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Background: Maternal healthcare service utilization is a pivotal indicator of a nation's progress in safeguarding the health and well-being of its women and children. In this context, women's empowerment emerges as a critical determinant influencing the utilization of maternal healthcare services. The study aims to assess the relationship between women's level of empowerment and utilization of maternal healthcare services among currently married women in India. Data and Methods: The study uses data from the fifth round of the National Family Health Survey conducted in 2019–2021 and analyzed 26,552 (15–49 aged) currently married women who had a live birth in the last 5 years preceding the survey. Additionally, univariate and bivariate analyses, multivariate logistic regression, and the SWPER index were used for the analysis. Results: Over the years, utilization of antenatal care, skilled birth attainment, and postnatal care has increased extensively in India. However, the study found that utilization of services was higher among empowered women, and it varies across the state with the extent of empowerment. State-level analysis shows that the extent of women empowerment was higher in Goa, followed by Tamil Nadu and Kerala, and lower in Jharkhand, followed by Tripura, so as the utilization of maternal and health care services. The extent of empowerment and utilization of services also varies by level of educational attainment, employment, and socio-economic status. Conclusion: There is a need for comprehensive strategies to enhance women's empowerment through education, employment, political participation, self-awareness, and reduction in gender-based violence and child marriages, which may improve awareness demand for better public health structure, and may ensure higher utilization of maternal healthcare services. Ultimately, these strategies may converse the higher maternal death and child mortality. Significance: What is already known about this subject? Existing literature in India mostly highlights a clear connection between women's autonomy and maternal healthcare services utilization. Women with higher autonomy, decision-making power, and mobility are more likely to use these services. However, in exploring the link between women's empowerment and maternal healthcare, some studies focus on education, employment, and media access among Indian mothers, sidelining broader empowerment dimensions. What this study adds? This study is likely the first to investigate the relationship between women's empowerment and the level of maternal healthcare service utilization in India. It covers key dimensions of women's empowerment, including Attitude to Violence, Social Independence, and Decision-making Power. Moreover, it is possibly the first Indian research paper to employ a survey-based women's empowerment index in this context. Notably, the assessment highlights Social Independence as a significant dimension. [ABSTRACT FROM AUTHOR]

Aim: The present paper aims to understand the fear of falling (FOF) and risk factors associated with FOF in community-dwelling individuals aged over 60 years in Pune, India. Subjects and methods: The study examined a random sample of 351 community-dwelling older adults. Data on demographic characteristics, health conditions, history of falls, and psychological factors were collected using a pre-tested, structured questionnaire. The Falls Efficacy Scale International (FES-I) was used to measure FOF. Univariate and bivariate logistic regression analyses were carried out to examine associations between various factors and FOF. Results: A high FES-I score was significantly associated with older age, females, unmarried status, education less than 6 years, living alone, unstable balance and gait, hypertension, arthritis, previous falls, self-reported loss of confidence, and depression. Adults older than 70 years of age (odds ratio, OR = 2.411), those with a history of falls (OR = 2.285), those reporting loss of confidence in the past 6 months (OR = 6.766), who had answered yes to the direct question of FOF (OR = 4.632), and had unstable balance (OR = 2.522) were also more likely to have higher FES-I values. Conclusion: A large number of older adults expressed concerns about falling and we also found several factors to be associated with developing FOF, supporting the need for screening. Thus, further research is needed in order to understand the relationship between severity of FOF and actual fall events for developing preventive measures which can be implemented before FOF becomes a problem. [ABSTRACT FROM AUTHOR]

Objectives Few Indian studies have examined the relationship between birth size and stunting in children. Studies on recovery from stunting in India are even fewer. This study, thus, investigates the relationship between birth size and stunting in Andhra Pradesh, India. This study further examines the factors associated with recovery from stunting using a longitudinal data. Methods We used data from the three waves of Young Lives Study (YLS) conducted in Andhra Pradesh in the years 2002, 2006-2007, and 2009 respectively. We used data from 1965 children in wave 1 to examine the association between birth size and stunting. For examining the factors associated with recovery from stunting between 1 and 5 years of age, and between 5 and 8 years, we use data from 582 and 670 children who were stunted at age 1 and age 5 respectively. We use multivariable logistic regression models to fulfil the objectives of the paper. Results The children who were of average- or large- size at birth were significantly less likely to be stunted than children who were of small size at birth (OR 0.61 and 0.47 respectively). Children of average/tall mothers were 0.41 times less likely to be stunted than children of shorter mothers. Severely stunted children were less likely than other stunted children to recover from stunting between 1 and 5 years of age, and between 5 and 8 years. Mother's height was statistically associated with recovery. Change in wealth status of the household was statistically associated with recovery between 1 and 5 years of age. In comparison, child immunization was associated with recovery between 5 and 8 years. Conclusions for Practice This study contributes to the understanding of the impact of birth size on childhood stunting, and to the extent of recovery from stunting in India. Further follow-up is necessary to demonstrate the impact during adolescence and adulthood. [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]

India's traditional kinship behavior have undergone certain fundamental changes due to recent development and functioning of Indian society. Of all, the most dominant change is in the form of co-residence of children with their parents in old age. Without familial support, falling or no income and poor health, today, older adults are the most vulnerable population sub-group in the total population. Therefore, by using the India Human Development Survey-II, 2011-12 data we study the relevant association of living arrangement on health status of the older adults. Our results indicate that older adults living alone have significant and strong association with adverse health conditions such as Cataract, Hypertension, and Heart Disease. On the backdrop of health variations of older adults, it is understood that among other socio-economic conditions, living arrangement have serious implications on the health status of the older adults. Thus, we strongly support the notion that older adults with proper family care and support are more likely to be in a better health position as compared to those deprived of it. [ABSTRACT FROM AUTHOR]

This paper examines the associations between male migration and mobility with HIV among married couples in India. Cross-sectional analyses of a nationally representative household survey conducted across all 29 states of India from 2005 to 2006 via the National Family Health Survey-3 (NFHS-3) included a subsample of 27,771 married couples who were tested for HIV as a part of their participation. Both bi-variate and multi-variate analyses were conducted. About 0.5% of the total married couples in the current study included an HIV-infected partner; 0.11% were HIV concordant and 0.38% were HIV serodiscordant couples. Adjusted logistic regression analyses demonstrated that HIV infection in couples (seroconcordant or serodiscordant) was significantly more likely among those couples where the man was migrant but not mobile and those couples where the man was migrant as well as mobile, relative to those couples where the man was neither migrant nor mobile. Male migration increases the risk for HIV among married couples in India, largely in the form of serodiscordance in which men are HIV infected. These findings document the need for not only primary prevention efforts to reduce HIV acquisition among migrant male workers, particularly more mobile migrants, but also efforts are needed to reduce subsequent transmission to their wives. [ABSTRACT FROM AUTHOR]

The living arrangement is an essential social support mechanism affecting older adults' health and well-being. As the Indian family structure changes over time, India's older population needs detailed investigation for its well-being due to living arrangements. This study investigates the association between the change in living arrangements after reaching age 60 years with subjective well-being and psychological health among older adults in India. We used the survey data "Building Knowledge Base on Population Ageing" in India conducted in 2011. The effective sample size for the study was 9231 older adults. Descriptive and bivariate analysis was done to present sample distribution and unadjusted estimates, respectively. Ordered logistic regression analysis was performed to understand the association between the living arrangements of the older adults and their psychological health. The outcome variables were ordered as 0 "best", 1 "good", and 2 "worst". The results showed that older adults with a change in living arrangement after turning 60 years had a higher prevalence of poor psychological health (27.5%) and low subjective well-being (36%). It was found that older adults with change in living arrangement after turning old had 84% and 54% higher likelihood to report worst psychological health [AOR: 1.84; CI: 1.48–2.27] and worst subjective well-being [AOR: 1.54; CI: 1.22–1.93] compared to older adults who did not change their living arrangement after turning old. A change in old-age living arrangements is associated with older adults' psychological health and subjective well-being in India. Older adults with a change in living arrangements need special policy attention. [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]

Summary: 'Indigenous peoples' across the globe suffer a disproportionate burden of mental illness. However, this burden is not fully explored in India despite having the second largest absolute concentration of indigenous peoples in the world. We did a secondary analysis of data from a cross-sectional survey in indigenous populations from the Nilgiri Biosphere Reserve in South India. Symptoms suggestive of psychological distress were reported by 39.9% participants. Being alone, tobacco use, hypertension, hypertension in family member, and violent conflict in household were independently associated with psychological distress. More epidemiological studies need to be conducted to map the burden and elaborate the relationships between mental health problems and socio-cultural factors in indigenous populations in India. [ABSTRACT FROM AUTHOR]

Aims: Healthcare utilization is a major challenge for low- and middle-income countries, especially for the publicly funded facilities. The study has tried to explore the women's opinion behind the non-utilization of public healthcare facilities in India. Subjects and methods: This was a cross-sectional study using nationally representative samples of 351,625 women of reproductive age (15–49 years) from the 29 States and seven Union Territories. Indian National Family Health Surveys NFHS-4 (2015–2016) was the data source. The respondents were asked why the members of their households do not utilize public healthcare facilities when members of their households are sick. They have options to respond either 'yes' or 'no'. Five reasons for non-utilization of public healthcare were asked: (i) 'there is no nearby facility'; (ii) 'facility timing is not convenient'; (iii) 'health personnel are often absent'; (iv) 'waiting time is too long'; and (v) 'poor quality of care'. Results: The majority of the women in India (88%) said that their family members did not use public healthcare facilities. The reasons behind this were 'no nearby facilities' (42.4%), 'inconvenient facility timing' (29.6%), 'poor quality of care' (52.3%), 'health personnel often absent' (16.8%) and 'long waiting time' (39.9%). Conclusions: importantly, during the last 10 years, the utilization of public health care facilities has dropped significantly, which should be taken seriously as the Indian Parliament has been placing emphasis on equity. [ABSTRACT FROM AUTHOR]

Background: Past investigations in different nations have demonstrated that food insecurity may lead to frailty among older adults; however, there is no evidence concerning these associations in India. Our investigation tries to fill this gap utilizing WAVE I of WHO SAGE 2007 information.Objectives: To examine the independent effect of food insecurity on frailty. To assess differences in frailty and other correlates between food secure and insecure older individuals.Methods: The Fried phenotype approach was used to create a frailty index using the presence of five indicators among older adults: exhaustion, weight loss, physical activity, weakness, and walking speed. Respondents were called robust, pre-frail, or frail based on the presence of zero, one, or two or more indicators from the five indicators, respectively. Individuals were classified as food insecure based on their responses to two five-point Likert scale-type questions: if they had less food than required because there was not enough food and if they had been hungry but did not eat because they could not afford food in more than 1 or 2 months in the last 12 months. Bivariate analysis was performed to determine the differences in all the correlates and frailty among older adults with food security and insecurity. Step-by-step logistic regression analysis was performed to estimate the effect of food insecurity on frailty.Results: Bivariate results show that from a total of 6650 adults aged 50 years or older, 16.05% are food insecure, and of them, 19% are frail. In addition, frailty is significantly associated with food insecurity (p < 0.001). These findings are further corroborated by multivariate analysis results showing that food insecure older adults have higher odds of being frail compared to their counterparts (OR = 1.31, 95% CI 1.10; 1.65, P < 0.001) in the adjusted model for all the correlates. Education and wealth are also among major factors aggravating frailty among older adults.Conclusion: Based on our results, we conclude that, after controlling for correlates, food insecurity is associated with frailty, which further prevents older adults from accessing nutritious food and causes them to lose their independence. Thus, the government needs to introduce focused sustenance programs for the elderly population who do not have regular access to food and are frail to prevent early disability and mortality. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine the association between the Haemophilus influenza type B (Hib) vaccination and child anthropometric outcomes in India. Subject and methods: The study used prospective cohort data from the Young Lives Study (YLS) conducted in Andhra Pradesh, India. The participants were 1,824 children (aged 54-76 months). Stunting and underweight were used to measure the child anthropometric outcomes. The study used the multivariate logistic regression model to examine the association between Hib vaccination and childhood stunting and underweight. Results: The result shows that stunting was lower among children who were vaccinated against Hib as compared to those who were not vaccinated (30.8% versus 39.5%). Similarly, the prevalence of underweight was also lower among the vaccinated children than the non-vaccinated ones (39.1% versus 48.0%). The results of the multivariate logistic regression analysis also suggest that children vaccinated against Hib were significantly less likely to be stunted (AOR: 0.76, 95% CI: 0.61-0.95) and underweight (AOR: 0.79, 95% CI: 0.64-0.98) than children who were not vaccinated against Hib, after controlling potentially confounding variables. Conclusions: The study concludes that vaccination against Hib, in addition to being a major intervention for reducing childhood infectious diseases and mortality, may be considered as a potential tool for reducing the burden of undernutrition in India. Therefore, the inclusion of the Hib vaccine into the Universal Immunization Programme will be helpful in reducing the burden of child malnutrition in India. [ABSTRACT FROM AUTHOR]

Using data from a cross-sectional bio-behavioral survey conducted among men who have sex with men ( n = 3833) in India, we examined differences related to HIV-related sexual risk, HIV/STI prevalence and intervention exposures between men who have sex with men and women (MSMW, 35 % of the sample) and men who have sex with men only (MSMO). Among MSMW, 93 % reported having female regular partners, 14 % had female paid partners, and all types of male partners (regular 55 %; casual 77.1 %; paying 47 %; paid 19 %). Logistic regression revealed that MSMW had higher odds of being aged 26 years and above (AOR 4.45, 95 % CI 3.66-5.42), lower odds of inconsistently using condoms with male partners (AOR 0.82, 95 % CI 0.67-0.98) and lower odds of having kothi (feminine/mostly receptive) identity (AOR 0.07, 95 % CI 0.06-0.09). HIV intervention exposure and HIV/STI prevalence did not differ significantly between MSMW and MSMO (HIV 13.1 vs. 12.2 %; active syphilis 3.5 vs. 3.1 %, respectively). Concurrent sexual partnerships with men and women pose risk of HIV transmission/acquisition for MSM and their male and female partners. All subgroups of MSM require tailored information and skills to consistently use condoms with different types of partners of either gender. [ABSTRACT FROM AUTHOR]

The increased reach of health programs in India during the past few decades has contributed to a decline in postnatal mortality including infant and child mortality; however, reduction in neonatal mortality remained negligible. About seven out of ten neonatal deaths take place within a week after birth. The progress in reduction as well as dimension along which early neonatal mortality is patterned in India remains unclear. We examine the trend in early neonatal mortality and its possible demographic and socioeconomic predictors using nationally representative data. Data from the three cross-sectional rounds of the National Family Health Survey of India from 1992 to 1993, 1998 to 1999 and 2005 to 2006 were analyzed. Early neonatal mortality rate was estimated for selected demographic and socioeconomic population groups and for major states in India using information on births and deaths during the 3 years preceding the respective surveys. Using the multivariate logistic regression model, we assessed proximate determinants of early neonatal deaths during 1990-2006. Sex of the child, child's birth size, birth order and interval, type of child's birth, mother's age at child's birth, mother's educational status, religion, household economic status and region of residence emerged as significant predictors of early neonatal deaths. The adjusted multivariate analysis indicates that majority of the socio-demographic predictors reveal a negligible decline in the probability of early neonatal deaths during 1990-2006. Moreover, based on comprehensive reviews of scientific literature on newborn's survival we document some of the recommended ways to prevent early neonatal mortality in India. [ABSTRACT FROM AUTHOR]

The role of circumcision in the transmission of human immunodeficiency virus (HIV) among men who have sex with men (MSM) in resource restricted regions is poorly understood. This study explored the association of circumcision with HIV seroprevalence, in conjunction with other risk factors such as marriage and sex position, for a population of MSM in India. Participants ( n = 387) were recruited from six drop-in centers in a large city in southern India. The overall HIV prevalence in this sample was high, at 18.6%. Bivariate and multivariable analyses revealed a concentration of risk among receptive only, married, and uncircumcised MSM, with HIV prevalence in this group reaching nearly 50%. The adjusted odds of HIV infection amongst circumcised men was less than one fifth that of uncircumcised men [adjusted odds ratio (AOR) 0.17; 95% CI 0.07-0.46; P < 0.001]. Within the group of receptive only MSM, infection was found to be lower among circumcised individuals (AOR, 0.30, 95% CI 0.12-0.76; P < 0.05) in the context of circumcised MSM engaging in more UAI, having a more recent same sex encounter and less lubricant use when compared to uncircumcised receptive men. To further explain these results, future studies should focus on epidemiologic analyses of risk, augmented by social and sexual network analyses of MSM mixing. [ABSTRACT FROM AUTHOR]

The objective of this study is to identify individual level factors that determine the use of skilled birth attendants in India. Data from the cross-sectional, population-based NFHS 3 Survey 2005-06 was used. A sample of 31,797 women, aged 15-49 years, who gave births in the 3 months preceding the survey and for whom information was available on most variables, were included in the analysis. Both bivariate and multivariate techniques were used to determine factors associated with the use of skilled attendants at birth. In the study we found that wealth is one of the strongest determinants of skilled birth attendant use, with the poor being at a disadvantage. There are significant differences in the use of skilled delivery care among the urban and rural populations in India. Women in urban areas are more likely to use skilled attendants. Muslim women and women with lower levels of education are also less likely to avail skilled delivery services. The use of skilled care depended significantly on the place of delivery. Women who gave history of antenatal visits were more likely to have skilled attendants at birth. Our analysis demonstrates that there are several financial, social, regional and cultural barriers to skilled birth attendant use in India. Effective strategies need to be planned to generate demand for skilled birth attendants and reduce barriers to care seeking, especially among rural poor. [ABSTRACT FROM AUTHOR]