Arupendra Mozumdar

Persistent Increase of Prevalence of Metabolic Syndrome Among U.S. Adults: NHANES III to NHANES 1999–2006

OBJECTIVE To compare the prevalence in metabolic syndrome (MetSyn) between 1988–1994 and 1999–2006 among U.S. adults of different races or ethnicities. RESEARCH DESIGN AND METHODS Analysis of data on 6,423 adult men and nonpregnant women aged ≥20 years from Third National Health and Nutrition Examination Survey (NHANES III) and 6,962 participants from the combined NHANES 1999–2006 were done. The revised National Cholesterol Education Program Adult Treatment Panel III definition was used to calculate MetSyn. RESULTS Both the unadjusted prevalence (27.9 ± 1.1% to 34.1 ± 0.8%, P < 0.001) and age-adjusted prevalence (29.2 ± 1.0% to 34.2 ± 0.7%, P < 0.001) increased from NHANES III to NHANES 1999–2006, respectively. Although MetSyn prevalence was highest in Mexican Americans, significant increases in prevalence occurred among non-Hispanic whites and non-Hispanic blacks, especially among younger women. CONCLUSIONS The persistent increase of MetSyn among U.S. adults is a serious public health concern because it raises the likelihood of increased prevalence of type 2 diabetes.

Changes in Metabolic Syndrome in American and Korean Youth, 1997–2008

BACKGROUND: Metabolic syndrome (MetSyn) in children and adolescence is increasing worldwide; however, its pattern may be different between Asians and Americans. We compare the prevalence and patterns of MetSyn between American and Korean children and adolescents between roughly 1998 and 2007. METHODS: Data from the American and Korean versions of the NHANES (NHANES and KNHANES) were used for this study. The main outcome is prevalence and pattern of MetSyn among participants separately in each country. In each survey, stratified multistage probability sampling designs and weighting adjustments were conducted to represent the entire population. The revised National Cholesterol Education Program criteria were used to define MetSyn. RESULTS: Totals of 934, 1781, and 1690 Americans aged 12 to 19 participated in NHANES 1988–1994, NHANES 1999–2002, and NHANES 2003–2006, respectively; and 1225, 976, 705, and 456 Koreans aged 12 to 19 have participated in KNHANES 1998, 2001, 2005, and 2007. The age-adjusted prevalence of MetSyn in American NHANES decreased from 7.3% to 6.7% and 6.5%, whereas in Korean NHANES there was an increase from 4.0% to 5.9%, 6.6%, and 7.8% in each country’s respective study. Increases in dyslipidemia and abdominal obesity contributed to the increased prevalence in Korea, whereas in the United States, decreases in low high-density lipoprotein cholesterolemia and high blood pressure contributed to a decreased prevalence. CONCLUSIONS: Considering different phenotype changes, different approaches should be conducted at the national level to reduce the burden and consequences of MetSyn between Korea and the United States.

Gender-Based Violence in Rural Uttar Pradesh, India Prevalence and Association With Reproductive Health Behaviors

This study explores the prevalence of different forms of domestic violence and their impact on women’s reproductive health behavior in rural Uttar Pradesh (UP), India. Data were collected as a part of a large household survey carried out in 2009-2010. A multistage stratified systematic sampling design was used. A total of 4,223 married women aged 15 to 49 years and 2,274 husbands of these women were interviewed. Data were analyzed using bivariate and multivariate analyses. More than one third of married women in rural UP had experienced one or more forms of violence, such as verbal abuse, physical manhandling, and sexual abuse by their spouse. Nearly 47% of the women had experienced some form of violence during their last pregnancy. Significant associations were found between violence and incorrect reproductive health behaviors, pregnancy complications, poor birth preparedness, poor likelihood of institutional delivery, limited postnatal care, and limited spousal communication for family planning. After controlling for socio-economic variables in multivariate analysis, only pregnancy complications (odds ratio [OR] = 1.62, 95% confidence interval [CI] = [1.40, 1.85]) and lack of delivery preparedness (OR = 0.79, 95% CI = [0.68, 0.93]) were found to be significantly associated with violence. Husband’s attitude and reporting of violence by their wives in different situations were not significantly associated. This study provides evidence of the association of violence on the reproductive health behavior of married women in rural India. The results argue for frontline health workers to identify and counsel pregnant women experiencing violence during antenatal check-up to reduce maternal morbidity and mortality.

Corrective Equations to Self-Reported Height and Weight for Obesity Estimates Among U.S. Adults: NHANES 1999–2008

Purpose: Estimating obesity prevalence using self-reported height and weight is an economic and effective method and is often used in national surveys. However, self-reporting of height and weight can involve misreporting of those variables and has been found to be associated to the size of the individual. This study investigated the biases in self-reporting of height and weight in the U.S. adult population and generated age-adjusted correction equations for self-reported height and weight separately for each ethnic groups specific height and weight quartile sample. Validity of the body mass index (BMI) classification calculated from corrected self-reported height and weight was also examined. Method: Data on self-reporting and direct measurement of height and weight from National Health and Nutrition Examination Survey 1999–2008 were analyzed. The final sample included 11,521 men and 10,905 nonpregnant women who were all U.S. citizens aged 20 years or older. Results: A variation in misreporting of self-reported height and weight depended on the gender, ethnicity, age, and size of the individual. The results from sensitivity and specificity analyses showed that the BMI calculated from corrected values of self-reported height and weight provided more accurate estimations of overweight and obesity than did BMI calculated from self-reported height and weight. Conclusion: In spite of some methodological concerns, the correction equation of self-reported height and weight generated in this study can be utilized as a method for quick assessment of estimating the obesity and overweight prevalence in the U.S. adult population.

Prevalence, trends, and determinants of menopause in India: NFHS 1992–93 to NFHS 2005–06

The purpose of this study was to estimate the prevalence of menopause in three rounds of the National Family Health Survey (NFHS), determine correlates of menopause, and estimate the age of start of menopause in Indian women.

Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India

BACKGROUND In India, pregnant women and recently delivered mothers of marginalized communities in Uttar Pradesh (UP) remain un-reached by frontline-health-workers. In these communities, self-help groups (SHGs) have the potential to reach these women with knowledge of home-based maternal and newborn care (HBMNC). OBJECTIVE The study examines the feasibility of SHGs to improve knowledge of HBMNC. The study identifies the facilitating factors and barriers to knowledge change. METHODS A panel study with a quasi-experimental design was conducted in Jhansi, UP. Peer educators, called Swasthya Sakhi, of the SHGs of the experimental area were trained on how to conduct discussions on HBMNC topics. Both at baseline and endline 233 women from the experimental area and 237 women from the comparison area were interviewed to measure their knowledge change in HBMNC topics. The net-effect of the intervention was examined using difference-in-difference (DID) analysis with propensity-score-matching (PSM) controlling for the effect of background characteristics of the participants from two study areas. Generalized-estimating-equation (GEE) was used to identify the facilitating factors and barriers to the knowledge change. RESULTS The findings show significant net-increases in womens knowledge for most of the HBMNC topics including danger signs for a pregnant mother and a newborn child, even after controlling for the background characteristics of the participants. The most significant determinant of the increase of knowledge was the womens education. CONCLUSION Findings from the study showed SHGs can increase HBMNC knowledge among women. However, studies with longer duration are required to examine the scalability and sustainability of the intervention.

Understanding the use of India's National Health Insurance Scheme for family planning and reproductive health services in Uttar Pradesh

Indias National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), expands health services to families living below the poverty line by enrolling them into the scheme through selected health facilities. Use and reasons for nonuse of RSBY for family planning (FP) and reproductive health (RH) services have not been explored previously. This cross-sectional study explored the use of RSBY for FP/RH services at private health facilities, knowledge of FP/RH service availability, and factors influencing knowledge among RSBY enrolled families. A total of 726 women and 640 men from enrolled families living in 3 cities of Uttar Pradesh, India, were interviewed. Use of FP/RH services at private hospitals enrolled in the RSBY was 2%. Nearly 20% of respondents used FP or delivery services from unenrolled private hospitals but could have accessed these services through the scheme. Over 75% of respondents were unaware of FP/RH service availability through RSBY. Respondents with some education were more likely to have this knowledge, while poorer families were less likely to have this knowledge. Findings suggest that for RSBY to reach the most vulnerable families, efforts need to be made to better educate enrolled families about their entitlements and benefits of the scheme.