The stigma surrounding people with severe mental illness in India leads to increased poverty among them, especially women, according to new research led by Jean-Francois Trani, PhD, assistant professor at the Brown School at Washington University in St. Louis.

Trani and fellow researchers, including Jill Kuhlberg, doctoral student and research associate at the Brown School, studied more than 1,000 patients and controls in the mental health department of a hospital in New Delhi from 2011-12, conducting interviews during hospital visits and at homes.

The results, “Mental Illness, Poverty and Stigma in India: A Case–Control Study,” are published in the journal The BMJ Open.

“Mental health professionals must incorporate an understanding of multidimensional poverty stressors as well as address family and community dynamics,” Trani wrote in the paper. “Our findings go beyond medical and public health and link mental health to international development.”

Trani and his team found that public stigma and poverty linked to mental illness were “pervasive and intertwined.” Assumptions by many that mentally ill people are violent and unable to work contribute to their unemployment.

Stigma associated with mental illness limits women from fulfilling family and social roles, increasing discrimination against them, the study found.

http://medicalxpress.com/news/2015-03-stigma-mental-illness-india-linked.html

India’s main public health programs, aimed at millions of rural poor, have been in disarray for months because the government changed the way that over $1.3 billion in federal funds were distributed, according to data and letters seen by Reuters.

In a bid last year to give India’s states more power, the federal health ministry started sending funds for public health programs to state treasuries, instead of direct transfers to its regional arms.

But poorly-run regional bureaucracies were unable to cope and both the flagship National Health Mission (NHM) and India’s AIDS prevention programs suffered – thousands of health workers were not paid for months and the construction of clinics in rural areas was delayed.

In some cases, state governments temporarily used the funds earmarked for health programs to meet needs of other sectors, health officials said.

The funds involved amounted to about one-third of the total federal spending on health, and led to further deterioration in India’s tattered public health system.

Eleven letters obtained by a Reuters reporter under India’s Right to Information Act revealed the health ministry’s desperate, and failed, attempts to push states to release funds to NHM arms.

The decision last year to route many payments through states, launched by the previous Congress party-led government, affected other sectors as well, but the impact on health programs has been glaring.

India spends just 1 percent of its GDP on public health, less than Afghanistan and Sierra Leone. On Saturday, the federal government increased the annual budget for its main health department by just 2 percent to $4.8 billion.

Still, India struggles to spend all of its allocated health funds because of an inadequate number of doctors and hospitals, and bureaucratic bungling. Data shows the government has only once spent all of its health budget since 2005.

Since April, the federal government has sent more than $1.3 billion to the states for the NHM, which undertakes treatment of diseases such as tuberculosis and malaria, construction of rural health centers and immunisation drives.

No state treasury released the funds to the designated health societies within a stipulated 15-day period, with delays running into months in some cases, according to government data seen by Reuters. More than $180 million is still to be released.

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Several NHM officials interviewed by Reuters said the state health units were deprived of funds for months. Salaries, training and building new clinics were hit.

In the northern state of Jammu and Kashmir, 9,000 health workers have not received salaries for three months and cash incentives for women who give birth in a government hospital have been withheld, said Yash Pal Sharma, the state’s director for the NHM.

Treasuries in the north-eastern states of Meghalaya and Mizoram held NHM funds for 151 days and 79 days, respectively, data as of Feb. 22 showed. In India’s third-largest state Maharashtra, funds sent in June reached the health society in December.

“Outreach programs have been severely impacted,” said a health ministry official in New Delhi. “The entire system has been paralysed, bureaucracy has become bureau-crazy.”

India’s AIDS prevention drive, a program separate from the NHM, was also affected by the new payments system. Workers from high-risk groups, such as sex workers and injectable drug users, who are employed to run programs within their communities are quitting because of irregular pay.

Rama, a project manager in one such community-based program for sex workers in Mumbai, said 17 of her 23 team members have quit because of delayed salaries. New people hired will take months before they can efficiently run the program.

“It takes a lot of time to build trust within our communities. Our HIV testing numbers have fallen by half because sex workers don’t trust new people,” said the 26-year-old, who says she moonlights as a sex worker herself to survive.

India runs more than 1,800 community-based programs for AIDS prevention. The World Bank has estimated India’s policy of targeting sex workers to control AIDS would avert three million infections during 1995-2015.

Government data showed that India’s National AIDS Control Organisation released $67 million to state governments in recent months as a second installment for the overall program, but only $39 million reached its state-level health societies. The first installment of $78 million was released by state treasuries after months of delays.

http://www.stuff.co.nz/world/asia/66911772/indias-health-programs-dented

Her first child survived eight months before succumbing to pneumonia; her second was stillborn; her third, delivered in a rickshaw, gasped for an hour before dying.

When she got pregnant for a fourth time, Juhi, a woman from a South Delhi slum who uses only one name, was spotted by a local health worker and taken to a mobile clinic. A doctor diagnosed severe anemia, gave her iron pills and begged her to eat more.

Juhi listened, and gave birth to a boy, Muhammad Sultan, who has survived his first birthday — a huge milestone in a country with about one-sixth of the world’s population but one-third of all newborn deaths.

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A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the world’s poorest countries. Poor sanitation and a growing tide of drug-resistant infections also affect nutrition.

But an important factor is the relatively poor health of young Indian women. More than 90 percent of adolescent Indian girls are anemic, a crucial measure of poor nutrition. And while researchers have long known that Indian mothers tend to be less healthy than their African counterparts, a new study published Monday in the Proceedings of the National Academy of Sciences demonstrates that the disparity is far worse than previously believed.

By analyzing census data, Diane Coffey of Princeton University found that 42 percent of Indian mothers are underweight. The figure for sub-Saharan Africa is 16.5 percent.

Ms. Coffey calculated that the average woman in India weighs less at the end of her pregnancy than the average woman in sub-Saharan Africa did at the beginning, an astonishing finding.

“In India, people are richer, better educated and have fewer children than those in sub-Saharan Africa, so it’s really surprising that Indian children are shorter and smaller than those in sub-Saharan Africa,” Ms. Coffey said in an interview. “But when you step back and look at the state of Indian mothers, it’s not such a surprise after all.”

Research has shown that genetics play no role in the size differences, leaving environmental factors as the only explanation, Ms. Coffey said.

The reasons for Indian mothers’ relatively poor health are many, including a culture that discriminates against them. Sex differences in education, employment outside the home, and infant mortality are all greater in India than in Africa.

“In India, young newly married women are at the bottom of household hierarchies,” Ms. Coffey said. “So at the same time that Indian women become pregnant, they are often expected to keep quiet, work hard and eat little.”

Mothers also suffer from the same sewage-borne infections that so often kill their babies, made endemic by the primitive sanitation in much of the country, Ms. Coffey said.

“It is likely that infectious disease is responsible for a signification portion of India’s pre-pregnancy underweight problem,” she said.

Dr. Shella Duggal, Juhi’s doctor at the mobile clinic, said that almost every pregnant woman she treats in her visits to Delhi’s slums is severely anemic. Parasites, spread by poor sanitation and dirty water, are a crucial reason, she said.

“So the first thing we do is deworm them and give them iron supplements,” Dr. Duggal said. “And then I tell them to eat.”

It is a prescription many of her patients find difficult to carry out, she said.

“These mothers are the last persons in their families to have food,” Dr. Duggal said. “First, she feeds the husband and then the kids, and only then will she eat the leftovers.”

http://www.nytimes.com/2015/03/03/world/asia/-pregnant-women-india-dangerously-underweight-study.html?_r=0