To assess the knowledge, attitude, and preventive practices related to kala-azar in Madhepura district of Bihar, a community-based cross-sectional study was carried out in November 2014. A total of 353 households were interviewed from 24 villages of four blocks of Madhepura district. Data were collected using structured interview schedule. For knowledge, attitude, and preventive practice indexes, scores were assigned to individual questions based on the accuracy of responses. Univariate and binary logistic regressions were applied for the analysis. Eighty-four percent households had heard of kala-azar disease, but only 15.9% could recognize that sand flies were responsible for transmitting the disease. Overall, only 43.9% had fair knowledge on kala-azar disease (e.g., mode of transmission, signs and symptoms, and the outcome if left untreated) and the vector (breeding place, season, and biting time). Almost 48.6% had a favorable attitude toward treatability and management of kala-azar and 37.7% practiced proper mechanism to prevent and control kala-azar. Occupation emerged as a significant predictor for all three indexes. Other important predictors for the attitude index were literacy, household type, households ever had a kala-azar case, and knowledge index. Despite 61.8% of the households ever reported to have a member diagnosed with kala-azar, the overall knowledge of the disease and vector, attitude, and practices about prevention and control of kala-azar was found to be lagging. Therefore, our investigation suggests that further strengthening of comprehensive knowledge about kala-azar and preventive practices is needed.

Background Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India. Methods The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension. Results The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts. Conclusion Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

It would be reasonable to hypothesize that common unobserved factors, such as psychological stress and anxiety, as well as genetic and environmental factors, simultaneously influence the tendency for overweight or obesity and the prevalence of chronic disease. The paper tries to examine the joint influence of an individual's and socio-economic characteristics in determining overweight or obesity and chronic disease. Methods: The sample comprised of 112,062 male and female participants age 15-49 years. For the simultaneous joint estimation approach we employ a seemingly unrelated probit model with and without control for endogeneity.Results: The non-zero correlation coefficient obtained from the analysis reveals that overweight or obesity is related to diabetes and hypertensions, indicating the existence of unmeasurable individual factors that commonly affect the propensity to diabetes and hypertension and overweight or obesity. A 10% increase in overweight and obesity causes increment of 4% in diabetes, 4.9% in hypertension. Further, among the overweight or obese individual, a 10% increase in overweight and obesity causes increment of 4.7% in diabetes, and 6.5% in hypertension in the study area. Conclusion:The study indicates presence of unobserved factors that simultaneously affect overweight/obesity and prevalence of both diabetes and hypertension. Policy and health promotion programme should also give special attention to the unmeasurable factors (for example: genetic factors, psychological stress and long working hour) that commonly influence the risk of overweight or obesity and chronic diseases.

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ObjectiveThis study examines the association of maternal height with caesarean section (CS) in India. It is hypothesised that maternal height has no significant effect on the risk of undergoing caesarean section.DesignA cross-sectional study based on a nationally representative large-scale survey data (National Family Health Survey-4), conducted in 2015–2016.Setting and participantsAnalysis is based on 125 936 women age 15–49 years, having singleton live births. Logistic regression has been performed to determine the contribution of maternal height to the ORs of CS birth, adjusting for other exposures. Restricted cubic spline was used as a smooth function to model the non-linear relationship between height and CS. Height data were decomposed using the restricted cubic spline with five knots located at the 5th, 27.5th, 50th, 72.5th and 95th, percentiles.Primary and secondary outcome measuresThe main outcome variable of interest in the study is CS. Maternal height is the key explanatory variable. Other explanatory variables are age, parity, sex of child, birth weight, wealth index, place of residence, place of child delivery and household health insurance status.ResultsThe results reveal that the odds of undergoing CS significantly decrease with increase in maternal heights. Mothers with a height of 120 cm (adjusted OR (AOR): 5.08; 95% CI 3.83 to 6.74) were five times more likely, while mothers with height of 180 cm were 23% less likely (AOR: 0.77; 95% CI 0.62 to 0.95) to undergo CS as compared with mothers with height of 150 cm.ConclusionsShorter maternal height is linked to a higher risk of CS. Our findings could be used to argue for policies that target stunting in infant girls and avoid unnecessary CS, as there is potential effect on growth during adolescence and early adulthood, with the goal to increase their adult heights, thereby lowering their risk of CS and adverse delivery outcomes.

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Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015–16 and District Level Household and Facility Survey (DLHS) 2012–13. The study is limited to only districts whose data are available in both DLHS 2012–13 and NFHS 2015–16. The methods of analysis include bivariate statistics, Pearson’s chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client’s confidence in the services, which is the key to success for any voluntary family planning program like in India.

Background: In India according to the National Crime Records Bureau (NCRB) data 1, 31,666 people committed suicide and out of this 12,360 were farmers committed in 2014. When the suicide rate increases in a particular group in society, it is often an indicator that there are factors in the general environment which are placing selective pressure on the group in question. The present study examines the mental health status of Farmers in Maharashtra, India. Methods: The cross-sectional study design was adopted to conduct this study. Three hundred (300) Household were selected for this study. The sample size was distributed proportionately in each village using Probability Proportional to size (PPS) sampling method. Households were stratified based on the loan amount to ensure that all types of borrower-farmers were included in the sample. The loan amounts were classified into three categories: up to Rs. 30,000, Rs. 31,000 to Rs. 60,000, and more than Rs. 60,000. Univariate, Bivariate and logistic regression analysis have been conducted. Results: More than half 58%of farmers have reported distress of mental health and 41.7% farmers were reported no distress of mental health in last two weeks. Mean of the mental health status of farmers is 0.58, and standard deviation (SD) is 0.49.The most commonly reported symptoms of mental health relate to anxiety and insomnia, with 55% of farmers suffering from this symptoms. The second highest ranking prevalence of symptoms is somatic problems (34.7%). Conclusion:The immediate clinical and non-clinical interventions should be initiated to mitigate the suicides among the farmers.