A retrospective cross-sectional survey was conducted to assess key practices and costs relating to home-and institutional delivery care in rural Rajasthan, India. One block from each of two sample districts was covered (estimated population-279,132). Field investigators listed women who had delivered in the past three months and contacted them for structured case interview. In total, 1,947 (96%) of 2,031 listed women were successfully interviewed. An average of 2.4 and 1.7 care providers attended each home-and institutional delivery respectively. While 34% of the women delivered in health facilities, modern care providers attended half of all the deliveries. Intramuscular injections, intravenous drips, and abdominal fundal pressure were widely used for hastening delivery in both homes and facilities while post-delivery injections for active management of the third stage were administered to a minority of women in both the venues. Most women were discharged prematurely after institutional delivery, especially by smaller health facilities. The cost of accessing home-delivery care was Rs 379 (US$ 8) while the mean costs in facilities for elective, difficult vaginal deliveries and for caesarean sections were Rs 1,336 (US$ 30), Rs 2,419 (US$ 54), and Rs 11,146 (US$ 248) respectively. Most families took loans at high interest rates to meet these costs. It is concluded that widespread irrational practices by a range of care providers in both homes and facilities can adversely affect women and newborns while inadequate observance of beneficial practices and high costs are likely to reduce the benefits of institutional delivery, especially for the poor. Government health agencies need to strengthen regulation of delivery care and, especially, monitor perinatal outcomes. Family preference for hastening delivery and early discharge also require educational efforts.
In 2002In -2003 of women aged 15-49 years in a block of southern Rajasthan were investigated to determine the cause of death and care-seeking behaviour. Family members of 156 (98%) of 160 deceased women were interviewed following the comprehensive listing of all deaths among women of reproductive age. Of the 156 deaths, 31 (20%) were pregnancy-related; 77% of these women died during the postpartum period, and 74% of the deaths occurred in the home. Direct and indirect obstetric causes were responsible for 58% and 29% of the deaths respectively; 12% were injury-related deaths. Medical care was sought for 65% of the women, and 29% were hospitalized. Family perception of not being able to afford treatment at distant hospitals was a major barrier to seeking care, and 60% of those who sought care had to borrow money for treatment. Lack of skilled attendance and immediate postpartum care were major factors contributing to deaths. Improved access to emergency obstetric care facilities in rural areas and steps to eliminate costs at public hospitals would be crucial to prevent pregnancy-related deaths.
Objective: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). Design: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely RUTF-C, RUTF-L, or A-HPF, under two age strata (6–17 months and 18–59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, viz. child, family, and nutritional predictors, were analysed. Setting: Rural and urban slum areas of three states of India, viz. Rajasthan, Delhi, and Tamil Nadu Subjects: In total, 906 children (age: 6–59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Results: Being a female child [AHR: 1.269 (1.016–1.584)], better employment status of the child’s father [AHR: 1.53 (1.197–1.95)], and residence in a rental house [AHR: 1.485 (1.137–1.94)] increased the chances of recovery. No hospitalisation [AHR: 1.778 (1.055–2.997)], no fever, [AHR: 2.748 (2.161–3.494)], and ≤2 episodes of diarrhoea [AHR: 1.579 (1.035–2.412)] during the treatment phase; availability of community-based peer support to mothers for feeding [AHR: 1.61 (1.237–2.097)]; and a better weight-for-height Z-score (WHZ) at enrolment [AHR: 1.811 (1.297–2.529)] predicted higher chances of recovery from SAM. Conclusion: The probability of recovery increases in children with better WHZ, and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support, and better employment status of the father.
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