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This article investigates the covariates of out-of-pocket expenditure (OOPE) on health care, with a special focus on the Empowered Action Group (EAG) states of India. These states are economically weaker and vulnerable. For analysis, the study uses a nationally representative database—the India Human Development Survey (IHDS I, 2004–2005 and IHDS II, 2011–2012)—by applying the log-linear regression method. Four regression models have been specified in the article. The pooled regression method is applied to check the robustness of the models. Results identify that factors such as the location of the respondent, education, waiting time in hospitals, household expenditure per capita and the location of the hospital play a significant role in determining the OOPE on health care in India. Among other factors, waiting time in the hospital and the distant treatment location result in higher opportunity costs for better treatment facilities, hence increasing the burden on OOPE. The study concludes with suggestions based on these covariates, especially for the EAG states. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) poses a significant global health challenge and focused research is vital for improving maternal and neonatal health outcomes. The purpose of this study was to determine the effect of oxidative stress (OS) and DNA damage on PTB. Methods: There were two groups: (a) cases consisting of mothers with PTB (<37 weeks of gestation, n = 100) and (b) controls consisting of mothers with term birth (>37 weeks of gestation, n = 100). Women with vaginal infection, non-cephalic presentation, multiple gestations, fetal anomalies, Cesarean delivery, pregnancy with Mullerian anomalies, or preeclampsia were excluded from the study. OS analysis was conducted by measuring levels of superoxide dismutase (SOD), catalase (CAT), lipid peroxidation (LPO), and total protein and DNA damage were evaluated by CBMN-Cyt assay. Statistical analysis was performed using students' t -test and one-way ANOVA. Results: Low levels of antioxidants SOD and CAT (p <.0001), and total protein (p <.0001), besides high malondialdehyde (byproduct of LPO) (p <.0001) were observed in the PTB group. Moreover, high frequencies of micronuclei (p <.0001) and nucleoplasmic buds (p <.01) were detected in the PTB mothers compared to term birth mothers, while no significance was observed in the nucleoplasmic bridge frequencies. Conclusion: When the body's immune system and antioxidants fail to cope up with the generated OS, it can lead to PTB. Along with other body tests, OS markers and CBMN-Cyt tests have the potential to be used in diagnostics for early warning as well as monitoring and advising mothers for a better pregnancy outcome. [ABSTRACT FROM AUTHOR]

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017–2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI −0.10; outpatient CI −0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India. [ABSTRACT FROM AUTHOR]

Background: Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. Methods: Data for 533,495 children under 5 years of age (U–5) were analysed in the context of three commonly used indicators of early childhood undernutrition – wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. Results: Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. Conclusions: The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation. [ABSTRACT FROM AUTHOR]

Nutrition deficiency is commonly observed in lactating mothers and is a rising trend in India due to improper dietary patterns, physiological factors, socio-economic and demographic factors. The aim was to study the nutritional status and its related factors among lactating mothers in the urban areas of Delhi region, India. A structured, pre-tested and validated questionnaire was used to capture the socio-demographic information, including economical and medical conditions, of 150 lactating women in Delhi, India. Pearson correlation coefficient and association of various factors were determined. 72.5 per cent of women were in the age bracket of 20–25 years and in low-income group (70 per cent). The prevalence of underweight was 21.33 per cent, and the mean and SD of body mass index (BMI) of mothers were 19.17 ± 2.1 and 20.70 ± 2.3 for sedentary and moderate workers, respectively. There were significant correlations found between BMI, energy, carbohydrates, fat and protein intake (p <.05). Multivariate regression model was used to associate the nutrition of participants' income group, education, type of work, age of mothers and frequency of meals. Based on the results, intervention programmes for dietary correction and the effect of nutrition on the body have to be emphasised to lactating mothers for better health and nutritional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Mission Balam Sukham's Nutrition Rehabilitation Centre (NRC) combats malnutrition through prevention, treatment, and community engagement, ensuring children receive adequate nutrition for healthy growth. Objective: To document IYCF practices and risk factors of severe acute malnutrition (SAM) among NRC beneficiaries Methodology: A prospective cohort study was conducted comprising of 63 children aged 6 months to 5 years having SAM alongwith complications admitted at NRC of South Gujarat over the duration of 10 months. Observations: 90.5% poverty, 57.1% migrants, 7.9% single parent. 69.8% initiated breastmilk within 1hr, 15.9% weren't fed with colostrum, 6.3% were given pre-lacteals. 93.7% were exclusively breastfed, 6.3% initiated breastmilk at the time of 6 months. 16%, 60% and 9.8% met the criteria of MDD, MMF and MAD respectively. Boys show significant association on admission and discharge both (t = 2.43, p= 0.026 on admission and t= 2.66, p= 0.015 on discharge). In 13-24 months, MDD group (t = 2.34, p=0.02), children not suffering from anaemia shows significant weight (t=-2.540, p=0.18). Conclusion & Recommendations: Children's weight improvement is linked to better IYCF practices, emphasizing its importance of caregiver attention and education, highlighting need to address cultural barriers and promote practices like exclusive breastfeeding and continuous breastfeeding, focusing on empowering mothers and caretakers. [ABSTRACT FROM AUTHOR]

The underweight status among older adults in India and its association with other health risks has received little attention. Using nationally representative data from the first wave of the Longitudinal Aging Study in India (LASI, 2017-18), this study examined the underweight status among the Indian older adults and investigated its relationship with various health outcomes. The effective sample size of this study was 28,050 older adults aged 60 years or above. Multivariable logistic and linear regression models were employed to meet the objectives of the study. Underweight status was found to be negatively associated functional health, cognitive function, and grip strength. However, no significant association was observed between underweight status and depressive symptoms. Moreover, socioeconomic, demographic, and geographic factors were identified as strong determinants of underweight status among Indian older adults. India has implemented a wide range of nutrition policies that primarily focus on children, mothers, and adolescents. While these policies are important, it is equally crucial to develop interventions specifically tailored for adults and older adults. [ABSTRACT FROM AUTHOR]

Background: Child labor is considered one of the main social problems that affect the community and has a physical and psychosocial impact on a child's health, growth, and development. The study aimed to describe the sociocultural discourses of children involved in child labor. A macroethnographic approach was used to collect the data from the selected community areas of Punjab, India. Materials and Methods: A community-based qualitative study using purposive sampling was carried out among children engaged in child labor (n = 8). The data were gathered through in-depth or semi-structured interviews and non-participant observation under four phases: community context assessment, egocentric network analysis, validation, and dissemination of study findings. The guide for consolidated criteria for reporting qualitative research (COREQ) was followed. Ongoing analysis was conducted using Spradley's analysis approach to identify the themes. Results: Thematic analysis resulted in the emergence of various themes related to child labor, namely, adaptability, money-centric attitude, sense of being underserved, social deprivation, work burden, reduced emotional expression, workaholism, abuse, family shoulder, family cohesion, and sense of industry. Apart from that, inhuman living and working conditions, as well as school deprivation among study subjects, were observed. Poverty emerged as the single most compelling factor for child labor in India. Conclusion: The study concluded that child labor had a negative impact on children's overall development. An effective intervention to stop child labor is if vulnerable children are identified through primary healthcare, and a relationship of trust is built that allows for the provision of health care, education, support, and referral to additional services outside the health sector. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations. Design/methodology/approach: Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic's MHAT services and activities, as found during field visits and interviews with staff members and volunteers. Findings: The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics. Originality/value: The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources. [ABSTRACT FROM AUTHOR]

Background: Despite a commendable rise in the number of women seeking delivery care at public health institutions in South India, it is unclear if the benefit accrues to wealthier or poorer socio-economic groups. The study's aim was to investigate at how the public subsidy is distributed among Indian women who give birth in public hospitals in the southern regions. Methods: Data from the Indian Demographic Health Survey's fifth wave (NFHS-5, 2019–21) was used in this study. A total of 22, 403 were institutional deliveries across all the southern states of India were included. Out-of-pocket expenditure (OOPE) on childbirth in health institutions was the outcome variable. We used summary statistics, Benefits Incidence Analysis (BIA), concentration index (CI), and concentration curve (CC) were used. Results: Most women in the lowest, poorest, and medium quintiles of wealth opted to give birth in public facilities. In contrast, about 69% of mothers belonging to highest quintile gave birth in private health institutions. The magnitude of CI and CC of institutional delivery indicates that public sector usage was concentrated among poorer quintiles [CIX: − 0.178; SE: 0.005; p < 0.001] and private sector usage was concentrated among wealthier quintiles [CIX: 0.239; SE: 0.006; p < 0.001]. Benefit incidence analyses suggest that middle quintile of women received the maximum public subsidy in primary health centres (33.23%), followed by richer quintile (25.62%), and poorer wealth quintiles (24.84%). These pattern in the secondary health centres was similar. Conclusion: Poorer groups utilize the public sector for institutional delivery in greater proportions than the private sector. Middle quintiles seem to benefit the most from public subsidy in terms of the median cost of service and non-payment. Greater efforts must be made to understand how and why these groups are being left behind and what policy measures can enhance their inclusion and financial risk protection. [ABSTRACT FROM AUTHOR]

Background: Construction laborers succumb to poor health due to the inherent workplace health hazards and poor socio-economic living conditions. With rising healthcare expenses, the increased risk of poor health may aggravate their economic status, pushing them deeper into poverty. Settings and Design: The current cross-sectional multicenter study comprehensively investigated the determinants of health, health-seeking behavior, and poor economic impact regarding catastrophic health expenditure (CHE) among construction laborers. Methods and Material: We collected details on illnesses among self and family members of the construction laborers that required healthcare visits during the previous year and their approximate expenses. Among the 1110 participants with complete data, 37% reported illness requiring a healthcare visit either for self or a family member. Results: Regression models to ascertain demographic and living condition determinants of perceived illness revealed an increased risk of illness when the kitchen is shared with the living space (OR = 1.87) and use unhygienic smoky cooking fuels (OR = 1.87). More than 25% of those who reported illness incurred CHE. Conclusion: We conclude that the frequency of perceived illness and the economic impact, i.e., CHE is relatively higher among the construction laborers. Our results demonstrate that poor living conditions add to the burden of morbidity in construction workers and families. Providing healthcare coverage for this population and engaging and educating them about affordable healthcare are necessary future steps to prevent the worsening of the economic situation. [ABSTRACT FROM AUTHOR]

This phenomenological study was conducted in rural Rajasthan, India, to explore young widows' lived experiences. On receipt of written informed consent, we interviewed 14 young widows. The data were analyzed in an idiographic style using the interpretive phenomenological approach. The perspective of loss and sociocultural contexts grounded the analysis. Six themes emerged corresponding to the women's widowhood experiences: becoming a widow; entangled by customs; stigmatization; the impossible marriage; hope in widowhood; and economic deprivation. The results underline the predicaments of young widows, and these experiences are largely framed by the sociocultural and gender norms prevailing in rural communities. The study's findings imply the need for strengthening social and legislative measures for young widows. [ABSTRACT FROM AUTHOR]

Background: When immunization of under-five children results in Out-of-Pocket Expenditure (OOPE), it affects motivation of parents for vaccination inversely. Objectives: To assess determinants affecting preference for specific/mixed type of health facilities and to estimate out-of-pocket expenditure towards immunization of under-five children. To assess opinion of participants for prevention/decreasing OOPE towards immunization. Methods: A community-based cross-sectional study was conducted at one of zones of Ahmedabad city, selected by simple random sampling. Following technique of "30x7 cluster survey" with necessary house-hold information received from Municipal Corporation, selection of 7 children was pursued from each cluster reaching to sample-size of 210 (30 X 7). Results: Of 211 children included in study, 124(58.77%), 68(32.23%) and 19(9%) had taken immunization services from government, private and mixed variety respectively. Majority of families (110, 88.71%) preferring government healthcare-facility for immunization incurred expenses <5000 INR/child as while in other two groups, all beneficiaries had expensed>5000 INR/child. Conclusions: Determinants like child's gender, parents' education, Type of family, Socio-economic status, delivery place of child and occupation of father had statistically significant association with preferred place of vaccination. Fixation of upper ceiling-limit of vaccines which are recommended by pediatricians but not covered in government run program was one of suggestions. [ABSTRACT FROM AUTHOR]

Introduction: Mental health issues were neglected in India. However, coronavirus disease 2019 (COVID-19) had raised the importance of mental health. Hence, this study aimed to determine the prevalence of awareness and utilization of the mental health services provided by primary care centers during the COVID-19 pandemic. Methods: This community-based cross-sectional study was conducted among individuals aged 18 years and above in selected primary health center (PHC) service areas, Karnataka, South India. The sample size was 388. A semi-structured questionnaire was used to collect the information. Results: The mean (standard deviation [SD]) age of the participants was 42.7 (±15.37) years and 76% were female. The prevalence of awareness was 47% (95% confidence interval [CI] 41.8%–52.0%), and only 1% (95% CI 0.8%–2.6%) had utilized the mental health services through PHCs during COVID-19. About 82% (95% CI 78.0%–85.8%) were willing to avail the mental health services through PHCs. No formal education (adjusted prevalence ratios [APR] = 7.33, 95% CI 1.81–29.60, P = 0.005) and current psychological distress (APR = 2.99, 95% CI 2.08–4.30, P = 0.00) were significantly associated with unwillingness to avail care from PHCs. Conclusion: The awareness and utilization of mental health services through primary care centers were poor in the community. Strategic measures must be implemented through the mental health program to improve the utilization of the services. [ABSTRACT FROM AUTHOR]

Poverty increases vulnerability towards somatisation and influences the sense of mastery and well-being. The present study on adolescents living in relative poverty in a high-income group country (Israel) and a low-middle-income group country (India) explored the nature of somatisation tendency (ST) and its relationship with potency and perception of poverty (PP). Potency, a buffer against stress-induced negative health effects, was hypothesized to be negatively related to ST and mediate the link between PP and ST. Purposive sampling was used to collect questionnaire-based data from community youth (12–16 years) of two metropolitan cities—Kolkata (India, N = 200) and Tel-Aviv (Israel, N = 208). The nature of ST, PP and potency was analysed using descriptive and inferential statistics and correlation-regression statistics and mediation analysis were used to understand the relationship among them. A clinically significant level of ST was reported by both Indian and Israeli youth experiencing 5–7 somatic symptoms on average. Potency was found to be a significant predictor of ST in both countries (p < 0.05) and emerged as a significant mediator (p < 0.001) in the PP and ST relationship among Indian adolescents. The present study highlights potency as a protective buffer in economically vulnerable community adolescents and re-establishes a high prevalence of ST among them, irrespective of their country's global economic position. [ABSTRACT FROM AUTHOR]

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]

Around 60.6% of health expenditure in India originates from private spending or out-of-pocket expenditure. Such large health spending has a tendency to sink sizeable number of people into poverty and deepen the already poor into more appalling conditions. This article makes an attempt to study the impact of health expenditure on poverty levels in the Jammu and Kashmir (J&K) region of India using micro-level data (68th round of National Sample Survey Organisation [NSSO]). First, a region-wise poverty profile is estimated, then, poverty deepening and incidence of catastrophic health expenditure is measured. Finally, socio-economic determinants of catastrophic health expenditure are estimated using logit and probit models. The results show that the poverty levels further increase by around 2% (estimated 185,000 individuals) on account of out-of-pocket health expenditure. Also, poverty gap increases, deepening the economic distress of the poor people. The highest gap is observed in most vulnerable areas, such as hilly and geographically disadvantageous regions. An estimated 9.6% of population in J&K spends catastrophic out-of-pocket health expenditure and 2.6% spend more than their capacity to pay. Married, higher per capita expenditure groups, and socially weaker sections exhibit increased probability of experiencing health catastrophe while as higher levels of education decreases this likelihood. [ABSTRACT FROM AUTHOR]

Most of the women who use alcohol and tobacco before pregnancy likely to use alcohol and tobacco during pregnancy. The objectives of this study was to describe alcohol and tobacco use, and to identify associated characteristics during preconception period. The Indian National Family Health Survey-4 was used. A total of 65,238 preconception, young, married women were included and analysed usingbivariate and multivariate analyses statistical techniques. The data revealed that 4.3% of preconception women in India were using alcohol and tobacco. The prevalence of alcohol and tobacco use was higher among older women (5.6%), Scheduled Tribes (14.2%), living in rural areas (5.0%), non-educated (8.9%), poorest households (9.1%), northeast region (25.0%) and with a low body mass index (BMI) (6.2%). The adjusted odds ratios shown that after controlling for important background factors, being Hindu, from scheduled tribes, already having children, being underweight, from poorest households and Northeast region had higher odds of alcohol and tobacco use compared to with their corresponding reference groups. Findings suggest that preconception women of reproductive age who use alcohol and tobacco should be strongly encouraged and supported to quit alcohol and tobacco use before pregnancy for preventing adverse birth outcomes. [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]

Introducing complementary feeding at 6 months can reduce premature death. We examined timing and factors associated with complementary feeding using the Indian Human Development Survey II (n = 11,218 women). Only 21% of mothers initiated complementary feeding at 6 months, 42% at 7–9 months, 33% at ≥10 months. In adjusted results, we found mothers with low income, with no formal education, and who had never formally worked were less likely to introduce complementary feeding at 6 months (p > 0.05). Our results indicate women in less advantaged groups are less likely to initiate complementary feeding at recommended age than women in more advantaged groups. [ABSTRACT FROM AUTHOR]

Majority of people in low- and middle-income countries with mental illness do not receive healthcare, leading to chronicity, suffering and increased costs of care. This study estimated the out-of-pocket expenditure (OOPE), catastrophic health expenditure (CHE), and poverty impact due to mental illness in India. Data was acquired from the 76th round data of the National Sample Survey (NSS) on the theme 'Persons with Disabilities in India Survey', July–December 2018. Data of 6,679 persons who reported mental illness during the survey was included for analysis. OOPE, CHE, poverty impact and state differentials of healthcare expenditure on mental illness were analysed using standard methods. In total, 18.1% of the household's monthly consumption expenditure was spent on healthcare on mental illness. About 59.5% and 32.5% of the households were exposed to CHE based on 10% and 20% thresholds, respectively. About 20.7% of the households were forced to become poor from non-poor due to treatment care expenditure on mental illness. Our study suggests the critical need to accelerate on various measures for early diagnosis and management of mental health issues along with financial risk protection for reducing financial impact of healthcare expenditure on mental illness among households in India. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the Government of India launched the Pradhan Mantri Jan Arogya Yojana (PM-JAY), a part of the Ayushman Bharat scheme as a progressive step toward universal health coverage. The scheme was intended to provide health insurance for the socioeconomically deprived population. This study was undertaken to assess the coverage of the scheme and to assess the reduction in medical out-of-pocket expenditure (OOPE). Methods: This was a cross-sectional study conducted among the urban slum dwellers in Mysuru. A semi-structured questionnaire was used for the study. Oral consent was taken from the participants before administering the questionnaire. Data were collected by face-to-face interviews. Statistical tests such as percentages and mean were calculated using SPSS software (Version 26, Licensed by JSSAHER). Results: The study was conducted among 104 individuals, of which 73% were females. Only 38 (33%) of the participants had PM-JAY cards while 59 (56.73%) did not have any health insurance. Thirty percentage (78.95%) of the card holders had utilized the insurance in the past 1 year and incurred an OOPE of Rs. 25,873/-. For all the cardholders, this amount was spent from their savings. Conclusion: The coverage of the scheme and OOPE reduction toward health care is still lacking. Greater measures need to be taken by medical officers, medicosocial workers, and other field workers to identify eligible households and help them avail the benefits of this scheme. [ABSTRACT FROM AUTHOR]

Health is one of the major determinants of the overall well-being of a society. The World Health Organization has emphasised the right to health for all, and the universal health coverage is a paradigm of this emphasis with an agenda of nobody to be left behind in the provision of health services without any financial burden by 2030.This article tries to analyse the extent of catastrophic expenditure being incurred by the people despite being sheltered under a financial protection (Health Insurance) in the state of Maharashtra. The impact caused by out-of-pocket (OOP) health expenditure on the economic status of the people in the state is assessed using the National Sample Survey Office's 71st round conducted by the Ministry of Health and Family Welfare, Government of India. It was found that over 4.18% of the population endured the burden caused by OOP expenditure by falling below the poverty line post health payments. A higher proportion of rural population is observed to have experienced a fall in the economic status from above poverty line (APL) to below poverty line (BPL) due to high OOP expenditure than that of the urban population in Maharashtra. [ABSTRACT FROM AUTHOR]

Aim: Infectious diseases continue to be a significant impediment in the attainment of sustainable development goals related to health. A lack of essential household amenities and social determinants are the primary cause behind the outbreak of infectious diseases in LMICs. The current study aimed to examine the socio-demographic determinants of infectious diseases vis-à-vis basic household amenities in India. Subject and methods: This study was based on nationally representative data of 'Key indicators of Social Consumption in India: Health' conducted by the National Sample Survey Organisation between July 2017 and June 2018. The study measured the inicidence of various infectious diseases across basic household amenities and socio-demographic variables. Multivariate logistic regression is employed to analyse the association between the likelihood of a particular infectious disease and various intersectional variables. Results: The study findings reveal that the lack of household amenities such as access to a toilet, clean drinking water, garbage disposal and socio-economic determinants such as area of residence, gender, poverty and age have a significant impact on the incidence of infectious diseases in India. Among various infectious diseases jaundice, malaria and others, including tuberculosis and typhoid, dengue fever and chikungunya, have a relatively higher incidence. Approximately 22.32% of the population do not have proper toilet facility, 45.56% have proper tap water facility, while 50% either use water from spring/well or other unprotected sources and about half of the population do not have any arrangement for garbage disposal. Among socio-demographic determinants, incidence of infections is relatively higher in rural areas, other backward classes (OBCs), males, children, and adults. Conclusions: The study findings outlined that there is a need for better government interventions towards reducing the burden of infectious diseases in India, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community. Methods: This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0. Results: Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband's alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation. Conclusion: Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women's education and empowerment, and support system are likely to decrease the burden of CMDs in this population. [ABSTRACT FROM AUTHOR]

This individually randomized trial was conducted to estimate the effect of promoting community‐initiated kangaroo mother care (ciKMC) in low birthweight (LBW) infants on infant breastfeeding performance. It was designed as a substudy within a larger primary trial on ciKMC and infant survival. Five hundred fifty stable LBW mother‐infant dyads (1500−2250 g) who provided consent, were consecutively enroled for breastfeeding performance assessment. The ciKMC intervention included promotion and support of continuous skin‐to‐skin contact and exclusive breastfeeding (EBF) through home visits during the neonatal period. The primary outcome was effective breastfeeding performance indicated by an infant breastfeeding assessment tool score of ≥10 after the end of the neonatal period. As secondary outcomes, we reported maternal satisfaction related to infant breastfeeding, and EBF after the end of the neonatal period. We completed outcome assessments in 96% of participants. In the ciKMC arm, 92% of the infants showed effective breastfeeding performance against 81% in the control arm [adjusted prevalence ratio (aPR): 1.24, 95% confidence interval (CI): 1.16−1.32]. In the ciKMC arm, 65% of the mothers reported to be very satisfied with their infants' breastfeeding against 51% in the control arm (aPR: 1.22, 95% CI: 1.05−1.41). The proportion of infants practicing EBF was 89% in the ciKMC arm against 45% in the control arm (aPR: 1.62, 95% CI: 1.45−1.81). Our study findings suggest that promotion of ciKMC can improve effective breastfeeding, EBF and maternal satisfaction related to breastfeeding in LBW infants. Key messages: In low birthweight (LBW) infants, breastfeeding can be challenging with low prevalence of exclusive breastfeeding (EBF).Our trial in North India among 550 LBW infants showed that promotion of community‐initiated Kangaroo mother care (ciKMC) can substantially improve infant breastfeeding performance.ciKMC promotion substantially improved EBF prevalence at the end of the neonatal period, number of breastfeeds per day and duration of each breastfeed. It also enhanced mother's satisfaction with their infant's breastfeeding performance. [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]

Background: Child marriage is not a new phenomenon in India. The prevalence of child marriage remains high in many districts of West Bengal. Objectives: The present study aims to address socioeconomic factors associated with girl child marriage and its effect on selected pregnancy outcomes among women in the Malda district of West Bengal. Methods: The study is based on primary data, collected from the Manikchak CD block by adopting a random sample survey technique. The participants in the study consisted of 357 ever married women aged 15–49 years. Results: Multivariate analysis revealed that the prevalence of child marriage was substantially higher among women who had no formal education resided in the marginalized family. Similarly, educated parents were less likely to marry their daughter at an early age. Besides, the likelihood of miscarried or stillbirth, complications during pregnancy and delivery were significantly higher among those married <18 years than those married at 18 years or later. Conclusions: The findings of this study suggest preventing child marriage by increasing opportunities for girls' education and employment. The targeted approach should be made among rural and poor girls to reduce the vulnerability of child marriage. [ABSTRACT FROM AUTHOR]

The study aimed to find out the association between self-care behaviors and glycemic control in older Type 2 diabetes mellitus patients in Multan, Pakistan. Data were collected from respondents registered in the Diabetic Clinic of Nishtar College and Hospital Multan from October 2018 to November 2018 through a self-administrative questionnaire. The simple random sample method was used, and a total of 154 Type 2 patients were selected randomly. The inclusion criteria were (a) respondents having Type 2 diabetes at least 6 months prior; (b) respondents being 60 years of age or above; (c) respondents registered in hospital diabetic clinic and (d) respondents belonging to low-income families having monthly income less than PKR 15000. The exclusion criteria were respondents having any physical disability and being dependent on others in physical movement and Type 1 diabetes mellitus patients. Descriptive and simple binary logistic regression was used to analyze the data through SPSS. The results of the study showed that mean glycemic control of respondents was (HbA1c, 8.47%), and only 48 (31.2%) respondents had better glycemic control. The respondent's level of education, Body Mass Index, hypertension, comorbidities, knowledge about diabetes and self-care behaviors (exercise, monitor glucose, medicine adherence, and diet plan) were significantly associated with glycemic level (P <.05). Bivariate logistic regression showed respondents, who performed self-care behaviors (to exercise daily 30 minutes, to monitor glucose two times in a week, regular medicine adherence, and to manage diet plan daily) had better glycemic control. The study concluded that few older Type 2 patients managed their better glycemic control in low economic status. The doctors and educationists must provide Type 2 self-care guidelines to older patients so that they may manage their glycemic control better and reduce the diabetes-related complications and treatment costs in Pakistan. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find the demographic factors associated with the spread of COVID-19 and to suggest a measure for identifying the effectiveness of government policies in controlling COVID-19. The study hypothesizes that the cumulative number of confirmed COVID-19 patients depends on the urban population, rural population, number of persons older than 50, population density, and poverty rate. A log-linear model is used to test the stated hypothesis, with the cumulative number of confirmed COVID-19 patients up to period t as a dependent variable and demographic factors as an independent variable. The policy effectiveness indicator is calculated by taking the difference of the COVID rank of the i th state based on the predicted model and the actual COVID rank of the i th state. Our study finds that the urban population significantly impacts the spread of COVID-19. On the other hand, demographic factors such as rural population, density, and age structure do not impact the spread of COVID-19 significantly. Thus, people residing in urban areas face a significant threat of COVID-19 as compared to people in rural areas. [ABSTRACT FROM AUTHOR]

Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18–45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists – ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers. [ABSTRACT FROM AUTHOR]

In India, strict public health measures to suppress COVID-19 transmission and reduce burden have been rapidly adopted. Pandemic containment and confinement measures impact societies and economies; their costs and benefits must be assessed holistically. This study provides an evolving portrait of the health, economic and social consequences of the COVID-19 pandemic on vulnerable populations in India. Our analysis focuses on 100 days early in the pandemic from 13 March to 20 June 2020. We developed a conceptual framework based on the human right to health and the UN Sustainable Development Goals (SDGs). We analysed people's experiences recorded and shared via mobile phone on the voice platforms operated by the Gram Vaani COVID-19 response network, a service for rural and low-income populations now being deployed to support India's COVID-19 response. Quantitative and visual methods were used to summarize key features of the data and explore relationships between factors. In its first 100 days, the platform logged over 1.15 million phone calls, of which 793 350 (69%) were outbound calls related largely to health promotion in the context of COVID-19. Analysis of 6636 audio recordings by network users revealed struggles to secure the basic necessities of survival, including food (48%), cash (17%), transportation (10%) and employment or livelihoods (8%). Themes were mapped to shortfalls in 10 SDGs and their associated targets. Pre-existing development deficits and weak social safety nets are driving vulnerability during the COVID-19 crisis. For an effective pandemic response and recovery, these must be addressed through inclusive policy design and institutional reforms. [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]

Objective: This paper aims to understand the recent trends and correlation of tobacco use and factors associated with an attempt to quit smokeless tobacco (SLT) use among adults from Northeast India. Methods: We used data from two rounds of the cross-sectional Global Adult Tobacco Survey. The paper applied proportion test statistics to examine the change in the prevalence of tobacco use between the two periods. Binary logistic regression was applied to determine the associated risks of tobacco use. Results: Prevalence of SLT use among adults increased significantly by 3.9% from 2009-10 to 2016–17. In the same period, the prevalence of smoking had declined by 2.4%. Increase in use of SLT use was more prominent among women and illiterate adults, rural and poor households, while a decrease in prevalence of smoking was observed among adults. A significant proportion of educated people, students, and homemakers, reported that they had quit smoking; however, the proportion of attempts to quit SLT had increased significantly among older adults, rural residents, and those with low education levels. Conclusions: Actions involving the community, youth, women, the less educated and poor adults are necessary to encourage them quit SLT use and smoking in the north-eastern states of India. [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: The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries. Methods: The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation. Results: We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged. Conclusions: Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands. [ABSTRACT FROM AUTHOR]

Objectives: Current tobacco use (CTU) and secondhand smoke (SHS) exposure among older adults in India (≥60 years) are prevalent in India and indicate the importance of addressing associated factors. Methods: Pooled Global Adult Tobacco Survey India 2009–2010 and 2016–2017 data (n = 17,299) for older adults examined prevalence of CTU and SHS exposure at home and/or in public places and associated socioeconomic and demographic correlates. Results: CTU among older adults in India was 44.6%, and SHS exposure at home and public places were 20.0% and 30.0%, respectively. Men, younger age-group, rural, lower education, lower wealth index, and lower knowledge were independently associated with CTU. Men, rural, lower education, lower wealth index, CTU, and lower knowledge were independently associated with SHS exposure at home. Men, younger age, and rural residence were associated with SHS exposure in public places. Conclusion: CTU and SHS exposure among older adults in India suggest targeted interventions to address associated social and demographic factors. [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]

Background: In adolescents, major depression is projected to rank the second most cause of human illness by the year 2022. Unfortunately, half of the depressed adolescents go undiagnosed in primary care settings. Objectives: The objective is to estimate the prevalence of severe depression among rural adolescents and also to identify few epidemiological determinants causing severe depression. Settings and Design: This cross-sectional study included 341 adolescents from a selected village of Balasore, Odisha. Materials and Methods: A semi-structured questionnaire, and "Beck's Depression Inventory II" questionnaire for screening depression. Results: Only 24 (7%) of adolescents were found to be having severe depression. The subcategories of depression showed mild mood disturbance in 8.8%, borderline depression in 15.2%, and moderate depression in 12% individuals. Almost 267 (78.2%) were between 15 and 19 years of age. The mean age (standard deviation) of the participants was 16 ± 1.9 years. Majority of the participants belonged to joint family and lower middle-class status as per the Modified Kuppuswamy Scale. Conclusion: Female gender was found to be significantly associated with depression (P = 0.006). Other contributory factors for depression were sleep duration (<6 h), parental fighting, and socioeconomic status. [ABSTRACT FROM AUTHOR]

In India, incidence of burn injuries is quite high due to widespread illiteracy, old customs like dowry and use of kerosene for lighting and cooking; poverty, overcrowding and unemployment, other social & emotional factors, lack of safety measures at industrial setup & lack of adequate healthcare services. Although, mortality in cases of burns has been reduced considerably by modern advance healthcare services, yet death due to burns is not an uncommon event. The study was carried out with the aim to study the various demographic parameters related to deaths due to burns such as age, sex, occupation, socio-economic status, marital status, locality and source of fire. It was a 1.6 years prospective study of cases of burns autopsied at the mortuary of Gandhi medical college, Bhopal. The relevant information was obtained from inquest papers, history provided by relatives of the deceased and postmortem examination. On data analysis, it was found that incidence of burns was found to be higher higher in females (55.0%) as compared to males (45.0%). young adults between the age group of 21-30 years have been the major victims of burns (41.00%). In both sexes, majority of the burn cases were married (74%). Most of the burn cases belonged to middle class, were housewives (51 %). and from rural areas (75 %). Hence, steps need be taken by Govt., NGOs and medical professionals to reduce the mortality due to burns. [ABSTRACT FROM AUTHOR]

Objective To determine the acceptability of keeping a self-written health diary among members of low-income communities, with the aim of generating needed health data. Methods We identified three different types of impoverished communities (tribal, inner-city slum and rural) in north India, and conducted a baseline survey to establish the sociodemographic properties of the members of 595 (tribal), 446 (slum) and 51 (rural) households. We designed health diaries with a single page to fill in per month, each with a carbon duplicate, and distributed diaries to willing participants. Health volunteers visited households each month to assist with diary completion and to collect duplicate pages for a period of one year. We compared the frequency of illnesses reported in health diaries with baseline survey data. Findings A total of 4881 diary users (tribal: 2205; slum: 2185; rural: 491) participated in our project. In terms of acceptability, 49.6% (1093/2205), 64.7% (1413/2185) and 79.0% (388/491) at the tribal, slum and rural sites, respectively, expressed satisfaction with the scheme and a willingness to continue. In the tribal and slum areas, we observed increased reporting of illnesses from health diaries when compared with baseline data. We observed that influenza-like illnesses were reported with the highest frequency of 58.9% (2972/5044) at the tribal site. Conclusion We observed high levels of acceptability and participation among the communities. From our initial field studies, we have observed the benefits to both our study participants (timely preventive education and referrals) and to service providers (obtaining health data to allow improved planning). [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]

Background: Health outcomes in India are characterized by pervasive inequities due to deeply entrenched socio-economic gradients amongst the population. Therefore, it is imperative to investigate these systematic disparities in health, however, evidence of inequities does not commensurate with its policy objectives in India. Thus, our paper aims to examine the magnitude of and trends in horizontal inequities in self-reported morbidity and untreated morbidity in India over the period of 2004 to 2017–18. Methods: The study used cross-sectional data from nationwide healthcare surveys conducted in 2004, 2014 and 2017–18 encompassing sample size of 3,85,055; 3,35,499 and 5,57,887 individuals respectively. Erreygers concentration indices were employed to discern the magnitude and trend in horizontal inequities in self-reported morbidity and untreated morbidity. Need standardized concentration indices were further used to unravel the inter-regional and intra-regional income related inequities in outcomes of interest. Additionally, regression based decomposition approach was applied to ascertain the contributions of both legitimate and illegitimate factors in the measured inequalities. Results: Estimates were indicative of profound inequities in self-reported morbidity as inequity indices were positive and significant for all study years, connoting better-off reporting more morbidity, given their needs. These inequities however, declined marginally from 2004(HI: 0.049, p< 0.01) to 2017–18(HI: 0.045, P< 0.01). Untreated morbidity exhibited pro-poor inequities with negative concentration indices. Albeit, significant reduction in horizontal inequity was found from 2004(HI= − 0.103, p< 0.01) to 2017–18(HI = − 0.048, p< 0.01) in treatment seeking over the years. The largest contribution of inequality for both outcomes stemmed from illegitimate variables in all the study years. Our findings also elucidated inter-state heterogeneities in inequities with high-income states like Andhra Pradesh, Kerala and West Bengal evincing inequities greater than all India estimates and Northeastern states divulged equity in reporting morbidity. Inequities in untreated morbidity converged for most states except in Punjab, Chhattisgarh and Himachal Pradesh where widening of inequities were observed from 2004 to 2017–18. Conclusions: Pro-rich and pro-poor inequities in reported and untreated morbidities respectively persisted from 2004 to 2017–18 despite reforms in Indian healthcare. Magnitude of these inequities declined marginally over the years. Health policy in India should strive for targeted interventions closing inequity gap. [ABSTRACT FROM AUTHOR]

In the tribal region, risk of death among neonates is influenced to a great extent by factors related to the mother such as situation of the mother prior to and post pregnancy, care received before, during and after pregnancy, birth order, and care received by the child during the first few years of his/her life. There is paucity of basic epidemiological data on reproductive health outcomes of displaced people (Hynes et al. in JAMA 288(5):595–603, 2002). Therefore, this study aims to examine the social factors responsible for neonatal deaths among displaced tribal communities in India. Sequential exploratory study design was used to collect data from displaced tribal communities in the state of Odisha and Chhattisgarh during 2016–2017. A purposive sampling method was used to select the sample from the definite population. Results indicate that in total 115 (59.3%) women had experienced at least one child deaths. Analysis of neonatal deaths suggests that about 39.2% women experienced at least one or more neonatal death during the last 5 years. Women who chose to deliver at home experience higher neonatal deaths (47.1%) in comparison to the women who delivered at the health facility (26.0%). The logistic regression analysis indicate that mothers education, place of delivery, utilization of the services, possession of Below Poverty Line (BPL) card and Particularly Vulnerable Tribal Group (PVTG) status are significant predictors of neonatal mortality. The probability of occurrence of neonatal mortality is 60% lower for literate women as compared to the illiterate women. Findings of the study identified three phases of delay that affect displaced tribal women in accessing and receiving health care services. Displaced tribal women are late in recognizing health problems of neonates and delay in seeking medical care due to rooted cultural barriers. Women who participated in this study had low levels of risk perception about delivering children at home and visiting traditional healer for the treatment. This is mainly due to their personal experiences of uneventful deliveries conducted by mothers-in-law or Traditional Birth Attendants (TBA) and sociocultural beliefs. There is need for provision of culturally sensitive instruction to service providers. This would further motivate service providers to sensitize the displaced tribal communities on various free healthcare services available to them. [ABSTRACT FROM AUTHOR]

In India, many people living with HIV (PLHIV) do not successfully initiate antiretroviral therapy (ART) after diagnosis. We conducted a clinic-based qualitative study at the Y.R. Gaitonde Centre for AIDS Research in Chennai, Tamil Nadu to explore factors that influence ART non-initiation. We interviewed 22 men and 15 women; median age was 42 (IQR, 36-48) and median CD4+ was 395 (IQR, 227-601). Participants were distrustful of HIV care freely available at nearby government facilities. Faced with the perceived need to access the private sector and therefore pay for medications and transportation costs, non-initiators with high CD4+ counts often decided to postpone ART until they experienced symptoms whereas non-initiators with low CD4+ counts often started ART but defaulted quickly after experiencing financial stressors or side effects. Improving perceptions of quality of care in the public sector, encouraging safe serostatus disclosure to facilitate stronger social support, and alleviating economic hardship may be important in encouraging ART initiation in India. [ABSTRACT FROM AUTHOR]

Antenatal morbidities and associated malpractices are quite prevalent in slums of Delhi. This paper aims to highlight the relationship between calories intake, seasonality and gravida. It also draws attention towards inter-related aspects of antenatal practices and morbidity among women. Survey of 400 women conducted in the slums of Delhi indicated high occurrence of antenatal and post-natal malpractices. The findings indicated that discrepancies in the advice given by the medical practitioners and traditional birth attendants (TBAs). This was seen to adversely impact a majority of expectant mothers. The finding support a strong direct relationship between calories intake, seasonality morbidity and mortality patterns among women as well as their children. Although ample research has been done on homebirths and their challenges, the perspectives of TBAs (who assist in the majority of homebirths) remain unexamined. The present study sought to add to this knowledge base by uncovering various practices prevalent in low income households of a cosmopolitan city like Delhi. [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]

Context: Asthma prevalence and severity is increasing among Indian children. There is the paucity of data on pediatric asthma in rural India and treatment received by asthmatics is not up-to-standard treatment guidelines. Aim: The aim is to estimate asthma prevalence and factors influencing access to standard asthmatic care among 5-15 years aged children. Settings and Design: Cross-sectional study conducted in rural north-Karnataka for 1 year. Subjects and Methods: The International Study of Asthma and Allergies in Childhood questionnaire was administered to participants followed by clinical examination. A child was considered as asthmatic if there was affirmative response to: (a) History of wheeze in the past 12 months, (b) Physician diagnosed/ever asthma, (c ) history of taking inhaled/oral bronchodilators. Statistical Analysis: All characteristics were summarized descriptively. Results: Prevalence of Current-wheeze, Ever-asthma, and wheeze on exertion were 4%, 2%, and 3.7%, respectively. About 63.9% of asthmatics had severe-asthma and 44.4% reported severe attack of wheezing limiting speech. About 89% of current-wheezers used only oral medications for wheeze/asthma, 50% did not take medicines as per doctors' advice. None availed regular follow-up. Financial constraints and ignorance were major reasons cited. Conclusions: Illiteracy, poverty, lack of proper guidelines, and non-availability of inhalational medications have affected treatment adherence resulting in severe asthma. [ABSTRACT FROM AUTHOR]