Papers by Prashant Kumar Singh
BMJ Open, 2021
Objective Areca nut is one of the most widely consumed substances globally, after nicotine, ethan... more Objective Areca nut is one of the most widely consumed substances globally, after nicotine, ethanol and caffeine and classified as carcinogenic to humans. This study examines the disparity and determinants of areca nut consumption with and without tobacco in India. Design Nationally representative cross-sectional study. Participants We used the nationally representative Global Adult Tobacco Survey 2016–2017. The analytical sample size was 74 037 individual’s aged 15 years and above with a response rate of 92.9%. Measures Current consumption of areca nut without tobacco and with tobacco. Method We examined determinants of areca nut consumption (without tobacco and with tobacco) using multinomial logistic regression, accounting for the survey design. Results About 23.9% (95% CI 23.1 to 24.8) of the adult population consume areca nut, that is, approximately 223.79 million people in India; majority of users (14.2%–95% CI 13.5 to 14.9) consumed areca nut with tobacco. When compared with ...
Journal of cross-cultural gerontology, Jan 15, 2016
The rapid growth of the older population in India draws attention to the factors that contribute ... more The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rura...
PLOS ONE
Background: Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May ... more Background: Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May 2009, this study tests for evidence and argues that health and climatic shocks are essentially linked forming a continuum and with exposure to a marginal one, coping mechanisms and welfare outcomes triggered in the response is significantly affected.
Indian Journal of Human Development
Social Science & Medicine
erspective in Public Health - Sage
PLOS ONE
BACKGROUND: Although child immunization is regarded as a highly cost-effective lifesaver, about f... more BACKGROUND: Although child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12-23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India's public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992-2006 across six major geographical regions in India.DATA AND METHODS: Three rounds of the National Family Health Survey (NFHS) conducted during 1992-93, 1998-99 and 2005-06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time.KEY FINDINGS: The analysis of change over one and half decades (1992-2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992-2006.CONCLUSION: This study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.
Global Health Action / COACTION
BACKGROUND: Addressing inequitable coverage of maternal and child health care services among diff... more BACKGROUND: Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets.OBJECTIVE: This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH) care services across household wealth quintiles in India and its states.DESIGN: Utilizing the District Level Household and Facility Survey conducted during 2007-08, this paper has constructed a Composite Coverage Index (CCI) in MNCH care.RESULTS: The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a ≤50% coverage in MNCH care services, which demands special attention.CONCLUSION: India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.
World Journal of Pediatrics / Springer
Health Policy and Planning / Oxford University Press
BACKGROUND Studies have often ignored examining the role of community- and district-level factors... more BACKGROUND Studies have often ignored examining the role of community- and district-level factors in the utilization of maternity healthcare services, particularly in Indian contexts. The Social Determinants of Health framework emphasizes the role of governance and government policies, the measures for which are rarely incorporated in single-level individual analysis. This study examines factors associated with maternal healthcare utilization in nine high focus states in India, which shares more than half of the total maternal deaths in the country; accounting for individual-, household-, community- and district-level characteristics. METHODS The required data are extracted from the third round of the nationally representative District Level Household and Facility Survey conducted during 2007-08. Multilevel analyses were applied to three maternity outcomes, namely, four or more antenatal care visits, skilled birth attendance and post-natal care after birth.Findings Results show that along with individual-/household-level factors, community and district-level factors influence the pattern of utilization of maternal healthcare services significantly. At the community level, the odds of maternal healthcare utilization were lower in rural areas and in communities with a high concentration of poor and illiterate women. Moreover, the average population coverage of primary health centres (PHCs), availability of labour room in PHC and percentage of registered pregnancies were significant factors at the district level that influenced the use of maternity care services. The study also found a strong association between the extent of previous use of maternal healthcare and its effect on subsequent usage patterns. CONCLUSION This study highlights the role of strengthening public health infrastructure at district level in the study area, and promoting awareness about available healthcare services and subsidized schemes in the community. To reach out to rural and underprivileged communities and to apply a participatory approach from the programme officials are issues to delve into.
ournal of Biosocial Science / Cambridge University Press
Summary This study examines the association between age cohort and utilization of maternal health... more Summary This study examines the association between age cohort and utilization of maternal health care services in India, before and after adjusting for individual, household and contextual factors. Using data from the Demographic and Health Survey 2005-06, women were classified into three distinct age cohorts based on their age at childbirth: 15-24, 25-34 and 35-49 years. Binary logistic regression models were applied to assess the influence of women's age cohort on receiving full antenatal care (ANC) and skilled birth attendance (SBA). The analytical sample included the women who delivered their most recent birth at any time in the 5 years preceding the survey. Women belonging to the younger age cohort were found to be disadvantaged in receiving full ANC, whereas increasing age of women was negatively associated with receiving SBA. Low level of education, low mass media exposure, low autonomy, belonging to deprived social groups, poor economic status and residence in the central region were found to be major constraining factors in receiving full ANC and SBA for women in India. The findings support the need for 'age-sensitive' interventions that tailor programmes and incentives to women's health care needs through the reproductive life-stage. Urgent efforts are needed to ensure that women who are illiterate and those belonging to low autonomy and low socioeconomic groups receive the recommended maternal health care benefits.
WHO Eastern Mediterranean Health Journal / World Health Organisation
Journal of Public Health / Springer
Aim This study examines the factors associated with the utilisation of maternal healthcare servic... more Aim This study examines the factors associated with the utilisation of maternal healthcare services by married adolescent women in the age group 15–19. Subjects and methods Using the nationally representative cross-sectional data from the fourth wave of Mali Demographic and Health Survey (MDHS), 2006, the present study tries to demonstrate the factors associated with the indicators of maternal healthcare service utilisation among women who had the experience of childbirth in their adolescence (age 15–19) during the 5 years preceding the survey date. Three indicators were measured: adolescent women who had at least four antenatal care visits, those who had undergone safe delivery care, and those who had received post natal care after delivery. Bivariate analyses including chi-square tests to determine the difference in proportion, and logistical models to understand the net effect of explanatory variables on selected outcomes were applied. Results Results show the poor performance in maternal healthcare utilisation in Mali. Factors such as women’s education, husband’s education, women’s personal barrier index, mass media exposure, place of residence and previous delivery services used appeared to be the most significant factors associated with the utilisation of maternity services by Malian adolescents. Conclusion The present study indicates that a strong community based campaign is necessary to raise awareness about the adverse effects of early marriage and childbearing. It is important to tailor programs to meet the unique needs of the varied teen populations and take into consideration how the family environment and relationships influence decision making about sex, contraception and childbearing.
Journal of Public Health / Oxford University Press
BACKGROUND: Increasing the coverage of key maternal, newborn and child health interventions is es... more BACKGROUND: Increasing the coverage of key maternal, newborn and child health interventions is essential, if India has to attain Millennium Development Goals 4 and 5. This study assesses the coverage gap in maternal and child health services across states in India during 1992-2006 emphasizing the rural-urban disparities. Additionally, association between the coverage gap and under-5 mortality rate across states are illustrated.METHODS: The three waves of National Family Health Survey (NFHS) conducted during 1992-1993 (NFHS-1), 1998-1999 (NFHS-2) and 2005-2006 (NFHS-3) were used to construct a composite index of coverage gap in four areas of health-care interventions: family planning, maternal and newborn care, immunization and treatment of sick children.RESULTS: The central, eastern and northeastern regions of India reported a higher coverage gap in maternal and child health care services during 1992-2006, while the rural-urban difference in the coverage gap has increased in Gujarat, Haryana, Rajasthan and Kerala over the period. The analysis also shows a significant positive relationship between the coverage gap index and under-five mortality rate across states.CONCLUSION: Region or area-specific focus in order to increase the coverage of maternal and child health care services in India should be the priority of the policy-makers and programme executors.
Maternal and Child Health Journal / Springer
Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is... more Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is known about factors that affect access of teenage mothers to maternal and child health (MCH) services in Niger. This paper explores potential factors associated with the utilization of MCH care services by adolescent mothers. Using the third wave of the Niger demographic and health survey (NDHS) 2006, we estimate three multivariate logistic regression models to assess individual characteristics associated with the utilization of antenatal care (ANC) and safe delivery care services among adolescent women, as well as full immunization received by children born to adolescent mothers. The analytical sample includes 934 adolescent mothers out of 1,835 respondents aged 15-19, and within this group, 493 mother-child dyads for children aged 12-59 months. Possessing any level of education was found associated with the increased use of all three selected MCH services, while urban residence and higher income were associated with the increased use of two of three MCH services studied. Higher birth order plus a birth interval more than 2 years for the most recent birth appeared associated with the lower probability of antenatal care visits and safe delivery care. This study finds that women who attended at least four ANC visits were more likely to experience safe delivery care, and the children whose mothers had safe delivery care were more likely to receive full immunization. Therefore, an effective program should be designed to promote a continuum of MCH care with special attention to adolescent women who are uneducated, poor and residing in rural areas.
Journal of Community Health / Springer
The increased reach of health programs in India during the past few decades has contributed to a ... more The increased reach of health programs in India during the past few decades has contributed to a decline in postnatal mortality including infant and child mortality; however, reduction in neonatal mortality remained negligible. About seven out of ten neonatal deaths take place within a week after birth. The progress in reduction as well as dimension along which early neonatal mortality is patterned in India remains unclear. We examine the trend in early neonatal mortality and its possible demographic and socioeconomic predictors using nationally representative data. Data from the three cross-sectional rounds of the National Family Health Survey of India from 1992 to 1993, 1998 to 1999 and 2005 to 2006 were analyzed. Early neonatal mortality rate was estimated for selected demographic and socioeconomic population groups and for major states in India using information on births and deaths during the 3 years preceding the respective surveys. Using the multivariate logistic regression model, we assessed proximate determinants of early neonatal deaths during 1990-2006. Sex of the child, child's birth size, birth order and interval, type of child's birth, mother's age at child's birth, mother's educational status, religion, household economic status and region of residence emerged as significant predictors of early neonatal deaths. The adjusted multivariate analysis indicates that majority of the socio-demographic predictors reveal a negligible decline in the probability of early neonatal deaths during 1990-2006. Moreover, based on comprehensive reviews of scientific literature on newborn's survival we document some of the recommended ways to prevent early neonatal mortality in India.
Journal of Public Health / Springer
Aim While there has been a considerable decline in birth rate worldwide, there is growing concern... more Aim While there has been a considerable decline in birth rate worldwide, there is growing concern among program and policy makers about the level of adolescent birth rate (ABR, birth per 1,000 women aged 15–19 years), commonly considered an indicator of teenage childbearing, a potential cause of maternal and child morbidity and mortality. This has also been addressed in the fifth Millennium Development Goal. The insufficient performance in reducing ABR led to the establishment of the United Nations Interagency Task Force on Adolescent Girls (UNITFAG) in 2010. The UNITFAG aims to make girls a priority in national development planning and it is expected that by 2015, the task force would have successfully rolled out comprehensive programs in twenty developing countries that will improve their health and education, promote their leadership skills and protect them from violence. In this overview, we discuss both the accomplishments and the barriers faced in addressing ABR globally, and the policies and programs required to tackle them. Subject and methods Literature review Results We propose a bi-model approach to address the issue of teenage childbearing. The approach includes preventing early marriage and focuses on postponing childbearing among girls who were married at an early age. Conclusion The most effective approach to make communities realise how teenage childbearing compromises the health of mothers as well as their children is the targeted community based intervention.
PLOS ONE
BACKGROUND: India, with a population of more than 1.21 billion, has the highest maternal mortalit... more BACKGROUND: India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15-19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)-5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15-19) in India during 1990-2006.METHODS AND FINDINGS: Data from three rounds of the National Family Health Survey of India conducted during 1992-93, 1998-99, and 2005-06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990-2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups.CONCLUSION: Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive 'adolescent scheme' along the lines of 'Continuum of Maternal, Newborn and Child health Care' to address the unmet need of reproductive and maternal healthcare services among adolescent women in India.
Journal of Public Health / Springer
Aim Despite major advances in maternal and child health care initiatives in India, the Millennium... more Aim Despite major advances in maternal and child health care initiatives in India, the Millennium Development Goal (MDG)-4 targeting a two-third reduction in under-five mortality appears to be unattainable by 2015. This paper assesses India’s feasibility towards averting infant (0–11 months) and child (0–4 years) mortality by 2015 across regions and major states. Subjects and methods Using statewise estimates on infant mortality rate (IMR) during 1990–2009 and child mortality rate (CMR) during 1990–2008 from the Sample Registration System of India, this paper estimates average annual rate of reduction (AARR) in IMR and CMR across regions and major states. The estimates are also provided for the shortfall in IMR and CMR from the projected estimates of 2015 and the required AARR for the successive years up to 2015. Results Estimated figures suggest that India has experienced a substantial decline in the IMR and CMR since 1990. However, an AARR of around 10 and 8 % is required for reducing infant (during 2010–2015) and child mortality (during 2009–2015), respectively, in order to achieve a two-third reduction in the IMR and CMR from the level of 1990. Conclusion Although the MDG-4 target is based on U5MR in totality, this study draws attention towards the progress in major components of the U5MR separately, and advocates for disaggregation of MDG target at national level in terms of focus (region-specific) towards achieving required reduction in separate components of under-five mortality.
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Papers by Prashant Kumar Singh