Multiple faces of the health transition

The incidence of cancer is rising in African countries It has been noted that about 650,000 people in Africa develop cancer annually. Because treatment remains largely unavailable or inaccessible, about 510,000 cancer deaths occur annually, an 80 percent mortality ratio. More than one-third of the cancer deaths in Africa are due to cancers that are easily preventable and/or treatable if detected early. Cancer kills more people in Uganda compared to Tuberculosis, Malaria and HIV/AIDS combined, health experts have said.
The study combined several research methods that included secondary data from various reports, news articles, journals and documents dotted around in different agencies, which have tried to address the cancer challenge, environment impacts of cancer and development issues of the country. Observation was also utilized to analyze the relationship between magnitude of cancer and people’s laxity to receive diagnosis for their health problems with a focus on the different health issues and how they affect people’s health
To this day Uganda has the highest infection rates in the world with 60% of cancer infections. Survival rates of preventable and treatable cancer infections stand at 10%. Experts blame this on patients who go for diagnosis at later stages of illness when treatment is often least effective.

Staphylococcus aureus (S. aureus) is one of the most serious gram-positive bacteria causing several infections. Because of its intrinsic ability to develop resistance to antibiotics, nowadays only few drugs can be confidently mentioned for the treatment of S. aureus infections. The study aimed to investigate the antibiotics susceptibility pattern of S. aureus among patients.
A cross-sectional study was conducted on antibiotic susceptibility of S. aureus among patients. A total of 323 wound and nasal swab specimens were collected and inoculated on mannitol salt agar (Oxoid) and incubated at 37oC for 18 to 24 hours. Gram-staining and specific biochemical tests were used to identify the study organism. Sensitivity of the isolates to ten commonly used antibiotics was determined by Kirby-Bauer antibiotic sensitivity testing method. The isolates were found to be highly resistant to penicillin G and cephalothin (98.8%; each). Chloramphenicol, amoxicillin/clavulanic acid and oxacillin were also resisted by 53.1%, 50.6% and 38.3% of the isolates, respectively. Least resistance was obtained for ciprofloxacin, vancomycin and gentamycin. There was higher S. aureus prevalence for inpatient isolates than outpatients’. The isolates showed high resistance and multidrug resistance pattern to several combinations of the tested antibiotics.

In Tanzania, despite the fact that majority of population lives within 5 kilometers of a primary health facility, utilization of these facilities is limited owing to poor quality of primary healthcare. This study tests the hypothesis that women bypass the nearest primary health facility in order to receive better care for antenatal care (ANC) elsewhere and assesses covariates of this behavior. We combine original data on mothers with recent pregnancies from cross-sectional household survey (n=912) with health facility survey collected in 2011 in Rufiji, Kilombero and Ulanga Districts. Bypassers are defined as mothers who opt to seek care at facilities other than the nearest to her home village. Multivariate logistic regression is used to examine the maternal and contextual factors associated with odds of bypassing proximate facilities. Initial results show more than half of women interviewed sought these services at a health facility outside of home village rather than at the closest dispensary. Bypassers were 5 to 6 times more likely to visit health center or hospital than primary dispensary. The strong patterns of bypassing reveal mothers’ preferences for better ANC services, despite additional costs and time involved. This suggests crucial need to improve the quality of community-based ANC services to achieve health equity.

We aim to investigate long-term prostate cancer survivors’ quality of life (QoL) over time. We employ growth curve model to examine the panel data from a population-based survey of survivors with localized prostate cancer in southeast of U.S. (N=1008). Survivors on average are 3 years post-diagnosis at intake and followed-up annually for 3 years. QoL is measured using SF12. Time-invariant factors include age, race, and education at intake. Time-varying variables include family income, marital status, time since diagnosis, prostate cancer specific bowel, hormonal, sexual, and urinary symptoms (EPIC-26), and comorbid conditions (Charlson Index).
Being younger (p<.01), being black (p<.05), having higher family income (p<.0001), having college or higher education (p<.01), and having fewer bowel (p<.05), hormonal (p<.0001), urinary irritability (p<.01), and sexual (p<.05) symptoms and comorbidities (p<.001) predict better physical QoL over time. Being older (p<.0001), being married (p<.01), and having fewer hormonal (p<.001) and sexual (p<.05) symptoms and comorbidities (p<.05) predict better mental QoL over time.
Both time-invariant and time-varying factors contribute to survivors’ QoL over time. To improve their QoL, clinicians need to attend to both prostate cancer specific symptoms and aging-related factors.

Social class and economic well-being have been identified as important social determinants that shape health inequalities. In particular, socioeconomic inequalities in mortality not only explain prevailing exposure of disadvantaged individual and ecological circumstances but also cumulative exposure to adverse circumstances. This paper examines contribution of contextual and socioeconomic factors on mortality differential across the stages of life course using third round of large scale District Level Household Survey (2007-08). Multiple logistic regressions have been applied to evaluate the impact of socioeconomic variables (Gender, Caste, Wealth Index etc) on age-pattern of mortality. Age has been grouped into six categories to capture the different stages of life course:infant ( <1 year), young children (aged 2–5 years), children to adolescent (aged 6–18 years), young adult (aged 19–44 years), Middle-aged (aged 45–64 years), and elderly (aged 65 years and older). Finding clearly suggests mortality risk across the life course, is disproportionally associated with economically backward and lower caste people. Although, Income quintile gradient has found to considerable weaker in Adult ages as compared to younger ages. State level variation in mortality has also been observed which supports the contextual influence on mortality

A fundamental question in human aging research is what makes us survive to and at older ages. The separation and reunification of Germany provides us with a unique opportunity to assess external determinants of human survival to oldest ages on a population scale. In this context, we seek to estimate the impact of mortality selection among older East Germans before reunification as a reason for the quick catch up of life expectancy to the West after reunification. We use a gamma gompertz model to account for mortality convergence due to frailty variations caused by changing external conditions. We assume that the unfavourable conditions before reunification lead to a survival of more robust individuals than in the West and to quicker convergence of mortality among these age groups.

Health plays a vital role in acquisition and management of “life-cycle wealth” by way of building “human capabilities” in developing economies like India. As children are important potential assets of a nation, providing good health and reduce infant and child mortality is felt increasing important. In India, several efforts have been made to address the above issue. An effort has been made to examine the trends in IMRs across rural-urban areas, male-female and social groups and indentify the factors that affect IMRs.
India witnessed a persistent decline in IMR from 129 in 1971 to 50 in 2009. The IMR was higher in rural than in urban areas. The decline in IMR in rural areas is found to be much faster than in urban areas. Across social groups, the IMRs were higher among scheduled castes (SCs)/scheduled tribes (STs)-historically exploited sections of the society- compared to other backward castes (OBCs) and Others. The net state domestic product, the female work participation rate (WPR), poverty, the rate of female literacy and the health infrastructures are found to important factors that affect IMR. In a bid to reduce IMR further, improving female's education and their access to employment and reduction in poverty should be accorded top priority in the development paradigm of India.

Numerous studies show that high life expectancy is closely related to low life disparity. Unlike life expectancy, which can be increased by mortality decline at any age, averting deaths may either reduce or increase life disparity. Disparity can thus be decomposed into two opposite components, called compression and expansion, according to the effect of mortality decline on the age distribution of mortality. Conventional measures of disparity do not distinguish between the two components and inevitably provide misleading information on the equalization of life chances in a population. Based on the relevant properties of the change in disparity, we develop a new measure of disparity, the ratio of expansion to compression (REC), which can account for the relative importance of the two components. With this simple measure, we can obtain not only a clearer vision of the evolution of disparity, but also a consistent interpretation of the change in disparity related to mortality decline, just as we do with life expectancy. Empirical analysis shows the advantages of the new measure over conventional measures of disparity.

In 2005, with the goal of reducing the numbers of maternal and neonatal deaths, the Government of India launched Janani Suraksha Yojana (JSY), a conditional cash transfer scheme, to incentivize women to give birth in healthy health facility. The main objective of this program is to ensure that each delivery is conducted in an institution and is attended by a skilled birth attendant (SBA), to minimize or prevent maternal deaths and pregnancy -related complications in women and at the same time ensure the well -being of the mother and the new-born. This paper investigates the different dimensions of Janani Suraksha Yojana and the impact of the JSY on the behavior of beneficiaries.
A total 1500 married women has interviewed and all were from the rural villages under the Community Health Centre (CHC). The findings indicate that the maximum women’s prefer to conduct their deliveries at the private hospitals because the attitude of the health personnel at the government hospital is not cordial and they have to suffer many problems to receive the benefits of the JSY. 33% respondent has given the birth of their baby at the government hospital while 61% at the private hospitals. While 83% were registered at the CHC for their health checkups during pregnancy.
Keywords: Janani Suraksha Yojana, ASHA, Community Health Centre

Health is another important dimension of welfare that may be impacted- being left behind and lead to potential health problems. It becomes important to see that, ‘What effects does migration of husbands has on the wives that they left behind?’ ‘Are the wives left behind getting the benefits of their husbands working outside?’ Specifically this study asked for the impact of out-migration of husbands on the health of wives. Primary data has been collected in rural area of Garhwal, a district in the state of Uttarakhand in India. The total sample size is 262 left-behind wives due to husbands’ out-migration and 256 wives of non-migrants. There is no sign that wife get sick, suffer from RTI/STI, self-reported health worsens as a result of an out-migration of husband except mental health. Coefficient for wives of out-migrant husband has negative sign which means that this group of wives are less likely to assign higher rating in their status of mental health. Wives of both the groups were asked to rank their health. The percentage distribution across both the group is not showing much difference. There is no sign that self-reported health worsens as a result of a household member’s migration.