Wednesday December 19, 2018

Andaman and Nicobar reports lowest infant mortality rate

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New Delhi: A data released by the National Family Health Survey (NFHS 4) this week, stated that the Andaman and Nicobar Islands, a union territory, reported India’s lowest infant mortality rate (deaths per 1,000 live births) and under-five mortality rate (deaths per 1,000 children) among 13 states and two union territories.

The Andaman and Nicobar Islands, a union territory, reported India’s lowest infant mortality rate (deaths per 1,000 live births) and under-five mortality rate (deaths per 1,000 children) among 13 states and two union territories for which data was released this week.

Madhya Pradesh (MP) reported the highest infant mortality rate (IMR) as well as under-five mortality rate (u5MR) with 51 and 65, respectively, according to data published by the health ministry, as per the National Family Health Survey 4 (NFHS 4), a nationwide health census, the last data for which was released in 2005-06.

Over this decade, rising female literacy, later marriages, the ability to take financial decisions, better healthcare, cooking facilities and water supply are among the reasons why Indian mothers and children are living longer, according to data from the 13 states and two union territories.

But some afflictions have seen limited progress, such as anaemia, reported in half the children in 10 states and more than half the women in 11 states. Overall, progress is uneven across India, the data shows.

The Andaman and Nicobar Islands have an infant mortality rate of 10, better than Brazil (15), the same as China and Bulgaria, according to World Health Organisation data, and better than a host of countries with higher per capita incomes. In contrast, MP’s infant mortality rate is worse than some of the world’s poorest countries, such as Gambia and Ethiopia.

Data for union territories and the newly minted one-and-a-half-year-old state of Telangana has been featured for the first time in the NFHS.

Crucial data is missing for some of India’s most backwards states requiring special healthcare intervention by the central government – officially called empowered action group (EAG) states – including Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.

Almost all the 13 states and two union territories have seen a decline in infant mortality rates and under-five mortality rates. The highest fall in IMR was seen in Tripura – from 51 deaths per 1,000 live births in 2005-06 to 27 in NFHS 4 (2015-16).

The highest fall in under-five mortality was seen in West Bengal – from 59 to 32 over the same period.

The direct reasons for improvement are better maternal and child health practices such as more breastfeeding, births in healthcare institutions (instead of at home), improved vaccination and the use of diarrhoea medication. The indirect reasons include rising female literacy, later marriages, better cooking facilities such as gas thus reducing health risks from wood or coal-fired stoves and financial inclusion.

The states that have seen improvements in IMR and U5MR clearly improved their child health indicators. Tripura, which saw the highest decline in IMR, has also seen a decline in the prevalence of diarrhoea, from 8.4 percent in 2005-06 to 4.9 percent in 2015-16, and an increase in fully immunised children from 49.7 percent to 57.7 percent.

West Bengal, which has seen the second highest reduction in IMR and the highest decline in U5MR, has been able to achieve these through increased availability of oral rehydration solution (ORS) for children suffering from diarrhoea (42.6 percent to 64.7 percent) and improving immunisation from 64.3 percent to 84.4 percent of children.

Karnataka saw a decline in IMR from 43 in 2005-06 to 28 in 2015-16 and decline in U5MR from 54 to 32. The state saw an increase in consumption of iron tablets by mothers from 28.2 percent to 45.3 percent.

The state also saw an increase in the percentage of mothers who received full ante-natal care from 24.8 percent to 32.9 percent and an increase in institutional births from 64.7 percent to 94.3 percent showing a direct correlation between improvement in maternal health and reduction in child mortality.

The correlation between sanitation and IMR numbers is well documented. Tripura and West Bengal have seen improvements in sanitation facilities, which have resulted in decreased IMR figures across these states. West Bengal has seen an increase in the percentage of households with improved sanitation facilities from 34.7 percent to 50.9 percent.

Female empowerment through literacy and financial inclusion has also helped in reducing infant and maternal mortality. The education of mothers and their ability to make decisions affects infant and child mortality, according to this study published by the UK-based Institute of Development Studies (IDS). This is evident in West Bengal, where female literacy rates rose from 58.8 percent to 71 percent, alongside declines in both IMR and U5MR.

Similarly, Tripura’s female literacy rose from 68.5 percent to 80.4 percent and Karnataka’s from 59.7 percent to 71.7 percent.

Women in the three states also reported increased participation in household decisions. For example, in Karnataka, female participation increased from 68.6 percent to 80.4 percent. One of the reasons for the improvement of the status of women can also be attributed to their ability to spend their own income. This has been achieved through financial inclusion, which has led to many having their own bank account, the IDS study said.(IANS) (picture courtesy: aif.org)

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Hospitals Worldwide Detain Patients If They Cant Pay The Bill

Earlier this month, the High Court ruled again that imprisoning patients “is not one of the acceptable avenues [for hospitals] to recover debt.

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Margaret Oliele, a former detained patient, poses for a portrait in her home in Nairobi, Kenya. VOA

Doctors at Nairobi’s Kenyatta National Hospital have told Robert Wanyonyi there’s nothing more they can do for him. Yet more than a year after he first arrived, shot and paralyzed in a robbery, the ex-shopkeeper remains trapped in the hospital.

Because Wanyonyi cannot pay his bill of nearly 4 million Kenyan shillings ($39,570), administrators are refusing to let him leave his fourth-floor bed.

At Kenyatta National Hospital and at an astonishing number of hospitals around the world, if you don’t pay up, you don’t go home.

The hospitals often illegally detain patients long after they should be medically discharged, using armed guards, locked doors and even chains to hold those who have not settled their accounts. Even death does not guarantee release: Kenyan hospitals and morgues are holding hundreds of bodies until families can pay their loved ones’ bills, government officials say.

An Associated Press investigation has found evidence of hospital imprisonments in more than 30 countries worldwide, according to hospital records, patient lists and interviews with dozens of doctors, nurses, health academics, patients and administrators. The detentions were found in countries including the Philippines, India, China, Thailand, Lithuania, Bulgaria, Bolivia and Iran. Of more than 20 hospitals visited by the AP in Congo, only one did not detain patients.

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A relative adjusts the oxygen mask of a tuberculosis patient at a TB hospital on World Tuberculosis Day in Hyderabad, India. VOA

Millions possibly affected

“What’s striking about this issue is that the more we look for this, the more we find it,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “It’s probably hundreds of thousands, if not millions of people that this affects worldwide.”

During several August visits to Kenyatta National Hospital — a major medical institution designated a Center of Excellence by the U.S. Centers for Disease Control and Prevention — the AP witnessed armed guards in military fatigues standing watch over patients. Detainees slept on bedsheets on the floor in cordoned-off rooms. Guards prevented one worried father from seeing his detained toddler.

Kenya’s ministry of health and Kenyatta canceled several scheduled interviews with the AP and declined to respond to repeated requests for comment.

Health experts decry hospital imprisonment as a human rights violation. Yet the United Nations, U.S. and international health agencies, donors and charities have all remained silent while pumping billions of dollars into these countries to support their splintered health systems or to fight outbreaks of diseases including AIDS and malaria.

“People know patients are being held prisoner, but they probably think they have bigger battles in public health to fight, so they just have to let this go,” said Sophie Harman, a global health expert at Queen Mary University of London.

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Detained patients lie on beds in the Kenyatta National Hospital in Nairobi, Kenya. VOA

Hospitals often acknowledge detaining patients isn’t profitable, but many say it can sometimes result in a partial payment and serves as a deterrent.

‘A way to conduct business’

Festus Njuguna, an oncologist at the Moi Teaching and Referral Hospital in Eldoret, about 300 kilometers northwest of Nairobi, said the institution regularly detains children with cancer who have finished their treatment, but whose parents cannot pay.

“It’s not a very good feeling for the doctors and nurses who have treated these patients, to see them kept like this,” Njuguna said.

Still, many officials openly defend the practice.

“We can’t just let people leave if they don’t pay,” said Leedy Nyembo-Mugalu, administrator of Congo’s Katuba Reference Hospital. He said holding patients wasn’t an issue of human rights, but simply a way to conduct business: “No one ever comes back to pay their bill a month or two later.”

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FILE – A Yemeni woman suspected of being infected with cholera receives treatment at a hospital in the capital Sanaa. VOA

Global health agencies and companies that operate where patients are held hostage often have very little to say about it.

The CDC provides about $1.5 million every year to Kenyatta National Hospital and Pumwani Maternity Hospital, helping to cover treatment costs for patients with HIV and tuberculosis, among other programs. The CDC declined to comment on whether it was aware that patients were regularly detained at the two hospitals or if it condones the practice.

Dr. Agnes Soucat of the World Health Organization said it does not support patient detentions, but has been unable to document where it happens. And while the WHO has issued hundreds of health recommendations on issues from AIDS to Zika virus, the agency has never published any guidance advising countries not to imprison people in their hospitals.

‘Cruel, inhuman and degrading’

Many Kenyan human rights advocates lament that hospitals continue to hold patients despite what was seen as a landmark judgment in 2015.

Back then, the High Court ruled that the detention of two women at Pumwani who couldn’t pay their delivery fees — Maimuna Omuya and Margaret Oliele — was “cruel, inhuman and degrading.” Omuya and her newborn were held for almost a month next to a flooded toilet while Oliele was handcuffed to her bed after trying to escape.

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A doctor gestures outside a hospital in the Algerian town of Boufarik, as the country faces a cholera outbreak. VOA

Earlier this month, the High Court ruled again that imprisoning patients “is not one of the acceptable avenues [for hospitals] to recover debt.”

Omuya said she is still psychologically scarred by her detention at Pumwani, especially after another recent run-in with a Nairobi hospital.

Also Read: Kenya’s First Breast Milk Bank to Combat Newborn Mortality

Several months ago, her youngest brother was treated for a suspected poisoning. When Omuya and her family were unable to pay the bill, the situation took a familiar but unwelcome turn: he was imprisoned. Her brother was only freed after his doctor intervened.

“Detentions still go on because there are no rights here,” Omuya said. “What I suffered, I want no one else to suffer.” (VOA)