ABSTRACT
Background: Neonatal health remains a thrust area of public health, and an increased out-of-pocket expenditure (OOPE) may hamper efforts toward universal health coverage. Public spending on health remains low and insurance schemes few, thereby forcing impoverishment upon individuals already close to poverty line. Objective: To determine catastrophic health expenditure (CHE) in neonates admitted to the government neonatal intensive care unit (NICU) and factors associated with of out-of-pocket expenditure. Methods: This cross-sectional study was conducted in a governmental NICU at Agra from May 2017 to April 2018. A sample of 450 neonatal admissions was studied. Respondents were interviewed for required data. OOPE included costs at NICU, intervening health facilities, and transport as well. SPSS version (23.0 Trial) and Epi Info were used for analysis. Results: Of the 450 neonates analyzed, the median total OOPE was Rs. 3000. CHE was found among 55.8% of cases with 22% spending more than their household monthly income. On binary logistic regression, a higher total OOPE of Rs. 3000 or more was found to be significantly associated with higher odds of residing outside Agra (adjusted odds ratio [AOR] = 1.829), delay in first cry (AOR = 1.623), referral points ?3 (AOR = 3.449), private sector as first referral (AOR = 2.476), and when treatment was accorded during transport (AOR = 1.972). Conclusions: OOPE on neonates amounts to a substantial figure and is more than the country average. This needs to be addressed sufficiently and comprehensively through government schemes, private enterprises, and public杙rivate partnerships.
ABSTRACT
Background: As per the Child Mortality Report 2018 by UNICEF the current neonatal mortality rate in India stands at 24 per 1000 live births with it being more than the national average for Uttar Pradesh. The neonatal morbidity and outcome pattern in terms of discharge or otherwise shows considerable national, state, district and sub- district variations due to a multitude of diverse factors contributing to it at various levels. Aim & Objective: The aim of the study was to explore the mortality rate and outcome in NICU setting, and factors influencing the outcomes. Methods and Material: This government NICU based follow-up study comprised of data analysed from 450 neonates through a semi-structured questionnaire using face to face interview technique. Data was evaluated in SPSS and; independent t test and chi square test were applied. Statistical analysis used: Data was evaluated in SPSS and; independent t test and chi square test were applied. Results: For morbidity low birth weight (LBW) (14.4%) and for mortality LBW/prematurity (56%) were the most common causes. The discharge rate was 64.4%. Good outcome in the form of successful discharge was statistically significant with birth weight (p=0.000), gestational age (0.001), length of stay at NICU (p=0.003) male sex (p=0.003) and feeding of newborn (p=0.002) Conclusions: The study enunciates a high discharge rate in tertiary care government NICU with a mixed morbidity and mortality profile. The causes are mainly preventable and hence can be largely mitigated through dedicated ante natal, intra natal and post-natal care.
ABSTRACT
Background: With increasing life expectancy people are living longer but they are not necessarily healthier than before. Nearly a quarter (23%) of the overall global burden of death and illness is in people aged over 60, and much of this burden is attributable to long-term illness like non-communicable diseases and mental health problems. Aims & Objectives: Aim of the study the magnitude of depression among elderly population of Agra. Objectives To estimate the prevalence of depression in elderly population of Agra. 2. To study the factors associated with depression among elderly population of Agra. Material and Methods: This study was conducted among 355 elderly in urban Agra. Data was collected by house to house visit using pre-designed and pre-tested schedule. Geriatric depression scale (GDS-30) was used to assess the burden of depression in study population. Results: The mean age of the study participants was 68.05 years. Depression was found in 50.1% among study population and 15.5% had severe depression. Depression was more among the Illiterates, Muslims, financial dependents, those who were suffering from chronic disease/s, encountered a stressor in the last 6 months, less religious, not living with partner or suffered elderly abuse. Conclusion: High burden of depression was found among the victims of elderly abuse. Stressful life events and absence of spouse were found to be significant risk factors for depression. To deal with these factors we suggest a link worker Geriatric Age Social Health Agent (G-ASHA) to act as a link between family, community and authorities.