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Covariates of diarrhoea among under-five children in India: Are they level dependent?

ABSTRACT: Program interventions like access to improved water supply, sanitation and hygiene do not have a systematic response to the aggregate health outcomes. Therefore, this is an attempt at recognising the concept of level sensitivity while verifying the association between prevalence of diarrhoea in under-five children in a district and its corresponding coverage of improved water supply and sanitation and hygiene. Information obtained in the DLHS-4 including 275 districts from 19 states and 2 union territories of India forms the database for this analysis. Universal access to safe drinking water, improving coverage of sanitation in a district beyond 71 percent across the country and beyond 78 percent among the non-south DLHS districts, has the potential to realise reductions in the prevalence of diarrhoea in under-five children in a district. The effect of improved sanitation seems to work synergistically with these indicators only at better levels of prevalence of diarrhoea in under-five children in a district. This offers lessons for the Clean India Mission in terms of universalising access to safe water and coverage up to three-fourths of households with sanitation in a district for the positive externalities to manifest in reduced prevalence of diarrhoea in under-five children.

SUBMITTER: Ramanathan M

PROVIDER: S-EPMC6703849 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Covariates of diarrhoea among under-five children in India: Are they level dependent?

Ramanathan Mala M Vijayan Bevin B

PloS one 20190821 8

Program interventions like access to improved water supply, sanitation and hygiene do not have a systematic response to the aggregate health outcomes. Therefore, this is an attempt at recognising the concept of level sensitivity while verifying the association between prevalence of diarrhoea in under-five children in a district and its corresponding coverage of improved water supply and sanitation and hygiene. Information obtained in the DLHS-4 including 275 districts from 19 states and 2 union ...[more]

PMID: 31433822

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Project description:BackgroundThis paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India.Methodology/principal findingsInformation on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007-08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention.ConclusionEven after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India.

Project description:BACKGROUND:Diarrhoea is one of the major contributors to death among under-five children in Ethiopia. Studies conducted in different countries showed that rural children are more severely affected by diarrhoea than urban children. Thus, this study was aimed to identify the socio-demographic, environmental and behavioural associated risk factors of the occurrence of diarrhoea among under-five children in rural Ethiopia. METHODS:Data for the study was drawn from the 2016 Ethiopian Demographic and Health Survey. A total of 8041 under-five children were included in the study. Binary logistic regression was used to assess the association of occurrence of diarrhoea with socio-demographic, environmental and behavioural factors among under-five children. RESULTS:Children aged 6-11?months (AOR:3.5; 95% CI: 2.58-4.87), 12-23?months (AOR: 3.1; 95% CI: 2.33-4.04) and 24-35?months (AOR: 1.7; 95% CI: 1.26-2.34) as compared to >?35?months were significantly associated with an increasing prevalence of diarrhoea. Children in Afar region (AOR: 1.92; 95% CI: 1.01-3.64) and Gambela region (AOR: 2.12; 95% CI: 1.18, 3.81) were significantly associated with an increasing prevalence of diarrhoea, but a decreasing prevalence in Somali region (AOR: .42; 95% CI: (.217-.80) as compared to Tigray region. Increasing prevalence of diarrhoea was also significantly associated with male children (AOR: 1.3; 95% CI: 1.05-1.58); households who shared toilet facilities with other households (AOR: 1.4; 95% CI: 1.09-1.77); fourth birth order (AOR: 1.81; 95% CI: 1.17-2.79), and fifth and above birth order (AOR: 1.85; 95% CI: 1.22, 2.81) as compared to first order; and mother's current age 35-49?years in a household with ?3 under-five children (AOR: 4.7; 95% CI: 1.64-13.45) as compared to those maternal ages of 15-24?years in a household with ?2 under-five children. CONCLUSION:The age of a child, sex of a child, region, birth order, toilet facilities shared with other households and the interaction effect of the number of under-five children with mother's current age are identified as associated risk factors for diarrhoea occurrence among under-five children in rural Ethiopia. The findings show the need for planning and implementing appropriate prevention strategies considering these risk factors for rural under-five children.

Project description:Anemia is highly prevalent in India, especially in children. Exposure to ambient fine particulate matter (PM2.5) is a potential risk factor for anemia via. systemic inflammation. Using health data from the National Family and Health Survey 2015-2016, we examined the association between ambient PM2.5 exposure and anemia in children under five across India through district-level ecological and individual-level analyses.MethodsThe ecological analysis assessed average hemoglobin levels and anemia prevalence (hemoglobin < 11 g/dL considered anemic) by district using multiple linear regression models. The individual-level analysis assessed average individual hemoglobin level and anemia status (yes/no) using generalized linear mixed models to account for clustering by district. Ambient PM2.5 exposure data were derived from the Multiangle Imaging SpectroRadiometer (MISR) level 2 aerosol optical depth (AOD) data and averaged from birth date to date of interview.ResultsThe district-level ecological analysis found that, for every 10 μg m-3 increase in ambient PM2.5 exposure, average anemia prevalence increased by 1.90% (95% CI = 1.43, 2.36) and average hemoglobin decreased by 0.07 g/dL (95% CI = 0.09, 0.05). At the individual level, for every 10 μg m-3 increase in ambient PM2.5 exposure, average hemoglobin decreased by 0.14 g/dL (95% CI = 0.12, 0.16). The odds ratio associated with a 10-μg m-3 increase in ambient PM2.5 exposure was 1.09 (95% CI = 1.06, 1.11). There was evidence of effect modification by wealth index, maternal anemia status, and child BMI.ConclusionOur results suggest that ambient PM2.5 exposure could be linked to anemia in Indian children, although additional research on the underlying biologic mechanisms is needed. Future studies on this association should specifically consider interactions with dietary iron deficiency, maternal anemia status, and child BMI.Keywords: Anemia; Children; Ambient PM2.5 exposure; India; Association.

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Covariates of diarrhoea among under-five children in India: Are they level dependent?

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Covariates of diarrhoea among under-five children in India: Are they level dependent?

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