Prevalence and determinants of multiple chronic conditions (MCC) among young adults in Indian households: an analysis of NFHS-5.

BACKGROUND: Multiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households. METHODS: Data used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019-21. Data sets of men (15-54 years) and women (15-49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results. RESULTS: A prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33-0.39)), urban areas (AOR 1.11 (1.02-1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81-0.97)), and ST (AOR 1.30 (1.17-1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress. CONCLUSION: A 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.

Processed food consumption and risk of non-communicable diseases (NCDs) in South Africa: evidence from Demographic and Health Survey (DHS) VII.

We aimed to analyse the association between processed food consumption and the risk of non-communicable diseases (NCDs) in South Africa. In this empirical study, we analysed nationally representative secondary data obtained from the South African Demographic and Health Survey (SADHS) VII. The survey included 13,288 occupied households, of which 11,083 were interviewed. In the interviewed households, 12,717 eligible adults aged 15 and older were identified and 10,336 were successfully interviewed. The study included four processed food groups (i.e. fried foods, takeaway foods/fast foods, salty snacks/packed chips, and processed meats) and eight NCDs (i.e. hypertension, cardiac arrest, cancer, stroke, hypercholesterolaemia, diabetes, chronic bronchitis, and asthma). As per the logistic regression results following adjustment, none of the disease states showed association with all four processed food groups. However, at least three processed food groups showed a significant positive association with hypertension, cardiac arrest, and diabetes. Two processed food groups showed significant positive association with stroke, and chronic bronchitis; one with hypercholesterolaemia and asthma; and cancer was not associated with any food groups. Processed meat and salted snacks/packed chips were each associated with five chronic conditions. In summary, we found that the consumption of any of the processed food groups increased the risk of NCDs in the South African population. Enabling policy and regulatory efforts in the production and distribution of processed foods, combined with improved awareness among the population need to be prioritised for immediate action. Facilitating the populations to choose traditional healthy diets would be a sustainable strategy for the prevention of NCDs.

Auditing causality of the multiple-burden of malnutrition in India and South Africa: a critical need for directions.

Developing economies are shaped by the current predicament of urbanisation and its impact on health is inevitable. In the post-pandemic times, India and South Africa witnessed a GDP growth rate of about 1·7 % and 1·9 %, respectively, while the developed economies like Europe and the USA have bounced back with more than 2 % GDP. The similarities and differences between India and South Africa provide potential candidates to study nutrition transition with the elements of urbanisation. In both countries, increased access to convenience foods is a consequence of the rapid expansion of small and medium enterprises, open international markets and expanding food supply chains. Also, there has been significant acculturation and people have moved away from traditional diets in these two countries. A spate of similar changes in the food environment is a telling sign of serious ill-health consequences in both countries. Generating evidence on causality is fundamental to informing policy. India and South Africa qualify as potential candidates to study the multiple burdens of malnutrition. Collaborating with different disciplines such as data sciences and capacitating analytic skills are key to progress in this direction.

Socio-demographic and economic determinants of household expenditure on eating out in India - Evidence from India Human Development Survey (IHDS) II.

Background: 'Eating out (EO)' has witnessed a significant increase across nations and in India. Understanding food behaviour from an economic standpoint is essential to recognize food systems and nutrition transition. Aim: Our work compared the macro-data on per capita income and gross state domestic product from India with household expenditure on eating out. Using the India Human Development Survey II micro-data we studied the socio-demographic and economic determinants of household expenditure on eating out. Methods: The study design is a secondary data analysis of India Human Development Survey II from a sample of N = 42,152 households. It included socio-demographic and economic predictors, such as religion, caste, residence, migration for work, education, number of household members, income source, total annual income, consumption expenditure and poverty status. Results: No consistent trends emerged in the macroeconomic comparisons using gross state domestic product and per capita income. Results of logistic regression showed that the reserved caste categories OBC [COR 1.2 (1.1-1.2)] and SC/ST/Others [COR 1.1 (1-1.1)], household heads education up to secondary [COR 0.4 (0.4-0.5)] and higher secondary and above [COR 0.7 (0.6-0.8)], urban place of residence [COR 0.55 (0.53-0.58)], organised sector [COR 0.7 (0.6-0.7)] as the income source, higher annual income [COR 0.52 (0.50-0.54)], higher annual consumption expenditure [COR 0.44 (0.42-0.46)] and above poverty line [COR 2.1 (1.9-2.2)] were significantly positively associated with expenditure on eating out (p = <0.05). All these variables stayed significant in the multinomial regression model as well. Conclusion: This analysis confirms the increase in household income along with other demographics, increases the frequency of eating out. However, such trends remained inconsistent in macroeconomic assessments using gross state domestic product and per capita income.

Pooled prevalence of food away from home (FAFH) and associated non-communicable disease (NCD) markers: a systematic review and meta-analysis.

BACKGROUND: Food away from home (FAFH) is an 'eating behavior' widely practiced across nations, more common in developed nations. Likewise, in developing countries an increase of close to 50% indicates an upsurge in FAFH consumption. While various indices and tools are used to assess diet quality, diversity, or healthy eating, FAFH is less utilized to study dietary behaviors and the associated disease risk. OBJECTIVE: To calculate the pooled estimate of FAFH and identify the associated non-communicable disease (NCD) markers. DESIGN: Systematic review and meta-analysis. METHODS: Independent electronic searches were conducted across 6 databases: Medline, Web of Science, Scopus, Cochrane library, Ingenta, and CAB direct. Observational studies investigating the association between FAFH and NCD markers published between the year 2011 and 2021 were eligible for inclusion. Studies that included overweight or obese participants, pregnant women, or those under institutional care at baseline were excluded. The guidelines for reporting meta-analysis of observational studies in epidemiology were adhered to in the preparation of this systematic review. RESULTS: The random effects combined estimate for the overall prevalence of FAFH was 39.96% (95% CI 29.97-53.29). High heterogeneity (τ2 = 0.63, I2 = 100%) and high risk of bias were observed among the selected studies. The test for overall effect was observed to be z = 25.11 (p < 0.001). Eleven out of fourteen studies showed a positive association between FAFH and anthropometric changes. Twelve out of seventeen studies showed a positive association between FAFH and cardiovascular disease (CVD) biomarkers. CONCLUSION: Our work confirms FAFH as an evolving dietary behavior in both developing and developed countries, emphasizing the lack of representation from low-income countries. The association of FAFH with obesity and non-communicable disease risk is reinforced by our analyses. These findings should enable policy decisions to meet the rising demand of FAFH with healthier options to prevent the risk of NCD.

Determinants of Anthropometric Failure Among Tribal Children Younger than 5 Years of Age in Palghar, Maharashtra, India.

BACKGROUND: Measuring undernutrition using composite index of anthropometric failure (CIAF) and identifying its determinants in tribal regions is essential to recognize the true burden of undernutrition in these settings. OBJECTIVE: To determine anthropometric failure and its determinants among tribal children younger than 5 years in Palghar, Maharashtra, India. METHODS: A cross-sectional survey employing CIAF was performed in children <5 years to estimate undernutrition in the tribal district of Palghar in Maharashtra, India. Anthropometric measurements, maternal and child characteristics were recorded from 577 mother-child pairs in 9 villages. RESULTS: As per Z score, prevalence of stunting, wasting, and underweight were 48%, 13%, and 43%, respectively. According to CIAF, 66% of children had at least one manifestation of undernutrition and 40% had more than one manifestation of undernutrition. Odds of anthropometric failure were 1.5 times higher among children of mothers who were illiterate (adjusted odds ratio [AOR] =1.57, 95% CI: 1.0-2.3), children who had birth weight >2.5 kg had lesser odds (AOR: 0.63, 95% CI: 0.4-0.9) of anthropometric failure, and children who had initiated early breastfeeding had 1.5 times higher odds of anthropometric failure (crude odds ratio: 1.5, 95% CI: 1.0-2.1). However, when adjusted for other independent variables, the results were not significant. CONCLUSION: The alarming proportion of anthropometric failure among tribal children calls for urgent short-term interventions to correct undernutrition and long-term interventions to improve maternal literacy and awareness to prevent and manage child undernutrition.

Water, sanitation and hygiene (WaSH) practices and diarrhoea prevalence among children under five years in a tribal setting in Palghar, Maharashtra, India.

Providing safe drinking water, sanitation and hygiene (WaSH) in geographically isolated settings is a global public health priority. Prevalence of WaSH practices among mothers and diarrhoea among their children (birth to 59 months) was studied in nine randomly selected tribal villages of Mokhada in Palghar, Maharashtra, India. A community-based cross-sectional survey among 577 mother-child pairs was performed. Participants were recruited from the anganwadi list of enrolled children through household visits. WaSH index was used for assessing WaSH practices. Well was the major (47%) drinking water source. Almost 70% treated and covered the stored drinking water. Nearly 75% of the mothers used soap for washing hands before food and 35% after defecation. Open drains and open defecation were observed in 99% and 50% of households, respectively. The median score for drinking water index was 3 (interquartile range (IQR) = 2), personal hygiene index (PHI) was 2 (IQR = 2), household hygiene index (HHI) was 2 (IQR = 1) and composite index (CI) was 6 (IQR = 2). Prevalence of diarrhoea among children was found to be 33.4% and was significantly associated with poor HHI (p = .007), PHI (p < .001) and CI (p < .001). Measures to provide basic WaSH resources combined with efforts to create awareness would ensure improved WaSH practices and prevent diarrhoea.