Determinants of exclusive breastfeeding in rural South India

Background

While breastfeeding rates have improved globally, disparities in breastfeeding practices persist particularly in rural and low resource settings. In India, only 56% of Indian mothers practice exclusive breastfeeding (EBF) for the recommended six months. As India leads the world in the number of preterm births, under 5 years of age malnutrition and neonatal mortality, understanding the factors associated with EBF can help improve the nutritional status for millions of infants. We assessed the factors associated with EBF in rural Mysore, India.

Methods

This cross-sectional analysis was nested within a cohort study assessing the feasibility and uptake of mobile prenatal care and HIV counseling and testing intervention in Mysore District. Multivariable logistic regression was used to identify the factors associated with EBF for infants between birth and six months. Exclusive breastfeeding was defined as breastfeeding with no other liquids or breastfeeding substitutes given to infants exceptfor medicine or oral rehydration solution, between birth and 6 months and was assessed at six months postpartum.

Results

We surveyed mothers who delivered in rural Mysore taluk between 2008 and March 2011. A total of 1292 mothers participated in the study. The overall breastfeeding rate at six months postpartum was 74.9% and the EBF rate was 48.5%. Factors associated with EBF included higher maternal age (Adjusted Odds Ratio[aOR] 1.04; 95% Confidence Interval [CI] 1.00, 1.09), lower maternal education (aOR1.56, 95% CI 1.10, 2.21), and 7–10 antenatal visits (aOR 1.57; 95% CI 1.09, 2.27). The most common reason for non-exclusive breastfeeding was the mother’s feeling that she did not have enough milk (23.7%). Infants that were not exclusively breastfed were most commonly fed formula/animal milk (42.6%) or castor oil/ghee (18.4%).

Conclusions

Less than half of the mothers in our sample reported exclusive breastfeeding in a rural region of Karnataka, India in the first six months, a rate lower than national and state level rates. Future interventions should evaluate whether antenatal education can improve breastfeeding outcomes. The only modifiable factor was number of antenatal visits. Breastfeeding education should be emphasized at every antenatal visit so that even mothers with fewer than 7–10 antenatal visits can learn the best techniques and benefits of breastfeeding.

     

Determinants of maternity care services utilization among married adolescents in rural India

Background

Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.

Methodology/Principal Findings

Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.

Conclusions

The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to poor and specific sub-groups of the population in rural areas to address the unmet need for maternal healthcare service utilization.     

Determinants of use of maternal-child health services in rural Ghana

This study uses data from the Ghana Demographic and Health Survey (GDHS) of 1993 to examine factors determining the use of maternal-child health (MCH) services in rural Ghana. The MCH services under study are: (1) use of a doctor for prenatal care; (2) soliciting four or more antenatal check-ups; (3) place of delivery; (4) participation in family planning. Bivariate and multivariate techniques are employed in the analyses. The analyses reveal that the use of MCH services tends to be shaped mostly by level of education, religious background and region of residence, and partially by ethnicity and occupation. The implications of these results are discussed.     

Area variations in use of modern contraception in rural Bangladesh: a multilevel analysis.

This study in Bangladesh found that inter-cluster variation in the use of modern reversible methods of contraception was significantly attributable to the educational levels of the female family planning workers working in the clusters. Women belonging to clusters served by educated workers had a higher probability of being contraceptive users than those whose workers had only completed primary education. At the household level, important determinants of use were socioeconomic status and religion. At the individual level, the woman being the wife of the household head and having some education were positively related to her being a user. The model also found that inter-household variation was significantly greater than inter-cluster variation. Finally, the study concludes that after controlling for various covariates at all three levels, the clusters do not have significantly different levels of use of modern reversible methods of contraception. There are, however, some special areas where contraceptive use is dramatically low, and these contribute significantly to the observed inter-cluster variation.     

Determinants of early initiation of breastfeeding in rural Niger: cross-sectional study of community based child healthcare promotion

Background

Most child deaths are preventable and caused by behaviorally modifiable factors. By promoting optimal breastfeeding, we can reduce neonatal and child mortality risks by 45%. This paper provides new family and community based perspectives to identify factors interfering with the program impact on promoting early initiation of breastfeeding among the most vulnerable populations in rural Niger.

Methods

A secondary analysis of a retrospective cross-sectional study evaluated a UNICEF behavior change program on child healthcare. The study sample is based on a post-hoc constitution of two groups exposed and unexposed to the program. All women (n = 1026) aged 14–49 years having at least one child below 24 months of age were included. We measured crude and adjusted odds ratios with chi-square and multivariate logistic regression models.

Results

Independent variables shown to be associated with early breastfeeding include sales activities compared to household work with no direct income (AOR 7.7; 95% CI 1.3, 47.8) and mutual decision for harvest use (AOR 8.6; 95% CI 2.0, 36.8). Antenatal care did not modify the timing of breastfeeding initiation.

Conclusions

A high risk group of mothers with social and economic vulnerability are prone to suboptimal breastfeeding within the first hour of birth. Support from family and neighbors positively influenced early breastfeeding. Those who had no direct income and limited access to health services were a high-risk group, prone to delayed initiation of breastfeeding.

     

Microevolutionary change in Arikara Crania: a multivariate analysis

Measurements of human crania from five archaeological sites were subjected to canonical analysis. The five sites form a temporal sequence, ranging from prehistoric (ca. 1600 A.D.) to late historic (1830 A.D.), and belonging archaeologically to the Coalescent Tradition, which in South Dakota encompasses the historic Arikara Indians and their prehistoric ancestors. One canonical variate in each sex arranges the sites in their appropriate temporal sequence, presumably reflecting systematic microevolutionary change. The hypothesis that the morphological change resulted from gene flow from either White or Mandan Indian sources was tested using a two-group discriminate function. The function is found to effectively discriminate a Mandan sample and prehistoric Arikara, but becomes progressively less effective on the historic Arikara crania. This would suggest that Mandan gene flow into Arikara populations is responsible for the observed temporal variation. A similar analysis using British White crania suggests the possibility of slight White influence, but the effect is minimal compared to Mandan.     

Molecular analysis of G6PD variants in northern Italy: a study on the population from the Ferrara district

In the Ferrara district, an area south of the Po delta, four different variants of glucose-6-phosphate dehydrogenase (G6PD;E.C.1.1.49) have been described as a result of biochemical characterization of the enzyme protein: one was G6PD Mediterranean (G6PD Med) and three were local variants named Ferrara I, II, and III. The Ferrara I variant was recently analysed at the DNA level and shown to correspond to G6PD A^376G/202A, while the mutations causing the variants II and III, still remain unknown. We analysed the G6PD coding region of 18 apparently unrelated G6PD deficient subjects, whose families have lived in the Ferrara district for at least three generations: 12 subjects had G6PD Med^563T/1311T, 3, G6PD Santamaria^376G/542T and 2, G6PD A-^376G/202A. In one subject we found a new mutation, a GA transition at nucleotide 242 causing an ArgHis amino acid replacement at position 81. We named this new variant G6PD Lagosanto^{242 A}. Phenotypically the enzyme has nearly normal kinetic properties and appears different from the variants Ferrara II and III.     

Determinants of rural and urban fertility differentials in Nigeria

Whatever proximate variables are examined, their differential effects on rural and urban fertility are small. This indicates that no major disturbance has taken place in urban or rural reproductive norms. However, two possible reasons for the converging pattern of rural and urban fertility in Nigeria are identified. One is that urban mothers in the first half of the childbearing age range have higher fertility than their rural counterparts. The other is that breast-feeding and post-partum abstinence, which are the major determinants of marital fertility, exert a more depressing influence on rural than urban fertility.     

Water quality and public health in northern Sudan: a study of rural and peri-urban communities

Access to adequate supplies of good quality drinking water continues to be limited among many rural and peri-urban communities in Africa, despite several decades of water improvement programmes. The present study investigated water quality at the source and point of consumption among rural and peri-urban communities in northern Sudan. Faecal coliform counts were determined by the membrane filtration technique and geometric mean counts compared in different seasons and among the different communities. Among nomadic pastoralists and riverine villages, both water sources and water stored for consumption had faecal coliform counts grossly in excess of WHO standards, with higher counts at the end of the rainy season. In the peri-urban community on the outskirts of Omdurman, while water quality from the distribution system had faecal coliform counts generally below 10 dl - 1, after storage, water was of considerably lower quality, with faecal coliform counts up to 1000 d1 - 1. The highest counts again occurred in the rainy season. Rates of diarrhoeal disease for Khartoum province were also greatest towards the end of the rainy season. The study has shown that poor quality water continues to be a major risk factor for public health in these communities.     

Preferences for sex of children: a multivariate analysis

Data from the 1973-74 Growth of Alberta Family Study were used to determine whether women who express a preference for sons versus daughters differ from each other in terms of selected characteristics. 67% of the 599 women surveyed indicated a preference for at least 1 child of each sex. However, the majority of those who wanted 3 children desired 2 sons and 1 daughter, indicating a slight son preference. Discriminant function analysis indicated the pull toward son preference was greater the higher the woman's education, the more sisters the wife has, and the higher the current family size and number of additional children expected. While the number of wife's sisters makes the greatest contribution to daughter preference among adolescent mothers, birth place (Canada) was most important among older women. Finally, it was shown that acceptance of traditional female roles was a significant discriminator among women with a strong sex preference and those with no sex preference at all. These findings suggest that sex preference may become an important factor in fertility decisions as family size continues to decrease. If sex predetermination were to become possible, an imbalance in the sex ratio is a likely result.     

Perceived Morbidity,Healthcare-Seeking Behavior and Their Determinants in a Poor-Resource Setting: Observation from India

BackgroundTo control the double burden of communicable and non-communicable diseases (NCDs), in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting.MethodsBetween October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2.ResultsRecent illnesses were reported by 55.91% (n=24600) participants. Among diagnosed ailments (n=23626), 50.92% (n=12031) were NCDs. Respiratory (17.28%,n=7605)), gastrointestinal (13.48%,n=5929) and musculoskeletal (6.25%,n=2749) problems were predominant. Non-qualified practitioners treated 53.16% (n=13074) episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers(AOR_Pri)=0.76, 95% confidence interval=0.71-0.83) and for Govt. healthcare provider(AOR_Govt)=0.80(0.68-0.95)], females [AOR_Govt=0.80(0.73-0.88)], Muslims [AOR_Pri=0.85(0.69-0.76) and AOR_Govt=0.92(0.87-0.96)], backward castes [AOR_Govt=0.93(0.91-0.96)] and rural residents [AOR_Pri=0.82(0.75-0.89) and AOR_Govt=0.72(0.64-0.81)] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AOR_Pri=0.41(0.37-0.46) & AOR_Govt=0.41(0.37-0.46), osteoarthritis: AOR_Pri=0.72(0.59-0.68) & AOR_Govt=0.58(0.43-0.78)], gastrointestinal [AOR_Pri=0.28(0.24-0.33) & AOR_Govt=0.69(0.58-0.81)], respiratory [AOR_Pri=0.35(0.32-0.39) & AOR_Govt=0.46(0.41-0.52)] and skin infections [AOR_Pri=0.65(0.55-0.77)] were also less often treated by qualified practitioners. Better education [AOR_Pri=1.91(1.65-2.22) for ≥graduation], sanitation [AOR_Pri=1.58(1.42-1.75)] and access to safe water [AOR_Pri=1.33(1.05-1.67)] were associated with healthcare-seeking from qualified private practitioners. Longstanding NCDs [chronic obstructive pulmonary diseases: AOR_Pri=1.80(1.46-2.23), hypertension: AOR_Pri=1.94(1.60-2.36), diabetes: AOR_Pri=4.94(3.55-6.87)] and serious infections [typhoid: AOR_Pri=2.86(2.04-4.03)] were also more commonly treated by qualified private practitioners. Potential limitations included temporal ambiguity, reverse causation, generalizability issues and misclassification.ConclusionIn this poor-resource setting with high morbidity, ailments and their perceived severity were important predictors for healthcare-seeking. Interventions to improve awareness and healthcare-seeking among under-privileged and vulnerable population with efforts to improve the knowledge and practice of non-qualified practitioners probably required urgently.     

Self-care in rural areas of India and Nepal

Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar, better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.Portions of this paper were presented at the CPHA/WFPHA Annual Meetings and International Congress on Primary Health Care — A Global Perspective, Halifax, Nova Scotia, Canada, May 23–26, 1978. It is based on projects supported by the following institutions or agencies: India - Indian Council of Medical Research, Directorates of Health and Family Planning — Punjab and Karnataka, and the Agency for International Development (U.S.); and Nepal: Institute of Medicine (Nepal) and the International Development Research Centre (Canada).     

Habitat selection and association of stream insects: a multivariate analysis

SUMMARY. Habitat selection and interspecies associations of stream insects were evaluated from a set of quantitative benthos samples and habitat measurements (velocity, depth, substrate, quantities of fine and leafy detritus) from a mountain stream. Substrate was characterized by an in situ grid method which effectively describes the size and distribution of the larger surficial materials within each sample unit. A principal components ordination of samples as characterized by abundance data over all species accounted for 54% of the total variance in three dimensions but implied continuous rather than discrete faunal change with habitat. Gradients in the habitat could not be identified with real confidence. Canonical correlation analysis identified three significant habitat-fauna interactions. The first corresponded to the gradient from eroding to depositing substrates and included detritus abundance, the second distinguished areas of fine from leafy detritus and the third appeared to include velocity-stone size interactions. A graphical technique based on ordination of physical data and clustering of associated species adequately summarized the distribution of five Ephemerella mayflies. The multivariate and interactive nature of stream bottom environments is discussed for problems involving prediction and experimental design and control.