/ijgo.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess associations of hyperglycemia in pregnancy with the risk of postpartum hemorrhage (PPH) in a prospective cohort of Indigenous and non-Indigenous women, compared with normoglycemia. METHODS Data were from 1102 (48% Indigenous) women of the Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Age-adjusted associations of gestational diabetes mellitus (GDM) or pre-existing type 2 diabetes mellitus (T2DM), obstetric and demographic covariables with PPH (blood loss ≥500 ml) were assessed using logistic regression. Multivariable-adjusted models included Indigenous ethnicity, diabetes type and their interaction. RESULTS A higher proportion of Indigenous women developed PPH than non-Indigenous women (32% versus 22%; P < 0.001). Compared with non-Indigenous women with normoglycemia, risks of PPH for Indigenous women with GDM or T2DM were higher (odds ratio [OR] 1.83, 95% confidence intervals [CI] 1.11-3.02, and OR 1.72, 95% CI 0.99-3.00 after age adjustment, OR 1.84, 95% CI 1.06-3.19, and OR 1.33, 95% CI 0.70-2.54 after adjustment for school education and delivery mode, and OR 1.62, 95% CI 0.95-2.77, and OR 0.99, 95% CI 0.53-1.86 after adjustment for birth weight). Importantly, Indigenous women without hyperglycemia in pregnancy were not at increased risk of PPH. CONCLUSION The significantly higher rates of PPH experienced by Indigenous women compared with non-Indigenous women may be explained by a greater effect of GDM among Indigenous women that was only partly accounted for by birth weight.
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Affiliation(s)
- Isabelle M Lucas
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Obstetrics & Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth L M Barr
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Danielle K Longmore
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Paediatrics, Western Health, Melbourne, Victoria, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Connors
- Population & Primary Health, Top End Health Service, Darwin, Northern Territory, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Simon
- Department of Obstetrics & Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Adeliesje Goodrem
- Midwifery Group Practice, Top End Health Service, Darwin, Northern Territory, Australia
| | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,The University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Harold D McIntyre
- Mater Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Sadov RI, Panova IA, Nazarov SB, Kuzmenko GN, Klycheva MM. [Changes in the indicators of thromboelastography and platelet function in pregnant women with various forms of hypertensive disorders in the third trimester of pregnancy.]. Klin Lab Diagn 2020; 65:281-288. [PMID: 32298543 DOI: 10.18821/0869-2084-2020-65-5-281-288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022]
Abstract
The aim of this research is the study of haemostasis of pregnant women suffering from various forms of hypertensive disorders in their III trimester of pregnancy. 165 women at 26-41 weeks of pregnancy were examined: 22 women had moderate preeclampsia, 31 had severe preeclampsia, 45 women suffered from chronic hypertension, 20 women have developed preeclampsia on the background of chronic hypertension and 47 women had no hypertensive disorders (control group). The hemostasis system has been assessed using the results of the following investigations: thromboelastography, induced platelet aggregation with ADP and adrenaline at a dosage of 1.25 and 2.5 μg/ml respectively and collagen at a dosage of 20 mg/ml, platelet ATP secretion and the average concentration of platelet components. Thromboelastography has been performed using TEG® 5000 thromboelastograph (Haemoscope Corporation, USA). The study of platelet aggregation and platelet ATP secretion has been performed at automatic aggregometer CHRONO-LOG® Model 700 (USA). The mean platelet component concentration has been measured using SIEMENS ADVIA 2120i automated hematology analyzer (Siemens Healthcare Diagnostics Inc., USA). Thromboelastogram analysis showed a decrease in the plasma hemostasis activity in all groups of women with hypertensive disorders. The functional activity of platelets of women with moderate preeclampsia and chronic arterial hypertension did not change in comparison with to the control group. The disorder of dense platelet granules degranulation and decrease in their aggregation ability have been detected in a cohort with severe preeclampsia. The decrease in adrenaline induced platelet aggregation has been noted in the group of women suffering from preeclampsia on the background of chronic arterial hypertension. Thromboelastography analysis (R, K, angle α, TMA, Cl, LY30) may be useful for the differential diagnosis of severe preeclampsia and chronic arterial hypertension. The results of the study led to the conclusion that it is advisable to use low doses of ADP and adrenaline as inducers of platelet aggregation, considering their granulocyticity and the ability to secrete ATP.
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Affiliation(s)
- R I Sadov
- Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation
| | - I A Panova
- Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation
| | - S B Nazarov
- Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation
| | - G N Kuzmenko
- Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation
| | - M M Klycheva
- Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation
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