Search

Despite remarkable success in the Millennium Development Goal era, Bangladesh experienced a sluggish reduction in the under-5 mortality rate (U5MR) between 2014 and 2017–18. Our study aimed to explain this stagnancy by examining the variation in the key predictor-specific mortality risks over time, using the Bangladesh Demographic and Health Survey 2011, 2014 and 2017–18 data. We applied multilevel mixed effects logistic regression to examine the extent to which the under-5 mortality (U5M) risks were associated with the key sociodemographic and health service-specific predictors. We found that the rise in mortality risks attributable to maternal age 18 years or below, low maternal education, mother’s overweight or obesity and the absence of a handwashing station within the household were the key contributors to the stagnant U5MR between 2014 and 2017–18. Poverty and low education aggravated the mortality risks. Besides, antenatal care (ANC) and postnatal care (PNC) did not impact U5M risks as significantly as expected. Compulsory use of ANC and PNC cards and strict monitoring of their use may improve the quality of these health services. Leveraging committees like the Upazila Hospital Management Committee can bring harmony to implementing policies and programmes in the sectors related to U5M. [ABSTRACT FROM AUTHOR]

Motivation: Much of the world's population still lacks access to safe drinking water and sanitation, particularly people living in poverty and in rural areas. The literature suggests that lack of access to water, sanitation, and hygiene (WASH) contributes to poor development of young children. That further leads to inadequate cognitive stimulation, stunting, iodine and iron deficiency, and lower productivity. Purpose: We aim to study the status of early childhood health in Indonesia by measuring an Early Childhood Health Index and to examine the role of access to safe water, sanitation, and hygiene in improving children's health using the national representative data of Indonesian Family Life Survey (IFLS) waves 4 (in 2007) and 5 (in 2014). Methods and approach: Our methodological approach consisted of two steps. First, we developed WASH Index and Early Childhood Health Index using polychoric Principal Component Analysis (PCA), then assessed the association between the two indices using Ordinary Least Squares (OLS) regression. Findings: Overall, we found significant associations between the WASH Index and children's health status and nutritional status. The results also show that several important indicators of WASH (in particular, quality of drinking water, washing and bathing water, and sanitation) improved between 2007 and 2014. Children's access to health care and several children's health indicators also got better. Nevertheless, we still observed stable conditions or even worsening conditions in other components, namely an increase in stunting and children's morbidity. Policy implications: This study provides evidence that access to safe drinking water, sanitation, and hygiene is essential to improve children's health status. In accordance with Government Regulation of the Republic of Indonesia number 185 from 2014, the government at the national, provincial, and district levels must accelerate the development of public infrastructure to ensure access to safe drinking water, sanitation, and hygiene for the entire population as this investment is essential to improve young children's health and reduce the prevalence of stunting in Indonesia. [ABSTRACT FROM AUTHOR]

The feminisation of ageing observed across the world is a significant challenge in many societies. Women's greater longevity is associated with the increased likelihood of age-related disability and morbidity. Furthermore, gendered disadvantage and poverty can make access to health care increasingly problematic in later years. Among the Indian states, Kerala has the highest number of residents above the age of 60 and many are older widows. Given this context, this paper explores what promotes access to health care for older widows living alone in the south Indian state of Kerala. Thirty-two in-depth interviews, eight focus group discussions and eight units of participant observation were carried out among widows, health-care providers and key informants. Applying a reflexive inductive approach to our analysis, the main barriers to access that emerged were altered family structures and loneliness, whilst enablers included good social networks and access to neighbourhood clinics. Our participants' social networks were drawn from three levels: family, neighbourhood and the wider community. The ability to form a personal community from their social networks and the quality of relationships within this community strongly predicted the capacity to access health care. Efforts to improve access to health care for older widows requires a response that is rooted in the socio-cultural context of the community. Comprehensive social protection policies that promote initiatives to engender social capital among the older population, decentralised primary health-care services, and the training and sensitisation of health service staff would be key to promote equitable access for older widows. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tobacco is the leading cause of death and disease in India. This study examines the effect of training intervention in behavioral counseling on intention to quit tobacco in primary healthcare settings in India. The intervention included training to improve behavioral counseling practices of primary care physicians (PCPs) based on the 5As approach to increase patients' motivation to quit tobacco. METHODS: A quasi-experimental design was used for the study. The intervention consists of training of primary care physicians in the behavioral intervention in tobacco cessation. The intervention was conducted in twelve districts of two states in India (Rajasthan and Odisha) in 2016-2017. Four districts were randomly sampled for the study. A total of 1314 participants (intervention and control) were recruited for the study in the baseline and end-line surveys, respectively. Intention to quit in 30 days was the primary outcome measure. Difference-indifference (DiD) logistic regression models were used separately for smokers and smokeless tobacco users to estimate the odds of intention to quit. Analysis was done in STATA Version 14. RESULTS: The intervention and time variable had a significantly positive influence on the intention to quit tobacco among smokers. Smokers in the intervention districts had higher odds of intention to quit (OR=9.82; 95% CI: 1.67-57.72) compared to smokers in the control districts. Smokeless tobacco (SLT) users had higher odds of intention to quit (OR=3.06; 95% CI: 1.35-6.98) in the end-line survey compared to baseline survey. CONCLUSIONS: Our findings indicate that building capacity in behavioral intervention in primary care settings can help increase the intention to quit among smokers. The observed difference in intention to quit between smokers and SLT users suggests the need of tailored counseling interventions for SLT users. There is a need for further research to design and evaluate training and behavioral interventions for SLT and dual (smoking and SLT) users in primary care settings in low- and middle-income countries. [ABSTRACT FROM AUTHOR]