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Sultānpur Lodhi, India

Cronin A.A.,UNICEF India Country Office | Thompson N.,Arghyam Inc.
Journal of Water Sanitation and Hygiene for Development

This paper reviews progress on monitoring and evaluation on water, sanitation and hygiene (WASH) programmes in rural India, focusing on the Government programs and the related data and monitoring initiatives. The current state of the WASH sector is presented and discussed in terms of progress across geographical, wealth and social groupings, Though progress has been made, key challenges include data quality, reliability, standardization, availability, reach to all social groups and scaling up with quality services. Possible ways forward are proposed at various administrative levels (National, State, District and down to the individual) and discussed along with good sector practices. Efforts that advocate for increased public data becoming available on-line and then using this to improve the visualization of data are described. Recommendations are identified around increasing evidence-based policy and implementation and help support corrective management action via the linking of monitoring to intervention to results and stronger integration across the social, financial and technical issues. © IWA Publishing 2014. Source

Agrawal P.,UNICEF India Country Office | Gupta K.,International Institute for Population Sciences | Mishra V.,United Nations Population Division | Agrawal S.,NCR
Women and Health

Psychosocial factors among overweight, obese, and morbidly obese women in Delhi, India were examined. A follow-up survey was conducted of 325 ever-married women aged 20–54 years, systematically selected from 1998–99 National Family Health Survey samples, who were re-interviewed after 4 years in 2003. Information on day-to-day problems, body image dissatisfaction, sexual dissatisfaction, and stigma and discrimination were collected and anthropometric measurements were obtained from women to compute their current body mass index. Three out of four overweight women (BMI between 25 and 29.9 kg/m2) were not happy with their body image, compared to four out of five obese women (BMI of 30 kg/m2 or greater), and almost all (95 percent) morbidly obese women (BMI of 35 kg/m2 or greater) (p <.0001). It was found that morbidly obese and obese women were five times (adjusted odds ratio [aOR] 5.29, 95% confidence interval [CI] 2.02–13.81, p <.001) and two times (aOR 2.30, 95% CI 1.20–4.42, p <.001), respectively, as likely to report day-to-day problems; twelve times (aOR 11.88, 95% CI 2.62–53.87, p <.001) and three times, respectively, as likely (aOR 2.92, 95% CI 1.45–5.88, p =.001) to report dissatisfaction with body image; and nine times (aOR 9.41, 95% CI 2.96–29.94, p <.001) and three times (aOR 2.93, 95% CI 1.03–8.37, p =.001), respectively, as likely to report stigma and discrimination as overweight women. © , Published with license by Taylor & Francis Source

Prinja S.,Post Graduate Institute of Medical Education and Research | Manchanda N.,Post Graduate Institute of Medical Education and Research | Mohan P.,UNICEF India Country Office | Gupta G.,UNICEF | And 4 more authors.
Indian Pediatrics

Objective: To assess the unit cost of level II neonatal intensive care treatment delivered through public hospitals and its fiscal implications in India. Design: Cost analysis study. Setting: Four Special Care Newborn Units (SCNUs) in public sector district hospitals in three Indian states, i.e. Bihar, Madhya Pradesh and Orissa, for the period 2010. Methods: Bottom-up economic costing methodology was adopted. Health system resources, i.e. capital, equipment, drugs and consumables, non-consumables, referral and overheads, utilized to treat all neonates during 2010 were elicited. Additionally, 360 randomly selected treatment files of neonates were screened to estimate direct out-of-pocket (OOP) expenditure borne by the patients. In order to account for variability in prices and other parameters, we undertook a univariate sensitivity analysis. Main Outcome Measures: Unit cost was computed as INR (Indian national rupees) per neonate treated and INR per bed-day treatment in SCNU. Standardized costs per neonate treatment and per bed day were estimated to incorporate the variation in bed occupancy rates across the sites. Results: Overall, SCNU neonatal treatment costs the Government INR 4581 (USD 101.8) and INR 818 (USD 18.2) per neonate treatment and per bed-day treatment, respectively. Standardized treatment costs were estimated to be INR 5090 (USD 113.1) per neonate and INR 909 (USD 20.2) per bed-day treatment. In the event of entire direct medical expenditure being borne by the health system, we found cost of SCNU treatment as INR 4976 (USD 110.6) per neonate and INR 889 (USD 19.8) per bed-day. Conclusions: Level II neonatal intensive care at SCNUs is cost intensive. Rational use of SCNU services by targeting its utilization for the very low birth weight neonates and maintenance of community based home-based newborn care is required. Further research is required on cost-effectiveness of level II neonatal intensive care against routine pediatric ward care. Source

Mazumder S.,Center for Health Research and Development | Taneja S.,Center for Health Research and Development | Bahl R.,World Health Organization | Mohan P.,UNICEF India Country Office | And 7 more authors.
BMJ (Online)

Objective: To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practices and on neonatal and infant morbidity. Design: Cluster randomised trial. Setting: Haryana, India. Participants: 29 667 births in nine intervention clusters and 30 813 births in nine control clusters. Main outcome measures: The pre-specified outcome was the effect on treatment seeking practices. Post hoc exploratory analyses assessed morbidity, hospital admission, post-neonatal infant care, and nutritional status outcomes. Interventions: The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers, improved case management of sick children, and strengthening of health systems. Outcomes were ascertained through interviews with randomly selected caregivers: 6204, 3073, and 2045 in intervention clusters and 6163, 3048, and 2017 in control clusters at ages 29 days, 6 months, and 12 months, respectively. Results: In the intervention cluster, treatment was sought more often from an appropriate provider for severe neonatal illness (risk ratio 1.76, 95% confidence interval 1.38 to 2.24), for local neonatal infection (4.86, 3.80 to 6.21), and for diarrhoea at 6 months (1.96, 1.38 to 2.79) and 12 months (1.22, 1.06 to 1.42) and pneumonia at 6 months (2.09, 1.31 to 3.33) and 12 months (1.44, 1.00 to 2.08). Intervention mothers reported fewer episodes of severe neonatal illness (risk ratio 0.82, 0.67 to 0.99) and lower prevalence of diarrhoea (0.71, 0.60 to 0.83) and pneumonia (0.73, 0.52 to 1.04) in the two weeks preceding the 6 month interview and of diarrhoea (0.63, 0.49 to 0.80) and pneumonia (0.60, 0.46 to 0.78) in the two weeks preceding the 12 month interview. Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life (risk ratio 3.19, 2.67 to 3.81). Conclusion: Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity, a likely explanation for the reduction in mortality observed following implementation of the programme in this study. Source

Mohan P.,UNICEF India Country Office | Kishore B.,Ministry of Health and Family Welfare | Singh S.,Jawaharlal Institute of Postgraduate Medical Education & Research | Bahl R.,World Health Organization | And 2 more authors.
Journal of Health, Population and Nutrition

At the current rate of decline in infant mortality, India is unlikely to achieve the Millennium Development Goal on child survival. Integrated Management of Neonatal and Childhood Illness (IMNCI), adapted from the global Integrated Management of Childhood Illness to enhance the focus on newborns and on community health workers, is the central strategy within the National Reproductive and Child Health Programme to address high infant mortality. This paper assessed the progress of IMNCI in India, identified the programme bottlenecks, and also assessed the effect on coverage of key newborn and childcare practices. Programme data were analyzed to ascertain the implementation status; rapid programme assessment was conducted for identifying the programme bottlenecks; and results of analysis of two rounds of district-level household surveys were used for comparing the change in the coverage of child-health interventions in IMNCI and control districts. More than 200,000 community health workers and first-level healthcare providers were trained during 2005-2009 at a variable pace across 223 districts. Of the reported births (n=1,102,573), 65.5% were visited by a trained worker within 24 hours, and 63.1% were visited three times within 10 days. Poor supervision and inadequate essential supplies affected the performance of trained workers. During 2004-2008, 12 early-implementing districts had covered most key newborn and child practice indicators compared to the control districts; however, the difference was significant only for care-seeking for acute respiratory infection (net difference: 17.8%; 95% confidence interval 2.3-33.2, p<0.026). Based on the early experience of IMNCI implementation in different states of India, measures need to be taken to improve supportive supervision, availability of essential supplies, and monitoring of the programme if the strategy has to translate into improved child survival in India. © International Centre for Diarrhoeal Disease Research, Bangladesh. Source

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