Showing papers in "Journal of Health Population and Nutrition in 2016"
BRAC1
TL;DR: Higher values of iron, manganese, and arsenic reduced drinking water quality in Bangladesh, and awareness raising on chemical contents in drinking water at household level is required to improve public health.
Abstract: Public health is at risk due to chemical contaminants in drinking water which may have immediate health consequences. Drinking water sources are susceptible to pollutants depending on geological conditions and agricultural, industrial, and other man-made activities. Ensuring the safety of drinking water is, therefore, a growing problem. To assess drinking water quality, we measured multiple chemical parameters in drinking water samples from across Bangladesh with the aim of improving public health interventions. In this cross-sectional study conducted in 24 randomly selected upazilas, arsenic was measured in drinking water in the field using an arsenic testing kit and a sub-sample was validated in the laboratory. Water samples were collected to test water pH in the laboratory as well as a sub-sample of collected drinking water was tested for water pH using a portable pH meter. For laboratory testing of other chemical parameters, iron, manganese, and salinity, drinking water samples were collected from 12 out of 24 upazilas. Drinking water at sample sites was slightly alkaline (pH 7.4 ± 0.4) but within acceptable limits. Manganese concentrations varied from 0.1 to 5.5 mg/L with a median value of 0.2 mg/L. The median iron concentrations in water exceeded WHO standards (0.3 mg/L) at most of the sample sites and exceeded Bangladesh standards (1.0 mg/L) at a few sample sites. Salinity was relatively higher in coastal districts. After laboratory confirmation, arsenic concentrations were found higher in Shibchar (Madaripur) and Alfadanga (Faridpur) compared to other sample sites exceeding WHO standard (0.01 mg/L). Of the total sampling sites, 33 % had good-quality water for drinking based on the Water Quality Index (WQI). However, the majority of the households (67 %) used poor-quality drinking water. Higher values of iron, manganese, and arsenic reduced drinking water quality. Awareness raising on chemical contents in drinking water at household level is required to improve public health.
145 citations
TL;DR: It is shown that women participation in decision-making regarding household purchases was significantly associated with higher DD, after adjusting for individual and household level covariates, suggesting that improving women decision- making autonomy could have a positive impact on women dietary intake.
Abstract: Low-quality monotonous diet is a major problem confronting resource-constrained settings across the world. Starchy staple foods dominate the diets in these settings. This places the population, especially women of reproductive age, at a risk of micronutrients deficiencies. This study seeks to examine the association between women’s decision-making autonomy and women’s achievement of higher dietary diversity (DD) and determine the socio-demographic factors that can independently predict women’s attainment of higher DD. The study used data from the 2008 Ghana Demographic and Health Survey. The participants comprised of 2262 women aged 15–49 years and who have complete dietary data. The DD score was derived from a 24-h recall of intake of foods from nine groups. The score was dichotomized into lower DD (DD ≤4) and higher (DD ≥5). Logistic regression was used to assess the association between women decision-making autonomy (final say on how to spend money, making household purchases, own health care, opinions on wife-beating, and sexual intercourse with husband) and the achievement of higher DD. The logistic regression models were adjusted for covariates at the individual and household levels. The analysis showed that women participation in decision-making regarding household purchases was significantly associated with higher DD, after adjusting for individual and household level covariates. The odds of achieving higher DD were higher among women who had a say in deciding household purchases, compared to women who did not have a say (OR = 1.74, 95 % CI = 1.24, 2.42). Women who had more than primary education were 1.6 times more likely to achieve higher DD, compared to those with no education (95 % CI = 1.12, 2.20). Compared to women who lived in polygamous households, those who lived in monogamous households had higher odds of achieving higher DD (OR = 1.42, 95 % CI = 1.04, 1.93). Net other covariates, women who have a say in making household purchases are more likely to achieve higher DD compare to those who do not have a say. This may indicate autonomy to buy nutritious foods, suggesting that improving women decision-making autonomy could have a positive impact on women dietary intake.
99 citations
TL;DR: Misconceptions about weight gain during pregnancy and food taboos were widespread, particularly among older and illiterate rural communities, and future nutrition programs should promote diversification of both the agricultural production and consumption.
Abstract: The nutritional status of women before and during pregnancy can be determined by maternal knowledge, attitudes, and perceptions towards certain foods. The present study aimed to explore maternal dietary habits, food taboos, and cultural beliefs that can affect nutrition during pregnancy in rural Arsi, central Ethiopia. A qualitative, cross-sectional study, involving 38 key informant in-depth interviews and eight focus group discussions, was conducted among purposefully selected pregnant women and their husbands, elderly people, community leaders, health workers, and agriculture office experts. Participants were selected purposefully from all the major agro-ecologic areas of the study site. Data was analyzed manually using the thematic framework analyses method. The pregnant women reported that they did not change the amount and type of foods consumed to take into account their increased nutritional need during pregnancy. The consumption of meat, fish, fruits, and some vegetables during pregnancy remained as low as the pre-pregnancy state, irrespective of the women’s income and educational status. Although not practiced by all, a number of taboos related to the intake of certain food items and misconceptions that can adversely affect nutritional status during pregnancy were identified. The most common taboos were related to the consumption of green leafy vegetables, yogurt, cheese, sugar cane, and green pepper. However, the frequency and extent of the practice varied by maternal age, family composition, and literacy level. Older mothers, from rural villages, and those with no formal education were more likely to practice the taboos than younger and educated ones. Almost all of the participants disfavored weight gain during pregnancy in fear of obstetric complications associated with the delivery of a bigger infant. Misconceptions about weight gain during pregnancy and food taboos were widespread, particularly among older and illiterate rural communities. Thus, future nutrition programs should promote diversification of both the agricultural production and consumption.
94 citations
TL;DR: Assessing the nutrition evolution of the children who were initially diagnosed as stunted and of those who were diagnosed as normal showed that although these children were Oportunidades beneficiaries for 9 years and their families improved their living conditions, children still had a high prevalence of stunting and 69.6 % had not recovered yet.
Abstract: In Mexico, despite that the fact that several social programs have been implemented, chronic undernutrition is still a public health problem affecting 1.5 million children of <5 years. Chiapas ranks first in underweight and stunting at national level with a stunting prevalence of 31.4 % whereas for its rural population is 44.2 %. The purpose of this paper is to determine if the nutritional status of a cohort of children living in poor rural communities under Oportunidades has changed. We were interested in assessing the nutrition evolution of the children who were initially diagnosed as stunted and of those who were diagnosed as normal. Oportunidades is an anti-poverty program of the Mexican government consisting mainly in monetary transfers to the families living in alimentary poverty. A 9-year cohort prospective study was conducted with nutritional evaluations of 222 children. Anthropometric indices were constructed from measurements of weight, height, and age of the children whose nutritional status was classified following WHO standards. The results showed that although these children were Oportunidades beneficiaries for 9 years and their families improved their living conditions, children still had a high prevalence of stunting (40.1 %) and 69.6 % had not recovered yet. Children who were initially diagnosed with normal nutritional status and became stunted 2 years later had a higher risk (relative risk (RR) 5.69, 2.95–10.96) of continuing stunted at school age and adolescence. Oportunidades has not impacted, as expected, the nutritional status of the study population. These findings pose the question: Why has not the nutritional status of children improved, although the living conditions of their families have significantly improved? This might be the result of an adaptation process achieved through a decrease of growth velocity. It is important to make efforts to watch the growth of the children during their first 3 years of age, to focus on improving the diet of women at fertile age and pay special attention to environmental conditions to break the vicious cycle of malnutrition.
62 citations
TL;DR: Lifestyle intervention improves the lifestyle behaviors during pregnancy and increases the appropriate GWG for prepregnancy body mass index (BMI), but it has a limited effect in terms of improving dietary habits and has no effect on PWR.
Abstract: Although it is known that lifestyle behaviors of pregnant women are closely related to maternal and fetal health, number of data concerning efficacy of intervention on lifestyle during pregnancy is limited. The purpose of this study is to determine the effect of lifestyle interventions on improving dietary habits and lifestyle behaviors, ensuring gestational weight gain (GWG) within recommended levels and limiting postpartum weight retention (PWR). The study was conducted as a randomized controlled trial in a family health center located in Istanbul, Turkey, between June 2011 and July 2012. The primary outcomes were GWG, and the proportion of pregnant women whose GWG was within the Institute of Medicine (IOM) guidelines. One hundred two pregnant women with gestation ≤12 weeks, age ≥18 years, gravidity ≤2, and who did not intend to lose weight in prepregnancy period were randomly included in this study as intervention (n = 51) and control (n = 51) groups. The study was completed with 45 women for each group. The control group received routine antenatal care. The intervention group was received an individualized lifestyle intervention focusing on healthy lifestyle, diet, exercise, and weight monitoring as four sessions at 12–15, 16–18, 20–24, and 37 weeks gestation. Lifestyle behaviors were evaluated with Health-Promoting Lifestyle Profile-II. Dietary habits were assessed by 3-day dietary recalls, and weight was followed from pregnancy until 6 weeks postpartum. The lifestyle interventions had a significant effect on improving lifestyle behaviors, protein intake, percentage of energy from protein, calcium, magnesium, iron, zinc, and vegetable intakes when adjusted for confounders (p 0.05). Lifestyle intervention improves the lifestyle behaviors during pregnancy and increases the appropriate GWG for prepregnancy body mass index (BMI), but it has a limited effect in terms of improving dietary habits and has no effect on PWR.
62 citations
TL;DR: This bibliometric overview of publications on Campylobacter can be used to assess extent of interaction and response of researchers, food regulators, and health policy makers to global burden of campylobacateriosis.
Abstract: Campylobacter species are widespread zoonotic pathogens. Campylobacter jejuni causes a form of gastroenteritis called campylobacteriosis. Campylobacter drug resistance is considered a serious threat. In order to better understand national and international research output on Campylobacter, we conducted this bibliometric overview of publications on Campylobacter. This study can be used to assess extent of interaction and response of researchers, food regulators, and health policy makers to global burden of campylobacateriosis. Scopus database was used to retrieve publications with the following keywords (Campylobacter/campylobacteriosis, C. jejuni, C. coli). The study period was set from 2000 to 2015. All types of journal documents, excluding errata, were considered. Bibliometric indicators such as annual growth of publications, country contribution, international collaboration, and citation analysis were presented. The quality of retrieved data was indirectly assessed by Hirsch index and impact factor of journals. A total of 5522 documents were retrieved with median (Q1–Q3) citations of 9 (2–23) and h-index of 113. Annual number of publications showed a fluctuating increase. The core leading journals were Applied and Environmental Microbiology journal and Journal of Food Protection with 246 (4.46%) publications for each. The USA (1309; 23.6%) was the most productive country while Danmarks Tekniske Universitet (150; 2.7%) was the most productive institution. Half of the top ten productive countries were European. France had the lowest percentage (33.5%) of articles with international collaboration while Netherlands (57.7%) had the highest percentage of articles with international collaboration. Approximately half (50.1%) of retrieved articles were published in journals under the subject area of “immunology/microbiology”. Main themes in highly cited articles were molecular biology/genetics and public health burden of campylobacteriosis. There were 728 (13.1%) articles on campylobacter-related drug resistance, and the top cited articles focused mainly on increasing resistance to quinolones and fluoroquinolones. There was a clear increase in number of publications on Campylobacter. Rational use of antimicrobials in humans, poultry, and animals is highly recommended. International collaboration is highly required particularly in implementing new diagnostic screening technologies to minimize global health burden of Campylobacter and ensure food safety.
55 citations
TL;DR: All of the municipal tap water samples and most of the bottled drinking water samples distributed in Dharan municipality were found to be contaminated with one or more than one type of indicator organisms.
Abstract: Water-related diseases are of great concern in developing countries like Nepal. Every year, there are countless morbidity and mortality due to the consumption of unsafe drinking water. Recently, there have been increased uses of bottled drinking water in an assumption that the bottled water is safer than the tap water and its use will help to protect from water-related diseases. So, the main objective of this study was to analyze the bacteriological quality of bottled drinking water and that of municipal tap water. A total of 100 samples (76 tap water and 24 bottled water) were analyzed for bacteriological quality and pH. The methods used were spread plate method for total plate count (TPC) and membrane filter method for total coliform count (TCC), fecal coliform count (FCC), and fecal streptococcal count (FSC). pH meter was used for measuring pH. One hundred percent of the tap water samples and 87.5 % of the bottled water samples were found to be contaminated with heterotrophic bacteria. Of the tap water samples, 55.3 % were positive for total coliforms, compared with 25 % of the bottled water. No bottled water samples were positive for fecal coliforms and fecal streptococci, in contrast to 21.1 % and 14.5 % of the tap water samples being contaminated with fecal coliforms and fecal streptococci, respectively. One hundred percent of the tap water samples and 54.2 % of the bottled water samples had pH in the acceptable range. All of the municipal tap water samples and most of the bottled drinking water samples distributed in Dharan municipality were found to be contaminated with one or more than one type of indicator organisms. On the basis of our findings, we may conclude that comparatively, the bottled drinking water may have been safer (than tap water) to drink.
50 citations
TL;DR: In this study, childhood diarrhea occurrences remained high and both individual- and community-level factors determined the occurrence of diarrhea.
Abstract: Childhood diarrhea is one of the major public health problems in Ethiopia. Multiple factors at different levels contribute to the occurrence of childhood diarrhea. The objective of the study was to identify the factors affecting childhood diarrhea at individual and community level. A cross-sectional study design was employed from February to March 2015 in high and low hotspot districts of Awi and West and East Gojjam zones in Amhara Region, northwest Ethiopia. Districts with high and low hotspots with childhood diarrhea were identified using SaTScan spatial statistical analysis. A total of 2495 households from ten (five high and five low hotspot) randomly selected districts were included in the study. A semi-structured questionnaire was used to collect data. Data were entered and cleaned in Epi Info 3.5.2 version and analyzed using Stata version 12. A multilevel logistic regression was used to identify factors associated with childhood diarrhea. The prevalence of childhood diarrhea was 13.5 % and did not show significant variation between high [14.3 % (95 % CI 12.3–16.2 %)] and low [12.7 % (95 % CI 10.9–14.6 %)] hotspot districts. Individual- and community-level factors accounted for 35 % of childhood diarrhea variation across the communities in the full model. Age of children (6–35 months), complementary feeding initiation below 6 months, inadequate hand washing practices, limited knowledge of mothers on diarrhea, lowest wealth status of households, and longer time interval to visit households by health extension workers were factors for increasing the odds of childhood diarrhea at the individual level. At the community level, lack of improved water supply and sanitation and unvaccinated children with measles and rotavirus vaccine were the factors associated with childhood diarrhea. In this study, childhood diarrhea occurrences remained high. Both individual- and community-level factors determined the occurrence of diarrhea. Interventions should consider both individual- and community-level factors to reduce the occurrence of childhood diarrhea.
42 citations
TL;DR: In this paper, the authors investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana from 1993 to 2008.
Abstract: Improving child health is one of the major policy agendas for most of the governments, especially in the developing countries. These governments have been implementing various strategies such as improving healthcare financing, improving access to health, increasing educational level, and income level of the household to improve child health. Despite all these efforts, under-five and infant mortality rates remain high in many developing nations. Some previous studies examined how economic development or household’s economic condition contributes to child survival in developing countries. In Ghana, the question as to what extent does economic circumstances of households reduces infant and child mortality still remain largely unanswered. Thus, the purpose of this study is to investigate the extent to which wealth affects the survival of under-five children, using data from the Demographic and Health Survey (DHS) of Ghana. In this study, we use four waves of data from Demographic and Health Surveys (DHS) of Ghana from 1993 to 2008. The DHS is a detailed data set that provides comprehensive information on households and their demographic characteristics in Ghana. Data was obtained by distributing questionnaires to women (from 6000 households) of reproductive age between 15 and 49 years, which asked, among other things, their birth history information. The Weibull hazard model with gamma frailty was used to estimate wealth effect, as well as the trend of wealth effect on child’s survival probability. We find that household wealth status has a significant effect on the child survival in Ghana. A child is more likely to survive when he/she is from a household with high wealth status. Among other factors, birth spacing and parental education were found to be highly significant to increase a child’s survival probability. Our findings offer plausible mechanisms for the association of household wealth and child survival. We therefore suggest that the Government of Ghana strengthens and sustains improved livelihood programs, which reduce poverty. They should also take further initiatives that will increase adult education and improve health knowledge. To the best of our knowledge, this is the first study in Ghana that combines four cross sectional data sets from DHS to study a policy-relevant question. We extend Standard Weibull hazard model into Weibull hazard model with gamma frailty, which gives us a more accurate estimation. Finally, the findings of this study are of interest not only because they provide insights into the determinants of child health in Ghana and other developing countries, but they also suggest policies beyond the scope of health.
32 citations
TL;DR: Results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery and Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.
Abstract: Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period. Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE. The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE. Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.
26 citations
TL;DR: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials.
Abstract: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin’s concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. ClinicalTrials.gov NCT00860470
TL;DR: The study revealed S. flexneri as the predominant serogroup in Nepal and found children below 10 years were more prone to the disease and Nalidixic acid, ampicillin, co-trimoxazole, and ciprofloxacin should not be used empirically as the first-line drugs in treatment of shigellosis.
Abstract: Shigella is a major cause of gastroenteritis especially in children In developing countries, the incidence is frequent and results are often life threatening Changing epidemiology and emerging antibiotic resistance warrants continuous monitoring of susceptibility The present study highlights the changing epidemiology and drug resistance patterns of Shigella isolated at different hospitals of Nepal over a period of 13 years (Jan 2003–Dec 2015) This study was carried out in 12 participating laboratories Stool specimens received at respective laboratories were processed for isolation and identification of Shigella species and confirmed by serotyping at National Public Health Laboratory Antimicrobial resistance patterns were determined by Kirby Baeur disc diffusion test A total of 332 isolates were identified as Shigella species of which Shigella flexneri (50 %) was the predominant serotype Shigella dysenteriae, Shigella sonnei, Shigella boydii, and untypable Shigella spp respectively, accounted for 286, 2754, 102, 45, and 66 % of the total number Change in prevalent serotype is noted over the years S dysenteriae was the prevalent species in Nepal in 2003 and 2004, but since 2005, S flexneri remained prevalent Majority of the isolates were recovered from children aged 1–10 years and was statistically significant (p = 0023) compared to the other age groups High resistance among all Shigella species to the first-line drugs like ampicillin (88 %), cotrimoxazole (76 %), ciprofloxacin (39 %,) and nalidixic acid (80 %) was observed; 461 % of total isolates were multidrug resistant (MDR), and the most common MDR profile was ampicillin, nalidixic acid, and co-trimoxazole Prevalence of MDR increased significantly in 2010 as compared to 2003 Only few Shigella isolates were resistant to ceftriaxone The study revealed S flexneri as the predominant serogroup in Nepal Children below 10 years were more prone to the disease Nalidixic acid, ampicillin, co-trimoxazole, and ciprofloxacin should not be used empirically as the first-line drugs in treatment of shigellosis Since the distribution of different species of Shigella and their antibiotic susceptibility profile may vary from one geographical location to another and may also change with time, continuous local monitoring of resistance patterns is necessary for appropriate antimicrobial therapy
TL;DR: Country-specific strategies for reducing alcohol consumption, e.g. educational awareness programmes of alcohol use on Chinese campuses and alcohol prevention schemes among German youth before entering university, are sensible.
Abstract: Alcohol use is reported in university students with discrepancy between countries. The study objectives were to assess prevalence and associated factors of alcohol consumption among university students in Germany and China. Data used were from 1853 Chinese and 3306 German university students. Alcohol consumption frequency was measured by a question “How often did you drink alcohol in the last three months?” with six possible responses, which were later collapsed into three categories of “At least once a week”, “Less than once a week” and “Never”. Problem drinking was measured by the CAGE test and defined as a CAGE score of two or more (four as the maximum). Simple and multivariable logistic regressions were used for association analyses. German students reported more often “At least once a week” drinking (59.8 vs. 9.0 %). Among Germans, women drank less often “At least once a week” (OR = 0.40, 0.30–0.53). Among Chinese, a higher BMI was associated with drinking “At least once a week” (OR = 1.09, 1.02–1.18). Age revealed a positive association with “At least once a week” drinking in Chinese (1.33, 1.21–1.46) but a negative association in Germans (OR = 0.97, 0.94–0.99). Having a father with high educational level was positively related to “At least once a week” drinking in both countries (OR = 4.25, 2.67–6.78 for Chinese; OR = 1.32, 1.01–1.72 for Germans). Doing less than once a week physical exercise was negatively associated with “At least once a week” drinking in Chinese and German students (OR = 0.27, 0.15–0.48 for Chinese; OR = 0.69, 0.49–0.96 for Germans). Among the German students, 20.3 % reported problem drinking. Being a female (OR = 0.32, 0.26–0.40) and performing less than once a week physical activity (OR = 0.73, 0.56–0.95) were negatively associated with problem drinking, while having a father with high educational level (OR = 1.32, 1.09–1.60) and experiencing higher level of perceived stress (OR = 1.08, 1.04–1.13) were positively related to problem drinking. Country-specific strategies for reducing alcohol consumption, e.g. educational awareness programmes of alcohol use on Chinese campuses and alcohol prevention schemes among German youth before entering university, are sensible.
TL;DR: Findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy in Nigeria.
Abstract: The study investigated the factors associated with compliance to the recommended ≥90-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria. A cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers. There were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents (χ
2 = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away (χ
2 = 24.638; p < 0.001). Those in higher wealth quintile complied more (χ
2 = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not (χ
2 = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance (χ
2 = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance. These findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy.
TL;DR: The results showed that the safe distance from the tubewell to the pit latrine varied from site to site depending on the horizontal and vertical distances of the Tubewell as well as hydrogeological conditions of a particular area.
Abstract: Groundwater drawn from shallow tubewells in Bangladesh is often polluted by nearby pit latrines, which are commonly used toilets in rural and sub-urban areas of the country. To determine the minimum safe distance of a tubewell from a pit latrine in different hydrogeological conditions of Bangladesh, 20 monitoring wells were installed at three study sites (Manda, Mohanpur and Bagmara) with the vertical and horizontal distances ranging from 18–47 to 2–15 m, respectively. Water samples were collected three times in three seasons and tested for faecal coliforms (FC) and faecal streptococci (FS) as indicators of contamination. Soil samples were analysed for texture, bulk density and hydraulic conductivity following standard procedures. Sediment samples were collected to prepare lithological logs. When the shallow aquifers at one of the three sites (Mohanpur) were overlained by 18–23-m-thick aquitards, the groundwater of the monitoring wells was found contaminated with a lateral and vertical distances of 2 and 31 m, respectively. However, where the aquitard was only 9 m thick, contamination was found up to lateral and vertical distances of 4.5 and 40.5 m, respectively. The soil textures of all the sites were mainly composed of loam and sandy loam. The hydraulic conductivities in the first aquifer at Manda, Mohanpur and Bagmara were 5.2–7.3, 8.2 and 1.4–15.7 m/h, respectively. The results showed that the safe distance from the tubewell to the pit latrine varied from site to site depending on the horizontal and vertical distances of the tubewell as well as hydrogeological conditions of a particular area.
TL;DR: The presence of pathogenic and non-pathogenic bacteria in the polyherbal medicines used for the treatment of tuberculosis in the Eastern Cape Province of South Africa is revealed.
Abstract: Polyherbal medicines are used for the treatment of many diseases in many African and Asian communities. With the increasing use of these remedies, several investigations have shown that they are associated with a broad variety of residues and contaminants. This study investigates the presence of bacteria in the polyherbal medicines used for the treatment of tuberculosis (TB) in the Eastern Cape Province of South Africa. Bacterial DNA was extracted from the polyherbal medicines, and a fragment of the bacterial 16S rRNA gene was amplified by PCR with universal primers 27F and 518R. The amplicons were visualised on agarose gel electrophoresis, followed by end repair and adaptor ligation. They were further purified and quantified using Library Preparation kit NEBNext® UltraT DNA Library Prep Kit for Illumina, and the amplicons were run on illumina’s MiSeq platform. Different bacterial species were identified in all each of the polyherbal medicines. Generally, the most prominent and common bacteria recovered from all the samples were Bacillus sp., Enterobacter sp., Klebsiella sp., Rahnella sp., Paenibacillus sp., Clostridium sp. and Pantoea sp. Others are Pseudomonas sp., Raoultella ornithinolytica, Salmonella enterica and Eubacterium moniliforme. This study, thus, revealed the presence of pathogenic and non-pathogenic bacteria in the polyherbal medicines used for the treatment of tuberculosis in the study area. The implications of the findings are discussed in relation to the health care of the patients of tuberculosis in the study area, having in mind that they are immunocompromised individuals.
TL;DR: In this paper, the authors assessed the current level of map usage and spatial tools for health sector planning in Bangladesh and found that despite the increasing efforts to gather spatial data in developing countries, the use of maps is mostly for visualization of health indicators rather than informed decision making.
Abstract: In spite of the increasing efforts to gather spatial data in developing countries, the use of maps is mostly for visualization of health indicators rather than informed decision-making. Various spatial tools can aid policymakers to allocate resources effectively, predict patterns in communicable or infectious diseases, and provide insights into geographical factors which are associated with utilization or adequacy of health services. In Bangladesh, the launch of District Health Information System 2, along with recent efforts to gather spatial data of facilities location, provides an interesting opportunity to study the current landscape and the potential barriers in advancing the use of spatial tools for informed decision making. This study assessed the current level of map usage and spatial tools for health sector planning in Bangladesh, focusing on investigating why map usage and spatial tools remained at a basic level for the purpose of health policy. The study design involved in-depth interviews, followed by an expert survey (n = 39) obtained through snowball sampling. Our survey revealed that assessing areas with shortage of community health workers emerged as the top most for basic map usage or primarily for visualization purpose, while planning for emergency and obstetric care services, and disease mapping was the most frequent category for intermediate and advanced map usage, respectively. Furthermore, we found lack of inter-institutional collaboration, lack of continuous availability of trained personnel, and lack of awareness on the use of geographic information system (GIS) as a decision-making tool as three most critical barriers in the current landscape. Our findings highlight the barriers in increasing the adoption of spatial tools for health policymaking and planning in Bangladesh.
TL;DR: Assessment of food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County shows that the stigma due to HIV affected the occupation and ability to earn income and recommends a food-based intervention program among the already malnourished children.
Abstract: HIV and AIDS affect most the productive people, leading to reduced capacity to either produce food or generate income. Children under-fives are the most vulnerable group in the affected households. There exists minimal information on food security status and its effect on nutritional status of children under-fives in households affected by HIV and AIDS. The aim of this study was to assess food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County. A cross-sectional analytical design was used. A formula by Fisher was used to calculate the desired sample size of 286. Systematic random sampling was used to select the children from a list of identified households affected by HIV. A questionnaire was used to collect data. Focus group discussion (FGD) guides were used to collect qualitative data. Nutri-survey software was used for analysis of nutrient intake while ENA for SMART software for nutritional status. Data were analyzed using SPSS computer software for frequency and means. Qualitative data was coded and summarized to capture the emerging themes Results show that HIV affected the occupation of people with majority being casual laborers (37.3 %), thus affecting the engagement in high income generating activities. Pearson correlation coefficient showed a significant relationship between dietary diversity score and energy intake (r = 0.54 p = 0.044) and intake of vitamin A, iron, and zinc (p < 0.05). A significant relationship was also noted on energy intake and nutritional status (r = 0.78 p = 0.038). Results from FGD noted that HIV status affected the occupation due to stigma and frequent episodes of illness. The main source of food was purchasing (52.7 %). With majority (54.1 %) of the households earning a monthly income less than US$ 65, and most of the income (25.7 %) being used for medication, there was food insecurity as indicated by a mean household dietary diversity score of 3.4 ± 0.2. This together with less number of meals per day (3.26 ± 0.07 SD) led to consumption of inadequate nutrients by 11.4, 73.9, 67.7, and 49.2 % for energy, vitamin A, iron, and zinc, respectively. This resulted to poor nutritional status noted by a prevalence of 9.9 % in wasting. Stunting and underweight was 17.5 and 5.5 %, respectively. Qualitative data shows that the stigma due to HIV affected the occupation and ability to earn income. The research recommends a food-based intervention program among the already malnourished children.
TL;DR: The evaluation of TG/HDL-C ratio should be considered for one of cardiovascular risk factor predictors among Han adults in Xinjiang.
Abstract: To determine whether TG/HDL-C ratio, which has been shown to be an indicator of the metabolic syndrome (MetS) and insulin resistance (IR), can predict cardiovascular risk factors in the Chinese Han population in Xinjiang. The cardiovascular risk survey (CRS) was conducted from October 2007 to March 2010. A total of 14,618 representative participants were selected using a four-stage stratified sampling method. A total of 5757 Han participants were included in the study. The present statistical analysis was restricted to the 5595 Han subjects who had complete anthropometric data. The sensitivity, specificity, and distance on the receiver operating characteristic (ROC) curve in each TG/HDL level were calculated. The shortest distance in the ROC curves was used to determine the optimal cutoff of the TG/HDL-C ratio for detecting cardiovascular risk factors. The prevalence of hypertension, hypercholesterolemia, and hypertriglyceridemia was higher with higher TG/HDL-C ratio for both men and women. The TG/HDL-C ratio was positively associated with systolic blood pressure, diastolic blood pressure, and serum concentrations of total cholesterol. The optimal TG/HDL-C ratio cutoffs for predicting hypertension, dyslipidemia, diabetes, and ≥2 of these risk factors for Han adults in Xinjiang were 1.3, 1.3, 1.4, and 1.4 in men and 0.9, 1.0, 1.0, and 1.1 in women, respectively. The evaluation of TG/HDL-C ratio should be considered for one of cardiovascular risk factor predictors among Han adults in Xinjiang.
TL;DR: Preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future and the inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers.
Abstract: Among the studies published after the year 2000 which focused on nutrition at preschool, only three aimed to assess children’s intake of energy and selected nutrients at preschool. The purpose of this study was to assess dietary intake in children during their stay at preschool. The studied population comprised 128 4–6-year-old children who attended preschools in Pila, Poland. Intakes of energy and macronutrients were estimated from a 5-day weighed food record completed by the preschool staff. Weight and height were measured, and BMI was calculated. Statistical analysis was carried out using the IBM SPSS Statistics 21.0 computer programme. The data were analysed according to gender. Energy intake was the lowest in children with underweight, 2004 kJ (478 kcal), and the highest in obese children, 3388 kJ (809 kcal). Energy intake from lactose was statistically significantly higher in boys than in girls, 3.0 vs 2.6 %. Statistically significantly higher percentage of boys in comparison to girls had intakes of vitamin C below 70 % of EAR, 56.9 vs 38.1 %. It is important to highlight the excessive intake of energy from saturated fatty acids and energy from sucrose, along with inadequate intake of energy from polyunsaturated fatty acids. We also found excessive intake of sodium and inadequate intakes of dietary fibre, water, vitamin D, vitamin E, folate, niacin, calcium and potassium. Preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future. The inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers. More research is needed to investigate dietary intake of children during their stay at preschool. Common regulations worked out for all preschools in the European Union would be a good way to provide adequate nutrition to preschool children.
TL;DR: It is contended that inflammation-induced tryptophan depletion forms part of a much wider effect of pro-inflammatory activity on the nutritional profile of HIV-infected patients.
Abstract: MV was the project leader. PB developed and validated the GC-MS method for
the analysis of tryptophan and performed the biochemical and immunological
analyses. MV and PB were responsible for the project design, analyses of the
results and writing of the manuscript. PL was involved in the sourcing of
patients and the clinical examination of all patients.
TL;DR: A comprehensive account of consanguinity and IC-F in RYK District is presented and would be helpful in getting an insight into the structure of this population.
Abstract: Rahim Yar Khan (RYK) District is a multi-ethnic assemblage of both ancient and migrated communities in Southern Punjab, Pakistan. There is a paucity of knowledge on the bio-demographic structure of this endogamous population. We have carried out a cross-sectional epidemiological study in RYK District and recruited 2174 random Muslim married females. Detailed account of marital union types, level of consanguinity, and subject’s fertility, was taken. The analyses of these data revealed that consanguineous unions (CU) were 58.46 %, rendering an inbreeding coefficient (IC-F) = 0.0355. The CU were observed to be significantly higher in subjects originating from rural areas, speaking Saraiki language, illiterate or having a religious/Madarsa education only, and belonging to nuclear family type. The rate of consanguinity was also higher in subjects whose husbands were engaged in unskilled manual or skilled manual jobs, and had consanguinity in the parental generation. Multivariate logistic regression analyses revealed that variables like Saraiki language, illiteracy, reciprocal marriages, and parental consanguinity, were the significant predictors of CU in the subject. Among the first cousin unions (which constituted 52 % of all marriages), parallel-cousin and patrilineal unions were in the majority (54 and 57 %, respectively), and father’s brother’s daughter type had the highest representation (31 %). The analyses further demonstrated that fertility and mean live-births were significantly higher in women who had CU compared to the non-consanguineous (NCU) group (p < 0.006); and significantly higher number of sons per women were born to the mothers who had CU compared with the NCU sample (p = 0.0002). However, there were no differences in the CU and NCU samples with respect to pre- or post-natal mortalities and child morbidities. The scientific findings in RYK District are distinct from the observations in other Pakistani populations and clue to a unique nature of this population. This study presents a comprehensive account of consanguinity and IC-F in RYK District and would be helpful in getting an insight into the structure of this population.
TL;DR: This study indicates that access to a franchise is correlated with access to and increased use of LAPMs, which are more effective, and cost-effective, methods of FP in Kenya.
Abstract: In Kenya, as in many low-income countries, the private sector is an important component of health service delivery and of providing access to preventive and curative health services. The Tunza Social Franchise Network, operated by Population Services Kenya, is Kenya’s largest network of private providers, comprising 329 clinics. Franchised clinics are only one source of family planning (FP), and this study seeks to understand whether access to a franchise increases the overall use or provides another alternative for women who would have found FP services in the public sector. A quasi-experimental study compared 50 catchment areas where there is a Tunza franchise and no other franchised provider with 50 purposively matched control areas within 20 km of each selected Tunza area, with a health facility, but no franchised facility. Data from 5609 women of reproductive age were collected on demographic and socioeconomic status, FP use, and care-seeking behavior. Multivariate logistic regression, with intervention and control respondents matched using coarsened exact matching, was conducted. Overall modern contraceptive use in this population was 53 %, with 24.8 % of women using a long-acting or permanent method (LAPM). There was no significant difference in odds of current or new FP use by group, adjusted for age. However, respondents in Tunza catchment areas are significantly more likely to be LAPM users (adj. OR = 1.49, p = 0.015). Further, women aged 18–24 and 41–49 in Tunza catchment areas have a significantly higher marginal probability of LAPM use than those in control areas. This study indicates that access to a franchise is correlated with access to and increased use of LAPMs, which are more effective, and cost-effective, methods of FP. While franchised facilities may provide additional points of access for FP and other services, the presence of the franchise does not, in and of itself, increase the use of FP in Kenya.
TL;DR: It is found that maternal hyperglycemia during labor is highly associated with macrosomia in neonates, and gestational diabetes was insufficiently screened in this series.
Abstract: Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. A prospective cohort study was held at the Maternity of the Yaounde Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant. One hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant. The main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series.
TL;DR: A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding, suggesting a model of behavior change communication strategy as a response to socio-economic disparity.
Abstract: Early initiation of breastfeeding after birth is a key behavioral health factor known to decrease neonatal mortality risks. Yet, few demographic studies examined how a community-based intervention impacts postpartum breastfeeding among the socio-economically deprived population in Sub-Saharan Africa. A post-intervention evaluation was conducted in 2011 to measure the effect of a UNICEF-led behavior change communication program promoting child health care in rural Niger. A quantitative survey is based on a post hoc constitution of two groups of a study sample, exposed and unexposed households. The sample includes women aged 15–49 years, having at least one child less than 24 months born with vaginal delivery. Rate ratio for bivariate analysis and multivariate logistic regression were applied for statistical analysis. The outcome variable is the initiation of breastfeeding within the first hour of birth. Independent variables include other behavioral outcome variables, different types of communication actions, and socio-demographic and economic status of mothers. The gaps in socio-economic vulnerability between the exposed and unexposed groups imply that mothers deprived from accessing basic health services and hygiene facilities are likely to be excluded from the communication actions. Mothers who practiced hand washing and used a traditional latrine showed 2.0 times more likely to initiate early breastfeeding compared to those who did not (95 % CI 1.4–2.7; 1.3–3.1). Home visits by community volunteers was not significant (AOR 1.2; 95 % CI 0.9–1.5). Mothers who got actively involved in exclusive breastfeeding promotion as peers were more likely to initiate breastfeeding within the first hour of birth (AOR 2.0; 95 % CI 1.4–2.9). A multi-sectorial approach combining hygiene practices and optimal breastfeeding promotion led to supporting early initiation of breastfeeding. A peer promotion of child health care suggests a model of behavior change communication strategy as a response to socio-economic disparity.
TL;DR: Against the backdrop of quality initiatives in the country to foster United Health Care (UHC), frontline health providers’ perspectives about quality and safety need to be considered and utilized.
Abstract: Quality instillation has its own challenges, facilitators and barriers in various settings. This paper focuses on exploration of quality components related to practices, health system challenges and quality enablers from providers’ perspectives with a focus on maternal health studied through a pilot research conducted in 2012–2013 in two states of India—Bihar and Jharkhand—with relatively poor indicators for maternal health. Qualitative data through in-depth interviews of 49 health providers purposively selected from various cadres of public health system in two districts each from Bihar and Jharkhand states was thematically analysed using MAXQDA Version 10. Maternity management guidelines developed by the National Health Mission, India, were considered as a tool to learn instillation of quality in provision of health services in various selected health facilities. Infrastructure, human resources, equipments and materials, drugs, training capacity and health information systems were described as health system challenges by medical and paramedical health providers. On a positive note, the study findings simultaneously identified quality enablers such as appreciation of public-private partnerships, availability of clinical guidelines in the form of wall posters in health facilities, efforts to translate knowledge and evidence through practice and enthusiasm towards value of guidelines. Against the backdrop of quality initiatives in the country to foster United Health Care (UHC), frontline health providers’ perspectives about quality and safety need to be considered and utilized. The provision of adequate health infrastructure, strong health management information system, introduction of evidence-based education and training with supportive supervision must constitute parallel efforts.
TL;DR: Dietary Mg was not significantly correlated with diabetes, while serum MG was inversely correlation with diabetes in the Chinese population, while dietary Mg intake and serum Mg were not significantly correlation in the diabetes population.
Abstract: A number of studies have reported the association between magnesium (Mg) and diabetes. However, the various conclusions were inconsistent and the data on the Chinese population was limited. The objective of this study was to evaluate the association among dietary Mg, serum Mg, and diabetes in Chinese adults. A cross-sectional study that contained 2904 subjects was conducted. Biochemical test results and dietary intakes of subjects were collected for analysis. The adjusted odds ratios (ORs) and the corresponding 95 % confidence intervals (95 % CIs) were used to determine the relationship between Mg status and diabetes by logistic regression. The prevalence of diabetes of the investigated population was 10.1 %. Dietary Mg intake was not significantly correlated with diabetes (P > 0.05). The significant negative association between serum Mg and diabetes existed, and the multivariate adjusted OR was 0.34 (95 % CI 0.24, 0.49) in model 3 for the highest quartile of serum Mg compared with the lowest. The P values for trend were all less than 0.001 for the relationship between serum Mg and diabetes. Dietary Mg intake and serum Mg were not significantly correlated in the diabetes population (P = 0.936). Dietary Mg was not significantly correlated with diabetes, while serum Mg was inversely correlated with diabetes in the Chinese population. Meanwhile, dietary Mg intake and serum Mg were not significantly correlated in the diabetes population.
TL;DR: Communicating the science of water quality and health risks in developing countries requires sample collection and analysis by knowledgeable personnel trained in the sciences, compiling baseline data, and, ultimately, an effective risk presentation back to households to motivate behavioral changes to effectively protect future water resources and human health.
Abstract: Suppose 35 % of the households with children under 5 years of age in a low-income suburban neighborhood in a developing country have diarrhea where improved water sources are available. Clearly, something is amiss—but what? In addition to focusing on the need to examine water quality among water sources that meet the ‘improved’ category when assessing health risk, the relative importance of the range of transmission routes for diarrhea is unknown. In Malawi, relevant baseline data affecting human health are simply not available, and acquiring data is hampered by a lack of local analytical capacity for characterizing drinking water quality. The objective of this work is to develop a risk communication program with partnership among established regional development professionals for effectively meeting the sustainable development goals. A field study was conducted in the city of Mzuzu, Malawi, to study water quality (total coliform and Escherichia coli) and human dimensions leading to development of a public health risk communication strategy in a peri-urban area. A structured household questionnaire was administered to adult residents of 51 households, encompassing 284 individuals, who were using the 30 monitored shallow wells. The water quality data and human dimension questionnaire results were used to develop a household risk presentation. Sixty-seven percent and 50 % of well water and household drinking water samples, respectively, exceeded the WHO health guideline of zero detections of E. coli. Technology transfer was advanced by providing knowledge through household risk debriefing/education, establishing a water quality laboratory at the local university, and providing training to local technicians. Communicating the science of water quality and health risks in developing countries requires sample collection and analysis by knowledgeable personnel trained in the sciences, compiling baseline data, and, ultimately, an effective risk presentation back to households to motivate behavioral changes to effectively protect future water resources and human health.
TL;DR: It is indicated that consumption of coffee was independently and significantly associated with OP, and the prevalence of OP was less frequent in Chinese men with moderate coffee intake.
Abstract: The main purpose of this study was to evaluate the associations between frequency of coffee intake and osteoporosis (OP) in a general Chinese male sample. We conducted a large-scale, community-based, cross-sectional study to investigate the associations by using a self-report questionnaire to estimate the frequency of coffee intake. A total of 992 men were available for data analysis in this study. Multiple regression models controlling for confounding factors to include frequency of coffee intake variable were performed to investigate the relationships for OP. Positive correlations between frequency of coffee intake and T-score were reported (β = 0.211, P = 0.024). Multiple regression analysis indicated that the frequency of coffee intake was significantly associated with OP (P < 0.05 for model 1 and model 2). The men with moderate frequency of coffee intake had a lower prevalence of OP. The findings indicated that consumption of coffee was independently and significantly associated with OP. The prevalence of OP was less frequent in Chinese men with moderate coffee intake. ClinicalTrials.gov, NCT02451397
TL;DR: CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities, however, despite the government’s efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery.
Abstract: The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012–2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government’s efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on strengthening the public sector’s ability to provide emergency obstetric care, the CY program is a potential means by which the state can ensure its poor mothers have access to necessary care if uptake is increased.