Solving India’s sanitation puzzle

60% of the world’s open defecation happens in India, and 70% of households in rural India defecate in the open. Widespread open defecation persists in rural India not because of a lack of infrastructure, but because of unique cultural practices concerning ritual impurity, and a history of caste and untouchabilit

Drug prescribing patterns in elderly patients in a tertiary level hospital

Background: Elderly people have multiple co morbidities and are often prescribed potentially inappropriate medications (PIMs). As there is paucity of information about the prescribing practices in elderly this study was undertaken to assess drug utilization patterns in elderly patients.Methods: A prospective observational study was conducted in a tertiary care hospital. A total of 576 prescriptions of elderly patients were included in the study. Prescribing patterns among elderly patients attending OPD and admitted to wards of departments of Medicine, Psychiatry, Dermatology, Pulmonary Medicine, General Surgery, E.N.T., Ophthalmology, Orthopaedics, Obstetrics and Gynaecology were analysed using the prescribing indicators (WHO criteria). The PIMs were identified as per the Beers 2012 criteria.Results: The average number of drugs per patient was 3.91±1.93 for O.P.D and 7.37 ±2.22 for I.P.D. patients. 37.76% patients in I.P.D. and 26.87% patients in O.P.D. received a medication which was potentially inappropriate as per Beers 2012 criteria. 7.58% (234/3088) of total medications prescribed to patients in the study were potentially inappropriate. There was a significant increase in the number of PIMs (p value ˂0.05) as the total number of drugs prescribed increased.Conclusions: Educational programmes are needed to reinforce rational prescribing by physicians and precautions should be taken while prescribing potentially inappropriate drugs to elderly patients

Drug prescribing pattern in acute gastroenteritis in an in-patient setting in a private hospital

Background: Diarrheal diseases cause significant morbidity in developing countries and are the leading cause of death in children. The study was undertaken to assess drug utilization patterns in patients with gastroenteritis in a private setting.Methods: The in-patient data records of 208 patients (96 males, 112 females) admitted with acute gastroenteritis in a private hospital in Mumbai over 2 years were analysed. WHO core drug prescribing indicators - average number of drugs per prescription, percentage of drugs prescribed by generic name, percentage of encounters resulting in prescription of an antibiotic, percentage of encounters resulting in prescription of an injection were assessed. Patient demographics and trends in use of antibiotics, antiemetics and antidiarrheals were assessed.Results: The average total number of drugs prescribed per patient was 6.33 and average number of antibiotics was 1.61. 99% of drugs were prescribed using brand names. Percentage of encounters resulting in prescription of injection was 97.11%. Cephalosporins were the most commonly used group of antimicrobials (62.5%) followed by fluroquinolones (49.03%) and antiamoebic drugs (35.58%). Diphenoxylate was the most commonly prescribed antidiarrheal drug and ondansetron was the most commonly prescribed antiemetic agent. Cephalosporins were the most commonly used antimicrobials in patients diagnosed with enteric fever.Conclusions: Emperical irrational use of antibiotics was observed. There was paucity of stool culture for identification of causative agents. Review of antibiotic susceptibility patterns needs to be done on a regular basis. Educational programmes to reinforce the need for ORS and zinc supplementation are necessary.

Near-universal marriage, early childbearing, and low fertility: India's alternative fertility transition

Objective: To compare fertility in India to both low-to-middle-income and high-income countries (LMICs and HICs) and describe the patterns that have accompanied India's transition to low fertility. Methods: We use data from the Demographic and Health Surveys (DHS), the United Nations (UN), and the Organisation for Economic Co-operation and Development (OECD) to observe factors associated with fertility decline in 36 Indian states and 76 countries. Results: Although fertility in India has declined to levels similar to HICs, women's entry into marriage and initiation of childbearing are more in line with patterns found in LMICs. The vast majority of women in India (97Š) are married by age 30, and their average age at first birth is only 21.3 years old. In spite of these patterns, average fertility has declined in India as a result of earlier termination of childbearing. Among more recent cohorts, fewer women progressed to higher-order births and about half of women obtained a sterilization by age 35. Conclusions: India has reached low fertility by mechanisms outside the traditional indicators of fertility decline. In contrast to countries that have achieved low fertility through delayed age at first birth, women in India have continued to enter unions and bear children early, lowered their age at last birth, and increasingly ended their fertility via sterilization following the birth of two children. Contribution: Evidence from India reveals an alternative pathway to low fertility, highlighting the limitations of traditional socioeconomic indicators for explaining fertility decline

Interrelationships among health, the environment, and social inequality in India

This dissertation examines the interrelationships among health, the environment, and social inequality in India. The first chapter examines the health and human capital consequences of expansions in coal-powered electricity generation in the developing world. Using variation in coal plant capacity within place across cohorts in India, a large coal consumer, I find that children born exposed to a median-sized coal plant are 0.1 standard deviations shorter than unexposed children. Supporting air pollution as a channel, effects are larger among children living closer to coal plants. Changes in coal capacity do not predict changes in other local socio-economic factors, demographics, employment, or infrastructure. Effects are similar by socioeconomic status, but richer households live closer to coal plants. The second chapter, published in the Proceedings of the National Academy of Sciences and co-authored with Payal Hathi and Aashish Gupta, investigates life expectancy differentials along lines of caste, religion, and indigenous identity in India, home to some of the largest populations of marginalized social groups in the world. Using a large, high-quality survey that measured mortality, social group, and economic status, we are the first to estimate and decompose life expectancy differences between higher-caste Hindus, comprising Other Backward Classes and high-caste Hindus, and three of India's most disadvantaged social groups: Adivasis, Dalits, and Muslims. Relative to higher-caste Hindus, Adivasi life expectancy is more than four years lower, Dalit life expectancy is more than three years lower, and Muslim life expectancy is about one year lower. Economic status explains less than half of these gaps. The differences between the life expectancy of higher-caste Hindus and the life expectancies of Adivasis and Dalits are comparable to the Black-White gap in the US in absolute magnitude. The differences are larger in relative terms because overall life expectancy in India is lower. Our findings extend the literature on fundamental causes of global health disparities. Methodologically, we contribute to the literature on mortality estimation and demographic decomposition using survey data from low- and middle-income contexts. The third chapter, published in World Development and co-authored with Aashish Gupta and Nazar Khalid, studies why households are slow to adopt clean cooking fuels in rural north India. Exposure to air pollution from cooking with solid fuels has important consequences for public health. This paper focuses on rural north India, where despite robust economic growth and government subsidies, the vast majority of households mainly use solid fuels. Using new qualitative and quantitative data collected in the context of a policy environment that dramatically expanded ownership of liquid petroleum gas (LPG), we find that patriarchal gender norms and attitudes encourage the use of solid fuels in this region. North Indian society confers low status to women, promotes women’s seclusion, and constrains women’s engagement in economic activities outside of the home. These beliefs encourage women to preserve gas, promote women's work that facilitates the use of solid fuels, and hinder communication between the cook and the decision-maker regarding LPG refills. When rural north Indian households use gas, it is frequently to facilitate the adherence to norms of seclusion that prevent women from leaving the home to collect solid fuels. In addition to expanding access and improving economic conditions, future research and policy interventions should pay careful attention to the gender norms and attitudes that discourage the use of gas.Economic

ahs_life_tables

life tables and their standard errors from Vyas, Hathi, and Gupta (2021): https://osf.io/preprints/socarxiv/vkacx

Sanitation and Religion in South Asia: What Accounts for Differences across Countries?

<p>Exposure to open defecation has serious consequences for child mortality, health, and human capital development. South Asia has the highest rates of open defecation worldwide, and although the incidence declines as household income rises, differences across South Asian countries are not explained by differences in per capita income. The rate of open defecation in sub-national regions of Bangladesh, India and Nepal is highly correlated with the fraction of the population that identifies as Hindu, in part because certain rituals of purity and pollution discourage having latrines in close proximity to one’s home. Almost all open defecation occurs in rural areas, and this paper estimates how much the rate could be reduced if rural households in regions that have a higher fraction of Hindus, where open defecation is still common, altered their behaviour to reflect that of non-Hindu households in regions that are predominantly non-Hindu, where the rate of open defecation is much lower. Using nonparametric reweighting methods, this paper projects that rural open defecation in Bangladesh, India, and Nepal could be reduced to rates of between 6 and 8 per cent, compared to the prevailing level of 65 per cent.</p

An Experiment with Air Purifiers in Delhi during Winter 2015-2016.

Particulate pollution has important consequences for human health, and is an issue of global concern. Outdoor air pollution has become a cause for alarm in India in particular because recent data suggest that ambient pollution levels in Indian cities are some of the highest in the world. We study the number of particles between 0.5μm and 2.5μm indoors while using affordable air purifiers in the highly polluted city of Delhi. Though substantial reductions in indoor number concentrations are observed during air purifier use, indoor air quality while using an air purifier is frequently worse than in cities with moderate pollution, and often worse than levels observed even in polluted cities. When outdoor pollution levels are higher, on average, indoor pollution levels while using an air purifier are also higher. Moreover, the ratio of indoor air quality during air purifier use to two comparison measures of air quality without an air purifier are also positively correlated with outdoor pollution levels, suggesting that as ambient air quality worsens there are diminishing returns to improvements in indoor air quality during air purifier use. The findings of this study indicate that although the most affordable air purifiers currently available are associated with significant improvements in the indoor environment, they are not a replacement for public action in regions like Delhi. Although private solutions may serve as a stopgap, reducing ambient air pollution must be a public health and policy priority in any region where air pollution is as high as Delhi's during the winter

Block randomization of test type by calendar day and time of day^a.

<p>Block randomization of test type by calendar day and time of day<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0167999#t001fn001" target="_blank">^a</a>.</p

Particle counts in New Delhi are much higher than in urban background sites of other cities and towns.

<p>Particle counts in New Delhi are much higher than in urban background sites of other cities and towns.</p