COVID-19 and BAME Group in the United Kingdom

COVID-19 is known to disproportionately affect ethnic minorities in number of settings. This phenomenon has also been reported in the UK where the black, Asian and minority ethnic (BAME) group has adverse health outcomes in terms of number of both cases and mortality rates when compared to the white local population. This trend is also observed among the BAME staff working in the National Health Service. Number of plausible explanations and the importance of various approaches including social-determinants approach is pointed out. This pandemic has re-ignited the debate on social inequalities, issues around social deprivation and health inequalities within the UK. This article concludes with some policy recommendations

Health sector allocation in India’s budget (2021–2022): a trick or treat?

The Finance Minister of India Nirmala Sitharaman announced the Budget in February 2021, giving health and well-being as a top priority for the government, with an impressive increase of 137% over the previous year’s health sector budget. The need to strengthen primary, secondary and tertiary public healthcare systems was a clear message from the budget statement. The authors analyse the current budget in the context of chronic underinvestment in health and question whether this allocation will make any meaningful impact on the public health infrastructure as the impressive headline allocation appears to be more of a trick than a treat to the health sector

Decomposition analysis of the decline in binary and triad undernutrition among preschool children in India

Background: To examine the socio-demographic factors associated with the decline in undernutrition among preschool children in India from National Family Health Survey (NFHS)-3, 2005–06 to NFHS– 5, 2019–21. Methods: For this study data were obtained from India’s nationally representative datasets such as NFHS-3 and NFHS-5. The outcome variables for this study were Binary undernutrition which were defined as the coexistence of anemia and either stunting or wasting and Undernutrition triad which were defined as the presence of Iron deficiency anemia, stunting and wasting, respectively. Decomposition analysis was used to study the factors responsible for a decline in undernutrition. This method was employed to understand how these factors contributed to the decline in undernutrition whether due to change in the composition (change in the composition of the population) or propensity (change in the health-related behaviour of the population) of the population over a period of 16 years. Results: Results showed that rate, which contributes 85.26% and 65.64%, respectively, to total change, was primarily responsible for a decline in both binary undernutrition and undernutrition triad. Reduction in Binary undernutrition was mainly explained by the change in the rate of education level of the mothers and media exposer during the inter-survey period. On the other hand, the decline in the Undernutrition triad can be explained by household wealth index, mother’s education, birth order and a change in people’s knowledge or practice about the preceding birth interval. Conclusion: Identifying important factors and understanding their relationship with the decline of undernutrition can be beneficial for reorienting nutrition-specific policies to achieve the targets of the Sustainable Development Goals by 2030

Assessment of variation in cesarean delivery rates between public and private health facilities in India from 2005 to 2016

Importance: The rates of cesarean deliveries have more than doubled in India, from 8% of deliveries in 2005 to 17% of deliveries in 2016. The World Health Organization recommends that cesarean deliveries should not exceed 10% to 15% of all deliveries in any country. An understanding of the association of private and public facilities with the increase in cesarean delivery rates in India is needed. Objective: To assess the association of public vs private sector health care facilities with cesarean delivery rates in India and to estimate the potential cost savings if private sector facilities followed World Health Organization recommendation for cesarean deliveries. Design, Setting, and Participants: This cross-sectional study used institutional delivery data from the representative National Family Health Survey (NFHS) in India, including data from the NFHS-1 (1992-1993), the NFHS-3 (2005-2006), and the NFHS-4 (2015-2016). The NFHS-3 and NFHS-4 provided data on 22 647 deliveries and 195 366 deliveries, respectively. The NHFS-4 was the first survey to provide data on out-of-pocket expenditures for delivery by facility type, allowing for a comparison of cesarean deliveries and costs between public and private facilities. The primary sample comprised all pregnant women who delivered infants in public and private institutional facilities in India and who were included the NFHS-3 and the NFHS-4; data on pregnant women who were included in the NFHS-1 were used for comparison. The study's findings were analyzed through geographic mapping, data tabulation, funnel plots, multivariate logistic regression analyses, and potential cost-savings scenario analyses. Data were analyzed from June to December 2019. Main Outcomes and Measures: The main outcome was the rate of cesarean deliveries by facility type (public vs private) and by participant socioeconomic, demographic, and health characteristics. Secondary outcomes were the potential number of avoidable cesarean deliveries and the potential cost savings if private sector facilities followed the World Health Organization recommendations for cesarean deliveries. Results: In the NFHS-3, 22 610 total births occurred at institutional facilities. Of those, 2178 births (15.2%) were cesarean deliveries in public facilities, and 3200 births (27.9%) were cesarean deliveries in private facilities. Of 195 366 total institutional births in the NFHS-4, 15 165 births (11.9%) were cesarean deliveries in public facilities, and 20 506 births (40.9%) were cesarean deliveries in private facilities. The cesarean delivery rate in public health facilities increased from 7.2% in the NFHS-1 to 11.9% in the NFHS-4, whereas in private health facilities, the rate increased from 12.3% to 40.9% during the same period. A substantial increase was found in cesarean delivery rates between the NFHS-3 (2005-2006) and the NFHS-4 (2015-2016), with 22 states exceeding the World Health Organization's upper threshold of 15% in the NFHS-4. The odds ratio for cesarean deliveries in private facilities compared with public facilities increased from 1.62 (95% CI, 1.49-1.76) in the NFHS-3 to 4.17 (95% CI, 4.04-4.30) in the NFHS-4. The number of avoidable cesarean deliveries would have been 1.83 million, with a potential cost savings of $320.60 million, if private sector facilities in India had followed the 15% threshold for cesarean delivery rates recommended by the World Health Organization. Conclusions and Relevance: In this study, private sector health facilities were associated with a substantial increase in cesarean deliveries in India. Further research is needed to assess the factors underlying the increase in cesarean deliveries in private sector facilities

Mind the gap: temporal trends in inequalities in infant and child mortality in India (1992–2016)

- Temporal trends in inequalities in infant and child mortality over two and half decades in India. - Relative change in inequalities in child mortality over survey periods. - Scatter plots to identify states with largest inequalities among wealth index groups. - Concentration Index by various background characteristics. - Decomposition analysis identifying the factors contributing in inequality in infant mortality between richest and poorest groups. - Gap between the poorest and richest groups has narrowed in most states in India in recent years

Comparing socio-economic inequalities in self-reported and undiagnosed hypertension among adults 45 years and over in India: what explains these inequalities?

Background: Hypertension (HTN) is a leading cause of mortality and morbidity in developing countries. For India, the hidden burden of undiagnosed hypertension is a major concern. This study aims to assess and explain socio-economic inequalities among self-reported and undiagnosed hypertensives in India. Methods: The study utilized data from the Longitudinal Aging Study in India (LASI), a nationally-representative survey of more than 72,000 older adults. The study used funnel plots, multivariable logistic regression, concentration indices, and decomposition analysis to explain the socio-economic gap in the prevalence of self-reported and undiagnosed hypertension between the richest and the poorest groups. Results: The prevalence of self-reported and undiagnosed hypertension was 27.4 and 17.8% respectively. Monthly per capita consumption expenditure (MPCE) quintile was positively associated with self-reported hypertension but negatively associated with undiagnosed hypertension. The concentration index for self-reported hypertension was 0.133 (p < 0.001), whereas it was − 0.047 (p < 0.001) for undiagnosed hypertension. Over 50% of the inequalities in self-reported hypertension were explained by the differences in the distribution of the characteristics whereas inequalities remained unexplained for undiagnosed hypertension. Obesity and diabetes were key contributors to pro-rich inequality. Conclusions: Results imply that self-reported measures underestimate the true prevalence of hypertension and disproportionately affect the poorer MPCE groups. The prevalence of self-reported HTN was higher in the richest group, whereas socio-economic inequality in undiagnosed hypertension was significantly concentrated in the poorest group. As majority of the inequalities remain unexplained in case of undiagnosed hypertension, broader health systems issues including barriers to access to health care may be contributing to inequalities

A longitudinal study of incident hypertension and its determinants in Indian adults aged 45 years and over: evidence from nationally representative WHO-SAGE study (2007-2015) Running head Incident hypertension and its determinants

Objectives: Hypertension (HT) is a leading cause of mortality and morbidity in developing countries. This study aimed to estimate the incidence of HT among adults aged 45 years and older in India and its associated risk factors. Methods: This study used longitudinal data from the Indian sample of the first and second waves of the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE). A bivariate analysis using Pearson's chi-square test was done to examine the associations of individual, lifestyle, and household characteristics with HT status reported in Wave 2. Incident HT changes were analyzed by adjusting for various covariates in the generalized estimating equation (logit link function) with an exchangeable correlation matrix and robust standard errors. Results: The study found that during the 8-year period from 2007 to 2015, the incidence of HT in individuals aged 45 years and over was 20.8%. Pre-hypertensive individuals had an overall incidence rate of 31.1 per 1,000 [95% confidence interval (CI): 26.20–35.9] and a 2.24 times higher odds ratio: 2.24 (95% CI: 1.65–3.03) of developing incident HT compared to those who were normotensive. Adults aged 45 years and older, overweight/obese individuals, and women were more at risk of incident HT. Conclusion: One in five individuals had developed HT over 8 years, with a greater risk of incident HT among women than men. Pre-hypertensive individuals were at a greater risk of developing incident HT compared to normotensive individuals. The study recommends comprehensive and effective management of pre-HT to tackle the burden of H

Clustering of child deaths among families in low- and middle-income countries: a meta-analysis

BACKGROUND AND AIMS: Several studies have examined the phenomenon of "death clustering," in which two or more children born to the same mother or from the same family die at an early age. Therefore, a scientific examination of the results is essential to understand how the survival status of the older siblings affects the survival of the younger siblings. By using meta-analysis, this study aims to provide a quantitative synthesis of the results of studies on "child death clustering" in low- and middle-income countries (LMICs). METHODS: This study followed the PRISMA-P 2015 guidelines. We used four electronic databases-PubMed, Medline, Scopus, and Google Scholar with search and citation analysis capabilities. Initially, 140 studies were identified, but only 27 met the eligibility criteria eventually. These were studies that had used the death of a previous child as a covariate to determine the survival status of the index child. The heterogeneity and the publication bias of the studies were examined using the Cochran test, I 2 statistic, and Egger's meta-regression test. RESULTS: The pooled estimate of 114 study estimates for LMICs contains some bias. India's 37 study estimates were distributed more or less equally along the middle line, indicating no publication bias, while there was a slight bias in the estimates for Africa, Latin America, and Bangladesh. The odds of experiencing the death of the index child in the selected LMICs were 2.3 times higher for mothers who had lost any prior child as compared to those mothers who had not had any prior child loss. For African mothers, the odds were five times higher, whereas for Indian mothers, the odds were 1.66 times higher. Mothers' characteristics, such as education, occupation, health-seeking behavior, and maternal competence, significantly affect the child's survival status. CONCLUSION: Achieving the sustainable development goals would not be possible if mothers in countries experiencing high levels of under-five mortality are not provided with better health and nutrition facilities. Mothers who have lost multiple children should be targeted for assistance

Serious adverse events and fatal outcomes following COVID-19 vaccination in the UK: lessons for other countries

Vaccines have taken the centre stage in the fight against COVID-19 pandemic, and in reducing hospitalisation and associated mortality. Countries around the world are heavily dependent on the successful rollout of their vaccination programmes to open up the societies and re-start their economies. However, the success of any vaccine programme, to a large extent, depends upon the efficacy and safety of the vaccines. Given that UK has been way ahead in vaccinating its population, is considered a successful model compared to other countries in Europe and elsewhere and has a yellow card reporting system for adverse events, we use UK as an example to understand the side effects and fatal outcomes following vaccinations. Our results show that AstraZeneca seems to be underperforming in terms of overall reporting of minor adverse events, serious incidents and fatal outcomes following vaccination. The risk of serious anaphylactic reaction and fatal outcome was 1.36 and 1.17 times more in case of AstraZeneca vaccine when compared with Pfizer BioNTech vaccine. The analysis has implications for vaccine policies and programmes both at nation-state and global levels