Economic consequences of maternal illness in rural Bangladesh

We use panel data on household consumption combined with information taken from the medical records of women who gave birth in health facilities to explore the economic consequences of maternal ill health, in the context of a rural population in Bangladesh. The findings suggest that there is a large reduction in household resources associated with maternal illness, driven almost entirely by spending on health care. In spite of this loss of resources, we find that households are able to fully insure consumption against maternal ill health, although confidence intervals are unable to rule out a small effect. Households in our study area are shown to have good access to informal credit (whether it be from local money lenders or family relatives), and this appears critical in helping to smooth consumption in response to these health shocks, at least in the short term.     

Welfare consequences of access to health insurance for rural households: Evidence from the New Cooperative Medical Scheme in China

This study evaluates the welfare benefits of the New Cooperative Medical Scheme (NCMS), the main public health insurance plan for the rural population in China. The findings show that the value of the NCMS to recipients is slightly lower than the government's costs of implementation, ranging from 0.79 to 0.97 per RMB of the resource cost of the NCMS. The estimated moral hazard costs are low compared with the total benefits. It is also estimated that the benefits originating from the NCMS's insurance function only constitute 20% of the total benefits, suggesting a need for higher generosity levels among rural households. Our results shed new light on the welfare effects of access health insurance among low‐ and middle‐income households.     

农民家庭合同保健制度的实践与思考

河南省武陟县地处黄河北岸 ,全县共有人口 62万 ,其中农业人口 5 1.5万 ,占 83.3%。全县辖 15个乡镇 ,366个行政村。有乡镇卫生院 15所 ,农村社区卫生服务站 5 7个 ,一体化管理村卫生所 2 93个 ,一体化管理防疫点 4 3个 ,乡村医生 984人。1999年以来 ,该县在全面开展乡村卫生组织管理一体化和农村社区卫生服务的基础上 ,积极进行农民家庭合同保健试点探索 ,在建立新时期农民健康保障制度方面进行了有益的尝试 ,并取得较好成效。截止2 0 0 0年底 ,全县共有 11767户农户同社区卫生服务站或卫生所签订了家庭保健合同 ,占全县总农户的9.87%。参…     

The economic consequences of malaria for households: a case-study in Nepal

Increased attention has recently been paid to the impact of illness on the well-being of households in developing countries. This has been a particular theme in the case of malaria, but relatively little evidence is available on how households react to malaria and on its impact on expenditure and time allocation patterns. This paper reports the results of a study designed to investigate the economic consequences of malaria for households in Nepal. A household survey of malaria cases in two districts provided information on use of various sources of treatment, their cost to households, time lost by the person with malaria, the extent to which others inside or outside the household provided assistance with the normal work of the malaria patient, the time spent caring for a child with malaria and any financial losses associated with the malaria episode. Out-of-pocket expenditure on treatment differed greatly between the two districts, for reasons associated with the choice of public or private sources of treatment and the number of visits made per episode. The majority of households appeared to cope without great difficulty with the reduction in labour supply caused by a malaria episode, by drawing largely on the time of adult family members. Caution is advised in extrapolating the results to other situations, given the extent to which local factors are likely to influence the impact on households. Moreover, the findings relate to a situation where a malaria control programme is in place: a relatively greater impact per household would occur in the absence of control. However, it is argued that such surveys have value in informing health policy, particularly in relation to setting priorities and treatment policy.     

Daily average exposures to respirable particulate matter from combustion of biomass fuels in rural households of southern India

Indoor air pollution resulting from combustion of biomass fuels in rural households of developing countries is now recognized as a major contributor to the global burden of disease. Accurate estimation of health risks has been hampered by a paucity of quantitative exposure information. In this study we quantified exposures to respirable particulate matter from biomass-fuel combustion in 436 rural homes selected through stratified random sampling from four districts of Tamil Nadu, India. The study households are a subset of a larger sample of 5,028 households from the same districts in which socioeconomic and health information has been collected. Results of measurements for personal exposures to respirable particulate matter during cooking were reported earlier. This has been extended to calculation of 24-hr exposures with the aid of additional measurements during noncooking times and the collection of time-activity records. Concentrations of respirable particulate matter ranged from 500 to 2,000 micro g/m(3) during cooking in biomass-using households, and average 24-hr exposures ranged from 90 +/- 21 micro g/m(3) for those not involved in cooking to 231 +/- 109 micro g/m(3) for those who cooked. The 24-hr exposures were around 82 +/- 39 micro g/m(3) for those in households using clean fuels (with similar exposures across household subgroups). Fuel type, type and location of the kitchen, and the time spent near the kitchen while cooking were the most important determinants of exposure across these households among other parameters examined, including stove type, cooking duration, and smoke from neighborhood cooking. These estimates could be used to build a regional exposure database and facilitate health risk assessments.     

A contingent valuation study to estimate the parental willingness-to-pay for childhood diarrhoea and gender bias among rural households in India

We used contingent valuation technique to estimate the parental willingness to pay for an episode of diarrhoea among 324 children of both sexes aged between five and seven years in two rural villages of Chennai in India. The aim was to examine if there was any gender bias in the parental willingness to treat children for a diarrhoeal episode, and if so to what extent. The willingness to pay was specified as a hedonic function of the duration and severity of an episode, and of parents' socioeconomic characteristics. The findings suggest that parents were willing to pay more to protect their male child compared to the female child suffering from a diarrhoeal episode. The median willingness to pay to avoid an episode for male and female children were calculated at Rs. 33.7 (approx. US0.72) and Rs. 25.2 (approx. US 0.72) and Rs. 25.2 (approx. US 0.54) respectively – a difference of around 34%. After adjusting for the greater duration and severity of the illness, it was found that the difference between the two medians increased to 51%.     

Dual forms of malnutrition in the same households in Malaysia--a case study among Malay rural households

This report is a part of a multi-centre study in Asia on the problem of dual forms of malnutrition in the same households. In Malaysia, the prevalence of underweight and stunting persist among young children from poor rural areas. Overweight in adults, especially women from poor rural areas has been reported in recent years. Thus, this study was undertaken in order to assess the presence of the dual burden of underweight child-overweight mother pairs in a poor rural community. Out of 140 Malay households identified to have at least one child aged 1-6 years and mother aged above 20 years, 52.1% of the mothers were overweight, 15.7% of the children were underweight, 27.1% stunted and 5% wasted. Socio-economic background and food intake frequency data were collected from 54 underweight child/overweight mother pairs (UW/OW) and 41 normal weight child/normal weight mother pairs (NW/NW). Compared with the overweight mothers, a higher percentage of the normal weight mothers had received secondary education, were employed and with a higher household monthly income, although these differences were not significant. Patterns of food intake of the mothers and children appeared to have more similarities than differences between the UW/OW and NW/NW groups. Quantitative dietary intakes for 2 days using 24-hr recall and physical activity energy expenditure over the same period were assessed in a sub-group of UW/OW and NW/NW mothers and children. The NW/NW children showed significantly higher intake of total calories, fat and riboflavin than the UW/OW counterparts. Mean energy and nutrient intake of mothers from both groups were not significantly different, although the NW/NW mothers showed higher intake adequacy for total calories and most nutrients. While most of the mothers from both groups reported having no chronic illnesses, about half of the children in both groups had infections, especially gastrointestinal infections, over a 2-week period. Energy expenditure from physical activity for both UW/OW and NW/NW mothers and children did not differ significantly. This study confirmed inadequate intake of total energy and nutrients as the major factor for underweight in Malay children from rural areas. However, assessing intake and physical activity by interview methods were not sensitive enough to overcome perceived problems of under-reporting of energy intake and over-estimation of energy expenditure, especially by overweight subjects. Further investigations on a larger sample are necessary to understand the family dynamics leading to the double burden of malnutrition within the same household.     

Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India.

The epidemiology of rheumatic fever and rheumatic heart disease in a rural community (total population 114,610) in northern India was studied by setting up a registry based on primary health care centres. Health workers and schoolteachers were trained to identify suspected patients in school and village surveys (121 villages). Medical specialists screened 5-15-year-olds (n = 31,200). The population was followed up for 3 years (from March 1988 to March 1991). All suspected and registered cases were investigated by serial echocardiography and Doppler ultrasonography at a tertiary care centre. A total of 102 cases were confirmed to have rheumatic fever/rheumatic heart disease (prevalence, 0.09%); 66 were aged 5-15 years (prevalence, 0.21%). A total of 48 patients (24 males, 24 females; mean age, 12.11 +/- 3.7 years) were diagnosed to have a possible first attack of rheumatic fever (incidence, 0.54 per 1000 per year). Arthritis was observed in 36 (75%) and carditis in 18 (37.5%) of cases. Prolapse of the anterior mitral leaflet into the left atrium occurred in 5 (22%) cases with carditis. Mitral regurgitation was observed in all 18 cases of carditis; over the period of observation it disappeared in three cases and progressed to mitral stenosis in a further three. A total of 22 patients (11 males, 11 females; mean age, 19.41 +/- 8.1 years) were registered as rheumatic fever recurrences, and 32 patients (18 females, 14 males; mean age, 22.1 +/- 10.1 years) had chronic rheumatic heart disease. Of those with recurrences, 9 (41%) had carditis and 11 (50%) had arthritis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Parasite contamination of soil in households of a Mexican rural community endemic for neurocysticercosis

High neurocysticercosis (NC) prevalence was recently determined by a computed tomography (CT) scan study in the community of Tepetzitzintla, State of Puebla, Mexico. The aim of the present work was to evaluate the magnitude of fecal and parasite contamination by Taenia spp. in the soil of households of this community during the four seasons of the year. The toilet, backyard, kitchen, washboard, water containers and corrals of 14 to 26 households were sampled during each season. High Taenia spp. egg intensity was found in 24.2% of the sampled areas. The highest percentage was detected in Spring and the lowest in Summer. Significantly higher levels of Taenia spp. eggs were present in kitchen soil samples. A significant correlation was found between the presence of Taenia spp. eggs in household soil during the Summer, and NC diagnoses of the inhabitants by CT scan. Coproparasitological examinations and anti-cysticercal antibodies were determined in a cohort of inhabitants of the sampled households. Antibody levels and coproparasitological results were not associated with NC. Overall, these results illustrate the high degree of fecal contamination of potential risk to human health in rural communities and could be of use for control programmes.     

Health consequences of vasectomy in India.

Vasectomy acceptance has been declining in India during the past 20 years. Even if the risk of prostate cancer is marginally higher in vasectomized men, this risk in India has to be assessed against the immediate safety and other possible long-term benefits of this procedure. The Indian Council of Medical Research has launched a case-control study, which is unlikely to be time-consuming or beyond the available means and resources, in order to obtain definitive data on this problem. Meanwhile, vasectomy remains an excellent procedure for the couple seeking permanent methods of contraception, and specific efforts to promote its acceptance must continue in India.     

Occupational therapy in rural India

India is called the land of villages. In 1951, 82.7% of the Indian population lived in rural areas. Sanskritisation and urbanisation have changed the pattern. It is expected that by the year 2020 this percentage would come down to 55%. These villagers are relocating in urban slums. Thus from the rehabilitation point of view both problems pose challenges. An Indian village community is a political, economic and cultural unit. At the urban slum area at Malwani and in small villages near Juchandra, community rehabilitation programmes were found to be most pragmatic. Community education and preventive occupational therapy are found to be essential steps in rural rehabilitation. Therapists have to work on ‘disability, attitude and beliefs’ and change the behaviour to deal with the grass root (basic) causes. It is felt that for longer sustainment, community-based rehabilitation should originate within the community. Heath professionals must recognise the capabilities of individuals within the support structure of the family and community, while helping individuals to improve the quality of their lives.     

Note: storage practices,salt intake and iodine content of salt consumed in rural households of Haryana State,North India

A survey of 180 rural families from different zones of Haryana State was carried out to know the type and intake of salt used and the domestic storage practices followed by rural households using a questionnaire method. Salt samples from rural households were analyzed for their iodine content. Results indicated that most of the people in rural Haryana consume powdered salt and stored it in airtight containers. Daily intake per person ranged from 9.91 to 11.42 g. In the wet zone a higher percentage of families consume iodized salt. Analysis of iodine in salt samples showed that of samples from three zones, 39% contained no iodine; with 9% < 15 ppm; 14% 15-29 ppm and 37% > or = 30 ppm.     

Female-headed households contending with AIDS-related hardship in rural South Africa

Mainstream research and the popular media often equate female-headship with household vulnerability, crisis, and disorganization. Epidemic levels of HIV/AIDS in some parts of sub-Saharan Africa compound this portrait of hopelessness. In South Africa, the impact of HIV/AIDS on households depends on race, class, and place. As female-headed households increase in number, we need to better understand how female-heads in poor rural areas contend with AIDS related challenges. We analyze qualitative interviews with 16 female heads and the members of their households in a rural community to examine the response to AIDS-related illness, death, or caring for orphaned children. Our analysis examines female-heads' financial and social resources and how these resources buffer against hardship in households affected by AIDS. We find considerable heterogeneity among rural female-headed households and their access to resources to combat AIDS-related hardship. Our findings have important policy implications both in terms of identifying individual and household vulnerabilities as well as leveraging the potential for resilience for female-heads in rural South African communities.     

Politics of rural health in India

The setting up of the National Rural Health Mission is yet another political move by the present government of India to make yet another promise to the long suffering rural population to improve their health status. As has happened so often in the past, it is based on questionable premises. It adopts a simplistic approach to a highly complex problem. The Union Ministry of Health and Family Welfare and its advisors, either because of ignorance or otherwise, have doggedly refused to learn from the many experiences of the past, both in terms of the efforts to earlier somewhat sincere efforts to develop endogenous mechanisms to offer access to health services as well as from the devastative impact on the painstakingly built rural health services of the imposition of prefabricated, ill-conceived, ill-formulated, techno-centric vertical programmes on the people of India. The also ignore some of the basic postulates of public health practice in a country like India. That did not substantiate the bases of some of their substantive contentions with scientific data obtained from health systems research reveals that they are not serious about their promise to rural population. This is yet another instance of what Romesh Thaper had called 'Baba Log playing government government'.