Public Spending on Health and Childhood Mortality in India

The present study attempts to investigate the association between public spending on health and childhood mortality in India; using time-series cross-sectional data from various government sources for the period 1985-2009. Infant and child (age 1 to 4 years) mortality rates were used as the indicators for childhood mortality. Ordinary least squares, generalized least squares and fixed effects regression models were used to investigate the association between public spending on health and childhood mortality. The findings suggest insignificant association between public spending on health and childhood mortality both at the country level and for the EAG states. On the contrary, per capita state income and female literacy were significantly associated with improved childhood survival. Percentage of the population living below the poverty line was significantly associated with infant and child mortality only in the EAG states. The findings call for a number of other measures along with increased public spending on health to reduce infant and child mortality in India

Public Spending on Health and Childhood Mortality in India

The present study attempts to investigate the association between public spending on health and childhood mortality in India; using time-series cross-sectional data from various government sources for the period 1985-2009. Infant and child (age 1 to 4 years) mortality rates were used as the indicators for childhood mortality. Ordinary least squares, generalized least squares and fixed effects regression models were used to investigate the association between public spending on health and childhood mortality. The findings suggest insignificant association between public spending on health and childhood mortality both at the country level and for the EAG states. On the contrary, per capita state income and female literacy were significantly associated with improved childhood survival. Percentage of the population living below the poverty line was significantly associated with infant and child mortality only in the EAG states. The findings call for a number of other measures along with increased public spending on health to reduce infant and child mortality in India

Neonatal, 1–59 month, and under-5 mortality in 597 Indian districts, 2001 to 2012: estimates from national demographic and mortality surveys

Background India has the largest number of child deaths of any country in the world, and has wide local variation in under-5 mortality. Worldwide achievement of the UN 2015 Millennium Development Goal for under-5 mortality (MDG 4) will depend on progress in the subregions of India. We aimed to estimate neonatal, 1–59 months, and overall under-5 mortality by sex for 597 Indian districts and to assess whether India is on track to achieve MDG 4. Methods We divided the 2012 UN sex-specifi c birth and mortality totals for India into state totals using relative birth rates and mortality from recent demographic surveys of 24 million people, and divided state totals into totals for the 597 districts using 3 million birth histories. We then split the results into neonatal mortality and 1–59 month mortality using data for 109 000 deaths in children younger than 5 years from six national surveys. We compared results with the 2001 census for each district. Findings Under-5 mortality fell at a mean rate of 3·7% (IQR 3·2–4·9) per year between 2001 and 2012. 222 (37%) of 597 districts are on track to achieve the MDG 4 of 38 deaths in children younger than 5 years per 1000 livebirths by 2015, but an equal number (222 [37%]) will achieve MDG 4 only after 2020. These 222 lagging districts are home to 41% of India’s livebirths and 56% of all deaths in children younger than 5 years. More districts lag behind the relevant goal for neonatal mortality (251 [42%]) than for 1–59 month mortality (197 [33%]). Just 81 (14%) districts account for 37% of deaths in children younger than 5 years nationally. Female mortality at ages 1–59 months exceeded male mortality by 25% in 303 districts in nearly all states of India, totalling about 74 000 excess deaths in girls. Interpretation At current rates of progress, MDG 4 will be met by India around 2020—by the richer states around 2015 and by the poorer states around 2023. Accelerated progress to reduce mortality during the neonatal period and at ages 1–59 months is needed in most Indian districts. Funding Disease Control Priorities 3, Canadian Institutes of Health Research, International Development Research Centre, US National Institutes of Health

Public health spending and infant and child mortality in India: a state-year panel analysis

Background: To investigate the association between public health spending and probability of infant and child death in India. Methods: We used data from the three rounds of National Family Health Survey (NFHS) conducted in India during 1992-93, 1998-99 and 2005-06 to investigate the association between public health spending and probability of infant and child death. We used data from the birth history of three NFHS rounds to create state-year panels of births, infant and child deaths, state-level public finance variables, food grain production, household and individual variables for the period 1980-2005. Two-stage probit regression model is used to investigate the association. State-level per capita gross fiscal deficit is used as an instrument for estimating two-stage probit model. Findings: Findings suggest association between public health spending and infant and child mortality in India. A 10% increase in per capita public health spending is likely to reduce the probability of infant and child deaths by 0•005 (95% CI: 0•003, 0•007) and 0•003 (95% CI: 0•002, 0•004) respectively. The second and third lags of public health spending were also statistically significant. Other factors affecting infant and child death were sex of the child, birth order, mother’s age at birth of the index child, mother’s schooling and urban-rural residence. Interpretation: Public health spending was associated with probability of infant and child death in India. Our findings lend support to the government’s initiative to increase public health spending in India

Increasing role of abstinence and infecundity in non-use of contraceptive methods in India

This paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005–06: N=37,296; 2015–16: N=247,024), which surveyed currently married women aged 15–49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex: 10%; infrequent sex: 3%) and infecundity (menopausal/hysterectomy: 12%; subfecund/infecund: 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015–16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005–06 to 2015–16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples

Public health spending and infant and child mortality in India: a state-year panel analysis

Background: To investigate the association between public health spending and probability of infant and child death in India. Methods: We used data from the three rounds of National Family Health Survey (NFHS) conducted in India during 1992-93, 1998-99 and 2005-06 to investigate the association between public health spending and probability of infant and child death. We used data from the birth history of three NFHS rounds to create state-year panels of births, infant and child deaths, state-level public finance variables, food grain production, household and individual variables for the period 1980-2005. Two-stage probit regression model is used to investigate the association. State-level per capita gross fiscal deficit is used as an instrument for estimating two-stage probit model. Findings: Findings suggest association between public health spending and infant and child mortality in India. A 10% increase in per capita public health spending is likely to reduce the probability of infant and child deaths by 0•005 (95% CI: 0•003, 0•007) and 0•003 (95% CI: 0•002, 0•004) respectively. The second and third lags of public health spending were also statistically significant. Other factors affecting infant and child death were sex of the child, birth order, mother’s age at birth of the index child, mother’s schooling and urban-rural residence. Interpretation: Public health spending was associated with probability of infant and child death in India. Our findings lend support to the government’s initiative to increase public health spending in India

Age-specifi c and sex-specifi c adult mortality risk in India in 2014: analysis of 0·27 million nationally surveyed deaths and demographic estimates from 597 districts

Background As child mortality decreases rapidly worldwide, premature adult mortality is becoming an increasingly important contributor to global mortality. Any possible worldwide reduction of premature adult mortality before the age of 70 years will depend on progress in India. Indian districts increasingly have responsibility for implementing public health programmes. We aimed to assess age-specifi c and sex-specifi c adult mortality risks in India at the district level. Methods We analysed data from fi ve national surveys of 0∙27 million adult deaths at an age of 15–69 years together with 2014 demographic data to estimate age-specifi c and sex-specifi c adult mortality risks for 597 districts. Cause of death data were drawn from the verbal autopsies in the Registrar General of India’s ongoing Million Death Study. Findings In 2014, about two-fi fths of India’s men aged 15–69 years lived in the 253 districts where the conditional probability of a man dying at these ages exceeded 50%, and more than a third of India’s women aged 15–69 years lived in the 222 districts where the conditional probability of a woman dying exceeded 40%. The probabilities of a man or woman dying by the age of 70 years in high-mortality districts was 62% and 54%, respectively, whereas the probability of a man or woman dying by the age of 70 years in low-mortality districts was 40% and 30%, respectively. The roughly 10-year survival gap between high-mortality and low-mortality districts was nearly as extreme as the survival gap between the entire Indian population and people living in high-income countries. Adult mortality risks at ages 15–69 years was highest in east India and lowest in west India, by contrast with the north–south divide for child mortality. Vascular disease, tuberculosis, malaria and other infections, and respiratory diseases accounted for about 60% of the absolute gap in adult mortality risk at ages 15–69 years between high-mortality and low-mortality districts. Most of the variation in adult mortality could not be explained by known determinants or risk factors for premature mortality. Interpretation India’s large variation in adult mortality by district, notably the higher death rates in eastern India, requires further aetiological research, particularly to explore whether high levels of adult mortality risks from infections and non-communicable diseases are a result of historical childhood malnutrition and infection. Such research can be complemented by an expanded coverage of known eff ective interventions to reduce adult mortality, especially in high-mortality district

Is economic inequality in family planning in India associated with the private sector?

This study examined the pattern of economic disparity in the modern contraceptive prevalence rate (mCPR) among women receiving contraceptives from the public and private health sectors in India, using data from all four rounds of the National Family Health Survey conducted between 1992–93 and 2015–16. The mCPR was measured for currently married women aged 15–49 years. A concentration index was calculated and a pooled binary logistic regression analysis conducted to assess economic disparity (by household wealth quintiles) in modern contraceptive use between the public and private health sectors. The analyses were stratified by rural–urban place of residence. The results indicated that mCPR had increased in India over time. However, in 2015–16 only half of women—48% (33% from the public sector, 12% from the private sector, 3% from other sources)—were using any modern contraceptive in India. Over time, the economic disparity in modern contraceptive use reduced across both public and private health sectors. However, the extent of the disparity was greater when women obtained the services from the private sector: the value of the concentration index for mCPR was 0.429 when obtained from the private sector and 0.133 when from the public sector in 2015–16. Multivariate analysis confirmed a similar pattern of the economic disparity across public and private sectors. Economic disparity in the mCPR has reduced considerably in India. While the economic disparity in 2015–16 was minimal among those accessing contraceptives from the public sector, it continued to exist among those receiving services from the private sector. While taking appropriate steps to plan and monitor private sector services for family planning, continued and increased engagement of public providers in the family planning programme in India is required to further reduce the economic disparity among those accessing contraceptive services from the private sector

Determination of ethambutol MICs for Mycobacterium tuberculosis and Mycobacterium avium isolates by resazurin microtitre assay

Objectives: To test susceptibilities of Mycobacterium tuberculosis (MTB) isolates to ethambutol by the Lowenstein-Jensen (LJ) proportion method and resazurin microtitre assay (REMA) and to evaluate REMA for the determination of ethambutol MICs for MTB and Mycobacterium avium isolates. Methods: A total of 50 MTB and 20 M. avium isolates were tested to determine the MICs of ethambutol by REMA and agar dilution method. MTB isolates were also tested by the LJ proportion method. Results: REMA provided ethambutol susceptibility results for all the isolates within 8-9 days. For MTB isolates, REMA showed 96.7% sensitivity, 100.0% specificity and 98.0% accuracy when LJ proportion results were taken as 'gold standard'. For both MTB and M. avium isolates, the MICs determined by REMA were lower than those determined in agar medium, indicating that MIC values determined by REMA are closer to the actual MICs for the isolates. Conclusions: REMA can be used as a rapid and inexpensive method for mycobacterial drug susceptibility testing against ethambutol. In comparison with the agar method, the MICs determined by REMA can more accurately be correlated with achievable plasma concentrations of antimycobacterial agents