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For countries with high maternal mortality and morbidity, on-time initiation of antenatal care (ANC) is indispensable. Therefore this paper aims for studying the median survival time (MST) of first ANC among pregnant women as well as understanding the contextual factors that influence a mother's decision to access ANC services in India. The study used cross-sectional survey data obtained from the NFHS-4 conducted in 2015–2016. The MST of the timing of the first ANC visit was estimated using the Kaplan-Meir estimate. A multivariate Cox-proportional hazard regression model was used to identify the factors related to the timing of the first ANC visit with a 95% confidence interval (CI). Overall at least one ANC checkup was assessed by 60.15% of women and the median survival time for the first ANC checkup was found to be 4 months. Early initiation of ANC in pregnant women increased by 37% (AHR: 1.37, CI:1.34–1.39) for primary education, and 88% (AHR:1.88, CI:1.86–1.90) for secondary education compared to women having no formal education. Results of the current study revealed that the median survival time of the first ANC visit was 4 months in India which is delayed compared to recommendations of WHO. Therefore boosting the access and utilization of antenatal care coverage among pregnant women can ensure the best health outcomes for their pregnancy. [ABSTRACT FROM AUTHOR]

India has also joined the club of ageing countries in the world with a rapid health transition and experienced demographic ageing. The rapid growth of the older adult population has raised serious concerns about their health and healthcare utilization. However, very limited research has been done on the effects of demographic ageing on health and healthcare utilization. With this perspective, the present study looked at patterns in morbidity prevalence and health-seeking behaviour among older adults in India. The data was used from the National Sample Survey Organization, 75th round (2017–18) government of India. The total sample for the analysis is 1,26,42 older adults aged 60 and above. Univariate, bivariate, and binary logistic regression analysis was employed to understand the effects of socio-demographic conditions on morbidity prevalence among older adults and their healthcare-seeking behaviour. The prevalence of non-communicable diseases were found to be higher (14.4%) than communicable diseases (5.4%), and other morbidities (8.5%) among older adults (≥ 60) in India during 2017–18. The prevalence of communicable (6.3%), non-communicable (21.8%), and Other diseases (11.7%) were higher among the oldest-older adults (80 + years) compared to other groups. The prevalence of the non-communicable disease was considerably higher among male older adults as compared to females. The morbidity pattern of older adults varies remarkably across the states of India. More than half of the older adults (54%) visited private health care facilities for seeking their in-patient care. The utilization of private health facilities was higher among male than female older adults in India. The findings of this study are essential in assisting policymakers and healthcare providers in identifying individuals at risk, and might be incorporated into present initiatives for older people's social, economic, and health security. [ABSTRACT FROM AUTHOR]

The present study investigated linkages between multiple socio-economic vulnerabilities with infant and child mortality in India and its specific regions. Data from the National Family Health Survey (2015–16) was used for calculating the key-outcome variables, namely infant mortality and child mortality. The effective sample size for the study was 259,627. Bivariate analysis and binary logistic regression analysis were employed to examine three dimensions of vulnerabilities such as education, wealth, and caste on infant and child mortality. Children born to women with multiple-vulnerabilities were more likely to die than those born to non-vulnerable women. Women who were vulnerable in all the three-dimensions were more likely to have their children die as infants than those who were not vulnerable in any dimensions (predicted probabilities; 0.054 vs 0.026). The predicted probability for child mortality was 0.063 for women who were vulnerable and 0.028 for non-vulnerable women. [ABSTRACT FROM AUTHOR]

Background: Despite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - particularly across states and regions. Therefore, this study applies the spatial-regression model to examine the spatial distribution of SBA across districts of India. Furthermore, the study tries to understand the spatially associated population characteristics that influence the low coverage of SBA across districts of India and its regions.Methods: The study used national representative cross-sectional survey data obtained from the fourth round of National Family Health Survey, conducted in 2015-16. The effective sample size was 259,469 for the analysis. Moran's I statistics and bivariate Local Indicator for Spatial Association maps were used to understand spatial dependence and clustering of deliveries conducted by SBA coverage in districts of India. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of deliveries conducted by SBA.Results: Moran's I value for SBA among women was 0.54, which represents a high spatial auto-correlation of deliveries conducted by SBA over 640 districts of India. There were 145 hotspots for deliveries conducted by SBA among women in India, which includes almost the entire southern part of India. The spatial error model revealed that with a 10% increase in exposure to mass media in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Interestingly, also with the 10% increase in the four or more antenatal care (ANC) in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Again, if there was a 10% increase of women with first birth order in a particular district, then the deliveries conducted by SBA significantly increased by 6.1%. If the district experienced an increase of 10% household as female-headed, then the deliveries conducted by SBA significantly increased by 1.4%.Conclusion: The present study highlights the important role of ANC visits, mass media exposure, education, female household headship that augment the use of an SBA for delivery. Attention should be given in promoting regular ANC visits and strengthening women's education. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding is one of the most effective ways to ensure infant health and survival. Inadequate breastfeeding practices, and knowledge among adolescent mothers have led to unprecedented infant and child morbidity and mortality. Given, the high global prevalence of adolescent mothers it is imperative to understand how the knowledge of breastfeeding practices operates among adolescent girls across different socio-economic settings. Materials & methods: Data was carried out from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey, conducted in 2015–16. Descriptive statistics along with bivariate analysis was done to examine the preliminary results. For analysing the association between the binary outcome variable and other explanatory variables, binary logistic regression method was used. The explanatory variables were educational status of the respondent, media exposure, working status, ever pregnant status (only for married adolescent girls), sex and age of the household head, educational status of the head of the household, caste, religion, wealth index, residence and states. Results: About 42%, 50%, and 42% of married adolescent girls had knowledge of immediate breastfeeding, yellowish milk, and exclusive breastfeeding respectively. The odds of knowledge about immediate breastfeeding [married-AOR: 1.57; CI: 1.09–2.28 and unmarried-AOR: 1.30; CI: 1.08–1.55], yellowish milk feeding [married-AOR: 2.09; CI: 1.46–3.01 and unmarried-AOR: 1.39; CI: 1.17–1.66], and exclusive breastfeeding [married-AOR: 1.74; CI: 1.2–2.52 and unmarried-AOR: 1.46; CI: 1.22–1.76] were significantly more among adolescent girls aged 19 years old compared to 15 years old girls. Adolescent married and unmarried girls with 10 & above years of schooling were 1.82 times [AOR: 1.82; CI: 1.52–2.18] and 2.69 times [AOR: 2.69; CI: 2.08–3.47] more likely to have knowledge about immediate breastfeeding, 1.74 times [AOR: 1.74; CI: 1.45–2.09] and 2.10 times [AOR: 2.10; CI: 1.68–2.62] more likely to have knowledge about yellowish milk feeding, and 3.13 times [AOR: 3.13; CI: 2.6–3.78] and 3.87 times [AOR: 3.87; CI: 2.95–5.08] more likely to have knowledge about exclusive breastfeeding respectively than girls with no schooling. Conclusion: Breastfeeding practices and interpersonal counselling from elders in the household should be encouraged. Ongoing breastfeeding promotion programs of the government should promote high education of adolescent girls. Mass media interventions should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. Methods: This paper uses a national-level data set of both NFHS-3 (2005–06) and NFHS-4 (2015–16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. Results: Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. Discussion and conclusion: It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination. [ABSTRACT FROM AUTHOR]

Introduction: Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods: The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran's I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results: The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion: It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels. [ABSTRACT FROM AUTHOR]

Background: The International Diabetes Federation (IDF) estimated that 1.1 million children and adolescents aged 14–19 years are living with diabetes. Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose. It is also recognized as a complex disease that affects people of different ages due to different causes. The present study aims to estimate the prevalence of pre-diabetes/diabetes at the national level. Additionally, the respective study determines the factors associated with pre-diabetes/diabetes conditions among adolescents at the national level. Methods: The data for this study was carried out from the Comprehensive National Nutrition Survey (CNNS), the first-ever nationally representative nutrition survey of children and adolescents in India. The study used a sample size of 17,865 adolescent boys and 17,965 adolescent girls for the analysis. Descriptive statistics, bivariate analysis, and logistic regression analysis were done to carve out the results. Results: The prevalence of pre-diabetes/diabetes was 12.3% and 8.4% among adolescent boys and girls in India, respectively. Body mass index and Subscapular skinfold thickness were the two most important predictors of pre-diabetes/diabetes among adolescents. Further, physical activities show a negative association with pre-diabetes/diabetes. Moreover, interaction models in the present study clearly reveal the fact that adolescent girls were less likely to suffer from pre-diabetes/diabetes than adolescent boys. Additionally, it was found that the prevalence of pre-diabetes/diabetes was high among adolescent girls from lower socio-economic strata. Conclusion: The high prevalence of pre-diabetes and diabetes among adolescents portrayed serious public health concern in India. As body mass index and Subscapular skinfold thickness were positively associated with pre-diabetes/diabetes conditions among adolescents. Therefore, effective approaches are needed to be taken to tackle these pre-diabetes/diabetes conditions among adolescents and especially among adolescent boys. [ABSTRACT FROM AUTHOR]

• Adolescent girls have a higher prevalence of suicidal tendency. • Suicidal tendencies are more among adolescents with moderate to severe symptoms of depression, who consume tobacco, alcohol and who are physically inactive. • Adolescents in the age group 16–19 years, and married girls have more suicidal tendencies. • Adolescents who are engaged in work have more suicidal tendencies. Suicide is a significant public health problem. A rise in the trend of suicide among adolescents, therefore warrants special attention. The present research is undertaken because of the dearth of literature and limited knowledge about prevention of suicide among adolescents in India. By analyzing the data of Understanding the Lives of Adolescents and Young Adults project survey in two Indian states of Uttar Pradesh and Bihar, the study aimed to understand the risk factors associated with the suicidal tendency among adolescents. The study hypothesized no association of suicidal tendency among adolescents with depressive symptoms, physical activity, and substance use. The bivariate and multivariate results indicate a strong significant and positive association of severe depression, physical inactivity, and substance use among adolescents who have suicidal tendencies. The findings imply that an early detection of depression, awareness about the harmful affect of tobacco and alcohol consumption, and encouragement of adolescents to participate in physical activity will avert adolescents from having suicidal tendencies. [ABSTRACT FROM AUTHOR]