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Muhammad A, Rizvee MSH, Khan U, Khan H, Bachlany A, Baloch B, Shafiq Y. Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi. PLoS One 2024; 19:e0298120. [PMID: 38578771 PMCID: PMC10997060 DOI: 10.1371/journal.pone.0298120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/16/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. METHODS A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis. RESULTS Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors. CONCLUSION The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.
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Affiliation(s)
| | | | - Uzma Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | - Hina Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | | | - Benazir Baloch
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Yasir Shafiq
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan
- CRIMEDIM–Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Muralidhar K, Nishimura H, Coursey K, Krupp K, Jaykrishna P, Srinivas V, Madhivanan P. Knowledge and practice of family planning among pregnant tribal women in Southern India: an observational study. Contracept Reprod Med 2024; 9:2. [PMID: 38217011 PMCID: PMC10785510 DOI: 10.1186/s40834-023-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND There are over 700 Scheduled Tribes (ST) living in 30 Indian states. As with other indigenous groups across the world, Indian ST have some of the poorest infant and child health outcomes of any communities in India. A child born to an ST family is 19% more likely to die in the first month of life and has a 45 percent risk of dying in their first year compared with other Indian populations. Research suggests that early conception, high fertility, and low use of family planning methods are large contributors to these disparities. METHODS A cross sectional survey in Kannada was conducted among 303 pregnant tribal women in Mysore, India after obtaining informed consent. Univariate and multivariable analyses were carried out to determine the demographic and psychosocial factors associated with knowledge of contraceptive methods using Stata 14.0. RESULTS There was widespread knowledge about female sterilization, while only 39.3% of women reported hearing about one or more forms of temporary contraception, and 36.3% knew where to get them. The largest proportion of women had heard about copper-T (33.0%), followed by oral contraceptive pills (23.8%), condoms (11.9%), and injectables (4.6%). Only 2.7% of women reported ever using any form of temporary contraception. Results from the multivariable logistic regression indicated that knowledge of at least one form of temporary contraception was linked to higher age (adjusted odds ratio[AOR]: 1.09; 95% CI: 1.02, 1.17), greater number of years of marriage (AOR: 0.90; 95% CI: 0.85, 0.96), and last birth in a government facility (AOR: 3.67; 95% CI: 1.99, 6.82). CONCLUSIONS The study revealed poor knowledge and utilization of temporary contraceptive methods among a tribal population in rural Mysore, India. Interventions aiming to increase knowledge of contraceptive options are important for birth spacing in this population and should target younger women and those without contact with government health facilities.
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Affiliation(s)
- Kiranmayee Muralidhar
- Public Health Research Institute of India, Mysore, Karnataka, India.
- JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
| | - Holly Nishimura
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Coursey
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245209, Tucson, Arizona, 85724-5209, USA
| | | | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, P.O. Box 245209, Tucson, Arizona, 85724-5209, USA
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Blanchard AK, Ansari S, Rajput R, Colbourn T, Houweling TAJ, Lorway R, Isac S, Prost A, Anthony J. 'That is because we are alone': A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India. Glob Public Health 2024; 19:2348640. [PMID: 38716491 DOI: 10.1080/17441692.2024.2348640] [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: 11/16/2023] [Accepted: 04/22/2024] [Indexed: 05/15/2024]
Abstract
This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages' level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of 'socio-spatial remoteness' that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.
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Affiliation(s)
- Andrea K Blanchard
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | | | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | | | - Robert Lorway
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Shajy Isac
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
| | - Audrey Prost
- Institute for Global Health, University College London, London, UK
| | - John Anthony
- Institute for Global Public Health, University of Manitoba, Winnipeg, Canada
- India Health Action Trust, Lucknow, India
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Sharma B, Lahariya C, Majella MG, Upadhyay A, Yadav S, Raina A, Khan T, Aggarwal N. Burden, Differentials and Causes of Stillbirths in India: A Systematic Review and Meta Analysis. Indian J Pediatr 2023; 90:54-62. [PMID: 37556034 DOI: 10.1007/s12098-023-04749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023]
Abstract
India contributes the highest absolute number of stillbirths in the world. This systematic review and meta-analysis was conducted to synthesize the burden, timing and causes of stillbirths in India. Forty-nine reports from 46 studies conducted in 21 Indian states and Union Territories were included. It was found that there was no uniformity/standardization in the definition of stillbirths and in the classification system used to assign the cause. The share of antepartum stillbirths was estimated to be two-third while remaining were intrapartum stillbirths. Maternal conditions and fetal causes were found to be the leading cause of stillbirth in India. The maternal condition was assigned as the commonest cause (25%) followed by fetal (14%), placental cause (13%), congenital malformation (6%) and intrapartum complications (4%). Approximately 20% of the stillbirths were assigned as unknown or unexplained. This review demonstrates that there is a paucity of quality stillbirth data in India. Other than the state level differences in stillbirth rates, no other data is available on inequities in stillbirths in India. There is an urgent need for strengthening availability and quality of stillbirth data in India on both stillbirth rates as well as the causes. There is a need to conduct additional research to know the timing of the stillbirths, causes of death and actual burden. India needs to strengthen stillbirth audits along with registry to find out the modifiable factors and delays for making country specific preventive strategies. The policy makers, academic community and researchers need to work together to ensure accelerated and equitable reduction in stillbirths in India.
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Affiliation(s)
- Bharti Sharma
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, 110029, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, 302029, India
| | - Marie Gilbert Majella
- Department of Community Medicine, Sri Venkateshwara Medical College Hospital & Research Center, Puducherry, India
| | - Anita Upadhyay
- Director- Projects, Human Capital Lighthouse Consulting Pvt Ltd, New Delhi, 110029, India
| | - Sapna Yadav
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, 110029, India
| | - Ankit Raina
- Department of Public Health, Survival for Women & Children (SWACH) Foundation, Panchkula, Haryana, India
| | - Tamkin Khan
- Department of Obstetrics & Gynecology, Aligarh Muslim University, Aligarh, U.P, India
| | - Neelam Aggarwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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Aggarwal N, Lahariya C, Sharma B, Khan T, Sood B, Singh VV, Verma S, Upadhyay A, Dhaliwal LK. Stillbirths in India: Current Status, Challenges, and the Way Forward. Indian J Pediatr 2023; 90:63-70. [PMID: 37605065 DOI: 10.1007/s12098-023-04807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/23/2023] [Indexed: 08/23/2023]
Abstract
Stillbirth is a major public health challenge and a multifaceted issue that leads to significant financial, physical, mental, financial, and psychosocial implications. India has made substantial progress in stillbirth reduction. Yet, many challenges continue and the absolute number of stillbirths remain high. This paper presents the national and state level burden of stillbirths and discusses about the magnitude, risk factors, causes and inequities in stillbirths. A few additional approaches for reduction of preventable stillbirths have been suggested. The authors argue that the institutional mechanisms need to be developed to ensure all stillbirths are registered in a timely manner. There is a need for standard definition for classification of stillbirths and document the cause, to roll-out suitable interventions. There is a need for state specific interventions to address different causes, as Indian states have variable stillbirth rates. The stillbirth audits should be institutionalised as a continuous quality improvement exercise to bring local accountability and reduce stillbirth rate. The healthcare system and providers must be trained to offer bereavement support to the affected mothers and families. These approaches should be implemented through primary healthcare system as well.
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Affiliation(s)
- Neelam Aggarwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India.
| | - Chandrakant Lahariya
- Foundation for People-Centric Health Systems, New Delhi, India
- SD Gupta School of Public Health, The IIHMR University, Jaipur, India
| | - Bharti Sharma
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
| | - Tamkin Khan
- Department of Obstetrics & Gynecology, Aligarh Muslim University, Aligarh, U.P, India
| | - Bulbul Sood
- Former Senior Strategic Advisor, Jhpiego India, New Delhi, India
| | | | - Shruti Verma
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-Centric Health Systems, New Delhi, India
| | - Anita Upadhyay
- Human Capital Lighthouse Consulting Pvt Ltd, New Delhi, India
| | - L K Dhaliwal
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India
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Satav AR, Satav KA, Kelkar AS, Sahasrabhojaney VS, Dani VS, Raje DV, Simoes EAF. Verbal autopsy to assess causes of mortality among the economically productive age group in the tribal region of Melghat, central India. Indian J Med Res 2023; 158:217-254. [PMID: 37861621 PMCID: PMC10720956 DOI: 10.4103/ijmr.ijmr_3299_21] [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: 11/11/2021] [Indexed: 10/21/2023] Open
Abstract
Background & Objectives Verbal autopsy (VA) is the systematic and retrospective inquiry (from relatives) about the symptoms of an illness prior to death. In tribal India, 67-75 per cent of deaths occur at home with an unknown cause of death (CoD). Hence, the aim of this study was to determine the CoD in the 16-60 yr age group utilizing VA. Methods A prospective, community based longitudinal study was conducted in 32 tribal villages in the Melghat region of Maharashtra, between 2004 and 2020. Number of deaths and VAs in 16-60 yr age group were collected by village health workers (VHWs) and supervisors, verified by five different persons (internal-external) and cross-checked by three VA interpretation trained physicians. A modified version of WHO VA was used. Cause-specific mortality fractions were calculated. Results Of the 1011 deaths recorded, mortality in males was significantly higher than females (P<0.001). A total of 763 VAs were conducted which revealed that tuberculosis was the leading CoD, followed by jaundice, heart diseases, diarrhoea, central nervous system infections and suicide. Suicides were significantly more common among males than in females (P=0.046). Significantly, more deaths occurred during the monsoon (P=0.002), especially diarrhoeal deaths (P=0.024). Interpretation & conclusions The findings of this study suggest that, in Indian tribal areas, infectious diseases are the leading causes of morbidity and one of the major causes of deaths in economically productive age group. Intensified VHW-mediated interventions are required to reduce the premature deaths.
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Affiliation(s)
- Ashish Rambhau Satav
- Department of Medicine, Mahatma Gandhi Tribal Hospital, Amravati, Maharashtra, India
- Department of Community Health, Mahatma Gandhi Tribal Hospital, Amravati, Maharashtra, India
| | - Kavita Ashish Satav
- Department of Community Health, Mahatma Gandhi Tribal Hospital, Amravati, Maharashtra, India
- Department of Ophthalmology, Mahatma Gandhi Tribal Hospital, Amravati, Maharashtra, India
| | - Abhay Suresh Kelkar
- Department of Medicine, Mahatma Gandhi Tribal Hospital, Amravati, Maharashtra, India
| | | | | | | | - Eric A. F. Simoes
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Bango M, Ghosh S. Reducing infant and child mortality: assessing the social inclusiveness of child health care policies and programmes in three states of India. BMC Public Health 2023; 23:1149. [PMID: 37316824 DOI: 10.1186/s12889-023-15812-7] [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: 06/06/2022] [Accepted: 05/04/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Even though the overall infant mortality rate and child mortality rate have considerably declined in India, the marginalised groups-Scheduled Caste, and Scheduled Tribe, continue to have higher mortality rates. This study looks at the changes in IMR and CMR amongst disadvantaged and advanced social groups at the national level and in three states of India. DATA AND METHODS Data from five rounds of National Family Health Survey spanning nearly three decades have been used to measure IMR and CMR according to the social groups for India and for selected states-Bihar, West Bengal, and Tamil Nadu. The relative hazard curves were drawn to understand which social group's children face a higher risk of dying in the first year of birth and between first year and age four in those three states. Further, a log-rank test was applied to examine whether the differences between the survival curves or distributions of the three social groups are statistically significant. Finally, the binary logit regression model was applied to investigate the effect of ethnicity, and other socio-economic and demographic covariates on the risk of infant and child deaths (1-4 years) in the country and in selected states. RESULTS Hazard curve shows the probability of death within one year of birth was highest among the children belonging to the ST families, followed by SCs in India. And, the CMR was found to be higher amongst the STs compared to all other social groups as well at the national level. While Bihar had a remarkably high infant and child mortality rates, Tamil Nadu possessed the lowest child death rates irrespective of class, caste, and religion. The regression model revealed that most of the caste/tribe gaps in infant and child deaths might be attributed to the place of residence, mother's level of education, economic status, and the number of children in a family. Notably, the multivariate analysis showed that ethnicity was an independent risk factor, when controlled for socioeconomic status. CONCLUSION The study detects the persistence of significant caste/tribe differentials in infant and child mortality in India. Poverty, education and health care access issues could be the possible reasons for the premature deaths of the children from deprived castes and tribes. There is a need to critically analyse the current health programmes aimed at reducing IMR and CMR to make them attuned to the needs of the marginalised communities.
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Affiliation(s)
- Madhumita Bango
- Research Scholar, School of Health Systems Studies, Tata Institute of Social Sciences, V.N. Purav Marg, Deonar, Mumbai, Maharashtra-400088, India.
| | - Soumitra Ghosh
- Centre for Health Policy, Planning, and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, V.N. Purav Marg, 400088, India
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Pregnancy outcomes among Indian women: increased prevalence of miscarriage and stillbirth during 2015-2021. BMC Pregnancy Childbirth 2023; 23:150. [PMID: 36890450 PMCID: PMC9992916 DOI: 10.1186/s12884-023-05470-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Pregnancy outcome is an important health indicator of the quality of maternal health. Adverse pregnancy outcomes is a major public health problem, which can lead to poor maternal and neonatal outcomes. This study investigates the trends in pregnancy outcomes prevalent during 2015-2021 in Indian women. METHODS The study analysed the data presented in the fourth (2015-16) and fifth (2019-21) rounds of National Family Health Survey (NFHS). The absolute and relative changes in the birth outcomes of last pregnancy during the five years preceding the surveys were estimated using data collected from 195,470 women in NFHS-4 and from 255,549 women in NFHS-5. RESULTS Livebirth decreased by 1.3 points (90.2% vs. 88.9%), and nearly half of the Indian states/UTs (n = 17/36) had lower than the national average of livebirth (88.9%) reported during 2019-21. A higher proportion of pregnancy loss was noted, particularly miscarriages increased in both urban (6.4% vs. 8.5%) and rural areas (5.3% vs. 6.9%), and stillbirth increased by 28.6% (0.7% vs. 0.9%). The number of abortions decreased (3.4% vs. 2.9%) among Indian women. Nearly half of the abortions were due to unplanned pregnancies (47.6%) and more than one-fourth (26.9%) of abortions were performed by self. Abortions among adolescent women in Telangana was eleven times higher during 2019-21 as compared to 2015-16 (8.0% vs. 0.7%). CONCLUSION Our study presents evidence of a decrease in the livebirth and an increase in the frequency of miscarriage and stillbirth among Indian women during 2015-2021. This study emphasises that there is a need of regional-specific, comprehensive and quality maternal healthcare programs for improving livebirth among Indian women.
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