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Background: The Central Government of India introduced the National Health Mission (NHM) in 2005 to improve health outcomes by enhancing publicly financed (government) health expenditure and health infrastructure at the state level. This study aims to examine the effects of the state-level heterogeneity in publicly financed spending on health services on major health outcomes such as life expectancy, infant mortality rate, child mortality rate, the incidence of malaria, and immunization coverage (i.e., BCG, Polio, Measles, and Tetanus). Methods: This study investigates the relationships between publicly financed health expenditure and health outcomes by controlling income and infrastructure levels across 28 Indian States from 2005 to 2016. Along with all states, the empirical analysis has also been carried out for high-focus and non-high-focus states as per the NHM fund flow criteria. It has applied panel fixed-effects and random effects model wherever required based on the Hausman test. Results: The empirical results show that publicly financed health expenditure reduces infant mortality, child mortality, and malaria cases. At the same time, it improves life expectancy and immunization coverage in India. It also finds that the relationship between publicly financed health expenditure and health outcomes is weak, especially in the high-focus states. Conclusions: Given the healthcare need for achieving desirable health outcomes, Indian States should enhance publicly financed expenditure on health services. This study augments essential guidance for implementing public health policies in developing countries. [ABSTRACT FROM AUTHOR]

This study aimed to assess the association between work participation and various health outcomes in older community-dwelling adults in India. The cross-sectional sample consisted of 14,342 male and 8342 female participants (≥60 years) from the Longitudinal Aging Study in India (LASI) Wave 1 in 2017–2018. Among older men (≥60 years) who had ever been working, 45.5% and among older women (≥60 years), 35.7% were working. In adjusted Poisson, linear or logistic regression analyses, work participation was among both men and women associated with better self-rated health status, lower prevalence of insomnia symptoms, lower prevalence of heart disease or stroke, lower prevalence of diabetes, lower functional limitations, lower physical inactivity, and higher heavy episodic drinking. In addition, among men, work participation was associated with current tobacco use, and among women, work participation was associated with higher cognitive functioning, and lower prevalence of depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: The social capital theory is increasingly being looked at as a valuable paradigm to understand if community socioeconomic factors influence health behaviours and outcomes. This requires an understanding of the forms in which social capital manifests and the levels at which it operates. Design/methodology/approach: Thus, the purpose of this paper is to study if social capital is associated with health outcomes among older adults in India and providing an estimate of the extent to which the neighbourhood differences in health outcomes among the older adults can be attributed to social capital. Findings: The authors find several forms of social capital to be associated with health outcomes among older adults. The results show that community-level social capital variables collectively explain 12.81% unexplained neighbourhood variation in self-rated health, 2.5% variation in psychological well-being and 11.32% variation in the ability to perform activities of daily living, respectively. Originality/value: The findings highlight the role social capital plays in serving as a coping mechanism for older adults to survive deteriorating health and social exclusion and call for conscious investment in building social capital. [ABSTRACT FROM AUTHOR]

Background: Antenatal care is pivotal for maternal and child health, with husband involvement enhancing its efficacy. This study conducted in Mangalore, India, aimed to evaluate husbands' knowledge and engagement in antenatal care, aligning with Sustainable Development Goals (SDGs) for human health and well-being. Objectives: The study aimed to assess husbands' understanding of and involvement in supporting their wives during pregnancy. Methodology: A cross-sectional study surveyed 150 husbands using a semi-structured questionnaire, collecting data on personal details, antenatal care knowledge, and involvement in their wives' pregnancy care. Descriptive statistics and Chi-Square tests were employed for analysis. Results: The majority of husbands exhibited sufficient knowledge of antenatal care, particularly regarding identifying danger signs. However, levels of active involvement varied due to socio-cultural factors and work commitments. While many accompanied their wives to appointments and participated in decision-making, some faced barriers such as work obligations. Conclusion: Enhancing husband involvement is essential for achieving SDG targets in maternal health. Tailored interventions addressing socio-cultural barriers can empower husbands to play a more active role in supporting maternal well-being. By fostering inclusive healthcare practices, we can improve health outcomes for mothers, infants, and communities at large. [ABSTRACT FROM AUTHOR]

Financing is an important aspect of any program for successful transformation. Financial commitment of government is considered to be the highest form of commitment for successful work. Without budgetary provision, no program can achieve the desired target. The role of health financing of central government, international donor agencies, provincial government, and local bodies have been identified. The paper focused on monitoring and evaluation mechanisms for health financing in the context of recent developments. Health financing models have been discussed to gain an understanding about relation of financing and overall healthcare development. The search engines like PubMed, Scopus, Web of Sciences, and jstor (journal storage) were consulted to unearth the mechanism of health finances for development of good health. The paper put forth various themes and sub-themes according to financial implications on health structure of India. All healthcare programs need a continuous stream of resources like medicine, workforce, physical infrastructure, monitoring, and evaluation to achieve good health. Whereas, different stakeholders also need financial support to evolve with great vigour and vivacity. There is a pressing need to infuse financial resources into public health system for achievement of universal health care rather than incremental growth in traditional financial processes spreading over several decades. The specific roles and responsibilities of central, provincial, local governments, and international donors have to be delineated to expedite resource mobilisation. However, while implementing programs, there should be coordination among all the stakeholders. [ABSTRACT FROM AUTHOR]

Background: Insomnia continues to be neglected globally, despite its high prevalence. Guidelines by the health regulatory agencies call for studies to evaluate the effect of sedative-hypnotics on sleep quality.Methods: We conducted a pre-post observational study to evaluate sleep quality among 186 inpatients receiving short-term oral sedative-hypnotic therapy in a tertiary care teaching hospital in Kozhikode (Kerala), India. Using Pittsburgh Sleep Quality Index_Past-Week (PSQI_PW) questionnaire, patients were interviewed upon hospital admission and at follow up after ≥1-week of sedative-hypnotic therapy. Additionally, we interviewed 36 physicians to understand the current clinical perception about sedative-hypnotics.Results: Mean (SD) age of the study patients was 59 (7.5) years. Majority (63.4%) of the patients were men. Of the various primary diagnoses for hospitalization, cardiovascular disease was the most common (22.6%, n = 49). Sedative-hypnotic therapy improved the mean (SD) PSQI_PW overall score by 6.79 points (pre: 12.70 (3.5) vs. post: 5.91 (2.8); p < 0.0001). Statistically significant improvements in sleep duration, latency, efficacy, and day dysfunction were observed. Higher proportion of study patients were prescribed benzodiazepines (73.7%) compared to zolpidem (26.3%). Patients treated with zolpidem reported higher improvements in mean overall PSQI_PW scores compared to those treated with benzodiazepines, however these differences were not statistically significant upon adjusting for age, gender and primary diagnosis for hospitalization. Qualitative interviews indicate that that physicians consider zolpidem to be safer and more efficacious.Conclusions: In our study, sedative-hypnotic therapy helped improve sleep quality among the hospitalized patients. More studies evaluating the comparative efficacy and safety of zolpidem vs. benzodiazepines - including among patient groups with varying demographic and clinical characteristics - are needed. India must develop evidence-based treatment guidelines to inform the clinical practice around the use of sedative-hypnotics. [ABSTRACT FROM AUTHOR]

With the free availability of antiretroviral therapy in India, one expects that the out-of-pocket (OOP) expenditure would reduce and would not be a significant financial burden. However, the cost of seeking care is also dependent on accessibility of services, as well as other non-medical and indirect expenses. This study aims to analyze the OOP expenditure in availing antiretroviral therapy (ART) services and determine the prevalence and pattern of catastrophic and impoverishing health expenditure. The study also discusses the policy implications of these findings in the light of growing commitment toward universal health coverage. This was a cross-sectional study. A total of 434 patients receiving antiretroviral treatment were interviewed. OOP expenses included a measure of direct medical expenditure, non-medical expenditure, and indirect expenditure incurred in availing ART services. A threshold level of 40% of 'capacity to pay' was taken as catastrophic expenditure. Based on previous research, different demographic, socio-economic, and clinical factors were selected as independent variables to determine their association with catastrophic expenditure. Logistic regression was conducted to study the association between independent and dependent variables keeping the level of significance at <0.05. The mean OOP expenditure among patients with human immunodeficiency virus (HIV) taking ART was Rs. 238.8 ± 193.7. Majority of these expenses were incurred on non-medical expenditure (58.1%), while indirect expenditure accounted for 29.7%. The direct health expenditure was the lowest (12.2%) type of expenditure in the total OOP expenditure. OOP spending was catastrophic in 8.1% (35/434) of households in our study. Patients belonging to nuclear family (odds ratio [OR] = 2.99; 95% confidence interval [CI] = 1.19–7.58), who are unemployed (OR = 2.56; 95% CI = 1.18–5.54), of lower socio-economic classes (OR = 8.46; 95% CI = 1.93–37.02), those who traveled more than 50 km for getting drugs (OR = 2.80; 95% CI = 1.26–6.23), and those having CD4 cell count lower than 200 (OR = 3.11; 95% CI = 1.32–7.32) were found to be independently and significantly associated with catastrophic OOP health expenditure among patients with HIV. A high direct and indirect expenditure was observed among patients with HIV seeking treatment in North India leading to catastrophic expenditure in a significant number of households. A service-level integration of HIV care at subdistrict levels within the Universal health coverage (UHC) framework could reduce catastrophic expenditure. • Antiretroviral therapy (ART) is given free to patients with HIV/AIDS, but the compounding costs incurred because of non-medical and indirect expenses are high. • The high out-of-pocket (OOP) expenditure was found to be catastrophic in 8.1% of the households availing ART services. • Households of about two-fifth of patients availing ART services were pushed below or further below the prevailing poverty line in India, including creation of one-tenth new poor households. • Catastrophic expenditure was associated with unemployment, longer distance to treatment centre and higher disease severity. • Service-level integration of HIV care within the UHC framework could be beneficial in reducing OOP expenditure. [ABSTRACT FROM AUTHOR]

The health performance of Gujarat viewed in terms of the Human Development Index (HDI) portrays it as a medium performer in the country. However, the index of health component for Gujarat is found to be positively contributing to the HDI ranking of the state. It is, therefore, crucial to review the status of health performance of Gujarat among the other states for improving its relative standing in human development. In this context, the present article attempts to identify the gaps in performance of the health-related outcome, output and input indicators from the best performers in each indicator. Moreover, the article also reviews the trends in health performance of Gujarat over time and also estimates the effectiveness of the state in converting its health inputs to outputs and outputs to outcomes. The results indicate that the outcome indicators have improved in the absolute sense but have high performance gaps except the maternal mortality rate (MMR). Majority of the output and input indicators, however, show poor absolute performance and high performance gaps that have been expanding over time. The effectiveness of conversion of health indicators in Gujarat suggests that while the state has moved above average in conversion of outputs to outcomes, it has moved at a slightly below-average level in converting its inputs to outputs over time. Improving the health status of Gujarat requires targeted efforts in specific areas such as controlling neonatal deaths, improving coverage of children under immunization and addressing malnourishment. Additionally, building adequate health infrastructure and employing the required manpower are also relevant. [ABSTRACT FROM AUTHOR]

Background: Research on the natural history and long-term outcomes of alcohol use disorders (AUD) is important to guide health policy. However, attrition is a major challenge in longitudinal studies and can affect validity of findings. Materials and Methods: A 4-year follow-up study was conducted on a randomly selected subgroup of a sample of men in rural and urban communities in Goa to assess attrition, preliminary estimates of AUD outcomes, and chronic disease risk factors. Results: Overall attrition rate was 16.7% with a higher attrition in AUD compared to abstainers or casual drinkers. Incidence of AUD at 4 years was 12.8% while the persistence rate of AUD was 53.9%. A trend for poorer health and health behaviors and higher blood pressure was observed in AUD. Conclusion: The results of this study suggest a relatively low attrition rate despite the long follow-up period and support the feasibility of conducting a definitive cohort study with the entire sample. [ABSTRACT FROM AUTHOR]

In this paper we explore how India's growing commercial health insurance (CHI) segment can be reformed to deliver adequate financial protection and good health outcomes. We lay out key issues in the demand- and supply-sides of the insurance market that need to be addressed for CHI to be more aligned toward universal health coverage (UHC). On the demand side, we identify a consumer who strays far from the rational actor paradigm and therefore one whose needs require a fundamentally different approach than the one that commercial health insurance in India has so far taken. We lay out precisely the different stages involved in bringing a consumer to the insurance market and the conditions under which that consumer is likely to purchase insurance. On the supply side, we describe the many concerns that a new entrant into the commercial health insurance market must grapple with. We conclude with a set of pathways that brings the two sides of the market together to shed light on possible pathways for reform in the commercial health insurance sector in India. Despite the many challenges that this sector faces in India, we believe that there is room for optimism, and with the right amount of regulatory foresight, even room for radical transformation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ashraf, Ghosh, Kumar, Nambiar and Prasad.)

Environmental pollution in the era of sustained economic development is an inevitable occurrence. However, the rising levels of pollutant emissions hamper air quality, hence, affecting health outcomes. Previous studies have assessed the case-by-case effect of ambient air pollution on mortality and morbidity, however, the impact on disability-adjusted life years (DALYs) and welfare cost have not been investigated entirely. Here, we conduct an empirical analysis of the 28-Year trend to analyze the nexus between ambient particulate matter and ozone, mortality, DALYs, and welfare cost across 195 countries and territories by employing novel dynamic panel estimation methods. We find that none of the 195 countries and territories studied between 1990 and 2017 meet WHO guideline for air quality, thus, mitigating ambient air pollution is at risk. However, Spain with an annual average of PM 2.5 not exceeding 15.12 μg/m 3 is closer to WHO guideline of 10 μg/m 3 /annum. Among the countries (China, the US, Russia, India, Germany and Japan) with the highest welfare cost of premature death associated with the exposure to outdoor PM 2.5 and ozone, China is the most vulnerable to economic burden - spending US$1.58 trillion (constant 2010) in 2017. This study demonstrates that ambient air pollution has a significant impact on economic development (welfare cost) and health outcomes (mortality, premature deaths, and DALYs)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: The present study delves into the health inequalities between the two most socially deprived groups namely Scheduled Tribes (STs) and Scheduled Castes (SCs) in rural India., Design/methodology/approach: This study used health-specific three rounds of National Sample Survey Office (NSSO) unit-level data for analyses. Probit model has been used to predict the differences in access to maternal healthcare services. Blinder-Oaxaca decomposition method is used to explore the inequality in health of rural population in India and assess the estimated relative contribution of socioeconomic and demographic factors to inequalities in maternal health., Findings: The study establishes that STs women often perform poorly compared to SCs in terms of maternal health such as antenatal care, postnatal care and institutional delivery. Blinder-Oaxaca decomposition method shows that there exist health inequalities between STs and SCs women. Difference in household income contributes 21-34 percent and women's education 19-24 percent in the gap of utilization of maternal healthcare services between SCs and STs women. A substantial part of this difference is contributed by availability of water at home and geographical region. Finally, the study offers some policy suggestions in order to mitigate the health inequalities among socially marginalized groups of SCs and STs women in rural areas., Originality/value: This study measures and explains inequalities in maternal health variables such as antenatal care, postnatal care and institutional delivery in rural India. Research on access to maternal healthcare facilities is needed to improve the health of deprived sections such as STs and SCs in India. The results of this study pinpoint the need for public health decision-makers in India to concentrate on the most deprived and vulnerable sections of the society. This study thus makes a detailed and tangible contribution to the current knowledge of health inequalities between the two most deprived social groups, i.e., SCs and STs., (© Emerald Publishing Limited.)

We use randomized roommate assignment in dormitories in a college in Kolkata in India to examine peer effects in weight gains among roommates. We use administrative data on weight, height, and test scores of students at the time of college admission and then survey these students at the end of their first and second years in college. We do not find any significant roommate specific peer effect in weight gain. Our results rather suggest that an obese roommate reduces the probability that the other roommates become obese in subsequent years. We examine potential mechanism using survey data on students' eating habits, smoking, exercise, and sleeping patterns. We find that obese roommates sleep longer, which in turn improves the sleep pattern of others, which might explain the weak negative effect of obese roommates on the weight of others in the same room., (© 2019 John Wiley & Sons, Ltd.)

Objectives: To simulate the long-term health outcomes of canagliflozin 100 mg versus glimepiride over 20 years in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin from the perspective of the Indian health care system., Methods: Health outcomes were simulated using the validated Economic and Health Outcomes Model of T2DM. Patient demographic characteristics, biomarker values, and treatment effects were sourced from a subgroup of Indian patients enrolled in a 52-week, head-to-head study of canagliflozin versus glimepiride (mean maximum dose of 5.6 mg/d) in patients with T2DM inadequately controlled with metformin. Outcomes were discounted at 5%. Sensitivity analyses were conducted using alternative values for key model inputs., Results: Relative to glimepiride, treatment with canagliflozin 100 mg was associated with approximately 14 more patients surviving at year 20 per 1,000 patients treated and 0.43 quality-adjusted life-years gained, largely because of improved body weight and reduced risk of macrovascular and microvascular morbidity over 20 years. Risk reductions were the largest for microvascular complications (e.g., chronic kidney disease and albuminuria). Improved health outcomes were driven by better glycated hemoglobin control associated with canagliflozin versus glimepiride, which also delayed the need for rescue therapy. Key components of quality-adjusted life-year gains included the avoidance of hypoglycemic episodes, chronic kidney disease, and weight gain, as well as increased survival with canagliflozin compared with glimepiride., Conclusions: Simulation results suggest that canagliflozin 100 mg may provide better long-term health outcomes compared with glimepiride in Indian patients with T2DM inadequately controlled with metformin., (Copyright © 2018 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) ( N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

Background: Health literacy is a term employed to assess the ability of people to meet the increasing demands related to health in a rapidly evolving society. Low health literacy can affect the social determinants of health, health outcomes and the use of healthcare services. The purpose of the study was to develop a survey construct to assess health literacy within the context of regional culture. Different socioeconomic status among the Eastern and Middle Eastern countries may restrict, health information access and utilization for those with low literacy., Methods: By employing expert panel, Delphi technique, focus group methodologies, and pre-testing using participants (N = 900) from the UAE and India, a survey construct to the Eastern-Middle Eastern cultures was developed. Reliability was assessed using Cronbach's α and validity using Factor analysis. Kiaser-Meyer-Olkin (KMO) sampling adequacy and Bartlett's tests were used to assess the strength of the relationship among the variables., Results: Inclusion of non-health related items were found to be critical in the authentic assessment of health literacy in the Eastern and Middle Eastern population given the influence of social desirability. Thirty-two percentage of the original 19-item construct was eliminated by the focus group for reasons of relevance and impact for the local culture. Field pretesting participants from two countries, indicated overall construct reliability (Cronbach's α =0.85), validity and consistency (KMO value of 0.92 and Bartlett's test of sphericity was significant)., Conclusion: The Eastern-Middle Eastern Adult Health Literacy (EMAHL13), screening instrument is brief, simple, a useful indicator of whether or not a patient can read. It assessespatients' ability to comprehend by distinguishing between health and non-health related items. The EMAHL13 will be a useful too for the reliable assessment of health literacy in countries, where culture plays a significant impact. This will be the first steptowards providing equitable access to healthcare for countries that have large populations with low socioeconomic status.

Purpose: The study explores the conditions contributing to slum dweller's vulnerability to poor health and examines interplay between economic, physical/infrastructural, and social factors affecting health status to inform policy and programme., Methods: The methodology deployed for data analysis was mixed deductive-inductive. A deductive framework was adapted for categorizing the data into four broad themes: Economic, Physical/Infrastructure, Social, and Health. Using Braun and Clarke's principle, we also mapped sub themes based on researchers' insights with the experiences shared by the slum populations. The study was conducted across 13 districts in slum areas to gather information from vulnerable groups based on the 40 focus group discussions., Findings: Poverty serves as a primary driver of domestic/internal migration from rural to urban areas, aggravating issues such as illiteracy, unemployment, and inadequate living conditions, which predispose slum dwellers to various health problems. Limited access to food, poor water quality, and improper waste disposal further compound health risks. People living in slums face economic, social, and physical vulnerabilities leading to health vulnerability and outcome., Conclusions: Enhancing the health and well-being of slum dwellers requires adopting an integrated and comprehensive approach of policy intervention, community mobilization, and multisectoral intervention.