Suchergebnisse

Population ageing is not only humanity's greatest triumphs but also one of our greatest challenges. It is a demographic imperative which has socioeconomic and political consequences across the globe. Economies are globalising, technology is evolving rapidly and people are more likely to live in cities. Of late, developing countries, like India, are experiencing the challenge of these developmental discourses, in the form of changes in demographic scenario and family structure, leaving fewer older people with families to care for them. So we are at crossroads. The real issue is, therefore, how older people can sustain themselves, remain healthy, be an integral part of society and enjoy a good quality of life, without impeding the pace of development. The response to the challenges of ageing should take into consideration the realities of an individual country or region, avoiding the trap of a 'one size fits all' model, and importantly, should have strong analytical understanding of underlying demographic processes and factors.

The purpose of this article was to conduct a review on the determinants of maternal morbidity and mortality, obstetric health scenario, especially after the implementation of the Janani Surksha Yojana (JSY) and recognise the existing gaps in research in obstetric health and healthcare utilisation in India. The articles were retrieved using search engines like Google Scholar and PubMed, using specific combination of terms along with the grey literature available in national and regional health databases. Although the current medical knowledge and interventions are capable to tackle most physical preconditions responsible for maternal deaths, yet the utilisation of healthcare facilities depends on the available health infrastructure, human resources and quality of services that are accessible and acceptable to the beneficiaries. Acceptability especially is impacted by the health-seeking behaviour of a community. The implementation of JSY is believed to contribute to the decline of maternal mortality ratio, yet maternal health outcome reports gross inequity in terms of utilisation of antenatal care and postnatal care at many sub-national levels. Thus, micro-level studies are required to understand critically the level of utilisation of formal healthcare facilities, in order to ensure an unscathed maternal health profile throughout India.

AbstractThe state of pregnancy and child birth is a stretch of intense vulnerability and incurs reproductive cost, which is governed within a specific socio-ecological context. We asked in our research whether the obstetric morbidities at three stages: antepartum, intrapartum and postpartum, and their concomitants differed significantly between sedente and migrant populations. 403 Oraon indigenous women [203 sedente and 200 migrants] living in Eastern India were selected. Data on socio-demographic, reproductive, maternal health care services and obstetric morbidities were collected using semi structured schedules. We applied Categorical Principal Component Analysis (CATPCA) on the first three variables; PC1 and PC4 were loaded with "socio-demographic and maternal health care services" and PC2 and PC3 loaded with "socio-demographic and reproductive" variables. We applied Poisson regression to examine the determinants of obstetric morbidities. Bivariate analyses showed significant (p ≤ 0.05) sedente-migrant differences in variables related to socio-demographic, reproductive, maternal health care and obstetric morbidities. Poisson regression showed migrants were more likely (p ≤ 0.001) to experience ante and intrapartum morbidities than the sedentes, after controlling the confounders. PC1, PC2 and PC3 could significantly (p ≤ 0.05) predict ante and intrapartum morbidities. For postpartum morbidities, barring the variables related to availing of maternal health care services at the time of child delivery and post delivery, neither migration status nor any of the PCs was a significant predictor. For example, participants who delivered their child in health institutions and had episiotomy and/or caesarean delivery (p ≤ 0.01); and those who availed first PNC within the 24 hours of delivery, stayed under medical supervision after delivery for more than 48 hours and received higher coverage of PNCs were more and less likely respectively (p ≤ 0.05) to have experienced postpartum morbidities. We conclude that the maternal obstetric morbidities and their concomitants differed between sedente and migrant Oraon populations owing to their living in differential socio-ecological contexts.

The present study aimed to investigate how menopausal symptoms are related to different stages of postmenopausal years. The study participants (n = 715) were divided into four groups based on the quartile values of their years after menopause – Stage 1(1 – 2 years), Stage 2 (>2 – 5 years), Stage 3 (>5 – 9 years), and Stage 4 (>9 years). Menopausal symptoms were grouped into three domains namely physical, urinary and vaginal. We applied Correspondence Analysis to determine the interdependent relationship between menopausal symptoms and postmenopausal stages. The highest canonical correlation was observed between vaginal domain and menopausal stages. Participants who were at menopausal stages 3 and 4 independently showed proximity with vasomotor symptoms and urge incontinence; and those at stages 1 and stages 2 were more prone to physical symptoms. Arthralgia is recognized in early menopausal life, however its intensity increased with increase in menopausal age. The prevalence of urogenital atrophy increased with increase in postmenopausal years.

We examined how the perception/beliefs towards lifestyle and the actual lifestyle are related to body composition, blood pressure and blood sugar levels among Santals and Hindu caste populations using the cultural consonance model. The study involved 210 individuals (109 Bengali Hindu and 101 Santals), aged 18–50 years living in the city of Howrah, West Bengal, India. Principal component analyses were performed to extract the components from the variables used in perception towards lifestyle. Multiple linear regression analyses and multivariate analysis of covariance were used to understand association of body composition, blood pressure and blood sugar levels with both the perception towards and actual lifestyle and ethnicity, respectively. Results showed that there is a difference between perception towards and actual pattern of lifestyle among the members of two ethnic groups, indicating low cultural consonance. However, both the variables were associated with body composition, blood pressure and blood sugar levels, but not ethnicity, after removing the effects of socio-demographic and lifestyle variables. We conclude that shared knowledge and perception towards healthy lifestyle among individuals, perhaps encoded in own culture, often fail to get translated in actual lifestyle pattern and eventually affect physical health.

Gynaecological problem makes up a sizable proportion of disease burden in women. Majority of these problems remain unaddressed as cultural and gender norms make women silent to report these problems. Undiagnosed and untreated gynaecological problems at young age may have physical and psychological consequences in later life. This article aims to understand the prevalence of gynaecological problems and its concomitants among young married women of rural West Bengal. We collected data on 1,107 young married women, aged 24 years or below, inhabiting the rural areas of three districts of West Bengal with at least one child of five years or below. A pretested structured schedule was used to collect data on socio-demographic variables and symptoms related to gynaecological problems and their management. Focus group discussions (FGDs) were conducted to get an in-depth understanding of the participants towards gynaecological problems and management. Around 41 per cent of women reported at least one of the gynaecological problems. Excessive vaginal discharge with bad odour, pain or burning sensation while passing urine, itching at vagina, lower abdominal pain, menstrual irregularities and painful menstruation were the most reported problems. Only 22 per cent of participants sought medical advice. FGDs reveal that there is a variation among the participants regarding the perception and awareness of gynaecological problems. Sexual activity, early marriage and menstrual hygiene were perceived to be the causes of gynaecological problems. The local healers were consulted at the initial stage of the problem; qualified medical practitioners were consulted when the problem persisted. We conclude from this study that socio-cultural factors remain the primary reason behind the high prevalence of gynaecological problem among the study participants.

AbstractThe aim of the present study was to estimate the prevalence and examine the determinants of consanguineous marriage types in India. Data for 456,646 ever-married women aged 15–49 years were analysed from the National Family Health Survey (NFHS)-4 conducted in 2015–16. The overall prevalence of consanguineous marriage was 9.9%; the South region (23%) and North-East region (3.1%) showed the highest and lowest prevalences, respectively. Muslims had a higher prevalence (15%) than Hindus (9%). The prevalence of first cousin marriage (8.7%) was more than that of second cousin (0.7%) and of uncle–niece marriages (0.6%). Women living in urban areas and in nuclear families, having a higher level of education and belonging to affluent families were less likely to marry their cousins (p < 0.01). Women living in the South region of the country were more likely to marry their cousins, as well as uncles (p < 0.001). Close scrutiny of the trends in the results (odds ratios) revealed no clear relationship between socioeconomic condition and consanguineous marriage. The study results suggest that religion and north–south regional dichotomy in culture largely determine consanguineous marriage rather than socioeconomic condition in India.