A structured additive modeling of diabetes and hypertension in Northeast India

Background Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India. Methods The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension. Results The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts. Conclusion Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

Prevalence of malnutrition among women and adolescent girls: impact of urbanization in rural–urban interface of Bangalore

PurposeIndia is facing a double burden of malnutrition, i.e. undernutrition and obesity. Women and adolescent health and nutrition are very relevant issues which have not received much attention it deserves in India, especially in the context of a girl child. Hence, the purpose of this study is to assess malnutrition among women and adolescent girls as well as the associated factors.Design/methodology/approachAn attempt was made to assess malnutrition among women and adolescent girls and associated factors. The required data was collected from the north (616) and south transects (659) sample households of Bangalore constituting a total sample size of 1,275. The data was analyzed by adopting multiple linear regression and multinomial logistic regression analysis using STATA software.FindingsThe effects of this study simply confirmed that, urbanization had an instantaneous effect on dietary repute of women and adolescent girls, while transferring throughout the gradient from rural to urban with the growing significance of weight problems and obese. In adolescent girls, about 31% were underweight followed by normal weight and overweight across rural–urban interface of Bangalore. The factors such as education, consumption of meat and animal products, a dummy for urban, diabetes and blood pressure were significantly and positively influencing the nutritional status (Body Mass Index) of women across rural–urban interface. While consumption of vegetables, wealth index and per capita income had a positive and significant influence on the nutritional status of adolescent girls.Originality/valueWith limited studies and data available in Karnataka, especially in Bengaluru, one of the fastest growing cities in the world. Against this backdrop, the study was conducted to assess the prevalence of malnutrition among women and adolescents and its association with various socio-economic variables.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household’s wealth index

Background Child mortality is an important social indicator that describes the health conditions of a country as well as determines the country’s overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household’s wealth index on the association between woman’s education and child mortality has also been investigated. Methods The comprehensive dataset of the Pakistan Demographic and Health Survey 2017–18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women’s education and household wealth index has been used to investigate the moderating role of the household’s wealth index. Results The results indicate that the likelihood of child mortality decreases with an increase in women’s education, their empowerment, their husband’s education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household’s wealth index on the association between woman’s education and child mortality. Conclusions Household wealth status moderates the association between women’s education and child mortality. The absolute slope of the curve showing the association of women’s education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household’s wealth status strengthens the relationship between women’s education and child mortality. With the increase in the household’s wealth status, the effect of a mother’s education on child mortality becomes more pronounced.

Spatial Distribution of Infant Mortality in Ethiopia: Using Demographic Health Survey, the Ethiopia

Background Mortality is one of the demographic variables that affect population trends. Among mortality of children, Infant mortality contributed to more than 75% of all under-five deaths globally. It disproportionately affects those living in the different regions of countries and within the region. Exploring the spatial distribution and identifying associated factors is important to design effective intervention programs to reduce infant mortality. Thus, this study aimed to assess the spatial distribution and associated factors of infant mortality in Ethiopia using the 2016 Ethiopian Demographic and Health Survey (EDHS). Method The Data this study were used Ethiopian Demographic and Health Survey in 2016. A total of 11,023 live births from the EDHS data were included in the analysis. Spatial analysis was done to explore spatial distribution of infant mortality using ArcGIS version 10.4. Results This study revealed that the spatial distribution of infant mortality was non-random in the country with Moran’s index 0.1546 (P-value=0.0185). The Afar and Somali regions of Ethiopia were identified in this study on the hot spot of infant mortality. Conclusions The spatial distribution of infant mortality varies across the country. ANC usage, sex of a child, birth interval, birth size, birth type, birth order, wealth index, residence, region, and the spatial variable (Si) were significant predictors of infant mortality. Therefore, it needs interventions in the hot spot areas. Focusing on maternal health care services, rural residences, multiple births, infants having a smaller birth size, and male infants deserves special attention.

Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: A multilevel mixed-effects analysis

There is a dearth of information on childhood vaccination coverage in Bangladesh. Thus, this study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data on vaccination coverage for children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. The overall prevalence (weighted) of full vaccination among children aged 12-35 months was 86.17% in 2011 and 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of immunization coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.

Timing of the first antenatal care visit and associated risk factors in rural parts of Ethiopia

Early antenatal care visit promotes early detection and treatment of complications during pregnancy. The aim of this study was to assess the timing of the first antenatal care visit and associated factors in rural parts of Ethiopia. Only 3065 women from 2016 Ethiopian Demographic and Health Survey in rural area were included in this study. The descriptive and binary logistic regression analysis used to identify the determinants associated with the timing of the first antenatal care visit. This study revealed that 31% of women visited the first antenatal care within the first three months. Our study revealed that women education, maternal age, region, media access, women occupation, distance from health facility, wealth index, pregnancy complication and plan for pregnancy had significant effects on timing of the first antenatal care visit early. To initiate pregnant mothers to attend the first ANC visit timely, community-based services like media coverage, education, transportation and giving awareness about the necessity of having antenatal care service early is mandatory.

Effect of maternal height on the risk of caesarean section in singleton births: evidence from a large-scale survey in India

ObjectiveThis study examines the association of maternal height with caesarean section (CS) in India. It is hypothesised that maternal height has no significant effect on the risk of undergoing caesarean section.DesignA cross-sectional study based on a nationally representative large-scale survey data (National Family Health Survey-4), conducted in 2015–2016.Setting and participantsAnalysis is based on 125 936 women age 15–49 years, having singleton live births. Logistic regression has been performed to determine the contribution of maternal height to the ORs of CS birth, adjusting for other exposures. Restricted cubic spline was used as a smooth function to model the non-linear relationship between height and CS. Height data were decomposed using the restricted cubic spline with five knots located at the 5th, 27.5th, 50th, 72.5th and 95th, percentiles.Primary and secondary outcome measuresThe main outcome variable of interest in the study is CS. Maternal height is the key explanatory variable. Other explanatory variables are age, parity, sex of child, birth weight, wealth index, place of residence, place of child delivery and household health insurance status.ResultsThe results reveal that the odds of undergoing CS significantly decrease with increase in maternal heights. Mothers with a height of 120 cm (adjusted OR (AOR): 5.08; 95% CI 3.83 to 6.74) were five times more likely, while mothers with height of 180 cm were 23% less likely (AOR: 0.77; 95% CI 0.62 to 0.95) to undergo CS as compared with mothers with height of 150 cm.ConclusionsShorter maternal height is linked to a higher risk of CS. Our findings could be used to argue for policies that target stunting in infant girls and avoid unnecessary CS, as there is potential effect on growth during adolescence and early adulthood, with the goal to increase their adult heights, thereby lowering their risk of CS and adverse delivery outcomes.

Timing of the First Antenatal Care Visit and Associated Risk Factors in Rural Parts of Ethiopia

Early antenatal care visit promotes early detection and treatment of complications during pregnancy. The aim of this study was to assess the timing of the first antenatal care visit and associated factors in rural parts of Ethiopia. Only 3065 women from 2016 Ethiopian Demographic and Health Survey in rural area were included in this study. The descriptive and binary logistic regression analysis used to identify the determinants associated with the timing of the first antenatal care visit. This study revealed that 31% of women visited the first antenatal care within the first three months. Our study revealed that women education, maternal age, region, media access, women occupation, distance from health facility, wealth index, pregnancy complication and plan for pregnancy had significant effects on timing of the first antenatal care visit early. To initiate pregnant mothers to attend the first ANC visit timely, community-based services like media coverage, education, transportation and giving awareness about the necessity of having antenatal care service early is mandatory.

Spatial Pattern and Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 Ethiopian mini demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.