Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India.

OBJECTIVE:To explore intersections of social determinants of maternal healthcare utilization using the Classification and Regression Trees (CART) algorithm which is a machine-learning method used to construct prediction models. METHODS:Institutional review board approval for this study was granted from Public Health Service-Ethical Review Board (PHS-ERB) and from the Health Ministry Screening Committee (HMSC) facilitated by Indian Council for Medical Research (ICMR). IRB review and approval for the current analyses was obtained from University of California, San Diego. Cross-sectional data were collected from women with children aged 0-11 months (n = 5,565) from rural households in 25 districts of Uttar Pradesh, India. Participants were surveyed on maternal healthcare utilization including registration of pregnancy (model-1), receipt of antenatal care (ANC) during pregnancy (model-2), and delivery at health facilities (model -3). Social determinants of health including wealth, social group, literacy, religion, and early age at marriage were captured during the survey. The Classification and Regression Tree (CART) algorithm was used to explore intersections of social determinants of healthcare utilization. RESULTS:CART analyses highlight the intersections, particularly of wealth and literacy, in maternal healthcare utilization in Uttar Pradesh. Model-1 documents that women who are poorer, illiterate and Muslim are less likely to have their pregnancies registered (71.4% vs. 86.0% in the overall sample). Model-2 documents that poorer, illiterate women had the lowest ANC coverage (37.7% vs 45% in the overall sample). Model-3, developed for deliveries at health facilities, highlighted that illiterate and poor women have the lowest representation among facility deliveries (59.6% vs. 69% in the overall sample). CONCLUSION:This paper explores the interactions between determinants of maternal healthcare utilization indicators. The findings in this paper highlights that the interaction of wealth and literacy can play a very strong role in accentuating or diminishing healthcare utilization among women. The study also reveals that religion and women's age at marriage also interact with wealth and literacy to create substantial disparities in utilization. The study provides insights into the effect of intersections of determinants, and highlights the importance of using a more nuanced understanding of the impact of co-occurring forms of marginalization to effectively tackle inequities in healthcare utilization

Impact of Press Mud and Animal Manure in Comparison with NPK on the Growth and Yield of Triticale (<i>Triticosecale wittmack</i>) Genotypes Cultivated under Various Irrigation Regimes

It is needful to have alternative nutritious cereal crops to feed the ever increasing population and meet food security in the long run. Triticale (Triticosecale wittmack) is used for both livestock feed and human consumption as it contains higher protein and lysine contents than other cereals. Synthetic fertilizers applied in combination with organic amendments can play a pivotal role in increasing crop yields. Field experiments were designed to explore the impact of chemical fertilizers (NPK), press mud and animal manure on growth and yield of triticale genotypes cultivated under different irrigation regimes. Experiments were laid out by using randomized complete block design (RCBD) with split-split plot arrangements having three replicates and comprised of different treatments such as chemical fertilizers (T1 = control, T2 = NPK, T3 = press mud and T4 = animal manure), genotypes (G1 and G2), and irrigation regimes (I1 = full irrigation, I2 = irrigation was skipped at heading stage, and I3 = irrigation was skipped at heading and grain filling stages). Statistical analyses of collected data depicted the significant effect of chemical fertilizers, organic amendments, genotypes and irrigation regimes on various yield and yield related attributes of triticale. The highest increment in various observed attributes like plant height, leaves per plant, spike length, spikelets per spike, grains per spike, leaf area, 1000-grain weight, biological yield and grain yield was recorded in I1, followed by I2 and I3; in case of varieties, G1 performed better than G2 while T3 had maximum values in the aforementioned parameters as compared to other treatments. The application of NPK in combination with press mud and animal manure improved the growth and yield of triticale genotypes cultivated under different irrigation regimes. Thus, NPK along with organic amendments and irrigation practices can successfully be used to improve the growth and yield of triticale