Outcomes In India Research Articles

Association between women’s autonomy and reproductive health outcomes in India

Association between women’s autonomy and reproductive health outcomes in India

IMPACT OF VOCATIONAL EDUCATION ON ECONOMIC GROWTH: AN ANALYSIS OF THE INDIAN ECONOMY

Vocational education can be seen as an important tool in leveraging India’s demographic dividend. Given the labor surplus in terms of the young population, it is important to examine how vocational education and training can serve as a critical driver of economic growth. This study aims at examining the impact of vocational education and training on economic growth in India, using the framework of the augmented Solow growth model by decomposing human capital into vocational education, along with primary, secondary and higher education. Using an ARDL model based on the annual data from 1990 to 1991 and 2019 to 2020, the study analyzes the short-run and long-run impact of vocational education. The results indicate that in the case of India, the impact of vocational education on economic growth is both a short-run and long-run phenomenon exhibiting a stable positive relation. Other control variables used in this study, such as Investment, Population, Openness and Inflation are found with a significant impact on economic growth. The study suggests that it is necessary to upgrade vocational education programs to create high-quality workers with a view to improving productivity and macroeconomic outcomes in India.

Do the fathers matter? Paternal perspective of exclusive breastfeeding practices: A community-based cross-sectional study in urban slums of Bhubaneswar, Odisha

ABSTRACT Introduction: Although various policies have been framed to improve exclusive breastfeeding outcomes in India, the father’s role in breastfeeding is grossly ignored. Gender inequalities are still predominant in several parts of India. Fathers’ involvement in breastfeeding decision-making plays a significant role in improving the outcome. However, till now, this domain has been neglected in India. Henceforth, we aimed to see the knowledge and attitudes of fathers regarding breastfeeding in a community setting. Methods: It was a community-based cross-sectional study done in the urban slums of Bhubaneswar, Odisha. One hundred seventy-one fathers with their children between six months and one year were recruited by simple random sampling. Knowledge was assessed with a semi-structured questionnaire, and attitude was measured with the Iowa Infant Feeding Attitude Scale (IIFA). Results: In the present study, 1.18% of fathers had good knowledge regarding breastfeeding. 46.2% had average knowledge regarding breastfeeding, and 57.3% had positive attitudes toward formula feeding. Discussion: We have found that most fathers had a positive attitude toward formula feeding, and very few fathers had good knowledge of breastfeeding. Henceforth, further focus in this area is required to improve breastfeeding outcomes.

Navigating trust and health in India: the influence of social status and neighbourhood environment

BackgroundThe research on the relationship between interpersonal trust and health has primarily focused on Western contexts, with scarce attention in developing contexts. Addressing this gap, the study examines the association between interpersonal trust (both generalised and particularised) and health outcomes (self-rated health /SRH, and depression) among Indian adults, considering the moderating roles of social statuses (gender and caste) and macro-level factors like district-level income inequality.MethodsThe study draws on data from the World Health Organization's (WHO) Study on global AGEing and adult health (SAGE) Wave-1, collected between 2007 and 2010. This dataset provides a comprehensive overview of health outcomes, including self-rated health (SRH) and depression, socio-cultural status of adults aged 18 and above in India. Additionally, district-level data on income inequality, quantified through the Gini index, were incorporated to examine the influence of contextual socioeconomic influence on the trust-health relationship. Multilevel regression analysis with interaction effects with social statuses and income inequality at district was employed in the analysis to investigate the intricate relationship between interpersonal trust (both generalised and particularised) and health outcomes.ResultsThe study reveals that while generalised trust does not directly influence depression or SRH, particularised trust acts as a protective factor for both health outcomes. Gender-specific interaction effect shows that generalised trust reduces depression among males and improves SRH among females. Notably, caste does not significantly moderate the trust-health relationship. High district-level income inequality, however, modifies these associations: generalised trust is associated with improved SRH in areas of high inequality, whereas particularised trust correlates with increased depression in these districts.ConclusionThe findings highlight the complex dynamics between interpersonal trust, social status, and income inequality in shaping health outcomes in India. Generalised trust emerges as a potential buffer against the health-detrimental effects of income inequality, providing crucial insights for developing targeted health interventions. These results offer valuable guidance for global health policymakers and practitioners in effectively allocating development aid to enhance health outcomes, especially among the most marginalised groups.

Socioeconomic inequalities in adverse pregnancy outcomes in India: 2004-2019.

Although India has made substantial improvements in public health, it accounted for one-fifth of global maternal and neonatal deaths in 2015. Stillbirth, abortion, and miscarriage contribute to maternal and infant morbidity and mortality. There are known socioeconomic inequalities in adverse pregnancy outcomes. This study estimated changes in socioeconomic inequalities in rates of stillbirth, abortion, and miscarriage in India across 15 years. We combined data from three nationally representative health surveys. Absolute inequalities were estimated using the slope index of inequality and risk differences, and relative inequalities were estimated using the relative index of inequalities and risk ratios. We used household wealth, maternal education, and Scheduled Caste and Scheduled Tribe membership as socioeconomic indicators. We observed persistent socioeconomic inequalities in abortion and stillbirth from rates of 2004-2019. Women at the top of the wealth distribution reported between 2 and 5 fewer stillbirths per 1,000 pregnancies over the study time period compared to women at the bottom of the wealth distribution. Women who completed primary school, and those at the top of the household wealth distribution, had, over the study period, 5 and 20 additional abortions per 1,000 pregnancies respectively compared to women who did not complete primary school and those at the bottom of the wealth distribution. Women belonging to a Scheduled Caste or Scheduled Tribe had 5 fewer abortions per 1,000 pregnancies compared to other women, although these inequalities diminished by the end of the study period. There was less consistent evidence for socioeconomic inequalities in miscarriage, which increased for all groups over the study period. Despite targeted investments by the Government of India to improve access to health services for socioeconomically disadvantaged groups, disparities in pregnancy outcomes persist.

Pathways of Care in the Hospital Visiting Patients Having Mental Health Problems in Central India

Background: There is a high community prevalence of mental health problems in India. Psychiatric patients often consult nonspecialist or unqualified health providers which results in significant treatment delays and poor mental health outcomes. Knowledge of existing treatment-seeking practices may be useful to design specific and effective awareness programs. Objectives: The objectives were to study the types of health-care providers contacted by patients suffering from different mental illnesses as well as assess the treatment delays and associated factors. Methodology: A cross-sectional observational descriptive study was done in a psychiatry clinic of a tertiary health care center and teaching hospital in Central India. The information was collected from consecutive newly visiting patients on two predefined weekdays through face-to-face interviews. A predesigned sociodemographic format and World Health Organization pathways interview schedule were used to assess pathways of care. Results: Data were collected from 157 participants. Majority of participants were males (58%). Mood disorders were the most common diagnostic category (28%), followed by substance-related disorders (23%) and anxiety disorders (21%). Eighty (51%) among the total participants consulted psychiatrist in the first visit. Allopathic practitioners were the second commonly consulted health provider category. The median delay in treatment was maximum in substance-related disorders (7 years). Conclusion: Significant delay in treatment was observed across all diagnostic categories. Training general practitioners in the diagnosis and treatment of mental illnesses and a structured health-care referral system to enhance appropriate psychiatry consultations may be desirable to improve mental health outcomes in India.

Differential Impacts of Life Course Exposure to PM2.5 and its Sources on Child Health Outcomes in India

Differential Impacts of Life Course Exposure to PM2.5 and its Sources on Child Health Outcomes in India

Environmental pollutant exposures and children’s cognitive, academic and mental health outcomes in India

Environmental pollutant exposures and children’s cognitive, academic and mental health outcomes in India

Awareness Regarding Screening Programs in General Population to Improve Health Indicators: Genetic Counselors as Facilitators

Public health screening programs are crucial for early disease detection, but limited awareness hinders their effectiveness in India, regardless of literacy. This study assessed awareness levels for key programs among 294 literate and illiterate individuals via an online survey. Results showed high awareness for antenatal care (96%). Newborn screening (NBS) and thalassemia screening awareness were higher in females, particularly regarding thalassemia's hereditary nature (73% vs 61% and 73% vs 57%). Cervical cancer awareness increased with education (83% for graduates). Interestingly, even those with no education displayed some awareness of breast cancer screening. Prostate cancer awareness was similar across genders, with limited knowledge even among highly educated individuals (66% for Ph.Ds). These findings highlight a critical gap in public health education. Genetic counselors can bridge this gap by implementing targeted campaigns, partnering with schools and communities, and collaborating with healthcare professionals. Empowering individuals with knowledge is essential for improved population health outcomes in India.

Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021

BackgroundThe health of India’s children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children.MethodsWe used data from five rounds of India’s National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities. ResultsThe socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity.ConclusionsDespite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India’s most vulnerable children.

Use of AI-driven support system to help courts in predicting child custody outcomes in India

Predicting child protection outcomes using AI-driven support systems under Indian law raises interesting possibilities and challenges. This study examines the feasibility of using AI in Indian courts to assist in child custody decision-making. The Indian legal system is complex and topical in child custody cases, where sociocultural and family factors heavily influence judicial decisions. The potential integration of AI provides an opportunity for objectivity and continuity in accuracy to enter the system. However, there are several challenges to implementing such a system in India. These areas include addressing ethical concerns related to algorithmic decision-making about sensitive family matters using the right, this research topic raises questions about the feasibility of introducing AI into the Indian childcare decision-making process. This suggests the need to carefully consider these challenges and their potential benefits when assessing the utility and appropriateness of using AI-driven support systems in Indian courts to set childcare outcomes to help judges in faster fact-finding and to make decisions on the same. In addition, we analyzed the use of AI in other countries.

Assessment of Knowledge and Utilization of Prefabricated Band and Loop Space Maintainers in Primary Dentition Among Dentists: A Cross-Sectional Questionnaire Study.

Preserving primary dentition is essential for maintaining optimal oral health and development in children. Premature loss of primary teeth due to caries, infection, crowding, or trauma can necessitate orthodontic intervention and lead to various complications. Space maintainers are critical for preserving arch space until the eruption of permanent teeth, thereby preventing issues such as ectopic eruption, crowding, and malocclusion. Despite their advantages, prefabricated space maintainers (PSMs) are underutilized. This study aims to evaluate the knowledge, attitudes, and practices of Indian dentists regarding PSMs in primary teeth. A cross-sectional questionnaire survey was conducted among 100 dental practitioners in Chennai. A 10-item self-administered questionnaire, developed based on a comprehensive literature review and expert consultations, assessed demographics, knowledge of PSM indications and techniques, current practices, perceived barriers, and preferences for continuing education. The questionnaire's reliability was confirmed with a Cronbach's alpha value of 0.85. Descriptive statistics, including frequencies andpercentages, were used to summarize the participants' demographic characteristics, knowledge levels, and current practices related to PSMs. Of the 100 respondents, 86 (86%) were males and 14 (14%) were females. Only 19 (19%) reported using PSMs, while 36 (36%) used conventional space maintainers. A significant proportion (42 (42%)) of the respondents held a master's degree in dental surgery, yet only 11 (11%) had participated in Continuing Dental Education (CDE) programs on space maintainers. The perceived benefit of PSMs being a single appointment procedure was acknowledged by 82 (82%) of the respondents, whereas 76 (76%) participants identified cost as a major drawback. Notably, 45 (45%) practitioners did not consider PSMs necessary. This survey highlights notable obstacles in the adoption of PSMs among Indian dentists, emphasizing the need for focused educational initiatives. Improving knowledge and practices related to PSMs can enhance pediatric dental care and oral health outcomes in India.

Machine learning-based prediction models for electoral outcomes in India: a comparative analysis of exit polls from 2014–2021

Machine learning-based prediction models for electoral outcomes in India: a comparative analysis of exit polls from 2014–2021

Disparity by caste and tribe: Understanding women's empowerment and health outcomes in India

AimWomen's empowerment status varies greatly in India according to caste, class, ethnicity and region. This paper aims to investigate the caste/tribe disparity in women's empowerment by region, the main correlates of each domain of empowerment, and the association of women's empowerment with nutritional and health care access outcomes, specifically anaemia, menstrual hygiene, and institutional delivery. MethodologyUsing National Family Health Survey-5 (2019–2021) data, we have created a modified survey-based women's empowerment index (SWPER) using principal component analysis with Oblique varimax rotation. The first four components are interpreted as an attitude to violence, freedom of movement, decision-making power and social independence. Several multivariate regression models were used to understand the factor associated with empowerment and the association of women's empowerment with different health outcomes. ResultsThe results indicate that women from the forward castes are the most empowered in most domains except decision-making. However, after controlling other background variables, the forward castes women are found to be the most empowered in attitude to violence, whereas Scheduled Castes and Scheduled Tribes women were found to be the most empowered women in decision-making. With regards to social independence, deprived castes women are more empowered than the forward castes women. The likelihood of empowerment in social independence domain increases with increasing wealth. There are wide regional variations in empowerment level between different social groups. Caste/tribe identity plays a significant role in determining health outcomes in India. Among all empowerment domains, social independence emerges as the most significant associated factor with improved health across all caste/tribe groups. ConclusionThe path to women's empowerment in India must recognize the intersectionality of caste/tribe identities, and address regional disparities. Social independence emerges as a critical determinant across all caste/tribe groups for improving health. Measures should be taken to empower women through the underlying factors of social independence.

A mixed-methods study on impact of active case finding on pulmonary tuberculosis treatment outcomes in India

BackgroundTuberculosis (TB) remains a significant public health burden in India, with elimination targets set for 2025. Active case finding (ACF) is crucial for improving TB case detection rates, although conclusive evidence of its association with treatment outcomes is lacking. Our study aims to investigate the impact of ACF on successful TB treatment outcomes among pulmonary TB patients in Gujarat, India, and explore why ACF positively impacts these outcomes.MethodsWe conducted a retrospective cohort analysis in Gujarat, India, including 1,638 pulmonary TB cases identified through ACF and 80,957 cases through passive case finding (PCF) from January 2019 to December 2020. Generalized logistic mixed-model compared treatment outcomes between the ACF and PCF groups. Additionally, in-depth interviews were conducted with 11 TB program functionaries to explore their perceptions of ACF and its impact on TB treatment outcomes.ResultsOur analysis revealed that patients diagnosed through ACF exhibited 1.4 times higher odds of successful treatment outcomes compared to those identified through PCF. Program functionaries emphasized that ACF enhances case detection rates and enables early detection and prompt treatment initiation. This early intervention facilitates faster sputum conversion and helps reduce the infectious period, thereby improving treatment outcomes. Functionaries highlighted that ACF identifies TB cases that might otherwise be missed, ensuring timely and appropriate treatment.ConclusionACF significantly improves TB treatment outcomes in Gujarat, India. The mixed-methods analysis demonstrates a positive association between ACF and successful TB treatment, with early detection and prompt treatment initiation being key factors. Insights from TB program functionaries underscore the importance of ACF in ensuring timely diagnosis and treatment, which are critical for better treatment outcomes. Expanding ACF initiatives, especially among hard-to-reach populations, can further enhance TB control efforts. Future research should focus on optimizing ACF strategies and integrating additional interventions to sustain and improve TB treatment outcomes.

Relationship between adolescent anemia and school attendance observed during a nationally representative survey in India

BackgroundAnemia has been suggested to be related with schooling outcomes in India. Less is known, however, about whether the observed relationship persists after accounting for all household-level factors which may confound the association between anemia and schooling.MethodsNationally representative data on adolescents aged 15–18 years with data on measured hemoglobin level and school attendance were extracted from India’s National Family Health Surveys conducted between 2005 and 2021. We compared school attendance between adolescents living in the same household but with varying levels of hemoglobin concentration, while controlling for age and period effects. We assessed heterogeneity in the relationship between anemia and school attendance across anemia severity groups and socio-demographic characteristics.ResultsThe proportion of adolescents with any anemia is 55.2% (95% CI: 55.0–55.5) among young women and 31.0% (95% CI: 30.6–31.5) among young men. In conventional (between-household) regression models, having any anemia is associated with a 2.5 percentage point reduction (95% CI: 2.1–2.8) in school attendance; however, in household fixed-effects models, anemia has qualitatively small and non-significant effects on school attendance. Our results are consistent using alternative model specifications as well as across anemia severity groups, genders, types of relationship to the household head, household wealth quintiles, and states and union territories in India.ConclusionsThis within-household analysis finds little evidence that anemia is associated with school attendance among adolescents in India. Observational studies likely overstate the connection between anemia and school attendance due to household factors that have not been accounted for.

Practical Considerations of Remote Care in Thoracic Aortopathy in India.

Background: Thoracic aortopathy includes conditions like aortic aneurysms and dissections, posing significant management challenges. In India, care delivery is complicated by geographic vastness, financial constraints, and healthcare resource disparities. Telemedicine and digital health technologies offer promising solutions. Methods: A comprehensive review of literature and clinical experiences was conducted to explore the implementation of remote care strategies for thoracic aortopathy in India. The review included studies from 2000 to 2023 and insights from cardiothoracic specialists. Results: Remote care benefits include improved access to specialized expertise, enhanced patient engagement, and optimized resource utilization. Telemedicine enables consultations without travel, and remote monitoring facilitates early intervention. However, challenges like technology integration, digital literacy, patient engagement, privacy concerns, and regulatory compliance need addressing. Discussion: Telemedicine offers significant advantages but requires overcoming challenges to ensure effective, secure care. Careful planning for technology integration, patient education, robust privacy measures, and supportive regulatory policies are essential. Addressing these issues can bridge the healthcare access gap and improve outcomes in India's diverse landscape.

Examining Inflation Expectations within Asian Economies: Application of Wavelet Quantile Analysis towards Assessing Monetary Policy Credibility

The relevance of rational expectations has generated a renewed interest in assessing the accuracy of monetary policy declarations. Despite the enduring principles of the rational expectations theory, a remarkably dependable central bank can alleviate inflation by skillfully managing inflation expectations, thus avoiding adverse effects on employment. This paper explores the complex relationship between inflation expectations, target inflation rates, and the credibility of monetary policy, emphasizing the importance of rule compliance and transparent communication for establishing public confidence in central banks. While the estimation processes the study utilizes wavelet-based quantile regression by investigating data from 1990q1 to 2021q4, with variations across selected countries. The credibility index (CI) is employed to instrument the dependability of monetary policies. Nevertheless, the results of this study indicate that Policy credibility has a significant impact on inflation expectations in Bangladesh and Sri Lanka, underscoring the importance of clear communication and institutional reforms. Different outcomes in India and considerable effects in Pakistan underscore the necessity of customized policy measures and communication strategies to address inflation and promote economic stability in South Asia.

Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study

One-fifth of people with drug-resistance tuberculosis (DR-TB) who were initiated on newer shorter treatment regimen (with injection) had unfavourable treatment outcomes in India as on 2020. Evidence on self-driven solutions and resilience adapted by people with DR-TB (PwDR-TB) towards their multi-dimensional disease and treatment challenges are scarce globally, which we aimed to understand. In this qualitative study using positive deviance framework, we conducted semi-structured in-depth interviews among consenting adult PwDR-TB (7 women, 13 men) who completed shorter treatment regimen (including injections) with maximum treatment adherence. The study was conducted in the southern districts of Bengaluru and Hyderabad, India between June 2020 and December 2022. Caregivers (14 women, 6 men) and health providers (8 men, 2 women) of PwDR-TB were also interviewed. Interviews were conducted in local language (Kannada, Tamil, Telugu, Urdu and Hindi) and inquired about practices, behaviours, experiences, perceptions and attributes which enabled maximum adherence and resilience of PwDR-TB. Interviews were audio recorded, transcribed, and translated to English and coded for thematic analysis using inductive approach. Distinctive themes explanatory of the self-driven solutions and resilience exhibited by PwDR-TB and their caregivers were identified: (i) Self-adaptation towards the biological consequences of drugs, by personalised nutritional and adjuvant practices, which helped to improve drug ingestion and therapeutic effects. Also home remedies and self-plans for ameliorating injection pain. (ii) Perceptual adaptation towards drugs aversion and fatigue, by their mind diversion practices, routinisation and normalisation of drug intake process. and constant reinforcement and re-interpretation of bodily signs of disease recovery (iii) Family caregivers intense and participatory care for PwDR-TB, by aiding their essential life activities and ensuring survival, learning and fulfilling special nutritional needs and goal oriented actions to aid drug intake (iv) Health care providers care, marked by swift and timely risk mitigation of side-effects and crisis response (v) Acquired self-efficacy of PwDR-TB, by their decisive family concerns resulting in attitudinal change. Also being sensitised on the detrimental consequences of disease and being motivated through positive examples. Synthesised findings on self-driven solutions and resilience towards the multi-dimensional DR-TB challenges provides opportunity for developing and testing new interventions for its effectiveness in DR-TB care settings globally. Designing and testing personalised cognitive interventions for PwDR-TB: to inculcate attitudinal change and self-efficacy towards medication, developing cognitive reinforcements to address the perception burden of treatment, skill building and mainstreaming the role of family caregivers as therapeutic partners of PwDR-TB, curating self-adaptive behaviours and practices of PwDR-TB to normalise their drug consumptions experiences could be the way forward in building resilience towards DR-TB. United States Agency for International Development (USAID) through Karnataka Health Promotion Trust (KHPT), Bengaluru, India.

Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India.

The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.