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Background: Cancer is often detected much later to its onset, resulting in poor prognosis. This makes cancer the second most common cause of death globally. Looking for cancers much before any symptoms occur is termed "cancer screening" and is a powerful strategy for prevention, early diagnosis, and better management of several cancers. This paper examines the status of cancer screening in India from the National Family Health Survey (NFHS)-5 report for the period of 2019–2021. Methods: Secondary data on participation in screening for cervical, breast, and oral cancer were extracted from the NFHS-5 report. Participation status for all the above cancer types is represented as percentages and compared across 28 states and eight union territories in India. Results: The percentages of women who have ever undergone cervical, breast, and oral cavity screening were 1.9%, 0.9%, and 0.9%, respectively. About 1.2% of men participated in oral cavity screening. The highest percentage of cervical and breast cancer screening participation was reported in Tamil Nadu (9.8% and 5.6%, respectively), followed by Puducherry (7.4% and 4.2%) and Mizoram (6.9% and 2.7%). Andaman and Nicobar Islands reported the highest oral cancer screening among women (10.1%) while Andhra Pradesh (6.3%) reported the highest participation among men. Conclusion: Cancer screening participation in India is extremely inadequate and calls for the immediate attention of national and state governments. Additional efforts are warranted to improve public awareness of cancer screening, and appropriate measures should be implemented to conduct well-organized screening programs across the country to ensure maximum participation. [ABSTRACT FROM AUTHOR]

Background: With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0-11 months), children (12-59 months) and under-five (0-59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India.Methods: The study used data from the National Family Health Survey (2015-16) which includes all the birth histories of 475,457 women aged 15-49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity.Results: About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55-1.80] and 1.46 times [CI: 1.37-1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32-1.44] and 1.24 times [CI: 1.20-1.29] higher for infant and under-five mortality respectively in the EAG regions.Conclusion: The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood. [ABSTRACT FROM AUTHOR]

Recent attention to Millennium Development Goals by the international development community has led to the formation of targets to measure country-level achievements, including achievements on health status indicators such as childhood immunization. Using the example of immunization in India, this paper demonstrates the importance of disaggregating national averages for a better understanding of social disparities in health. Specifically, the paper uses data from the India National Family Health Survey 1992–93 to analyze socioeconomic, gender, urban-rural and regional inequalities in immunization in India for each of the 17 largest states. Results show that, on average, southern states have better immunization levels and lower immunization inequalities than many northern states. Wealth and regional inequalities are correlated with overall levels of immunization in a non-linear fashion. Gender inequalities persist in most states, including in the south, and seem unrelated to overall immunization or the levels of other inequalities measured here. This suggests that the gender differentials reflect deep-seated societal factors rather than health system issues per se. The disaggregated information and analysis used in this paper allows for setting more meaningful targets than country averages. Additionally, it helps policy makers and planners to understand programmatic constraints and needs by identifying disparities between sub-groups of the population, including strong and weak performers at the state and regional levels. [Copyright &y& Elsevier]

Purpose: VISHRAM is a community-based mental health program to address psycho-social distress and risk factors for suicide in a predominantly rural population in Central India, through targeted interventions for the prevention and management of Depression and Alcohol Use Disorders (AUD). The evaluation was designed to assess the impact of program on the contact coverage of evidence-based treatments for depression and AUD through a repeated survey design. This paper describes the baseline prevalence of depression among adults in rural community, association of various demographic and socio-economic factors with depression and estimates contact coverage and costs of care for depression.Methods: Population-based cross-sectional survey of adults in 30 villages of Amravati district in Vidarbha region of Central India. The outcome of interest was a probable diagnosis of depression which was measured using the Patient Health Questionnaire (PHQ-9). Data were analyzed using simple and multiple logistic regression.Results: The outcome of current depression (PHQ-9 ≥ 10) was observed in 14.6 % of the sample (95 % CI 12.8-16.4 %). The contact coverage for current depression was only 4.3 % (95 % CI 1.5-7.1 %). Prevalence of depression varied greatly between the two sites of the study; higher age, female gender, lower education, economic status below poverty line and indebtedness were associated with depression; and while a contact coverage with formal health care was very low, a large proportion of affected persons had consulted family members.Conclusions: Our findings clearly indicate that psycho-social distress in rural communities in Maharashtra is strongly associated with social determinants such as gender, poverty and indebtedness and affects the entire population and not just farmers. [ABSTRACT FROM AUTHOR]

The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8 times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%). The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes, (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days. [ABSTRACT FROM AUTHOR]

This paper examines emerging patterns of low fertility in regions of India. Using data from the National Family Health Survey, I find that, on average, women in India's low-fertility states follow an ordered life course of marriage followed by first birth, but limit higher-parity births through sterilisation at earlier ages and at higher rates. For a longitudinal perspective, I focus on the Indian state of Kerala, where the total fertility rate has been at- or below-replacement levels for more than 20 years. Women across successive birth cohorts in Kerala are marrying later, but, once married, they transition to first birth at similar rates across birth cohorts. Unlike in most of Europe and East Asia where non-marriage and substantial delays in marriage and childbearing drive low fertility, widespread female sterilisation and the restriction of childbearing to the period soon after marriage are important factors driving below-replacement fertility in regions of India. [ABSTRACT FROM PUBLISHER]

Although son preference in patrilineal society is an established fact, daughter preference in matrilineal society is not thoroughly examined. Very few studies have been carried out on the issue. This paper attempts to explore the daughter preference and contraceptive-use in matrilineal tribal societies in Meghalaya, India. Data from the National Family Health Survey 1998-1999 have been used in this study because, among the large-scale surveys, only this dataset allows identification of matrilineal sample. Mean, percentage, and standard deviation are computed in the present study. Further, the data have been cross-tabulated, and logistic regression has been run through SPSS (version 15). Among the ever-married matrilineal women, 17% desired more sons than daughters but 18.2% desired more daughters than sons. About 11% of ever-married women could achieve their desired sex composition of children. However, a very striking finding suggests that, even after achieving desired sex composition of children, as high as 61.8% of women were still not using contraception mainly because of programme factors while one-fourth were still depending on temporary methods. The rest 13.2% adopted terminal method of contraception, which calls for immediate attention of planners. With the increase in the number of sons but without daughter, contraceptive-use drastically decreased. The most desired sex composition of children seems to be two daughters and a son. Absence of daughter with increase in the total number of sons increased the desire for additional children. Every woman with two or more sons but without daughter wanted the next child to be a daughter. Thus, there are ample evidences to draw the conclusion that there is, in fact, a daughter preference in the matrilineal tribal societies in Meghalaya, India. Policy-makers may, thus, target the women who have achieved fertility and should ensure that daughter preference does not lead to the negligence to sons. [ABSTRACT FROM AUTHOR]

This paper presents a new method for estimating the effect of child mortality on the total fertility rate (TFR). The method is based on discrete-time survival models of parity progression that allow construction of a multivariate multidimensional life table of fertility with four dimensions: woman's age, parity, duration in parity, and number of previous child deaths. Additional socio-economic variables are included in the set of predictor variables in the underlying survival models of parity progression. The life table yields a replacement rate, which measures the effect of one additional child death on the TFR. The method is illustrated by applying it to three Indian National Family Health Surveys. Major findings are that dead children are incompletely replaced, and that the replacement rate rises as the TFR falls, reflecting women's increasing ability to control their fertility. [ABSTRACT FROM AUTHOR]

Abstract: Despite its economic success, India has made little progress towards meeting its Millennium Development Goal targets of reducing undernourishment, particularly among children. In this paper, we use nationally representative datasets, the National Family Health Surveys (NFHS II and NFHS III) and the National Sample Survey (55th and the 61st rounds) to analyse the link, if any, between child nutritional outcomes and calorie intakes. Our analysis finds evidence of an improvement in the height-for-age z-scores, but a worsening in weight-for-height z-scores for children aged 0–3 over the period 1998/1999–2005/2006. There is also evidence of a sharp decline in per adult equivalent calorie intake from the principal food items over roughly this same period. Moreover, this decline was observed across all the expenditure quintiles. Our analysis is therefore able to identify a co-movement of declining nutritional intake for both adults and children and a lack of progress in improving nutritional outcomes of children. [Copyright &y& Elsevier]

This paper examines recent trends in sex ratio at birth in all the major states of India, based on three rounds of the National Family Health Survey. It finds evidence of an increase in the ratio, particularly at the second-order birth among women having a first daughter in many states in the northwestern region of the country. Also, there are signs of daughter aversion emerging in Odisha, an eastern state. Based on parity progression ratios and the trend in sex selection, an attempt is made to estimate the peak of sex ratio at birth in India. With moderate intensification in sex selection in the northwestern region, sex ratio at birth is expected to reach a peak of 117–119 males per 100 females around the period 2021–2026. If, in addition, sex selection spreads further in the southeastern region, the sex ratio at birth in India could even increase to a level of 124. [ABSTRACT FROM PUBLISHER]

Abstract: This paper investigates the extent of socioeconomic inequalities in antenatal care use and related medical procedures in Brazil and India, which represent transition economies with contrasting geographical and sociocultural composition and health care provision. Concentration indices and regression analyses applied on recent Demographic Health Survey data reveal high and proportionate distribution of antenatal coverage in Brazil, whereas the Indian case present problems of both scale and equity. Inequalities in access to four or more antenatal visits are significantly pronounced in India, and in Brazil the differences are significant only for those who had six or more visits. Brazil''s universal healthcare model which proved effective in promoting equitable distribution of antenatal care could be implemented in India. Future interventions should emphasis quality of care in monitoring essential antenatal services especially targeting the poor and deprived communities. [Copyright &y& Elsevier]

This paper examines trends in three reproductive healthcare indicators- namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992-1993 and 2005-2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in all three indicators has increased in the country, among both the urban poor and non-poor. However, the utilization of reproductive health services is concentrated among the urban non-poor cutting across the states, with the exception of Kerala. While the non-poor/poor gap in antenatal care and medical assistance at delivery remained large over the years, the gap in contraceptive use has narrowed down cutting across states. After adjusting for other confounders, household poverty was found to be a significant barrier in the utilization of reproductive healthcare services across the states. It has been observed that the utilization of reproductive healthcare services followed a continuum of rural total, urban poor, and urban non-poor. [ABSTRACT FROM AUTHOR]

This paper analyses the Indian National Family Health Survey (2005-2006) data to present certain broad descriptive features of child health inequalities in India and their distribution across well-defined socio-economic groups classified by gender and sector-of-origin, and their dispersal across space. This study finds that poorer sections of the population are beleaguered with ill health whether in the quest for child survival or due to anxieties pertaining to child nutrition. The concentration index value for the indicators of under-five mortality, full immunisation and underweight outcomes at the national level is calculated to be -0.159, 0.204 and -0.158, respectively. The other disturbing finding here is that there are reigning regional and gender disadvantages irrespective of the developmental status of the State. This study would not only help policymakers to recognise these persistent inequalities but also would help understand health performance at the state and regional levels thus facilitating targeting intervention. [ABSTRACT FROM AUTHOR]

Indigenous populations are the most marginalized and vulnerable communities in India, constituting 8.2% of India's total population, four times larger than the total population of Australia. The state of Jharkhand accounts for 27.7% of the total indigenous population of India. This paper compares the health and socio-economic and demographic indicators among indigenous and non-indigenous women in Jharkhand in terms of 'disadvantage ratio', by exploring the data of 1614 ever-married women (women who are currently married or who have been married at some point in their lives) from India's second National Family Health Survey (NFHS-2), conducted during 1998-99. The study revealed that the indigenous women of Jharkhand were highly disadvantaged in terms of socio-demographic, family planning, and important aspects of maternal health and nutrition compared to non-indigenous women. They were not only disadvantaged within the state in different parameters, but also across the indigenous female population of India as a whole. The findings call for urgent implementation of special health care strategies for reducing health and socio-economic/demographic disparities among the indigenous population of Jharkhand. [ABSTRACT FROM AUTHOR]

Objective. In India, Scheduled Castes and Scheduled Tribes (ST/SC) have been excluded from Hindu society for thousands of years. Together, they comprise over 24% of India's population and still suffer worse health conditions compared to the rest of the Indian population. This paper decomposes the gap in child malnutrition between the ST/SC and the remaining Indian population, looking at both the ST/SC's disadvantageous distribution of health determinants and possible discriminatory or behavioral differences. Design and setting. A Blinder-Oaxaca decomposition was applied to decompose the gap in children's average height-for-age z scores, using data from the 1998/1999 Indian Demographic Health Survey. Results. The gap was found to be primarily caused by the ST/SC's lower wealth, education and use of health care services, but also differences in the effects of health determinants played an important role. It was found that within rural areas ST/SC are not necessarily located further from educational and health care facilities. Conclusions. The use of Oaxaca type decomposition can be very useful when studying ethnic inequalities in health as it explicitly allows for discriminatory or behavioral effects. The results did not point to discrimination against ST/SC regarding health care or education. However, in the quest to increase health care use and education among ST/SC, policy makers will have to take into account all the barriers to these services, including those related to cultural sensitivity and acceptability. [ABSTRACT FROM AUTHOR]

Background: Rising health spending is associated with high out-of-pocket expenditure (OOPE), catastrophic health spending (CHS), increasing poverty, and impoverishment. Though studies have examined poverty and impoverishment effect of health spending in India, there is limited research on the regional patterns of health spending by type of health centers. This paper tests the hypothesis that the poor people from the poorer states of India pay significantly more for hospitalization in public health centers than those in the richer states of India.Methods: Data from the Social Consumption of Health Survey (71st round, 2014), carried out by the National Sample Survey (NSS) is used in the analyses. Descriptive statistics, log-linear regression model and tobit model were used to examine the determinants and variations in health spending.Results: Inter-state variations in the utilization of public health services and the OOPE on hospitalization are high in India. States with high levels of poverty make higher use of the public health centers and yet incur high OOPE. In 2014, the mean OOPE per episode of hospitalization in public health centers in India was ₹5688 and ₹4264 for the economically poor households. It was lowest in the economically developed state of Tamil Nadu and highest in the economically poorer state of Bihar. The OOPE per episode of hospitalization in public health centers among the poor in the poorer states was at least twice that in Tamil Nadu. Among the poor using public health centers, the share of direct cost account 24% in Tamil Nadu compared to over 80% in Bihar, Odisha and other poorer states. Adjusting for socio-economic correlates, the cost of hospitalization per episode (CHPE) among the poor using public health centers was 51% lower than for the non-poor using private health centers in India.Conclusion: The poor people in the poorer states in India pay significantly more to avail hospitalization in public health centers than those in the developed states. Provision of free medicines, surgery and free diagnostic tests in public health centers may reduce the high OOPE and medical poverty in India. [ABSTRACT FROM AUTHOR]