Ashish Singh

Utilization of postnatal care for newborns and its association with neonatal mortality in India: an analytical appraisal.

Background39% of neonatal deaths in India occur on the first day of life, and 57% during the first three days of births. However, the association between postnatal care (PNC) for newborns and neonatal mortality has not hitherto been examined. The paper aims to examine the association of PNC for newborns with neonatal mortality in India.MethodsData from District Level Household Survey, waive three (DLHS-3) conducted in 2007–08 is utilized in the study. We used conditional logit regression models to examine the association of PNC with neonatal mortality. The matching variables included birth order and the age of the mother at the birth of the newborn.ResultsThe findings suggest no association between check-up of newborns within 24 hours of birth and neonatal mortality. However, the place where the newborns were examined was significantly associated with neonatal mortality. Moreover, findings do reveal that children of mothers who were advised on ‘keeping baby warm (kangaroo care) after birth’ during their antenatal sessions were significantly less likely to die during the neonatal period compared to those children whose mothers were not advised about the same.ConclusionsThe findings are relevant because ‘keeping baby warm’ is one of the most cost-effective and easiest interventions to save babies from dying during the neonatal period. Though randomized controlled trials have already demonstrated the effectiveness of ‘keeping baby warm’, for the first time this has been found effective in a large-scale population-based study. The findings are of immense value for a country like India where the neonatal mortality rates are unacceptably high.

INEQUALITY OF OPPORTUNITY IN EARNINGS AND CONSUMPTION EXPENDITURE: THE CASE OF INDIAN MEN

The paper associates inequality of opportunities with outcome differences that can be accounted by predetermined circumstances which lie beyond the control of an individual, such as parental education, parental occupation, caste, religion, and place of birth. The non‐parametric estimates using parental education as a measure of circumstances reveal that the opportunity share of earnings inequality in 2004–05 was 11–19 percent for urban India and 5–8 percent for rural India. The same figures for consumption expenditure inequality are 10–19 percent for urban India and 5–9 percent for rural India. The overall opportunity share estimates (parametric) of earnings inequality due to circumstances, including caste, religion, region, parental education, and parental occupation, vary from 18 to 26 percent for urban India, and from 16 to 21 percent for rural India. The overall opportunity share estimates for consumption expenditure inequality are close to the earnings inequality figures for both urban and rural areas. The analysis further finds evidence that the parental education specific opportunity share of overall earnings (and consumption expenditure) inequality is largest in urban India, but caste and geographical region also play an equally important role when rural India is considered.

Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions

Background and Objectives Despite Indias substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI) in immunization status of Indian children and to examine the inter-regional and inter-temporal variations in the GWHI. Data and Methods The present study used households with a pair of male-female siblings (aged 1–5 years) from two rounds of National Family Health Survey (NFHS, 1992–93 and 2005–06). The overall inequality in the immunization status (after controlling for age and birth order) of children was decomposed into within-households and between-households components using Mean log deviation to obtain the GWHI component. The analysis was conducted at the all-India level as well as for six specified geographical regions and at two time points (1992–93 and 2005–06). Household fixed-effects models for immunization status of children were also estimated. Results and Conclusions Findings from household fixed effects analysis indicated that the immunization scores of girls were significantly lower than that of boys. The inequality decompositions revealed that, at the all-India level, the absolute level of GWHI in immunization status decreased from 0.035 in 1992–93 to 0.023 in 2005–06. However, as a percentage of total inequality, it increased marginally (15.5% to 16.5%). In absolute terms, GWHI decreased in all the regions except in the North-East. But, as a percentage of total inequality it increased in the North-Eastern, Western and Southern regions. The main conclusions are the following: GWHI contributes substantially to the overall inequality in immunization status of Indian children; and though the overall inequality in immunization status declined in all the regions, the changes in GWHI were mixed.

Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE.

Background and Objectives The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. Data and Methods The paper uses data from the World Health Organisation’s Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Results and Conclusions Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.

Impact of indoor air pollution from the use of solid fuels on the incidence of life threatening respiratory illnesses in children in India

BackgroundIndia contributes 24% of the global annual child deaths due to acute respiratory infections (ARIs). According to WHO, nearly 50% of the deaths among children due to ARIs is because of indoor air pollution (IAP). There is insufficient evidence on the relationship between IAP from the use of solid fuels and incidence of life threatening respiratory illnesses (LTRI) in children in India.MethodsPanel data of children born during 2001–02, from the Young Lives Study (YLS) conducted in India during 2002 and 2006–07 was used to estimate the impact of household use of solid fuels for cooking on LTRI in children. Multivariable two-stage random effects logistic regression model was used to estimate the odds of suffering from LTRI among children from households using solid fuels relative to children from households using other fuels (Gas/Electricity/Kerosene).ResultsBivariate results indicate that the probability of an episode of LTRI was considerably higher among children from households using solid fuels for cooking (18%) than among children from households using other fuels (10%). Moreover, children from households using solid fuels in both the rounds of YLS were more likely to suffer from one or more than one episode of LTRI compared to children from households using solid fuels in only one round. Two-stage random effects logistic regression result shows that children from households using solid fuels were 1.78 (95% CI: 1.05-2.99) times as likely to suffer from LTRI as those from households using other fuels.ConclusionThe findings of this paper provide conclusive evidence on the harmful effects of the use of solid fuels for cooking on LTRI in India. The Government of India must make people aware about the health risks associated with the use of solid fuels for cooking and strive to promote the use of cleaner fuels.

Adverse Consequences of Unintended Pregnancy for Maternal and Child Health in Nepal

In Nepal, 26%-38% of recent births are estimated to be from unintended pregnancies, but little is known whether these pregnancies have adverse consequences for the health of the mother and child. Data from the 2011 Nepal Demographic and Health Survey are used to examine the hypothesis that unintended pregnancies are associated with negative health outcomes for both mothers and children. When the pregnancy was unintended (compared with when it was intended) mothers were more likely to receive inadequate prenatal care (odds ratio OR = 1.50; 95% confidence interval [CI] = 1.28-1.77). They were also more likely to opt for home births (OR = 1.30; 95% CI = 1.11-1.52). Likewise, the resultant newborns of unintended pregnancies were more likely to receive inadequate immunization (OR = 1.18; 95% CI = 1.00-1.40) and to remain stunted (OR = 1.25; 95% CI = 1.00-1.56). Findings suggest significant associations between unintended pregnancy and negative health outcomes for both mothers and children in Nepal.

Screech Frequency Prediction in Underexpanded Axisymmetric Screeching Jets

Average shock spacing and average standing wavelength are estimated from computed near-field of axisymmetric underexpanded screeching jets at low supersonic Mach numbers. These are used to predict screech frequencies based on existing formulations which rely either on shock spacing or on standing wavelength. Results obtained suggest that shock spacing and standing wavelength may respectively be dominant length scales for A1 and A2 axisymmetric screech modes observed for axisymmetric jets at low supersonic Mach numbers. This implies that presence of two axisymmetric screech modes in supersonic jet screech could be attributed to the two co-existing length scales in the jet near-field.

Measuring Inequality of Poverty: Theory and an Application to India

The commonly used poverty indices measure the overall level of poverty in a society but fail to capture the differential intensity of poverty across different socioeconomic groups. This article proposes a new measure, Inequality of Poverty Index (similar to dissimilarity index in the literature on inequality of opportunity) that captures inequality in distribution of poverty across different subgroups. It can be used to determine the major socioeconomic factors/characteristics/circumstances causing between-group disparity in poverty and effect of a specific factor on poverty relative to other factors and time. The article also provides an application of the index and potential policy implications.

Traditional vs. non‐traditional healing for minor and major morbidities in India: uses, cost and quality comparisons

To examine the uses, cost and quality of care of traditional healing for short‐term morbidities and major morbidities in India and to compare them with the non‐traditional healing.