Deaths In India Research Articles

The price of a woman: Re-examining the use of financial incentives for women’s health in India

ABSTRACTThe use of financial incentives is a common instrument to advance women’s health across low and middle-income countries. Since the 1990s, the conditional cash transfer (CCT) for health has been generally lauded by researchers, policy makers and international financial institutions due to demonstrated improvements in access to health services and a range of health outcomes. Some scholars, however, have cautioned that CCTs should be further scrutinised to assess potential unintended consequences and moral concerns in a variety of contexts. In this article, I re-examine Janani Suraksha Yojana (JSY), a cash incentive programme that aims to promote institutional deliveries in order to reduce high levels of home deliveries and maternal deaths in India. I adopt a critical perspective, focusing on the specific instrument of dowry through the lens of capitalist patriarchy (Mies, M. (1986). Patriarchy and accumulation on a world scale. London: Zed Books). Global and national health policy experts and policy makers require a greater awareness of the dowry system, since this system may hamper the use of financial incentives by reinforcing the commodification of women.

Microeconomic Costs, Insurance, and Catastrophic Health Spending Among Patients With Acute Myocardial Infarction in India

Ischemic heart disease is the leading cause of death in India, and treatment can be costly. To evaluate individual- and household-level costs and impoverishing effects of acute myocardial infarction among patients in Kerala, India. This investigation was a prespecified substudy of the Acute Coronary Syndrome Quality Improvement in Kerala study, a stepped-wedge, cluster randomized clinical trial conducted between November 2014 and November 2016 across 63 hospitals in Kerala, India. In this cross-sectional substudy, individual- and household-level cost data were collected 30 days after hospital discharge from a sample of 2114 respondents from November 2014 to July 2016. Data were analyzed from July through October 2018 and in March 2019. Health insurance status. The primary outcomes were detailed direct and indirect cost data associated with acute myocardial infarction and respondent ability to pay as well as catastrophic health spending and distress financing. Catastrophic health spending was defined as 40% or more of household expenditures minus food costs spent on health, and distress financing was defined as borrowing money or selling assets to cover health costs. Hierarchical regression models were used to evaluate the association between health insurance and measures of financial risk. Costs were converted from Indian rupees to international dollars (represented herein as "$"). Among 2114 respondents, the mean (SD) age was 62.3 (12.7) years, 1521 (71.9%) were men, 1144 (54.1%) presented with an ST-segment elevation myocardial infarction, and 1600 (75.7%) had no health insurance. The median (interquartile range) expenditure among respondents was $480.4 ($112.5-$1733.0) per acute myocardial infarction encounter, largely driven by in-hospital expenditures. There was greater than 15-fold variability between the 25th and 75th percentiles. Individuals with or without health insurance had similar monthly incomes and annual household expenditures, yet individuals without health insurance had approximately $400 higher out-of-pocket cardiovascular health care costs (median [interquartile range] total cardiovascular expenditures among uninsured, $560.3 [$134.1-$1733.6] vs insured, $161.4 [$23.2-$1726.9]; P < .001). Individuals without health insurance also had a 24% higher risk of catastrophic health spending (adjusted risk ratio, 1.24; 95% CI, 1.07-1.43) and 3-fold higher risk of distress financing (adjusted risk ratio; 3.05; 95% CI, 1.45-6.44). The results of this study indicate that acute myocardial infarction carries substantial financial risk for patients in Kerala. Expansion of health insurance may be an important strategy for financial risk protection to disrupt the poverty cycle associated with cardiovascular diseases in India.

Cardiovascular risk prediction in India: Comparison of the original and recalibrated Framingham prognostic models in urban populations.

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death in India. The CVD risk approach is a cost-effective way to identify those at high risk, especially in a low resource setting. As there is no validated prognostic model for an Indian urban population, we have re-calibrated the original Framingham model using data from two urban Indian studies. Methods: We have estimated three risk score equations using three different models. The first model was based on Framingham original model; the second and third are the recalibrated models using risk factor prevalence from CARRS (Centre for cArdiometabolic Risk Reduction in South-Asia) and ICMR (Indian Council of Medical Research) studies, and estimated survival from WHO 2012 data for India. We applied these three risk scores to the CARRS and ICMR participants and estimated the proportion of those at high-risk (>30% 10 years CVD risk) who would be eligible to receive preventive treatment such as statins. Results: In the CARRS study, the proportion of men with 10 years CVD risk > 30% (and therefore eligible for statin treatment) was 13.3%, 21%, and 13.6% using Framingham, CARRS and ICMR risk models, respectively. The corresponding proportions of women were 3.5%, 16.4%, and 11.6%. In the ICMR study the corresponding proportions of men were 16.3%, 24.2%, and 16.5% and for women, these were 5.6%, 20.5%, and 15.3%. Conclusion: Although the recalibrated model based on local population can improve the validity of CVD risk scores our study exemplifies the variation between recalibrated models using different data from the same country. Considering the growing burden of cardiovascular diseases in India, and the impact that the risk approach has on influencing cardiovascular prevention treatment, such as statins, it is essential to develop high quality and well powered local cohorts (with outcome data) to develop local prognostic models.

Kālavañcana in the Konkan: How a Vajrayāna Haṭhayoga Tradition Cheated Buddhism’s Death in India

In recent decades the relationship between tantric traditions of Buddhism and Śaivism has been the subject of sustained scholarly enquiry. This article looks at a specific aspect of this relationship, that between Buddhist and Śaiva traditions of practitioners of physical yoga, which came to be categorised in Sanskrit texts as haṭhayoga. Taking as its starting point the recent identification as Buddhist of the c.11th-century Amṛtasiddhi, which is the earliest text to teach any of the methods of haṭhayoga and whose teachings are found in many subsequent non-Buddhist works, the article draws on a range of textual and material sources to identify the Konkan site of Kadri as a key location for the transition from Buddhist to Nāth Śaiva haṭhayoga traditions, and proposes that this transition may provide a model for how Buddhist teachings survived elsewhere in India after Buddhism’s demise there as a formal religion.

Relation of Menarche, and Breast and Ovarian Cancer in Women

AbstractCancer is one of the leading causes of death in India and it has become an important public health problem, with more than 800,000 new cases being reported every year. In India, the most frequent cancers usually seen among women are those of cervix, uterus, breast, ovary, lip, oral cavity, and esophagus. Among these, breast and ovarian cancer are seen frequently in Indian women. The study is aimed at finding the relationship of menarche with breast and ovarian cancer, and also determining the association between types of cancer and selected demographic variables. A descriptive study was conducted on a sample consisting of 100 participants at the Justice K.S Hegde Charitable Hospital, Mangaluru. The result showed that majority (56%) of the sample experienced their first menarche at less than 13 years and had no family history of breast or ovarian cancer. Among the 100 women, 62% were diagnosed with breast cancer. There is a significant association between types of cancer and age. The p-value is 0.027 at (p &lt; 0.05) level of significance. The study concluded that there is a significant association between types of cancer with age.

Study of perception and behaviour in patients with coronary heart disease about risk factors and life style modification in tertiary care hospital, Bhavnagar

Background: Non-communicable diseases are now the major cause of death in India, with cardiovascular diseases being the dominant cause. Very few studies had been done regarding patients perception of risk factors, behaviour change and counselling. So this study is based on patient perspective and role of health education for patients. The objective of the study was to identify the risk factors of CHD, to assess behaviour changes whether lifestyle and habits modified by patients of CHD, to assess perception, to assess effectiveness of counselling.Methods: A cross-sectional study was conducted in 174 patients attending follow up Out Patient Department in Tertiary Care Hospital, Bhavnagar using questionnaire which includes personal data, BMI, history of risk factors, behaviour change and medical counselling. Data was analyzed by epi info and appropriate statistical tests were applied.Results: Total 73 patients were addicted to tobacco; smoking or alcohol. Mean duration of addiction was 22.43 years. Counselling was given by doctors at the time of illness to 94% patients. Counselling regarding disease, risk factors, lifestyle modification has got positive effect in 96% patients and only 4% patients were in need of further future counselling.Conclusions: More and more emphasis should be given to preventive aspect and population should be given counselling before actual illness.

COMPARATIVE EVALUATION OF EFFICACY AND SAFETY OF ASPIRIN + CLOPIDOGREL WITH ASPIRIN+TICAGRELOR IN PATIENTS WITH CARDIOVASCULAR DISEASES. AN OBSERVATIONAL STUDY.

Background: Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity in both developed and developing countries. It is a leading cause of death in India, and its contribution to mortality is rising. Platelets play an essential role in the pathogenesis of acute coronary syndromes (ACS). Therefore an important part of the treatment of ACS, and of primary and secondary preventive measures in coronary heart disease, consists of antiplatelet treatment. Dual antiplatelet therapy (DAPT) provides more intense platelet inhibition than single antiplatelet therapy resulting in incremental reductions in the risk of thrombotic events after percutaneous coronary intervention (PCI) or ACS, but it has been associated with an increased risk of major bleeding. It is interesting to consider that there is no Indian data on the efficacy of recently developed antiplatelet drugs other than in combination with aspirin, and that we remain unaware of the extent to which combinations with aspirin improve efficacy but increase risk.&#x0D; Methodology: Study was prospective, observational clinical study carried out in the Department of Medicine, of Index Medical College Hospital &amp; Research Centre. A total of 80 patients with CAD were enrolled for the study and were equally divided in two groups each of 40 for evaluating efficacy and safety of dual antiplatelet therapy. Follow-up was done at 8 weeks, 16 weeks, and 24 weeks, patients were asked to provide information regarding their current medications, any morbidity and their complications [if any]. Demographic parameters were analyzed by descriptive statistics. Comparison between groups was done by Chi–square Test. Survival analysis was done by suitable statistical method.&#x0D; Result: The median age was 55 years in group 1 and 57 years in group 2. Hypertension was most common associated disorders in group 1 [25 (62.55%)] and group 2 [27 (67.5%)], which was followed by diabetes and dyslipidemia. index events for present study enrolment was unstable angina, non–ST-segment elevation MI, ST-segment elevation MI and others amongs the study groups. With 6 months of follow-up, the rate of the primary event like death from any cause was 7.5 percent in the clopidogrel plus aspirin group and 2.5 percent in the ticagrelor plus aspirin group. The primary safety end point (severe bleeding) was 2.5 % in the clopidogrel plus group 1 and none in group 2.&#x0D; Conclusion: the combination of clopidogrel plus aspirin was found to be non inferior to aspirin plus ticagrelor dual therapy in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes among patients with stable cardiovascular disease or multiple cardiovascular risk factors. The risk of moderate to severe bleeding was increased slightly in both the groups. Our findings do support the use of dual antiplatelet therapy across the broad population tested where single antiplatelet therapy are not giving maximum benefits&#x0D; Keywords: Acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), Coronary artery disease (CAD), Dual antiplatelet therapy (DAPT)

An exome wide association study of pulmonary tuberculosis patients and their asymptomatic household contacts

Tuberculosis is a leading cause of death in India. To identify genetic variants associated with susceptibility or resistance to Mycobacterium tuberculosis infection, we have performed an exome-wide association study with 0.2 million exonic variants among 119 pairs of tuberculosis patients and their clinically asymptomatic household contacts. The strongest association was identified for rs61104666[A], a synonymous variant (p.E292E) of exon 5 of the gene SIGLEC15 (OR = 2.4, p = 1.49 × 10−5). We also found association of non-coding variants in the 3′UTR region of a gene encoding the class II human leukocyte antigens (HLAs), HLA-DRA. rs13209234[A] (minor allele frequency (MAF) = 13.8%) (OR = 0.35, P = 2.5 × 10−4) and rs3177928[A] (minor allele frequency (MAF) = 13.7%) (OR = 0.35, P = 3.3 × 10−4) were associated with protection from tuberculosis. These two SNPs, rs13209234 and rs3177928, are in complete linkage disequilibrium. These associations remained valid when additional data on freshly recruited individuals were jointly analyzed on 250 patient-control pairs. The identified gene, HLA-DRA, suggest involvement of immune regulation, indicating pathways associated with antigen presentation in tuberculosis infection.

Study of incidence and outcome of structural malformed foetus in delivered patients

Introduction: Congenital fetal anomalies are one of the most threatening complications which are prevalent in the society associated with severe morbidity and mortality in the newborn foetus. Congenital anomalies account for 8% to 15% of perinatal deaths and 13% to 16% of neonatal deaths in India. The etiology of congenital abnormality may be genetic or environmental. Aim and Objective: The present study was carried out with the aim to determine the overall incidence and outcome of congenital structural malformations in delivered patients, to identify the most common structural anomaly and study the socio-demographic correlates with structural anomalies and compared them to previous studies. Materials and Methods: The study was conducted on all obstetrics patients with concent who have delivered with fetal congenital malformations in Medical College Pune, Maharashtra over a period of 2 year satisfying inclusion and exclusion criteria. The questionnaire was prepared included the information regarding mothers age, gender birthweight, religion and socioeconomic, past and personal history was included. Data management and analysis was done using Epi-info software. The frequency distribution and graph was prepared. The categorical variables was assessed using Pearson chi-square. Results: It was observed that the overall incidence of structural malformed foetus delivered came out to be 1.2%. Low Birth weight, Low socio economic status and female gender of child are commonly involved in congenital structural malformations. There was no significant association observed between system involved with gender of child, gestational age or history of abortion. The most common anomaly found is related to GIT followed by the Genitourinary. Conclusion: We conclude that gastrointestinal, genitor-urinary, cardiovascular and nervous systems are commonly involved in congenital structural malformations. Among the gastro-intestinal system congenital hypertrophic pyloric stenosis and An

The impact of measles immunization campaigns in India using a nationally representative sample of 27,000 child deaths.

India comprises much of the persisting global childhood measles mortality. India implemented a mass second-dose measles immunization campaign in 2010. We used interrupted time series and multilevel regression to quantify the campaign's impact on measles mortality using the nationally representative Million Death Study (including 27,000 child deaths in 1.3 million households surveyed from 2005 to 2013). 1-59 month measles mortality rates fell more in the campaign states following launch (27%) versus non-campaign states (11%). Declines were steeper in girls than boys and were specific to measles deaths. Measles mortality risk was lower for children living in a campaign district (OR 0.6, 99% CI 0.4-0.8) or born in 2009 or later (OR 0.8, 99% CI 0.7-0.9). The campaign averted up to 41,000-56,000 deaths during 2010-13, or 39-57% of the expected deaths nationally. Elimination of measles deaths in India is feasible.

Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies

SummaryBackgroundWith global survival increasing for children younger than 5 years of age, attention is required to reduce the approximately 1 million deaths of children aged 5–14 years occurring every year. Causes of death at these ages remain poorly documented. We aimed to explore trends in mortality by causes of death in India, China, Brazil, and Mexico, which are home to about 40% of the world's children aged 5–14 years and experience more than 200 000 deaths annually at these ages.MethodsWe examined data on 244 401 deaths in children aged 5–14 years from four nationally representative data sources that obtained direct distributions of causes of death: the Indian Million Death Study, the Chinese Disease Surveillance Points, mortality data from the Mexican Instituto Nacional de Estadística y Geografía, and mortality data from the Brazilian Institute of Geography and Statistics. We present data on 12 main disease groups in all countries, with breakdown by communicable and nutritional diseases, non-communicable diseases, injuries, and ill-defined causes. To calculate age-specific and sex-specific death rates for each cause, we applied the national cause of death distribution to the UN mortality envelopes for 2005–16 for each country.FindingsUnlike Brazil, China, and Mexico, communicable diseases still account for nearly half of deaths in India in children aged 5–14 years (73 920 [46·1%] of 160 330 estimated deaths in 2016). In 2016, India had the highest death rates in nearly every category, including from communicable diseases. Fast declines among girls in communicable disease mortality narrowed the gap by 2016 with boys in India (32·6 deaths per 100 000 girls vs 26·2 per 100 000 boys) and China (1·7 vs 1·5). In China, injuries accounted for the greatest proportions of deaths (20 970 [53·2%] of 39 430 estimated deaths, in which drowning was a leading cause). The homicide death rate at ages 10–14 years was higher for boys than for girls in Brazil, increasing annually by an average of 0·7% (0·3–1·1). In India and China, the suicide death rates were higher for girls than for boys at ages 10–14 years. By contrast, in Mexico it was higher for boys than for girls, increasing annually by an average of 2·8% (2·0–3·6). Deaths from transport injuries, drowning, and cancer are common in all four countries, with transport accidents among the top three causes of death for both sexes in all countries, except for Indian girls, and cancer in the top three causes for both sexes in Mexico, Brazil, and China.InterpretationMost of the deaths that occurred between 2005 and 2016 in children aged 5–14 years in India, China, Brazil, and Mexico arose from preventable or treatable conditions. This age group is important for extending some of the global disease-specific targets developed for children younger than 5 years of age. Interventions to control non-communicable diseases and injuries and to strengthen cause of death reporting systems are also required.FundingWHO and the University of Toronto Connaught Global Challenge.

Does the safe childbirth checklist (SCC) program save newborn lives? Evidence from a realistic quasi-experimental study, Rajasthan, India

BackgroundThe WHO Safe Childbirth Checklist (SCC) is a facility-based reminder tool focusing on essential care to improve quality of intrapartum care. We aimed to assess the impact of an intervention package using the SCC tool on facility-based stillbirths (SBs) and very early neonatal deaths (vENDs), in Rajasthan, India.MethodsWithin a quasi-experimental framework, districts were selected as intervention or comparison, matched by annual delivery load. The SCC tool was introduced at all district and sub-district level health facilities in the seven intervention districts, followed by monthly supportive supervision visits. In addition, supply of drugs and equipment were facilitated in all facilities (2013–2015). Facilities in the comparison districts provided routine care. Analysis included only the facilities with a specialized newborn care unit and information on all births was collected from facility registers. The primary outcome was the combined facility-based stillbirths and very early neonatal deaths (within 3-days after birth). We used generalized estimating equation with a Poisson regression model, with time as a linear term and adjusted for facility type in our model to estimate the effect of the intervention. [ClinicalTrials.gov: NCT01994304].Results77,239 births were recorded from 19 intervention facilities and 59,800 births from 15 comparison facilities. The intervention facilities reported 1621 stillbirths and 505 vENDs compared to 1390 stillbirths and 420 vENDs from the comparison facilities (RR 0.89, CI 0.81, 0.97). This translated to 11.16% (p = 0.01) reduction in total mortality (11.39% in stillbirths alone) in the intervention facilities.ConclusionOur results suggest that the SCC program is an effective intervention that could potentially avert 40,000 intrapartum deaths in India annually, most of reduction coming from prevention of stillbirths.

An observational comparative study of different doses of azilsartan and with chlorthalidone combination in moderate hypertension

Background: High blood pressure (BP) is one of the significant non-communicable diseases that are of high prevalence in our country. Hypertension (HTN) is responsible cause of 57% of stroke and 24% of coronary heart disease deaths in India. Eight classes of medications are currently used in the treatment of hypertension. Azilsartan medoxomil is a newly added FDA approved drug to the ARB class of antihypertensive agents. azilsartan and chlorthalidone combination is also got the FDA approval. There is limited study in between these two groups regarding efficacy especially in rural Bengal.Methods: A prospective observational study was done in medicine OPD of Bankura Sammilani Medical College for twelve weeks with two groups that are azilsartan (80mg) and fixed dose combination of azilsartan (40mg) plus chlorthalidone (12.5mg) in the age group of 18 to 55years of moderate hypertensive patients. Change of heart rate was assessed as safety parameter.Results: It was found that both the group of drugs are very much effective in lowering blood pressure constantly in respect of both systolic and diastolic BP but azilsartan monotherapy in high dose reduce systolic blood pressure slightly high. Significant change of heart rate was not seen with both the groups.Conclusions: Both the group was effective as well as safe in hypertensive patients.

A New Dimension To The Classification of Ayurvedokta Hridya Dravyas And Their Possible Mode Of Action

The death due to ischemic heart disease is increasing in Indian population at an alarming rate and accounts for around 15-20% of all deaths in India. Similarly obesity, atherosclerosis and hypertension is also on the alarming rise. The faulty dietary habit with high intake of oily, fatty, carbohydrate rich food is one of the major reason for hyperlipidemia, atherosclerosis, hypertension and coronary artery disease. Ayurveda have well established doctrine of dietary ethics and regimen. Ayurveda had described the various heart pleasant and heart beneficial (Hridya) food items such as vegetables, fruits, flowers and drugs. But, Ayurvedokta “Hridya” dravyas are not classified into specific categories in classical texts depending upon their mode of action. Hence, needs to be classified and their mode of action with respect to their beneficial effect on heart also needs to be established. As per Ayurveda, heart is also a seat of mind and acts as independent brain to carry out certain immediate responses. In the result it is found that Ayurvedokta “Hridya” dravyas can be broadly classified into Kapha-har Hridya dravyas and Kapha-kar Hridya dravyas. These Hridya dravyas exert their heart pleasing action by various ways. For e.g. Hridya flower exert action by its pleasing fragrance and mood elevation. Hridya fruits exert their action by taste and vagal stimulation. It is concluded that Kapha-har Hridya dravyas are having beneficial effect on heart and are useful in controlling obesity, atherosclerosis and hypertension and thereby preventing coronary artery disease. The Kapha-kar Hridya dravyas are rich in carbohydrates and beneficial in improving the nutritional status of the body.

Redefining Death: Urgent Need to Evolve toward a Homogeneous Definition of Death in India.

ABSTRACTThe interdependent circulatory-respiratory criteria and brainstem criteria are used to define death. Continuing life-support in brainstem dead patients is a legal conundrum for the health-care professionals and an ethical worry for the society at large. There is an urgent need to revisit this subject to evolve a more uniform definition of death irrespective of the circumstances. A compelling take-home message from this discussion is to spread awareness about brainstem death amongst healthcare professionalsHow to cite this articleVadi S, Shroff S. Redefining Death: Urgent Need to Evolve Toward a Homogeneous Definition of Death in India. Indian J Crit Care Med 2019;23(8):368–370.

Road Traffic Accidents in India: Need for Urgent attention and Solutions to Ensure Road Safety

The present study aims to analyse the road accidents in India at National, state and inter-city levels. According to the recent available statistics, there is age and gender-wise variations in the proportion of road traffic accidents and deaths where males have a very high percentage share of fatalities (85%) when compared to females (15%). Tamil Nadu had the highest percentage share of accidents (14.9) and Uttar Pradesh had the highest percentage share of fatalities (12.8). Some of the possible solution to combat this raising trend of road traffic accidents are- awareness initiatives, maintenance of good data base, planning and designing for road safety, remedial action at high crash sites, design for pedestrians and cyclists and implementation of strict speed limits. Thus there is an urgent need to provide emphasis on road safety and curtail the worsening situation of road traffic accidents, injuries and deaths in India which is the need of the hour.

Vehicle Accident Alert System

In today's world, as we know the frequency of road accidents has exponentially increased. Whenever we see the news or read newspaper, we find at least one case of road accident every day. Road accidents are a serious issue all over the world. Recent survey suggests that 650,000 accidents happen around the world on an average, out of which 140,000 occur in India. In every six minutes there is one death in India, due to road accidents. There is no system for quick support, identification and proclamation regarding an accident. In this paper we are providing prime solution to this limitation. The aim of our paper is to detect an accident as soon as it occurs and to contact the emergency services and respective family members and friends so that proper action can be taken in quick time to avoid fatal loss. This system is implemented using the open source Internet of Things (IOT) platform Node MCU. Once the accident has occurred Node MCU gets activated and it sends the location of the accident using Blynk application to the emergency services and provided emergency contacts immediately.

A Study of Demographic Profile of Death Due to Burns

Fire has been known to mankind for about 400, 000 years. Although the use of fire was known to ancient man, it is probably the potential fury of an unharnessed fire that made man bow before it. Burn injuries occur universally and have plagued mankind ever since antiquity till the present day. Burn injuries are the commonest cause of unnatural death in India and constitute a major cause of death and morbidity in the world and in this country too. Burns always have posed a threat to the sensitive human body.

Epidemiology of confirmed coronary heart disease among population older than 60 years in rural central India—A community-based cross-sectional study

BackgroundThree-fifths of total deaths in India are attributed to noncommunicable diseases, and coronary heart disease (CHD) is one of the dominant causes. There are only few studies available in India to find confirmed CHD by pragmatic approach. This study aims to find prevalence of confirmed CHD and its risk factors in rural community of central India. Materials and methodsThis was a community-based cross-sectional study during 2013–2014 involving adults ≥60 years from 13 villages in rural central India. We screened CHD on the basis of history and standard 12-lead ECG. Apart from the past documentation of CHD, we diagnosed confirmed CHD in symptomatic patients or with resting ECG changes by means of echocardiography, exercise ECG test or coronary angiography whenever needed. ResultsWe screened 1190 of 1415 individuals ≥60 years for CHD. Five hundred eighty were men and 610 were women. Diagnosis of CHD was confirmed in 61 individuals (29 men and 32 women). The prevalence of CHD in individuals older than 60 years was 51.3 per 1000 population. Hypertension was the only independent risk factor associated with CHD, whereas association of diabetes mellitus, obesity, socioeconomic status and smoking with CHD was not significant. ConclusionPrevalence of confirmed CHD has increased in agrarian rural community in central India, which requires further studies to find out causative factors.

Birth Order, Fertility, and Child Height in India and Africa

The poor state of child health in India has generated a number of puzzles that have received attention in the literature. A recent focus on birth order has produced contradictory results. Coffey and Spears (2019) document an early-life survival advantage in India accruing to later birth orders, which they interpret as the result of a pattern of improving maternal nutrition over mothers' childbearing careers. In apparent contrast, Jayachandran and Pande (2017) show, using the same set of demographic surveys, a disadvantage in child height for later birth orders in India relative to Africa's birth order gradient.They interpret this pattern as discrimination against later birth-order children in India. This paper resolves the apparent contradiction, showing how differing correlations between sibsize (a child's number of siblings) and household wellbeing can account for the empirical findings of both studies: A mother having higher fertility, rather than lower, implies more socioeconomic disadvantage within India than within Africa.Accounting for sibsize reverses the apparent Indian laterborn disadvantage in child height, reversing the interpretation of Jayachandran and Pande. In short, a child's sibsize (or, equivalently, its mother's fertility) is an omitted variable in Jayachandran and Pande's analysis of birth order effects. Resolving these puzzles is critical for human development policy to combat the enduring challenges of disproportionately high rates of stunting and neonatal death in India, where one-fifth of global births occur.