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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]

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]

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]

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]

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]

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]

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women's perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression "tension" to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women's distress and the need for scholarship on women's mental health in low-income settings to be more attuned to gendered forms of marginalization. [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]

Objectives mHealth interventions for MNCH have been shown to improve uptake of antenatal and neonatal services in low- and middle-income countries (LMICs). However, little systematic analysis is available about their impact on infant health outcomes, such as reducing low birth weight or malnutrition among children under the age of five. The objective of this study is to determine if an age- and stage-based mobile phone voice messaging initiative for women, during pregnancy and up to 1 year after delivery, can reduce low birth weight and child malnutrition and improve women's infant care knowledge and practices. Methods We conducted a pseudo-randomized controlled trial among pregnant women from urban slums and low-income areas in Mumbai, India. Pregnant women, 18 years and older, speaking Hindi or Marathi were enrolled and assigned to receive mMitra messages (intervention group N = 1516) or not (Control group N = 500). Women in the intervention group received mMitra voice messages two times per week throughout their pregnancy and until their infant turned 1 year of age. Infant's birth weight, anthropometric data at 1 year of age, and status of immunization were obtained from Maternal Child Health (MCH) cards to assess impact on primary infant health outcomes. Women's infant health care practices and knowledge were assessed through interviews administered immediately after women enrolled in the study (Time 1), after they delivered their babies (Time 2), and after their babies turned 1 year old (Time 3). 15 infant care practices self-reported by women (Time 3) and knowledge on ten infant care topics (Time 2) were also compared between intervention and control arms. Results We observed a trend for increased odds of a baby being born at or above the ideal birth weight of 2.5 kg in the intervention group compared to controls (odds ratio (OR) 1.334, 95% confidence interval (CI) 0.983–1.839, p = 0.064). The intervention group performed significantly better on two infant care practice indicators: giving the infant supplementary feeding at 6 months of age (OR 1.4, 95% CI 1.08–1.82, p = 0.009) and fully immunizing the infant as prescribed under the Government of India's child immunization program (OR 1.531, 95% CI 1.141–2.055, p = 0.005). Women in the intervention group had increased odds of knowing that the baby should be given solid food by 6 months (OR 1.89, 95% CI 1.371–2.605, p < 0.01), that the baby needs to be given vaccines (OR 1.567, 95% CI 1.047–2.345, p = 0.028), and that the ideal birth weight is > 2.5 kg (OR 2.279, 95% CI 1.617–3.213, p < 0.01). Conclusions for Practice This study provides robust evidence that tailored mobile voice messages can significantly improve infant care practices and maternal knowledge that can positively impact infant child health. Furthermore, this is the first prospective study of a voice-based mHealth intervention to demonstrate a positive impact on infant birth weight, a health outcome of public health importance in many LMICs. [ABSTRACT FROM AUTHOR]

The poor often experience illness and the treatment costs are high and even catastrophic for the poor. This paper reports the extent of illness, treatment‐seeking behaviour and out of pocket healthcare expenditures and the determinants of treatment‐seeking behaviour and healthcare expenditures among the urban poor living in Delhi. A total of 2,998 households participated in the study. Socio‐demographic details, illness experiences (episodic illness in the past 3 months, hospitalisation in the past 1 year and any chronic illness), treatment seeking and healthcare expenditures were collected for all household members through a pretested, interviewer‐administered questionnaire. Logistic regressions were carried out for factors associated with treatment‐seeking choices. Multiple linear regressions were carried for factors associated with out of pocket expenditures (OOPE). Of the total 15,218 household members (of the 2,998 households), 4,052 (26.6%) experienced episodic illness (mainly fever, respiratory illnesses, food‐ and waterborne diseases and eye infections) in the past 3 months, 230 (1.5%) were hospitalised and 976 (6.4%) have chronic illness (mainly hypertension, diabetes, arthritis and respiratory problems). Of the 2,998 households, 2,225 (74.2%) households reported at least one event of illness. Unqualified practitioners were the main source of care for episodic illnesses. Perceived seriousness of the illness, having Employees State Insurance Scheme (ESIS) benefit, higher educational status of the head of the household, higher monthly household incomes, belonging other backward castes and settled‐migrant status led to seeking formal care. Dengue was the main reason for hospitalisation. Government including ESIS hospitals were mainly utilised for hospitalisation. Healthcare expenditures were higher for private healthcare. Possession of mandatory health insurance was protective against OOPEs. OOPEs were more for the men/boys and for the young. Improving access to government healthcare services is important. Extending the ESIS to the unorganised workers including urban poor migrants should be considered so as to bring them under mandatory social protection. [ABSTRACT FROM AUTHOR]

We characterized the impact of a Private-Public Partnership (PPP) on the continuum of HIV care (e.g., treatment initiation, ART effectiveness and loss to follow-up) among adults enrolled at a private hospital/ART link center in the southern state of Karnataka, India from 2007 through 2012. Data on 2326 adults in care were compiled using an electronic database supplemented with medical chart abstraction. Survival methods with staggered entries were used to analyze time to ART initiation and loss to follow-up as well as associated factors. Mixed effects linear regression models were used to assess ART effectiveness. The mean age of adults in care was 36 years; 40% were male. The majority were married, had less than primary education, and less than 45 US dollars (3000 Indian Rupee) monthly income. The mean CD4 at presentation was 527 cells/mm3. The median time from ART eligibility to initiation was 5 and 2 months for before and after the PPP, respectively (p < 0.001). Becoming eligible after PPP was associated with more rapid treatment initiation (Hazard Ratio: [95% Confidence Interval] 1.49 [1.11, 1.99]). Moreover, among the 1639 persons lost to follow-up, more rapid loss was observed before the PPP (12.77 months) vs. after (13.37 months) (p = 0.25) and there was a significant interaction between ART status and calendar time before and after the PPP (p < 0.001). Being on treatment was associated with a lower likelihood of becoming lost before the PPP (HR: [95% CI] 0.33 [0.27, 0.42]), but this association was reversed after the PPP (HR: [95% CI] 1.77 [1.54, 2.04]), p-value for interaction <0.001. Treatment response measured by CD4 was comparable before and after the PPP (p = 0.088). Our findings suggest that PPP models of ART delivery may improve HIV treatment initiation and loss to follow-up without compromising the effectiveness of treatment. Efforts to expand these system-level interventions should be considered with on-going evaluation. [ABSTRACT FROM AUTHOR]

Improving micronutrient intakes of under-nourished mothers in low- and middle-income countries increases birth weight, but there is little data on the nature and timing during gestation of any effects on fetal growth. Ultrasound measures of fetal size were used to determine whether and when a food-based supplement affected fetal growth. Non-pregnant women living in Mumbai slums, India ( N = 6,513), were randomly assigned to receive either a daily micronutrient-rich snack containing green leafy vegetables, fruit, and milk (treatment) or a snack made from lower-micronutrient vegetables (control) in addition to their usual diet from before pregnancy until delivery. From 2,291 pregnancies, the analysis sample comprised 1,677 fetuses (1,335 fetuses of women supplemented for ≥3 months before conception). First-trimester (median: 10 weeks, interquartile range: 9-12 weeks) fetal crown-rump length was measured. Fetal head circumference, biparietal diameter, femur length, and abdominal circumference were measured during the second (19, 19-20 weeks) and third trimesters (29, 28-30 weeks). The intervention had no effect on fetal size or growth at any stage of pregnancy. In the second trimester, there were interactions between parity and allocation group for biparietal diameter ( p = .02) and femur length ( p = .04) with both being smaller among fetuses of primiparous women and larger among those of multiparous women, in the treatment group compared with the controls. Overall, a micronutrient-rich supplement did not increase standard ultrasound measures of fetal size and growth at any stage of pregnancy. Additional ultrasound measures of fetal soft tissues (fat and muscle) may be informative. [ABSTRACT FROM AUTHOR]

Objectives In low-income settings, neonatal mortality rates (NMR) are higher among socioeconomically disadvantaged groups. Institutional deliveries have been shown to be protective against neonatal mortality. In Gujarat, India, the access of disadvantaged women to institutional deliveries has increased. However, the impact of increased institutional delivery on NMR has not been studied here. This paper examined if institutional childbirth is associated with lower NMR among disadvantaged women in Gujarat, India. Methods A community-based prospective cohort of pregnant women was followed in three districts in Gujarat, India (July 2013-November 2014). Two thousand nine hundred and nineteen live births to disadvantaged women (tribal or below poverty line) were included in the study. Data was analyzed using multivariable logistic regression. Results The overall NMR was 25 deaths per 1000 live births. Multivariable analysis showed that institutional childbirth was protective against neonatal mortality only among disadvantaged women with obstetric complications during delivery. Among mothers with obstetric complications during delivery, those who gave birth in a private or public facility had significantly lower odds of having a neonatal death than women delivering at home (AOR 0.07 95% CI 0.01-0.45 and AOR 0.03, 95% CI 0.00-0.33 respectively). Conclusions for Practice Our findings highlight the crucial role of institutional delivery to prevent neonatal deaths among those born to disadvantaged women with complications during delivery in this setting. Efforts to improve disadvantaged women's access to good quality obstetric care must continue in order to further reduce the NMR in Gujarat, India. [ABSTRACT FROM AUTHOR]

We use a representative sample of 2561 children 0–23 months old to identify the factors most significantly associated with child stunting in the state of Maharashtra, India. We find that 22.7% of children were stunted, with one ‐ third (7.4%) of the stunted children severely stunted. Multivariate regression analyses indicate that children born with low birthweight had a 2.5 ‐ fold higher odds of being stunted [odds ratio (OR) 2.49; 95% confidence interval (CI) 1.96–3.27]; children 6–23 months old who were not fed a minimum number of times/day had a 63% higher odds of being stunted (OR 1.63; 95% CI 1.24–2.14); and lower consumption of eggs was associated with a two ‐ fold increased odds of stunting in children 6–23 months old (OR 2.07; 95% CI 1.19–3.61); children whose mother's height was < 145 cm, had two ‐ fold higher odds of being stunted (OR 2.04; 95% CI 1.46–2.81); lastly, children of households without access to improved sanitation had 88% higher odds of being severely stunted (OR 1.88; 95% CI 1.17–3.02). Attained linear growth (height ‐ for ‐ age z ‐ score) was significantly lower in children from households without access to improved sanitation, children of mothers without access to electronic media, without decision making power regarding food or whose height was < 145 cm, children born with a low birthweight and children 6–23 months old who were not fed dairy products, fruits and vegetables. In Maharashtra children's birthweight and feeding practices, women's nutrition and status and household sanitation and poverty are the most significant predictors of stunting and poor linear growth in children under 2 years. Key messagesOne in five (22.7%) of children 0–23 months old in the state of Maharashtra were stunted, and one ‐ third (7.4%) of the stunted children were severely stunted.Birthweight, child feeding, women's nutrition and household sanitation were the most significant predictors of stunting and poor linear growth in children under 2 years.Children born to mothers whose height was below 145 cm, had two ‐ fold higher odds of being stunted; children born with a low birthweight had a 2.5 ‐ fold higher odds of being stunted.Low feeding frequency and low consumption of eggs, dairy products, fruits and vegetables were associated with stunting and poor linear growth in children 6–23 months old.Children of households without access to improved sanitation had 88% higher odds of being severely stunted. [ABSTRACT FROM AUTHOR]

Poor mental health functioning among persons living with HIV (PLHIV) has gained considerable attention particularly in low-income countries that disproportionately carry the global HIV/AIDS burden. Fewer studies, however, have examined the relationship between poverty indicators and mental health among PHLIV in India. Based on this cross-sectional study of 196 HIV-seropositive adults who received medical services at Shalom AIDS Project in Delhi, India, structural equation modeling and mediation analysis were employed to estimate the associations between poverty indices (household asset index, food security, unemployment, water treatment, sanitation), HIV-health factors (illness in the past 3 months, co-morbid medical conditions), and psychological distress. In the final model, ownership of fewer household assets was associated with higher levels of food insecurity, which in turn was associated with higher psychological distress. Also, the household asset index, food insecurity, and unemployment had a larger effect on psychological distress than new opportunistic infections. These findings build on increasing evidence that support concerted efforts to design, evaluate, and refine HIV mental health interventions that are mainstreamed with livelihood programming in high poverty regions in India. [ABSTRACT FROM AUTHOR]

Intakes of micronutrient-rich foods are low among Indian women of reproductive age. We investigated whether consumption of a food-based micronutrient-rich snack increased markers of blood micronutrient concentrations when compared with a control snack. Non-pregnant women (n 222) aged 14–35 years living in a Mumbai slum were randomised to receive a treatment snack (containing green leafy vegetables, dried fruit and whole milk powder), or a control snack containing foods of low micronutrient content such as wheat flour, potato and tapioca. The snacks were consumed under observation 6 d per week for 12 weeks, compliance was recorded, and blood was collected at 0 and 12 weeks. Food-frequency data were collected at both time points. Compliance (defined as the proportion of women who consumed ≥ 3 snacks/week) was >85 % in both groups. We assessed the effects of group allocation on 12-week nutrient concentrations using ANCOVA models with respective 0-week concentrations, BMI, compliance, standard of living, fruit and green leafy vegetable consumption and use of synthetic nutrients as covariates. The treatment snack significantly increased β-carotene concentrations (treatment effect: 47·1 nmol/l, 95 % CI 6·5, 87·7). There was no effect of group allocation on concentrations of ferritin, retinol, ascorbate, folate or vitamin B12. The present study shows that locally sourced foods can be made into acceptable snacks that may increase serum β-carotene concentrations among women of reproductive age. However, no increase in circulating concentrations of the other nutrients measured was observed. [ABSTRACT FROM PUBLISHER]

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined. [ABSTRACT FROM AUTHOR]

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]

Increasing rates of school enrolment have changed childhoods in the global South, so that it is now the norm for children to attend at least some years of primary school. This paper explores the extent to which valuing of children as educational projects and outcomes may be displacing previous valuations of children as contributors to the domestic economy. The paper draws on qualitative interview data from Young Lives, a longitudinal study of children growing up in four developing countries, using a case study approach to explore the experiences of four children in rural Andhra Pradesh, India. The paper suggests that children are balancing expectations for the future with responsibilities to their families in the present, and concludes that the over-valuing of formal qualifications and the under-valuing of forms of work such as agriculture risk being internalised by children, leaving those who do not succeed feeling they are 'a waste'. [ABSTRACT FROM AUTHOR]

Introduction: The Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress. However, scant evidence exists about the distribution of child mortality at low sub-national levels, which in diverse and decentralized countries like India are required to inform policy-making. This study estimates changes in child mortality across a range of markers of inequalities in Orissa and Madhya Pradesh, two of India's largest, poorest, and most disadvantaged states. Methods: Estimates of under-five and neonatal mortality rates were computed using seven datasets from three available sources - sample registration system, summary birth histories in surveys, and complete birth histories. Inequalities were gauged by comparison of mortality rates within four sub-state populations defined by the following characteristics: rural-urban location, ethnicity, wealth, and district. Results: Trend estimates suggest that progress has been made in mortality rates at the state levels. However, reduction rates have been modest, particularly for neonatal mortality. Different mortality rates are observed across all the equity markers, although there is a pattern of convergence between rural and urban areas, largely due to inadequate progress in urban settings. Inter-district disparities and differences between socioeconomic groups are also evident. Conclusions: Although child mortality rates continue to decline at the national level, our evidence shows that considerable disparities persist. While progress in reducing under-five and neonatal mortality rates in urban areas appears to be levelling off, polices targeting rural populations and scheduled caste and tribe groups appear to have achieved some success in reducing mortality differentials. The results of this study thus add weight to recent government initiatives targeting these groups. Equitable progress, particularly for neonatal mortality, requires continuing efforts to strengthen health systems and overcome barriers to identify and reach vulnerable groups. [ABSTRACT FROM AUTHOR]

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

This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents’ formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes. [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]

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

This study considers care-seeking patterns for maternal morbidity in Mumbai's slums. Our objectives were to document women's self-reported symptoms and care-seeking, and to quantify their choice of health provider, care-seeking delays and referrals between providers. The hypothesis that care-seeking sites for maternal morbidity mirror those used for antenatal care was also tested. We analysed data for 10,754 births in 48 slum areas and interviewed mothers about their illnesses and care-seeking during pregnancy. Institutional care-seeking was high across the board (>80%), and higher for ‘trigger’ symptoms suggestive of complications (>88%). Private-sector care was preferred, and increased with socio-economic status, although public providers also played an important role. Most women sought treatment at the same site they received their antenatal care, most were treated within 2 days, and less than 2% were referred to other providers. Our findings suggest that poor women in Mumbai recognise symptoms of obstetric complications and the need for health care. However, that more than 80% also sought care for minor conditions implies that the tendency to seek institutional care for serious conditions reflects a broader picture of care-seeking for all illnesses. The role of private health-care providers needs greater recognition, and further research is required on provider motivations and behaviour. [ABSTRACT FROM AUTHOR]