COVID mortality in India: National survey data and health facility deaths.
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ABSTRACT:
SUBMITTER: Jha P
PROVIDER: S-EPMC9836201 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
COVID mortality in India: National survey data and health facility deaths.
Jha Prabhat P Deshmukh Yashwant Y Tumbe Chinmay C Suraweera Wilson W Bhowmick Aditi A Sharma Sankalp S Novosad Paul P Fu Sze Hang SH Newcombe Leslie L Gelband Hellen H Brown Patrick P
Science (New York, N.Y.) 20220106 6581
India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal in ...[more]
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Project description:BackgroundIt is estimated that India has more deaths from rabies than any other country. However, existing estimates are indirect and rely on non-representative studies.Methods and principal findingsWe examined rabies deaths in the ongoing Million Death Study (MDS), a representative survey of over 122,000 deaths in India that uses enhanced types of verbal autopsy. We estimated the age-specific mortality rates of symptomatically identifiable furious rabies and its geographic and demographic distributions. A total of 140 deaths in our sample were caused by rabies, suggesting that in 2005 there were 12,700 (99% CI 10,000 to 15,500) symptomatically identifiable furious rabies deaths in India. Most rabies deaths were in males (62%), in rural areas (91%), and in children below the age of 15 years (50%). The overall rabies mortality rate was 1.1 deaths per 100,000 population (99%CI 0.9 to 1.4). One third of the national rabies deaths were found in Uttar Pradesh (4,300) and nearly three quarters (8,900) were in 7 central and south-eastern states: Chhattisgarh, Uttar Pradesh, Odisha, Andhra Pradesh, Bihar, Assam, and Madhya Pradesh.Conclusions and significanceRabies remains an avoidable cause of death in India. As verbal autopsy is not likely to identify atypical or paralytic forms of rabies, our figure of 12,700 deaths due to classic and clinically identifiable furious rabies underestimates the total number of deaths due to this virus. The concentrated geographic distribution of rabies in India suggests that a significant reduction in the number of deaths or potentially even elimination of rabies deaths is possible.
| S-EPMC3464588 | biostudies-literature
Project description:BackgroundInfluence of contraceptive use on increased gap between successive births and attributed reduced risk of child deaths is well documented in developing countries. However, there is scarcity of evidence on direct contribution of contraceptive use on child survival especially in Indian context.MethodsUsing information given in the reproductive calendar history of the National Family Health Survey of India conducted in 2015-16, this study examines the effect of modern contraceptive use on childhood mortality - infant mortality rate (IMR) and under-five mortality rate (U5MR). Bivariate analysis and cox proportional hazard model is applied in the study.ResultsFinding reveals that use of reversible contraceptives prior to birth resulted in low childhood mortality rates. IMR is 35 per 1000 live births among births with preceding use of modern reversible contraceptives as compared to 44 per 1000 live births among births with no use. Similarly, U5MR is 41 per 1000 live births as compared to 61 per 1000 live births among births with preceding use of contraceptive and no use respectively. The use of reversible modern contraceptives prior to birth is protective against child mortality even among births with preceding birth interval of less than 24 months.ConclusionsThis study provides evidence of dual benefit of contraceptive use. Such information is important for promoting evidence-based advocacy to expand use of family planning services. This will help the country to achieve Sustainable Development Goal 3.2 which calls for end of preventable deaths during childhood.
| S-EPMC7200929 | biostudies-literature
Project description:BackgroundThe ever-growing trend of abdominal obesity worldwide has garnered global attention over the past three decades. In India, BMI has conventionally been used to measure obesity. National Family Health Survey (NFHS) is the largest demographic and health survey (DHS) in India. For the first time, the NFHS conducted the fifth round in 2019-21 which assessed abdominal obesity through waist circumference. The objective of the current study was to determine the prevalence of abdominal obesity and explore the associated socioeconomic factors.MethodsThe prevalence of abdominal obesity in India was determined using the NFHS-5 dataset, where waist circumference was used as a measure. Multivariable binary logistic regression was then employed to examine the association of different socioeconomic factors with abdominal obesity.FindingsThe prevalence of abdominal obesity in the country was found to be 40% in women and 12% in men. The findings show that 5-6 out of 10 women between the ages of 30-49 are abdominally obese. The association of abdominal obesity in women is stronger with older age groups, urban residents, wealthier sections, and non-vegetarians. For those practising the Sikh religion, the prevalence is higher in both men and women. Abdominal obesity is also on the rise in rural areas and is penetrating lower and middle socioeconomic sections of society.InterpretationThe findings of the current study highlight the need for the government and other stakeholders to proactively design targeted interventions for abdominal obesity, especially for women in their thirties and forties in India. Further research is recommended to understand the driving factors of abdominal obesity, their inter-operability, and the disease risk associated with this type of obesity.FundingNone.
| S-EPMC10363491 | biostudies-literature
Project description:BackgroundLow birthweight (LBW), defined as birthweight < 2500gms, is the largest contributor to the malnutrition disability-adjusted-live-years in India. We report on the inadequacy of birthweight data, which is a significant barrier in the understanding of LBW epidemiology, to address malnutrition in India.MethodsData from the recent round of the National Family Survey (NFHS-5) were utilised. Birthweight of livebirths in the last 5 years was documented in grams either from the health card or based on mother's recall. We computed the coverage of birthweight measurement availability and the extent of heaping (values of 2500, 3000 and 3500gms) by the place of delivery and by the survival of newborn during the neonatal period. Heaping of > 55% was considered as poor-quality birthweight data. LBW prevalence per 100 livebirths was estimated and extrapolated for under-reporting of birthweight. Findings are reported for India and its 30 states.ResultsBirthweight measurement coverage irrespective of the place of delivery was (89·8%; 95% CI 89·7-90) for India, and varied by 2 times among the states with the highest coverage in Tamil Nadu (99·3%) and the lowest in Nagaland (49·7%). Home deliveries had the least coverage of birthweight measurement (49.6%; 95% CI 49.0-50.1) as compared with public health facility (96.3%; 95% CI 96.2-96.3) and private health facility (96%; 95% CI 95.8-96.1) deliveries. This coverage was 66·5% (95% CI 65·2-67·7) among neonatal deaths as compared with 90.4 (95% CI 90.3-90.6) for livebirths who survived the neonatal period for India. The proportion of health card as the data source increased for livebirths born in year 2015 to year 2020 but then dropped for livebirths born in year 2021 (p < 0.001). The proportion of heaping was 52·0% (95% CI 51·7-52·2) in the recorded birthweight for India, and heaping > 55% was seen in 10 states irrespective of the type data source; and 3 states in addition had heaping > 55% in mother's recall. LBW prevalence was estimated at 17·4% (95% CI 17·3-17·6) for India, and ranged from 4.5% in Nagaland and Mizoram to 22.5% in Punjab for livebirths for whom birthweight was available. We estimated LBW at 77.8% for whom birthweight was not available, and the adjusted LBW prevalence for all livebirths was estimated at 23.5% (95% CI 23.3-23.8) for India.ConclusionsWithout measuring birthweight for every newborn irrespective of the survival and place of delivery, India may not able to address reduction in low birthweight and neonatal mortality effectively to meet global or national targets.
| S-EPMC10386228 | biostudies-literature
Project description:BackgroundVerbal autopsy is the main method used in countries with weak civil registration systems for estimating community causes of neonatal and 1-59-month-old deaths. However, validation studies of verbal autopsy methods are limited and assessment has been dependent on hospital-based studies, with uncertain implications for its validity in community settings. If the distribution of community deaths by cause was similar to that of facility deaths, or could be adjusted according to related demographic factors, then the causes of facility deaths could be used to estimate population causes.MethodsCauses of neonatal and 1-59-month-old deaths from verbal/social autopsy (VASA) surveys in four African countries were estimated using expert algorithms (EAVA) and physician coding (PCVA). Differences between facility and community deaths in individual causes and cause distributions were examined using chi-square and cause-specific mortality fractions (CSMF) accuracy, respectively. Multinomial logistic regression and random forest models including factors from the VASA studies that are commonly available in Demographic and Health Surveys were built to predict population causes from facility deaths.ResultsLevels of facility and community deaths in the four countries differed for one to four of 10 EAVA or PCVA neonatal causes and zero to three of 12 child causes. CSMF accuracy for facility compared to community deaths in the four countries ranged from 0.74 to 0.87 for neonates and 0.85 to 0.95 for 1-59-month-olds. Crude CSMF accuracy in the prediction models averaged 0.86 to 0.88 for neonates and 0.93 for 1-59-month-olds. Adjusted random forest prediction models increased average CSMF accuracy for neonates to, at most, 0.90, based on small increases in all countries.ConclusionsThere were few differences in facility and community causes of neonatal and 1-59-month-old deaths in the four countries, and it was possible to project the population CSMF from facility deaths with accuracy greater than the validity of verbal autopsy diagnoses. Confirmation of these findings in additional settings would warrant research into how medical causes of deaths in a representative sample of health facilities can be utilized to estimate the population causes of child death.
| S-EPMC7291588 | biostudies-literature
Project description:BackgroundNeonatal mortality is one of the key impediments in achieving global sustainable development goals, especially in lower middle income countries (LMICs). As an LMIC with the highest reported neonatal mortality rate in Southeast Asia, Indonesia faces inequitable distribution of health facilities across the archipelago. Therefore, in this paper, we aim to evaluate the determinants of neonatal mortality rate in Indonesia to search for better strategies to overcome this problem.MethodsWe conducted an analysis of the 2017 Indonesia Demographic Health Survey dataset of 10,838 live-born infants born from singleton pregnancies in 2017. Using a hierarchical approach, multivariate analysis was conducted to identify potential factors (including socioeconomic, household, and proximate determinants) that contributed to neonatal mortality.ResultsThe lack of participation in postnatal care [odds ratio (OR) = 20.394, p = 0.01)] and delivery complications other than prolonged labour (OR = 2.072, p = 0.02) were the maternal factors that significantly associated with increased risk of neonatal death. Regarding neonatal factors, low-birth-weight infants appeared to be more vulnerable to neonatal death (OR = 12.489, p = 0.01).ConclusionLow participation in postnatal care, development of labour complications, and low birth weight were associated with higher neonatal mortality. It implies that in a limited resource and geographically challenging country such as Indonesia, improving the quality and optimizing services of public hospitals with equitable distribution of quality health care services in all regions should be prioritized in the efforts of reducing neonatal mortality rate.
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Project description:Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.
| S-EPMC6201882 | biostudies-literature
Project description:ObjectiveClinical studies demonstrate the efficacy of interventions to reduce neonatal deaths, but there are fewer studies of their real-life effectiveness. In India, women often seek facility delivery after complications arise, rather than to avoid complications. Our objective was to quantify the association of facility delivery and postnatal checkups with neonatal mortality while examining the "reverse causality" in which the mothers deliver at a health facility due to adverse perinatal events.MethodsWe conducted nationally representative case-control studies of about 300,000 live births and 4,000 neonatal deaths to examine the effect of, place of delivery and postnatal checkup on neonatal mortality. We compared neonatal deaths to all live births and to a subset of live births reporting excessive bleeding or obstructed labour that were more comparable to cases in seeking care.FindingsIn the larger study of 2004-8 births, facility delivery without postnatal checkup was associated with an increased odds of neonatal death (Odds ratio = 2.5; 99% CI 2.2-2.9), especially for early versus late neonatal deaths. However, use of more comparable controls showed marked attenuation (Odds ratio = 0.5; 0.4-0.5). Facility delivery with postnatal checkup was associated with reduced odds of neonatal death. Excess risks were attenuated in the earlier study of 2001-4 births.ConclusionThe combined effect of facility deliveries with postnatal checks ups is substantially higher than just facility delivery alone. Evaluation of the real-life effectiveness of interventions to reduce child and maternal deaths need to consider reverse causality. If these associations are causal, facility delivery with postnatal check up could avoid about 1/3 of all neonatal deaths in India (~100,000/year).
| S-EPMC4610669 | biostudies-literature
Project description:BackgroundCigarettes and smokeless tobacco (SLT) products are among a wide range of tobacco products that are addictive and pose a significant health risk. In this study, we estimated smoking- and SLT use-related mortality hazard ratios (HRs) among U.S. adults by sex, age group, and cause of death, for nine mutually exclusive categories of smoking and/or SLT use.MethodsWe used data from the public-use National Health Interview Survey Linked Mortality with mortality follow-up through 2015. We used Cox proportional hazard models to estimate mortality HRs, adjusted by race/ethnicity, education, poverty level, body mass index, and tobacco-use status.ResultsWith never users as reference group, HRs for smoking-related diseases for male exclusive current smokers aged 35-64 and 65+ were 2.18 (95% confidence interval [CI]: 1.79-2.65), and 2.45 (95% CI: 2.14-2.79), respectively. Similar significant HR estimates were found for females and for all-cause mortality (ACM) and other-cause mortality (OCM) outcomes. HRs for exclusive current SLT users were only significant for males aged 35-64 for ACM (HR: 2.04, 95% CI: 1.27-3.27) and OCM (HR: 2.80, 95% CI: 1.50-5.25). HRs for users who switched from cigarettes to SLT products were significant for males aged 65+ for smoking-related diseases (HR: 2.06, 95% CI: 1.47-2.88), SLT-related diseases (HR: 1.99, 95% CI: 1.36-2.89), and ACM (HR: 1.63, 95% CI: 1.21-2.19).ConclusionsMale exclusive current SLT users aged 35-64 had a significant HR for ACM and OCM outcomes, suggesting that deaths not attributed to SLT use could be contributing to the ACM elevated HR for exclusive current SLT users.
| S-EPMC8482579 | biostudies-literature
Project description:BackgroundThe conventional indicators of infant and under-five mortality are aggregate deaths occurring in the first year and the first five years, respectively. Monitoring deaths by <1 month (neonatal), 1-11 months (post-neonatal), and 12-59 months (child) can be more informative given various etiological causes that may require different interventions across these three mutually exclusive periods. For optimal resource allocation, it is also necessary to track progress in robust estimates of child survival at a smaller geographic and administrative level.MethodsData on 259 627 children came from the 2015-2016 Indian National Family Health Survey. We used a random effects model to account for the complex survey design and sampling variability, and predicted district-specific probabilities of neonatal, post-neonatal, and child mortality. The resulting precision-weighted estimates are more reliable as they pool information and borrow strength from other districts that share the same state membership. The Pearson correlation and Spearman's rank correlation were assessed for the three mortality estimates, and the Moran's I measure was used to detect spatial clustering of high burden districts for each outcome.ResultsThe majority of under-five deaths was disproportionately concentrated in the neonatal period. Across all districts, the predicted probability of neonatal, post-neonatal, and child mortality varied from 6.0 to 63.9 deaths, 3.8 to 47.6 deaths, and 1.7 to 11.8 deaths per 1000 live births, respectively. The overall correlation between district-wide probabilities of mortality for the three mutually exclusive periods was moderate (Pearson correlation = 0.47-0.58, Spearman's rank correlation = 0.58-0.64). For each outcome, a relatively strong spatial clustering was detected across districts that transcended state boundaries (Moran's I = 0.61-0.76).ConclusionsSufficiently breaking down the under-five mortality to distinct age groups and using the precision-weighted estimations to monitor performances at smaller geographic and administrative units can inform more targeted interventions and foster accountability to improve child survival.
| S-EPMC7568918 | biostudies-literature