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Soren SK, Sahu S, Kujur A, Dandpat A, Kashyap V, Kumari P, Ragini KJ, Kumari A, Kumar D. Predictors of Breastfeeding Initiation Among Postnatal Mothers at Tertiary Care Center of a Tribal Dominant State in India: A Regression Analysis. Cureus 2021; 13:e16936. [PMID: 34513506 PMCID: PMC8418779 DOI: 10.7759/cureus.16936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Early initiation of breastfeeding (EIBF) is one of the most important predictors for the survival of a child, spacing between two children, and prevention from childhood infections. Breastfeeding plays an important role in reducing child mortality and morbidity but the practice of EIBF globally is way behind the required time for initiation of breastfeeding after delivery. So, we planned to evaluate the early time of initiation of breastfeeding among the postnatal mothers and to determine the predictors of early initiation of breastfeeding in a tertiary hospital setting. Methodology A hospital-based cross-sectional study was conducted in the postnatal ward of Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand for a period of three months (March-May 2017). Our study included 200 postnatal mothers who delivered normal and healthy babies. Mother-infant dyads enrolled in our study were interviewed personally during six hours of the postpartum period. Irrespective of the mode of delivery, all babies born during the study period whose mothers consented to be a part of the study were included. Data collected were entered in MS Excel and analyzed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results A total of 200 postnatal mothers fulfilling the study criteria were enrolled during the study. Of them, the majority 98 (49%) belonged to the age group 18-25 years. A hundred and twenty-six (63%) of them resided in rural areas, 182 (91%) were housewives, and only 86 (43%) of them had completed secondary education & above. Early initiation of breastfeeding was found to be only 43 (21.5%) among postnatal mothers. Predictors found to be statistically significant with EIBF were mother's residential status [odds ratio (OR): 2.98; 95% confidence interval (CI): 1.25-7.13], educational status of mother (OR: 3.18; 95% CI: 1.12-9.01) mode of delivery of the baby (OR: 8.93; 95% CI: 2.66-30.06) and ante-natal care (ANC) visits (OR: 0.441; 95% CI: 0.311-0.651). Women’s age, religion, ethnicity, occupation, type of family, and socioeconomic status displayed no statistically significant relationship with EIBF. Conclusions It is concluded that nearly one-fifth of mothers in the study initiated breastfeeding within one hour of post-delivery. Maternal education, frequent ANC visits, place of residence, and mode of delivery were also associated with EIBF in India. Nursing staff, as well as clinicians, should reinforce the importance of early initiation of breastfeeding by providing proper health education to post-natal beneficiaries.
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Affiliation(s)
- Santosh K Soren
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Surendra Sahu
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Anit Kujur
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Aishwarya Dandpat
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vivek Kashyap
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Pragya Kumari
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Kumari J Ragini
- Obstetrics & Gynaecology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Archana Kumari
- Obstetrics & Gynaecology, Rajendra Institutue of Medical sciences, Ranchi, Ranchi, IND
| | - Dewesh Kumar
- Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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Jungari S, Paswan B. Does the National Rural Health Mission improve the health of tribal women? Perspectives of husbands in Maharashtra, India. Public Health 2019; 176:50-58. [DOI: 10.1016/j.puhe.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 09/17/2018] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
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Senanayake P, O'Connor E, Ogbo FA. National and rural-urban prevalence and determinants of early initiation of breastfeeding in India. BMC Public Health 2019; 19:896. [PMID: 31286907 PMCID: PMC6615079 DOI: 10.1186/s12889-019-7246-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF) reduces the risk of neonatal mortality. Previous studies from India have documented some factors associated with EIBF. However, those studies used data with limited sample size that potentially affect the application of the evidence. Additionally, the effectiveness of national breastfeeding programmes requires up-to-date analysis of new and robust EIBF data. The present study aimed to investigate the prevalence and determinants of EIBF in India and determine to what extent these factors differ by a mother's residence in the rural or urban area. METHODS This study used information from a total weighted sample of 94,401 mothers from the 2015-2016 India National Family Health Survey. Multivariate logistic regression was used to investigate the association between the study factors and EIBF in India and rural-urban populations, after adjusting for confounders and sampling weight. RESULTS Our analysis indicated that 41.5% (95% confidence interval (CI): 40.9-42.5, P < 0.001) of Indian mothers initiated breastfeeding within 1-h post-birth, with similar but significant different proportions estimated for those who resided in rural (41.0, 95% CI: 40.3-41.6, P < 0.001) and urban (42.9, 95% CI: 41.7-44.2, P < 0.001) areas. Mothers who had frequent health service contacts and those with higher educational attainment reported higher EIBF practice. Multivariate analyses revealed that higher educational achievement, frequent antenatal care visits and birthing in a health facility were associated with EIBF in India and rural populations (only health facility birthing for urban mothers). Similarly, residing in the North-Eastern, Southern, Eastern and Western regions were also associated with EIBF. Birthing through caesarean, receiving delivery assistance from non-health professionals and residing in rural areas of the Central region were associated with delayed EIBF in all populations. CONCLUSION We estimated that more than half of Indian mothers delayed breastfeeding initiation, with different rural-urban prevalence. Key modifiable factors (higher maternal education and frequent health service contacts) were associated with EIBF in India, with notable difference in rural-urban populations. Our study suggests that targeted and well-coordinated infant feeding policies and interventions will improve EIBF for all Indian mothers.
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Affiliation(s)
- Praween Senanayake
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Elizabeth O'Connor
- Medical Education Unit, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia. .,Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State, Nigeria.
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Gupta M, Angeli F, Bosma H, Prinja S, Kaur M, van Schayck OCP. Utilization of Intergovernmental Funds to Implement Maternal and Child Health Plans of a Multi-Strategy Community Intervention in Haryana, North India: A Retrospective Assessment. PHARMACOECONOMICS - OPEN 2017; 1:265-278. [PMID: 29441503 PMCID: PMC5711747 DOI: 10.1007/s41669-017-0026-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION A multi-strategy community intervention known as the National Rural Health Mission (NRHM) was implemented in India from 2005 to 2012 in an attempt to reduce maternal and child mortality. OBJECTIVE This study examined the extent to which the NRHM's maternal and child health (MCH) sector plans were implemented. We observed trends in how intergovernmental (use of central government funds by state governments) budgets were allocated and used to implement MCH plans in Haryana, India. METHODS We conducted a retrospective assessment of programme implementation plans, MCH budget allocation and expenditure and financial monitoring reports during the NRHM implementation period. The yearly budget utilization rate was calculated for each MCH strategy implemented. On the basis of this budget utilization rate, we classed the extent of MCH strategy implementation as fully, partially or not implemented. The status of MCH indicators before, during and after the NRHM period was obtained from national demographic surveys. The budget utilization rate was correlated with MCH outcomes. RESULTS The overall budget allocated for MCH plans increased from $US6.6 million during the 2005-2006 period to $US66.7 million in the 2012-2013 period. The rate of budget utilization increased from 20.6% in 2007-2008 to 89% in 2012-2013. Expenditure exceeded the initially allocated budget for patient referral services (111.5%), human resources (110.1%), drugs and logistics (170%), accredited social health activists (133.3%) and immunization (106.4%). Additional budget was obtained from the state health budget. Plans for referral services, human resources, drug provision, accredited social health activists and immunization were fully implemented, few schemes (<1%) were not implemented, and all other schemes were only partially implemented. MCH indicators improved significantly (p < 0.05). The rate of institutional childbirth was highly and positively correlated with rates of budget utilization for implementing accredited social health activists (r = 0.96) and financial incentives for hospital delivery schemes (r = 0.5). CONCLUSIONS The trend for increasing use of the allocated budget for MCH strategies, improvement in MCH indicators and their positive correlation indicate better and more effective implementation of NRHM MCH strategies than in the past in Haryana, India. However, overall, the NRHM was only partially implemented.
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Affiliation(s)
- Madhu Gupta
- Department of Community Medicine, Room No. 130, School of Public Health, PGIMER, Chandigarh, India
| | - Federica Angeli
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Shankar Prinja
- Department of Community Medicine, Room No. 130, School of Public Health, PGIMER, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine, Room No. 130, School of Public Health, PGIMER, Chandigarh, India
| | - Onno C. P. van Schayck
- Department of Family Practice, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Gupta M, Bosma H, Angeli F, Kaur M, Chakrapani V, Rana M, van Schayck OC. A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India. BMC Public Health 2017; 17:698. [PMID: 28893214 PMCID: PMC5594476 DOI: 10.1186/s12889-017-4706-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. METHODS An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre- (2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. RESULTS The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. CONCLUSIONS MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.
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Affiliation(s)
- Madhu Gupta
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Hans Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Federica Angeli
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkatesan Chakrapani
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Monica Rana
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Room No. 130, PGIMER, Chandigarh, India
| | - Onno C.P. van Schayck
- Department of Family Practice, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Impact of a Multi-Strategy Community Intervention to Reduce Maternal and Child Health Inequalities in India: A Qualitative Study in Haryana. PLoS One 2017; 12:e0170175. [PMID: 28099465 PMCID: PMC5242542 DOI: 10.1371/journal.pone.0170175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
A multi-strategy community intervention, known as National Rural Health Mission (NRHM), was implemented in India from 2005 to 2012. By improving the availability of and access to better-quality healthcare, the aim was to reduce maternal and child health (MCH) inequalities. This study was planned to explore the perceptions and beliefs of stakeholders about extent of implementation and effectiveness of NRHM's health sector plans in improving MCH status and reducing inequalities. A total of 33 in-depth interviews (n = 33) with program managers, community representatives, mothers and 8 focus group discussions (n = 42) with health service providers were conducted from September to December 2013, in Haryana, post NRHM. Using NVivo software (version 9), an inductive applied thematic analysis was done based upon grounded theory, program theory of change and a framework approach. Almost all the participants reported that there was an improvement in overall health infrastructure through an increased availability of accredited social health activists, free ambulance services, and free treatment facilities in rural areas. This had increased the demand and utilization of MCH services, especially for those related to institutional delivery, even by the poor families. Service providers felt that acute shortage of human resources was a major health system level barrier. District-specific individual, community, and socio-political level barriers were also observed. Overall program managers, service providers and community representatives believed that NRHM had a role in improving MCH outcomes and in reduction of geographical and socioeconomic inequalities, through improvement in accessibility, availability and affordability of the MCH services in the rural areas and for the poor. Any reduction in gender-based inequalities, however, was linked to the adoption of small family sizes and an increase in educational levels.
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Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India. PLoS One 2016; 11:e0150537. [PMID: 27003589 PMCID: PMC4803212 DOI: 10.1371/journal.pone.0150537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/15/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 aimed to reduce maternal and child health (MCH) inequalities across geographical, socioeconomic and gender categories in India. The objective of this study is to quantify the extent of reduction in these inequalities pre- and post-NRHM in Haryana, North India. METHODS Data of district-level household surveys (DLHS) held before (2002-04), during (2007-08), and after (2012-13) the implementation of NRHM has been used. Geographical, socioeconomic and gender inequalities in maternal and child health were assessed by estimating the absolute differences in MCH indicators between urban and rural areas, between the most advantaged and least advantaged socioeconomic groups and between male and female children. Logistic regression analyses were done to observe significant differences in these inequalities between 2005 and 2012. RESULTS There were significant improvements in all MCH indicators (p<0.05). The geographical and socioeconomic differences between urban and rural areas, and between rich and poor were significantly (p<0.05) reduced for pregnant women who had an institutional delivery (geographical difference declining from 22% to 7.6%; socioeconomic from 48.2% to 13%), post-natal care within 2 weeks of delivery (2.8% to 1.5%; 30.3% to 7%); and for children with full vaccination (10% to 3.5%, 48.3% to 14%) and who received oral rehydration solution (ORS) for diarrhea (11% to -2.2%; 41% to 5%). Inequalities between male and female children were significantly (p<0.05) reversed for full immunization (5.7% to -0.6%) and BCG immunization (1.9 to -0.9 points), and a significant (p<0.05) decrease was observed for oral polio vaccine (4.0% to 0%) and measles vaccine (4.2% to 0.1%). CONCLUSIONS The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 might have resulted in significant reductions in geographical, socioeconomic and gender inequalities in MCH in Haryana, as causal relationships cannot be established with descriptive research.
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