| 1. |
|
|
| 2. |
|
|
| 3. |
- Hirve, Siddhivinayak, 1961-
(författare)
-
"In general, how do you feel today?" Self-rated health in the context of aging in India
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Most aging research comes from the developed world. Aging research in India is focused on disease states and risk factors. Evidence on elderly health, physical performance and disability to understand the psycho-social or socio-behavioral risk is limited in India. Self-rated health (SRH) is used often in survey settings to quickly assess health status and is known to predict morbidity and mortality. The first wave of the Study on global AGEing and adult health (SAGE) survey provides an opportunity to explore the complex construct of SRH in the context of the aging process in its various key life domains of health, disability, cognition, activities of daily life, work, family, security and well-being in low and middle income settings.Objectives: This research aims to (a) understand pathways through which the social environment, functional disability, health behaviour and chronic disease experience influence SRH, (b) examine the role of SRH in predicting mortality, (c) validate SRH to improve its interpersonal comparability, and (d) assess how well estimates of SRH derived directly from a ‘small area’ survey compare with ‘small area’ estimates derived indirectly from a ‘large area’ survey.Methods: The Vadu Health and Demographic Surveillance System (HDSS) monitor health and demographic trends in a rural population of more than 100 000 in 22 villages in India since 2002. The full and short version of the SAGE survey was implemented in Vadu in 2007-09 among 321 and 5432 individuals aged 50 years and above, respectively. A structural equation model tested pathways through which social and biological factors influenced SRH. A Cox proportional hazard model examined the role of SRH as a predictor for mortality. Anchoring vignettes were used to evaluate SRH for reporting heterogeneity. The Hierarchical Ordered Probit model adjusted SRH for reporting heterogeneity. The SRH prevalence estimates for Vadu derived indirectly (indirect synthetic estimate, empirical Bayes estimate, Hierarchical Bayes estimate) from the national SAGE survey were compared with estimates derived directly from the Vadu SAGE survey, using different design and model-based techniques.Results: Older individuals reported poor SRH compared to those younger. Women rated their quality of life and SRH poorer than men. The effect of age on SRH was mediated through functional disability. Higher socioeconomic status and higher quality of life was in turn associated with better SRH but this relationship lacked statistical significance. Smoking or consumption of tobacco was associated with at least one chronic illness which in turn was associated with poor SRH and quality of life. However the association between chronic illness and SRH and quality of life was not statistically significant. Mortality risk was higher among individuals who reported bad/very bad SRH, disability and lack of spousal support independent of age and sex. There was strong evidence of reporting heterogeneity in SRH that was influenced by age, sex, education and socioeconomic status. The prevalence of ‘good / very good’ SRH was estimated to be 50%. This direct survey estimate compared well with the prevalence estimate of about 45% derived indirectly from model-based small area estimation methods. The indirect synthetic estimate for Vadu (23.2%) was a poor approximation to the direct survey or modelbased estimate.Conclusion: This research establishes the value and utility of SRH as a simple measure of health and predictor of mortality in an aging context. It provides evidence to formulate programs and policies towards an enabling social environment and an ability to function in key life domains of health and well-being. It highlights the need to identify and adjust self-rated responses for interpersonal incomparability prior to making comparisons across individuals or groups of individuals. It highlights the potential of using information from large national surveys by district level managers for planning and evaluation of policies and programs at the district or sub-district level. Finally, this research provides the basis for integrating SRH and related questions into routine HDSS.
|
|
| 4. |
- Karlsson, Omar, et al.
(författare)
-
The relationship of household assets and amenities with child health outcomes: an exploratory cross-sectional study in India 2015–2016
- 2020
-
Ingår i: SSM - Population Health. - : Elsevier BV. - 2352-8273. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- Healthy development of children in India is far from ensured. Proximate determinants of poor child health outcomes are infectious diseases and undernutrition, which are linked to socioeconomic status. In low- and middle-income countries, researchers rely on wealth indices, constructed from information on households’ asset ownership and amenities, to study socioeconomic disparities in child health. Some of these wealth index items can, however, directly affect the proximate determinants of child health. This paper explores the independent association of each item used to construct the Demographic and Health Surveys’ wealth index with diverse child health outcomes. This cross-sectional study used nationally representative sample of 245,866 children, age 0–59 months, from the Indian National Family Health Surveys conducted in 2015–16. The study used conditional Poisson regression models as well as a range of sensitivity specifications. After controlling for socioeconomic status, health care use, maternal factors, community-level factors, and all wealth index items, the following wealth index items were the most consistently associated with child health; type of toilet facilities, water source, refrigerator, pressure cooker, type of cooking fuel, having a bank account, land usable for agriculture, floor material, roof material, mobile phone, and motorcycle/scooter. The association with type of toilet facilities and water source was particularly strong for mortality, showing a 16-35% and 14-26% lower mortality, respectively. Most items used to construct the Demographic and Health Surveys’ wealth index only indicate household socioeconomic status, while a few items may affect child health directly, and can be useful targets for policy intervention.
|
|
| 5. |
- Karlsson, Omar, et al.
(författare)
-
Weakening association of parental education: analysis of child health outcomes in 43 low- and middle-income countries
- 2018
-
Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 48:1, s. 83-97
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundParental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association.MethodsWe used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach decomposition, and assessed a range of sensitivity specifications.ResultsThe point estimate for an additional year of maternal education has attenuated by 0.27% points (56%) for under-5 mortality, 0.34% points (15%) for child stunting, 0.42% points (30%) for child underweight and 0.09% points (24%) for child wasting. The point estimate for paternal education has attenuated by 0.20% points (53%) for under-5 mortality, 0.15% points (8%) for child stunting, 0.28% points (24%) for underweight and 0.06% points (19%) for wasting. Changes in confounding and mediation by fertility, household living standards and urban-rural differences explain to a large extent the attenuations. Geospatial clustering increasingly drives the association of parental education with child health.ConclusionsThe role of parental education in child health has attenuated considerably over time in low-resource settings. Decision makers should take into account this weakening association when designing policies aimed at improving child health.
|
|
| 6. |
- Li, Zhihui, et al.
(författare)
-
Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods : a multicountry analysis in 64 low- and middle-income countries
- 2021
-
Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups.METHODS: Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita.RESULTS: Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions-as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively.CONCLUSIONS: Along with the countries' economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health.
|
|
| 7. |
|
|
| 8. |
|
|
