Tobacco use in India is characterized by a high prevalence of smoking and smokeless tobacco use, with dual use also contributing a noticeable proportion. In the context of such a high burden of ...tobacco use, this study examines the regional variations, and socioeconomic, demographic and other correlates of smoking, smokeless tobacco and dual use of tobacco in India.
We analyzed a cross sectional, nationally representative sample of individuals from the Global Adult Tobacco Survey in India (2009-10), which covered 69,296 individuals aged 15 years and above. The current tobacco use in three forms, namely, smoking only, smokeless tobacco use only, and both smoking and smokeless tobacco use were considered as outcomes in this study. Descriptive statistics, cross tabulations and multinomial logistic regression analysis were adopted as analytical tools. Smokeless tobacco use was the major form of tobacco use in India followed by smoking and dual tobacco use. Tobacco use was higher among males, the less educated, the poor, and the rural population in India. Respondents lacking knowledge of health hazards of tobacco had higher prevalence of tobacco use in each form. The prevalence of different forms of tobacco use varies significantly by states. The prevalence of tobacco use increases concomitantly with age among females. Middle-aged adult males had higher prevalence of tobacco use. Age, education and region were found to be significant determinants of all forms of tobacco use. Adults from the poor household had significantly higher risk of consuming smokeless tobacco. Lack of awareness about the selected hazards of tobacco significantly affects tobacco use.
There is an urgent need to curb the use of tobacco among the sub-groups of population with higher prevalence. Tobacco control policies in India should adopt a targeted, population-based approach to control and reduce tobacco consumption in the country.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Women, unlike men, are subjected to triple burden of disease, namely, non-communicable and communicable diseases and reproductive health related diseases. To assess prevalence of triple burden of ...disease of currently married women and to contrast out of pocket maternal care expenditure of these diseases in India.
This study uses nationally representative unit level data from the 71st round (2014) of the National Sample Survey Organisation. Descriptive statistics and bivariate analysis are employed to assess triple burden of diseases by background of currently married women. Mean out of pocket (OOP) expenditure for healthcare care by demographic and household characteristics of women are also compared by type of diseases. Two parts model is adopted for assessment of determents of out of pocket healthcare expenditure of women.
Overall medical and non-medical expenses of non-communicable disease are much higher than those of other disease and disability, reproductive health related and communicable diseases. OOP expenditure for treatment of non-communicable diseases, reproductive health and related diseases and other disease and disability are significantly higher than the inpatient treatment of communicable diseases and the differences are statistically significant.
Out of pocket expenditure for treatment of non-communicable diseases is the highest, followed by that of other diseases & disability, then reproductive health related diseases and the least is for communicable diseases. OOP expenditures for maternal healthcare in private health facilities are much higher than in public health facilities regardless of types of disease. Women from households having insurance of any member spent less than that of women from households not having health insurance. There is an urgent need to expand the outreach of the public health system in India to rural areas.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There is an evidence of increasing inpatient expenditure for decedents. Estimates used to assess the economic burden of out-of-pocket (OOP) healthcare expenditure provide an underestimation for ...inpatient decedent cases. The aims of this paper are to study the trend and pattern of inpatient decedent expenditure and decipher the reasons behind the increasing cost in India.
Using three rounds of national level National Sample Survey (NSS) data on morbidity & healthcare conducted during 1995-2015 in India, total and component-wise cost of dying was estimated by the socio-demographic characteristics and types of diseases. Generalised linear model was employed to find the changing effect of inpatient decedents on inpatient expenditure on three-time points.
More than half among inpatient decedents were elderly. Mean inpatient expenditure for neoplasm, circulatory system-related diseases and external causes of mortality and morbidity increased substantially during these two decades. Mean decedent inpatient expenditure become double, diagnostic and bed charges increased by 243%, 323% respectively during 2004-05 to 2014-15. During 2014-15 average decedents aged 15-59 years spent ₹53599 in last twelve month of their life. Controlling all other potential factors, the inpatient expenditure among decedents increased substantially between 1995-96 and 2014-15.
Out-of-pocket inpatient health expenditure widened between survivor and decedents in between 1995-2014. Increase in the proportion of elderly, proportion of non-communicable and lifestyle-related diseases, expenses on drugs, diagnostics, bed charges largely private sector expenses were the leading reasons for increasing inpatient decedent expenditure. Age-based risk adjustment and modification of end-of-life care are strongly required, future social insurance based on the health-based value of out-of-pocket expenditure rather than their pure consumption value need to be designed to tackle the burden.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study aims to examine the inter-district and inter-village variation of utilization of health services for institutional births in EAG states in presence of rural health program and availability ...of infrastructures. District Level Household Survey-III (2007-08) data on delivery care and facility information was used for the purpose. Bivariate results examined the utilization pattern by states in presence of correlates of women related while a three-level hierarchical multilevel model illustrates the effect of accessibility, availability of health facility and community health program variables on the utilization of health services for institutional births. The study found a satisfactory improvement in state Rajasthan, Madhya Pradesh and Orissa, importantly, in Bihar and Uttaranchal. The study showed that increasing distance from health facility discouraged institutional births and there was a rapid decline of more than 50% for institutional delivery as the distance to public health facility exceeded 10 km. Additionally, skilled female health worker (ANM) and observed improved public health facility led to significantly increase the probability of utilization as compared to non-skilled ANM and not-improved health centers. Adequacy of essential equipment/laboratory services required for maternal care significantly encouraged deliveries at public health facility. District/village variables neighborhood poverty was negatively related to institutional delivery while higher education levels in the village and women's residing in more urbanized districts increased the utilization. "Inter-district" variation was 14 percent whereas "between-villages" variation for the utilization was 11 percent variation once controlled for all the three-level variables in the model. This study suggests that the mere availability of health facilities is necessary but not sufficient condition to promote utilization until the quality of service is inadequate and inaccessible considering the inter-districts variation for the program implementation.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The study of the effect of community clustering of under-five mortality has its implications in both research and policy. Studies have shown the contribution of community factors on under-five ...mortality. However, these studies did not account for censoring. We examine the presence of community dependencies and determine the risk factors of under-five mortality in India and its six state-regions by employing a Weibull hazard model with gamma shared frailty. We considered every possible way to ensure that the frailty models used in the study are not merely a consequence of how the data are organized rather than representing a substantive assumption about the source of the frailty. Data from the fourth round of the National Family Health Survey has been used. The study found that except for south India, children born in the same community in India and the other five state-regions shared similar characteristics of under-five mortality. The risk of under-five mortality decreased with an increase in mother’s schooling. Except for northern region, female births were less likely to die within first five years of life. We found a U-shaped relationship between preceding birth interval and under-five mortality. History of sibling’s death, multiple births and low-birthweight significantly increases the risk of under-five mortality in all the six state-regions. The Hindu–Muslim mortality gaps and Scheduled Caste or Tribe’s mortality disadvantage is diminishing. Since the factors associated with under-five mortality were not necessarily the same across the six state-regions of India, adopting a uniform approach in dealing with under-five mortality in India may not benefit all the regions equally.
Post 2005 in India, a number of public policy initiatives were introduced to strengthen existing programs for welfare of the ever-increasing population aged 60 years and older. Using a National ...Transfer Accounts framework, this paper attempts to assess the implications of policy changes by evaluating changes in lifecycle deficit and changes in public and familial support of the elderly especially in meeting their lifecycle deficit between 2004 and 05 and 2011–12. It found that labour income of the elderly increased marginally during 2004–2012, but the level of consumption of the elderly marginally slipped down. Lifecycle deficit (LCD) of the elderly population aged 60 years and older declined due to the intertwining effect of increased labour income and declining consumption. Familial support to the elderly did not improve between 2004 and 2012, instead their net contribution to intra-household transfers is greater than their benefits. Asset based reallocation remains the main source of financing the LCD of the elderly. Benefits of the elderly in meeting their lifecycle deficit from policy changes is nominal.
This paper examines the extent of familial monetary support for the elderly in China, India, Indonesia, Japan, Korea, the Philippines, and Thailand, representing diverse public social security and ...assistance programs for the elderly across Asian countries. Using the National Transfer Accounts framework, Japan was found to experience the highest and China the lowest lifecycle deficit (LCD). Except Indonesia, the consumption of public and private goods and services at old ages is fast increasing in the Asian countries. In Japan public transfer supports 39.4% of the LCD of the 60 plus population and private asset-based reallocation, which includes liquidation and sale of assets, finances 33.7%. On the other in Indonesia and India LCD of elderly is largely 70.5 and 63.9% respectively are met by private asset-based reallocation. Public support for the 60 plus population in South Korea constitutes 22.9% of the LCD, whereas 52.6% is met by asset-based reallocation. The corresponding figures for China are 41.3 and 32.2% respectively.
Household risk factors affecting child health, particularly malnutrition, are mainly basic amenities like drinking water, toilet facility, housing and fuel used for cooking. This paper considered the ...collective impact of basic amenities measured by an index specially constructed as the contextual factor of child malnutrition. The contextual factor operates at both the macro and micro levels namely the state level and the household level. The importance of local contextual factors is especially important when studying the nutritional status of children of indigenous people living in remote and inaccessible regions. This study has shown the contextual factors as potential factors of malnutrition among children in northeast India, which is home to the largest number of tribes in the country. In terms of macro level contextual factor it has been found that 8.9 per cent, 3.7 per cent and 3.6 per cent of children in high, medium and low risk households respectively, are severely wasted. Lower micro level household health risks, literate household heads, and scheduled tribe households have a negating effect on child malnutrition. Children who received colostrum feeding at the time of birth and those who were vaccinated against measles are also less subject to wasting compared to other children, and these differences are statistically significant.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In India marrying across the caste kindles strong community resentment, leading to the extent of honor killing, yet few couples dare to defy this stringent social norm. Analysis of large-scale survey ...(India Human Development Survey 2011–12) data exhibits an inconsequential rise in this social incongruity since 1951 to attain 4.5% in 2012. It is most prevalent in the northeastern region (11.6%), but least prevalent in caste-ridden central India (1.8%). Multi-variate statistics exhibit that if women are allowed to choose their life-partner, caste takes a rear-seat in marriage contemplation. It is quite prominent among the women who selected the husband by themselves and knew the husband at least one year before the marriage. Contrary to general notion, education is not able to promote inter-caste marriage. Odds of inter-caste marriage taking place in Dalit (lowest social standing) households is much lesser than the higher caste. Resilient targeted efforts are necessary to promote inter-caste marriage, which may loosen the noose of the caste system in India.
The paper sheds light on changing occupation pattern and income and gender gap in the real earning of elderly 60 years and above in India. It is found that work participation of elderly in India has ...increase from 13.3% in 2004–05 to 16.4% in 2011–12 and for males the increase is significant from 19.4 to 23.3% while that for females is marginal from 7.1 to 10.1% during this period. Occupations classified as agricultural and animal farming, labourer, business, salaried and professional and part time worker constitutes 17.8, 55.9, 8.4, 12.8 and 5.1% respectively in 2004–05 and corresponding figures for 2011–12 are 17.6, 53.2, 2.7, 12.2 and 14.4% respectively. The mean annual earning for elderly engaged in the aforesaid occupation in order are Rs. 14,277, Rs. 19,315, Rs. 32,932, Rs. 93,880 and Rs. 44,811 in 2004–05 and the corresponding mean earning in 2011–12 after adjustment of inflation are Rs. 11,719, Rs. 27,591, Rs. 30,896, Rs. 109,673 and Rs. 21,078 respectively. The gender gap in earning is significant and has not change over time. Multigenerational living arrangement and residing rural areas are found to have deterrent effect on annual earning, while household income quintile has significant enhancing effect on annual earning but age and incidence of long term morbidities have no significant effect on annual earning. Contribution of endowment factors in gender in earning gap decreases.
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