Multiple faces of the health transition

The present study examines urban-rural differentials in maternal health care services in the regions of Madhya Pradesh by demographic and socio-economic characteristics using third round of District Level Household and Facility Survey (2007-08). Bivariate and multivariate techniques have been used for analysis. Result shows wide gap between rural and urban areas in utilizing maternal health care services in the regions of Madhya Pradesh. Malwa and South Central Region are the best performing region while South Western and Northern Region are the worst performing regions. Full ANC is very low in Madhya Pradesh. But there is much variation among the regions and within the regions among rural and urban areas. Almost half of the women in Madhya Pradesh had safe delivery. There also prevails noticeable difference in safe delivery and PNC. Multivariate analysis shows that education is a key factor that influences the utilization of maternal health care services.

An attempt has been made to explore status of maternal health and utilisation of maternal health care services among maternal death reported households in India and its regions. District Level Household and Facility Survey (2007-08) data reiterates, maternal deaths are significantly high in rural areas especially in high focus Non-North Eastern States. Results show inverse relationship between economic status and maternal deaths. There is wide disparity in maternal mortality ratio within various regions in India with highest as 390 in Assam and lowest as 81 in Kerala per 100000 live births. 56 percent deaths were reported during pregnancy. Contraceptive coverage in households reported maternal deaths is at the low level and moreover in the same household the usage of modern methods of contraception is also low this is clearly indicative of the low coverage of birth spacing methods that exposed women to repeated unwanted births hence, increasing risk of maternal morbidity and mortality.

While there is a widespread interest for gender health differences in public policy and scientific debates within developed countries, studies on this topic are scarce in developing countries, particularly in sub-Saharan Africa. However, gender differences in sub-Saharan Africa health status are important, with the few available studies showing that women report worse health than men. Nevertheless, the sources of these differences are rarely explored. We used an extension of Oaxaca-Blinder decomposition using logistic models with data from the 2002 World Health Survey to partition the women-men poor self-rated health (SRH) gaps into a component reflecting differential “exposure” to risk factors between women and men, and a component reflecting differential “vulnerability” to risk factors in sixteen sub-Saharan African countries. We found that women more often reported poor SRH than men in all the countries analyzed (apart from Kenya). Decomposition analyses showed that differential exposure largely explained the women-men gaps in poor SRH in all the countries studied, with an explained part ranging from a low of 64% in Zambia to a high of 122% in Malawi. Disability, arthritis, socio-economic, psychosocial and behavioral risk factors proved important contributors to the observed differences in men’s and women’s poor SRH.

ADL and IADL indexes, both of which are self-reported limitations on the daily activities, are limited to differentiate the contextual barriers and intrinsic impairment for of disability status in the elderly population. This study examines four types of disability measurements in the Chinese elderly disability trend analysis: 1) the self-reported difficulty in IADL, 2) the self-reported dependency in ADL, 3) the self-evaluated function performance, and 4) the objective performance in function tests. The data are from three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2002, 2005 and 2008. The results showed contrasting trends under four different measurement schemes. The fact that the trends based on objective performance is reversed in comparison with trends of ADL and IADL suggests that it is likely that the ADL and IADL improvement could be largely due to the changes in the living environment of the elderly instead of the improvement of their body functions. To better understand the source of disability in the elderly population is extremely important for medical interventions, elderly care and public policy development and we call for more attentions to such a measurement problems in the disability trend studies.

The objective of this study is to present the method proposed by Sullivan and to estimate the healthy life expectancy using different measures of state of health, based on information from the World Health Survey carried out in Brazil in 2003. By combining information on mortality and morbidity into a unique indicator, simple to calculate and easy to interpret, the Sullivan method is currently the one most commonly used for estimating healthy life expectancy. The results show higher number of healthy years lost if there is a long-term disease or disability that limits daily activities, regardless of the difficulty in performing such activities or the severity of the functional limitations. The two measures of healthy life expectancy adjusted by the severity of functional limitation show results very similar to estimates based on the perception of state of health, especially in advanced age. It was also observed, for all measures used, that the proportion of healthy years lost increases significantly with age and that, although females have higher life expectancy than males, they live proportionally less years in good health.

While studies examining differentials in mortality across Eastern European countries abound, few researchers to date have focused on the diversity in quality of life. Using data from the European Values Study (EVS), the present study investigates variations in quality of life, measured by healthy life expectancy (HLE) between ages 20 and 74 for 23 Eastern European countries in 2008. The analyses from the prevalence-based Sullivan method demonstrate substantial disparities in quality of life between East Central Europe and the former Soviet Union. In 2008, the difference in HLE amounted to 21.79 years for men (ranging from 35.57 years in Macedonia to 13.98 years in Russia) and 21.86 years for women (from 34.37 years in the Czech Republic to 12.51 years in Russia). These findings suggest that men and women in East Central Europe enjoy much healthier lives compared to those in the former Soviet Union. Fully understanding the diversity in population health status within Eastern European countries requires research that focuses not only on quantity of life but also on quality of life.

Malaria continues to represent a major public health problem in areas of endemicity, with an estimated 225 million cases worldwide in 2009. The 2015 goals of the World Health Organization’s (WHO’s) Roll Back Malaria Partnership are to reduce global malaria cases by 75% from 2000 levels and to reduce malaria deaths to near zero through universal coverage by effective prevention and treatment interventions. Maternal health is linked with maternal education that results in greater utilization of modern health services. Educated women are better able to break away from tradition to use moderns’ means of safeguarding their own health and those of their children. Educated women are better able to use what is available in the community to their advantage. Pregnant women are vulnerable and exposed to malaria within the tropical countries. Based on the magnitude and the importance of the problem, the following objectives were assigned to this study:
• Describe the use of insecticide treated nets (ITNs) among pregnant women
• Identify socio-demographic factors which are statistically associated to the use of insecticide treated nets (ITNs) among pregnant women
• Examine the magnitude and sense of the influence of each determinant of the use of insecticide treated nets (ITNs) among pregnant women.

Cardio-vascular mortality is the flaring global problem. According to WHO, it stood on the top with 29.34 percent in the leading causes of global death. In recent years, promotive and protective health care has been emerging as a major approach throughout the world. This trend is really a convincing convergence of contemporary medicine towards the traditional approaches of Yoga and Ayurveda in preventive cardiology.
Yoga and Ayurveda, the ancient Indian medicine system has several preventive measures to reduce the cardiac mortality. In this study different dynamics of Yoga like various pranayama and Asanas and Ayurvada like Nidan Parivarjan (Elimination of cause), Ahara-Vihar (Food habits and Life style interventions), Aushadhi (Cardio-protective drug) –“Rasona Ksheerpaka” (a preparation of Allium sativum and milk) have been considered. These interventions have been found effective to address the regression of contributing factors of cardio-vascular disease like hypertension, high blood sugar, dyslipidaemia, high uric acid in blood, stress, obesity, smoking and reducing the mortality rate significantly. The outcome of this study revealed a new dimension of integrated approach of Yoga and Ayurvedic interventions in preventive cardiology and reducing the mortality of cardio-vascular disease.

It is acknowledged that the level of injury mortality reacts quickly to socioeconomic changes. Transition from the Soviet system initially brought a two-fold rise from the average level of the 80’s to an injury SDR of 242 per 100000 in 1994 in Estonia (54 in EU). Thereafter the decline, both in total mortality and injury mortality, has been exemplary. The nature and success of reforms is the best explanation for differences among countries according to Vallin and Shkolnikov. During the Asian crisis of 1997/8 and especially the 2008/9 global recession, which had severe economic consequences, the trend did not change – injury SDR fell from 110 in 2007 to 77 in 2011.

Interestingly today, when the injury mortality is much lower, inherent characteristic features still remain in Estonia. The male/female ratio, globally around 2, has firmly stayed at 4-5 during past 20 years. Unlike in most countries where injury mortality is peaking in the oldest age group, a second peak at the age of 45-59 is evident.

There is a notable difference between cohorts during the transition – those born around 1955 were hit the hardest. Employed population has enjoyed a significant decline of injury deaths, unemployed have seen their situation stabilise.

This study is one of the first attempts to quantify and decompose health inequalities among the older population in India. At the same time, the study aims to examine whether these inequalities vary for the older population below 70 years and 70 years and above. The initial investigation begins with a bivariate assessment of the socioeconomic differentials in terms of poor health status of the older population. Subsequently, concentration index is used as a measure of health inequality, which is further decomposed into determining factors to find out the relative contribution of the different socioeconomic predictors. Decomposition estimates suggest that poor economic condition stand to be the dominant contributor to health inequalities among older population followed by illiteracy and rural place of residence. Comparative assessment suggests that socioeconomic inequality is critical for health inequality for the population below 70 years and 70 years and above as well.