Biological and behavioural aspects of health and mortality

Overweight and obesity are major contributors of insulin resistance and their prevalence and determinants are known to vary in different populations.The objective of the study was to assess the proportion and determinants of overweight and obesity among diabetic women of reproductive age attending a tertiary hospital in Bangladesh.This cross-sectional analytic study was conducted among 888 diabetic women of reproductive age using a semi-structured questionnaire and purposive sampling technique.The overall prevalence of overweight was47%(95%CI48-45) and that of obesity was23%(95%CI21-24).On Pearson’s correlation analysis, BMI(r=0.135,p=0.001) and WC(r=0.162,p=0.001) were significantly associated with age and similarly BMI(r=0.151,p=0.001),WC(r=0.087,p=0.009)and WHR(r=0.094, p=0.005) were correlated with income.On binary logistic regression, BMI was significantly associated with age(p<0.05),income(p<0.05) and management of diabetes by OHA(p<0.05). On the other hand, WC was significantly associated with age(p<0.001),income(p<0.05) and management of diabetes by OHA(p<0.05).WHR was significantly associated with duration of diabetes(p<0.05).A high prevalence of both overweight and obesity exists in diabetic women of reproductive age and associated with increasing age, income, duration of diabetes, and use of oral hypoglycemic agents.

A growing body of literature has shown that early life conditions have strong implications for later life health and wellbeing. There are not many existing works, however, that analyse whether exposure to disease in infancy affects reproductive health. Using data from Southern Sweden for women born between 1813 and 1898 this work intends to cover some of these gaps. Previous research that used the same data showed that individuals exposed to whooping cough in infancy had greater risks of dying from early adulthood and until old age. An impact was also observed on the reproductive health of low SES women, who experienced lower proportions of male births, possibly due to a higher incidence of miscarriages, as well as higher offspring infant mortality. Using dynamic path analysis, the current work analyses whether exposure to whooping cough in infancy affects female fertility directly and/or indirectly. Besides possibly having direct impacts on fecundity, the effect that early life conditions have on the survival of the preceding child could, in fact, have physiological and behavioural implications on the hazard of experiencing a successive birth and on its timing. SES will also be considered as a further intermediate variable.

In the light of growing share of neonatal mortality in Under-5 mortality in recent decades in India, this study attempted to examine the individual, household, and community level factors affecting neonatal mortality in rural India. We analysed information on singleton live births from District Level Household Survey conducted in 2007-08. Multilevel modeling with MCMC procedure was used to examine the factors. The odds of neonatal death significantly decreased with increasing proportion of rich households in the village. Parental education, caste, and employment of the mother were found significant. The odds of death decreased if the households had access to improved sanitation, pucca house and electricity. The odds of death were higher for babies born in a health facility, male neonates, and neonates whose mothers experienced delivery complications. Neonates whose mothers received two tetanus toxoid injections were less likely to die in the neonatal period. Ensuring the consumption of an adequate quantity of tenatnus toxoid (TT) injections, targeting vulnerable groups like young and SC mothers, and improving the overall household environment by increasing access to improved toilets, electricity, and pucca houses could also contribute to further reductions in neonatal mortality in rural India.

An individual is rational about making healthcare choices and despite of availability of TB drugs at door steps; people are not using it as their direct healthcare choice. In the present study an attempt has been made to study the factors leading to different healthcare choices in presence of social barriers which is often attached to stigmatized diseases like TB. A small scale survey data on 367 TB patients have been collected from high TB incidence area to capture the factors responsible for various healthcare choices made for treatment of tuberculosis. Bi-variate results shows that age, sex, marital status, level of education and economic status is significantly related to mean number of healthcare choices made. Despite of this, only eight percent of patient directly went to DOTS centre for check up. It is also observed that those with earlier experience of TB in the household make more healthcare choices. Discrimination faced due to TB is also significantly influencing the number of healthcare choices made for treatment. There is clear indication that somewhere tuberculosis program has failed to gain faith and believe on treatment provided for treatment of tuberculosis within community.

Health status at older ages around the globe has changed due to changes in epidemiological environment, diet/nutrition, medical technology, public and individual health practices. But the change is likely to vary across countries with different economic, epidemiological, and policy circumstances. Using 2 waves of nationally representative datasets from 5 countries with varying income levels, we examine changes in biological risk in US, England, Mexico, Taiwan and Indonesia. Biological risk factors include systolic and diastolic blood pressure (BP), BMI, total, HDL cholesterol, and HbA1c. Our analysis includes those age 50+ who participated in physical exam and blood collection. We find patterns of age-specific onset of high-risk levels of biological risk vary across countries. No single country has the highest or lowest onset levels for all factors. A relatively low-income country, Indonesia, has the highest onset rates for high BP, though its rate of overweight onset is the lowest;while the high-income countries (US, England) have higher onset rates of overweight, their onset rates of high BP tend to be lower. The US had fairly high levels of onset of high HbA1c;England had relatively high levels of high cholesterol onset. Our findings indicate different levels of onset of biological risk across countries with different income.

Over the past decade indeed, there is a near-absence of studies that have identified the determinants of consistent use of institutional delivery services for all births within a woman. Hence, the objective of this study is to explain the consistency of institutional delivery in the country by considering all births within women using NFHS 2005-06 data. To fulfil the objective multilevel binary logistic regression model and multivariate multilevel analytical approach has been applied. Result shows that children, born 2-4 years back from the date of survey were less likely to deliver in an institution than recent born child. Compare to second order birth, first order birth were more likely to deliver in an institution. A strong positive effect of women education and wealth index on all three births in an institutional delivery was also pronounced. Significant economic differentials were found for institutional delivery for all three births. Mother belongs to upper wealth quintile had less more chance to deliver all three births in an institution. Result shows that child those who have born 2-4 years back from the date of survey were less likely to deliver in an institution than recent born child. For third last birth place of delivery, child age had no important effect.

Son preference is a salient feature of many Asian populations, both contemporary and historical. Though sons are thought to experience a biological disadvantage in survival throughout the life-course, evidence has shown that daughters often fare worse, implicating preferential treatment of sons. In this paper, we examine evidence for gender-based differences in mortality among Taiwanese who were alive during the Japanese occupation. An interesting feature of this population is an unusually high rate of adoption, which has also been linked to higher levels of mortality among Taiwanese. Using event history analysis of longitudinal data collected from household registers, we explore these variables in an attempt to identify the factors associated with the hazard of death among colonial-era Taiwanese.

Considerable number of demographically laggard countries will forego MDGs 4 and 5, and Nepal is not an exception to it. International reports reveal that, lack of adequate birth preparedness is one of greatest encumbrance in failure to reach MDGs 4 and 5. In this context, this study estimated birth preparedness among Nepali women and its association with institutional delivery and postnatal care by using latest demographic health survey data for Nepal. The study used latest round of Nepal Demographic and Health Survey Data. Bivariate and multivariate models are applied as the methods of data analyses. Results reveal that the overall level of birth preparedness is greater among women with pregnancy complications, lower age group, higher education and economic status and with greater women autonomy. Findings reveal that birth preparedness is one of the critical factors in determining the likelihood of having institutional delivery and checkups after delivery. At policy perspective, this study reinstates that laggard countries like Nepal have to ensure adequate and universal birth preparedness in order to achieve not only goal 4 and 5 of MDGs, but have to catch the standards set by developed countries in terms of maternal and child health outcome.

In the context of Nepal, this study calculates inequalities in utilisation of maternal health care and relative contribution of different factors affecting it. It used data from the latest round of Nepal Demographic and Health Survey-4, 2011. Concentration index and decomposition of concentration index are used as the methods of analyses. CI estimates in three selected indicators suggest considerable inequalities in maternal health care utilisation. Results of decomposition analyses indicate that the critical factors contributing to inequalities in <3ANCs are poor economic status of households and women's and her partner’s illiteracy. However, in case of no institutional delivery, along with poor economic status of household and women’s illiteracy, the rural place of residence also emerged as a critical factor. For no post natal care within a day, birth order becomes significant factor, next to poor economic status of the household in terms of the relative contribution to total inequalities. Policies and program targeting maternal health interventions need to take note of the findings to achieve equity with efficiency in utilisation of maternal health care, and further to achieve the targets of millennium development goal 5 in Nepal.

Abortion has been legalized long before in India. Still it has been big issues as a considerable number of maternal deaths occur either due to the fact, that it is done illegally under unsafe procedures or direct/indirect effect of gynecological morbidity on women’s health. The study focuses on the association between abortion and gynecological morbidity in India. District level household and facility survey (2007-08) is used for the study. Bivariate and multivariate analyses are used.
The women who have experienced induced abortion are 2 times more likely to have gynecological morbidity as compare to live birth. Those women have spontaneous abortion are around 2 times more likely to have gynecological morbidity as compare to live birth. Encourage awareness programs on reproductive health issues mainly focusing on abortion and related health problems and gynecological morbidity can play an important role to reduce the severity of the problem in India.