Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men.

Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.

STATE-LEVEL DIETARY DIVERSITY AS A CONTEXTUAL DETERMINANT OF NUTRITIONAL STATUS OF CHILDREN IN INDIA: A MULTILEVEL APPROACH.

This study aimed to identify the determinants of nutritional status of children in India with a special focus on dietary diversity at the state level. Household-level consumption data from three rounds of the Consumer Expenditure Survey of the National Sample Survey Organization (1993-2012) were used. Information on the nutritional status of children was taken from the National Family Health Survey (2005-06). Dietary diversity indices were constructed at the state level to examine diversity in quantity of food consumed and food expenditure. Multilevel regression analysis was applied to examine the association of state-level dietary diversity and other socioeconomic factors with the nutritional status of children. It was observed that significant variation in childhood stunting, wasting and underweight could be explained by community- and state-level factors. The results indicate that dietary diversity has increased in India over time, and that dietary diversity at the state level is significantly associated with the nutritional status of children. Moreover, percentage of households with a regular salaried income in a state, percentage of educated mothers and mothers receiving antenatal care in a community are important factors for improving the nutritional status of children. Diversity in complementary child feeding is another significant determinant of nutritional status of children. The study thus concludes that increasing dietary diversity at the state level is an effective measure to reduce childhood malnutrition in India.

FEMALE EDUCATION AND ITS ASSOCIATION WITH CHANGES IN SOCIO-DEMOGRAPHIC BEHAVIOUR: EVIDENCE FROM INDIA.

Education is a crucial factor in influencing the pattern and timing of marriage for women, and the changes in levels of female literacy will also change the dynamics of family formation. India has experienced consistent improvement in levels of female literacy; therefore, this study examined the association of women's education with the changes in their demographic behaviour in the Indian context. The central idea of the paper is to examine the differences in age at marriage and first birth, choice of marriage partner and the number of children ever born based on educational attainment of women. In addition, the study examined incongruence in years of schooling and discontinuation from school, for children based on education of the mother. The study utilized data from the third round of District Level Household and Facility Survey. The sample constituted 344,164 ever-married women aged 35 years and above with surviving children aged 5-20 years. The results imply that women with higher education are more likely to marry late and have fewer children compared with less educated women. Accordingly, increase in education of women also increases the probability of marrying men with better education than themselves. The study further observed that education of wife has a greater association with the number of children ever born than the education of husband. At the same time, incongruence in years of schooling and drop-out from school are both high for children of uneducated women. The study also found that the children from urban areas are more likely to drop out than their rural counterparts. In addition to education of the mother, number and composition of children in the family and economic condition of the household are some other factors that influence the educational attainment of children.

Indicators to examine quality of large scale survey data: an example through district level household and facility survey.

BACKGROUND: Large scale surveys are the main source of data pertaining to all the social and demographic indicators, hence its quality is also of great concern. In this paper, we discuss the indicators used to examine the quality of data. We focus on age misreporting, incompleteness and inconsistency of information; and skipping of questions on reproductive and sexual health related issues. In order to observe the practical consequences of errors in a survey; the District Level Household and Facility Survey (DLHS-3) is used as an example dataset. METHODS: Whipple's and Myer's indices are used to identify age misreporting. Age displacements are identified by estimating downward and upward transfers for women from bordering age groups of the eligible age range. Skipping pattern is examined by recording the responses to the questions which precede the sections on birth history, immunization, and reproductive and sexual health. RESULTS: The study observed errors in age reporting, in all the states, but the extent of misreporting differs by state and individual characteristics. Illiteracy, rural residence and poor economic condition are the major factors that lead to age misreporting. Female were excluded from the eligible age group, to reduce the duration of interview. The study further observed that respondents tend to skip questions on HIV/RTI and other questions which follow a set of questions. CONCLUSION: The study concludes that age misreporting, inconsistency and incomplete response are three sources of error that need to be considered carefully before drawing conclusions from any survey. DLHS-3 also suffers from age misreporting, particularly for female in the reproductive ages. In view of the coverage of the survey, it may not be possible to control age misreporting completely, but some extra effort to probe a better answer may help in improving the quality of data in the survey.