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Dandona R, Pandey A, Kumar GA, Arora M, Dandona L. Review of the India Adolescent Health Strategy in the context of disease burden among adolescents. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 20:100283. [PMID: 38234699 PMCID: PMC10794100 DOI: 10.1016/j.lansea.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/24/2023] [Accepted: 09/07/2023] [Indexed: 01/19/2024]
Abstract
Background A nuanced understanding of the health needs of adolescents in the context of the India Adolescent Health Strategy (IAHS) is needed to inform policy interventions for improving the health and well-being of adolescents in India. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we identified the top ten causes of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) disaggregated by sex and age group (10-14 and 15-19 years) for India and its states in 2019. To inform the IAHS of refinement or expansion in focus needed to improve adolescent health in India, we reviewed the extent to which the top 10 causes of disease burden are addressed in the IAHS, and the availability of and age- and sex-disaggregation in the service utilisation data for adolescents captured in the Adolescent Friendly Health Clinic monitoring information system (AFHC MIS) and Health Management Information System (HMIS). We also reviewed the availability of and age-and sex-disaggregation in the data capture at the population level for the IAHS outcome indicators in the data sources identified in the IAHS operational framework. Findings Females in the 10-14 and 15-19 years age groups suffered 6.75 million and 9.25 million DALYs, respectively, 39.1% and 44.2% of which were YLLs; the corresponding DALYs for males were 6.71 million and 9.65 million (42.3% and 41.1% YLLs), respectively. Within the 6 thematic areas of the IAHS, most strategies and indicators identified are for sexual and reproductive health followed by nutrition, and broadly these conditions accounted for YLDs and not YLLs in adolescents. Significant gaps in the IAHS in comparison to the disease burden for fatal diseases and conditions were seen across injuries, communicable diseases, and non-communicable diseases. Injuries accounted for 65.9% and 45.3% of YLLs in males and females aged 15-19 years, and 40.8% in males aged 10-14 years. Specifically, road injuries (15.3%, 95% UI 11.0-18.0) and self-harm (11.3%, 95% UI 8.7-14.2) accounted for most of the injury deaths in 15-19 years whereas drowning (7.7% 95% UI 5.8-9.6) and road injuries (6.9%, 95% UI 4.7-8.6) accounted for the most injury deaths in 10-14 years males. However, only self-harm and gender-based violence are specifically addressed in the IAHS with non-specific interventions for other injuries. Diarrhoea, lower respiratory infections, malaria, encephalitis, tuberculosis, typhoid, cirrhosis, and hepatitis are the other disease conditions accounting for YLLs and DALYs in adolescents but these are neither addressed in the IAHS nor in service provision under the AFHC MIS. There is no age- or sex-disaggregation in the cause of death data captured in the HMIS to allow an understanding of mortality in adolescents. For the IAHS outcome indicators at the population level, data capture for the 10-14 years irrespective of sex was largely missing from the population surveys and none of the surveys captured data for either females or males aged 15-19 years for physical inactivity and mental health indicators. Interpretation The considerable differences seen in the IAHS thematic focus as compared with the leading causes of fatal and non-fatal disease burden in adolescents in India, and in the availability of population-level data to monitor the outcome indicators of the IAHS can pose substantial limitations for improving adolescent health in India. The findings in this paper can be utilized by decision makers to refine action aimed at improving adolescent health and well-being. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | | | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Kumar P, Srivastava S, Chaudhary P, Muhammad T. Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey. PLoS One 2023; 18:e0291485. [PMID: 37703256 PMCID: PMC10499255 DOI: 10.1371/journal.pone.0291485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Most of the existing literature in developing countries focused on either the rising trend of CS or its determinants. There is a paucity of population-based studies on existing socioeconomic inequalities in availing CS services by women in Indonesia. This study aimed to assess the factors associated with caesarian section (CS) delivery and explore the various factors contributing to inequalities in CS delivery rates in Indonesia. METHODS The study utilized nationally representative cross-sectional data from the Indonesia Demographic and Health Survey (IDHS), 2017. We conducted multivariable logistic regression to find the factors associated with CS delivery. Concentration index and Wagstaff's decomposition analysis were used to examine the socioeconomic inequalities in CS delivery among women and associated factors. RESULTS About 17% of women in Indonesia delivered babies through CS. A concentration index of 0.31 in CS delivery rate showed a higher CS delivery rate among women belonging to rich households. About 44.7% of socioeconomic status inequality in CS delivery was explained by educational status among women who went for CS delivery. Women's place of residence explained 30.1% of socioeconomic inequality, and women's age at first birth explained about 11.9% and reporting ANC visits explained 8.4% of the observed inequality. Highest socioeconomic inequality was witnessed in central Sulawesi (0.529), followed by Maluku (0.488) and West Kalimantan (0.457), whereas the lowest was recorded in Yogyakarta (0.021) followed by north Sulawesi (0.047) and east Kalimantan (0.171). Education (44.7%) followed by rural-urban place of residence (30.1%) and age of first birth (11.9%) contributed most to explain the gap in CS delivery among rich and poor women. CONCLUSION The study highlighted the higher CS delivery rates among women from higher socioeconomic groups and thus, it is important to frame policies after identifying the population subgroups with potential underuse or overuse of CS method of delivery.
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Affiliation(s)
- Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | | | - T. Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Pradhan MR, Mondal S, Mudi PK. Gynecological morbidity and treatment-seeking among older adult (aged 45-59) women in India. Reprod Health 2023; 20:64. [PMID: 37106377 PMCID: PMC10134576 DOI: 10.1186/s12978-023-01611-1] [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: 12/25/2022] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Women's gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women's sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a "blind spot" in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45-59 years (N = 18,547) in India. METHOD The analysis was based on the nationally representative Longitudinal Ageing Study (2016-2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were 'had any GM' and 'sought treatment for any GM.' Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor's consultation or treatment were considered 'sought treatment for any GM.' Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level. RESULTS Fifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts. CONCLUSION Many older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.
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Affiliation(s)
- Manas Ranjan Pradhan
- Department of Fertility and Social Demography, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Sourav Mondal
- Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India.
| | - Prasanna Kumar Mudi
- Department of Fertility and Social Demography, International Institute for Population Sciences, Mumbai, India
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Akhtar MH, Ramkumar J. Primary Health Center: Can it be made mobile for efficient healthcare services for hard to reach population? A state-of-the-art review. DISCOVER HEALTH SYSTEMS 2023; 2:3. [PMID: 37520517 PMCID: PMC9870199 DOI: 10.1007/s44250-023-00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 08/01/2023]
Abstract
Indian healthcare system is in immediate need of a new healthcare delivery model to increase healthcare accessibility and improve the health outcomes of the marginalized. Inaccessibility and underutilization of Primary Health Centers (PHCs) disproportionately affect people living in remote areas. It is thus imperative for the designers, engineers, health professionals, and policymakers to come together with a collaborative mindset to develop innovative interventions that sustainably manage the accessibility of PHCs at large, promote preventive health, and thus improve the health outcomes of hard-to-reach communities. This article examines the available literature on barriers to primary healthcare in Indian context, the reason of failure of PHCs and the way forward. The article further analysis literature on existing Mobile Medical Units (MMUs) as an alternate solution to conventional PHCs and attempt to extract the major lessons to propose a mobile Primary Health Center (mPHC) in contrast to the existing conventional static PHCs. The intention is to find out the research gaps in the existing literature and try to address the same for future researchers, designers, engineers, health professionals and policy makers to think forward to make this idea of a mobile Primary Health Center (mPHC), as the main delivery model to cater basic healthcare services to the underserved communities.
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Marbaniang SP, Patel R, Kumar P, Chauhan S, Srivastava S. Hearing and vision difficulty and sequential treatment among older adults in India. Sci Rep 2022; 12:19056. [PMID: 36351946 PMCID: PMC9646738 DOI: 10.1038/s41598-022-21467-y] [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: 10/10/2021] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
Aging not only affect biomarker-related processes, but it also affects the physiological processes of the human body. Of all the physiological processes, hearing and vision are of utmost importance to a human. Therefore, this study examines the prevalence and factors associated with hearing and vision difficulty and their sequential treatment among older adults in India. Utilizing data from Building a Knowledge Base on Population Aging in India, study used two sets of outcome variables; firstly, self-reported hearing and vision difficulty and secondly, treatment-seeking for hearing and vision difficulty. A total of 9541 older adults aged 60+ years from seven major regionally representative states were selected. Descriptive statistics were used to perform preliminary analysis. Additionally, the study employed the Heckprobit selection model. It is a two-equation model. This model is used in order to accommodate the heterogeneity (i.e., shared unobserved factors) among older adults and then address the endogeneity (between hearing and vision loss problems and their treatment-seeking behaviour) for older adults in India, the model offers a two-step analysis and deals with the zero-sample issue. Around 59% and 21% of older adults reported vision and hearing difficulty, respectively. Only 5% of older adults suffering from hearing difficulty reported utilizing hearing aids. Lifestyle factors (smoking tobacco and chewing tobacco) significantly affect hearing and vision difficulty; various chronic diseases were also found to be associated with high levels of hearing and vision difficulty among older adults. Results from Heckprobit model shows that older adults with 11+ years of education had higher probability to use visual [β = 0.54, 95% confidence interval (CI): 0.37, 0.70] and hearing aids [β = 0.6, 95% CI: 0.18, 1.02]. The use of hearing and vision aids was lower among poor older adults, older adults from Scheduled Caste, and older adults in rural areas. The study indicates that more than half of older adults face vision difficulty and almost one-fourth face hearing difficulty in rural India, education and lifestyle appear to be the main driver of health-seeking behaviour. Additional attention shall be given to understand the strategies that may advocate a higher use for hearing aids among older adults.
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Affiliation(s)
| | - Ratna Patel
- grid.419349.20000 0001 0613 2600Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Pradeep Kumar
- grid.419349.20000 0001 0613 2600Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- grid.419349.20000 0001 0613 2600Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- grid.419349.20000 0001 0613 2600Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
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Saha R, Paul P, Yaya S, Banke-Thomas A. Association between exposure to social media and knowledge of sexual and reproductive health among adolescent girls: evidence from the UDAYA survey in Bihar and Uttar Pradesh, India. Reprod Health 2022; 19:178. [PMID: 35978427 PMCID: PMC9382779 DOI: 10.1186/s12978-022-01487-7] [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: 06/26/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Poor sexual and reproductive health (SRH) outcomes amongst adolescent girls in India have been associated with inadequate knowledge of SRH. Evidence suggests that social media can promote health-seeking behaviors. Our objective in this study was to determine the association between exposure to social media and SRH knowledge among adolescent girls in Bihar and Uttar Pradesh, India. Methods A cross-sectional study was conducted with 10,425 adolescent girls from the UDAYA survey (wave-2, 2018–19). Girls’ exposure to social media was the key predictor, and SRH knowledge of sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS were outcomes of interest. Multivariable logistic regression models were performed to assess the association between exposure to social media and knowledge of SRH among adolescent girls. Results Of the study participants (n = 10,425), 28.0% (n = 3,160) had exposure to social media. Overall, 8.7%, 11.4%, and 6.6% of respondents had sufficient knowledge of sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS, respectively. Exposure to social media was associated with increased odds of knowledge of sexual intercourse and pregnancy (Odds ratio [OR]: 1.38; 95% confidence interval [CI]: 1.18, 1.61), contraceptive methods (OR: 1.46; 95% CI: 1.27, 1.67), and HIV/AIDS (OR: 2.18; 95% CI: 1.84, 2.58). Conclusions Our study shows the potency of exposure to social media in influencing SRH knowledge, which exclusively benefits female adolescents who are educated, residing in urban areas, and from wealthier families. Digital media-focused interventions inclusive of socio-cultural contexts (e.g., strategic investment in education and creating economic opportunities) are crucial to optimize social media's impact on SRH knowledge enhancements. A substantial body of research shows that adolescent girls in India lack adequate sexual and reproductive health (SRH) knowledge. Evidently, this puts them at several health risks associated with early pregnancies, preventable gynecological morbidities such as irregular menstrual patterns, and urethral discharge, among several others. Perpetuated social stigma and lack of agency impede adolescents especially from marginalized communities from accessing accurate, sufficient, and timely SRH information from their immediate household members and healthcare providers at local service points. This adversely affects their health-seeking behaviors and ultimately results in avertable poor reproductive health outcomes. A growing body of literature highlights social media platforms (i.e., Facebook, Instagram, Twitter, etc.) as preferred modalities to gain SRH information among adolescents. Against this backdrop, we assessed the intricate association between social media exposure and SRH knowledge (across three dimensions: sexual intercourse and pregnancy, contraceptive methods, and HIV/AIDS) among adolescent girls in Bihar and Uttar Pradesh, India. We tested for association between several socio-demographic factors and SRH knowledge. Findings indicate that adolescents who were exposed to social media platforms were likely to have more SRH knowledge compared to those who were not. Socio-demographic factors like place of residence, for example residing in urban areas, higher levels of education and high wealth index acted as facilitators of social media exposure as well as SRH knowledge.
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Affiliation(s)
- Ria Saha
- Medway Council National Health Service, Kent, UK
| | - Pintu Paul
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, Imperial College London, London, UK
| | - Aduragbemi Banke-Thomas
- Centre for Vulnerable Children and Families, Institute for Lifecourse Development, University of Greenwich, London, UK.
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Jain M. The "shadow pandemic" of domestic violence. BMJ 2021; 374:n2166. [PMID: 34521630 DOI: 10.1136/bmj.n2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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