Manisha Dubey

Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.

Economic well-being and spending behaviour of households in India: does remittances matter?

Context: Studies on economic well-being and use of remittances are often limited to international migration and less on internal migration. But the remittances flow within and among the states of India is large and often linked to the diversity in demographic and socio-economic development. Though the issue of remittances is central to migration in India, there is no study that systematically examines the economic well-being of remittances and non-remittances households in India. Objective: The aim of this paper is to examine the economic well-being and spending behaviour of households that receive international remittances, internal remittances and do not receive any remittances in India. Data and Methods: The unit data from 64th round, schedule 10.2 of National Sample Survey 2007–2008 that covered employment, unemployment and migration particulars of 125,578 households in the country are used in the analyses. The households are classified into three groups; households receiving international remittances, domestic remittances and household did not receive any remittances based on the receipt of remittances from migrant member of the households in one year prior to survey. Economic well-being is measured by monthly per capita consumer expenditure and pattern of household spending on food, education, health and consumer durables. The state level analyses are limited to nine states of India due to limited sample size of international remittances. The average and marginal spending behaviour are compared for remittances receiving and non-remittances households. Descriptive and multivariate analyses are used to understand the differentials and determinants of economic well-being and the pattern of consumption expenditure of households. Results: The MPCE of households receiving internal remittances was 783 rupees compared to 1299 rupees for households receiving international remittances and 837 rupees for non-remittances households. The pattern is similar in seven states of India except in Uttar Pradesh and Maharashtra. The average budget share on food was 0.51 for non-remittances households, 0.53 for households receiving domestic remittances and 0.41 for households receiving international remittances. While the pattern of spending behaviour of households receiving international remittances is similar across the states, it is not same for domestic remittances. The average and marginal spending behaviour does not vary much at higher level of education of the households. At the margin, household receiving international remittances in India spent at least 59% more on health compared to 10% more among households receiving domestic remittances. Result on higher marginal budget spending of remittances household on health and consumer durables is mixed across the states. Conclusion: Though the economic conditions of households receiving domestic remittances is not necessarily better than that of non-remittances households in India, the marginal budget share on health, education and consumer durables of remittances households is higher than that of households not receiving remittances.

Threshold Levels of Infant and Under-Five Mortality for Crossover between Life Expectancies at Ages Zero, One and Five in India: A Decomposition Analysis.

Objectives Under the prevailing conditions of imbalanced life table and historic gender discrimination in India, our study examines crossover between life expectancies at ages zero, one and five years for India and quantifies the relative share of infant and under-five mortality towards this crossover. Methods We estimate threshold levels of infant and under-five mortality required for crossover using age specific death rates during 1981–2009 for 16 Indian states by sex (comprising of India’s 90% population in 2011). Kitagawa decomposition equations were used to analyse relative share of infant and under-five mortality towards crossover. Findings India experienced crossover between life expectancies at ages zero and five in 2004 for menand in 2009 for women; eleven and nine Indian states have experienced this crossover for men and women, respectively. Men usually experienced crossover four years earlier than the women. Improvements in mortality below ages five have mostly contributed towards this crossover. Life expectancy at age one exceeds that at age zero for both men and women in India except for Kerala (the only state to experience this crossover in 2000 for men and 1999 for women). Conclusions For India, using life expectancy at age zero and under-five mortality rate together may be more meaningful to measure overall health of its people until the crossover. Delayed crossover for women, despite higher life expectancy at birth than for men reiterates that Indian women are still disadvantaged and hence use of life expectancies at ages zero, one and five become important for India. Greater programmatic efforts to control leading causes of death during the first month and 1–59 months in high child mortality areas can help India to attain this crossover early.

Age and sex patterns of premature mortality in India.

Objectives To estimate premature mortality by age, sex and cause of death in India. Background Studies on premature mortality in India are limited. Although evidence suggests recent reductions in infant and child mortality, little is known about the age and sex patterns of premature deaths in India. Methods Secondary data from the Sample Registration System and, census of India and report on cause of death. A set of indices are used to estimate the premature mortality were analysed. Primary and secondary outcome measures Standardised years of potential life lost (YPLL), premature years of potential life lost (PYPLL) and working years of potential life lost (WYPLL) for broad age groups and by selected causes of death. Results From 1991 to 2011, the age-standardised rate of YPLL (per 1000 population) declined from 310 to 235 for males and from 307 to 206 for females. The estimated YPLL (in millions) declined from 134 to 147 for males and from 123 to 108 for females, the YPLL for adults (aged 15–65) increased by 32% for males and 28% for females, the standardised PYPLL (per 1000 population) declined from 259 to 137 for males and from 258 to 115 for females, the estimated PYPLL increased by 13% for all adult males and by 32% for 30–45-year-old adult males, and the standardised rate of WYPLL declined from 274 to 131 for males and from 295 to 91 for females. These findings suggest a significant improvement in early childhood mortality and increasing mortality trends in 30–45-year-old adult males. The YPLL and WYPLL standardised rates for males and females were highest for cardiovascular disease. Conclusions The increasing share of premature deaths among adults and high levels of premature mortality suggest an improvement in child survival increased attention should be given to prevention and treatment of non-communicable diseases in order to avoid premature deaths in India.

Trends, prospects and deprivation index of disability in India: Evidences from census 2001 and 2011

BACKGROUND Since the dawn of civilization, disabilities have existed in various dimensions of human life. World Health Organization (WHO) defines disability as an umbrella term, covering impairments, activity limitations, and participation restrictions. Globally, approximately 1 billion people have some form of disability, and approximately 20% have significant functioning impairments. OBJECTIVE This study aims to estimate the level, trends and prospects of disability in 640 districts of India. Data for the present study has been taken from Census of India, 2001 and 2011. METHODS A Disability Index was calculated at the district level, and state level indexing was done using the Disability Deprivation Index. The population for the year 2021 was projected using the exponential growth rate method. The Disability Deprivation Index was calculated using child labor, adult unemployment, illiteracy, and the ratio of beggars in the disabled population. RESULTS The study reveals that the proportion of the disabled population in India was 2.10% in 2001, which increased to 2.21% in 2011. According to the Disability Deprivation Index, Maharashtra was the best-performing state in 2011. There were 4.90 million new cases of disability in India during 2001-11, out of which 1.52 million cases belonged to non-congenital disability. CONCLUSIONS There is a rise in the disabled population in India, which needs special attention. The working status of the disabled is gloomy. The majority of the disabled people are non-working and need adequate rehabilitation measures that would facilitate employment.