Summary Background India has the largest number of child deaths of any country in the world, and has wide local variation in under-5 mortality. Worldwide achievement of the UN 2015 Millennium ...Development Goal for under-5 mortality (MDG 4) will depend on progress in the subregions of India. We aimed to estimate neonatal, 1–59 months, and overall under-5 mortality by sex for 597 Indian districts and to assess whether India is on track to achieve MDG 4. Methods We divided the 2012 UN sex-specific birth and mortality totals for India into state totals using relative birth rates and mortality from recent demographic surveys of 24 million people, and divided state totals into totals for the 597 districts using 3 million birth histories. We then split the results into neonatal mortality and 1–59 month mortality using data for 109 000 deaths in children younger than 5 years from six national surveys. We compared results with the 2001 census for each district. Findings Under-5 mortality fell at a mean rate of 3·7% (IQR 3·2–4·9) per year between 2001 and 2012. 222 (37%) of 597 districts are on track to achieve the MDG 4 of 38 deaths in children younger than 5 years per 1000 livebirths by 2015, but an equal number (222 37%) will achieve MDG 4 only after 2020. These 222 lagging districts are home to 41% of India's livebirths and 56% of all deaths in children younger than 5 years. More districts lag behind the relevant goal for neonatal mortality (251 42%) than for 1–59 month mortality (197 33%). Just 81 (14%) districts account for 37% of deaths in children younger than 5 years nationally. Female mortality at ages 1–59 months exceeded male mortality by 25% in 303 districts in nearly all states of India, totalling about 74 000 excess deaths in girls. Interpretation At current rates of progress, MDG 4 will be met by India around 2020—by the richer states around 2015 and by the poorer states around 2023. Accelerated progress to reduce mortality during the neonatal period and at ages 1–59 months is needed in most Indian districts. Funding Disease Control Priorities 3, Canadian Institutes of Health Research, International Development Research Centre, US National Institutes of Health.
Summary Background As child mortality decreases rapidly worldwide, premature adult mortality is becoming an increasingly important contributor to global mortality. Any possible worldwide reduction of ...premature adult mortality before the age of 70 years will depend on progress in India. Indian districts increasingly have responsibility for implementing public health programmes. We aimed to assess age-specific and sex-specific adult mortality risks in India at the district level. Methods We analysed data from five national surveys of 0·27 million adult deaths at an age of 15–69 years together with 2014 demographic data to estimate age-specific and sex-specific adult mortality risks for 597 districts. Cause of death data were drawn from the verbal autopsies in the Registrar General of India's ongoing Million Death Study. Findings In 2014, about two-fifths of India's men aged 15–69 years lived in the 253 districts where the conditional probability of a man dying at these ages exceeded 50%, and more than a third of India's women aged 15–69 years lived in the 222 districts where the conditional probability of a woman dying exceeded 40%. The probabilities of a man or woman dying by the age of 70 years in high-mortality districts was 62% and 54%, respectively, whereas the probability of a man or woman dying by the age of 70 years in low-mortality districts was 40% and 30%, respectively. The roughly 10-year survival gap between high-mortality and low-mortality districts was nearly as extreme as the survival gap between the entire Indian population and people living in high-income countries. Adult mortality risks at ages 15–69 years was highest in east India and lowest in west India, by contrast with the north–south divide for child mortality. Vascular disease, tuberculosis, malaria and other infections, and respiratory diseases accounted for about 60% of the absolute gap in adult mortality risk at ages 15–69 years between high-mortality and low-mortality districts. Most of the variation in adult mortality could not be explained by known determinants or risk factors for premature mortality. Interpretation India's large variation in adult mortality by district, notably the higher death rates in eastern India, requires further aetiological research, particularly to explore whether high levels of adult mortality risks from infections and non-communicable diseases are a result of historical childhood malnutrition and infection. Such research can be complemented by an expanded coverage of known effective interventions to reduce adult mortality, especially in high-mortality districts. Funding National Institutes of Health, Canadian Institutes of Health Research, University of Toronto.
Summary Background Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and ...prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. Methods This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35–70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 pack-years), and heavy smokers of bidis (>10 pack-years). Findings 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1–13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1 ) and FEV1 /forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 95% CI 1·02–1·62, heavy cigarette smokers 1·59 1·13–2·24, heavy bidi smokers 1·56 1·22–1·98), cardiovascular events (1·45 1·13–1·84, 1·47 1·05–2·06, 1·55 1·17–2·06, respectively) and respiratory events (1·30 0·91–1·85, 1·21 0·70–2·07, 1·73 1·23–2·45, respectively) across the smoking categories. Interpretation Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia. Funding Population Health Research Institute, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Ontario.
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible—not counted in the Millennium Development Goals, nor tracked by the UN, nor in the ...Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
Summary Background The age-specific mortality rates and total deaths from specific cancers have not been documented for the various regions and subpopulations of India. We therefore assessed the ...cause of death in 2001–03 in homes in small areas that were chosen to be representative of all the parts of India. Methods At least 130 trained physicians independently assigned causes to 122 429 deaths, which occurred in 1·1 million homes in 6671 small areas that were randomly selected to be representative of all of India, based on a structured non-medical surveyor's field report. Findings 7137 of 122 429 study deaths were due to cancer, corresponding to 556 400 national cancer deaths in India in 2010. 395 400 (71%) cancer deaths occurred in people aged 30–69 years (200 100 men and 195 300 women). At 30–69 years, the three most common fatal cancers were oral (including lip and pharynx, 45 800 22·9%), stomach (25 200 12·6%), and lung (including trachea and larynx, 22 900 11·4%) in men, and cervical (33 400 17·1%), stomach (27 500 14·1%), and breast (19 900 10·2%) in women. Tobacco-related cancers represented 42·0% (84 000) of male and 18·3% (35 700) of female cancer deaths and there were twice as many deaths from oral cancers as lung cancers. Age-standardised cancer mortality rates per 100 000 were similar in rural (men 95·6 99% CI 89·6–101·7 and women 96·6 90·7–102·6) and urban areas (men 102·4 92·7–112·1 and women 91·2 81·9–100·5), but varied greatly between the states, and were two times higher in the least educated than in the most educated adults (men, illiterate 106·6 97·4–115·7 vs most educated 45·7 37·8–53·6; women, illiterate 106·7 99·9–113·6 vs most educated 43·4 30·7–56·1). Cervical cancer was far less common in Muslim than in Hindu women (study deaths 24, age-standardised mortality ratio 0·68 0·64–0·71 vs 340, 1·06 1·05–1·08). Interpretation Prevention of tobacco-related and cervical cancers and earlier detection of treatable cancers would reduce cancer deaths in India, particularly in the rural areas that are underserved by cancer services. The substantial variation in cancer rates in India suggests other risk factors or causative agents that remain to be discovered. Funding Bill & Melinda Gates Foundation and US National Institutes of Health.
Summary Background India's 2011 census revealed a growing imbalance between the numbers of girls and boys aged 0–6 years, which we postulate is due to increased prenatal sex determination with ...subsequent selective abortion of female fetuses. We aimed to establish the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and to quantify the totals of selective abortions of girls with census cohort data. Methods We assessed sex ratios by birth order in 0·25 million births in three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective abortion of girls by assessing the birth cohorts of children aged 0–6 years in the 1991, 2001, and 2011 censuses. Our main statistic was the conditional sex ratio of second-order births after a firstborn girl and we used 3-year rolling weighted averages to test for trends, with differences between trends compared by linear regression. Findings The conditional sex ratio for second-order births when the firstborn was a girl fell from 906 per 1000 boys (99% CI 798–1013) in 1990 to 836 (733–939) in 2005; an annual decline of 0·52% (p for trend=0·002). Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. By contrast, we did not detect any significant declines in the sex ratio for second-order births if the firstborn was a boy, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts with no change or increases. After adjusting for excess mortality rates in girls, our estimates of number of selective abortions of girls rose from 0–2·0 million in the 1980s, to 1·2–4·1 million in the 1990s, and to 3·1–6·0 million in the 2000s. Each 1% decline in child sex ratio at ages 0–6 years implied 1·2–3·6 million more selective abortions of girls. Selective abortions of girls totalled about 4·2–12·1 million from 1980–2010, with a greater rate of increase in the 1990s than in the 2000s. Interpretation Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective abortion of girls is common. Funding US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, and Li Ka Shing Knowledge Institute.
Range resolution in radar can be achieved by splitting the long pulse of high energy into the high bandwidth of short pulses using pulse compression technique. Frequency modulation (Linear frequency ...modulation (LFM)) signal is used to improve range resolution. To get better range resolution, frequency step is introduced between a train of LFM pulses known as stepped frequency pulse train (the SFPT). The SFPT suffers from grating lobes when the product of sub-pulse duration and frequency step becomes more than one. The grating lobes and sidelobes present in the vicinity of the mainlobe. It can cause the false alarm detection and hide the small targets. In this work, Multi-Objective Grey Wolf Algorithm (MOGWO) is used to set the parameters of SFPT to mitigate the grating lobes and minimize the sidelobes at the matched filter output. Trade-off solutions between sidelobes versus grating lobes and mainlobe width versus sidelobes are obtained using the Pareto front for different ranges of SFPT parameters.
Modern radars require signals of the large frequency range to attain relatively greater range resolution. Frequency stepping is the technique to convert the narrowband signal, i.e., a train of pulses ...into a wideband signal to achieve high accuracy in range resolution measurements. Due to the cause of constant step in frequency of successive pulses, grating lobes appeared when the period of pulse multiplied by step in frequency exceeds unity as is needed in modern radars. Hence to achieve the best resolution, grating lobes height, sidelobes level, and mainlobe width have to be minimum. In this paper an attempt has been made to diminish grating lobes, minimize sidelobes and reduce mainlobe width using MOIDSA to find the parameters of Stepped Frequency Pulse Train (SFPT) mechanism. The compromise between various lobes is obtained by using three dimensional Pareto fronts for different ranges of SFPT parameters.
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