Multiple faces of the health transition

The main objective of this study is to determine the risk factors associated with maternal deaths. More specifically, to study the extent of maternal health care services received prior to deaths. A case control study was carried out to collect the information on 50 cases and 150 controls from a selected district of Uttar Pradesh, India. The deaths were identified from multiple sources e.g. health facility/hospital records, ASHA and snow-ball sampling method. The husband of dead women or any other family member who could provide reliable information was interviewed. Frequency distribution and cross tabulation has been done. Further, to check the association with different variables unadjusted and adjusted odds ratios will be calculated. Preliminary result indicates that most of these deaths belong to scheduled castes and other backward classes. Mostly cases were illiterate. Utilization of pregnancy, delivery and post delivery care services among cases were poor in comparison to controls.

The utilization of health care services by women during pregnancy and child birth is low in Nigeria, with only 35% of delivery taking place in health facility and 62 % of births take place at home. This situation not only leads to high maternal mortality in but puts Nigeria in the second position of countries with highest maternal mortality, just after India. Reduction in maternal deaths has been hindered not only by the absence of good health facilities but by socio-cultural factors prevalent within the society. This paper examined the socio-cultural factors which are least studied, especially which encourage male domination and lower status of women. Respondents consist of 458 women attending antenatal care clinic in State Hospital Ota were randomly selected and interviewed with the aid of questionnaire instrument. The data generated were analyzed using SPSS. The findings showed family type, respondent’s education, perception of cost of antenatal service, treatment place decision, husband perception of pregnancy, respondents dependency on husband for health facility visitation and service satisfaction are significant (P= .000, .023, .001, .005, .000, .000, .000) towards use of health care services by mothers. Recommendations were provided for improving maternal health delivery services in study area and beyond.

During the last century, Kerala witnessed drastic mortality reduction and high improvement in longevity. This achievement is often compared with that of developed countries. However, how far the early advantages in mortality reduction have further enhanced the health status of the people in Kerala remains unknown. In most developed countries, advanced stage of mortality reduction and further increase in longevity was achieved mainly due to mortality shift from adult , older to oldest ages (Olshansky and Ault 1986). However, such exploration on advanced mortality changes are lacking in Kerala. Considering this gap our study focused on changes in longevity and health status in Kerala. We used the methodology given by Olshansky and Ault in 1986, by decomposing the changes in longevity among different age groups (gender and spatial), and causes of deaths. We also estimated Health Adjusted Life Expectancy to understand health status along with longevity in Kerala. We used data from sources like; Census, CRS, DHS and survey data from SRS, MCCD, CDS-R, and NSSO. The paper concludes that though healthcare policies in Kerala are sufficient to address the health issues of infants, children and mothers in reproductive ages, the state also should make necessary policy initiatives to address the health problems of adults especially the males

Asthma from the past two decades has been a major public health challenge. A number of studies have suggested that increasing air pollution can accelerate asthma attacks. The objective of the study is to examine the effect of smoking on the risk of developing asthma in male and female. National Family Health Survey round third (NFHS-3) with a sample size of 109041 household has been used for the study. Logistic regression analysis is used to estimate the effects of tobacco smoke & cooking smoke on asthma prevalence with different demographic and socio-economic variables. Due to the large sex differentials in the exposure to cooking smoke and tobacco smoke, a separate analysis is carried out for male and female. Results show that the prevalence of asthma is higher in females than males. The logistic regression show that the females are at a higher risk of asthma than male if exposed to smoking or smoking fuels. The adjusted effect of exposure to smoking on the prevalence of asthma is large and statistically significant for women. It can be concluded that effect of smoking are higher for females than for males.

By applying the cluster analysis technique and Heligman-Pollard mortality model, the present paper aims to study the regional variations in mortality age patterns of EAG states including Assam in India for the most recent period 2010-11. The study exploited data from sample registration system 1996-2010 and Annual Health Survey 2010-11. It discovers the four clusters explaining different patterns of age specific mortality. Also identifies the two districts Dindori of state Madhya Pradesh and Chitrakoot of Uttar Pradesh having their own mortality pattern and this is true for males as well as for females also. It is found that there is considerable intra district variation in mortality patterns. Results clearly point out that united approach of health policies will not work properly and henceforth will not help in reducing mortality. Thus on the basis of findings study recommends not only for macro level as well as for micro level health policies and program.

This study investigates the age at onset and competing risk of major chronic diseases in India. Diseases considered are CVD, asthma, disorder of joints and bones, mental illness, diabetes and cancer. 60th round of NSSO data is used which is a multi-stage cluster sample survey covering 73868 nationally representative households. Marginal risk is estimated in terms of cumulative incidence function for a disease assuming rest five diseases as competing risk. A popular model for the cumulative incidence given by Fine & Gray is used which is the proportional hazards model for the subdistribution of a competing risk. This study reveals that the prevalence of CVD is highest among rest chronic diseases. The risk of major chronic diseases starts in the age around 40’s. For CVD and disorder of joints and bones females are more vulnerable. CVD and diabetes onset is earlier in richer and highly educated people in India.

In developing countries, individual livelihoods are threatened on a daily basis by exposure to shocks such as inflation, severe weather conditions and unstable markets while options for mitigation are limited. Individuals give resources typically financial to friends and family as a way to self-insure. This paper tests the reciprocity motive for transfer by examining how an individual’s survival expectation influences the amount they give in monetary transfer. To meet this goal, I apply an ordered logit model that utilizes data on respondents’ subjective estimates of the probability of death within a year to determine the likelihood of the size of monetary transfer they give to other family members. The theory of a ‘moral economy’ proposes that in infinitely repeated games an individual who does not expect that they will be around to gain at some point in the exchange interaction will not participate. As such, the expectation is that individuals who expect to die within a year will not transfer money to others. The findings from this study will have implications for the development of public safety nets programs, especially for areas with a high HIV prevalence rate as found in Malawi.

The present paper has explored the possible shift in age-sex structure and morbidity pattern among the population of India and states by 2051. “Morbidity and health care” schedule of NSSO 60th round survey, projected population and SRS reports have been used for analysis purpose. LEB for males and females will increase by 10 and 11years respectively during 2006-51. Proportion of elderly will increase at a rapid pace younger population will decline rather slowly. Age specific morbidity prevalence increases slowly for communicable diseases but the pace is much higher for non-communicable diseases. Disease burden shifts towards NCDs with the change in age structure, which shows some of the states facing NCDs as 3/4th of their disease burden. The shift in the disease burden calls for an urgent need for investment in health infrastructure as most of the NCDs are chronic in nature and seeks long term care.

Women in most societies and economies are at a higher risk of suffering from chronic illness and besides the types of health problems encountered by them also differ substantially from men particularly at old age. Nationally representative unit level data on morbidity and healthcare for the periods from NSS 60th (2004-05) and NSS 52nd (1995-96) are being used to examine the gender differences in health status among elderly persons in India. By decomposition of gender gap in prevalence of chronic diseases in the two surveys into place of residence, monthly per capita expenditure tertiles (MPCE) and education attainment, it is found that not only the prevalence of chronic diseases among elderly has increased almost three times, but also the gender gap has widened regardless of place of residence. Though the pace at which prevalence of chronic diseases has increased over time are same in both sectors, the level remains high throughout the time in urban than in rural. Of the total increase in gender gap in prevalence of chronic diseases contribution of rural areas is 65 percent and the rest 35 percent by urban area. The main contribution in the increase in gender gap in both the areas is from of literates and rich MPCE Tertile

China’s great famine is known as ‘three-year natural disaster’.For the lack of continuous statistical data from 1950 to 1982 in China, traditional research methods were powerless to reconstruct the life table and mortality trends. Calculation of excess deaths during the Great Famine is complicated and confusing.Data used in this study was from China’s six censuses on age distributions, annual age-specific fertility and mortality rates which were also obtained from one-percent population samples survey initialed in 80’s.Modified Lee-Carter model is used in the study. Based on modified Lee-Carter prediction model of morality, this study did reverse prediction with reference to China’s official age-specific mortality data to re-construct and calculate single-age morality and normal deaths if there were no great famine in the last century. In the end, with regard to total deaths estimation calculated by scholars home and abroad, we did estimation research of abnormal deaths led by famine.
It is shown in our result that population dynamics, especially abnormal deaths, during great famine, mainly occurred between 1958 and 1961. If there were no famine, normal deaths would be 43.39 to 43. 85 million. With famine, abnormal deaths are between 16.24 and 23. 37million.