Browsing by Subject "India"

Developing nations in Asia are posed to experience a significant increase in the population of older adults living in their respective societies. Over the coming decades, India, the second most populous country in the entire world, is poised to experience a significant increase in its elder population. India's population of adults 60 years of age or older is projected to increase from 8% to 19% of the countries total population by the year 2050. Figures predict that by mid-century, 323 million people in India will be aged 60 years or older, more than the total current U.S. population. As the demographic structure of India is making a dramatic shift, concerns regarding the health and wellbeing of the growing Indian elder population are emerging, as is the growing concern for social policy. In addition, Sri Lanka is the fastest aging nation in South Asia. Multiple factors, including an increase in the number of people considered to be the "oldest old" (80+ years of age), a decrease in the number of working age adults, and increases in disability amongst the elderly, could necessitate an increased need for institutionalization of elderly Sri Lankans into long-term care facilities.

This project aims to study aging in south Asia from two different perspectives. An analysis of existing data from Southern India was done to examine the attitudes and beliefs of Indian elders towards aging and support systems for the elderly. Mental health of Indian elders was assessed and logistic regression analysis was conducted to examine possible correlations between attitudes and beliefs of the elderly and elder mental health. In addition, a qualitative descriptive study of Sri Lankan elder homes was carried out in the southern district of Galle, Sri Lanka. A convenience sampling method was used to identify six elder homes located in the area, and visits were made to each of the homes. During the visits, elder home mangers were interviewed in order to gain general information on the functioning and history of the elder homes, as well as general information on the residents living at the facilities.

Results from the Kerala Aging Survey revealed that psychological distress was present for over one third of elders in Kerala. Rates of psychological distress were higher for women, the poor, and those with advanced age. Elder women appear to be especially vulnerable to psychological distress in old age. Elders believe that children are responsible for supporting parents in their old age; lack of satisfaction with support received from children was associated with the presence of psychological distress amongst elders. For the qualitative study on Sri Lankan elders homes, it was found that both familial and community support are significant factors in the long-term care of elderly Sri Lankans. Though many elder home residents had been diagnosed with a chronic NCD or disability, lack of familial support was consistently identified as the driving force necessitating the elderly to reside at the long-term care facilities. With little or no financial assistance from the government, the facilities themselves all relied heavily on donations from the community to function on a daily basis.

Background: India has the highest burden of cervical cancer mortality, globally, with 67,477 deaths in 2012. A novel device, the transvaginal digital colposcope (TVDC), or a small handheld colposcope, could potentially improve quality of care and address barriers to cervical cancer screening, by reducing patient discomfort and aiding practitioners in screening. Studies which validate India-WHO guidelines for cervical cancer screening report wide ranges of sensitivity and specificity for techniques currently used in low-resource settings, all of which are contingent on numerous factors from patient awareness to receptivity to user training, suggesting that the context is paramount to improving cervical cancer detection. To that end, assessment of the healthcare and physician environment in terms of practice and reaction to the new device is essential prior to device implementation in order to anticipate benefits or negative consequences of device use.

Methods: A survey was developed to explore experiences, practice, and approaches to cervical cancer screening based on a new technology, and administered to 15 gynecologists in various clinical settings in Hyderabad, India. First, participants answered questions about past and current practices for cervical cancer screening, diagnosis, and treatment procedures. Next, physicians assessed images from a clinical trial involving imaging of cervix by the TVDC and with standard colposcopy. To check physician interpretation of images from the clinical trial, biopsy or histologic confirmation was used for positive results, while colposcopy was used as the reference standard for negative results.

Results: Colposcopy and magnification for visualization of the cervix were preferred by all physicians, in spite of low frequency of in-house use or referrals for the procedure. Accuracy among physicians interpreting TVDC images ranged from 25%-100%, while accuracy with colposcopy images ranged from 38%-100%. Sensitivity for TVDC images and corresponding colposcopy images was 72% and 91% respectively, while specificity was 54% and 38% respectively. Physicians were more likely to report suspicion for cancer in positive cases with a false negative rate with TVDC images and corresponding colposcopy images at 19% and 0%. Images with the new device were either considered comparable to or were preferred to colposcopy images, but disagreement in interpretation between TVDC and colposcopy for the same patient ranged from 13%-63%.

Conclusion: This study shows how observation-based cervical cancer screening or diagnostic techniques, without preceding, adjunct screening or diagnostic tests, may have low specificity in disease detection. However, a new technology TVDC may be appropriate for this type of setting. Further research into patient attitudes, physician motivation, physician experience with colposcopy and clinical decision-making is required prior to implementation if gains in reduction of cervical cancer incidence and deaths are to be realized.

The literature on clientelism has extensively covered the direct exchange of private goods for political support between voters and politicians. Yet, patronage does not end with the distribution of food, medicine or public employment. In poor informal settlements, access to a sanitation system or clean drinking water is often mediated by local politicians.Therefore, the interaction between slum politics and the provision of Local Public Goods (LPG) is quite relevant and requires further study.

This dissertation explains the variation in infrastructure and public services in shantytowns as a function of social capital. Well-connected communities --with stronger ties among its members-- solve collective action problems, improving slum dwellers' quality of life. The linking mechanism between social capital and LPG is electoral coordination (bloc-voting). Neighbors agree for a common electoral strategy at the slum-level, which translates into an effective mechanism to demand for improvements in their locality (``good-type partisan homogeneity'').

Alternatively, isolation among slum dwellers deteriorate their access to and quality of LPG. Under the absence of social capital, when slum-level electoral behavior appears to be homogenous, it is likely signaling political clientelism and not community-led coordination. Ultimately the ``bad-type partisan homogeneity'' represents the inability of slum dwellers to enforce electoral accountability and sanction unresponsive governments. I test my hypotheses with survey data from Udaipur (India) and eight provinces in Argentina.

This is a dissertation about identity and governance, and how they are mutually constituted. Between 1838 and 1917, the British brought approximately half a million East Indian laborers to the Atlantic to work on sugar plantations. The dissertation argues that contrary to previous historiographical assumptions, indentured East Indians were an amorphous mass of people drawn from various regions of British India. They were brought together not by their innate "Indian-ness" upon their arrival in the Caribbean, but by the common experience of indenture recruitment, transportation and plantation life. Ideas of innate "Indian-ness" were products of an imperial discourse that emerged from and shaped official approaches to governing East Indians in the Atlantic. Government officials and planters promoted visions of East Indians as "primitive" subjects who engaged in child marriage and wife murder. Officials mobilized ideas about gender to sustain racialized stereotypes of East Indian subjects. East Indian women were thought to be promiscuous, and East Indian men were violent and depraved (especially in response to East Indian women's promiscuity). By pointing to these stereotypes about East Indians, government officials and planters could highlight the promise of indenture as a civilizing mechanism. This dissertation links the study of governance and subject formation to complicate ideas of colonial rule as static. It uncovers how colonial processes evolved to handle the challenges posed by migrant populations.

The primary architects of indenture, Caribbean governments, the British Colonial Office, and planters hoped that East Indian indentured laborers would form a stable and easily-governed labor force. They anticipated that the presence of these laborers would undermine the demands of Afro-Creole workers for higher wages and shorter working hours. Indenture, however, was controversial among British liberals who saw it as potentially hindering the creation of a free labor market, and abolitionists who also feared that indenture was a new form of slavery. Using court records, newspapers, legislative documents, bureaucratic correspondence, memoirs, novels, and travel accounts from archives and libraries in Britain, Guyana, and Trinidad and Tobago, this dissertation explores how indenture was envisioned and constantly re-envisioned in response to its critics. It chronicles how the struggles between the planter class and the colonial state for authority over indentured laborers affected the way that indenture functioned in the British Atlantic. In addition to focusing on indenture's official origins, this dissertation examines the actions of East Indian indentured subjects as they are recorded in the imperial archive to explore how these people experienced indenture.

Indenture contracts were central to the justification of indenture and to the creation of a pliable labor force in the Atlantic. According to English common law, only free parties could enter into contracts. Indenture contracts limited the period of indenture and affirmed that laborers would be remunerated for their labor. While the architects of indenture pointed to contracts as evidence that indenture was not slavery, contracts in reality prevented laborers from participating in the free labor market and kept the wages of indentured laborers low. Further, in late nineteenth-century Britain, contracts were civil matters. In the British Atlantic, indentured laborers who violated the terms of their contracts faced criminal trials and their associated punishments such as imprisonment and hard labor. Officials used indenture contracts to exploit the labor and limit the mobility of indentured laborers in a manner that was reminiscent of slavery but that instead established indentured laborers as subjects with limited rights. The dissertation chronicles how indenture contracts spawned a complex inter-imperial bureaucracy in British India, Britain, and the Caribbean that was responsible for the transportation and governance of East Indian indentured laborers overseas.

In this dissertation, I examine at the aggregate and individual levels, why contemporary fertility preferences diverge from actual fertility. I use three waves of cross-sectional survey data from the National Family Health Surveys from India (also known as the Indian Demographic and Health Surveys), fielded in 1992-3, 1998-9 and 2005-6 to investigate the disjuncture between preferences and behavior. The first empirical chapter outlines and operationalizes a new framework to decompose the incongruence between stated preferences and actual fertility into a set of parameters, such as unwanted births, gender preference and postponement of births to later ages, each of which varies in its level and intensity between societies and over time. By delineating the societal constraints that women do not incorporate in their childbearing intentions, this model provides a useful framework to explain variability in fertility in contemporary intermediate- and low-fertility populations. Equally important, the framework provides avenues to enquire into the fundamental structural and cultural correlates producing differences between family size preferences and actual fertility.

Subsequent empirical chapters explore various aspects of fertility preferences in detail. The second chapter probes a key socioeconomic correlate of individual-level fertility preferences, namely educational differences in preferences. In brief, I find that educational differences in family size preferences have considerably converged over time using two-way fixed effects models. However, there is still considerable heterogeneity in the implementation of preferences (as manifested by the use of contraception). Accordingly, in the third chapter, I analyze the multilevel sources of variation in the use of contraception by young women, given that they express a preference to space or stop childbearing. Using multilevel models, I find that community norms play a strong role in the use of contraception by young women to meet their fertility preferences to space or stop childbearing. I argue that community norms are an influential determinant of young women's ability to regulate their own fertility - serving to enhance or constrain their use of contraception to either space or stop childbearing.

Overall, findings from this dissertation highlight the macro-level factors that explain variation in contemporary fertility, of which fertility preferences emerge as a critical parameter. This dissertation also illuminates the growing convergence of fertility preferences across socioeconomic categories, while focusing attention on local community forces that influence fertility behavior even in the face of women's stated preferences.

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Background: The global rise in early-onset type 2 diabetes (T2D) is impacting the lives of millions of young individuals around the world. To address the knowledge gap and emotional burden in young adults with T2D, the research team designed a four-week education and goal-based peer support intervention, Kanasina Gulabi (Kannada: My Dream Rose), implemented in Mysore, India between June and July 2023. Methods: The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess feasibility. Peer navigators (n=3, mean age: 33 years) were recruited from the community and trained to deliver the intervention. Twenty-eight adults ≤ 40 years of age with T2D were recruited and quasi-randomly allocated to the intervention group (n=14, mean age: 33 years) or the control group (n=14, mean age: 33 years). Hemoglobin A1c, T2D knowledge, diabetes distress, diabetes-related stigma, depression severity, and optimism were assessed at baseline, immediately after the intervention, and at the 2-month follow-up. Attendance, fidelity, and acceptability were also assessed. Results: Intervention participants expressed high satisfaction with Kanasina Gulabi and gratitude for the guided knowledge and mentorship from their peer navigators. Participants displayed excellent attendance and adherence, with an average of 5 hours of Kanasina Gulabi exposure over 4 weeks. Peer navigators delivered the intervention with 100% fidelity. Results immediately following the intervention showed reductions in diabetes distress (Intervention: 30.9%, Control: 6.5%), diabetes-related stigma (Intervention: 25.3%, Control: 14.5%), and depression severity (Intervention: 58.3%, Control: 38.5%). Both groups presented an increase in T2D knowledge (Intervention: 19.7%, Control: 25.2%). Conclusion: Implementing Kanasina Gulabi in Mysore is feasible and acceptable, with intervention participants showing more positive changes on multiple psychosocial outcomes compared to the control group. Results support a full trial to evaluate its effectiveness and sustainability in young adults with T2D.

My research is driven by two questions: Why do some dissident groups choose nonviolence over violence while others prefer violence over nonviolence? Why do political movements, even those using the same tactics, unfold and evolve divergently? To answer the first question, I argue that nonviolent dissidents are dependent on human resources and violent dissidents are dependent on physical resources. Further, either strategy could be more costly, depending on the strategic environment in which the resistance movement takes place. For the second question, I contend that the opposition which poses a level of threat greater than the cost of policy change gains concession in a prolonged movement. Oppositions that are unable to sustain their activities do not constitute a credible threat and therefore are defeated rather swiftly. Finally, every process requires time and therefore a movement's duration should explain the outcome of significant progress. By analyzing 250 political movements of various types around the world, I provide empirical evidence to support my theory. To complement the large-N empirical analysis, an in-depth analysis of two movements (one violent and one nonviolent) in India is provided.