India's progress toward the 5th Millennium Development Goal: A critical review

The 5th millennium development goal is primarily aimed to reduce maternal deaths by 2015. In response, various maternal and child health initiatives are implemented at national level in India

An investigation to identify potential risk factors associated with common chronic diseases among the older population in India

© 2017 Indian Journal of Community Medicine. Background: In India, chronic diseases are the leading cause of death and their prevalence has constantly increased over the last decade. Objective: This study aimed to identify risk factors associated with common chronic diseases among people aged 50 years and over in India. Materials and Methods: Data from Wave 1 of the 2007/2008 Indian Study on Global Ageing and Adult Health (SAGE) was used to investigate the association between lifestyle choices and chronic diseases using logistic regression. Result: The fully adjusted model showed that significant independent risk factors for angina included area of residence, being diagnosed with diabetes, chronic lung disease (CLD) [highest odds ratio (OR) 4.77, 95% confidence interval (CI): 2.95-7.70] and arthritis. For arthritis, risk factors included having underlying diabetes, CLD diagnosis, or angina (highest OR 2.32, 95% CI: 1.63-3.31). Risk factors associated with CLD included arthritis, angina (highest OR 4.76, 95% CI: 2.94-7.72), alcohol use, and tobacco use. Risk factors associated with diabetes included level of education, area of residence, socioeconomic status, angina (highest OR 3.59, 95% CI: 2.44-5.29), CLD, arthritis, stroke, and vegetable consumption. Finally, risk factors associated with stroke included diabetes and angina (highest OR 3.34, 95% CI: 1.72-6.50). The presence of any other comorbidity was significantly associated with all five chronic diseases studied. Conclusion: The results show that within the older population, the contribution of lifestyle risk factors to the common chronic diseases investigated in this study was limited. Our findings showed that the major health issue within the study population was multimorbidity

Maternal smoking and the risk of still birth: systematic review and meta-analysis

BACKGROUND: Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth. METHODS: We searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31(st) December 2012. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth. RESULTS: 1766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p  <  0.0001). In subgroup analysis, smoking 1-9 cig/day and ≥10 cig/day was associated with an 9% and 52% increase in the odds of stillbirth respectively. Subsequently, studies defining stillbirth at ≥ 20 weeks demonstrated a 43% increase in odds for smoking mothers compared to mothers who do not smoke, (OR 1.43, 95% CI 1.32, 1.54, p  <  0.0001), whereas studies with stillbirth defined at ≥ 24 weeks and ≥ 28 weeks showed 58% and 33% increase in the odds of stillbirth respectively. CONCLUSION: Our review confirms a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority

Association of socioeconomic status with sex ratio at live birth in individuals living in the slums of Sholapur city, India

Background: The existence of female feticide in India is well known. However, limited data are available on the association of socioeconomic status (SES) on sex ratio at live birth in disadvantaged populations, despite the fact that 33% of the population of India live on less than $1.25 per day. Objective: To study the association of SES with sex ratio at live birth in individuals living in the slums of Sholapur city, India. Materials and Methods: We used the data collected as a part of a social work intervention in the slums of Sholapur city, Maharashtra, from January 2007 to August 2011. Two measures of SES were used, location of birth (government hospital compared to private hospital) and eligibility for means-tested financial support after delivery. Results: Data were available for 1391 infants. The infants born in government hospitals were more likely to be male compared to those born in private hospitals (sex ratio of 1.45 compared to 1.14, respectively, p = 0.03). Similarly, infants whose parents were eligible for post-delivery financial support had a trend to a higher sex ratio (1.47 compared to 1.18, p = 0.057). Maternal age was independently and inversely associated with sex ratio at live birth with a linear relation (OR per year increase in maternal age 0.96, 95% CI 0.93–1.00, p = 0.03). Conclusion: In this particular population, two measures of less affluent SES were associated with higher sex ratio at live birth. However, care should be taken while generalizing these observations to other disadvantaged groups living in India, but this represents an area of research where more epidemiological work is required, as these differences perpetuated over generations may have substantial demographic consequences

Weight, height and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross-sectional study

Objective:We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia.Methods:A cross-sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight and mid upper arm circumference (MUAC). Haemoglobin (Hb) levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Results:Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% CI: 0.08 to 0.15,

Healthcare benefits linked with Below Poverty Line registration in India: Observations from Maharashtra Anaemia Study (MAS)

A 2015 Lancet paper by Patel et al. on healthcare access in India comprehensively discussed national health programmes where some benefits are linked with the country’s Below Poverty Line (BPL) registration scheme. BPL registration aims to support poor families by providing free/subsidised healthcare. Technical issues in obtaining BPL registration by poor families have been previously reported in the Indian literature; however there are no data on family assets of BPL registrants. Here, we provide evidence of family-level assets among BPL registration holders (and non-BPL households) using original research data from the Maharashtra Anaemia Study (MAS). Social and health data from 287 pregnant women and 891 adolescent girls (representing 1178 family households) across 34 villages in Maharashtra state, India, were analysed. Several assets were shown to be similarly distributed between BPL and non-BPL households; a large proportion of families who would probably be eligible were not registered, whereas BPL-registered families often had significant assets that should not make them eligible. This is likely to be the first published evidence where asset distribution such as agricultural land, housing structures and livestock are compared between BPL and non-BPL households in a rural population. These findings may help planning BPL administration to allocate health benefits equitably, which is an integral part of national health programmes

Weight, height, and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross‐sectional study

We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia. A cross‐sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight, and midupper arm circumference (MUAC). Hb levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, and height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% confidence interval, CI, [0.08, 0.15], P < .001). Each kilogram of increase in the body weight showed an increase in Hb levels (0.02 g dl, 95% CI [0.01, 0.03], P = .001). With an each centimetre of increase in height, Hb increased by 0.01 g dl (95% CI [0.00, 0.02], P = .022). There was a consistent association between three measures of somatic growth and anaemia in the study population. It is likely that life‐course exposures from conception onwards contribute to this, and the public health implications are that preventing anaemia is a challenge that requires a multifaceted interventional approach. Understanding the importance of the timing of these life exposures will help design interventions that can achieve optimal results

Assessment of a non-invasive haemoglobin sensor NBM 200 among pregnant women in rural India

Objective: This study aimed to assess a non-invasive haemoglobin sensor NBM 200 in pregnant women in a rural Indian setting. Methods: The study population consisted of women between 3 to 5 months of pregnancy, from 33 villages in Tuljapur and Lohara blocks of Osmanabad district, Maharashtra between April 2014 and June 2015. Haemoglobin (Hb) measurements obtained from the non-invasive sensor NBM 200 were compared with measurements obtained from an automated haematology analyser Sysmex XP-100, using the Bland Altman method and Spearman’s Rank correlation coefficient. Interclass correlation coefficient (ICC), sensitivity and specificity values were used to assess the anaemia diagnostic accuracy of NBM 200 against the gold standard (Sysmex XP-100). Results: Data were obtained from 269 pregnant women (median age: 21 years, Interquartile range: 19 to 23 years). Haemoglobin levels estimated by the Sysmex XP-100 analyser ranged from 5.5 g/dL to 14.1 g/dL (mean: 10.0 g/dL, standard deviation (SD): 1.28), while measurements obtained from NBM 200 ranged from 9.5 g/dL to 14.6 g/dL (mean: 11.9 g/dL, SD: 1.43). The Spearman’s test found a significant, moderately positive correlation between the two methods (rs= 0.4, p<0.001), ICC was 0.22, and the Bland-Altman analysis showed a mean difference of -1.8 g/dL (95% Confidence interval (CI): -2.06 to -1.71) indicating a systematic overestimation of Hb using the NBM 200. The NBM 200 showed low sensitivity (33.7%; 95% CI: 27.3 - 40.5) but high specificity (91.8%; 95% CI: 81.9 - 97.3) for the diagnosis of anaemia. Conclusion: Haemoglobin measurements obtained from the NBM 200 were higher with consequent underestimation of anaemia as compared with the gold standard reference method. This limits the use of the NBM 200 as an anaemia diagnostic test in our study population consisting of women during pregnancy

Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study

Objective: The aim of this prospective study was to estimate the prevalence and risk factors for maternal anaemia and low birth weight in pregnant women living in Maharashtra state, India. Study design: Prospective study Methods: Women between 3 to 5 months of pregnancy were recruited from 34 villages based in Maharashtra state. Baseline data collection, anthropometric measurements and blood investigations were performed. Participants were followed-up to record birth weight. Results: In total, 303 women were eligible, and 287 (95%) provided data. 77% were anaemic defined as haemoglobin less than 11.0 g/dL at the time of recruitment, with a mean corpuscular volume (MCV) of 80.5 fl/cell, (standard deviation: 7.22, range: 53.4 to 93.8). Increased risk of anaemia was seen in women with consanguineous marriages (odds ratio (OR): 2.41, 95% Confidence Interval (CI): 1.16 to 5.01, p=0.01) after adjustment for potential confounding factors. Post-delivery data from full-term singleton live births demonstrated a 7% prevalence of low birth weight. Consanguineous marriage was a major risk for low birth weight (OR: 4.10, 95% CI: 1.25 to 13.41, p=0.02). The presence of maternal anaemia during 3 to 5 months of pregnancy was associated with lower risk of low birth weight (unadjusted OR: 0.34, 95% CI: 0.13 to 0.92, p= 0.03). Conclusion: About 30% of our study participants were in a consanguineous marriage, which was identified as a potentially avoidable risk factor for both anaemia and low birth weight