103 research outputs found
Utilization of maternal health care services in South India
In this study we examine the patterns and determinants of maternal
health care use across different social setting in south India: in the states
of Andhra Pradesh, Karnataka and Tamil Nadu. We use data from the
National Family Health Survey (NFHS) carried out during 1992-93 across
most states in India. The study focuses on most recent births to evermarried
women that took place during the four years prior to the date of
the survey. We have used logistic regression models to estimate the effect
of covariates on the utilization of maternal health services viz., antenatal
care, tetanus toxoid vaccine, place of delivery and assistance during
delivery. The study indicates that determinants of maternal health care
services are not same across states and for different maternal health care
indicators. Although illiterate women were less likely to use maternal
health care services; there was no difference among the educated. The
level of utilization of maternal health care services was found to be highest
in Tamil Nadu, followed by Andhra Pradesh and Karnataka. Part of the
interstate differences in utilization is likely to be due to differences in
availability and accessibility among the three south Indian states. It is
argued that the differential in access to health care facilities between
rural-urban areas is an important factor for lower utilization of maternal
health care services, particularly for institutional delivery and delivery
assistance by health personnel in the rural areas of the three states. Results
from this study indicate that health workers might play a pivotal role in
providing antenatal care in the rural areas.
JEL Classification: I 10, I 11, I 19
Key words: Utilization, Maternal health care, Reproductive health,
Regional differential, Indi
Age structural transition and economic growth : evidence from South and Southeast Asia
Age structural transition is a process and a consequence of shifting
age structure from a young aged population to old aged population. It is
well known that economic growth in the East Asian countries was
significantly contributed by demographic gift, that is decline in young
aged population and increase in working aged population. However,
little is known about the role of age structure changes on economic
growth in the context of South and Southeast Asia. In this paper an
attempt has been made to study the nature and process of age structural
transition in the countries of South (Bangladesh, India and Sri Lanka)
and Southeast Asia (Indonesia, Malaysia, Philippines, Singapore and
Thailand). Further, this paper also attempts to study the influence of age
structure changes on the economic growth in these countries. Time
series analysis covering the period 1950-92 has been used for studying
the relationship between age structure and economic growth, controlling
macroeconomic variables such as investment share of GDP, net foreign
balance, share of public consumption expenditure, inflation rate and
openness.
The ‘demographic bonus’ or ‘window of opportunity’ had a
positive impact on economic growth in all Southeast Asian countries
except in the Philippines. The South Asian countries did not perform
well in terms of economic growth at the onset of ‘window of opportunity’.
The results also indicate that countries that have had open economies
and had excellent human capital benefited more from the “window of
opportunity”. In the next 20-25 years, the window of opportunity is
likely to benefit most South Asian countries if favourable policies are
pursued to take advantage of this with opening up their economy. The
demographic bonus will be available for another 15-20 years followed
by a period of demographic turbulence in the Southeast Asian countries. There will be a faster growth in the old aged population after 15 years
and stagnantion/decline in the working aged population.
As the gaps between demographic indicators are narrowing among
the Asian countries, the question remains whether demographic
convergence will lead to economic convergence in the future. The
demographic transition has given the South Asian countries an
opportunity for economic convergence. However, whether that
opportunity is realised will depend on whether socio-economic policies
are favourable to economic growth.
JEL Classification: F43, J11, J18, J21, J24
Key words: Age structure, window of opportunity, economic growth,
open economy, South Asia, Southeast Asia
Morbidity patterns in Kerala : levels and determinants
This paper examines the levels, patterns, and determinants of
morbidity in Kerala. This study is based on a community survey
conducted in 2004, in three districts of the state namely
Thiruvananthapuram, Malappuram and Kannur. The survey covers 3320
households having 17071 individuals in all age groups. Reported
morbidity was captured for a period of fifteen days prior to the data of
survey. Life course analysis was performed to understand the risk of
morbidity at various stages, like infancy, early childhood, late childhood,
adolescence, reproductive ages and old age, in relation to the impact of
socio-economic, demographic and regional factors.
The level of morbidity is high in Kerala. Generally, higher levels
of morbidity have been observed among females, schedule castes, and
schedule tribes as compared to their counter parts. Socio-economic and
demographic determinants of morbidity varies both region and across
various stages of life course. Females are at greater risk of morbidity
than males. The risk of morbidity is significantly higher for illiterates
and non-formal literate than persons with higher education. Among the
important socio-economic determinants, education and SES showed a
negative relationship with morbidity. The risk of morbidity for females
is lower than males till the age of 34 years and thereafter it reverse. Poor
are at greater risk of morbidity than the rich. Disease specific prevalence
rate are computed according to the classification manual of World Health
Organization. Communicable diseases are coming down in the state.
However, non-communicable diseases are mounting irrespective of
socio-economic conditions. Major ten diseases with their co-existing
ailments were analysed in detail.
Most of the diseases prevalent in Kerala warrant constant medical
attention and treatment and sustained medical treatment is beyond the
wherewithal of the average households. The private health care system
cannot be an answer because of the high average cost of treatment. This
warrants greater and sustained efforts by the State in widening the scope
of public action.
Key words: Health Status, Morbidity, Levels and Determinants, life
Course Perspective, Kerala
JEL Classification: I10, I12
Where to deliver? Analysis of choice of delivery location from a national survey in India
<p>Abstract</p> <p>Background</p> <p>In order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.</p> <p>Methods</p> <p>Cross sectional analyses of the National Family Health Survey – 2 dataset.</p> <p>Setting</p> <p>Maharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery.</p> <p>Results</p> <p>A majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery.</p> <p>Conclusion</p> <p>As India's economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.</p
Rapid intrapartum test for maternal group B streptococcal colonisation and its effect on antibiotic use in labouring women with risk factors for early-onset neonatal infection (GBS2): cluster randomised trial with nested test accuracy study
Background: Mother-to-baby transmission of group B Streptococcus (GBS) is the main cause of early-onset infection. We evaluated whether, in women with clinical risk factors for early neonatal infection, the use of point-of-care rapid intrapartum test to detect maternal GBS colonisation reduces maternal antibiotic exposure compared with usual care, where antibiotics are administered due to those risk factors. We assessed the accuracy of the rapid test in diagnosing maternal GBS colonisation, against the reference standard of selective enrichment culture. Methods: We undertook a parallel-group cluster randomised trial, with nested test accuracy study and microbiological sub-study. UK maternity units were randomised to a strategy of rapid test (GeneXpert GBS system, Cepheid) or usual care. Within units assigned to rapid testing, vaginal-rectal swabs were taken from women with risk factors for vertical GBS transmission in established term labour. The trial primary outcome was the proportion of women receiving intrapartum antibiotics to prevent neonatal early-onset GBS infection. The accuracy of the rapid test was compared against the standard of selective enrichment culture in diagnosing maternal GBS colonisation. Antibiotic resistance profiles were determined in paired maternal and infant samples. Results: Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units; 906 mothers (951 babies) were in usual care units. There was no evidence of a difference in the rates of intrapartum antibiotic prophylaxis (relative risk 1.16, 95% CI 0.83 to 1.64) between the rapid test (41%, 297/716) and usual care (36%, 328/906) units. No serious adverse events were reported. The sensitivity and specificity measures of the rapid test were 86% (95% CI 81 to 91%) and 89% (95% CI 85 to 92%), respectively. Babies born to mothers who carried antibiotic-resistant Escherichia coli were more likely to be colonised with antibiotic-resistant strains than those born to mothers with antibiotic-susceptible E. coli. Conclusion: The use of intrapartum rapid test to diagnose maternal GBS colonisation did not reduce the rates of antibiotics administered for preventing neonatal early-onset GBS infection than usual care, although with considerable uncertainty. The accuracy of the rapid test is within acceptable limits. Trial registration: ISRCTN74746075. Prospectively registered on 16 April 2015
Late entry to antenatal care in New South Wales, Australia
AIMS: This study aimed to assess the prevalence of women who entered antenatal care (ANC) late and to identify factors related to the late entry to ANC in New South Wales (NSW) in 2004. METHODS: The NSW Midwives Data Collection contained data of 85,034 women who gave birth in 2004. Data were downloaded using SAS and transferred to STATA 8.0. Entering ANC after 12 weeks of gestation was classified as late. The Andersen Health Seeking Behaviour Model was used for selection and analyses of related factors. Regression and hierarchical analyses were used to identify significant factors and their relative contributions to the variation of pregnancy duration at entry to ANC. RESULTS: 41% of women commenced ANC after 12 weeks of gestation. Inequality existed between groups of women with predisposing characteristics and enabling resources contributed more to the variation in pregnancy duration at entry to ANC than needs. The groups of women with highest risk were teenagers, migrants from developing countries, women living in Western Sydney, Aboriginal and Torres Strait Islanders, women with three or more previous pregnancies and heavy smokers. The high risk groups with largest number of women were migrants from developing countries and women living in Western Sydney. CONCLUSION: A large number of women in NSW entered ANC late in their pregnancies. Efforts to increase early entry to ANC should be targeted on identified high risk groups of women
Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran
<p>Abstract</p> <p>Background</p> <p>One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings.</p> <p>Methods</p> <p>In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis.</p> <p>Results</p> <p>The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral.</p> <p>Conclusions</p> <p>Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women. Appropriate management of financial and insurance-related issues can help midwives and mothers make a rational decision when complications arise.</p
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