Hypertensive disorders of pregnancy and risk of diabetes in Indian women:a cross-sectional study

BACKGROUND: Epidemiological data from high-income countries suggest that women with hypertensive disorders of pregnancy (HDP) are more likely to develop diabetes later in life. OBJECTIVE: We investigated the association between pre-eclampsia and eclampsia (PE&E) during pregnancy and the risk of diabetes in Indian women. DESIGN: Cross-sectional study. SETTING: India. METHODS: Data from India's third National Family Health Survey (NFHS-3, 2005-2006), a cross-sectional survey of women aged 15-49 years, are used. Self-reported symptoms suggestive of PE&E were obtained from 39 657 women who had a live birth in the 5 years preceding the survey. The association between PE&E and self-reported diabetes status was assessed using multivariable logistic regression models adjusting for dietary intake, body mass index (BMI), tobacco smoking, alcohol drinking, frequency of TV watching, sociodemographic characteristics and geographic region. RESULTS: The prevalence of symptoms suggestive of PE&E in women with diabetes was 1.8% (n=207; 95% CI 1.5 to 2.0; p<0.0001) and 2.1% (n=85; 95% CI 1.8 to 2.3; p<0.0001), respectively, compared with 1.1% (n=304; 95% CI 1.0 to 1.4) and 1.2% (n=426; 95% CI 1.1 to 1.5) in women who did not report any PE&E symptoms. In the multivariable analysis, PE&E was associated with 1.6 times (OR=1.59; 95% CI 1.31 to 1.94; p<0.0001) and 1.4 times (OR=1.36; 95% CI 1.05 to 1.77; p=0.001) higher risk for self-reported diabetes even after controlling for dietary intake, BMI and sociodemographic characteristics. CONCLUSIONS: HDP is strongly associated with the risk of diabetes in a large nationally representative sample of Indian women. These findings are important for a country which is already tackling the burden of young onset of diabetes in the population. However, longitudinal medical histories and a clinical measurement of diabetes are needed in this low-resource setting

Impaired fertility and perceived difficulties conceiving in Ghana:measurement problems and prospects

What is the most appropriate measure of impaired fertility for understanding its social consequences in sub-Saharan Africa? The dearth of subjective measures in surveys in the region has prevented comparisons of subjective and objective measures. Perceived difficulties conceiving may have a greater impact than objective measures for social outcomes such as divorce, stigmatization and distress. This study compares 12- (clinical) and 24- (epidemiological) month measures from biomedicine and 5- and 7-year measures from demography with a subjective measure of impaired fertility using correlations, random effects models and test-retest models to assess relationships between measures, their association with sociodemographic characteristics and the stability of measures across time. Secondary panel data (1998-2004) from 1350 Ghanaian women aged 15-49 of all marital statuses are used. Longer waiting times to identification of impaired fertility required by demographic measures result in more stable measures, but perceived difficulties conceiving are most closely aligned with clinical infertility (r=0.61; p<0.05). Epidemiological infertility is also closely aligned with the subjective measure. A large proportion of those identified as having impaired fertility based purely on waiting times are successful contraceptors. Where subjective measures are not available, epidemiological (24-month) measures may be most appropriate for studies of the social consequences of impaired fertility. Accounting for contraceptive use is important in order to avoid false positives. Future research should consider a variety of measures of perceived difficulties conceiving and self-identified infertility to assess which is most valid; in order to accomplish this, it is imperative that subjective measures of infertility be included in social surveys in sub-Saharan Africa

Self-reported fertility impairments and help-seeking strategies among young women in Malawi

This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation

What predicts the actions taken toward observed child neglect?:the influence of community context and bystander characteristics

Objective: Using data from a sample of 3,679 respondents in 50 rural and urban communities in a midwestern state, the authors explore the relationship between individual and community characteristics and the provision of helping behavior when child neglect is observed. Method: Telephone surveys of community residents were analyzed in a series of logistic regression models. Results: At the individual level, age, gender, place of residence, and sentinel status were all found to have a significant effect. The level of role overlap, cohesion, comfort, and belongingness perceived to exist in the community were found to be important community-level predictors. Conclusion: Individual and contextual characteristics affected observation of a case of child neglect and the action taken

Difficulties conceiving and relationship stability in sub-Saharan Africa:the case of Ghana

Little is known about the relationship between self-identified difficulties conceiving, biomedical infertility, and union instability in sub-Saharan Africa. Previous research suggests that infertility increases the risk of psychological distress and marital conflict, encourages risky sexual behavior, and deprives infertile individuals and couples of an important source of economic and social capital. Qualitative research has suggested that there may be a link between infertility and divorce; less is known about the implications of infertility for unmarried couples. In this paper, discrete-time hazard models are applied to 8 waves of secondary panel data from Ghana collected by the Population Council of New York and the University of Cape Coast (pooled n=10,418) between 1998 and 2004. Results show a positive relationship between perceived difficulties conceiving and relationship instability for both married women and those in nonmarital sexual unions; this relationship, however, does not hold for biomedical infertility. Future research should examine this relationship using nationally representative data in a cross-national comparison to determine whether results hold across the subcontinent

The impact of benefit sanctioning on food insecurity:a dynamic cross-area study of food bank usage in the UK

Household food security, which may be compromised by short-term income shocks, is a key determinant of health. Since 2012, the UK witnessed marked increases in the rate of ‘sanctions’ applied to unemployment insurance claimants, which stop payments to claimants for a minimum of four weeks. In 2013, over 1 million sanctions were applied, potentially leaving people facing economic hardship and driving them to use food banks. Here we test this hypothesis by linking data from the Trussell Trust Foodbank Network with records on sanctioning rates across 259 local authorities in the UK. After accounting for local authority differences and time trends, as the rate of sanctioning increased by 10 per 100,000 adults, the rate of adults fed by foodbanks by an additional 3.36 adults per 100,000 (95% CI: 1.71 to 5.01). The availability of food distribution sites affected how tightly sanctioning and food bank usage were associated (p<0.001 for interaction term), such that in areas with few distribution sites, rising sanctions led to smaller increases in Trussell Trust food bank usage. Sanctioning appears to be closely linked with rising need for emergency food assistance, but the impact of sanctioning on food insecurity is likely not fully reflected in available data. There is a need to monitor household food insecurity in the UK to fully understand the impact of government policies on this outcome

Reimagining infertility:a critical examination of fertility norms, geopolitics, and survey bias

While it is estimated that 15% of couples worldwide are infertile, this figure hinges critically on the quality, inclusiveness, and availability of infertility data sources. Current infertility data and statistics fail to account for the infertility experiences of some social groups. We identify these people as the invisible infertile, and refer to their omission from infertility data and statistics – whether intentional or unintentional – as the process of invisibilization. We identify two processes through which invisibilization in survey data is produced: sampling, with focus on exclusionary definitions of the population at-risk, and survey instrument design, with focus on skip patterns and question wording. Illustrative examples of these processes are drawn from the Integrated Fertility Survey Series and the Demographic and Health Surveys. Empirical research is not designed in an objective vacuum. Rather, survey instruments and sampling techniques are shaped and influenced by the sociocultural norms and geopolitical context of the time and place in which they are created and conducted, reflecting broader social beliefs about family building and reproduction. Furthermore, population policy singularly aimed at curbing overpopulation in high fertility parts of the world limits the type of reproduction data collected, effectively rendering the infertility of some groups epidemiologically unfathomable. In light of these sociocultural and geopolitical forces, many marginalized groups are missing from RH statistics. The omission of entire groups from the scientific discourse casts doubt on the quality of research questions, validity of the analytic tools, and accuracy of scientific findings. Invisibility may also misguide evidence-based RH and family planning policies and deter equitable access to reproductive healthcare for some social groups, perpetuating social inequalities

Adequately diversified dietary intake and iron and folic acid supplementation during pregnancy is associated with reduced occurrence of symptoms suggestive of pre-eclampsia or eclampsia in Indian women

BACKGROUND/OBJECTIVE: Pre-eclampsia or Eclampsia (PE or E) accounts for 25% of cases of maternal mortality worldwide. There is some evidence of a link to dietary factors, but few studies have explored this association in developing countries, where the majority of the burden falls. We examined the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E in Indian women. METHODS: Cross-sectional data from India's third National Family Health Survey (NFHS-3, 2005-06) was used for this study. Self-reported symptoms suggestive of PE or E during pregnancy were obtained from 39,657 women aged 15-49 years who had had a live birth in the five years preceding the survey. Multivariable logistic regression analysis was used to estimate the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E after adjusting for maternal, health and lifestyle factors, and socio-demographic characteristics of the mother. RESULTS: In their most recent pregnancy, 1.2% (n=456) of the study sample experienced symptoms suggestive of PE or E. Mothers who consumed an adequately diversified diet were 34% less likely (OR: 0.66; 95% CI: 0.51-0.87) to report PE or E symptoms than mothers with inadequately diversified dietary intake. The likelihood of reporting PE or E symptoms was also 36% lower (OR: 0.64; 95% CI: 0.47-0.88) among those mothers who consumed iron and folic acid supplementation for at least 90 days during their last pregnancy. As a sensitivity analysis, we stratified our models sequentially by education, wealth, antenatal care visits, birth interval, and parity. Our results remained largely unchanged: both adequately diversified dietary intake and iron and folic acid supplementation during pregnancy were associated with a reduced occurrence of PE or E symptoms. CONCLUSION: Having a adequately diversified dietary intake and iron and folic acid supplementation in pregnancy was associated with a reduced occurrence of symptoms suggestive of PE or E in Indian women

Subsidising rice and sugar?:The Public Distribution System and Nutritional Outcomes in Andhra Pradesh, India

India’s main food and nutrition security programme, the Public Distribution System (PDS), provides subsidised rice and sugar to deprived households. Using longitudinal data from Young Lives for Indian children (n = 2,944) aged 5 to 16 years, we assessed whether PDS subsidies skewed diets towards sugar and rice consumption, increasing risk of stunting (low height-for-age). Linear regression models were used to quantify additional rice and sugar consumption associated with accessing the PDS, and the association with stunting linked to consumption. Controlling for sociodemographics, accessing the PDS was positively, significantly associated with consumption of rice (30g/day) and sugar (7.05g/day). There was no evidence that this increase corresponded to nutritional improvements. Each 100g increase in daily rice intake was associated with a lower height-for-age z-score (HAZ) and no decline in stunting. Results were robust to alternative model specifications. There was no evidence that receipt of PDS rice and sugar was associated with improvements in child nutrition