Associations between neighbourhood safety, social cohesion, sleep quality and sleep duration among older adults in India: Findings from the Study on Global Aging and Adult Health (WHO-SAGE), 2015.

BACKGROUND: Most studies on later-life health in India focus on families, with far less attention given to the health repercussions of neighbourhood conditions among older Indians. We address this limitation in existing research by examining the associations between perceptions of neighbourhood safety and social cohesion and sleep duration and sleep quality among older adults in India. METHODS: Data come from the Study on Global Aging and Adult Health (WHO-SAGE), India 2015 wave 2, with a sample of 7118 adults aged 50 years and above. Sleep quality and duration were assessed using subjective responses. Multivariable logistic and linear regression analyses were employed to test the research hypotheses. RESULTS: Prevalence of poor sleep quality was higher among older adults living in unsafe neighbourhoods (4.46%) than peers residing in safe neighbourhoods (3.52%), and it was also higher among those living in neighbourhoods with poor social cohesion (5.31%) than counterparts who lived in socially cohesive communities (3.10%). Older adults in neighbourhoods with poor social cohesion had higher odds of reporting compromised sleep quality (adjusted odds ratio 1.75, CI: 1.22-2.51) than those living in socially cohesive neighbourhoods. Moreover, compared to those who perceived they were living in safe neighbourhoods, their peers who perceived their neighbourhoods as unsafe reported shorter sleep duration, with a negative beta coefficient of -0.27 (CI: -0.45 to -0.085). CONCLUSION: That perceived unsafety and poor social cohesion within one's neighbourhood are associated with compromised sleep reflects the significance of making neighbourhoods safer and more integrated for later-life sleep health. In addition to micro-level strategies (e.g., balanced nutrition and physical activity), efforts to improve sleep health should optimise macro-level opportunities, such as rehabilitating and revitalising neighbourhoods, which may alleviate sleep disturbances and improve sleep outcomes among older adults.

Prevalence of dementia in India: National and state estimates from a nationwide study.

INTRODUCTION: Prior estimates of dementia prevalence in India were based on samples from selected communities, inadequately representing the national and state populations. METHODS: From the Longitudinal Aging Study in India (LASI) we recruited a sample of adults ages 60+ and administered a rich battery of neuropsychological tests and an informant interview in 2018 through 2020. We obtained a clinical consensus rating of dementia status for a subsample (N = 2528), fitted a logistic model for dementia status on this subsample, and then imputed dementia status for all other LASI respondents aged 60+ (N = 28,949). RESULTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%, with significant age and education gradients, sex and urban/rural differences, and cross-state variation. DISCUSSION: An estimated 8.8 million Indians older than 60 years have dementia. The burden of dementia cases is unevenly distributed across states and subpopulations and may therefore require different levels of local planning and support. HIGHLIGHTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%. About 8.8 million Indians older than 60 years live with dementia. Dementia is more prevalent among females than males and in rural than urban areas. Significant cross-state variation exists in dementia prevalence.

Early marriage and marital satisfaction among young married men in rural Uttar Pradesh, India.

OBJECTIVE: Lack of reliable and valid scales of Indian origin prompt researchers to borrow the marital satisfaction scale developed in different settings. The lack of a reliable scale to understand marital satisfaction in India prompted us to examine the marital satisfaction among young married men using ENRICH Marital Satisfaction (EMS) Scale developed in the Western context. Assessing the reliability of the EMS scale on the rural population of Lalitpur and Shrawasti, Uttar Pradesh, India; this study examines the determinants of marital satisfaction among young married men. RESULTS: Cronbach's alpha coefficient of 0.936 confirms the high reliability of the EMS scale for the surveyed population in two districts of India. Men belonging to households with higher monthly income (OR- 3.33; 95% C.I. - 1.71-6.50) were more likely to be satisfied in their marriage than their counterparts. Similarly, fathers', mothers', and married men's educational status were other important determinants of marital satisfaction. The study emphasizes the importance of family education as a strong predictor of marital satisfaction, and therefore policymakers may look into this aspect.

Multiple socioeconomic risks and cognitive impairment among older men and women in India.

Introduction: Socioeconomic status (SES) is negatively associated with innumerable health outcomes, including cognitive functioning. Yet much remains undiscovered about SES patterns in later-life cognition in low-and middle-income countries (LMICs). The purpose of this study was to examine the association between separate and combined socioconomic risks and cognitive impairment among older adults in India. Further, given gender disparities in later life cognitive functioning and SES, the study examines the associations between socioeconomic risks and cognitive impairment separately, for older men and women. Methods: Data come from the 2017-18, first wave of the Longitudinal Aging Study in India (LASI), with 31,464 older adults aged 60 years and above. Cognitive impairment was assessed using multiple broad measures of memory, orientation, arithmetic function, and visuo-spatial construction skills. We present descriptive statistics along with cross-tabulation of the outcome variable. Additionally, binary logistic regression analysis was used to test the association between outcome and explanatory variables. SES is measured using education, paid work status, and household wealth measured using monthly per-capita consumption expenditure (MPCE). Results: A proportion of 7.14% of the older men and 20.03% of older women reported cognitive impairment. The odds of cognitive impairment were higher among uneducated older men and women, and older men and women in lowest wealth quintile. Surprisingly, older women without current or prior work history report lower odds of cognitive impairment compared to their peers in labor force. While odds of cognitive impairment are higher among non-working older men, this association is not statistically significant. In older men, the odds of cognitive impairment were 5.34, 7.14, and 13.05 times higher with one, two, and three risk factors, respectively, compared with those with no risk exposure. A similar trend was observed for women but with comparatively lower odds. Conclusions: Our findings underscore the need to distinguish between varying elements of SES to construct "upstream" health policies and programs that redistribute resources. In particular, the findings support the use of multiple SES indicators in identifying older adults most susceptible to cognitive deficits, and planning gender-based interventions to improve cognitive health in late life.

Association of objective and subjective socioeconomic markers with cognitive impairment among older adults: cross-sectional evidence from a developing country.

OBJECTIVE: This study explored how various markers of objective and subjective socioeconomic status (SES) are associated with cognitive impairment among older Indian adults. DESIGN: A cross-sectional study was conducted using large nationally representative survey data. SETTING AND PARTICIPANT: This study used data from the Longitudinal Ageing Study in India (2017-2018). The sample included 31 464 older adults aged 60 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcome variable was cognitive impairment, measured through broad domains of memory, orientation, arithmetic function, and visuo-spatial and constructive skills. We estimated descriptive statistics and presented cross-tabulations of the outcome. Χ2 test was used to evaluate the significance level of differences in cognitive impairment by subjective (ladder) and objective SES measures (monthly per-capita consumption expenditure (MPCE) quintile, education and caste status). Multivariable linear and logistic regression analyses were conducted to fulfil the objectives. RESULTS: A proportion of 41.7% and 43.4% of older adults belonged to low subjective (ladder) and objective (MPCE) SES, respectively. Older adults with low subjective (adjusted OR (aOR): 2.04; p<0.05) and objective SES (aOR: 1.32; p<0.05) had higher odds of having cognitive impairment in comparison with their counterparts, with a stronger subjective SES-cognitive impairment association. Older adults with lower education or belonged to lower caste had higher odds of cognitive impairment than their counterparts. Interaction analyses revealed that older adults who belonged to lower subjective and objective (poorest MPCE quintile, Scheduled Castes and lowest education) SES had 2.45 (CI: 1.77 to 3.39), 4.56 (CI: 2.97 to 6.98) and 54.41 (CI: 7.61 to 388.93) higher odds of cognitive impairment than those from higher subjective and objective SES, respectively. CONCLUSION: Subjective measures of SES were linked to cognitive outcomes, even more strongly than objective measures of SES; considering the relative ease of obtaining such measures, subjective SES measures are a promising target for future study on socioeconomic indicators of cognitive impairment.

Childhood deprivations predict late-life cognitive impairment among older adults in India.

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017-18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64-21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.

Assessing socioeconomic inequalities in cognitive impairment among older adults: a study based on a cross-sectional survey in India.

BACKGROUND: The rapidly aging population is a major concern for countries, especially where cognitive health in older age is poor. The study examined the socioeconomic and health-related factors associated with cognitive impairment among older adults and the contribution of those factors to the concentration of low cognitive functioning among older adults from economically poor households. METHODS: Data this study were derived from the "Building Knowledge Base on Population Ageing in India" (BKPAI) survey, which was carried out in seven major states of India. The effective sample size for the analysis was 9176 older adults aged 60 years and above. Results from descriptive and bivariate analysis were reported in the initial stage. Multivariable logistic regression analysis was conducted to explore the associations. Additionally, the concentration index and concentration curve were used to measure socioeconomic inequality in cognitive impairment among older adults. Wagstaff decomposition was employed to explore the key contributors in the concentration index. RESULTS: Nearly 60% of older adults suffered from cognitive impairment in the study. The likelihood of cognitive impairment were higher among older adults with a low level of self-perceived income sufficiency [coefficient: 0.29; confidence interval (CI): 0.07- 0.52] compared to older adults with higher levels of perceived income status. Older adults with more than 10 years of schooling were less likely to be cognitively impaired [coefficient: -1.27; CI: - 1.50- -1.04] in comparison to those with no education. Cognitive impairment was concentrated among older adults from households with the lowest wealth quintile (concentration index (CCI): - 0.10: p < 0.05). Educational status explained 44.6% of socioeconomic inequality, followed by 31.8% by wealth status and 11.5% by psychological health. Apart from these factors, difficulty in instrumental activities of daily living (3.7%), caste (3.7%), and perceived income sufficiency to fulfil basic needs (3.0%) explained socioeconomic inequality in cognitive impairment among older adults. CONCLUSIONS: Findings suggest that older adults with lower perceived income, lower levels of education, poor physical and mental health, and poor physical and social resources were more likely to be cognitively impaired. Education, wealth and psychological health are major contributors in socioeconomic inequality in late-life cognitive impairment, which may be target areas in future policy formulation to reduce the inequality in cognitive impairment in older Indian adults.

How much of the female disadvantage in late-life cognition in India can be explained by education and gender inequality.

In social environments characterized by high levels of gender inequality, women fare worse than men in human capital accumulation and health. We examine the association of gender inequality with female disadvantage in late-life cognitive function, using newly available data from Wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI), representative of the Indian population over the age of 45. We find a substantial female gap in cognition among mid-aged and older adults in India; early life socioeconomic conditions and education explain up to 74 percent of the female disadvantage in cognition, and model predictions suggest that it takes nine years of education on average to overcome this deficit. However, further contextualizing the environment, we find that the level of education at which differences in late-life cognition between women and men become negligible increases with the degree of gender inequality.

Decomposing rural-urban differences in successful aging among older Indian adults.

The modernization and shift towards urbanized lifestyles have triggered several diseases, and the context of aging varies in urban and rural settings in India. The study aimed to investigate the urban-rural differences in successful ageing among older adults in India and the contributing factors in those differences. The study utilizes data from nationally representative Longitudinal Ageing Study in India (LASI, 2017-18). The analytical sample size for the study was 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis were carried out to present the initial results. Multivariable logistic regression and decomposition analysis was used to find the associations between explanatory variables and successful aging and to identify the contributions of covariates that explain the rural-urban differences in successful ageing. A proportion of 32% and 24% of older adults from rural and urban areas were successful agers with an urban disadvantage. Urban-dwelling older adults had 0.67 times [95% confidence interval (CI): (0.64, 0.71)] lower unadjusted odds of successful ageing than rural older adults. Again, after adjusting for the effect of other explanatory variables, urban older adults had 0.92 times [CI: (0.87, 0.98)] lower odds of being successful agers than their rural counterparts. The major contributors to the rural-urban inequality in successful aging were differences in regional distribution (17% contribution), waist circumference (16%), working status (16%), body mass index (13%) and physical activity (8%) among rural and urban older adults. The urban disadvantage in aging successfully may reflect the higher prevalence of adverse lifestyle behaviours in urban dwellers and under-diagnosis and under-reporting of many diseases in rural areas, particularly non-communicable diseases, suggesting the need for further investigation.

Hypertension awareness, treatment, and control and their association with healthcare access in the middle-aged and older Indian population: A nationwide cohort study.

BACKGROUND: Hypertension is the most important cardiovascular risk factor in India, and representative studies of middle-aged and older Indian adults have been lacking. Our objectives were to estimate the proportions of hypertensive adults who had been diagnosed, took antihypertensive medication, and achieved control in the middle-aged and older Indian population and to investigate the association between access to healthcare and hypertension management. METHODS AND FINDINGS: We designed a nationally representative cohort study of the middle-aged and older Indian population, the Longitudinal Aging Study in India (LASI), and analyzed data from the 2017-2019 baseline wave (N = 72,262) and the 2010 pilot wave (N = 1,683). Hypertension was defined as self-reported physician diagnosis or elevated blood pressure (BP) on measurement, defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Among hypertensive individuals, awareness, treatment, and control were defined based on self-reports of having been diagnosed, taking antihypertensive medication, and not having elevated BP, respectively. The estimated prevalence of hypertension for the Indian population aged 45 years and older was 45.9% (95% CI 45.4%-46.5%). Among hypertensive individuals, 55.7% (95% CI 54.9%-56.5%) had been diagnosed, 38.9% (95% CI 38.1%-39.6%) took antihypertensive medication, and 31.7% (95% CI 31.0%-32.4%) achieved BP control. In multivariable logistic regression models, access to public healthcare was a key predictor of hypertension treatment (odds ratio [OR] = 1.35, 95% CI 1.14-1.60, p = 0.001), especially in the most economically disadvantaged group (OR of the interaction for middle economic status = 0.76, 95% CI 0.61-0.94, p = 0.013; OR of the interaction for high economic status = 0.84, 95% CI 0.68-1.05, p = 0.124). Having health insurance was not associated with improved hypertension awareness among those with low economic status (OR = 0.96, 95% CI 0.86-1.07, p = 0.437) and those with middle economic status (OR of the interaction = 1.15, 95% CI 1.00-1.33, p = 0.051), but it was among those with high economic status (OR of the interaction = 1.28, 95% CI 1.10-1.48, p = 0.001). Comparing hypertension awareness, treatment, and control rates in the 4 pilot states, we found statistically significant (p < 0.001) improvement in hypertension management from 2010 to 2017-2019. The limitations of this study include the pilot sample being relatively small and that it recruited from only 4 states. CONCLUSIONS: Although considerable variations in hypertension diagnosis, treatment, and control exist across different sociodemographic groups and geographic areas, reducing uncontrolled hypertension remains a public health priority in India. Access to healthcare is closely tied to both hypertension diagnosis and treatment.

Effects of parental stature on child stunting in India.

Adult heights in India are short. Child stunting remains high though the prevalence fell from 48% to 38% in the decade prior to 2016. This study assesses the links between parental height and child stunting using nationally representative data on 28,975 under-five-year-old children from the 2015-16 National Family Health Survey. Parental heights are represented as quintiles. Logistic regression was applied to estimate the effect of parental heights after adjustment for household wealth, parental schooling, place of residence and other covariates. The unadjusted estimates showed the effect on stunting to be similar for maternal height, wealth and education. In the multivariate analysis maternal height emerged as the strongest predictor of stunting, with adjusted odds of 2.85 for the shortest compared with the tallest quintile. The two other strong predictors of stunting were paternal height and wealth, with adjusted odds of close to 2.0 for the lowest quintile relative to the highest quintiles. In comparison, associations between stunting and other factors were minor, with the partial exception of mother's education. The findings underscore the key role of intergenerational influences on stunting. Maternal height has a stronger association with childhood stunting than paternal height and socioeconomic influences such as education and household wealth. The influence of paternal height is also strong, equal in magnitude to household wealth. Health workers need to be alerted to the special needs of short women.

Mid upper arm circumference as an alternative measure to assess the nutritional status of adolescents: a study in India based on NFHS-4 data.

Use of body mass index (BMI) to assess the nutritional status of adolescents requires many resources, especially for country-level assessment. This study aimed to determine the relationship between BMI and mid upper arm circumference (MUAC) among adolescent males and females in India and to examine whether MUAC effectively represents the nutritional status of adolescents. The study utilized anthropometric measurement data collected by India's National Family Health Survey-4 (2015-16). The weighted sample for analysis included 91,315 female and 14,893 male adolescents. The BMI and MUAC measurements showed a positive correlation in both female and male adolescents. Using BMI-for-age Z-score classifications, 12.7% of the adolescents were undernourished. Using MUAC (in cm) as per NACS (Nutrition Assessment, Counselling, and Support) guidelines and Mramba et al. () classified 22.9% and 3.7% of the adolescents as undernourished respectively. Finally, using the MUAC-for-age Z-score classification, 98.4% of adolescents were determined to be normal and 1.7% undernourished. Sensitivity and specificity tests of the MUAC cut-offs, in comparison with BMI cut-offs, showed that all three MUAC cut-off classifications had high specificity (NACS cut-off: 81.3%; Mramba et al. cut-off (cm): 97.7%; Mramba et al. cut-off (Z-score): 99.1%). The NACS cut-off had moderately high sensitivity (52.2%) but the Mramba et al. cut-offs had low sensitivity (13.3% for the centimetre cut-off and 6.6% for the Z-score cut-off). Sensitivity and specificity tests proved the relationship between BMI and MUAC, and that MUAC represents adolescent nutritional status with considerable efficiency. With further research, it may be established that MUAC is a better and promising measure of adolescent nutrition, having the advantage of needing fewer resources for data collection. The MUAC has the potential to offer a simple and low-resource alternative to BMI to assess nutritional status among adolescents in poor countries.

Association of elder abuse, crime victimhood and perceived neighbourhood safety with major depression among older adults in India: a cross-sectional study using data from the LASI baseline survey (2017-2018).

OBJECTIVE: The study aims to explore the associations of elder abuse, crime victimhood and perceived safety with depression among older adults and examine the interactive effects of sex and place of residence in those associations. DESIGN: A cross-sectional study was conducted using a large survey data. SETTING AND PARTICIPANTS: The study used data from the Longitudinal Ageing Study in India wave 1 (2017-2018). The effective sample size was 31 464 older adults (aged 60 years or older). PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome variable was major depression, calculated using Short Form Composite International Diagnostic Interview. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives. RESULTS: 5.22% of the older adults (n=1587) experienced abuse in the past 1 year. 1.33% of the older individuals (n=402) were victims of a violent crime, and 14.30% (n=1886) perceived an unsafe neighbourhood. Also, 8.67% of the older adults (n=2657) were suffering from depression. Older adults who were abused had 2.5 odds of suffering from depression (adjusted OR (AOR): 2.47, CI: 1.96 to 3.10) and victims of a violent crime were 84% more likely to be depressed (AOR: 1.84, CI: 1.15 to 2.95) compared with their counterparts. Besides, older individuals who perceived as living in unsafe neighbourhood were 61% more likely to be depressed (AOR: 1.61, CI: 1.34 to 1.93) compared with their counterparts. In the interaction analysis, older women who reported abuse had higher odds of suffering from depression (AOR: 3.27; CI: 2.34 to 4.57) compared with older men who were not abused. Similar result was found in older adults reporting abuse and residing in rural areas (AOR: 3.01, CI: 2.22 to 4.07) compared with those urban residents reporting no abuse. CONCLUSIONS: Healthcare providers should pay more attention to the mental health implications of elder abuse, crime victimhood and perceived safety to grasp the underlying dynamics of the symptomology of late-life depression.

Association of self-perceived income status with psychological distress and subjective well-being: a cross-sectional study among older adults in India.

BACKGROUND: As the older population aged 65 and over worldwide, is estimated to increase from 9% in 2019 to 16% in 2050, rapid aging will transform the aspects such as economic security, employment status, and family structure. The effects of lower levels of perceived income and poor socioeconomic status on the mental health of older adults appear to be large and enduring. Therefore, the present study contributes to the literature on understanding the association of socioeconomic conditions and self-perceived income status in particular, with self-assessed mental health outcomes (psychological distress and subjective well-being) among older adults in India. METHODS: Data for the present study was derived from the Building Knowledge Base on Population Ageing (BKPAI) in India. Bivariate and binary logistic regression analyses were conducted to understand the relationship between socioeconomic status and outcome variables. RESULTS: About 43% of older adults had no income whereas 7% had income but perceived as not sufficient to fulfil their basic needs. Nearly, 9% of older adults were retired from regular employment. Almost 70% older adults had received no pension and nearly 18% of older adults had no asset ownership. It is revealed that older adults with income that is partially sufficient to fulfil their basic needs were 2.23 times [OR: 2.23, CI: 1.75-2.84] and 1.96 times [OR: 1.96, CI: 1.55-2.47] significantly more likely to suffer from psychological distress and low subjective well-being than those who had income which was sufficient to fulfil their basic needs. CONCLUSIONS: By focusing on four target areas such as the income support, education, family oriented initiatives and local or regional policies, the current framework for assessing the mental health among older adults in India can be modified. A move towards a guaranteed pension for eligible older individuals by which they do not have to remain as a financial burden on their children, may reduce their self-perceived economic distress and result in higher levels of wellbeing in older ages. Also, strategies to address socioeconomic disadvantages and gender differentials related to mental health status among older population are urgently needed.

Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India.

BACKGROUND: Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. METHODS: Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. RESULTS: About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21-1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72-0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. CONCLUSION: The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

Disentangling the effects of reproductive behaviours and fertility preferences on child growth in India.

We analysed population data from the 2015-16 National Family Health Survey to disentangle the intricate underlying effects of reproductive behaviours and fertility preferences on child growth. We expected birth interval length to be more strongly associated with stunting than sibsize and these effects to be moderated by whether the child was wanted or unintended (mistimed/unwanted). Regression analyses showed strong and equal effects of short birth interval and sibsize on stunting, when adjusted for potential confounders and unobserved between-mother heterogeneity. There were no statistical associations between stunting and mistiming/unwantedness of index children, suggesting the absence of discrimination against such children. We conclude that while fertility preferences have no effect, reproductive behaviours exert significant influence on child growth. Sibsize has been falling for many years in India but birth interval lengths have remained largely unchanged. The results underscore the need for strengthening uptake of reversible contraceptives to enable longer birth intervals.

DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA.

The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010-11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of -0.1147, -0.1146, -0.2859 and -0.0638 for <3 antenatal care visits; CI of -0.1338, -0.0925, -0.1960 and -0.2531 for non-institutional delivery; and CI of -0.1153, -0.0370, -0.1817 and -0.0577 for no postnatal care within 2 days of delivery for Bangladesh, Ethiopia, Nepal and Zimbabwe, respectively. The marginal effects suggested that the strength of the association between the outcome and explanatory factors varied across the different countries. Decomposition estimates revealed that the key contributing factors for socioeconomic inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.