Barun Kanjilal

Nutritional status of children in India: Household socio-economic condition as the contextual determinant

BackgroundDespite recent achievement in economic progress in India, the fruit of development has failed to secure a better nutritional status among all children of the country. Growing evidence suggest there exists a socio-economic gradient of childhood malnutrition in India. The present paper is an attempt to measure the extent of socio-economic inequality in chronic childhood malnutrition across major states of India and to realize the role of household socio-economic status (SES) as the contextual determinant of nutritional status of children.MethodsUsing National Family Health Survey-3 data, an attempt is made to estimate socio-economic inequality in childhood stunting at the state level through Concentration Index (CI). Multi-level models; random-coefficient and random-slope are employed to study the impact of SES on long-term nutritional status among children, keeping in view the hierarchical nature of data.Main findingsAcross the states, a disproportionate burden of stunting is observed among the children from poor SES, more so in urban areas. The state having lower prevalence of chronic childhood malnutrition shows much higher burden among the poor. Though a negative correlation (r = -0.603, p < .001) is established between Net State Domestic Product (NSDP) and CI values for stunting; the development indicator is not always linearly correlated with intra-state inequality in malnutrition prevalence. Results from multi-level models however show children from highest SES quintile posses 50 percent better nutritional status than those from the poorest quintile.ConclusionIn spite of the declining trend of chronic childhood malnutrition in India, the concerns remain for its disproportionate burden on the poor. The socio-economic gradient of long-term nutritional status among children needs special focus, more so in the states where chronic malnutrition among children apparently demonstrates a lower prevalence. The paper calls for state specific policies which are designed and implemented on a priority basis, keeping in view the nature of inequality in childhood malnutrition in the country and its differential characteristics across the states.

Regulating Health Care Markets In China And India

Health care markets in China and India have expanded rapidly. The regulatory response has lagged behind in both countries and has followed a different pathway in each. Using the examples of front-line health providers and health insurance, this paper discusses how their different approaches have emerged from their own historical and political contexts and have led to different ways to address the main regulatory questions concerning quality of care, value for money, social agreement, and accountability. In both countries, the challenge is to build trust-based institutions that rely less on state-dominated approaches to regulation and involve other key actors.

Exploring evidence-policy linkages in health research plans: A case study from six countries

The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. The cross-country research consortium provides a unique opportunity to explore the research-policy interface. Three key activities were undertaken during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon. These three activities yielded interesting findings. First, developmental consideration with four dimensions – poverty, vulnerabilities, capabilities, and health shocks – provides an entry point in examining research-policy interfaces in the six settings. Second, research plans focused upon on the ground realities in specific countries strengthens the interface. Third, focusing on research prioritized by decision-makers, within a politicized health arena, enhances chances of research influencing action. Lastly, early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface. The approach described has four main utilities: first, systematic analyses of research proposals using key considerations ensure such issues are incorporated into research proposals; second, the exact meaning, significance, and inter-relatedness of these considerations can be explored within the research itself; third, cross-country learning can be enhanced; and finally, translation of evidence into action may be facilitated. Health systems research proposals in low and middle income countries should include reflection on transferring research findings into policy. Such deliberations may be informed by employing the four key considerations suggested in this paper in analyzing research proposals.

Transforming health markets in Asia and Africa: improving quality and access for the poor.

This book chapter was published in the Transforming Health Markets in Asia and Africa: Improving Quality and Access for the Poor [© 2012 Taylor and Francis] and the definite version is available at: http://www.tandfebooks.com/doi/10.4324/9780203102060

Care seeking for postpartum morbidities in Murshidabad, rural India

Location Rural 898 (96.7) 50 (92.6) 445 (97.4) 403 (96.4) Social/individual Education: mother Up to primary 458 (49.3) 23 (42.6) 273 (59.7) 162 (38.8) Primary 173 (18.6) 13 (24.1) 78 (17.1) 82 (19.6) Middle school 206 (22.2) 12 (22.2) 84 (18.4) 110 (26.3) ≥ High school 92 (9.9) 6 (11.1) 22 (4.8) 64 (15.3) Education: household head Up to primary 557 (60.0) 33 (61.1) 302 (66.1) 222 (53.1) Primary 130 (14.0) 7 (13.0) 63 (13.8) 60 (14.4) Middle school 130 (14.0) 6 (11.1) 59 (12.9) 65 (15.6) ≥ High school 112 (12.1) 8 (14.8) 33 (7.2) 71 (17.0) Religion Muslim 581 (62.5) 32 (59.3) 283 (61.9) 266 (63.6) Hindu 348 (37.5) 22 (40.7) 174 (38.1) 152 (36.4) Institutional delivery 325 (35.0) 13 (24.1) 92 (20.1) 220 (52.6)

Multiple Shocks, Coping and Welfare Consequences: Natural Disasters and Health Shocks in the Indian Sundarbans

Background Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May 2009, this study tests for evidence and argues that health and climatic shocks are essentially linked forming a continuum and with exposure to a marginal one, coping mechanisms and welfare outcomes triggered in the response is significantly affected. Data & Methods The data for this study is based on a cross-sectional household survey carried out during June 2010. The survey was aimed to assess the impact of cyclone Aila on households and consequent coping mechanisms in three of the worst-affected blocks (a sub-district administrative unit), viz. Hingalganj, Gosaba and Patharpratima. The survey covered 809 individuals from 179 households, cross cutting age and gender. A separate module on health-seeking behaviour serves as the information source of health shocks defined as illness episodes (ambulatory or hospitalized) experienced by household members. Key findings Finding reveals that over half of the households (54%) consider that Aila has dealt a high, damaging impact on their household assets. Result further shows deterioration of health status in the period following the incidence of Aila. Finding suggests having suffered multiple shocks increases the number of adverse welfare outcomes by 55%. Whereas, suffering either from the climatic shock (33%) or the health shock (25%) alone increases such risks by a much lesser extent. The multiple-shock households face a significantly higher degree of difficulty to finance expenses arising out of health shocks, as opposed to their counterparts facing only the health shock. Further, these households are more likely to finance the expenses through informal loans and credit from acquaintances or moneylenders. Conclusion This paper presented empirical evidence on how natural and health shocks mutually reinforce their resultant impact, making coping increasingly difficult and present significant risks of welfare loss, having short as well as long-run development manifestations.

The Economics of HIV/AIDS

The most important among these research questions is: how and to what extent will HIV/AIDS affect our economies? In other words, how serious is the threat of an AIDS epidemic to a national, sectoral or household economic well-being? The answer to this question is extremely crucial for policy making since knowledge on the severity of impact at different levels enormously helps prioritise interventions. Issues related to economics of HIV/AIDS are concisely capsuled by 7’he.Econom ics ofHIVIA IDS.1beCaseofSouthandSouthEastAsía, a book published for and on behalf of the United Nations Development Programme (UNDP) (Bloom and Godwin 1997). The volume includes a collection of studies commissioned by the UNDP’s Regional HIV Project for Asia and the Pacific in 1990s. The introductory statements of the first article precisely reflects the principal theme of the book:

Drug Demand Reduction

Psychoactive drug (or substance) use is a global phenomenon. It effects almost every country, although its extent and characteristics differ from region to region. The UN estimates that some 180 million people worldwide-4.2 per cent of people aged 15 years and above-were consuming these drugs in the late 1990s, including cannabis (144 million), amphetamine-type stimulants (29 million), cocaine (14 million) and opiates (13.5 million, including 9 million addicted to heroin) (ODCCP 2000). In addition to its known consequences, such as, increased rates of crime and violence, susceptibility

Child Health in the Sundarbans: How Far Do Mutually Reinforcing Shocks Act As Contextual Determinants?

Childhood chronic under-nutrition and common childhood illness are highly prevalent in the delta region of the Sundarbans of West Bengal, India. The present work tested the hypothesis—frequent climatic shock is likely to predispose chronic and transient health shocks through behavioural responses of households in the presence of inaccessibility, inadequacy and acceptability barriers which act in the economy as long wave shocks. The work is based on a household and facility survey; primary data was collected in 19 blocks of the Sundarbans. The results highlight that transient climatic shock make child health worse through the pathway of chronic poverty, low resilience, physical and social barriers to health-seeking as well as ineffective service delivery systems. Further in-depth research is required to understand multiple vulnerabilities, related to coping of households and ways to improve the service delivery mechanism to have healthy children in the Sundarbans in the near future.

Young Women's Sexual and Reproductive Lives

Young women or adolescent girls are a world within themselves. Though the spark of extensive economic reforms and globalisation in the last few decades seems to have forced its way through this world the health care needs of adolescence the stage which bridges childhood and adulthood traditionally remained unattended for long. However it suddenly seems to have come into prominence with more focused attention from researchers and policy-makers throughout the developing world. Serious behavioural studies on the status of the reproductive and sexual health of young boys and girls have started showing how little we know about this silent but total transition in this vital organ of our society. The status of this newly discovered world and the scope of its needs have been examined and comprehensively unfurled by a recently published report of the Alan Guttmacher Institute (1998). The research for and publication of this well-edited report is part of a three-year project on youth worldwide undertaken by the Alan Guttmacher Institute in collaboration with organisations from 13 developing countries. The main theme of this report is centered around the needs of young women in this rapid and chaotic age of societal transition. How are they to be prepared physically and otherwise to deal with the major aspects of womens lives e.g. sexual relationships marriage and childbearing? Are the health and population programmes in developing countries appropriately equipped and aligned to cater to their specific needs? What is the evidence of the positive impact of enhancing economic and social opportunities on the sexual and reproductive health behaviour of adolescents? The report based on the data collected from a large number of countries succinctly documents the collected evidence and helps us build our own hypotheses on the above and many other questions. (excerpt)