Diarrhea and the urban environment in India: a cross-section and longitudinal analysis 公开

Dollard, Philip (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/ww72bb51z?locale=zh
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Abstract

India is home to almost one-fifth of the world’s population and a third of the world’s poor. There is a persistent health gap between rural populations, which typically have worse health outcomes, and rapidly growing urban centers, though the growth of urban slums has complicated the picture.  Diarrheal illness is one of the world’s leading cause of death and disability and is a major health concern in India.  This paper uses data from two waves of the India Human Development Survey, IHDS-I and IHDS-II, to examine prevalence of diarrhea in urban and rural areas of India, as well as associated risk factors.  Logistic regression is used for each separate survey wave, and generalized estimating equations are used to conduct longitudinal analysis on data from both survey waves combined.  Univariate analysis showed urban environment to have a protective effect on diarrhea in IHDS-I (OR = 0.63, 95% CI: 0.59, 0.67), IHDS-II (OR = 0.78, 95% CI: 0.72, 0.84), and longitudinal analysis (OR = 0.71, 95% CI: 0.67, 0.75). However, in all three cases, the association became null when adjusted for household income, literacy, and piped water, suggesting that these are major contributing factors in the difference between the health of urban and rural populations in India.  This paper uses longitudinal data to pinpoint important factors in the public health gap between urban and rural areas in a developing nation and adds to a growing body of literature implicating income inequality as having a negative effect on the health of nations, especially developing nations.

Table of Contents

Table of Contents

 

Chapter I……………………………………………………………………………..….…1

            India’s disease burden……………………………………………………………..1

            Urbanization……………………………………………………………………….3

            The intersection of urbanization and disease……………………………………...6

Chapter II……………………………………………………………………………….…9

        Abstract………………………………………………………………………………9

        Introduction………………………………………………………………………....10

        Methods…………………………………………………………………………..…12

        Results………………………………………………………………………………16

        Discussion………………………………………………………………………..…23

            Limitations…………………………………………………………………….…25

            Strengths…………………………………………………………………………26

            Conclusion……………………………………………………………………….26

Chapter III……………………………………………………………………………..…28

References……………………………………………………………………………..…30

Appendix A……………………………………………………………………………....35

Tables

        Table 1: Characteristics of participants

in IHDS-I and IHDS-II…………………………………………………………..16

        Table 2: Prevalence of diarrhea by strata

of covariates in IHDS-I and IHDS-II…………………………………………….19

Table 3: Difference of covariates between

survey waves and results of student's t-test…………………………………...…21

Table 4: Results of unadjusted and adjusted

analysis for IHDS-I, IHDS-II, and longitudinal data………………………….…21

Table 5: Unadjusted and adjusted odds ratios

for reported diarrhea in IHDS-I and IHDS-II……………………………………35

 

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