Jitendra Gouda

Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study.

BACKGROUND International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries. METHODS Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated. FINDINGS Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations. INTERPRETATION We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems. FUNDING The Lowitja Institute.

SELF-REPORTED MORBIDITY AND BURDEN OF DISEASE IN UTTAR PRADESH, INDIA: EVIDENCE FROM A NATIONAL SAMPLE SURVEY AND THE MILLION DEATHS STUDY

Uttar Pradesh is Indias most populous state with a population of 200 million. Any change in its fertility and mortality is bound to bring change at the national level. This study analysed the burden of disease in the state by calculating the disability-adjusted life year (DALY) for infectious and non-communicable diseases. Data were from two rounds (52nd and 60th) of the National Sample Survey Organization (NSSO) survey conducted in 1995-96 and 2004, respectively, and the Million Deaths Study (MDS) of 2001-03. Descriptive and multivariate analyses were carried out to identify the determinants of different types of self-reported morbidity and DALY. The results show that in Uttar Pradesh the prevalence of all selected self-reported infectious and non-communicable diseases increased over the study period from 1995 to 2004, and in most cases by more than two times. The highest observed increase in prevalence was in non-communicable diseases excluding CVDs, which increased from 7% in 1995 to 19% in 2004. The prevalence was higher for those aged 60 and above, females, those who were illiterate and rich across the time period and for all selected morbidities. The results were significant at p<0.001. The estimation of the DALY revealed that the burden of infectious diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1-5 years were more likely to report infectious diseases than corresponding males. The age distribution of the DALY indicated that individuals aged below 5 years and above 60 years were more susceptible to ill health. The growing incidence of non-communicable diseases, especially among the older generation, puts an additional burden on the health system in the state. Uttar Pradesh has to grapple with the unresolved problem of preventable infectious diseases on the one hand and the growth in non-communicable disease on the other.

Association of child health and household amenities in high focus states in India: a district-level analysis

Objectives To assess household amenities in districts of high focus states and their association with child health in India. Design The data for the study are extracted from Annual Health Survey (AHS) and Census 2011. Settings Districts in high focus states in India. Participants Information regarding children below 5 years of age and women aged 15–49 has been extracted from the AHS (2010–2011), and household amenities information has been obtained from the Census (2011). Measures Household amenities were assessed from the census at the district level in the high focus states. Child health indicators and wealth index were borrowed from AHS and used in this study to check their linkage with household amenities. Results Absence of drinking water from a treated source, improved sanitation, usage of clean cooking fuel and drainage facility in the household were adversely associated with the incidence of acute respiratory infection, diarrhoea, infant mortality rate (IMR) and under 5 mortality rate (U5MR). The mean IMR declined from 64 to 54 for districts where a high proportion of household have improved sanitation. The result of ordinary least square regression shows that improved sanitation has a negative and statistically significant association (β=−0.0067, p<0.01) with U5MR. Conclusions Although child healthcare services are important in addressing child health issues, they barely touch on the root of the problem. Building toilets and providing safe drinking water, clean cooking fuel and drainage facilities at the household level, may prevent a number of adverse child health issues and may reduce the burden on the healthcare system in India.

Government versus private primary schools in India

Purpose – This paper is an effort to identify the difference between government and private primary schools in terms of physical infrastructure, schooling costs and students performance. Further, the paper assessed the role of physical infrastructure and schooling costs on the performance of students. The paper aims to discuss these issues. Design/methodology/approach – This study used India Human Development Survey (IHDS) data. Bivariate, trivariate, χ2 and ANOVA test, factor analyses and Theil index are used as methods of analyses. Findings – The results present a distinct picture of government and private primary school education in India in terms of physical infrastructure standards, schooling cost and performance of students. In all the three selected indicators, private primary schools remained a forerunner or outperform the government primary schools in India. Besides this, the physical infrastructure and schooling cost found to have effect on performance of students both in private and public sch...

Inequality in the Utilization of Maternal Healthcare Services in Odisha, India

Odisha, one of the socioeconomically disadvantaged states of India, registers high maternal deaths. The state features wide regional and sociodemographic diversity with the Koraput-Balangir-Kalahandi (KBK) districts, dominated by disadvantaged tribal population. This study aims to assess the level and pattern of maternal healthcare services utilization among different subgroups of women in Odisha with a special focus on the regional, economic, and educational inequality using the latest District Level Household and Facility Survey (DLHS-III, 2007-08). Descriptive statistics and bivariate and multivariate analysis were used to understand the pattern of utilization of maternal healthcare services among women by different background characteristics. Concentration curve and decomposition analysis were used to understand the inequalities in utilization of maternal healthcare services and contribution of different socioeconomic factors. Results reveal wide regional variation in the utilization of maternal healthcare services. The utilization of maternal healthcare services is more concentrated among affluent households. Economic inequality in safe delivery is high. Decomposition analysis shows education as the leading contributor in explaining maternal healthcare services utilization. Enhancing literacy among women and improving of health infrastructure and its quality in rural and disadvantaged regions may be prioritized to improve the maternal health in Odisha.

Smokeless tobacco use among adult males in India and selected states: Assessment of education and occupation linkages

Abstract This article is an effort to analyze the influence of education and occupation as critical determinants of smokeless tobacco use among adult males in India and its selected states. Global Adult Tobacco Survey (GATS) India 2009–10 data are used to analyze the prevalence of smokeless tobacco use among adult males aged 15 years and above (N = 33,767) by their different education and occupational status. Bivariate and multivariate (Cox proportional survival model) analyses are carried out to assess the linkages of education and occupation with use of smokeless tobacco among adult males. The study suggests that the majority of Indian men are using khaini (18%) and gutkha (13%) (the local terms used for smokeless tobacco). Further, it is observed that education and occupation remain the two important critical predictors of smokeless tobacco use among men. A greater percentage of young men with no education from rural areas use smokeless tobacco (44.3%) than their counterpart group from urban areas. The socioeconomically disadvantaged states, noticeably the east and central (4.992 and 3.218; p < .001) states, record higher prevalence of smokeless tobacco use than other states. Considering the high prevalence of smokeless tobacco use among illiterate and socioeconomically deprived youths, there is an urgent need to sensitize the issue. More concrete efforts to generate awareness on the ill effects of tobacco use among the illiterate and those who are employed in low-profile occupations are needed.

Is fertility associated with the number of siblings of the couple? Evidence from India

Abstract The influence of family on an individual’s fertility has long been an important topic of interest in fertility research. Although studies conducted mostly in developed countries found a significant bearing of fertility of the parents on the fertility of the children, there is a lack of formal research around this topic in India. The present study analyses the effect of sibling size of husband and wife on the completed family size of women using information of 5506 ever-married women aged 45–49 years incorporated in the India Human Development Survey-II (2011–2012). Inferential statistics, bivariate, Chi-square and Poisson regression were used as the methods of analysis. The unadjusted estimates of Poisson regression reveal sibling size of women (IRR: 1.02; p < 0.001) and husband (IRR: 1.01; p < 0.001) have a positive correlation with the completed family size of women. However, in the adjusted model, the effect of sibling size especially of husband diminishes gradually in the presence of socio-economic covariates of the women.