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Item Addressing child under nutrition: can traditional practices offer a solution?(Glob. Health Action, 2017) Sarika Chaturvedi; Joanna Raven; Bhushan PatwardhanChild under nutrition continues to be a challenge to global development, especially in resource-poor contexts. In the multifaceted attempts to address this challenge, popular traditional practices, although closely linked to infant health, remain neglected and less researched. The World Health Organization's recent strategy on traditional medicine systems provides overarching guidance in this regard. In this commentary, we attempt to exemplify this. We highlight the importance of traditional child care practices with regard to child nutrition and the need for trans-disciplinary research to explore the potential of these for public health. Infant oil massage appears to be a potentially beneficial practice for child nutrition. Rigorous trans-disciplinary research on traditional infant massage can provide simple solutions to address child under nutrition and nurture human capabilities globally.Item An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India(Glob. Health Action, 2014) Marie Ng; Archana Misra; Vishal Diwan; Manohar Agnani; Alison Levin-Rector; Ayesha De CostaBackground: The Indian Janani Suraksha Yojana (JSY) program is a demand-side program in which the state pays women a cash incentive to deliver in an institution, with the aim of reducing maternal mortality. The JSY has had 54 million beneficiaries since inception 7 years ago. Although a number of studies have demonstrated the effect of JSY on coverage, few have examined the direct impact of the program on maternal mortality. Objective: To study the impact of JSY on maternal mortality in Madhya Pradesh (MP), one of India's largest provinces. Design: By synthesizing data from various sources, district-level maternal mortality ratios (MMR) from 2005 to 2010 were estimated using a Bayesian spatio-temporal model. Based on these, a mixed effects multilevel regression model was applied to assess the impact of JSY. Specifically, the association between JSY intensity, as reflected by 1) proportion of JSY-supported institutional deliveries, 2) total annual JSY expenditure, and 3) MMR, was examined. Results: The proportion of all institutional deliveries increased from 23.9% in 2005 to 55.9% in 2010 provincewide. The proportion of JSY-supported institutional deliveries rose from 14% (2005) to 80% (2010). MMR declines in the districts varied from 2 to 35% over this period. Despite the marked increase in JSY-supported delivery, our multilevel models did not detect a significant association between JSY-supported delivery proportions and changes in MMR in the districts. The results from the analysis examining the association between MMR and JSY expenditure are similar. Conclusions: Our analysis was unable to detect an association between maternal mortality reduction and the JSY in MP. The high proportion of institutional delivery under the program does not seem to have converted to lower mortality outcomes. The lack of significant impact could be related to supply-side constraints. Demand-side programs like JSY will have a limited effect if the supply side is unable to deliver care of adequate quality.Item Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis(Glob. Health Action, 2018) Hemant Deepak Shewade; Vivek Gupta; Srinath Satyanarayana; Atul Kharate; K. N. Sahai; Lakshmi Murali; Sanjeev Kamble; Madhav Deshpande; Naresh Kumar; Sunil Kumar; Prabhat PandeyBackground: There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. Objectives: To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). Methods: In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. Results: When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF (-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-058 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. Conclusion: ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.