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Stroke is a major public health problem all over the globe, especially in low and middle-income countries like India. In the urban areas of India, the disease has grown to epidemic proportions. The underprivileged residents in urban slum areas have poor health literacy, usually resulting in poor health-seeking behaviours. Hence, efforts towards stroke prevention and risk factor control are critical in urban slum areas. The objective of the study was to assess the awareness about stroke among adults residing in the urban slum area of Bangalore, India. A cross-sectional survey was conducted using a mixedmethods approach, where data were collected from 490 adults using selfreported questionnaires. Over half of the participants (52%) did not know that the brain is the primary organ affected by stroke. Hypertension (44.9%) and diabetes mellitus (23.6%) were the most cited risk factors by participants. In binary logistic regression analysis, higher education was a predictor of stroke awareness (OR 0.65, p=0.02). Several misconceptions about stroke risk factors were identified among the participants. Poor awareness about stroke and its risk factors among the underprivileged urban population is demonstrated in this study. The study highlights the need to develop and implement strategies and programmes to improve awareness about stroke for the whole community. [ABSTRACT FROM AUTHOR]

Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015–2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005–2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005–2006, while HI coverage has improved, disparities across social groups remain. [ABSTRACT FROM AUTHOR]

The article is aimed to assess trends in wealth-related inequalities in coverage of reproductive, maternal, neonatal and child health (RMNCH) interventions using delivery channels framework in Indian context, at national level as well as at state level—Tamil Nadu (TN) and Chhattisgarh (CG)—a better off and poorer state, respectively. We used National Family Health Survey—3rd (2005–2006) and 4th (2015–2016) to study the trends and differentials of inequalities in the RMNCH coverage. We have used two summary indices—absolute inequalities using the slope index of inequality (SII) and relative inequalities using the concentration index (CIX). Culturally driven interventions had pro-poor inequalities in TN, CG and in India, but the coverage has improved significantly for the women from wealthier households recently. Environmental interventions were highly inequal in distribution, particularly for the 'use of clean fuels'. Inequalities in the coverage of health facilities-based interventions has reduced in TN, CG and overall India, but more so in TN. The inequalities in coverage of community-based interventions have reduced over the period of ten years in TN, CG as well as at national level. Adopting RMNCH delivery channel framework could be useful for assessing and monitoring the progress of public health programmes. Policy makers can gain insights from the success of coverage of various interventions and determine specific implementation strategies to reduce inequalities in the coverage and its effectiveness. [ABSTRACT FROM AUTHOR]

Purpose: This study on spatial analysis of child labour in India is a macro level analysis on child labour using the census data, 2011 of Government of India. The population census which is conducted once in 10 years only provides district level data on work-force distribution. The study has spatial analysis of child labour in the age group of 5–14 years in India. To assess the magnitude of the children in the labour force, district level data of Census 2011 has been used in the study. The study has made an attempt to identify the districts where there is high level of children in the labour force. This paper aims to estimate the magnitude and trends of children's workforce participation using the census data as it is the only data base, which is available at the district level since 1961 onwards. The study has made an attempt to identify the clustering of child labour across districts in India and how child labour is clustered by different background characteristics. Design/methodology/approach: The study has used ArcGIS software package, GeoDa software and local indicator of spatial association test. Findings: The findings of study reveal that the proportion of rural, total fertility rate (TFR) and poverty headcount ratio is positively associated, whereas female literacy and the pupil-teacher ratio are negatively associated with child labour. It suggests that in the hot-spot areas and areas where there is a high prevalence of child labour, there is need to increase the teacher's number at the school level to improve the teacher-pupil ratio and also suggested to promote the female education, promote family planning practices to reduce TFR in those areas for reducing the incidences of child labour. Research limitations/implications: The study also recommends that the incidences of child labour can be controlled by a comprehensive holistic action plan with the active participation of social workers. Practical implications: The promulgation of effective legislation, active involvement of judiciary and police, political will, effective poverty alleviation and income generation programmes, sensitisation of parents, corporates and media can play effective role in mitigating the incidences of child labour in India. To achieve the sustainable development goals (SDGs) adopted by world leaders in 2015 to eradicate child labour in all its forms by 2025. Social implications: The study aims to achieve the SDGs adopted by world leaders in 2015 to eradicate child labour in all its forms by 2025. Originality/value: The study is purely original and there are no such studies in Indian context by using the latest software. [ABSTRACT FROM AUTHOR]

Consanguineous marriage is the legal union of male and female of a common ancestor related by blood. The most common prevailing form of consanguineous marriages is between first cousins. Middle East Asian countries and southern states in India show high prevalence. A comparative analysis between the two rounds of National Family Health Survey 1 and 4 have shown a declining trend for the practice of consanguineous marriages. The highest percentage of consanguineous marriages is seen among the first cousins from both father's and mother's side, most commonly practice in the southern states of Andhra Pradesh, Telangana, Tamil Nadu, and Karnataka except Kerala. Importantly, the practice of consanguineous marriage is higher among the Muslims of North India and Hindus of Southern India, among the Other Backward Classes and the less educated population of the middle and richer wealth index. A significant relationship can be noticed among consanguineous marriages and socio-economic variables. [ABSTRACT FROM AUTHOR]

India launched the National Rural Health Mission (NRHM) in 2005 to improve maternal and child health by providing good quality health services to all, especially deprived sections of society, to reduce inequality in access to health services. With the backdrop of NRHM, we analysed the extent to which the utilisation of maternal health care services (MHCSs) in the three stages of the continuum of care—antenatal care (ANC), care during child delivery and postnatal care (PNC)—–has improved among the poor vis-à-vis the rich in India, and the corresponding narrowing down in inequality in the period 2006–2016. Data from the 3rd round of the National Family Health Survey (NFHS) in 2005–2006, capturing the pre-NRHM period and the 4th round of NFHS 2015–2016, capturing the post-NRHM era ten years after the implementation of the flagship programme, are used for the analysis. We estimated absolute as well as relative measures of inequality, absolute gap and coverage ratio between the poor and rich, slope index of inequality and concentration index. Our findings show that maternal health care coverage increased significantly among the poor for all components of MHCSs. Even so, the extent of utilisation of services remains significantly lower among the poor in 2015–2016 compared to the coverage among the rich in 2005–2006. Although inequality declined at the national level over the decade, it still persists. High equity has been achieved in using skilled birth attendance during child delivery and institutional delivery during 2015–2016, however, inequality continues to be higher for ANC indicators including consumption of iron and folic acid supplements for at least 100 days, receipt of four or more antenatal check-ups and comprehensive health check-ups at least once during antenatal visits and receipt of first check-up in the first trimester. [ABSTRACT FROM AUTHOR]

Background It is thought that there is a high risk of zinc deficiency in India, but there are no representative national estimates. Objectives We aimed to evaluate the national and state-level prevalence of low serum zinc concentrations (SZCs) in Indian children from the nationally representative Comprehensive National Nutrition Survey. Methods Prevalence of low SZC, adjusted for C-reactive protein, was estimated among preschool (1–4 y; n  = 7874) and school-age children (5–9 y; n  = 10,430) and adolescents (10–19 y; n  = 10,140), using SZC cutoffs defined by the International Zinc Nutrition Consultative Group. Results Prevalence of low SZC was high among adolescents (31.1%; 95% CI: 29.8%, 32.4%), compared with school-age (15.8%; 95% CI: 15.3%, 16.3%) or preschool children (17.4%; 95% CI: 16.7%, 18.0%). However, stratification of prevalence by fasting status or using an alternative lower SZC cutoff independent of fasting status led to a reduction in prevalence by 3.7% or 7.8% in children <10 y, respectively. The prevalence of low SZC was higher among rural preschool children, those belonging to households with poor socioeconomic status, and those with severe stunting or underweight. Preschool children with diarrhea (22.6%; 95% CI: 20.8%, 24.4%), productive cough (22.7%; 95% CI: 18.5%, 27.5%), or malaria/dengue (38.5%; 95% CI: 29.4%, 48.2%) in the 2 wk preceding the survey had a higher prevalence of low SZC than those without morbidity (16.5%; 95% CI: 15.9%, 17.2%; 17.6%; 95% CI: 16.9%, 18.2%; and 17.5%; 95% CI: 16.8%, 18.1%, respectively). Conclusions The national prevalence of low SZC among preschool (17%) or school-age children (16%) was <20%, which is considered the cutoff indicating a problem of public health significance; but there were variations by state and socioeconomic status. In adolescents, however, the prevalence of low SZC was 31%, which warrants further investigation. The association of low SZC with diarrhea in preschool children necessitates better coverage of Zn administration in the management of diarrhea. [ABSTRACT FROM AUTHOR]

Background: Conventional indicators used to access the nutritional status of children tend to underestimate the overall undernutrition in the presence of multiple anthropometric failures. Further, factors contributing to the rich-poor gap in the composite index of anthropometric failure (CIAF) have not been explored. This study aims to estimate the prevalence of CIAF and quantify the contribution of factors that explain the rich-poor gap in CIAF. Methods: The present study used data of 38,060 children under the age of five years and their biological mothers, drawn from the nationally representative Comprehensive National Nutrition Survey of children and adolescents aged 0–19 years in India. The CIAF outcome variable in this study provide an overall prevalence of undernutrition, with six mutually exclusive anthropometric measurements of height-for-age, height-for-weight, and weight-for-age, calculated using the World Health Organization (WHO) Multicenter Growth Reference Study. Multivariate regression and decomposition analysis were used to examine the association between covariates with CIAF and to estimate the contribution of different covariates in the existing rich-poor gap. Results: An overall CIAF prevalence of 48.2% among children aged aged under 5 years of age was found in this study. 6.0% children had all three forms of anthropometric failures. The odds of CIAF were more likely among children belonging to poorest households (AOR: 2.41, 95% CI: 2.12–2.75) and those residing in urban area (AOR: 1.06, 95% CI 1.00–1.11). Children of underweight mothers and those with high parity were at higher risk of CIAF (AOR: 1.51, 95% CI: 1.42–1.61) and (AOR: 1.15, 95% CI: 1.08–1.22), respectively. Children of mother exposed to mass media were at lower risk of CIAF (AOR: 0.87, 95% CI: 0.81–0.93). Conclusion: This study estimated a composite index to assess the overall anthropometric failure, which also provides a broader understanding of the extent and pattern of undernutrition among children. Findings show that maternal covariates contribute the most to the rich-poor gap. As well, the findings suggest that intervention programs with a targeted approach are crucial to reach the most vulnerable groups and to reduce the overall burden of undernutrition. [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]

Introduction: This study investigated the correlation between substance use and non-communicable diseases according to socioeconomic status in India. Methodology: We analyzed nationally representative data from the fourth round of National Family and Health Survey (NFHS-4), which was conducted in 2015–16, and estimated the prevalence of tobacco and alcohol consumption among 112,122 men aged 15–54 years. A logistic regression analysis was performed to estimate the effect of substance use on non-communicable diseases. Results: It was found that 45% of men in the sample used tobacco in any form and 30% consumed alcohol. Men aged 50–54 years, divorced, separated or deserted, uneducated, belonging to the scheduled tribes and in the poorest wealth quintile consumed significantly higher quantities of substances. The results show that men who consume tobacco and alcohol significantly more likely to have diabetes or heart disease. Correlation of substance use and non-communicable diseases shows that men in the age group of 50 to 54 years, who are married, with higher educational attainments and belonging to the Christian religion are significantly more likely to have diabetes or heart disease. Conclusion: This study concludes that men of low socioeconomic status, who are substance users are at higher risk of developing non-communicable diseases. The study also highlights that men who consume tobacco and alcohol are significantly more likely to develop non-communicable diseases. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the leading causes of death among women globally. Cardiovascular disease--related events are more common in older women compared with men and are more likely to result in death. Although research in high-income countries suggests that women have unique sociobiological CVD risk factors, only a few study authors have examined risk factor knowledge among women from low- and middle-income countries. Objective: The aim of this study was to assess CVD risk factor knowledge among low-income urban Indian women. Methods: A cross-sectional study was conducted among a nonprobability sample of 607 slum-dwelling women, 40 to 64 years old, living in Mysore, India, between October 2017 and May 2018. Participants underwent an interviewer-administered questionnaire measuring demographics, CVD risk factor knowledge, and medical history. Results: Cardiovascular disease risk factor knowledge was low in this population and was associated with age, education, income, and caste. Approximately half of the participants (47%) answered less than 50% of the questions correctly, and a third had knowledge scores greater than 70%, which we defined as "good knowledge." Only 4 of 7 traditional CVD risk factors (ie, physical activity, smoking, overweight, and high cholesterol) were recognized by greater than half of the participants. The lowest knowledge levels were among older single women with no education and monthly household incomes less than Rs 3000 (approximately US $42). Conclusions: Previous research among slum dwellers in India reported a high prevalence of modifiable CVD risk factors compared with more affluent urban peers. Interventions aimed at CVD risk factor knowledge may be an important first step in controlling heart disease in this vulnerable population. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a critical public health issue that has reached epidemic proportions. Research investigating IPV among young women in India using large-scale population data is lacking. This study examined the prevalence and factors associated with IPV among women aged 15 to 24 years in India through a social-ecological approach. This cross-sectional study analyzed data from the National Family Health Survey, a population-based survey conducted in India from 2005 to 2006. The past-year prevalence of emotional, physical, and sexual forms of IPV, among ever-married women aged 15 to 24 years were computed. Multivariate logistic regression was conducted to evaluate the association of factors at various levels of the social-ecological framework with the past-year experience of emotional, physical, sexual, and any form of IPV. The past-year prevalence of IPV among women aged 15 to 24 years (n = 16,285) was 29%. Physical IPV was the most common, affecting 23% in the past year. The past-year prevalence of sexual IPV among women aged 15 to 24 years at 9.5% was higher than older women. Individual factors significantly associated with the past-year experience of all forms of IPV were the young age at first marriage, parental IPV, and ever had a terminated pregnancy. At the relationship level, husband's controlling behaviors, his consumption of alcohol, and experience of violence from other family members were positively associated with all forms of IPV in the past year. Poverty and acceptance of IPV increased the women's odds of experiencing IPV. IPV was associated with multiple factors occurring at all levels of the social-ecological framework. Actions to prevent and eliminate IPV in India demand multidisciplinary and collaborative efforts that are tailored specifically for adolescents and young women. It is imperative to protect the girls and young women from IPV; it protects the future of India. [ABSTRACT FROM AUTHOR]

• Multidimensional child poverty is notably more prevalent among STs and SCs. • Standard of living, ECD, and WASH are the dimensions that need committed thrust. • STs and SCs contribute more to the national MCP than their share of the population. • Head of household characterised by female gender, older age, and higher level of education is associated with a lower likelihood of MCP. • MCP tends to be more pronounced in nuclear families, households with 7+ members, rural areas, and central and eastern regions. Children are among the most vulnerable groups worldwide, bearing a disproportionate share of the burden of poverty. One-third of children, compared to one-sixth of adults, are multidimensionally poor. Experiencing poverty in childhood can have long-term negative consequences across generations. As a result, multidimensional poverty measures have recently been investigated in the child poverty literature. This study analysed multidimensional poverty among children (0–59 months) in India using the Alkire-Foster's counting approach and looked into how it differs across the country's well-known social stratification, the Caste system. The determinants of multidimensional child poverty (MCP) have been determined using multiple logistic regression. By using National Family Health Survey, 2019–21 data, the study revealed that the incidence of MCP in India is 32 %; highest among Scheduled Tribes (STs) (50 %), followed by Scheduled Castes (SCs) (37 %), Other Backward Classes (OBCs) (30 %) and 'Others' (22 %). Across all the Castes highest rates of deprivation were recorded in the indicators of standard of living and early childhood development (ECD) dimensions; together, they contribute more than 50 % to the MCP index (MCPI). The contribution of the water, sanitation, and hygiene (WASH) dimension in MCPI of STs is also noticeably higher (20.2 %). Of the 15 indicators considered, availability of TV/Radio, followed by immunisation, sanitation, cooking fuel, housing condition, and stunting, are the leading contributors with a combined contribution of more than 55 %. A child being a male, of higher birth order and born to a mother with higher years of schooling was more likely to experience multidimensional poverty. The household head's sex, age, and years of schooling were significantly associated with MCP. Across all castes, children from nuclear families, 7 + household members, higher number of children per woman, rural areas, central, eastern and north-eastern (except STs) regions were more likely to experience multidimensional poverty. [ABSTRACT FROM AUTHOR]

Empirical evidence suggests that macroeconomic growth in India is not correlated with any substantial reductions in the prevalence of child undernutrition over time. This study investigates the two commonly hypothesized pathways through which macroeconomic growth is expected to reduce child undernutrition: (1) an increase in public developmental expenditure and (2) a reduction in aggregate income ‐ poverty levels. For the anthropometric data on children, we draw on the data from two cross ‐ sectional waves of National Family Health Survey conducted in 1992–1993 and 2005–2006, while the data for per capita net state domestic product and per capita public spending on developmental expenditure and headcount ratio of poverty were obtained from the Reserve Bank of India and the Government of India expert committee reports. We find that between 1992–1993 and 2005–2006, state ‐ level macroeconomic growth was not associated with any substantial increases in public development expenditure or substantial reductions in poverty at the aggregate level. Furthermore, the association between changes in public development expenditure or aggregate poverty and changes in undernutrition was small. In summary, it appears that the inability of macroeconomic growth to translate into reductions in child undernutrition in India is likely a consequence of the macroeconomic growth not translating into substantial investments in development expenditure that could matter for children's nutritional status and neither did it substantially improve incomes of the poor, a group where undernutrition is also the highest. The findings here build a case to advocate a ‘support ‐ led’ strategy for reducing undernutrition rather than simply relying on a ‘growth ‐ mediated’ strategy. Key messagesIncreases in macroeconomic growth have not been accompanied by substantial increases in public developmental spending or reduction in aggregate poverty headcount ratio in India.Association between increases in public development expenditure or poverty headcount ratios and changes in child undernutrition, in particular, child stunting, is small to null.Reducing the burden of undernutrition in India cannot be accomplished solely relying on a growth ‐ mediated strategy, and a concerted support ‐ led strategy is required. [ABSTRACT FROM AUTHOR]

Gender inequality is exceptionally high in India. It shows up through various explicit measures, but implicit disparities embedded in patriarchal norms are harder to measure. This article explores whether disparate freedoms between genders influence paid-work capabilities—abilities, skills, resources, and opportunities at personal, interpersonal, and structural levels. Using a mixed-methods design, purposive sampling, and face-to-face interviews, this article reports paid-work capabilities of 67 women and 25 men. The study finds statistically significant gender differences in some work capabilities; however, combined capabilities for work impact type of work and income more for women than for men. Implications are discussed. [ABSTRACT FROM AUTHOR]

The results from this study indicate that a vast majority of people (almost 80 per cent) in India use the private sector for outpatient care curative services, albeit a slight decline is noted between 1995–96 and 2004. The utilization of private sector for outpatient services has become more inequitable across expenditure quintiles, favouring the rich at the national level during the period 1995–96 to 2004. There are also large inter-state variations in the choice between private and public provision for poor and non-poor people at the state level. The results indicate that Himachal Pradesh is the only state where the public outpatient services are well targeted and fairly accessible to the poor people (84 per cent) than other states. The multivariate analysis suggests that the gap in access to private provider for outpatient care between poor and non-poor, highly educated and uneducated and scheduled tribes (STs) and other social groups have broadened over the study period. Unlike outpatient care, the results show a trend of declining use of public health facilities for inpatient care. A sizeable proportion of the poor were forced to visit private provider due to non-availability of public facilities: this suggests the need for the public health care system to be responsive to the needs of the poor by ensuring availability of quality services in the public facilities. [ABSTRACT FROM PUBLISHER]

Background and aims: There is a dearth of studies investigating the prevalence and factors associated with unmet needs in people with schizophrenia from low- and middle-income countries. We aimed to study prevalence and risk factors for unmet need.Method: A case-control study design was employed. One hundred and one (101) consecutive patients attending a psychiatric hospital were assessed using Camberwell Assessment of Need Short version (CANSAS) and Positive and Negative Syndrome Scale (PANSS). Multivariate analysis was employed to adjust for confounders.Results: The majority of patients had many unmet needs. These unmet needs were significantly associated with lower education, poverty and persistent psychopathology on multivariate analysis.Conclusion: Unmet needs are associated with poverty, lower education and persistent psychopathology. There is a need to manage unmet needs, in addition to addressing psychopathology and poverty. [ABSTRACT FROM AUTHOR]

The study aimed to assess the demand for health insurance, gather evidence on willingness to pay (WTP) for health insurance and its determining factors amongst the urban poor in Mumbai. This was as-certained through dichotomous bidding process on 300 households (HHs). The findings reveal characteristics of a low-income group with a burden of disease and treatment financed through out-of-pocket (OOP) expenditure, which is at times catastrophic. These factors justify the demand for health care insurance in the study population expressed by one-third of the population. Results of the multivariate regression model suggest that HHs with presence of morbid conditions and prior experience of inpatient admissions were more likely to join and pay for health insurance. Within the ‘urban poor’, the relatively better-off HHs expressed greater WTP for health insurance. The results clearly indicate the need for a state-subsidized insurance scheme as more than 50 per cent of the people willing to pay expressed their inability to pay more than 1 per cent of the annual income. [ABSTRACT FROM PUBLISHER]