Background A disproportionately high proportion of maternal deaths (99 percent) in the world occur in low and middle income countries, of which 90 percent is contributed by Sub-Saharan Africa and South Asia. This study uses the effective "Three Delays" model to assess the socio-cultural barriers associated with maternal mortality in West Bengal, India. Methods It was a retrospective mixed methods study, which used facility-based as well as community-based approaches to explore factors associated with maternal deaths. We reviewed 317 maternal death cases wherein a verbal autopsy technique was applied on 40 cases. The Chi-square test (χ2) and multivariable logistic regression model were employed to accomplish the study objectives. Results The delay in seeking care (Type 1 delay) was the most significant contributor to maternal deaths (48.6 percent, 154/317). The second major impacting contributor to maternal deaths was the delay in reaching first level health facility (Type 2 delay) (33.8 percent, 107/317), while delay in receiving adequate care at the health facility (Type 3 delay) had a role in 18.9 percent maternal deaths. Women staying at long distance from the health facilities have reported [AOR with 95 % CI; 1.7 (1.11-1.96)] higher type 2 delay as compared to their counterparts. The study also exhibited that the women belonged to Muslim community were 2.5 times and 1.6 times more likely to experience type 1 and 2 delays respectively than Hindu women. The verbal autopsies revealed that the type 1 delay is attributed to the underestimation of the gravity of the complications, cultural belief and customs. Recognition of danger signs, knowledge and attitude towards seeking medical care, arranging transport and financial constraints were the main barriers of delay in seeking care and reaching facility. Conclusions The study found that the type-1 and type-2 delays were major contributors of maternal deaths in the study region. Therefore, to prevent the maternal deaths effectively, action will be required in areas like strengthening the functionality of referral networks, expand coverage of healthcare and raising awareness regarding maternal complications and danger signs.

Background: Tribals are intrinsically isolated and socially disadvantage groups currently living in India. Health parameters like nutritional deficiency leads them to several health consequences. Main objectives on which study is based, was to know prevalence and determinants of nutritional status among tribal women in Maharashtra. Data sources and methodology: Data of 3923 tribal women from the National Family Health Survey (NFHS-4), was used. Bi-variate and Logistic regression was calculated using a statistical tools linked with nutritional status. A spatial tool (ArcGIS) was used to study spatial variation of BMI & Anaemia in Maharashtra. Results: The prevalence of underweight is lower among tribal women but more than half of the total women are anaemic, less than 6% of obesity among them in Maharashtra. In the spatial analysis, predominant results of any anaemia of tribal women were found in the Northwest districts of Maharashtra. The highest (2.5-4.6%) and the moderate percentage (1.5-2.5%) of severe anaemia, and obesity were found in almost all the districts located in western Maharashtra, whereas the prevalence of high (48-62%) and moderate (35-48%) underweight was found dispersedly throughout Maharashtra. Conclusion:Tribal community in India is most susceptible in terms of social, health and education development.The government needs to focus on regional and community-based development approach for overall health improvement among tribal women in Maharashtra. These results may help policymakers to prepare apt strategies for the overall development of health among the people in general and tribal women in particular.

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Background Despite policies and social development, childhood malnutrition remains a significant public health and social challenge in many south Asian countries. Also, there is a lack of study for a comparative understanding between the nutrition policies and nutritional status of under-5 children in south Asian countries. In this context, the present study aims to understand the comparative evolution of nutritional policies and programs in south Asian countries between 1950 to 2016 and assess current nutritional status of children under the age of 5 in Bangladesh, India, Nepal, and Pakistan. Methods This study obtained yearly anaemia data from the Global Health Observatory Data Repository (World Health Statistics) from 1990 to 2016 for comparative analysis. The most recent Demographic Health Survey (DHS) rounds have been taken for four south Asian nations. Bivariate analysis and classical figures have been utilised to demonstrate the findings. Results In Bangladesh, Nepal, India, and Pakistan, the prevalence of anaemia decreased by 33%, 31%, 20%, and 12% from 1990 to 2016, respectively. While analysis of the policy and programs, the problem of under-nutrition in all selected countries stems from the lack of serious implementation of National Nutrition Policies. Conclusion This study suggests that the national nutrition programs require inter-sectoral coordination between central ministries within countries to reduce the anaemia level. In light of Sustainable Development Goals (SDG), a multi-faceted policy should be implemented to prevent and control malnutrition problems in these countries.

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