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Background: Reproductive span is the foundation of every woman's health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context. Methods: Secondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019–2021. A total of 671,967 women aged 15–49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives. Results: Currently, 6.3% of total study participant's reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India. Conclusion: To reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet. [ABSTRACT FROM AUTHOR]

Background: Globally by 2030, 38% of the world's population would be overweight, and another 20% would be obese. This has led to rising concerns regarding how swiftly and substantially the world is moving towards this epidemic of "globesity". India too is facing an increased burden of overweight and obese population. The changing dietary patterns are significantly associated with the increasing prevalence of overweight/obesity and related complications, especially among women. Hence, the present study aims to observe the spatial patterns of overweight or obesity among women in reproductive age group in India and factors associated with it. Methods: The study analyzed data from a cross-sectional nationwide household survey, i.e. National Family Health Survey (NFHS-4), 2015–16. The primary outcome variable of this study was overweight/obesity among reproductive-age women, which was measured through the body mass index (BMI) of the women. Bivariate and multivariate logistic regression analysis was used to analyze the data. Additionally, for spatial analysis in terms of overweight/obesity among women in India, univariate and bivariate Moran's I index measurements were used along with the usage of spatial regression models. Results: The value of spatial-autocorrelation for overweight or obese was 0.64, which depicts the moderately high prevalence of the overweight/obesity coverage over districts of India. The overall prevalence overweight/obesity among women in India is around 25% and higher proportion of women from urban areas (37.8%), and non-poor (33.4%) economic group reported to be overweight or obese. From spatial lag model, the lag coefficient was found to be 0.28, implying that a change in the prevalence of overweight/obesity among women in a certain district may statistically lag the prevalence of overweight/obesity by 28% in the neighbouring districts. There were significantly high clustering of overweight/obese women and non-poor wealth quintiles in 132 districts, mainly from states of Punjab, Haryana, Gujarat, Maharashtra, Kerala, Tamil Nadu, Karnataka and Andhra Pradesh. Additionally, there was high-high clustering of overweight/obese women and those who ever had caesarean in 82 districts, mostly from Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. Conclusion: The spatial patterns on the prevalence of overweight and obesity in India show that the women belonging to the southern states' districts are more overweight or obese in comparison to other states. The determinants like older age, higher education, urban residence, higher economic status are the key factors contributing to the prevalence of overweight or obesity among women in the reproductive age group. The study concludes and recommends an urgent need of interventions catering to urban women belonging to higher socio-economic status, to reduce the risks of health consequences due to overweight and obesity. [ABSTRACT FROM AUTHOR]

Background: Despite unprecedented socio-economic growth experienced by Indians in the past few decades, and a long history of anti-anaemia public health measures, prevalence of anaemia in Indian non-pregnant women of reproductive age group (NPWRA) has not declined. This warrants a firm understanding of what explains the anaemia situation over time, preferably by sub-populations. Therefore, we aimed to examine the trends of anaemia in tribal NPWRA (least privileged) and compare with the trends in the NPWRA of general caste (most privileged) between 1998 to 2021. Additionally, the study also explored explanation of any decline and tribal/general narrowing of these trends. Methods: We studied four rounds of National Family Health Survey (1998–99, 2005–06, 2015–16, 2019–21). We examined the trend of anaemia (haemoglobin < 12 g/dl) and its possible determinants in tribal and general NPWRA and estimated the portion of "decline" and "narrowing" that could be explained by the underlying and intermediate determinants (wealth, education, residence, parity and food security) using multiple logistic regression. Results: The distribution of determinants improved over 23 years in both the groups but more in tribals. But anaemia either remained unchanged or increased in both except 7.1 points decline in tribals between 2006–2016, leading also to 7 points narrowing of tribal/general gap. The modest attenuation of beta coefficients representing the change of anaemia prevalence (log of odds) in tribals from -0.314(-0.377, -0.251) to -0.242(-0.308, -0.176) after adjustment with determinants could explain only 23% of the decline. Similarly, only 7% of the narrowing of the tribal/general anaemia gap could be explained. Conclusions: The structural determinants wealth, education, food security, parity and urban amenities improved immensely in India but anaemia did not decline in this 23-year period. This implies that the "usual suspects" – the structural determinants are not the main drivers of anaemia in the country. The main driver may be absolute and/or functional deficiency status of micronutrients including iron attributable to inadequate uptake and absorption of these elements from Indian diets; and therefore, their effects are noticeable in every socio-economic stratum of India. Future research for aetiologies and new interventions for anaemia alleviation in India may focus on these factors. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Clinical biochemistry reference intervals (RIs) play a crucial role in interpreting patient test results and making informed clinical decisions. Using data from an ongoing Indian Council of Medical Research-National task force study on healthy women, normative ranges for commonly analyzed biochemical analytes were established. MATERIALS AND METHODS: A total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9898 women signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and comorbidities were excluded. RIs of 22 analytes were computed in the remaining 938 women controls. To estimate the 95% range of the reference distribution, the limits of the 2.5th percentile and the 97.5th percentile were used in the study. RESULTS: Mean ± standard deviation of age and body mass index of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m2 respectively. Centiles (2.5th-97.5th) of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters are presented. No significant difference in analytes was observed in relation to the area of residence, and age groups except in albumin (P = 0.03). The distribution of most of the parameters was consistent with the various RI studies conducted in India as well as other countries. CONCLUSION: This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive-age women recruited using a robust design across the country. The resource may serve as a reference range for common biochemical analytes for future in this age group. [ABSTRACT FROM AUTHOR]

Background: The common cause of anemia in the general population is iron deficiency. Anemia is adversely affecting women of reproductive age and child health which in turn results in increased morbidity and maternal death, and also hamper social-economic growth. Reproductive women are more prone to anemia due to inadequate dietary intake and iron loss during menstruation and pregnancy. Objectives: This study examined the level and trend of anemia prevalence among the socially disadvantaged group (SC&ST, OBC) of women as compared to the other women (general) and identified the main responsible factors behind this. Data and methods: The data for this analysis has been taken from three rounds of National Family Health Survey (NFHS) conducted during 2005–2006 (NFHS 3), 2015–16 (NFHS 4) and 2019–21 (NFHS 5). Univariate and bivariate analyses were used to assess the level of anemia among reproductive age group women of different social groups. The regression model represents the relative risk of different confounding factors on the occurrence of anemia. GIS technique used for graphical representation of anemia prevalence rate among different social groups of women in different states of India. Result: In India more than 15 states belong to the high prevalence (>%55) of anemia among socially backward groups in 2019–21. The anemia prevalence was high (>55%) in all social groups (SC & ST, OBC, general) observed in 7 states in NFHS-3, 4 in NFHS-4 and 11 states in NFHS-5. The overall result reveals that the SC&ST women were more prone to any anemia than OBC and general women and the prevalence rate slightly increased from 2005–06 to 2019–21. Among all variables, economic status dominantly controls the anemia level in all social groups. Anemia prevalence of the poor and poorest group of general women were much worse than the women of richer and richest groups of SC&ST, OBC. The odds of women having anemia were lower among higher educated and urban women as compared to the non educated and rural women, irrespective of social group. The prevalence of anemia decreases with increased age of women and increases with the number of child bearing. All differences were statistically significant. Conclusions: The problem of iron deficiency remains a major issue in India, where the majority of the states (eastern, north-eastern and central) suffer from high anemia prevalence rate and it increases over time. It is observed that multiple socio-demographic factors ranging from poor economic and educational status, rural residence to higher childbearing of women are responsible for predicting anemia levels among the social groups of women in India. To eradicate this problem India should improve women's overall nutrition status and their income. Meanwhile, GOI should be more focused on the existing policies related to anemia and on their actual implementation on grassroots level. [ABSTRACT FROM AUTHOR]

Background: In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. Methods: A full sample of 707,119 women aged 15–49 and a sub-sample of 357,353 women aged 30–49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15–49 and women aged 30–49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. Results: The proportion of breast and cervical cancer screening among women aged 30–49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30–49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31–1.62], aged 40–49 years [OR:1.35; 95% CI: 1.28–1.43], resided in the western [OR:1.62; 95% CI:1.4–1.87] or southern [OR:6.66; 95% CI:5.93–7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15–49 was similar to that of women 30–49. Conclusion: The overall proportion of cancer screening among women in 30–49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India. [ABSTRACT FROM AUTHOR]

Background: In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. Methods: A full sample of 707,119 women aged 15–49 and a sub-sample of 357,353 women aged 30–49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15–49 and women aged 30–49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. Results: The proportion of breast and cervical cancer screening among women aged 30–49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30–49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31–1.62], aged 40–49 years [OR:1.35; 95% CI: 1.28–1.43], resided in the western [OR:1.62; 95% CI:1.4–1.87] or southern [OR:6.66; 95% CI:5.93–7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15–49 was similar to that of women 30–49. Conclusion: The overall proportion of cancer screening among women in 30–49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India. [ABSTRACT FROM AUTHOR]

Background: Hypertension in women of reproductive age group is of special concern because of the vulnerability of women to pregnancy-induced hypertension apart from socio-cultural vulnerability. Aim: The objective of the study was to identify the predictors for hypertension among Indian women and to develop a risk score which would provide an opportunity for early detection and appropriate action. Material and Methods: This study was based on the data collected in National Family Health Survey in 2015–2016. Women in India of 15–49 years were the study population. Data were analysed using SPSS v17. Logistic regression analysis was carried and expressed as odds ratio with 95% confidence intervals to identify predictors of hypertension. The risk score for hypertension was developed after shrinkage of variables and by using regression coefficients obtained by standard Logistic Regression Model. Results: Among 6,87,230 women between 15 and 49 years, 77,788 (11.3%) were hypertensive. The study results revealed that there was an increasing trend in the prevalence of hypertension (26.5%) with increasing age, and with increasing weight (23.4%). Urban areas (12.3% vs 10.9%), alcoholics (19.2%) and various forms of tobacco users (14.8%) had more prevalence of hypertension. Conclusion: Age, residing in urban area, consuming tobacco products, consumption of alcohol, non-vegetarian diet and overweight, were found to be the significant predictor variables, and were used to develop the Risk Prediction score using logistic regression model. [ABSTRACT FROM AUTHOR]

The early detection of anaemia is important for its subsequent control and incidence among women of childbearing age. This study aimed to assess the anaemia status of preconception young married women in India using National Family Health Survey-4 data collected in 2015–16. A total 65,238 sample preconception young married women were analysed using univariate, bivariate and multivariate techniques. A majority belonged to the Hindu religion (81.7%), lived in rural areas (64.5%) and had secondary level education (51.8%), and 41.7% had not yet given birth. The percentage suffering from anaemia was 51.3%. The prevalence of anaemia was higher among younger women (55.3%), those from Scheduled Tribes (59.0%), those living in rural areas (52.8%), the non-educated (55.9%), those in the poorest wealth quintile (56.9%), those from the East region (57.0%) and those with a low body mass index (BMI) (58.4%). The adjusted odds ratios indicated that, after controlling for significant background factors, Hindu, Scheduled Tribe, Scheduled Caste, East region, already having a child, too thin for their height and poorer and poorest wealth quintiles had higher odds of suffering from anaemia compared with the reference groups. The odds of suffering from anaemia decreased with age and education. The study showed a high burden of anaemia and associated risk factors among preconception young married women in India. The finding will inform decision-makers when planning interventions to decrease anaemia among women of childbearing age in India. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20-35) women in India.Methods: We used the India National Family Health Survey (NFHS-4) 2015-2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20-35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.Results: We found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01-1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14-1.42) and with no education (1.22, 95% CI: 1.10-1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57-2.29) or obese (2.82, 95% CI: 1.88-4.24).Conclusions: Our findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India. [ABSTRACT FROM AUTHOR]

Objectives: Clinical biochemistry reference intervals (RIs) are essential benchmarks to interpret patient test results and make clinical decisions. In this study, data on healthy women collected in an ongoing ICMR-National task force study was used to establish normative ranges for common biochemical analytes. Methods: A total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9,898 women who signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and with comorbidities were excluded. RIs of 22 analytes were computed in remaining 938 women controls. The 95% of the reference distribution was estimated using 2.5th percentile and 97.5th percentile limits. Results: The mean ± SD of age and body mass index (BMI) of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m2 respectively. The median and 2.5th -97.5th percentiles of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters were computed. No significant difference in analytes were observed in relation to the area of residence, and age groups except in albumin (p = 0.03). The distributions for most of the parameters were consistent with the various reference interval studies conducted in India as well as other countries. Conclusion: This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive age women recruited using a robust design across the country. The resource may serve as reference range for common biochemical analytes for future in this age group. [ABSTRACT FROM AUTHOR]

Background: Seroprevalence and incidence of toxoplasmosis in women of child bearing age has remained a contentious issue in the Indian subcontinent. Different laboratories have used different patient recruitment criteria, methods and variable results, making these data difficult to compare. Aim: To map the point-prevalence and incidence of toxoplasmosis in India. Material and Methods: In this cross-sectional study, a total of 1464 women of fertile age were recruited from 4 regions using similar recruitment plans. This included women from northern (203), southern (512), eastern (250) and western (501) regions of India. All samples were transported to a central laboratory in Delhi and tested using VIDAS technology. Their age, parity, eating habits and other demographic and clinical details were noted. Results: Most women were in the 18–25 years age group (48.3%), followed by 26–30 years (28.2%) and 31–35 years (13.66). Few (45) women older than 35 yr. were included. Overall prevalence of anti-Toxoplasma IgG antibodies was seen in 22.40%, with significantly more in married women (25.8%) as compared to single women (4.3%). Prevalence increased steadily with age: 18.1% in the 18–25 yr. age group to 40.5% in women older than 40 yr. The prevalence was high (66%) in those who resided in mud houses. Region-wise, the highest prevalence was observed in South India (37.3%) and the lowest (8.8%) in West Indian women. This difference was highly significant (P<0.001). Prevalence was 21.2% in East India and 19.7% in North India. The IgM positivity rate ranged from 0.4% to 2.9% in four study centers. Conclusions: This pan-India study shows a prevalence rate of 22.4% with a wide variation in four geographical regions ranging from as low as 8.8% to as high as 37.3%. The overall IgM positivity rate was 1.43%, indicating that an estimated 56,737–176,882 children per year are born in India with a possible risk of congenital toxoplasmosis. Author Summary: Toxoplasmosis is a protozoan parasitic disease commonly transmitted and propagated by cats as family pets. Infection acquired during pregnancy can lead to congenital abnormalities in the fetus, still birth or intrauterine death. Seroprevalence and incidence of toxoplasmosis in Indian women of child bearing age has remained a contentious issue. Different laboratories have used different patient recruitment criteria, methods and variable results, making these data unreliable. There is no published pan-India seroprevalence study. Hence, a seroprevalence study was undertaken comprising 1464 women of reproductive age representing four distinct geographical regions of India. This resulted in an estimated prevalence of 22.4% (328); the highest prevalence being in South India (37.3%) followed by East India (21.2%) and North India (19.7%). West Indian women had the lowest seroprevalence (8.8%). This difference was highly significant. In our analysis we determined the possible risk-factors of infection in these women. These included lower socioeconomic status, residing in mud plastered houses, consumption of raw salad, drinking untreated water, owning pets and advanced age. Overall, the incidence rate of toxoplasmosis was 1.43%. Extrapolating the data, we estimate that between 56,737 and 176,882 children a year may be born in India with a possible risk of congenital toxoplasmosis, which can manifest itself in-utero or several years after birth. [ABSTRACT FROM AUTHOR]