Reproductive and child health transition among selected empowered action groups states of India: A district-level analysis.

BACKGROUND: Health is an inseparable part of life and central to all life supporting systems. The reproductive and child health shares a major portion of public health cases that is crucial for socio-economic development. Studies on reproductive and child health have traditionally been focused on demographic aspects using socio-economic parameters. Given the emphasis of Sustainable Development Goal (SDG)-3 on health and well-being, it is imperative to understand the geo-spatial dimension with the visible transition of key health indicators of fertility, maternal and infant/child health in the high burdened districts within these high focus Empowered Action Group (EAG) states of Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar that make up nearly 40% of India's population with relatively laggard health status. METHODOLOGY: This paper aims to understand the status and trend of key reproductive and child health indicators and vital statistics based on the recent representative demographic surveys. We intend to undertake a district level spatio-temporal analysis by developing District Composite Health Profile (DCHP) using Composite Index Method on selected 13 equally weighted key reproductive and child health indicators. The study has been carried out using data from National Family Health Survey-4 (2015-16) and National Family Health Survey-5 (2019-21) survey rounds. We employed geo-spatial techniques i.e. Moran's-I, and univariate LISA to comprehend the geographical clustering of high and low health burden districts and their heterogeneities at the district level. RESULTS/CONCLUSIONS: The study highlights emerging inter-districts, and inter-state disparities over survey periods. With consistent improvement in the selected EAG states over time, the overall reproductive and child health status through DCHP along with each indicator was relatively better in the states of Rajasthan and worse in Bihar. Districts along the Terai belt in Uttar Pradesh and Bihar consistently performed sluggish during survey rounds. The geo-spatial clustering follows the political boundary of states, albeit with intra-state variations. Monitoring of key health indicators using composite index method provides a useful leverage for identifying priority districts/regions for universal health access that should also consider geographical space as an important policy dimension.

Physical-mental health and awareness of HIV/STIs among men who have sex with men in selected cities of India.

BACKGROUND: Men who have Sex with Men being sexual minorities are a vulnerable section of society and are at greater risk of ill-treatment if they are 'out of the closet' regarding their sexuality. Previous evidence suggests that they experienced heightened susceptibility to physical and mental illnesses owing to widespread discrimination and victimization across different walks of life, particularly in developing countries. However, there is a paucity of sound data and scientific understanding related to linkages between physical-mental health and awareness about Human Immunodeficiency Virus/Sexually Transmitted Infections among Men who have Sex with Men in the Indian context. METHODS: Using a mixed-method approach, the present study examined the association between physical-mental well-being and awareness of comprehensive Human Immunodeficiency Virus/Sexually Transmitted Infections/relevant health behaviours based on primary data collected from 300 respondents from six selected metro cities in India. Descriptive statistics, chi-square test and binary logistic regression model have been used for the quantitative data analyses. In-depth interviews were conducted to contextualize and appreciate the substantive meanings and significance coming out from the quantitative results with the lived experiences of the study respondents. RESULTS: Finding suggests that one-fourth of the respondents were experiencing long-term illnesses while close to four out of ten respondents experienced short-term illnesses. About one-third of the respondents experienced disordered eating behaviour and mood swings. Close to one-fifth of the respondents reportedly contemplated suicidal thoughts. Awareness related to Sexually Transmitted Infections and preventive measures related to Human Immunodeficiency Virus risk was considerably low among Men who have Sex with Men. CONCLUSION: Awareness about sexual and reproductive health issues among Men who have Sex with Men needs to be strengthened to curtail the disproportionate risk and vulnerability of Human Immunodeficiency Virus and Sexually Transmitted Infections. The public healthcare system needs to be sensitized and upgraded to cater user-friendly quality healthcare services, without any discrimination against sexual minorities including Men who have Sex with Men. Furthermore, generating public awareness about gender and sexuality-related matters and reducing stigma and discrimination is critical for achieving the health-related sustainable development goals in India without leaving no one behind.

Assessing Socioeconomic Vulnerabilities Related to COVID-19 Risk in India: A State-Level Analysis.

OBJECTIVE: There is a paucity of scientific analysis that has examined spatial heterogeneities in the socioeconomic vulnerabilities related to coronavirus disease 2019 (COVID-19) risk and potential mitigation strategies at the sub-national level in India. The present study examined the demographic, socioeconomic, and health system-related vulnerabilities shaping COVID-19 risk across 36 states and union territories in India. METHODS: Using secondary data from the Ministry of Health and Family Welfare (MoHFW), Government of India; Census of India, 2011; National Family Health Survey, 2015-16; and various rounds of the National Sample Survey, we examined socioeconomic vulnerabilities associated with COVID-19 risk at the sub-national level in India from March 16, 2020, to May 3, 2020. Descriptive statistics, principal component analysis, and the negative binomial regression model were used to examine the predictors of COVID-19 risk in India. RESULTS: There persist substantial heterogeneities in the COVID-19 risk across states and union territories in India. The underlying demographic, socioeconomic, and health infrastructure characteristics drive the vulnerabilities related to COVID-19 in India. CONCLUSIONS: This study emphasizes that concerted socially inclusive policy action and sustained livelihood/economic support for the most vulnerable population groups is critical to mitigate the impact of the COVID-19 pandemic in India.

Heterogeneity in adult anthropometry by socioeconomic factors: Indian National Family Health Survey 2006 and 2016.

BACKGROUND/OBJECTIVES: Recent evidence suggests nonconstant nature of dispersion in adult women's body mass index (BMI) across sociodemographic groups. The overall variances in BMI and height are also shown to have substantially changed over time. We modeled complex variation in adults' anthropometry-BMI and height-by wealth and education, and assessed their differences over time in India. SUBJECTS/METHODS: Data from a total of 768,130 women and 180,691 men from the Indian National Family Health Survey (NFHS) 2006 and 2016 were used for the analysis. The average association between wealth and education with anthropometry was assessed from linear regression models assuming constant variance. Individual heterogeneity was modeled to obtain separate variances in anthropometry for each wealth quintile and education level. All analyses were stratified by survey year and sex. RESULTS: On average, the positive socioeconomic gradient in adult's BMI and height persisted over time with slight attenuation. The residual variance in BMI ranged from 10.1 to 14.9 (7.2-11.3) by education level and 6.1 to 17.4 (5.0-13.0) by household wealth for women (men) in 2006, and they increased over time for the lower socioeconomic groups but remained the same or decreased for the higher socioeconomic groups. No significant pattern was observed for variation in height for both genders. CONCLUSIONS: We found potential reversal in the socioeconomic patterning in BMI variability in India as suggested by the increasing dispersion among the least educated and poorest populations. For a comprehensive understanding of nutrition transition in developing countries, it is necessary to assess the changes in means and variances of anthropometry in tandem.

Micro-geographic targeting for precision public policy: Analysis of child sex ratio across 587,043 census villages in India, 2011.

Child sex ratio (CSR) is a marker of disproportionate sex ratio at birth and discriminatory practices that lead to differential survival in early childhood by sex. We used the 2011 Census on rural India to present the first local analysis of CSR across 587,043 villages. In our multilevel analysis considering villages, tehsils, districts, and states/union territories, we found 96% of the total variation in CSR to be attributed to villages. About 39% of the villages were 'boy' areas (CSR≤88 girls per 100 boys) and another 12% had deficits in girls (88 < CSR≤93), while 11% fell in the normal range of CSR (93103). The magnitude of local variation in CSR was heterogeneous across states/union territories and districts. Our findings provide timely evidence to inform localized programmes like Beti Bachao, Beti Padhao to be implemented with greater precision.

The infectious disease blood safety risk of Australian hemochromatosis donations.

BACKGROUND: It has been suggested that blood donors with hereditary hemochromatosis may pose an increased infectious disease risk and adversely affect recipient outcomes. This study compares the infectious disease risk of whole blood (WB) donors enrolled as therapeutic (T) donors to voluntary WB donors to evaluate the safety of blood products provided by the T donors. STUDY DESIGN AND METHODS: This was a retrospective cohort study of all WB donations at the Australian Red Cross Blood Service who donated between January 1, 2011, and December 31, 2013, comparing a yearly mean of 11,789 T donors with 107,773 total donations and a yearly mean of 468,889 voluntary WB donors with 2,584,705 total donations. We compared postdonation notification of infectious illnesses, bacterial contamination screening results, and positive tests for blood borne viruses in T and WB donors. RESULTS: Rates of transfusion-transmissible infections in donations destined for component manufacture were significantly lower in therapeutic donations compared to voluntary donations (8.4 vs. 21.6 per 100,000 donations). Bacterial contamination (43.0 vs. 45.9 per 100,000 donations) and postdonation illness reporting (136.2 vs. 110.8 per 100,000 donations) were similar in both cohorts. CONCLUSIONS: The Australian therapeutic venisection program enables T donors to provide a safe and acceptable source of donated WB that has a low infectious disease risk profile.

Secular trends in menarcheal age in India-evidence from the Indian human development survey.

BACKGROUND: Evidence from a number of countries in Europe and North America point towards the secular declining trend in menarcheal age with considerable spatial variations over the past two centuries. Similar trends were reported in several developing countries from Asia, Africa and Latin America. However, data corroborating any secular trend in the menarcheal age of the Indian population remained sparse and inadequately verified. METHODS: We examined secular trends, regional heterogeneity and association of socioeconomic, anthropometric and contextual factors with menarcheal age among ever-married women (15-49 years) in India. Using the pseudo cohort data approach, we fit multiple linear regression models to estimate secular trends in menarcheal age of 91394 ever-married women using the Indian Human Development Survey. RESULTS: The mean age at menarche among Indian women was 13.76 years (95 % CI: 13.75, 13.77) in 2005. It declined by three months from 13.83 years (95% CI: 13.81, 13.85) among women born prior to 1955-1964, to nearly 13.62 years (95% CI: 13.58, 13.67) among women born during late 1985-1989. However, these aggregate national figures mask extensive spatial heterogeneity as mean age at menarche varied from 15.0 years in Himachal Pradesh during 1955-1964 (95% CI: 14.89-15.11) to about 12.1 years in Assam (95% CI: 11.63-12.56) during 1985-1989. CONCLUSION: The regression analysis established a reduction of nearly one month per decade, suggesting a secular decline in age at menarche among Indian women. Notably, the menarcheal age was significantly associated with the area of residence, geographic region, linguistic groups, educational attainment, wealth status, caste and religious affiliations among Indian women.

Infant and child mortality in India in the last two decades: a geospatial analysis.

BACKGROUND: Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. METHODOLOGY: The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992-1993, NFHS 1998-1999 and DLHS 2002-2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. RESULT/CONCLUSIONS: This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time.

Trends in malnutrition among children in India: growing inequalities across different economic groups.

This paper examines the trends and patterns of economic inequalities with respect to child malnutrition by wealth status of population across major regions and states of India. Data from three rounds of National Family and Health Survey (NFHS) conducted during 1992-2006 were analyzed. The proportion of underweight children (measure of both acute and chronic malnutrition) has been used as a dependent variable. The wealth index is used as proxy for economic status of the population, and was estimated through principal component analysis by employing a set of variables representing durable asset ownership, access to utilities and infrastructure, and housing characteristics of respondents for all the three survey rounds. Bivariate analyses, poor-rich ratio and concentration indices were used to understand the trends in economic inequalities with respect to child malnutrition. Pooled logistic regression models were fitted to estimate the adjusted effect of economic status on the likelihood of child malnutrition over time. Results indicate sluggish change coupled with concomitant rise in economic inequalities with respect to child malnutrition in India during 1992-2006. The burden of malnutrition was disproportionately concentrated among poor children. In addition, average decline in malnutrition concealed large economic disparities across space and time.

Early marriage, poor reproductive health status of mother and child well-being in India.

BACKGROUND AND METHODOLOGY: Early marriage, women's poor reproductive health and child well-being are important areas of concern, especially in developing countries like India. Data from the third wave of National Family Health Survey (NFHS, 2005-2006) was used to examine the effects of early marriage on the reproductive health status of women and on the well-being of their children. Bivariate analyses, multiple linear regression and logistic regression were used for analyses. RESULTS: The results show that early age at marriage had detrimental effects on the reproductive health status of women. Women married at an early age were exposed to frequent childbearing, unplanned motherhood and abortions, which negatively affected their nutritional status. Children born to mothers with poor reproductive health had lower chances of survival and a higher likelihood of anthropometric failure (i.e. stunting, wasting and underweight). DISCUSSION AND CONCLUSIONS: Programmes should focus on delaying entry of adolescents into wedlock and motherhood through information, education and communication. More emphasis needs to be put on meeting the reproductive needs of poor adolescent mothers, and improving the nutritional status of their children, to break the vicious circle of poor reproductive health and poverty.

Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992-2006.

BACKGROUND: The use of maternal health care is limited in India despite several programmatic efforts for its improvement since the late 1980's. The use of maternal health care is typically patterned on socioeconomic and cultural contours. However, there is no clear perspective about how socioeconomic differences over time have contributed towards the use of maternal health care in India. METHODOLOGY/PRINCIPAL FINDINGS: Using data from three rounds of National Family Health Survey (NFHS) conducted during 1992-2006, we analyse the trends and patterns in utilization of prenatal care (PNC) in first trimester with four or more antenatal care visits and skilled birth attendance (SBA) among poor and nonpoor mothers, disaggregated by area of residence in India and three contrasting provinces, namely, Uttar Pradesh, Maharashtra and Tamil Nadu. In addition, we investigate the relative contribution of public and private health facilities in meeting the demand for SBA, especially among poor mothers. We also examine the role of salient socioeconomic, demographic and cultural factors in influencing aforementioned outcomes. Bivariate analyses, concentration curve and concentration index, logistic regression and multinomial logistic regression models are used to understand the trends, patterns and predictors of the two outcome variables. Results indicate sluggish progress in utilization of PNC and SBA in India and selected provinces during 1992-2006. Enormous inequalities in utilization of PNC and SBA were observed largely to the disadvantage of the poor. Multivariate analysis suggests growing inequalities in utilization of the two outcomes across different economic groups. CONCLUSIONS: The use of PNC and SBA remains disproportionately lower among poor mothers in India irrespective of area of residence and province. Despite several governmental efforts to increase access and coverage of delivery services to poor, it is clear that the poor (a) do not use SBA and (b) even if they had SBA, they were more likely to use the private providers.