BackgroundPhysician-coded verbal autopsy (PCVA) is the most widely used method to determine cause... more BackgroundPhysician-coded verbal autopsy (PCVA) is the most widely used method to determine causes of death (COD) in countries where medical certification of death is low. Computer-coded verbal autopsy (CCVA), an alternative method to PCVA for assigning the COD is considered to be efficient and cost-effective. However, the performance of CCVA as compared to PCVA is yet to be established in the Indian context.MethodsWe evaluated the performance of PCVA and three CCVA methods i.e., InterVA 5, InSilico, and Tariff 2.0 on verbal autopsies done using the WHO 2016 VA tool on 2,120 reference standard cases developed from five tertiary care hospitals of Delhi. PCVA methodology involved dual independent review with adjudication, where required. Metrics to assess performance were Cause Specific Mortality Fraction (CSMF), sensitivity, positive predictive value (PPV), CSMF Accuracy, and Kappa statistic.ResultsIn terms of the measures of the overall performance of COD assignment methods, for CSM...
Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wal... more Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wall of vagina connecting to bladder or to rectum due to prolonged obstructed labour without timely medical assistance. A few research studies carried out in India and recently conducted DLHS-3 survey (2007-08) has information on obstetric fistula that gives scope for further research. This paper examines prevalence of obstetric fistula and its correlates using DLHS-3 data for selected states in India. Ever experience of obstetric fistula among women in these states ranges from 0.3 percent to 3.4 percent, being highest in Uttarakhand. Women living in rural areas have higher chance of obstetric fistula. Age and physical maturity is important factor in the occurrence of fistula and it is found that those women who were below 18 years at the time of their first birth have higher risk of fistula in comparison to those who had child at 18 or above years. In addition to this, those having problem...
International Journal of Health Sciences and Research, 2016
Background: Epidemiologic transition is reflected by the change in pattern of causes of death in ... more Background: Epidemiologic transition is reflected by the change in pattern of causes of death in which infectious and parasitic diseases shift to chronic and degenerative diseases of adulthood. Cause of death trends and patterns are important for future health policy planning. Objectives: To measure mortality trends of different causes of deaths for urban population of India. Materials and Methods: The study used MCCD data for 1990-2010 and calculated proportion of major cause of death to total deaths by age and sex for all these years. Results: Analysis indicated that there had been shift in the age structure and cause of mortality. The unique feature of epidemiologic transition in urban India is that circulatory and respiratory deaths had increased their relative shares in mortality over time but infectious diseases did still remain a major cause of death at the same time. There was reduction in share of children‟s deaths and concentration of mortality in older age group. Conclusi...
International Journal of Multidisciplinary Research and Development, 2015
Information on cause of death plays an important role in mortality analysis. Knowledge about the ... more Information on cause of death plays an important role in mortality analysis. Knowledge about the cause of illness or death is of paramount importance for a country for upliftment of health status of people. Life table technique helps in examining the effect of specific cause of death elimination in life expectancy. One gets an idea about the gain in life expectancy if one is able to control a specific disease. The present paper aims to construct such life tables by using the data of the “Report on Medical Certification of Causes of Death 2003”, Registrar General & Census Commissioner, India, in India and its selected states namely, Bihar, Maharashtra, Rajasthan and Tamil Nadu to find out the potential gain in life expectancy at birth after partial and complete elimination of specified causes of death. The elimination of diseases of the circulatory system yields maximum gain in life expectancy at birth in India and all the selected states. Effective intervention needs to be put in pl...
Cause of death information is an important planning tool for health services. The curve of cause-... more Cause of death information is an important planning tool for health services. The curve of cause-ofdeath profile reflect picture of mortality and health circumstances of a country as it postulates that causes of death are different at different transition phases and in different age-sex groups of the population. In India, only a few studies had been carried out to understand the dynamics of causes of death. This study attempts to measure mortality trends by different causes of death for urban population of Rajasthan by using medical certification of cause of death (MCCD) data for 1990-2014 by calculating proportion of leading causes of death to total deaths by age and sex for all these years. Results showed that there had been changes in the pattern of causes of death and age pattern of mortality. Diseases of circulatory system and diseases of the digestive system were the leading causes of death accounting for 20.6% and 3.9% share which were below the national average of 31.6% and ...
International Journal Of Community Medicine And Public Health, Apr 24, 2020
Life expectancy is a statistical measure to depict average life span a person is expected to live... more Life expectancy is a statistical measure to depict average life span a person is expected to live at a given age under given age-specific mortality rates. 1 It is convenient, representative and comprehensive indicator to judge social and economic status and quality of life of a country or region; more intuitive than mortality rates; easy to interpret in terms of expectation of life and is most commonly used by policy-makers to set out national strategies for health. 2-3 Life expectancy in women was higher than in men in mid-2000 and women live longer in nearly all countries of the world probably due to social and economic transformation benefitting women more than men. 4 It is worthy to mention that in India in 1970-75, the urban life expectancy at birth for female (59.2 years) was slightly more than for male (58.8 years) and the same trend is continuing till now. In 2012-16, the female life expectancy (73.5 years) is also higher than that of male (70.9 years) by about three years. 5
International Journal of Scientific Reports, Nov 29, 2015
Out of six global deaths in a year one is from India which equals to 9.5 million deaths. 5 Presen... more Out of six global deaths in a year one is from India which equals to 9.5 million deaths. 5 Presently, India is experiencing epidemiological transition and changes in the mortality pattern as a result of its socioeconomic and ABSTRACT Background: Change in causes of death pattern is a reflection of epidemiological transition in which infectious and parasitic diseases shift to chronic and degenerative diseases of adulthood. Cause of death trend and pattern is important for future health policy planning. Methods: This study attempts to measure mortality trends by different causes of death for urban Maharashtra by using MCCD data for 1990-2010 by calculating proportion of major cause of death to total deaths by age and sex for all these years. Results: Results reveal that there has been shift in the structure of mortality by cause. Diseases of circulatory system were the leading causes of death accounting for about 31% share of all medically certified deaths which is well above the national average of about 30%. Similarly, the proportion of deaths due to certain conditions originating in the perinatal period appears to be low in the state (3.9%) compared to national average (7%). The proportions of deaths due to certain infectious and parasitic diseases and disease of the respiratory system appear to be very high (15.7% and 12.1% respectively) compared to national average (13.1% and 9.5% respectively). Conclusions: It was found that socioeconomically developed and demographically advanced urban Maharashtra bears the double burden of disease specific mortality.
International Journal of Scientific Reports, May 2, 2015
<p class=&... more <p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Reliable data on mortality and morbidity among women of reproductive age are scarce in India. The present study is the Rajasthan component of a large multi-centric study on cause of death by verbal autopsy conducted in five states of India. The data pertaining to deaths among women of reproductive age are presented. </p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>House-to-house surveys of a representative population from rural and urban areas in six districts of Rajasthan were undertaken by Probability of Proportion to Size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared for the purpose. International Classification of Diseases - ICD-10 was used to code the assigned cause of death. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 231 deaths of women of reproductive age were investigated, of which 36 (16%) were maternal deaths while 195 (84%) were non-maternal deaths. Nine out of ten maternal deaths were in rural area.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Certain infectious and parasitic diseases; pregnancy, childbirth and the puerpurium; injury, poisoning and other consequences of external causes; and symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified were found to be the major killers among the women of…
Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Mi... more Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and lessons learned to incorporate into the SDGs. The present study reviews and predicts different components of under-five mortality rate beyond 2015 to assess the present situation and to determine the future possibilities of achieving the new targets for SDGs in India. Data and Methods: It uses available time series data on different components of U5MR from the India's Sample Registration System (SRS). Autoregressive Integrated Moving Averages (ARIMA) model has been taken as the method of time series analysis to forecast the mortality rates beyond 2015. Results: There is a consistent pattern of faster decline in the under-five mortality compared with the neonatal mortality rate across all major states in India although neonatal mortality contributes largest share in under-five mortality. Again, share of neonatal death among under-five death is increasing steadily over the future projected years. This indicates very slow progress of reduction in neonatal mortality. Stimulating efforts with new intervention programmes will be needed to focus more on lowering neonatal mortality particularly in rural India.
This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011.... more This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, sex-ratio at birth, age and sex-specific pattern of mortality, and volume and age-sex distribution of net migration were derived from census records, Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced ...
The level of infant and child mortality is high among Scheduled Tribes particularly those living ... more The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas. Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992-2006. Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1...
Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wal... more Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wall of vagina connecting to bladder or to rectum due to prolonged obstructed labour without timely medical assistance. A few research studies carried out in India and recently conducted DLHS-3 survey (2007-08) has information on obstetric fistula that gives scope for further research. This paper examines prevalence of obstetric fistula and its correlates using DLHS-3 data for selected states in India. Ever experience of obstetric fistula among women in these states ranges from 0.3 percent to 3.4 percent, being highest in Uttarakhand. Women living in rural areas have higher chance of obstetric fistula. Age and physical maturity is important factor in the occurrence of fistula and it is found that those women who were below 18 years at the time of their first birth have higher risk of fistula in comparison to those who had child at 18 or above years. In addition to this, those having problem...
BackgroundPhysician-coded verbal autopsy (PCVA) is the most widely used method to determine cause... more BackgroundPhysician-coded verbal autopsy (PCVA) is the most widely used method to determine causes of death (COD) in countries where medical certification of death is low. Computer-coded verbal autopsy (CCVA), an alternative method to PCVA for assigning the COD is considered to be efficient and cost-effective. However, the performance of CCVA as compared to PCVA is yet to be established in the Indian context.MethodsWe evaluated the performance of PCVA and three CCVA methods i.e., InterVA 5, InSilico, and Tariff 2.0 on verbal autopsies done using the WHO 2016 VA tool on 2,120 reference standard cases developed from five tertiary care hospitals of Delhi. PCVA methodology involved dual independent review with adjudication, where required. Metrics to assess performance were Cause Specific Mortality Fraction (CSMF), sensitivity, positive predictive value (PPV), CSMF Accuracy, and Kappa statistic.ResultsIn terms of the measures of the overall performance of COD assignment methods, for CSM...
Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wal... more Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wall of vagina connecting to bladder or to rectum due to prolonged obstructed labour without timely medical assistance. A few research studies carried out in India and recently conducted DLHS-3 survey (2007-08) has information on obstetric fistula that gives scope for further research. This paper examines prevalence of obstetric fistula and its correlates using DLHS-3 data for selected states in India. Ever experience of obstetric fistula among women in these states ranges from 0.3 percent to 3.4 percent, being highest in Uttarakhand. Women living in rural areas have higher chance of obstetric fistula. Age and physical maturity is important factor in the occurrence of fistula and it is found that those women who were below 18 years at the time of their first birth have higher risk of fistula in comparison to those who had child at 18 or above years. In addition to this, those having problem...
International Journal of Health Sciences and Research, 2016
Background: Epidemiologic transition is reflected by the change in pattern of causes of death in ... more Background: Epidemiologic transition is reflected by the change in pattern of causes of death in which infectious and parasitic diseases shift to chronic and degenerative diseases of adulthood. Cause of death trends and patterns are important for future health policy planning. Objectives: To measure mortality trends of different causes of deaths for urban population of India. Materials and Methods: The study used MCCD data for 1990-2010 and calculated proportion of major cause of death to total deaths by age and sex for all these years. Results: Analysis indicated that there had been shift in the age structure and cause of mortality. The unique feature of epidemiologic transition in urban India is that circulatory and respiratory deaths had increased their relative shares in mortality over time but infectious diseases did still remain a major cause of death at the same time. There was reduction in share of children‟s deaths and concentration of mortality in older age group. Conclusi...
International Journal of Multidisciplinary Research and Development, 2015
Information on cause of death plays an important role in mortality analysis. Knowledge about the ... more Information on cause of death plays an important role in mortality analysis. Knowledge about the cause of illness or death is of paramount importance for a country for upliftment of health status of people. Life table technique helps in examining the effect of specific cause of death elimination in life expectancy. One gets an idea about the gain in life expectancy if one is able to control a specific disease. The present paper aims to construct such life tables by using the data of the “Report on Medical Certification of Causes of Death 2003”, Registrar General & Census Commissioner, India, in India and its selected states namely, Bihar, Maharashtra, Rajasthan and Tamil Nadu to find out the potential gain in life expectancy at birth after partial and complete elimination of specified causes of death. The elimination of diseases of the circulatory system yields maximum gain in life expectancy at birth in India and all the selected states. Effective intervention needs to be put in pl...
Cause of death information is an important planning tool for health services. The curve of cause-... more Cause of death information is an important planning tool for health services. The curve of cause-ofdeath profile reflect picture of mortality and health circumstances of a country as it postulates that causes of death are different at different transition phases and in different age-sex groups of the population. In India, only a few studies had been carried out to understand the dynamics of causes of death. This study attempts to measure mortality trends by different causes of death for urban population of Rajasthan by using medical certification of cause of death (MCCD) data for 1990-2014 by calculating proportion of leading causes of death to total deaths by age and sex for all these years. Results showed that there had been changes in the pattern of causes of death and age pattern of mortality. Diseases of circulatory system and diseases of the digestive system were the leading causes of death accounting for 20.6% and 3.9% share which were below the national average of 31.6% and ...
International Journal Of Community Medicine And Public Health, Apr 24, 2020
Life expectancy is a statistical measure to depict average life span a person is expected to live... more Life expectancy is a statistical measure to depict average life span a person is expected to live at a given age under given age-specific mortality rates. 1 It is convenient, representative and comprehensive indicator to judge social and economic status and quality of life of a country or region; more intuitive than mortality rates; easy to interpret in terms of expectation of life and is most commonly used by policy-makers to set out national strategies for health. 2-3 Life expectancy in women was higher than in men in mid-2000 and women live longer in nearly all countries of the world probably due to social and economic transformation benefitting women more than men. 4 It is worthy to mention that in India in 1970-75, the urban life expectancy at birth for female (59.2 years) was slightly more than for male (58.8 years) and the same trend is continuing till now. In 2012-16, the female life expectancy (73.5 years) is also higher than that of male (70.9 years) by about three years. 5
International Journal of Scientific Reports, Nov 29, 2015
Out of six global deaths in a year one is from India which equals to 9.5 million deaths. 5 Presen... more Out of six global deaths in a year one is from India which equals to 9.5 million deaths. 5 Presently, India is experiencing epidemiological transition and changes in the mortality pattern as a result of its socioeconomic and ABSTRACT Background: Change in causes of death pattern is a reflection of epidemiological transition in which infectious and parasitic diseases shift to chronic and degenerative diseases of adulthood. Cause of death trend and pattern is important for future health policy planning. Methods: This study attempts to measure mortality trends by different causes of death for urban Maharashtra by using MCCD data for 1990-2010 by calculating proportion of major cause of death to total deaths by age and sex for all these years. Results: Results reveal that there has been shift in the structure of mortality by cause. Diseases of circulatory system were the leading causes of death accounting for about 31% share of all medically certified deaths which is well above the national average of about 30%. Similarly, the proportion of deaths due to certain conditions originating in the perinatal period appears to be low in the state (3.9%) compared to national average (7%). The proportions of deaths due to certain infectious and parasitic diseases and disease of the respiratory system appear to be very high (15.7% and 12.1% respectively) compared to national average (13.1% and 9.5% respectively). Conclusions: It was found that socioeconomically developed and demographically advanced urban Maharashtra bears the double burden of disease specific mortality.
International Journal of Scientific Reports, May 2, 2015
<p class=&... more <p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Reliable data on mortality and morbidity among women of reproductive age are scarce in India. The present study is the Rajasthan component of a large multi-centric study on cause of death by verbal autopsy conducted in five states of India. The data pertaining to deaths among women of reproductive age are presented. </p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>House-to-house surveys of a representative population from rural and urban areas in six districts of Rajasthan were undertaken by Probability of Proportion to Size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared for the purpose. International Classification of Diseases - ICD-10 was used to code the assigned cause of death. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 231 deaths of women of reproductive age were investigated, of which 36 (16%) were maternal deaths while 195 (84%) were non-maternal deaths. Nine out of ten maternal deaths were in rural area.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Certain infectious and parasitic diseases; pregnancy, childbirth and the puerpurium; injury, poisoning and other consequences of external causes; and symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified were found to be the major killers among the women of…
Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Mi... more Background & Objectives: Sustainable Development Goals (SDGs) are set up as a part of the Post Millennium Development Goals (MDGs). Then it becomes essential to review the achievement of the MDGs in India and lessons learned to incorporate into the SDGs. The present study reviews and predicts different components of under-five mortality rate beyond 2015 to assess the present situation and to determine the future possibilities of achieving the new targets for SDGs in India. Data and Methods: It uses available time series data on different components of U5MR from the India's Sample Registration System (SRS). Autoregressive Integrated Moving Averages (ARIMA) model has been taken as the method of time series analysis to forecast the mortality rates beyond 2015. Results: There is a consistent pattern of faster decline in the under-five mortality compared with the neonatal mortality rate across all major states in India although neonatal mortality contributes largest share in under-five mortality. Again, share of neonatal death among under-five death is increasing steadily over the future projected years. This indicates very slow progress of reduction in neonatal mortality. Stimulating efforts with new intervention programmes will be needed to focus more on lowering neonatal mortality particularly in rural India.
This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011.... more This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, sex-ratio at birth, age and sex-specific pattern of mortality, and volume and age-sex distribution of net migration were derived from census records, Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced ...
The level of infant and child mortality is high among Scheduled Tribes particularly those living ... more The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas. Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992-2006. Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1...
Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wal... more Obstetric fistula is the most devastating form of maternal morbidity. It is an opening in the wall of vagina connecting to bladder or to rectum due to prolonged obstructed labour without timely medical assistance. A few research studies carried out in India and recently conducted DLHS-3 survey (2007-08) has information on obstetric fistula that gives scope for further research. This paper examines prevalence of obstetric fistula and its correlates using DLHS-3 data for selected states in India. Ever experience of obstetric fistula among women in these states ranges from 0.3 percent to 3.4 percent, being highest in Uttarakhand. Women living in rural areas have higher chance of obstetric fistula. Age and physical maturity is important factor in the occurrence of fistula and it is found that those women who were below 18 years at the time of their first birth have higher risk of fistula in comparison to those who had child at 18 or above years. In addition to this, those having problem...
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Papers by B K Gulati