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Global commitments to the education of children with disabilities, have led to progressive policy developments in India, and a surge in the enrolment of children who were traditionally excluded from the formal education system. This paper examines the perceptions and practices of mainstream teachers in rural government schools, within the context of increased learner diversity, focusing on how teachers understand, and respond to, the needs of children with disabilities. Data were collected through semi-structured interviews with teachers and classroom observations, in six primary schools, in three districts of Haryana. Our findings suggest that deficit-oriented views dominated teacher thinking, but they showed a readiness to engage with disability issues, recognising the value of education for all. However, they struggled in their classroom practices in relation to meeting diverse learner needs and exclusionary practices were further amplified for children with disabilities. Teachers were unwilling to take responsibility for the learning of children with disabilities, expressing significant concerns about their own preparedness, while highlighting the lack of effective and appropriate support structures. The paper concludes by drawing attention to the pressing need for effective teacher professional development opportunities and other support structures, to provide quality education. [ABSTRACT FROM AUTHOR]

Background: A decline in fertility rate and expansion in life span has resulted in the growth in the percentage of aged populations in the whole world. India and Odisha are no exceptions. Objectives: The objective of the present paper is to find out the incidence of functional ability/inability among the aged people of the rural areas of western Odisha of India. Materials and Methods: Katz Scale of ADL was used to assess the functional ability of elderly people. Six activities of daily living such as (Bathing, Dressing, Toilet, Mobility, Continence, and Feeding) were analyzed as per age and sex of the samples. Results: Of all the samples (1992), 98.5 percent are physically independent and only 1.4 percent are physically dependent. Out of 945 female elderly people, 931 (98.1%) are independent and out of 1047 male elderly people 1033 (98.6%) are independent. The physical dependency of females is more with a χ² -- value of 0.075 and p -- value of 0.466. The age group wise χ² -- value is 20.899 (3) and p -- value of 0.001. Conclusion: Lesser physical dependency is found among the elderly people in rural areas. An increase in dependency is seen with the increase in age. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to understand the patterns and incidence of child labour in India and to examine the magnitude of child labour across different social groups. It analyses the impact of the socio-economic background of the children on their participation in the labour market. Design/methodology/approach: The paper primarily relies on the data collected from secondary sources. The census of India data and the National Sample Survey Organisation (NSSO) 66th round data (2009–2010) on employment and unemployment in India for the study. The dependent variable on child labour has been computed by the author for the analysis in the paper. Findings: The findings of the paper suggest that poverty is not the only determinant of child labour, but gender and caste of a person is also a significant factor for child labour. The study found that children from lower-caste backgrounds in India seem to participate more in the labour market. In terms of gender, the study found that boys are more likely to engage in economic activities or paid jobs while girls are more likely to engage in household activities. Originality/value: Data used in this paper has been extracted by the author from unit level data provided by NSSO. The variables used for the analysis in the presented paper has been constructed by the author and the figures provided are the result of the author's estimation on data. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to examine the socio-economic inequalities that exist in the use of unhygienic menstrual practices in India and its states, as well as to identify the contribution of various socio-economic factors that leads to these inequalities. Design/methodology/approach: Data from the National Family Health Survey-5 (2019–21) for 240,285 menstruating women aged 15–24 years is used to examine the above objectives. The concentration index for unhygienic menstrual practices is calculated to measure the socio-economic inequalities, which are then decomposed into their determining factors. Findings: The state of Punjab experiencing the highest level of economic inequality, followed by Telangana and Haryana. The results from decomposition analysis suggest that rural residence (13%), illiteracy (7%), poor economic status (53%), not reading newspaper (12%) and not watching TV (14%) contribute 99% to the total socio-economic inequality in using unhygienic menstrual practices in India. The contribution of economic status to total inequalities is more in all the states except for Kerala and Mizoram, where caste and residence play an important role. Originality/value: This paper signifies the role of economic inequality in the use of unhygienic menstrual practices in India as well as the contribution of various socio-economic factors contributing towards these inequalities. The results from decomposition analysis suggest the need for unique health intervention strategies for different states following the evidence of major contributions to total inequalities in the use of unhygienic menstrual practices. [ABSTRACT FROM AUTHOR]

Background: The concept of stigma has been widely used to understand patterns of discrimination and negative ideas surrounding people with mental health problems, yet we know little of the specific nuances of how this might operate beyond the 'Global North'. Aim: This paper aims to explore the notion of stigma in an Indian context by considering the lived experience of patients, carers and community members. Methods: A sample of 204 participants, representing mental health patients, informal carers and community members was recruited from urban and rural areas in Kerala, India. Participants took part in interviews where they were encouraged to talk about their experiences of mental ill health, attitudes towards these problems, barriers encountered and sources of support. Results: Experiences akin to the experience of stigma in Europe and the United States were elicited but there were important local dimensions specific to the Indian context. The difficulties faced by people with diagnoses of mental disorders in finding marriage partners was seen as an important problem, leading to marriage proposals being refused in some cases, and secrecy on the part of those with mental health problems. Rather than the 'self-stigma' identified in the US, participants were more likely to see this as a collective problem in that it could reflect badly on the family group as a whole rather than just the sufferer. Conclusions: In the Indian context, the idioms of stigma emphasised impairments in marriage eligibility and the implications for the family group rather than just the self. [ABSTRACT FROM AUTHOR]

Purpose: The incidents of elder victimisation and cases of victimisation, in general, are increasing fast in the society. These incidents have had negative impact on the sense of well-being and way of life of the older people. Therefore, fear of crime is being considered as a most concerning psycho-social problem amongst the older people in contemporary time. The purpose of this study is to understand the impact of crime rate on the well-being of the older people and examine the linkage between psychological factors and fear of crime amongst the older people. Design/methodology/approach: The present study is based on the mixed method approach and an exploratory research designed applied to conduct the study. The field survey has been done from October 2012 to January 2013 on a sample of 220 older people of rural and urban areas of Lucknow in the state of Uttar Pradesh through purposive sampling. For the study, researcher has interviewed 137 male older people and 83 female older people through interview schedules and case studies. The data have been analysed through descriptive and narrative analysis. Findings: The study finds that those older people have direct or indirect experience of victimisation, they have anxiety and feel insecurity that someone can victimise them. The study also finds that the happiness of older people is more affected due to anxiety and phobia and have higher level of feeling of fear of crime in their neighbourhood and home. The study also finds whenever anti-social elements are active in the neighbourhood and they commit crimes, fear of crime and anxiety grasp the older people to a large extent causing a fracture in their psychological well-being. Originality/value: This work is the original work of researcher. This paper is related to the researcher's PhD dissertation work. This paper talks about how the psychological well-being of older people affects due to nature of crime in neighbourhood, phobia of crime and anxiety due to criminal activities. [ABSTRACT FROM AUTHOR]

Purpose: Fear of crime is an emerging social problem in Indian society that has a significant impact on the quality of life of the elderly. In the view of this fact, the purpose of this paper is to examine the factors such as (prior victimisation, vulnerability and incivility) which contribute their role in bringing fear of crime among the elderly. Design/methodology/approach: Mixed method approach has been applied in this paper. This study has been designed as an exploratory lead-in to a planned wider study into rural–urban context as possible factors in shaping the victimisation experience. The study has been conducted from October 2012 to January 2013 on a sample of 220 elderly living in both rural and urban areas of Lucknow in the state of Uttar Pradesh, India. Findings: The study found that elderly have been victimised by known persons as compared to unknown persons. Further, the study found that immediate neighbourhood was swarming with loiters, unruly teenagers, gangs, beggars and alcoholic people walk in the society which have significantly impact on the elderly and give threat in neighbourhood. Originality/value: This is an original work of researcher. [ABSTRACT FROM AUTHOR]

Notwithstanding, even after 75 years of independence adequate housing for all is an elusive dream for India. In 2011 India had 18.16 million homeless residents and 37 per cent of households lived in semi-permanent and temporary houses (Census of India, 2011). The condition of rural housing is worse and a thing to worry about. In this paper, an attempt has been made to investigate the condition of rural housing in India. The study concerned State wise rural-urban variation in the level of housing deprivation and its relationship with the socio-economic disparity. The database of this study is secondary, procured and compiled from the house listing and housing datasets of the Census of India (2011). The methodology of this study is mainly categorized into two segments-firstly, the identification of relevant housing and socio-economic deprivation variables. Secondly, to get fruitful analysis authors apply appropriate statistical techniques. Analysis revealed that wide state-level variations exist in access to basic amenities, specifically, drinking water, toilet facilities and electricity. There are prevalent disproportions across states in terms of housing deprivation. This deprivation is an all-prevalent phenomenon in rural areas. The Social and economic background of the households namely poverty, illiteracy, unemployment, caste identity are the main factors of rural housing deprivation. The result of this study argues urban favouritism in the provision of amenities over rural areas. [ABSTRACT FROM AUTHOR]

In this paper, we present a framework to examine the kinds of careers that rural disadvantaged youth would like to know about in a career guidance intervention as also related findings from two different rural disadvantaged contexts in India. Differences across gender, age group, region, and participation/non-participation in youth programmes are also explored. The results validate the importance of comprehensive career needs assessment and provide specific directions for designing and adapting career guidance interventions for rural disadvantaged youth. Implications for research and practice are discussed in general as well as for the specific contexts included in this study. [ABSTRACT FROM AUTHOR]

Purpose Despite increasing recognition of the importance of mental health at the workplace, there is very little evidence and limited research information on the issue of the poor mental health of the workers, especially miners. The purpose of this paper is to assess the relationship between stress faced by quarry workers in consonance with their socio-demographic characteristics and their working conditions.Design/methodology/approach This study was a cross-sectional study of quarry workers with comparison groups in the Karauli district of Rajasthan, a state located in north-western India. The study was conducted during the period May-September 2014, as part of a doctoral program. The study sample comprised a total of 218 quarry workers along with a comparison group of 203 non-miners. The level of occupational stress was assessed by using a General Health Questionnaire consisting of 12 questions.Findings This study found that the comparison group was at a low risk of psychological stress as compared to the mine workers. The independent risk factors for occupational stress among workers were illiteracy, gender (female), married, divorced/separated, and suffering from some occupational health problem.Social implications This study concluded that mine workers are at a high level of stress, which underscores the need for urgent interventions from the government to address the issue. This is especially important as mine workers make significant contributions to the national income.Originality/value This paper fulfills an identified need to study the mental health status of quarry workers, thereby helping fill a persistent gap in Indian research on this issue. [ABSTRACT FROM AUTHOR]

Background: Globally, tobacco use is a major public health concern given its huge morbidity and mortality burden that is inequitably high in low- and middle- income countries. The World Health Organization has suggested banning the advertisement, promotion and sponsorship of tobacco. However, governments in some countries, including India, are either directly engaged in tobacco industry operations or have a mandate to promote tobacco industry development. This paper analyses a short-term advocacy campaign that challenged the state-tobacco industry ties to draw lessons for effective public health advocacy. Method: This paper uses a case study method to analyze advocacy efforts in India to thwart the state-tobacco industry partnership: the Indian government's sponsorship and support to a global tobacco industry event. The paper explores multiple strategies employed in the five-month advocacy campaign (May to October 2010) to challenge this state-industry tie. In doing so, we describe the challenges faced and the lessons learnt for effective advocacy. Results: Government withdrew participation and financial sponsorship from the tobacco industry event. Use of multiple strategies including engaging all concerned government agencies from the beginning, strategic use of media, presence and mobilization of civil society, and use of legal tools to gain information and judicial action, were complementary in bringing desired outcomes. Conclusion: Use of multiple and complementary advocacy strategies could lead to positive outcomes in a short-time campaign. The Framework Convention on Tobacco Control could form an important advocacy tool, especially in countries that have ratified it, to advocate for improvements in national tobacco control regulations. [ABSTRACT FROM AUTHOR]

In 2020 editor-in-chief (Andrew Malekoff) issued a special call for papers for group work stories on pandemic 2020. Among the 28 stories accepted for the series there were 16 from India, 9 from the United States, 2 from Canada and 1 from Israel. General submissions from the U.S., Canada and Israel were typical for the journal. Atypical are submissions from India. Rather than publish the stories in one special issue of the Journal, he decided to spread them out over several issues through 2022. In the course of organizing the special series (with a December 2021 deadline) he continued communication with a few of the authors from India, with particular interest and concern in the deteriorating situation as 2021 unfolded. Although the present commentary is not about group work per se, it is an update by Ajay Saini, Nancy and Andrew Malekoff on the current state of affairs in India, with some contrast to the situation in the U.S., that offers continuing context for the stories in the series. [ABSTRACT FROM AUTHOR]

From research in central Chhattisgarh, this paper interprets the bearing that healthcare beliefs and practices may have in shaping maternal and child nutrition both in the light of biomedical recommendations and within the context and constraints of a rural village setting. It contends that health beliefs and practices that are at variance from biomedical recommendations appear to have few consequences for gestational nutrition and for child health in relation to pregnancy. In the postpartum however, health ideas at variance from biomedical recommendations appear to have an important bearing on maternal nutrition and infant feeding, and may put mothers and children at risk of nutritional deficiency. Maternal 'eating down' following a surgical procedure such as a caesarean delivery or tubectomy is especially noteworthy, since food intake quantity is reduced over an extended time frame. While caring practices are influenced by cultural formulations, they also reflect, perhaps, adaptations to health risks. [ABSTRACT FROM AUTHOR]

Background: The immunization coverage in India is far away from satisfactory with full immunization coverage being only 62% at national level. Targeting the intensive efforts to poor performing areas and addressing the determinants of nonimmunization and dropouts offers a quick solution. In this paper, we assess the inter-district variations in Haryana state, and the association of social determinants with partial and no immunization. Methodology: This analysis is based on data collected as part of a large household survey undertaken in the state of Haryana to measure the extent of Universal Health Coverage. A multistage stratified random sampling design was used to select primary sampling units (i.e., subcenters), villages, and households. A total of 11,594 mothers with a child between 12 and 23 months were interviewed on receipt of immunization services. Determinants of nonimmunization and partial immunization were assessed using multiple logistic regression. Results: About 21% of children aged 12-23 months were partially immunized, while 4.3% children aged 12-23 months had received "no immunization." While the coverage of full immunization was 74.7% at the state level, it varied from 95% in best performing district to 38% in poorest performing district. Odds of a partially immunized child were significantly higher in urban area (odds ratio [OR] = 1.23; 95% confidence interval [CI] = 1.1-1.38), among Muslim household (OR = 3.52; 95% CI = 3.03-4.11), children of illiterate parents (OR = 1.58; 95% CI = 1.22-2.05), and poorest quintile (OR = 1.61; 95% CI = 1.36-1.89). Conclusions: Wide interdistrict variations call for a need to consider changes in resource allocation and strengthening of the government initiatives to improve routine immunization in these districts. [ABSTRACT FROM AUTHOR]

Intellectual disability in India is substantially under-reported, especially amongst females. This study quantifies the prevalence and gender bias in household reporting of intellectual disability by estimating the age-and-gender specific prevalence of the intellectually disabled by education, Socio-Demographic Index (SDI) score, place of residence, (rural/urban) and income of household head. We estimated prevalence (per 100,000) at 179 (95% CI: 173 to 185) for males and 120 (95% CI: 115 to 125) for females. Gender differences declined sharply with increased education, was higher for lower ages and low income and varied little by state development. Under-identification and under-reporting due to stigma are two plausible reasons for the gender differences in prevalence that increase with age. [ABSTRACT FROM AUTHOR]

This paper critically evaluates the popular representation of rural decision making in India as guided by socio-cultural dynamics and as a resort from various social alignments. It investigates how decisions get taken about a decentralized governance scheme in rural India, what variables impact these decisions – namely, social, political, administrative or economic – and how these variables impact the scheme performance. Case studies and empirical analysis of performance of a decentralized welfare scheme in India, the Andhra Pradesh Rural Employment Guarantee Scheme (APREGS), demonstrates significant influence of agriculture-based economic dynamics and administrative efficiency factors. Local social hierarchies and cultural complexities do not come as the main concerns. These results challenge the traditional understanding of rural dynamics as totally controlled by caste hierarchies and authority of the large land owners and are discussed in the light of the institutional rational choice framework proposed by Elinor Ostrom. The results also call for a fresh and wider debate of whether India is witnessing a longer term indirect developmental outcome of empowerment which actively started in 1993 with the recognition of local governance systems (Panchayati Raj) as a formal democratic body. [ABSTRACT FROM PUBLISHER]

India is considered as a land of agriculture that engages 64% of the rural workplace and it has a major role in improving the condition of the rural areas. It is important to analyze the changing pattern of agriculture pricing to sustain the interests of the farming community. In this article, the changing pattern in agriculture pricing in India has been examined. Crop cultivation in the last 25 years has been considered as a source of cost escalation that affects the various agricultural factors. Significant changes have been found in the agricultural pricing in India due to changes in the method of agriculture practices. Bullock labor, human labor, manure, and traditional methods are the input that has affected agriculture pricing whereas changes in the irrigation method such as including modern technologies and using large-scale use of tube well have affected the agriculture pricing for maximizing the profits of the farmers. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence and determinants of cardiometabolic disease (CMD), and the factors associated with healthcare utilisation, among people with CMD. Methods: Using a cross-sectional design, 11,657 participants were recruited from randomly selected villages in 3 regions located in Kerala and Andhra Pradesh from 2014 to 2016. Multivariable logistic regression was used to identify factors independently associated with CMD and healthcare utilisation (public or private). Results: Thirty-four per cent (n = 3629) of participants reported having ≥1 CMD, including hypertension (21.6%), diabetes (11.6%), heart disease (5.0%) or chronic kidney disease (CKD) (1.6%). The prevalence of CMD was progressively greater in regions of greater socio-economic position (SEP), ranging from 19.1% to 40.9%. Among those with CMD 41% had sought any medical advice in the last month, with only 19% utilising public health facilities. Among people with CMD, those with health insurance utilised more healthcare (age-gender adjusted odds ratio (AOR) (95% confidence interval (CI)): 1.31 (1.13, 1.51)) as did those who reported accessing private rather than public health services (1.43 (1.23, 1.66)). Discussion: The prevalence of CMD is high in these regions of rural India and is positively associated with indices of SEP. The utilisation of outpatient health services, particularly public services, among those with CMD is low. [ABSTRACT FROM AUTHOR]

Background: Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. Methods: We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. Results: Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37–2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07–2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26–0.60, for participants aged 64–75 years vs 30–44 years), reporting more social support (OR = 0.65, 95% CI 0.49–0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61–0.89) were associated with lower odds of missing medication. Conclusions: Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to assess the prevalence and socio-economic determinants of common mental disorders among youth in India. Design/methodology/approach - The study utilizes data from "Youth in India: Situation and Needs 2006-2007". One-way analysis of variance is used to compare different groups. Poisson regression models are used to test the relationship of household, parental, and individual factors with mental health problems. Findings - An estimated 11-31 million youth suffer from reported mental health problems in India. Results suggest that the household and individual factors like place of residence, wealth quintile, age, education, and occupation are the most important determinants of mental health problems among Indian youth. Parental factors lose their statistical significance once individual factors are controlled. Research limitations/implications - Little is known about correlates of mental health among youth. Strengthening on-going programmes and creating awareness about mental health issues through various programmes may help improve scenario. The two limitations of the study are: first, data covering all the states would have given a broader and clear picture of the issue; and second, due to cross-sectional nature of the data the study is not able to look into the cause-effect relationship. Originality/value - There are few studies which have explored mental health problems covering smaller areas in India. This is the first and the largest study conducted on a representative population of Indian youth to determine the correlates of reported mental health problems using General Health Questionnaire-12. [ABSTRACT FROM AUTHOR]

Background: Abortion services were legalized in India in 1972, however, the access to safe abortion services is restricted, especially in rural areas. In 2002, medical abortion using mifepristone-misoprostol was approved for termination of pregnancy, however, its use has been limited in primary care settings. Methods: This paper describes a service delivery intervention for women attending with unwanted pregnancies over 14 years in four primary care clinics of Rajasthan, India. Prospective data was collected to document the profile of women, method of abortion provided, contraceptive use and follow-up rates after abortion. This analysis includes data collected during August 2001-March 2015. Results: A total of 9076 women with unwanted pregnancies sought care from these clinics, and abortion services were provided to 70 % of these. Most abortion seekers were married, had one or more children. After 2003, the use of medical abortion increased over the years and ultimately accounted for 99 % of all abortions in 2014. About half the women returned for a follow-up visit, while the proportion using contraceptives declined from 74 % to 52 % from 2001 to 2014. Conclusions: The results of our intervention indicate that integrating medical abortion into primary care settings is feasible and has a potential to improve access to safe abortion services in rural areas. Our experience can be used to guide program managers and service providers about reducing barriers and making abortion services more accessible to women. [ABSTRACT FROM AUTHOR]

Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana ('a scheme for solution'), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana. Methods: A descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process. Results: Forty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a "Below Poverty Line" card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation. Conclusions: Yukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India. [ABSTRACT FROM AUTHOR]

This paper examines the trends in economic inequality in infant mortality across urban-rural residence in India over last 14 years. We analysed data from the three successive rounds of the National Family Health Survey conducted in India during 1992-1993, 1998-1999, and 2005-2006. Asset-based household wealth index was used as the economic indicator for the study. Concentration index and pooled logistic regression analysis were applied to measure the extent of economic inequality in infant mortality in urban and rural India. Infant mortality rate differs considerably by urban-rural residence: infant mortality in rural India being substantially higher than that in urban India. The findings suggest that economic inequalities are higher in urban than in rural India in each of the three survey rounds. Pooled logistic regression results suggest that, in urban areas, infant mortality has declined by 22 % in poorest and 43 % in richest. In comparison, the decline is 29 and 32 % respectively in rural India. Economic inequality in infant mortality has widened more in urban than in rural India in the last two decades. [ABSTRACT FROM AUTHOR]

Background: Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015–16, the fourth National Family Health Survey (NFHS-4) – a cross-sectional survey – collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30–49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. Methods: Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. Results: In India as a whole, 6 % of women aged 30–49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). Conclusion: The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45–49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy. [ABSTRACT FROM AUTHOR]

Backgrounds: The Universal Immunization Program of India is one of the most cost-effective interventions in public health. Missing or delaying vaccination may elicit an uncertain immune response in the body, making the population susceptible to vaccine-preventable diseases. The objectives of this study were to determine the coverage of newborn immunization for birth doses under the National Immunization Schedule and its epidemiological determinants in the rural areas of the Dehradun district, Uttarakhand. Materials and Methods: A community-based cross-sectional study was conducted for a period of one year with a sample size of 570. World Health Organization (WHO) 30 Cluster sampling technique was used with 19 children in each cluster. The data on determinants were collected using a semi-structured, pre-designed schedule through a house-to-house survey. Multivariate analysis was conducted to identify factors associated with immunization coverage, taking the significance level as P < 0.05. Results: The coverage of the Bacillus Calmette-Guérin vaccine, oral polio vaccine zero dose and hepatitis B birth dose were 100%, 91.9%, and 58.8%, respectively in the study area with an overall prevalence of incomplete coverage of newborn immunization as 42.5%. The most cited reason for children being unimmunized with birth doses was the unavailability of vaccines at the birthplace center (29.6%). Conclusions: The prevalence of incomplete coverage of newborn immunization was quite high, which was undermining the holistic approach of the National Immunization Program. Vaccine availability and accessibility at the birthplace with capacity building and training of the healthcare workers may be considered to ensure coverage of birth doses. [ABSTRACT FROM AUTHOR]

Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients' autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members' preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients' family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care. [ABSTRACT FROM AUTHOR]

Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India. [ABSTRACT FROM AUTHOR]

Background: Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective: In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design: A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results: Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion: In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health. [ABSTRACT FROM AUTHOR]

Background: India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/ non participation, factors associated with non uptake of the program, and the role played by a program volunteer, accredited social health activist (ASHA), among mothers in Ujjain district in Madhya Pradesh, India. Methods: A cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program delivery, private facility delivery, or a home delivery. Results: The majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most program mothers reported receiving the cash incentive within two weeks of delivery. The ASHA's influence on the mother's decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home. Conclusion: In this study, a large proportion of women delivered under the program. Most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death. [ABSTRACT FROM AUTHOR]

Abstract Increasing caesarean births is a global trend and of recent origin in India. Besides its utility and disutility, increasing caesarean births exert higher economic burden on households and the nation. Using 148,746 births from the National Family Health Survey, 2015–16, this paper examines the correlates and provides comparable estimates of out of pocket expenditure (OOPE) on caesarean births in public and private health centres in India. The monthly state specific rural-urban consumer price index and the OOPE on births over seven years are used to derive comparable OOPE estimate at 2016 prices. A composite variable combining type of birth and place of delivery is computed and classified as private and caesarean, public and caesarean, private and non-caesarean, public and non-caesarean. Descriptive statistics, logistic and tobit regression model were used to understand the differentials and determinants of OOPE on caesarean births. Caesarean births were significantly higher among mothers belonging to higher socioeconomic status, first order births, mothers with high BMI, pregnancy complications, repeat caesarean and in private health centres confirming that both maternal demand and institutional factors are leading to the increasing in caesarean rates in India. The mean OOPE of caesarean births in public health centres of poorer states was higher than that in the richer states of India (US$107 in low performing states compared to US$88 in high performing states) while such differentials across private health centres are small. The marginal effect of a caesarean birth in private health centres in low performing states was US$296 dollar higher than that of non-caesarean births. Improving the public health centres for conducting caesarean births, developing standard guideline for clinical practices in conducting caesarean births and creating awareness on comprehensive pregnancy care can reduce the caesarean rates and OOPE on caesarean birth in India. Highlights • Incraese in caesarean births are due to both maternal and clinical factors. • Three of ten first-order births were caesarean; higher than any subsequent order. • Caesarean rate among mothers with prior caesarean births was above 90 percent. • OOPE of a caesarean birth in public health centre of poorer states was high. • Medicine and test accounts larger share of OOPE in public health centers in India. [ABSTRACT FROM AUTHOR]

Environmental sanitation is a major public health issue in India. Recent interventional studies on environmental sanitation in India highlighted the importance of prioritizing control strategies. Research related to the appropriate cost-effective intervention strategies and their implementation in Indian context is a big challenge. This paper discusses various intervention strategies related to environmental sanitation in India and emphasizes to prioritize it according to the need of country. [ABSTRACT FROM AUTHOR]

Abstract: This paper uses a close reading of villagers’ responses to the death in childbirth of a Muslim woman to raise questions about India’s current policy emphasis on institutional delivery as a means of reducing maternal mortality. After introducing the context and methods of our research, we describe recent policy interventions related to maternal health, including the National Rural Health Mission established in 2005. We then outline villagers’ commentaries on the specific maternal death, focusing on the costs to women’s health (and sometimes life) of high fertility; the lack of care available from rural government facilities and staff and the preference for delivering at home with the aid of local practitioners; the financial constraints that make people hesitate to seek medical treatment; and the high costs of private treatment and the poor treatment experienced in government facilities. Our core argument is that government health care provision in rural Uttar Pradesh is embedded in a moral universe characterised by widespread and long-term mistrust of state services and that encouraging institutional deliveries without addressing the perceptions of potential service users is a seriously flawed approach to reducing maternal mortality. The paper draws primarily on ethnographic research funded by the Wellcome Trust during 2002–2005, in a Muslim village in rural Bijnor district (in north-western Uttar Pradesh). [Copyright &y& Elsevier]

This paper offers a broad strategic assessment of the experience of rural industrialization in India. It does so from a policy perspective with the aim eventually of highlighting specific outstanding policy issues. Rural and small-scale industrialization (RSSI) has held a special place in Indian development thinking and policy formulation from the outset. This privileged position, however, does not derive from a universal consensus with regard to the rationale and policy framework applicable to this sub-sector. However, such has been the symbolic power and populist appeal of RSSI that it has retained its special status within diverse strategic and ideological frameworks. But how has the sub-sector performed? Is the infant industry still in need of paternalistic protection at the age of fifty? Are there any credible indications of a strategic break with longstanding policy frameworks inherited from the past? Can any crucial policy gaps be identified? How well does rural small-scale industry satisfy the extensive developmental claims made by its proponents? These are the general questions addressed. [ABSTRACT FROM AUTHOR]

Introduction: Nurses act as the major manpower of the primary healthcare setting by representing nearly half of all health professionals in India. Turnover among nurses in rural Primary Health Centres (PHCs) is receiving a great deal of attention around the world in both professional publications and the media. We have conducted a rapid literature review and from thereon, developed an analytical framework on the determinants of turnover of nurses in rural PHCs and policies adopted in India to overcome it. Literature reviews on studies addressing the turnover of registered nurses working in rural PHCs are scarce. The current review aims to develop an interpretive framework for future research and policymaking on nurse turnover of nurses in rural PHCs in India. Methods: The review includes policy documents, rural health statistics reports, quantitative, qualitative, and mixed studies on the turnover of nurses and policies adopted in rural PHCs in India. The articles published from 01 January 2001 to 31 October 2021, available in the English language will be screened by searching through databases, grey literature, and tracking. The Mixed Methods Appraisal Tool (MMAT) 2018 will be used for screening and the search process will be reported in the PRISMA flowchart 2020. The data on turnover of nurses will be synthesized in two ways: the magnitude of the problem, the determinants of turnover, and the policies designed to overcome it. Discussion: The interpretive framework can be used for future research and policy informing of exact-estimated, underestimated, overestimated, and non-estimated determinants and adopting policies on nurse turnover in rural PHCs in their context. [ABSTRACT FROM AUTHOR]

Nutrition‐sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed‐methods design to describe the links between household dynamics—specifically intrahousehold power inequalities and intrahousehold cooperation—and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster‐randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross‐sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision‐making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family‐centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate. Key messages: Household cooperation and intrahousehold power inequalities may influence children's and mothers' dietary diversity in rural OdishaThese factors partly determine the effects of nutrition‐sensitive agriculture (NSA) interventions tested in Upscaling Participatory Action and Videos for Agriculture and Nutrition, indicating that NSA interventions may be more effective if they include multiple family members.There is wide heterogeneity in household dynamics and the constraints that families face. Further research is needed to identify how interventions can respond to this heterogeneity so that NSA interventions are effective in an inclusive and empowering way. [ABSTRACT FROM AUTHOR]

Whether raising the price of addictive goods can reduce its burden is widely debated in many countries, largely due to lack of appropriate data and robust methods. Three key concerns frequently raised in the literature are: unobserved heterogeneity; omitted variables; identification problem. Addressing these concerns, using robust instrument and employing unique individual-level panel data from Indian Punjab, this paper investigates two related propositions (i) will increase in alcohol price reduce its burden (ii) since greater incomes raise the costs of inebriation, will higher incomes affect consumption of alcohol negatively. Distinct from previous studies, the key variable of interest is the budget share of alcohol that allows studying the burden of alcohol consumption on drinker's and also on other family members. Results presented show that an increase in alcohol price is likely to be regressive, especially on the bottom quartile, with a rise in the budget share of alcohol given budget constraint. This outcome is robust to different econometric specifications. Preliminary explorations suggest that higher per capita income increases the odds of quitting drinking. Results reported have wider implications for the effective design of addiction related health policies. [ABSTRACT FROM AUTHOR]

"Innovation" – whether in the form of digital technologies or business models – dominates imaginaries of global health futures and is often promoted as a "solution" through which the goal of universal health coverage can be achieved. Seemingly disrupting the status quo, it offers the promise of novel and simple answers to longstanding and complex social problems. In this article, I analyze a public-private partnership between the Indian state of West Bengal and an Indian-owned social enterprise. One of its defining features is an "innovative" financing mechanism based on loans and entrepreneurship. The project employs young people from marginalized communities as health entrepreneurs, who market digital healthcare in rural areas in order to provide access to affordable and high-quality biomedical care. Although the model promises sustainable modes of financing healthcare, it shifts financial risk to low-income groups. As health workers resisted attempts to be turned into self-reliant entrepreneurs and continued to make demands on the developmental state, frictions emerged during project implementation. The question of how healthcare should be made accessible and affordable, in what manner the state should be involved in financing it, and what role innovation should play in this regard was all contested. Although an entrepreneurial business model to deliver primary care is seen as an innovative solution at a time when government expenditure in the social sector remains low and levels of un- and underemployment are high, this paper complicates prevailing claims about its disruptive powers in India and argues that its effective role for equitable social change has to be critically examined. • This article analyzes an "innovative" financing mechanism for primary healthcare. • The model brings forth a new type of community health worker: health entrepreneurs. • Entrepreneurship in the social sector often promises economic sustainability. • But is also relies on precarious employment conditions and shifts financial risk. • Its effective role for equitable social change in India has to be critically examined. [ABSTRACT FROM AUTHOR]

Background: Depending on a country’s diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the work done by patients in accessing diagnostic services and completing the ‘test and treat’ loop. Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis. Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns. Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices. Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services. [ABSTRACT FROM PUBLISHER]

Much of the research on intimate partner violence (IPV) documents the negative impacts of violence on women, which are substantial. Less attention has been given to perceptions of the marital relationship given these experiences of violence. However, evidence suggests that many women affected by IPV within marriage remain in their relationships, particularly in contexts such as India, where divorce remains highly stigmatized. Understanding and supporting marital quality may need greater prioritization to support women who remain in relationships affected by violence. This study examines the association between IPV and marital quality among young married couples in rural India. We interviewed 1084 women and 1084 men at two time points (baseline, 18 months) in a western state in India and used multilevel mixed effects models to test the association between IPV and marital quality. We found that women's experience of physical and sexual IPV was associated with poor marital quality at 18 months. Women's experience of sexual IPV was also negatively associated with men's self-reported marital quality at 18 months. Among men, spouse's marital quality was positively associated with their own rating of marital quality. We also examined the reciprocal relationship between IPV and marital quality and found that women's report of poor marital quality was associated with their future experience of physical IPV, sexual IPV, and emotional IPV. Taken together, these findings suggest that IPV interventions need to target marital quality to be effective. To do this, we would need to shift our lens from empowering individuals to empowering couples to work together to improve their relationships. [ABSTRACT FROM AUTHOR]

Young adults (21-to-35-years) from six rural coastal villages in South India described their past and current careers and means of livelihood; an intergenerational comparison was also made. Sixty-eight young men and women engaged in paid work were interviewed; supplementary data was obtained about 224 young adults co-residing with the 68 interviewed participants. The careers and livelihoods of these young adults were marked by intersectionality of rural community, geography and gender. The geography of a coastal region privileged men in having coastal/marine careers whereas many women played supportive roles in their spouse's/brother's coastal livelihood. The fewer women engaged in paid work were employed in education, banking/finance, and nursing sectors. Implications for career guidance programmes for the rural population are discussed. [ABSTRACT FROM AUTHOR]

Evidence from developing countries demonstrates a mixed relationship of overweight/obesity with socioeconomic status (SES) and place of residence. Theory of nutrition transition suggests that over the course of development, overweight first emerges among rich and urban people before spreading among rural and poor people. India is currently experiencing a rapid rise in the proportion of overweight and obese population especially among adult women. Under the backdrop of huge socio-economic heterogeneity across the states of India, the inter-state scenario of overweight and obesity differs considerably. Hence, this paper investigates the evolution over time of overweight and obesity among ever-married Indian women (15–49 years) from selected ‘underweight states’ (Bihar, Orissa and Madhya Pradesh, where underweight proportion is predominant) and ‘overweight states’ (Kerala, Delhi and Punjab, where overweight is the prime concern), in relation to a few selected socio-economic and demographic indicators. This study analysed National Family Health Surveys- NFHS-2 (1998–99) and NFHS-3 (2005–06) following Asian population specific BMI cut-offs for overweight and obesity. The results confirm that within India itself the relationship of overweight and obesity with place of residence and SES cannot be generalized. Results from ‘overweight states’ show that the overweight problem has started expanding from urban and well-off women to the poor and rural people, while the rural-urban and rich-poor difference has disappeared. On the other hand in ‘underweight states’ overweight and obesity have remained socially segregated and increasing strongly among urban and richer section of the population. The rate of rise of overweight and obesity has been higher in rural areas of ‘OW states’ and in urban areas of ‘UW states’. Indian policymakers thus need to design state-specific approaches to arrest the rapid growth of overweight and its penetration especially towards under-privileged section of the society. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) services are a prime focus of the Government of India's National Health Mission (NHM), of which a key pillar is the promotion of maternal and child health. To ensure uninterrupted service delivery at the last mile, a cadre of Frontline Health Workers (FLHWs) has been appointed and health centres established at the village level. However, the onset of the COVID-19 pandemic and the nationwide lockdown from late March to June 2020 impacted pregnant women's access to institutional antenatal care services. Methods: Using a qualitative research design, data was collected through 12 in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health workers in the selected six districts under study. The narratives were analysed using inductive coding in Atlas.ti. Results: During the first wave of the COVID-19 pandemic, pregnant women, most of whom belonged to poor and marginalised groups, were left with limited access to health centres and FLHWs. Respondents from the study areas of rural Jharkhand, Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the lockdown that influenced their decision to access ANC services. These included anxieties around meeting their families' daily needs due to a loss of livelihood (in particular, abject food insecurity), inability to access healthcare, and a sense of mistrust in public health systems and functionaries. All of these, coupled with the real threat to health posed by COVID-19, disrupted their plans for pregnancy and delivery, further compunding the risk to their health and wellbeing. Conclusion: This study identified several social, behavioural and structural facets of the communities that contributed to the confusion, anxiety and helplessness experienced during the COVID-19 first wave by both groups, viz. pregnant women and FLHWs. In planning and implementing initiaves to ensure the delivery and uptake of ANC services in this and similar contexts during times of crisis, these facets must be considered. Plain language summary: This article highlights the status of ANC services during the nationwide lockdown imposed in the first wave of the COVID-19 pandemic in the Indian states of Jharkhand, Madhya Pradesh and Uttar Pradesh. Data was collected through 12 in-depth interviews with pregnant women and 17 in-depth interviews with frontline health workers. Findings suggest that pregnant women were aware of the unprecedented threat of COVID-19 and recommended protective measures through trusted sources of information, including their local Accredited Social Health Activist (ASHA). However, both pregnant women and FLHWs believed that the information they received on the health risks of the pandemic and strategies to address these was inadequate. Temporary suspension of health services in the rural countryside meant that pregnant women could not track the foetus's health status, resulting in confusion and distress. Limited or no interaction with FLHWs, coupled with a reported lack of attention to conditions unrelated to COVID-19 and discrimination at healthcare institutions increased the uncertainty around institutional deliveries. This was further heightened by the loss of livelihoods due to the shutdown of businesses during the lockdown, as the respondents could not turn to private hospitals for childbirth. This resulted in the collapse of the trust of pregnant women and their families in the public healthcare system. To bridge this gap and alleviate the sense of mistrust the pandemic has created in its end-users, strategies to improve the utilisation of health services should respond to the barriers identified in this study. [ABSTRACT FROM AUTHOR]

Aim: The high incidence of acute respiratory infection (ARI)-related morbidity and mortality is a major public health concern in developing countries. This study aimed to quantify regional inequalities and the degree of association between childhood ARI and background factors. Methods: This study utilised information of 238 945 children aged below five years extracted from the Fourth Indian National Family Health Survey conducted in 2015–16. Inter-state and regional inequality in the prevalence of ARI were quantified and presented using a map of India and forest plot. The association of background characteristics and ARI was quantified using bivariate and multivariable binary logistic regression models. Results: Significant inequalities in the prevalence of childhood ARI were observed across the six regions of India. Considering the children from north-east region as a reference, those from north, central and east regions were 0.68, 1.02 and 0.57 times more likely to suffer from ARI. Comorbidity, sex, age and nutritional status of children were significantly associated with the prevalence of ARI. Conclusions: ARI remains a significant public health concern among Indian children. The results of this study showed that significant regional disparities in the prevalence of ARI exist in India. This study adds value to the better understanding of inequality patterns and quantifies within- and intra-region inequalities in the prevalence of ARI in India. [ABSTRACT FROM AUTHOR]

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)'s "Building Knowledge Base on Population Aging in India" (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p <.000), 4.16 (CI = 3.02, 5.74, p <.000), and 5.06 (CI = 3.50, 7.31, p <.000) times more likely to experience abuse/mistreatment than elderly with no chronic diseases, respectively. In specific, this association is stronger for the elderly population residing in the urban areas. Furthermore, economic status and educational attainment have a protective role in determining elder abuse/mistreatment in India. In conclusion, multimorbidity has emerged as a significant risk factor of elder abuse/mistreatment in India. Measures to prevent elder abuse should consider the role of multimorbidity. [ABSTRACT FROM AUTHOR]

Background: Social inequities in early child bearing persist among young married people, especially among tribal populations in India. Rural women belonging to tribal groups and those coming from poor households are more likely to give birth before age 18. This paper explores the connection between ethnicity, gender and early fertility intention among young married people in rural India. Methods: The data is drawn from a cross sectional baseline evaluation of an intervention programme in rural India. A sample of 273 married young people was taken. Respondents were selected using systematic random sampling. Logistic Regression was used to assess the effect of being a tribal on early fertility intention and also to determine if covariates associated with early fertility intention differed by tribal status. Qualitative data was analysed using deductive content analysis approach. Results: Bivariate and logistic regression results indicated that young married people from tribal communities had higher odds of planning a child within one year of marriage than non-tribals (OR = 1.47, p-value-0.079). Findings further suggest that early fertility intention among tribals is driven by gender factors and higher education and among non-tribals, higher education and awareness on contraception are key predictors. Among tribals, the odds of planning a child within one year of marriage was strongly associated with inequitable gender norms (OR = 1.94, p-value-0.002). Higher education showed significant positive association with non-tribals (OR = 0.19, p-value-0.014) and positive association with tribals (OR = 0.56, p-value-0.416). Qualitative investigation confirms that fertility desires of young married people are strongly influenced by gender norms especially among tribal populations. Conclusion: Early child bearing was underpinned by complex ethnic factors and gender norms. Preference for early child bearing was seen most among tribal communities. Gender attitudes were a cause of concern especially among tribal groups. These results suggest that efforts to improve early child birth will require changing gender norms related to fertility among tribals as well as social equity issues including higher education among non-tribals and tribals. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiological transition remains a key contributor to the rising prevalence of non-communicable diseases (NCDs) across developing nations. Population-specific NCD risk factors estimates derived using World Health Organization (WHO) 'STEP-wise approach' are crucial for devising evidence-based public health interventions to combat NCDs. Objective: To estimate the prevalence of behavioral and biological risk factors for NCDs among the rural adult population of Puducherry district in India. Methodology: STEPS survey was conducted by following all three steps (behavioral, physical measurements and biochemical risk factors) of NCD risk factor assessment. A total of 790 participants were selected from 50 villages through multistage cluster sampling method. STEPS instrument was used to assess behavioral risk factors, physical measurements and biochemical (fasting blood glucose and total cholesterol) risk factors. Results: Tobacco use and alcohol consumption were present among 11.3% (95% Confidence Interval (CI): 9-13.6%) and 19.2% (95% CI: 16.5-22.4%) of the population, respectively. Low physical activity, inadequate intake of fruits and vegetables, overweight and obesity were observed among 29.3% (95% CI: 26.2-32.7%), 89.8% (95% CI: 87.6-92%), 15.6% (95% CI: 13.1-18.3%) and 38.9% (95% CI: 35.4-42.2%), respectively. About 28.2% (95% CI: 25.2-31.6%) had hypertension and 24.4% (95% CI: 20-29%) had diabetes mellitus. Abdominal obesity was twice highly prevalent among women. Tobacco and alcohol use were more common among men, whereas low physical activity, obesity and hypercholesterolemia were higher among women. Conclusion: Public health interventions to promote healthy lifestyle need to be initiated especially to increase physical activity, intake for fruits and vegetables, and quitting of tobacco and alcohol consumption in the rural population of Puducherry. [ABSTRACT FROM AUTHOR]

The Government of India has started a new scheme aimed at offering sanitary pads at a subsidized rate to adolescent girls in rural areas. This paper addresses menstrual health and hygiene practices among adolescent girls in a rural, tribal region of South Gujarat, India, and their experiences using old cloths, a new soft cloth (falalin) and sanitary pads. Qualitative and quantitative data were collected in a community-based study over six months, with a pre-and post- design, among 164 adolescent girls from eight villages. Questions covered knowledge of menstruation, menstrual practices, quality of life, experience and satisfaction with the different cloths/pads and symptoms of reproductive tract infections. Knowledge regarding changes of puberty, source of menstrual blood and route of urine and menstrual flow was low. At baseline 90% of girls were using old cloths. At the end of the study, 68% of adolescent girls said their first choice was falalin cloths, while 32% said it was sanitary pads. None of them preferred old cloths. The introduction of falalin cloths improved quality of life significantly (p<0.000) and to a lesser extent also sanitary pads. No significant reduction was observed in self-reported symptoms of reproductive tract infections. Falalin cloths were culturally more acceptable as they were readily available, easy to use and cheaper than sanitary pads. Le Gouvernement indien a lancé un plan qui propose des serviettes hygiéniques à prix subventionné aux adolescentes vivant dans les zones rurales. Cet article aborde la santé menstruelle et l'hygiène des adolescentes dans une région tribale rurale du Gujarat méridional, et leur expérience de l'utilisation de vieux chiffons, d'un nouveau tissu doux (falalin) et de serviettes hygiéniques. Les données qualitatives et quantitatives ont été recueillies par une étude communautaire sur six mois, avec évaluation préalable et postérieure, auprès de 164 adolescentes originaires de huit villages. Elles ont été interrogées sur leurs connaissances de la menstruation, leurs pratiques menstruelles, leur qualité de vie, l'utilisation et la satisfaction avec les différents linges/serviettes et les symptômes d'infections de l'appareil reproducteur. Elles connaissaient mal les changements de la puberté, la source des règles et la voie de l'urine et du flux menstruel. Au début de l'étude, 90% des adolescentes utilisaient de vieux chiffons. À la fin de l'étude, 68% des filles ont déclaré que leur premier choix était le linge en falalin, contre 32% pour les serviettes hygiéniques. Aucune n'a préféré les vieux chiffons. L'introduction des linges en falalin a sensiblement amélioré la qualité de vie (p<0,000) comme, dans une moindre mesure, les serviettes hygiéniques. Aucune réduction notable des symptômes auto-signalés d'infections de l'appareil reproducteur n'a été observée. Les linges en falalin étaient culturellement plus acceptables car les adolescentes pouvaient se les procurer et les utiliser aisément, et ils étaient moins onéreux que les serviettes hygiéniques. El Gobierno de India ha puesto en marcha un nuevo plan para ofrecer toallas sanitarias a una tarifa subsidiada a las adolescentes de zonas rurales. En este artículo se trata la salud menstrual y las prácticas de higiene entre las adolescentes de una región tribal rural de Gujarat meridional, en India, y sus experiencias usando paños viejos, un paño suave nuevo (falalin) y toallas sanitarias. Durante un plazo de seis meses, se recolectaron datos cualitativos y cuantitativos en un estudio comunitario, con un diseño preliminar y posterior, entre 164 adolescentes de ocho poblados. Las preguntas abarcaron sus conocimientos de la menstruación, prácticas menstruales, calidad de vida, experiencia y satisfacción con los diferentes paños y toallas sanitarias, y síntomas de las infecciones del tracto reproductivo. Pocas tenían conocimientos de los cambios relacionados con la pubertad, la fuente de la sangre menstrual y la vía del flujo urinario y menstrual. En la línea base, el 90% de las adolescentes estaban usando paños viejos. Al final del estudio, el 68% dijo que su primera elección era el paño falalin, mientras que el 32% dijo que prefería las toallas sanitarias. Ninguna prefirió los paños viejos. La introducción del paño falalin mejoró la calidad de vida considerablemente (p<0.000) y a menor grado también las toallas sanitarias. No se observó ninguna reducción significativa en los síntomas autoreportados de infecciones del tracto reproductivo. Los paños falalin fueron más aceptados culturalmente, ya que eran fáciles de adquirir y usar y más baratos que las toallas sanitarias. [ABSTRACT FROM AUTHOR]

Abstract: There is growing concern that climate change will lead to more frequent natural disasters that may adversely affect short- and long-term health outcomes in developing countries. Prior research has primarily focused on the impact of single, large disaster events but very little is known about how small and moderate disasters, which are more typical, affect population health. In this paper, we present one of the first investigations of the impact of small and moderate disasters on childhood morbidity, physical growth, and immunizations by combining household data on over 80,000 children from three waves of the Indian National Family and Health Survey with an international database of natural disasters (EM-DAT). We find that exposure to a natural disaster in the past month increases the likelihood of acute illnesses such as diarrhea, fever, and acute respiratory illness in children under 5 year by 9–18%. Exposure to a disaster in the past year reduces height-for-age and weight-for-age z-scores by 0.12–0.15 units, increases the likelihood of stunting and underweight by 7%, and reduces the likelihood of having full age-appropriate immunization coverage by nearly 18%. We also find that disasters'' effects vary significantly by gender, age, and socioeconomic characteristics. Most notably, the adverse effects on growth outcomes are much smaller among boys, infants, and families with more socioeconomic resources. [Copyright &y& Elsevier]

Abstract: India experienced tremendous economic growth since the mid-1980s but this growth was paralleled by sharp rises in economic inequality. Urban areas experienced greater economic growth as well as greater increases in economic inequality than rural areas. During the same period, child health improved on average but socioeconomic differentials in child health persisted. This paper attempts to explain wealth-based inequalities in child mortality and malnutrition using a regression-based decomposition approach. Data for the analysis come from the 1992/93, 1998/99, and 2005/06 Indian National Family Health Surveys. Inequalities in child health are measured using the concentration index. The concentration index for each outcome is then decomposed into the contributions of wealth-based inequality in the observed determinants of child health. Results indicate that mortality inequality declined in urban areas but remained unchanged or increased in rural areas. Malnutrition inequality increased dramatically both in urban and rural areas. The two largest individual/household-level sources of disparities in child health are (i) inequality in the distribution of wealth itself, and (ii) inequality in maternal education. The contributions of observed determinants (i) to neonatal mortality inequality remained unchanged, (ii) to child mortality inequality increased, and (ii) to malnutrition inequality increased. It is possible that the increases in child health inequality reflect urban biases in economic growth, and the mixed performance of public programs that could have otherwise offset the impacts of unequal growth. [Copyright &y& Elsevier]