Background Indonesia has shown a nominal increase in antenatal care (ANC) coverage from 93% to 96% in the Indonesia Demographic Health Survey (IDHS)—2012. This is high but for a comprehensive assessment of maternal health coverage in Indonesia, safe delivery services need to be assessed in conjunction with ANC coverage. Materials and methods The study uses survey data from the IDHS-2012 that was conducted among women aged 15–49 years who gave birth during the past 3 years preceding the survey. Socioeconomic and demographic factors affecting ANC coverage and safe delivery services are analysed by segregating the data into 7 regions of Indonesia. Results Multivariate results show that besides wealth and education differentials, regional differences significantly affect the usage of ANC and safe delivery services across the 7 regions. Univariate analyses show that Sulawesi, Maluku and Western New Guinea islands are at a disadvantage in accessing ANC and safe delivery services. Conclusions The study recommends that disaggregated regional targets be set in order to further reduce maternal mortality rates in Indonesia.

Background. India accounts for 24% to all under-five mortality in the world. Residence in rural area, poverty and low levels of mother’s education are known confounders of under-five mortality. Since two-thirds of India’s population lives in rural areas, mothers employed in agriculture present a particularly vulnerable population in the Indian context and it is imperative that concerns of this sizeable population are addressed in order to achieve MDG4 targets of reducing U5MR to fewer than 41 per 1,000 by 2015. This study was conducted to examine factors associated with under-five mortality among mothers employed in agriculture.Methods. Data was retrieved from National Family Household Survey-3 in India (2008). The study population is comprised of a national representative sample of single children aged 0 to 59 months and born to mothers aged 15 to 49 years employed in agriculture from all 29 states of India. Univariate and Multivariate Cox PH regression analysis was used to analyse the Hazard Rates of mortality. The predictive power of child mortality among mothers employed in agriculture was assessed by calculating the area under the receiver operating characteristic (ROC) curve.Results. An increase in mothers’ ages corresponds with a decrease in child mortality. Breastfeeding reduces child mortality by 70% (HR 0.30, 0.25–0.35, p = 0.001). Standard of Living reduces child mortality by 32% with high standard of living (HR 0.68, 0.52–0.89, 0.001) in comparison to low standard of living. Prenatal care (HR 0.40, 0.34–0.48, p = 0.001) and breastfeeding health nutrition education (HR 0.45, 0.31–0.66, p = 0.001) are associated significant factors for child mortality. Birth Order five is a risk factor for mortality (HR 1.49, 1.05–2.10, p = 0.04) in comparison to Birth Order one among women engaged in agriculture while the household size (6–10 members and ≥ 11 members) is significant in reducing child mortality in comparison to ≤5 members in the house. Under-five mortality among mothers employed in agriculture in India discriminated well between death and survival (Area Under ROC was 0.75, 95% CI [0.73–0.77]) indicating that the model is good for appropriate prediction of child mortality.Conclusion. In a nationally representative sample of households in India, mother’s age, breastfeeding, standard of living, prenatal care and breastfeeding health nutrition education are associated with reduction in child mortality.

Purpose: According to the 4th and 5th rounds of National Family Health Survey (NFHS), there is high prevalence of hysterectomies in the three states of Andhra Pradesh Telangana and Bihar. The three said states have more than double the number of hysterectomies taking place than the national average. Our purpose is to analyse whether these rates are increasing, decreasing or have stabilized and their reasons thereof. Such an analyses will help the policy makers in recommending good clinical practices within their states.Material and methods: We used data from NFHS-4 (2015-16) and NFHS-5 (2019-2021) rounds. We calculated the differences in predicted probabilities for various factors, performed a Fairlie Decomposition analyses to quantify the positive and negative contributors in the prevalence of hysterectomy across the three states over two time points, and assessed the association of various socio-demographic characteristics to hysterectomy through a multilevel logistic regression model.Results and conclusion: The results show that out of a total of 80,976 eligible respondents from the states under study, 5826 respondents self-reported that they had a hysterectomy done. It was found that older age, living in rural areas, belonging to other backward classes and higher wealth quintile, and higher parity positively contributed to the increased prevalence of hysterectomies in the three states. Higher educational attainment and previous use of family planning methods acted as protective factors. Characteristics at the household level had the highest intra-class correlation value in the prevalence of hysterectomy among women, followed by the Primary Sampling Unit and District levels, indicating high clustering in the prevalence of hysterectomy at the household level in all three states. Heavy menstrual bleeding/pain was the leading cause of hysterectomies in all three states, followed by fibroids/cysts in Andhra Pradesh and Telangana and Uterine disorder/ prolapse in Bihar. Over 80% of hysterectomies took place in the private hospitals.Recommendations: The study recommends better, more efficient and accountable hysterectomy surveillance to ensure more sustainable woman’s reproductive health services in India. Government should adopt and implement standard regulatory guidelines to prevent provider-driven avoidable hysterectomies. Moreover, we recommend informing primary care professionals about the long-term health effects of hysterectomy and promoting alternate therapies for treating uterine fibroids and heavy bleeding.

This review evaluated the association of place of residence (urban/rural) and under-five mortality in middle- and low-income countries. Both English and Spanish language studies conducted during the Millennium Development Goal (MDG) period (1990 to 2015) were reviewed. Twenty-six cross-sectional studies, all in the English language, were selected for further review. Published data were used for this analysis. A funnel plot was produced to ascertain the presence of publication bias. The combined relative risk for under-five mortality was estimated using a random-effects model and a meta-regression was conducted on 15 of the 26 studies. The studies had a combined effect size of 1.47 (95% confidence interval, 1.27–1.67). The results of the meta-regression showed a positive association between the relative risk and the percentage of the rural population for the various regions/countries. The coefficient for the variable rural population percentage was 0.007, indicating that for every one percent increase in the rural population percentage, there was a 0.007 increase in the relative risk for under-five mortality. However, this was not significant (p-value = 0.3). Rural disadvantage persists in middle- and low-income countries. This is important to evaluate policies and programmes designed to remove the gap in under-five mortality rates between urban and rural areas.

Background. Worldwide, cataract is a major cause of blindness. The paper aims to evaluate factors associated with borderline and poor outcomes of cataract surgery at an Eastern Regional Health Authority (ERHA) hospital in Trinidad and Tobago.Materials and Methods. A hospital-based, retrospective study was done on 401 patients who had undergone cataract surgery (unilateral and bilateral) at an ERHA Hospital between March 2009 and September 2014. Data was collected on variables concerning demographic, medical history, surgical history, ocular findings and visual acuity (VA). The outcome variable of interest was Snellen’s post-operative (presenting) VA which was transformed into a dichotomous variable with borderline and poor outcomes as one and good outcomes as the other. Data were analysed using univariate and multivariate logistic regression analyses.Results. Good outcome (presenting VA 6/18 or better) was seen in 350 (67%) eyes. The fitted model consisted of ocular co-morbidity (OR =2.133; 95% CI [1.346–3.380]), hypertension (OR = 0.520; 95% CI [0.381–0.928]), surgical procedure (OR = 1.56; 95% CI [1.004–2.425]), good preoperative VA (OR = 0.388, 95% CI [0.211–0.714]), borderline preoperative VA (OR = 0.485; 95% CI = [0.278–0.843]) and year of first visit to clinic (OR = 2.243; 95% CI [1.215–4.141]).Conclusion. There is a need for community-based outreach to increase awareness of eye health and diseases. It is recommended that the general population is encouraged to take responsibility for personal management. The facilities at the Hospital should also be enhanced.

There is a global lack of data concerning shark consumption trends, consumer attitudes, and public knowledge regarding sharks. This is the case in Trinidad and Tobago, where shark is a popular culinary delicacy. A Knowledge, Attitudes, and Practices (KAP) survey was conducted in Trinidad and Tobago. Six hundred and seven questionnaires were administered. Univariate and stepwise multivariate logistic regressions were performed to test the association between KAP and demographic categories. The response rate was 93.4% with 567 questionnaires returned (473 from Trinidad and 94 from Tobago). Two hundred and seventeen (38.3%) participants were knowledgeable, 422 (74.4%) displayed attitudes in favour of shark conservation and sustainable use, and 270 (47.6%) displayed practices promoting shark conservation and sustainable use. Island (AOR = 2.81, CI = 1.78, 4.46) and tertiary education (AOR = 2.31, CI = 1.20, 4.46) significantly influenced knowledge level. Gender (AOR = 1.50, CI = 1.02, 2.20) and island (AOR = 0.56, CI = 0.35, 0.90) significantly influenced attitude. Gender (COR = 1.59, CI = 1.14, 2.22) was significantly associated with practices. Over 70% of respondents ate shark, and 54.7% ate shark infrequently enough to avoid risks from heavy metal toxicity. Our results may be useful to develop public awareness and practice improvement initiatives in order to improve KAP regarding shark meat consumption.