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Eikenbary B, Devaraju P, Chakkravarthi A, Sihag KK, Nathan T, Thangaraj G, Srinivasan L, Kumar A. A molecular survey of zoonotic pathogens of public health importance in rodents/shrews and their ectoparasites trapped in Puducherry, India. Trans R Soc Trop Med Hyg 2024; 118:616-624. [PMID: 38768316 DOI: 10.1093/trstmh/trae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/18/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Globally, India has a high zoonotic disease burden and lacks surveillance data in humans and animals. Rodents are known reservoirs for many zoonotic diseases and their synanthropic behavior poses a great public health threat. METHODS In this study, trapped rodents/shrews from randomly selected villages within Puducherry, India, and their ectoparasites were screened for zoonotic pathogens, namely, Orientia tsutsugamushi, other pathogenic rickettsiae, Leptospira spp., Cryptosporidium spp., Coxiella burnetii and methicillin-resistant Staphylococcus aureus (MRSA) using conventional PCR. A total of 58 rodents/shrews were trapped from 11 villages. The species trapped were Suncus murinus (49/58, 84.48%), Rattus rattus (8/58, 13.79%) and Rattus norvegicus (1/58, 1.72%). All ectoparasites collected were identified as mites and its infestation rate was 46.55% (27/58). RESULTS Real-time PCR targeting the 47 kDa gene of O. tsutsugamushi revealed positivity in one rodent and one shrew (3.45%) and two mite pools (7.41%). Conventional PCR targeting the 56 kDa gene revealed positivity in one shrew and two mite pools and the phylogenetic analysis of all three amplicons indicated the circulation of the Gilliam-related serotype. MRSA was detected in the alimentary tract of a shrew (1/32, 3.13%). Leptospira spp., Rickettsia, Cryptosporidium spp. and Co. burnetii tested negative. CONCLUSIONS The detection of zoonotic pathogens within reservoir hosts and vectors poses a risk of transmission to humans. This study signifies the need for zoonotic pathogen surveillance in synanthropic rodents/shrews.
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Affiliation(s)
- Brenna Eikenbary
- Department of Global Health, Georgetown University, Washington DC, 20057, USA
| | - Panneer Devaraju
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | | | - Krishan Kumar Sihag
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Terence Nathan
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Gowdham Thangaraj
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Lakshmy Srinivasan
- Unit of One Health, ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre (ICMR-VCRC), Puducherry 605006, India
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Kuttiatt VS, Rahul A, Choolayil A, Kumar A. Advancing Equity in Health Care Among Dalits and Tribal People in India: The Progress, Current Realities, and the Way Forward. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241268179. [PMID: 39106365 DOI: 10.1177/27551938241268179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective.
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Affiliation(s)
- Vijesh Sreedhar Kuttiatt
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India, Puducherry, India
| | - Arya Rahul
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India, Puducherry, India
| | - Anoop Choolayil
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India, Puducherry, India
| | - Ashwani Kumar
- ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health and Family Welfare, Government of India, Puducherry, India
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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Das B, Adhikary M, Singha SR, Parmar D. Who is Anaemic in India? Intersections of class, caste, and gender. J Biosoc Sci 2024; 56:731-753. [PMID: 38831724 DOI: 10.1017/s0021932024000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Anaemia severely impacts physical and mental abilities, raises health risks, and diminishes the quality of life and work capacity. It is a leading cause of adverse pregnancy outcomes and maternal mortality, especially in developing nations like India, where recent data on anaemia from National Family and Health Survey (NFHS-4) (2015-16) and NFHS-5 (2019-21) indicate a tremendous rise. Anaemia is a marker of poor nutrition and health, and socio-economic factors such as gender norms, race, income, and living conditions influence its impact. As a result, there are disparities in how anaemia affects different segments of society. However, existing research on health inequity and anaemia often employs a single-axis analytical framework of social power. These studies operate under the assumption that gender, economic class, ethnicity, and caste are inherently distinct and mutually exclusive categories and fail to provide a comprehensive understanding of anaemia prevalence. Therefore, the study has adopted the theoretical framework of intersectionality and analysed the NFHS-5 (2019-21) data using bivariate cross-tabulations and binary logistic regression models to understand how gender, class, caste, and place of residence are associated with the prevalence of anaemia. The results suggest that the women of Scheduled Tribes (ST) and Scheduled Castes (SC) share a disproportionate burden of anaemia. This study confirms that economic class and gender, geographical location, level of education, and body mass index significantly determine the prevalence of anaemia. The ST and SC women who are economically marginalised and reside in rural areas with high levels of poverty, exclusion, and poor nutritional status have a higher prevalence of anaemia than other population groups. Thus, the study suggests that intersections of multiple factors such as caste, class, gender, and place of residence significantly determine 'who is anaemic in India'.
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Affiliation(s)
- Bikash Das
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
| | - Mihir Adhikary
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Smriti Rekha Singha
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
| | - Daksha Parmar
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
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Javed W, Mumtaz Z. South Asia's unprotected poor: A systematic review of why social protection programs fail to reach their potential. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002710. [PMID: 38870219 PMCID: PMC11175495 DOI: 10.1371/journal.pgph.0002710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
The incongruity between South Asia's economic growth and extreme poverty has led to a growing interest in social protection and subsequent implementation of anti-poverty initiatives. However, many programs have consistently fallen short of their full potential in reaching the poor. We reviewed the literature to understand the factors behind this failure. A search of EconLit, Global Health Database, MEDLINE and SocINDEX, supplemented by an external search, yielded 42 papers evaluating 23 programs. Inclusion criteria included social and political determinants of program outcomes. Articles were assessed for quality using the GRADE and GRADE CERQual criteria and analyzed using Thomas & Harding's thematic synthesis approach. We identified five themes: (1) structurally flawed program theories overlook the complexities of poverty and are rooted in simplistic cause-and-effect approaches; (2) elite capture through appropriation of benefits, powerful positioning in program implementation, and gatekeeping through relationships of patronage; (3) insufficient targeting strategies to reach the poorest; (4) neglect of gendered restrictions, hidden costs, lack of legal documentation, and physical and social exclusion; (5) active self-exclusion from social protection to maintain dignity, a perception that programs are substandard, and a lack of resources required. The review highlights the well-documented disconnect between South Asian social protection program designs and the ground realities of their 'ideal' beneficiaries. This stems from a dominance of Western-led poverty discourse that disregards the influence of caste, the challenge of effective engagement with a group whose identity remains unclear, and fast-paced funding calls that do not lend themselves to meaningful identification and collaboration with the invisible poor. We suggest this disconnect is intentional and reflects a broader power dynamic rooted in geopolitical interests and national priorities. Study limitations reflect the shortcomings of the existing literature, which largely uses quantitative research methods that fail to capture the multidimensional experiences of the poor.
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Affiliation(s)
- Warda Javed
- School of Public Health, University of Alberta, 3–309 Edmonton Clinic Health Academy, Edmonton, Canada
| | - Zubia Mumtaz
- School of Public Health, University of Alberta, 3–309 Edmonton Clinic Health Academy, Edmonton, Canada
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Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review. BMC Womens Health 2024; 24:325. [PMID: 38840156 PMCID: PMC11151574 DOI: 10.1186/s12905-024-03177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND The preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs). METHODS In this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O'Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method. RESULTS The main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services. CONCLUSIONS The evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.
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Affiliation(s)
- Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Seyede Maryam Najibi
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Razavi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
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Mayra K, Matthews Z, Sandall J, Padmadas SS. "I have to listen to them or they might harm me" and other narratives of why women endure obstetric violence in Bihar, India. Birth 2024. [PMID: 38840384 DOI: 10.1111/birt.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India. METHODS Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12. FINDINGS Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) "I am admitted under your care, so, I will have to do what you say"-Influence of power on care during childbirth; (2) "I was blindfolded … because there were men"-Influence of gender on care during childbirth; (3) "The more money we give the more convenience we get"-Influence of structure on care during childbirth; and (4) "How could I ask him, how it will come out?"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth. DISCUSSION Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.
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Affiliation(s)
- Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoë Matthews
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, UK
| | - Sabu S Padmadas
- Department of Social Statistics and Demography, Faculty of Social Sciences, University of Southampton, Southampton, UK
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Chayal V, Sagar V, Verma R, Kalhan M, Agrawal G, Sasidharan SK, Satija J, Jangra A, Punyani P, Arora H, Singh Y, Sharma D, Singmar A. Husband's involvement in utilization of maternal health services by their spouse in district Rohtak, Haryana. J Family Med Prim Care 2024; 13:2272-2277. [PMID: 39027839 PMCID: PMC11254083 DOI: 10.4103/jfmpc.jfmpc_1153_23] [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: 07/15/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 07/20/2024] Open
Abstract
Introduction Husband and wife as a couple are fully responsible for their current and future. In our society, the husband is mostly responsible for making the decision regarding any expenses. In India, there is a need to reduce the maternal mortality rate, and Husband's involvement in antenatal care could be a key to success as it will enable them to support their partner in adequate preparation for birth and to utilize emergency obstetric care early if complications arise. Aim and Objectives To find out about male involvement in the utilization of maternal healthcare services by their spouse and various factors affecting male involvement in the utilization of maternal healthcare services. Methods This study was conducted in urban and rural field practice areas attached to the Department of Community Medicine, PGIMS, Rohtak. The study included 400 couples where 200 each were recruited from rural and urban areas. Out of 17 subcenters under CHC Chiri eight, subcenters were selected randomly by lottery method. A line list of these couples was prepared at each subcenter using ANC and birth register. Couples were enrolled from this line list till a sample size of 25 was reached at each of these eight subcenters. In this way, a total of 200 couples were enrolled from rural areas in which women delivered and availed maternal health services in the last 6 months. In urban areas, an equal number of couples were enrolled from each of these three urban health posts till the sample size of 200 was reached in an urban area. Results The majority of the husbands (73%) reported that they participated in their wives' utilization of maternal health services. Twenty-seven percent did not participate in their wives' utilization of maternal health services. It also showed that 71.0% of the husbands did not know about the investigations that needed to be performed during a woman's pregnancy. Only 29% were aware of it. On analysis, it was observed that 73% of the husbands had good participation in their spouses' maternal and child health (MCH) care, while the rest had poor participation (27%). It also showed that as the education level of the participants' husbands increased, their participation in their spouses' MCH care increased, with the highest being observed among graduates (91.3%) and the lowest among those with primary schooling level education (66.7%) which were statistically significant.
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Affiliation(s)
- Vinod Chayal
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Vidya Sagar
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Meenakshi Kalhan
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Ginni Agrawal
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | | | - Jitesh Satija
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Annpurna Jangra
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Priya Punyani
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Himani Arora
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Yogender Singh
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Divya Sharma
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
| | - Achchhesh Singmar
- Department of Community Medicine, Pt. B.D Sharma PGIMS, Rohtak, Haryana, India
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Ziegler S, Srivastava S, Parmar D, Basu S, Jain N, De Allegri M. A step closer towards achieving universal health coverage: the role of gender in enrolment in health insurance in India. BMC Health Serv Res 2024; 24:141. [PMID: 38279165 PMCID: PMC10821565 DOI: 10.1186/s12913-023-10473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/12/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND There is limited understanding of how universal health coverage (UHC) schemes such as publicly-funded health insurance (PFHI) benefit women as compared to men. Many of these schemes are gender-neutral in design but given the existing gender inequalities in many societies, their benefits may not be similar for women and men. We contribute to the evidence by conducting a gender analysis of the enrolment of individuals and households in India's national PFHI scheme, Rashtriya Swasthya Bima Yojana (RSBY). METHODS We used data from a cross-sectional household survey on RSBY eligible families across eight Indian states and studied different outcome variables at both the individual and household levels to compare enrolment among women and men. We applied multivariate logistic regressions and controlled for several demographic and socio-economic characteristics. RESULTS At the individual level, the analysis revealed no substantial differences in enrolment between men and women. Only in one state were women more likely to be enrolled in RSBY than men (AOR: 2.66, 95% CI: 1.32-5.38), and this pattern was linked to their status in the household. At the household level, analyses revealed that female-headed households had a higher likelihood to be enrolled (AOR: 1.36, 95% CI: 1.14-1.62), but not necessarily to have all household members enrolled. CONCLUSION Findings are surprising in light of India's well-documented gender bias, permeating different aspects of society, and are most likely an indication of success in designing a policy that did not favour participation by men above women, by mandating spouse enrolment and securing enrolment of up to five family members. Higher enrolment rates among female-headed households are also an indication of women's preferences for investments in health, in the context of a conducive policy environment. Further analyses are needed to examine if once enrolled, women also make use of the scheme benefits to the same extent as men do. India is called upon to capitalise on the achievements of RSBY and apply them to newer schemes such as PM-JAY.
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Affiliation(s)
- Susanne Ziegler
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Friedrich-Ebert-Allee 32+36, 53113, Bonn, Germany.
| | - Swati Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Divya Parmar
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Sharmishtha Basu
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, B5/1 Safdarjung Enclave, 110029, New Delhi, India
| | - Nishant Jain
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, B5/1 Safdarjung Enclave, 110029, New Delhi, India
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Neethi Mohan V, Shirisha P, Vaidyanathan G, Muraleedharan VR. Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 - an analysis of Tamil Nadu and Chhattisgarh. BMC Pregnancy Childbirth 2023; 23:622. [PMID: 37649006 PMCID: PMC10466745 DOI: 10.1186/s12884-023-05928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The prevalence of C-sections in India increased from 17.2% to 2006 to 21.5% in 2021. This study examines the variations in C-section prevalence and the factors correlating to these variations in Tamil Nadu (TN) and Chhattisgarh (CG). METHODS Delivery by C-section as the outcome variable and several demographic, socio-economic, and clinical variables were considered as explanatory variables to draw inferences from unit-level data from the National Family Health Survey (NFHS-4; 2015-16 and NFHS-5; 2019-21). Descriptive statistics, bivariate percentage distribution, Pearson's Chi-square test, and multivariate binary logistic regression models were employed. The Slope Index of Inequality (SII) and the Concentration Index (CIX) were used to analyse absolute and relative inequality in C-section rates across wealth quintiles in public- and private-sector institutions. RESULTS The prevalence of C-sections increased across India, TN and CG despite a decrease in pregnancy complications among the study participants. The odds of caesarean deliveries among overweight women were twice (OR = 2.11; 95% CI 1.95-2.29; NFHS-5) those for underweight women. Women aged 35-49 were also twice (OR = 2.10; 95% CI 1.92-2.29; NFHS-5) as likely as those aged 15-24 to have C-sections. In India, women delivering in private health facilities had nearly four times higher odds (OR = 3.90; 95% CI 3.74-4.06; NFHS-5) of having a C-section; in CG, the odds were nearly ten-fold (OR = 9.57; 95% CI:7.51,12.20; NFHS-5); and in TN, nearly three-fold (OR = 2.65; 95% CI-2.27-3.10; NFHS-5) compared to those delivering in public facilities. In public facilities, absolute inequality by wealth quintile in C-section prevalence across India and in CG increased in the five years until 2021, indicating that the rich increasingly delivered via C-sections. In private facilities, the gap in C-section prevalence between the poor (the bottom two quintiles) and the non-poor narrowed across India. In TN, the pattern was inverted in 2021, with an alarming 73% of the poor delivering via C-sections compared to 64% of those classified as non-poor. CONCLUSION The type of health facility (public or private) had the most impact on whether delivery was by C-section. In India and CG, the rich are more likely to have C-sections, both in the private and in the public sector. In TN, a state with good health indicators overall, the poor are surprisingly more likely to have C-sections in the private sector. While the reasons for this inversion are not immediately evident, the implications are worrisome and pose public health policy challenges.
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Affiliation(s)
- Varshini Neethi Mohan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India.
| | - P Shirisha
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - Girija Vaidyanathan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
| | - V R Muraleedharan
- Department of Humanities and Social Sciences, Indian Institute of Technology Madras (IIT Madras), Chennai, 600 036, Tamil Nadu, India
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Singh A, Kumar V, Singh H, Chowdhury S, Sharma S. Assessing the coverage of full antenatal care among adolescent mothers from scheduled tribe and scheduled caste communities in India. BMC Public Health 2023; 23:798. [PMID: 37127687 PMCID: PMC10150462 DOI: 10.1186/s12889-023-15656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India. DATA AND METHODS Data from the fourth round of the National Family Health Survey 2015-16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have 'full ANC' only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC. RESULTS The utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044-0.459), household wealth (OR = 5.505, CI = 1.804-16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241-2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917-6.664). CONCLUSION In conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes.
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Affiliation(s)
- Aditya Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- External Research Collaborator, Girl Innovation, Research and Learning (GIRL) Centre, Population Council, New York, USA
| | - Vineet Kumar
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
| | - Harpreet Singh
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sourav Chowdhury
- Department of Geography, Raiganj University, Raiganj, West Bengal, India
| | - Sanjana Sharma
- Department of Geography, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Kandula NR, Islam N, Needham BL, Ahmed N, Thorpe L, Kershaw KN, Chen E, Zakai NA, Kanaya AM. A multilevel framework to investigate cardiovascular health disparities among South Asian immigrants in the United States. Ann Epidemiol 2023; 81:24-30.e1. [PMID: 36898570 PMCID: PMC10101928 DOI: 10.1016/j.annepidem.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Prior studies of cardiovascular health (CVH) disparities among immigrants of South Asian origin in the United States have examined South Asians as one homogenous group, focused primarily on Indian-origin immigrants, and examined risk at the individual level. METHODS We present current knowledge and evidence gaps about CVH in the three largest South Asian-origin populations in the United States-Bangladeshi, Indian, and Pakistani-and draw on socioecological and lifecourse frameworks to propose a conceptual framework for investigating multilevel risk and protective factors of CVH across these groups. RESULTS The central hypothesis is that CVH disparities among South Asian populations exist due to differences in structural and social determinants, including lived experiences like discrimination, and that acculturation strategies and resilience resources (e.g., neighborhood environment, education, religiosity, social support) ameliorate stressors to act as health protective factors. RESULTS Conclusions: Our framework advances conceptualization of the heterogeneity and drivers of cardiovascular disparities in diverse South Asian-origin populations. We present specific recommendations to inform the design of future epidemiologic studies on South Asian immigrant health and the development of multilevel interventions to reduce CVH disparities and promote well-being.
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Affiliation(s)
- Namratha R Kandula
- Department of Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL; Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL.
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor
| | - Naheed Ahmed
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Lorna Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine Northwestern University, Chicago, IL
| | - Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Chicago, IL
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington; Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington
| | - Alka M Kanaya
- Department of Medicine, Epidemiology & Biostatistics, University of California, San Francisco
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Sushil P, Chawla JK, Parasher RK. Coexistence of Biopsychosocial Factors With Lumbopelvic Pain in Indian Women: A Systematic Review. Cureus 2023; 15:e36937. [PMID: 37131563 PMCID: PMC10148965 DOI: 10.7759/cureus.36937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
In general, women appear to report lumbopelvic pain (LPP) more frequently. In addition to the biomechanical risks, this systematic review aimed to identify the add-on biopsychosocial implications of LPP among women in the Indian community. PubMed, ScienceDirect, Web of Science, PEDro, and Google Scholar were searched twice from inception to a final systematic literature search in December 2022. All studies addressing Indian women with LPP were selected. Studies on non-musculoskeletal LPP were excluded. Qualities of non-experimental and experimental research articles were assessed through the Critical Appraisal Skills Programme (CASP) checklist and Cochrane risk of bias criteria for Effective Practice and Organization of Care reviewsrespectively. Data synthesis was narrative as the selected studies differed substantially. Habitual squatting, kneeling, and continuous sitting were identified as ergonomic risks to LPP. Menopause, cesarean, and multiple deliveries influence the onset of LPP among women. There is a severe deficit in data about the musculoskeletal implications of LPP. There are insufficient data present to summarize the biopsychosocial risks of LPP. Even the exact anatomical sites of LPP were not described in most articles. Due to the severe scarcity of data, there is an alarming need to explore the musculoskeletal as well as psychosocial consequences of LPP in Indian women. Among rural women, LPP was common in those working as laborers; which are physically robust jobs with respect to strength and anthropometrics of women. Domestic chores in India involve a lot of manual work; placing unequal loads on the lumbar spine, eventually resulting in LPP. Therefore ergonomic strategies for women should be designed to meet the needs and demands of their respective occupations as well as domestic chores.
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Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Paul PL. Male partners' role in maternal health service utilization: a secondary analysis using 2015-16 National Family Health Survey (NFHS) data. Midwifery 2022; 113:103423. [PMID: 35870227 DOI: 10.1016/j.midw.2022.103423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE While prior research has documented several socio-demographic and policy level determinants of maternal health service utilization, the influence of partners and family on women's decisions to use maternal health services has received limited attention. This study focuses on the role of male partners in antenatal care, and examines the association between male partner attendance at antenatal care and maternal health service utilization. DESIGN Cross-sectional observational study. SETTING India. PARTICIPANTS This study utilized data from the 2015-16 National Family Health Survey (NFHS-4). Of all the ever-married women who had at least one live birth in the past five years, a total number of 144,840 respondents were included for the analysis on antenatal care utilization and 146,378 respondents were included for the analysis on institutional delivery. MEASUREMENTS The key dependent variables used for the study were timing and frequency of antenatal care, and institutional delivery; while the primary independent variable for the study was male partner attendance in antenatal care. Weighted descriptive statistics and multivariable logistic regression models were constructed to examine the association between male partner attendance in antenatal care and maternal health service utilization, controlling for participants' sociodemographic characteristics. RESULTS Controlling for all socio-demographic variables, the results showed that women who were accompanied by a male partner during antenatal care contacts were 18% more likely to report initiating antenatal care in the first trimester (OR= 1.18, 95% CI [1.13- 1.23]), 72% more likely to report having 4 or more antenatal care contacts (OR= 1.72, 95% CI [1.64 - 1.80]), 45% more likely to report having 8 or more antenatal care contacts during their pregnancy (OR= 1.45, CI [1.35 - 1.55]) and 40% more likely to have an institutional delivery (OR= 1.40, 95% CI [1.34 - 1.48). KEY CONCLUSIONS Few studies have examined the role of partners and family in influencing women's maternal health service utilization. The results of this study add to the growing knowledge base in the area of male partner involvement in maternal care by demonstrating that male partner attendance in antenatal care is positively associated with maternal health service utilization. IMPLICATIONS FOR PRACTICE These results provide support for interventions that aim at a gender transformative approach to maternal health. Engaging with male partners and educating them in antenatal care could lead to improved knowledge levels among the couple, and increased support and access to maternal health services.
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Affiliation(s)
- Pooja L Paul
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden.
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Beckingham A, Downe S, Fernandez E, Reed B, Kaur I, Aziz N, Kingdon C. Implementing Professional Midwife-Led Maternity Care in India for Healthy Pregnant Women: A Community Case Study. Front Public Health 2022; 10:875595. [PMID: 35757640 PMCID: PMC9221983 DOI: 10.3389/fpubh.2022.875595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
More women and neonates die each year in India than in almost every other country of the world. Since 1947, India has in principle provided free medical maternal health care to all pregnant and childbearing women. Although rates of maternal and neonatal deaths have fallen since the 1990s, major inequalities remain. Some Indian States have very high rates of interventions, (e.g., cesarean section), while others have intervention and care rates that are too low. Disrespectful treatment of women in labor and lack of evidence-based practice have also been reported. The World Health Organization and others have strongly recommended that professional midwives (trained in a woman-centered philosophy and to international standards) have a key role for reducing mortality and morbidity, minimizing unnecessary interventions in pregnancy and labor, and improving maternal care quality in low- and medium-income countries. This paper provides a community case-report of the first professional midwifery programme in India designed to international standards, implemented in 2011 in Hyderabad. We describe the design and implementation in the programme's first eleven years, as a basis for further scale-up and testing in India, and in other low- or medium-income countries. The ultimate aim is to improve maternal care quality, choice and outcomes in India and in similar socio-economic and cultural settings.
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Affiliation(s)
| | - Soo Downe
- UCLan THRIVE Centre, Research in Childbirth and Health (ReaCH) Unit, University of Central Lancashire, Preston, United Kingdom
| | | | | | | | | | - Carol Kingdon
- UCLan THRIVE Centre, Research in Childbirth and Health (ReaCH) Unit, University of Central Lancashire, Preston, United Kingdom
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Mayra K, Sandall J, Matthews Z, Padmadas SS. Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India. BMC Pregnancy Childbirth 2022; 22:318. [PMID: 35421943 PMCID: PMC9009281 DOI: 10.1186/s12884-022-04503-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. Objective 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women’s expectations of respectful care. Methods ‘Body mapping’, an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis. Findings Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt ‘good’ and ‘bad’. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy. Discussion The body maps capturing birth experiences, created through a participatory method, accurately portray women’s respectful and disrespectful births and are useful to understand women’s experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women’s choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04503-7.
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Mahajan N, Kaur B. Utilization of Postnatal Care among Rural Women in Punjab. Indian J Community Med 2021; 46:126-129. [PMID: 34035592 PMCID: PMC8117905 DOI: 10.4103/ijcm.ijcm_121_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 08/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background: The postchildbirth period presents considerable challenges in the form of health risks for the mother and the newborn, yet postnatal care (PNC) remains seldom utilized maternal and newborn health intervention. Objectives: The present study aims to study the coverage of PNC among rural women in Punjab and understand the factors that determine the utilization of PNC services. Materials and Methods: From rural areas of seven districts of Punjab, a total of 420 respondents were questioned using semi-structured interview schedule. Binary logistic regression is employed to understand the factors that influence the utilization of complete PNC. Results: The utilization of complete PNC has remained mere 25.9% in the present study. The results of multivariate logistic regression reveal that variables district, caste, birth order, and type of delivery significantly influence the utilization of complete PNC. Conclusion: The utilization of PNC component is found to be abysmal as compared to antenatal component and institutional delivery among the study group. There is a need to create awareness regarding the necessity of PNC among the women.
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Affiliation(s)
- Niharika Mahajan
- Punjab School of Economics, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Baljit Kaur
- Punjab School of Economics, Guru Nanak Dev University, Amritsar, Punjab, India
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Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward VC, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health impact of self-help groups scaled-up statewide in Bihar, India. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mehta KM, Irani L, Chaudhuri I, Mahapatra T, Schooley J, Srikantiah S, Abdalla S, Ward VC, Carmichael SL, Bentley J, Creanga A, Wilhelm J, Tarigopula UK, Bhattacharya D, Atmavilas Y, Nanda P, Weng Y, Pepper KT, Darmstadt GL. Health impact of self-help groups scaled-up statewide in Bihar, India. J Glob Health 2020; 10:021006. [PMID: 33425330 PMCID: PMC7761401 DOI: 10.7189/jogh.10.021006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The objective of this study was to assess the impact of self-help groups (SHGs) and subsequent scale-up on reproductive, maternal, newborn, child health, and nutrition (RMNCHN) and sanitation outcomes among marginalised women in Bihar, India from 2014-2017. METHODS We examined RMNCHN and sanitation behaviors in women who were members of any SHGs compared to non-members, without differentiating between types of SHGs. We analysed annual surveys across 38 districts of Bihar covering 62 690 women who had a live birth in the past 12 months. All analyses utilised data from Community-based Household Surveys (CHS) rounds 6-9 collected in 2014-2017 by CARE India as part of the Bihar Technical Support Program funded by the Bill & Melinda Gates Foundation. We examined 66 RMNCHN and sanitation indicators using survey logistic regression; the comparison group in all cases was age-comparable women from the geographic contexts of the SHG members but who did not belong to SHGs. We also examined links between discussion topics in SHGs and changes in relevant behaviours, and stratification of effects by parity and mother's age. RESULTS SHG members had higher odds compared to non-SHG members for 60% of antenatal care indicators, 22% of delivery indicators, 70% of postnatal care indicators, 50% of nutrition indicators, 100% of family planning and sanitation indicators and no immunisation indicators measured. According to delivery platform, most FLW performance indicators (80%) had increased odds, followed by maternal behaviours (57%) and facility care and outreach service delivery (22%) compared to non-SHG members. Self-report of discussions within SHGs on specific topics was associated with increased related maternal behaviours. Younger SHG members (<25 years) had attenuated health indicators compared to older group members (≥25 years), and women with more children had more positive indicators compared to women with fewer children. CONCLUSIONS SHG membership was associated with improved RMNCHN and sanitation indicators at scale in Bihar, India. Further work is needed to understand the specific impacts of health layering upon SHGs. Working through SHGs is a promising vehicle for improving primary health care. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Indrajit Chaudhuri
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Janine Schooley
- Project Concern International, Delhi, India and San Diego, California, USA
| | | | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andreea Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jess Wilhelm
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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Kumari M, Mohanty SK. Caste, religion and regional differentials in life expectancy at birth in India: cross-sectional estimates from recent National Family Health Survey. BMJ Open 2020; 10:e035392. [PMID: 32819936 PMCID: PMC7440832 DOI: 10.1136/bmjopen-2019-035392] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Though estimates of longevity are available by states, age, sex and place of residence in India, disaggregated estimates by social and economic groups are limited. This study estimates the life expectancy at birth and premature mortality by caste, religion and regions of India. DESIGN This study primarily used cross-sectional data from the National Family Health Survey (NFHS-4), 2015-2016 and the Sample Registration System (SRS), 2011-2015. The NFHS-4 is the largest ever demographic and health survey covering 601 509 households and 811 808 individuals across all states and union territories in India. MEASURES The abridged life table is constructed to estimate the life expectancy at birth, adult mortality (45q15) and premature mortality (70q0) by caste, religion and region. RESULTS Life expectancy at birth was estimated at 63.1 years (95% CI 62.60 -63.64) for scheduled castes (SC), 64.0 years (95% CI 63.25 - 64.88) for scheduled tribes (ST), 65.1 years (95% CI 64.69 - 65.42) for other backward classes (OBC) and 68.0 years (95% CI 67.44 - 68.45) for others. The life expectancy at birth was higher among o Christians 68.1 years (95% CI 66.44 - 69.60) than Muslims 66.0 years (95% CI 65.29 - 66.54) and Hindus 65.0 years (95% CI 64.74 -65.22). Life expectancy at birth was higher among females than among males across social groups in India. Premature mortality was higher among SC (0.382), followed by ST (0.381), OBC (0.344) and others (0.301). The regional variation in life expectancy by age and sex is large. CONCLUSION In India, social and religious differentials in life expectancy by sex are modest and need to be investigated among poor and rich within these groups. Premature mortality and adult mortality are also high across social and religious groups.
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Affiliation(s)
- Meena Kumari
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
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de Fátima Vasques Monteiro M, Barbosa CP, Vertamatti MAF, Tavares MNA, de Oliveira Carvalho AC, Alencar APA. Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil. BMC Health Serv Res 2019; 19:851. [PMID: 31747914 PMCID: PMC6868722 DOI: 10.1186/s12913-019-4566-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Over time, the Brazilian health system, a growing country, has been developing to ensure good accessibility to health goods and services. This development is focusing on the principle of universality of access and completeness of health care. In this context, we aimed to evaluate the completeness of care and universality of access for women in their pregnancy and puerperal period in Ceará, Brazil. Methods A descriptive, cross-sectional study based on a quantitative approach, using information collected from the database of the regulation system of the state of Ceará and data from the Prenatal Monitoring System. The research population comprised of 1701 women who delivered a baby in an obstetric reference unit in the Health Macro-Region of Cariri, Ceará, Brazil from January to December 2015. Results There was a high rate of cesarean delivery (49.7%) and a high waiting time for access to high-risk delivery (32.6%) and neonatal intensive care unit (72.9%). There was also a low percentage (41.1%) of pregnant women undergoing an adequate number of prenatal consultations, dental care (20%), educational activities (15%), visits to the maternity ward (0.1%), laboratory tests of the third trimester (29.2%) and puerperal consultation (37.9%). Conclusions It was concluded that the Maternal and Child Health Policy, especially the Rede Cegonha, which is still under development, does not ensure access and completeness of care for women during the prenatal, delivery, and puerperal periods, thus violating their reproductive rights. The results of this study allow a critical analysis by the academia and health managers in search of strategies to improve the services of Rede Cegonha in Brazil.
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Affiliation(s)
| | | | | | - Maria Nizete Alves Tavares
- Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil
| | | | - Ana Paula Agostinho Alencar
- Master in Nursing, Regional University of Cariri, Rua Coronel Antônio Luiz, 1161 - Pimenta, Crato, CE, 63105-010, Brazil
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Affiliation(s)
- Julia Hussein
- a Editor-in Chief, Reproductive Health Matters , London , UK
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