Demographic Health Surveys Program Research Articles

IJCM_71A: Adverse birth outcomes and its association with non-communicable diseases and behavioral risk factors among Indian women: a secondary analysis from National Family Health Survey- 5.

Background: Pregnancy may be associated with several adverse outcomes. India, with its diverse population, presents a unique setting for studying the determinants of adverse birth outcomes. Objectives: Among women respondents of National Family Health Survey (NFHS-5): 1. To estimate prevalence of adverse birth outcomes; 2. To determine association between adverse birth outcomes and various non- communicable diseases (NCDs), behavioral risk factors. Methodology: We have analyzed the latest available data from NFHS- 5 (2019-2021) gathered from Demographic Health Survey program with permission. Prevalence of adverse birth outcome was estimated using weighted prevalence. Binary logistic regression was performed to calculate adjusted odds ratio (AOR) and p-values < 0.005 were considered statistically significant. Results: Data pertaining to 2,02,798 respondents were analyzed. The mean (SD) age was 27.56 (±5.255) years. Prevalence of adverse birth outcome was 80318 (39.6%). Among the adverse birth outcomes, low birth weight (28,605, 17.7%) was more common followed by preterm birth (23,532, 12.3%). NCDs like anemia (AOR- 1.023; 95%CI- 1.004-1.042; p=0.019), hypertension (AOR- 1.059; 95%CI- 1.024-1.095; p<0.001), heart disease (AOR- 1.464; 95%CI- 1.285-1.668; p=0.00), thyroid disease (AOR- 1.258; 95%CI- 1.187-1.332; p<0.001), tobacco usage (AOR- 1.152; CI- 1.095-1.211; p<0.001) were significantly associated with presence of any adverse birth outcomes. Conclusion: From this secondary data analyzed from NFHS-5, prevalence of adverse birth outcome is high among Indian women aged 15-49 years. Several factors significantly associated with adverse birth outcomes were determined. Findings from this analysis may have implications concerning pregnant women with NCDs and behavioral risk factors.

IJCM_56A: What determines decision making among women? Insights from National Family Health Survey-5

Background: Women’s empowerment is a critical driver for economic growth and social prosperity. Broadly, the term refers to an improvement in women’s political, social, educational, economic, and health status. Decision making is an integral component of women’s empowerment. Objective: This secondary data analysis from NFHS 5 aims to measure the level of women decision-making capability and its determinants among women aged 15-49 years in India. Methodology: We have analyzed the latest available data from the National Family Health Survey-5 (NFHS-5) gathered from the Demographic Health Survey program after obtaining permission. Descriptive statistics were applied to determine the decision making among women. Logistic regression was applied to compute adjusted odds ratio (AOR) for determining the associated factors of women decision-making capability and p-values < 0.05 were considered statistically significant. Results: The total women respondents in the NFHS 5 dataset were 721145, of which data regarding women decision making was available for 77729 (10.7%). Total 68942(88.7%) women were involved in decision-making. Decision-making capacity was found to be significantly associated with age, education level, working status. Women aged more than 30 years were found to have more involvement in decision making as compared to those aged less than 30 years (AOR=1.76; CI=1.684-1.842; p< 0.05). Decision making was significantly associated with education (AOR=0.847; CI=0.807-0.889; p< 0.05). Working women were involved more in decision making as compared to non-working (AOR=1.494; CI=1.414-1.578; p< 0.05). Conclusion: This study sheds light on the relationship between women decision-making capacity and its association with sociodemographic variables. Several factors were found to be significantly associated with women decision making capability.

Estimates of a multidimensional index of nurturing care in the next 1000 days of life for children in low-income and middle-income countries: a modelling study

Nurturing care is crucial for children's ongoing development during the pre-primary education period, or the next 1000 days of life. We generated nationally representative prevalence estimates of access to ten basic indicators of nurturing care among children aged 3-4 years in low-income and middle-income countries (LMICs). We applied multiple imputation and predictive modelling to data on children living in LMICs. Individual-level data on ten indicators were from UNICEF's Multiple Indicator Cluster Surveys and the Demographic Health Surveys Program, and we included data on all children aged 36 to 59 months for whom the surveys asked relevant questions on parenting and child development. We defined minimally adequate care as receiving at least one of two indicators in each of five dimensions of nurturing care: responsive caregiving, early learning, safety and security, nutrition, and health. We used a two-step multi-level multiple imputation procedure to address missing data across individuals, indicators, and countries. Using imputed datasets, we generated a set of expected-a-posteriori estimates of the percentage and overall number of children receiving each indicator of nurturing care, as well as overall minimally adequate care, for each country, country income grouping, and region, and across all LMICs. For the 54 countries with individual-level data on all indicators, we also produced subgroup estimates of nurturing care on the basis of household wealth, child sex, and urbanicity. We included individual-level data collected between 2005 and 2019 on 426 349 children aged 3-4 years in 104 LMICs. Across the 137 LMICs considered in our modelling, we estimated that 62·0 million (90% credible interval [CrI] 51·6-71·7) children aged 3-4 years, equivalent to 25·4% (90% CrI 21·2-29·4) of that age group in LMICs, were receiving minimally adequate nurturing care at the time of assessment, leaving 181·9 million (172·2-192·3) without adequate care. Access to care was highest for nutrition (86·2% [84·2-88·2], or 210·3 million [205·4-215·1], with healthy weight), and lowest for early learning (29·3% [21·5-39·6], or 71·5 million [52·5-96·6], in early childhood care and education), responsive caregiving (29·7% [25·6-34·9], or 72·4 million [62·4-85·0], experiencing adequate stimulation from non-maternal caregivers), and safety and security (32·3% [28·3-36·7], or 78·7 million [68·9-89·5], living without physical punishment). Gaps were evident in the estimates, with 50·8% (38·3-60·7) of children from upper middle-income countries receiving minimally adequate care compared with 5·6% (4·8-6·4) in low-income countries. Within 54 countries with complete child-level data, 10·7% (10·4-10·9) of children from households in the lowest wealth quintile had access to minimally adequate care compared with 41·2% (40·7-41·7) in the highest quintile. Inequalities were also large by urbanicity (17·7% [17·5-18.0] rural vs 32·2% [31·8-32.6] urban) but smaller by child sex (23·9% [23·6-24·2] girls vs 22·1% [21·9-22·4] boys). Most children in LMICs are not receiving minimally adequate nurturing care during the next 1000-day period. Further investments in indicator measurement and resources for preschool-age children are needed, particularly for low-income populations and in the domains of responsive caregiving, early learning, and safety and security. None.

Spatial Distribution and Determinants of Nonautonomy on Decision Regarding Contraceptive Utilization among Married Reproductive-Age Women in Ethiopia: Spatial and Bayesian Multilevel Analysis.

Background Studies conducted to date in Ethiopia did not explore the spatial distribution, individual-level, and community-level factors affecting women's nonautonomy on decision to use contraceptives. Hence, this study aimed to assess the spatial distribution of women's nonautonomy on decision regarding contraceptive utilization and its determinants in Ethiopia. Methods Data were accessed from the Demographic Health Survey program official database website (https://dhsprogram.com). A weighted sample of 3,668 married reproductive-age women currently using contraceptives was included in this analysis. Bayesian multilevel logistic regression models were fitted to identify the determinants of women's nonautonomy on contraceptive utilization. Adjusted odds ratio with 95% credible interval was used to select variables that have a significant effect on nonautonomy on contraceptive utilization. Results A high proportion of women with nonautonomy on decision regarding contraceptive utilization was found in northern parts of Southern Nations, Nationalities, and People's Region, Southern parts of Oromia, and Benishangul-Gumuz regions of the country. Overall, 2876 (78.40% (95% CI: 77.0%, 79.7%)) women were nonautonomous on decision regarding contraceptive utilization. In the final model, age from 35–49 (AOR (95% CI) = 0.63 (0.54, 0.72)), living in the richer households (AOR (95% CI) = 0.12 (0.03, 0.26)), being married at 18 years or above (AOR (95% CI) = 0.33 (0.19, 0.57)), and residing in an rural areas (AOR (95% CI) = 1.34 (1.01, 1.71)) and metropolitan regions (AOR (95% CI) = 0.71(0.54, 0.91)) were associated with women's nonautonomy on decision regarding contraceptive utilization. Conclusions In Ethiopia, the spatial distribution of women's nonautonomy on decision about contraceptive utilization was nonrandom. More than three-fourths of married reproductive-age women in Ethiopia are nonautonomous on decision regarding contraceptive utilization. Region, residence, current age, age at marriage, and wealth index were statistically associated with women's nonautonomy on decision regarding contraceptive utilization.

Determinants of postnatal care coverage among mothers and new-borns in India: Evidence from a nationally representative survey.

Despite efforts taken by the Government of India, still mothers and new-borns are excluded from the postnatal care services, especially during the critical first 24 h after delivery. Hence, we have done this study to find the determinants of postnatal care for mothers and new-borns in India. We have analysed the NFHS-4 data gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Point estimates were reported as proportions with 95% Confidence Interval (CI). In total, 190,797 women who had at least one live birth were included. About 25.2% and 27.1% of the new-born received post-natal care within 24 and 48 h of delivery. The proportion of women who received post-natal care within 24 and 48 h after delivery was 63.4% and 65.2% respectively. Higher socioeconomic status, women living in Southern region, utilization of proper antenatal and intranatal care, and Caesarian mode of delivery had significantly higher postnatal care coverage among mothers and new-borns. This finding informs the policy makers regarding the status of postnatal care coverage, that can be incorporated to identify target populations for further strengthening of service delivery.

Consequences of school closure on access to education: Lessons from the 2013\u20132016 Ebola pandemic

The COVID-19 pandemic has seen an unprecedented shutdown of society. Among the various safety measures taken, much attention has been given to school closure as a non-pharmaceutical mitigation tool to curb the spread of the disease through ensuring “social” (physical) distancing. Nearly 1.725 billion children in over 95% of countries worldwide have been affected by school closures implemented in April 2020 as the virus continued to spread. In the field of education, policymakers’ attention has been directed at keeping students on board through remote learning and addressing the immediate needs of schools upon reopening. The study presented in this article focuses on who remains absent after schools resume. Using publicly available survey data from the USAID Demographic Health Surveys Program and the UNICEF Multiple Indicator Cluster Survey from before and after the 2013–2016 Ebola pandemic in Guinea and Sierra Leone in West Africa, the author examined changes in school enrolment and dropout patterns, with targeted consideration given to traditionally marginalised groups. At the time, schools closed for between seven to nine months in the two countries; this length and intensity makes this Ebola pandemic the only health crisis in the recent past to come close to the pandemic-related school closures experienced in 2020. The author’s findings suggest that post-Ebola, youth in the poorest households saw the largest increase in school dropout. Exceeding expected pre-Ebola dropout rates, an additional 17,400 of the poorest secondary-age youth were out of school. This evidence is important for minimising the likely post-COVID-19 expansion in inequality. The author’s findings point to the need for sustainable planning that looks beyond the reopening of educational institutions to include comprehensive financial support packages for groups most likely to be affected.

Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16).

To assess the spatial pattern and determinants of HIV infection in India. We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. 230213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR=2.58, 95% CI: 1.22-5.40), living in an urban area (aOR=2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR=4.25, 95% CI: 2.60-6.93), Southern (aOR=3.13, 95% CI: 1.99-4.91) or Western region (aOR=2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR=1.99, 95% CI:1.42-2.79), a suspected STI (aOR=2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR=7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. HIV infection among adults aged 15-54years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.

Prevalence and determinants of breast and cervical cancer screening among women aged between 30 and 49 years in India: Secondary data analysis of National Family Health Survey - 4.

">Breast and cervical cancers are the two leading causes of cancer-related morbidity and mortality in India. Early diagnosis of these cancers through screening offers the best chance to achieve successful treatment outcomes. Hence, the current study was done to determine the prevalence and predictors of breast and cervical cancer screening among women aged 30-49 years in India. We have analyzed the most recent National Family Health Survey-4 data (NFHS-4) gathered from Demographic Health Survey program. Stratification and clustering in the sample design were accounted using svyset command. Adjusted prevalence ratio (aPR) with 95% confidence interval (CI) was reported. In total, 336,777 women aged 30-49 years were included. Proportion of women aged 30-49 years with history of breast cancer examination in their lifetime was 12.9% (95% CI: 12.6-13.2%), while it was 29.8% (95% CI: 29.3-30.3%) for cervical cancer. It was found that women aged 45-49 years (aPR=1.09), married (aPR=2.18), higher educational level (aPR=1.28), richest quantile (aPR=1.96), no history of pill use (aPR=1.24), obese (aPR=1.06), and healthy dietary habits (aPR=1.47) were more likely to be screened for breast cancer. Predictors for cervical cancer screening were higher age group (aPR=1.06), married (aPR=2.94), secondary educational level (aPR=1.05), richest quantile (aPR=2.24), nonpill user (aPR=1.24), nontobacco user (aPR=1.07), and lower parity (aPR=1.09). A total of 1 out of 10 women in reproductive age group were screened for breast cancer while less than one in three for cervical cancer. Hence, it is important to spread awareness and increase access to screening services to achieve early diagnosis and better treatment outcomes.

Physical, emotional and sexual violence faced by spouses in India: evidence on determinants and help-seeking behaviour from a nationally representative survey

ObjectiveThe current study was done to determine the prevalence, determinants, disclosure status and help-seeking behaviour of spousal violence using a nationally representative sample of ever-married women in India.MethodsWe have analysed...

Family Planning Practices in Kerala: A Critical Appraisal Using National Family Health Survey Data

Background Adequate attention to family planning can not only reduce poverty and hunger in countries with high birth rates but also avert maternal and childhood deaths. Kerala, the southernmost state of India, has achieved its replacement level fertility rate far ahead of India. The study aims to analyze the contraceptive prevalence of the state over the years and also at the district level and the choices of different family planning methods in the state. Methodology This study is a secondary data analysis using the available information from the National Family Health Survey (NFHS) available from “The demographic health survey program’s data distribution system.” Results The contraceptive prevalence rate (CPR) of Kerala showed an initial increase followed by a sudden fall by more than 10% in 10 years period during the 2015 survey, thereafter stabilized in 2019. Among the modern contraceptive methods, the most commonly used method consistently over the years was female sterilization (46.6%) and the least common method was male sterilization (0.1%). The unmet needs in family planning in the state varied across the districts from as high as 19.3% to 5.6% though it was reduced by 1.2 percentage units as compared to NFHS-4 data. Conclusion The findings contradict the assumption that the use of modern spacing techniques will increase with female literacy and a higher standard of living. Female-oriented nature of family planning practices in the state should be revisited and strategies should be brought to bring equal participation of males and females. Districts with reduced CPR should be prioritized and region-specific policy recommendations are necessary to address specific needs.

Equity in coverage of maternal and newborn care in India: evidence from a nationally representative survey.

Despite efforts taken by the Government of India, mothers and newborns are excluded from the maternal and child health services, especially those in poorer and weaker sections of the society. Hence, we have utilized the most recent National Family Health Survey (NFHS-4) data to assess the socio-economic inequities in antenatal care (ANC), intranatal care and postnatal care (PNC) coverage for mothers and newborns in India. We have analysed the NFHS-4 data gathered from the Demographic Health Survey programme. Stratification and clustering in the sample design were accounted for using 'svyset' command. Point estimates were reported as proportions with 95% confidence interval. The concentration curve and index were used to represent the socio-economic inequities. Theil index was computed to report inequities across geographical regions and place of residence. In total, 190 797 women who had at least one live birth in the preceding 5 years were included. About 52.1% of women had at least four ANC visits and 81.4% had institutional delivery. About 25.2% and 27.1% of the newborn received PNC within 24 and 48 h of delivery. The proportion of women who received PNC within 24 and 48 h after the delivery was 63.4% and 65.2%, respectively. Maximum inequity was observed for ANC (concentration index-0.195) followed by receipt of PNC by mothers within 24 and 48 h (concentration index-0.106 and 0.103). Women from the rural areas had a disproportionately high proportion of home deliveries (Theil index-3813.6). The findings from this study inform the policymakers and planners about the socio-economic inequity existing across various maternal and child health indicators. This will help them in making informed decisions and strengthen the maternal and child health programme in our country.

BCG vaccination is associated with reduced malaria prevalence in children under the age of 5 years in sub-Saharan Africa

IntroductionMalaria continues to be a major cause of morbidity and mortality in sub-Saharan Africa (SSA) without effective interventions. Bacillus Calmette-Guérin (BCG) vaccine possesses protective non-specific effects, which extend beyond protection...

Preference for Private Sector for Vaccination of Under-Five Children in India and Its Associated Factors: Findings from a Nationally Representative Sample

Understanding the factors associated with private sector preference for vaccination will help in understanding the barriers in seeking public facility and also the steps to improve public-private partnership (PPP) model. We analysed the recent National Family Health Survey-4 data (NFHS-4; 2015-16) gathered from Demographic Health Survey programme. Stratification and clustering in the sample design was accounted using svyset command. Weighted proportion of children receiving private vaccination was 10.0% (95% CI: 9.7-10.3). Children belonging to highest wealth quantile (adjusted Prevalence ratio; aPR-1.58), male child (aPR-1.07) urban area (aPR-1.11), not receiving anganwadi/Integrated Childhood Development Services (aPR-1.71) and receiving antenatal care in private sector was significantly associated with higher proportion of private vaccination. Current study showed that 1 in 10 <5 years child in India received vaccination from private health facility. Preference for private health facility was found to be influenced by higher socio-economic strata, urban area residence and seeking private health facility for antenatal and delivery services.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

BackgroundDespite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries.MethodsIn this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania.FindingsIn each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest.ConclusionsBoth service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential newborn care services for rural areas and for people accessing lower–level facilities. Together, the low levels of both service availability and readiness across the five countries reinforce the vital importance of monitoring health facility capacity to provide care. In order to save newborn lives and improve equity in child survival, not only does women’s use of services need to increase, but facility capacity to provide those services must also be enhanced.

Philippines 1998: results from the Demographic and Health Survey.

This article presents summary statistics gathered from the 1998 Philippine National Demographic and Health Survey. The National Statistics Office and the Department of Health within the framework of the Demographic Health Survey Program of Macro International conducted the survey. The nationally representative survey collected data from 12,407 households. Interviews were also conducted with 13,983 women aged 15-49 years between March 3 and the first week of May 1998. The statistical data presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, postpartum variables, infant mortality trends and differentials, and children's health.