Kannan Navaneetham

Utilization of maternal health care services in Southern India.

This paper examines the patterns and determinants of maternal health care utilization across different social settings in South India: in the states of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu. Data from the National Family Health Survey (NFHS) carried out during 1992-93 across most states in India are used. Results show that utilization of maternal health care services is highest in Kerala followed by Tamil Nadu, Andhra Pradesh and Karnataka. Utilization of maternal health care services is not only associated with a range of reproductive, socio-economic, cultural and program factors but also with state and type of health service. The interstate differences in utilization could be partly due to variations in the implementation of maternal health care program as well as differences in availability and accessibility between the states. In the case of antenatal care, there was no significant rural-urban gap, thanks to the role played by the multipurpose health workers posted in the rural areas to provide maternal health care services. The findings of this study provide insights for planning and implementing appropriate maternal health service delivery programs in order to improve the health and well-being of both mother and child.

Maternal mortality in India: estimates from a regression model.

This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. Estimates derived for the major states suggest relatively high maternal mortality in the eastern and northern parts of the country. They also indicate a substantial decline in maternal mortality since the 1960s. The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India.

Socio-economic inequalities in child health: Recent evidence from India

Abstract This paper analyses the Indian National Family Health Survey (2005–2006) data to present certain broad descriptive features of child health inequalities in India and their distribution across well-defined socio-economic groups classified by gender and sector-of-origin, and their dispersal across space. This study finds that poorer sections of the population are beleaguered with ill health whether in the quest for child survival or due to anxieties pertaining to child nutrition. The concentration index value for the indicators of under-five mortality, full immunisation and underweight outcomes at the national level is calculated to be −0.159, 0.204 and −0.158, respectively. The other disturbing finding here is that there are reigning regional and gender disadvantages irrespective of the developmental status of the State. This study would not only help policymakers to recognise these persistent inequalities but also would help understand health performance at the state and regional levels thus facilitating targeting intervention.

Inequalities in Childhood Malnutrition in India: Some Evidence on Group Disparities

Abstract This paper examines inequalities in child malnutrition in India through three distinct — although inter‐related — types of empirical analysis. First, it reports the socio‐economic inequalities in childhood malnutrition across different Indian states. Second, it decomposes the gap in malnutrition between children belonging to poor and non‐poor households to understand the disadvantageous distribution of health determinants and their effects. This analysis indicates that the distribution of endowments and positive maternal characteristics are significant in widening the gap between the child malnutrition among poor and non‐poor households. Third, it examines the inter‐group disparities in child malnutrition and notes that child groups privileged in terms of income, mother’s nutritional status and education have lower malnutrition, whereas the group adverse in all three characteristics endures the most. The paper concludes that policies to reduce malnutrition inequalities should recognize that endowment revisions can be more effective if appended with behavioural interventions.

Comparison of Chernoff-type face and non-graphical methods for clustering multivariate observations

During the past few years the use of Chernoff-type faces (a technique of representing points in k-dimensional space graphically) has been accelerating for discovering clusters and outliers present in a set of multivariate observations. However, their validation for clustering multivariate data seems to be few. The present study deals with evaluating the efficiency of Chernoff-type faces (Flury and Riedwyl) and four non-graphical algorithms, viz., ‘Single linkage’, ‘Complete linkage’, ‘Group average’ and Wards methods for recovering true cluster structures. Four different data sets have been used, which were based on samples from mixtures of multivariate normal populations with varying variance-covariance matrix and different levels of separation factor. In order to account for the variability between the subjects, experiments with 30 subjects were conducted and they were asked to group all those faces together which look alike. The recovery of hierarchical cluster structure through Chernoff-type faces has been measured using the agreement score which is simply the number of subjects classifying the pair of faces together just by merely looking at the gestalt of a face. In all the four populations considered, the recovery of cluster structure through Chernoff-type faces using the perception matrix based on the classification of faces done by 30 subjects was more similar to that obtained by complete linkage method as evaluated by adjusted Rand statistic and Jaccard index. The efficacy of Chernoff-type faces in recovering true cluster structure seems to be poor when the classification is done by one subject only. The present study revealed that none of the subjects gave a true partitions in all the four populations considered. However, the recovery values (both adjusted Rand and Jaccard) had improved substantially when the clusters were obtained from perception matrix presenting the number of subjects who identified any two faces more similar in their gestalt.

Prevalence and determinants of adult under-nutrition in Botswana.

Background To estimate the prevalence and determinants of adult under-nutrition in Botswana. Methods A cross-sectional survey was conducted where a nationally representative sample of people aged 20 to 49 years was used for the analysis. The outcome measure of under-nutrition was measured as BMI<18.5 kg/m2. Results Of the total sample, 19.5% of males and 10.1% of females were underweight (BMI<18.5 kg/m2). The wealth index showed that 30.9% of the adult population with low a BMI belongs to the poorest 20% of the households while only 9.6% comprised of the richest 20% of the households. Results from logistic regression analysis indicated that both adult men and women who had no education and belonged to the low socioeconomic group had a statistically significant association with low BMI. Among the female adult population, being young and not having watched TV at least once a week were significantly associated with low BMI. For the male adult population, being unmarried was significantly associated with low BMI. Conclusions Programme interventions aimed at improving the nutritional status of adults can use these findings to make appropriate policy, to establish baselines and study nutritional changes over time and its covariates.

Individual, household and contextual factors associated with skilled delivery care in Ethiopia: Evidence from Ethiopian demographic and health surveys

Despite evidence that social contexts are key determinants of health, research into factors associated with maternal health service utilization in Ethiopia has often focused on individual and household factors. The downside is that this underestimates the importance of taking contextual factors into account when planning appropriate interventions in promoting safe motherhood in the country. The purpose of this study is to fill this knowledge gap drawing attention to the largely unexplored contextual factors affecting the uptake of skilled attendance at delivery in a nationally representative sample. Data for the study comes from two rounds of the Ethiopian Demographic and Health Surveys (EDHS) conducted in the year 2005 and 2011. Analysis was done using a two-level multivariable multilevel logistic regression model with data from 14, 242 women who had a live birth in the five years preceding the surveys clustered within 540 (in the year 2005) and 624 (in the year 2011) communities. The results of the study point to multiple levels of measured and unmeasured factors affecting the uptake of skilled delivery care in the country. At community level, place of residence, community level of female education and fertility significantly predict the uptake of skilled delivery care. At individual and household level, maternal age, birth order, maternal education, household wealth and access to media predict the uptake of such service. Thus, there is a need to consider community contexts in the design of maternal health programs and employ multi-sectorial approach to addressing barriers at different levels. For example, improving access and availability of skilled delivery care should eventually enhance the uptake of such services at community level in Ethiopia. At individual level, efforts to promote the uptake of such services should constitute targeted interventions paying special attention to the needs of the youth, the multiparous, the less educated and women in the poorest households.

Morbidity patterns in Kerala : levels and determinants

This paper examines the levels, patterns, and determinants of morbidity in Kerala. This study is based on a community survey conducted in 2004, in three districts of the state namely Thiruvananthapuram, Malappuram and Kannur. The survey covers 3320 households having 17071 individuals in all age groups. Reported morbidity was captured for a period of fifteen days prior to the data of survey. Life course analysis was performed to understand the risk of morbidity at various stages, like infancy, early childhood, late childhood, adolescence, reproductive ages and old age, in relation to the impact of socio-economic, demographic and regional factors. [WP No. 411].

Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional study

Objectives The objectives of this study are: (1) to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and (2) to identify risk factors for unmet need for family planning among married women. Design This study used secondary data from a cross-sectional survey that was conducted to provide a snapshot of health issues in Botswana. Setting Nationally representative population survey data. Participants 2601 married or in union women aged 15–49 years who participated in the 2007 Botswana Family Health Survey were included in the analysis. Primary outcome Unmet need for family planning, which was defined as the percentage of all fecund married women who are not using a method of contraception even though they do not want to get pregnant. Results Married women who had unmet need for family planning were 9.6% in 2007. Most of the unmet need was for limiting (6.7%) compared to spacing (2.9%). Unmet need for family planning was more likely to be among women whose partners disapproved of family planning, non-Christians, had one partner and had never discussed family planning with their partner. Women of low parity, aged 25–34 years, and greater exposure to mass media, were less likely to have experienced unmet need. The patterns and magnitude of covariates differed between unmet need for limiting and for spacing. Conclusions The prevalence of unmet need for family planning was low in Botswana compared to other sub-Saharan African countries. The findings from this study reemphasise the importance of womens empowerment and mens involvement in womens sexual and reproductive healthcare needs and services. Different approaches are needed to satisfy the demand for family planning for spacing and limiting.

The influence of cohort effects on mortality trends in India Role of economic factors

The inferences drawn from this study are as follows: The stagnation/ increase in mortality rates of adult ages in the recent years in India as well as for the major states may be attributed to food shortages and price hikes experienced in the country during 1960–74. In other words, all those who were adults during 1980s had experienced the crisis of hunger due to nonavailability of food as well as entitlement failure during their childhood. These persons would have had higher risk of dying in their life time and that may be one of the main reasons for the stagnation or increase in adult mortality in India and in most of the states. The findings of the study suggest that, the economic crisis experienced in India during the late eighties, may decrease the survival chances of those born during this period in their future life time. However, successful containment of increase in food prices during the period of crisis would be helpful in protecting the entitlement of vulnerable groups. The policy implication of the study is that it is essential to control the prices of food during the time of food shortages and or economic crisis and even in the period when food is available, measures should be undertaken to evolve efficient distribution system ensuring the supply of food to those vulnerable groups, who were unlucky to be born or were in infancy during the period of economic crisis. Thus, essentially this is a study in interaction of economic factors and demographic trends in an economy where large segments of the population are periodically subject to heightened food insecurities, compression of real wages and entitlement failures.