Assessing the prevalence and predictors of anemia among pregnant women in India: findings from the India National Family Health Survey 2019-2021.

BACKGROUND: Anemia is more prevalent in low- and middle-income countries including India. Anemia in pregnancy is associated with increased risk of maternal health problems and adverse birth outcomes. This study estimates the prevalence and associated risk factors of anemia among pregnant women in India. METHODS: This cross-sectional study is based on secondary data from the India National Family Health Survey-V (NFHS-5) conducted during 2019-2021. We extracted data of 27,317 currently pregnant women to estimate the prevalence and contributory factors associated with anemia using descriptive statistics and logistic regression analysis. RESULTS: The prevalence of anemia among pregnant women in India was 52.2%. Anemia was higher among adolescent women (61.5%), those with no education (59.2%), those belonging to poorest wealth index (61.9%), scheduled tribes (59.3%), and those from the eastern region of India (62.1%). Further, it was more prevalent among women with a habit of smoking, tobacco, or alcohol (63.0%), and women with shorter birth intervals (59.7%). Among Indian states, anemia prevalence was higher in the state of Bihar (63.1%) and the union territory of Ladakh (71.4%). Logistic regression models show that women with no education (aOR = 1.41, 95% CI = 1.27-1.57), belonging to a poorest wealth quintile (aOR = 1.69, 95% CI = 1.51-1.90), and those with a habit of smoking, tobacco, or alcohol (aOR = 1.39, 95% CI = 1.18-1.63) were more anemic than their counterparts. Additionally, women with no education showed a four-times higher risk of severe anemia (aOR = 4.79, 95% CI = 2.75-8.36) than their highly educated counterparts. CONCLUSION: Anemia affects half of all pregnant women in India. Anemia prevalence is higher among adolescents, illiterate, poor, and tribal communities. Social norm-based interventions and strengthening the community health facilitators should be implemented to reduce the high burden of anemia in India.

Anemia in pregnancy increases the risk of maternal and new-born health problems that lead to unfavorable pregnancy outcomes. This study aimed to find the current proportion and factors influencing anemia among currently pregnant Indian women. This study analyzed the data of 27,317 currently pregnant women reported with hemoglobin levels to find the prevalence and contributing factors of anemia. The study revealed that about 52.2% of pregnant women suffer from anemia inclusive of 1.4% with severe anemia. The anemia proportion was higher in women living in the eastern region of India, the poorest households, teenage pregnant women, and women with no formal education. Severity was higher in women belonging to the poorest households, tribal groups, and those with a habit of smoking, tobacco, or alcohol. Further, women with no formal education were four-times more likely to have a risk of severe anemia during their pregnancy. Maternal anemia hampers the growth and development of the newborns. Thereby, anemia adds a huge burden to the nation's economy and health system. High rates of anemia among pregnant women could be a probable factor linked to the higher rate of maternal and child health illness and death in the eastern region, poorest strata, and other vulnerable populations in India. Special attention needs to be focused to ensure that these populations have easy access to healthy nutrition and the best public health systems.

Factors associated with stigma and manifestations experienced by Indian health care workers involved in COVID-19 management in India: A qualitative study.

Healthcare personnel who deal with COVID-19 experience stigma. There is a lack of national-level representative qualitative data to study COVID-19-related stigma among healthcare workers in India. The present study explores factors associated with stigma and manifestations experienced by Indian healthcare workers involved in COVID-19 management. We conducted in-depth interviews across 10 centres in India, which were analysed using NVivo software version 12. Thematic and sentiment analysis was performed to gain deep insights into the complex phenomenon by categorising the qualitative data into meaningful and related categories. Healthcare workers (HCW) usually addressed the stigma they encountered when doing their COVID duties under the superordinate theme of stigma. Among them, 77.42% said they had been stigmatised in some way. Analyses revealed seven interrelated themes surrounding stigma among healthcare workers. It can be seen that the majority of the stigma and coping sentiments fall into the mixed category, followed by the negative sentiment category. This study contributes to our understanding of stigma and discrimination in low- and middle-income settings. Our data show that the emergence of fear of the virus has quickly turned into a stigma against healthcare workers.

High-risk pregnancy in India: Prevalence and contributing risk factors - a national survey-based analysis.

Background: High-risk pregnancies (HRP) place women and their offspring at the highest risk for morbidity and mortality. Maternal and medical risks increase pregnancy risk and complications during pregnancy and childbirth. Here, we reported the current prevalence of high-risk pregnancies among Indian women, which is defined through various factors such as maternal, lifestyle, medical, current health risk and adverse birth outcomes. Methods: This is a cross-sectional study based on secondary data from India's National Family Health Survey-5 (NFHS-5). A total of 23 853 currently pregnant women were considered for analysis after considering the inclusion and exclusion criteria. The prevalence and contributing factors of high-risk pregnancies were estimated using descriptive statistics and logistic regression, respectively. Results: The prevalence of high-risk pregnancies among Indian women was 49.4%, with 33% of women having a single high-risk, and 16.4% having multiple high-risk pregnancies. Notably, pregnant women from Meghalaya and Manipur states had 67.8% and 66.7% with one or more high-risk factors, respectively. About 31.1% of women had short birth spacing, and 19.5% of women had adverse birth outcomes during the last birth. Logistic regression analysis showed that women with no education (adjusted odds ratio (AOR) = 2.02; 95% confidence interval (CI) = 1.84-2.22) and the poorest wealth quintile (AOR = 1.33; 95% CI = 1.04-1.29) had significantly higher odds of having HRP than those with higher education and the highest wealth quintile, respectively. Conclusions: Nearly half of all pregnancies in India have one or more high-risk factors, which is a matter of concern, and the risks were higher among the vulnerable population such as no educated, poorest groups etc. The leading high-risk factors such as short-birth spacing, adverse birth outcomes, and caesarean deliveries should be addressed through the health policy and programmes.

Association between intimate partner violence and nutritional status among Indian women: a latent class analysis approach.

BACKGROUND: Intimate partner violence (IPV) is an unabating public health issue that has numerous negative repercussions for women's health. Its detrimental impact on women's nutritional outcomes has been documented in a few studies from low- and middle-income countries; however, there is a lack of granular understanding in terms of the typology of IPV experiences and their association with nutritional outcomes. This study explores the distinct classes of IPV experience among women in India and examines how these classes are associated with their nutritional outcomes. METHODS: Using data of 60,622 ever-married women aged 15-49 years from the 2019-21 National Family Health Survey (NFHS-5), latent class analysis (LCA) was performed to identify distinct groups of women based on their IPV experiences. BMI was used to assess women's nutritional status, and it was classified as: <18.5 kg/m2 (underweight), 18.5-24.9 kg/m2 (normal) and ≥ 25.0 kg/m2 (overweight). Further, multinomial logistic regression analyses were used to estimate the odds of being underweight or overweight by latent classes of IPV experiences. RESULTS: LCA model identified four distinct IPV experience groups of women: Low Physical and Low Sexual IPV (LPLS-IPV) class (72%); High Physical and Low Sexual IPV (HPLS-IPV) (12.5%); High Sexual and Low Physical IPV (HSLP-IPV) (12%); and High Physical and High Sexual (HPHS-IPV) class (3.5%). The likelihood of being underweight was higher among women in the HPHS-IPV class (aOR: 1.24, 95% CI: 1.08-1.44), followed by those in the HPLS-IPV class (aOR: 1.11, 95% CI: 1.04-1.20). CONCLUSION: The latent class groups found that high physical IPV experiences were associated with women's nutritional outcomes. The experiences of women having both high physical and sexual violence affect women's nutritional outcomes to a greater extent and they are more likely to be undernourished.

Pregnancy outcomes among Indian women: increased prevalence of miscarriage and stillbirth during 2015-2021.

BACKGROUND: Pregnancy outcome is an important health indicator of the quality of maternal health. Adverse pregnancy outcomes is a major public health problem, which can lead to poor maternal and neonatal outcomes. This study investigates the trends in pregnancy outcomes prevalent during 2015-2021 in Indian women. METHODS: The study analysed the data presented in the fourth (2015-16) and fifth (2019-21) rounds of National Family Health Survey (NFHS). The absolute and relative changes in the birth outcomes of last pregnancy during the five years preceding the surveys were estimated using data collected from 195,470 women in NFHS-4 and from 255,549 women in NFHS-5. RESULTS: Livebirth decreased by 1.3 points (90.2% vs. 88.9%), and nearly half of the Indian states/UTs (n = 17/36) had lower than the national average of livebirth (88.9%) reported during 2019-21. A higher proportion of pregnancy loss was noted, particularly miscarriages increased in both urban (6.4% vs. 8.5%) and rural areas (5.3% vs. 6.9%), and stillbirth increased by 28.6% (0.7% vs. 0.9%). The number of abortions decreased (3.4% vs. 2.9%) among Indian women. Nearly half of the abortions were due to unplanned pregnancies (47.6%) and more than one-fourth (26.9%) of abortions were performed by self. Abortions among adolescent women in Telangana was eleven times higher during 2019-21 as compared to 2015-16 (8.0% vs. 0.7%). CONCLUSION: Our study presents evidence of a decrease in the livebirth and an increase in the frequency of miscarriage and stillbirth among Indian women during 2015-2021. This study emphasises that there is a need of regional-specific, comprehensive and quality maternal healthcare programs for improving livebirth among Indian women.

Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled "Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas," conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. OBJECTIVE: This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19-affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. METHODS: In-depth interviews will be conducted with clients-women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services-and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19-affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. RESULTS: Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. CONCLUSIONS: The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43329.

National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: A study protocol.

BACKGROUND: Snakebite envenoming (SBE) is an acute, life-threatening emergency in tropical and subtropical countries. It is an occupational hazard and a major socioeconomic determinant. Limited awareness, superstitions, lack of trained health providers, poor utilization of anti-venom results in high mortality and morbidity. India is the snakebite capital of the world. Yet, information on awareness, knowledge, and perceptions about snakebite is limited. Data on capacity building of health systems and its potential impact is lacking. Recommended by the National Task Force on snakebite research in India, this protocol describes the National Snakebite Project aiming for capacity building of health systems on prevention and management of snakebite envenomation in Maharashtra and Odisha states. METHODS: A cross-sectional, multi-centric study will be carried out in Shahapur, Aheri blocks of Maharashtra, and Khordha, Kasipur blocks of Odisha. The study has five phases: Phase I involves the collection of retrospective baseline data of snakebites, facility surveys, and community focus group discussions (FGDs). Phase II involves developing and implementing educational intervention programs for the community. Phase III will assess the knowledge and practices of the healthcare providers on snakebite management followed by their training in Phase IV. Phase V will evaluate the impact of the interventions on the community and healthcare system through FGDs and comparison of prospective and baseline data. DISCUSSION: The National Snakebite Project will use a multi-sectoral approach to reduce the burden of SBE. It intends to contribute to community empowerment and capacity building of the public healthcare system on the prevention and management of SBE. The results could be useful for upscaling to other Indian states, South Asia and other tropical countries. The findings of the study will provide critical regional inputs for the revision of the National Snakebite Treatment protocol. TRIAL REGISTRATION: Registered under the Clinical Trials Registry India no. CTRI/2021/11/038137.

Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India.

BACKGROUND/OBJECTIVES: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. METHODS: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. RESULTS: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. CONCLUSIONS/RECOMMENDATIONS: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.

Missing men in family planning: understanding the socio-spatial differentials in male sterilization and male spacing methods of contraception in India.

Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992-93 (3.5%) to 2015-16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43-1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44-9.38), north-eastern (aOR: 11.37, 95% CI: 10.62-12.18), eastern (aOR: 6.96, 95% CI: 6.60-7.34), western (aOR: 4.65, 95% CI: 4.40-4.92) and central (aOR: 10.89, 95% CI: 10.35-11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.

Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study.

BACKGROUND: COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. METHODS: A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. RESULTS: Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66-3.41), income≥20000(AOR = 1.74, 95% CI, (1.16-2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09-2.46), contact tracing (AOR = 2.05, 95% CI (1.1-3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14-6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28-2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). CONCLUSION: The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Socio-biomedical predictors of child nutrition in India: an ecological analysis from a nationally representative Demographic and Health Survey, 2015-2016.

BACKGROUND: Despite significant economic growth and development, undernutrition among children remains a major public health challenge for low- and middle-income countries in the twenty-first century. In Millennium Development Goals, India committed halving the prevalence of underweight children by 2015. This study aimed to explain the geographical variation in child malnutrition level and understand the socio-biomedical predictors of child nutrition in India. METHODS: We used the data from India's National Family Health Survey 2015-2016. The survey provided estimates of stunting, wasting, and underweight at the national, state, and district level to measure nutritional status of under-five children. Level of stunting, wasting and underweight at the district level are considered as outcome variables. We have used variance inflation factor to check the multicollinearity between potential predictors of nutrition. In this study, we performed spatial analysis using ArcGIS and multiple linear regression analysis using Stata version 15. RESULTS: Five states (Uttar Pradesh, Bihar, Madhya Pradesh, Jharkhand and Meghalaya) had very high prevalence of stunting (40% and above). High prevalence of wasting was documented in Jharkhand, Madhya Pradesh, Chhattisgarh, and Karnataka (23 to 29%). Jharkhand, Madhya Pradesh, Maharashtra, and Chhattisgarh had the highest proportion of underweight children in the country. We found that electricity and clean fuel use in the household, use of iodized salt, and level of exclusive breastfeeding had significantly negative influence on the stunting level in the districts. The use of iodized salt has similar effect on the wasting status of under-five children in the districts (b: - 0.27, p < 0.10). Further, underweight level had a negative association with clean fuel use for cooking (b: - 0.17, p < 0.01), use of iodized salt (b: - 0.36, p < 0.10), breastfeeding within one hour (b: - 0.18, p < 0.10), semisolid/solid food within 6-8 months (b: - 0.11, p < 0.05) and Gross Domestic Product of the districts (b: - 0.53, p < 0.10). CONCLUSION: In the study, a variety of factors including electricity and clean fuel use in the household, use of iodized salt, level of exclusive breastfeeding, breastfeeding within one hour, semisolid/solid food within 6-8 months and Gross Domestic Product of the districts have a significant association with nutritional status of children.

Psychosocial impact of COVID-19 pandemic on healthcare workers in India & their perceptions on the way forward - A qualitative study.

Background & objectives: The healthcare system across the world has been overburdened due to the COVID-19 pandemic impacting healthcare workers (HCWs) in different ways. The present study provides an insight into the psychosocial challenges faced by the HCWs related to their work, family and personal well-being and the associated stigmas. Additionally, the coping mechanisms adopted by them and their perceptions on the interventions to address these challenges were also explored. Methods: A qualitative study was conducted between September and December 2020 through in-depth telephonic interviews using an interview guide among 111 HCWs who were involved in COVID-19 management across 10 States in India. Results: HCWs report major changes in work-life environment that included excessive workload with erratic timings accentuated with the extended duration of inconvenient personal protection equipment usage, periods of quarantine and long durations of separation from family. Family-related issues were manifold; the main challenge being separated from family, the challenge of caregiving, especially for females with infants and children, and fears around infecting family. Stigma from the community and peers fuelled by the fear of infection was manifested through avoidance and rejection. Coping strategies included peer, family support and the positive experiences manifested as appreciation and recognition for their contribution during the pandemic. Interpretation & conclusions: The study demonstrates the psychological burden of HCWs engaged with COVID-19 care services. The study findings point to need-based psychosocial interventions at the organizational, societal and individual levels. This includes a conducive working environment involving periodic evaluation of the HCW problems, rotation of workforce by engaging more staff, debunking of false information, community and HCW involvement in COVID sensitization to allay fears and prevent stigma associated with COVID-19 infection/transmission and finally need-based psychological support for them and their families.

Differential impact of COVID-19 in pregnant women from high-income countries and low- to middle-income countries: A systematic review and meta-analysis.

BACKGROUND: SARS-CoV-2 has infected a large number of pregnant women. OBJECTIVE: To compare clinical, perinatal outcomes of women with COVID-19 from high-income countries (HICs) and low- to middle-income countries (LMICs). SEARCH STRATEGY: Online databases were searched. SELECTION CRITERIA: Original studies on pregnant women with COVID-19 were included. DATA COLLECTION AND ANALYSIS: Information on clinical presentation, co-morbidities, pregnancy outcomes, neonatal outcomes, and SARS-CoV-2 infection in neonates was extracted. MAIN RESULTS: The pooled estimate of SARS-CoV-2 positive neonates is 3.7%. Symptomatic presentations are less common in LMICs compared to HICs (odds ratio [OR] 0.38). Diabetes (OR 0.5), hypertension (OR 0.5), and asthma (OR 0.14) are commonly reported from HICs; hypothyroidism (OR 2.2), anemia (OR 3.2), and co-infections (OR 6.0) are commonly reported in LMICs. The overall risk of adverse pregnancy outcomes is higher in LMICs compared to HICs (OR 2.4). Abortion (OR 6.2), stillbirths (OR 2.0), and maternal death (OR 7.8) are more common in LMICs. Preterm births and premature rupture of membranes are comparable in both groups. Neonatal deaths (OR 3.7), pneumonia (OR 7.5), and neonatal SARS-CoV-2 infection (OR 1.8) are commonly reported in LMICs. CONCLUSIONS: In LMICs, pregnant women and neonates are more vulnerable to adverse outcomes due to COVID-19. PROSPERO registration no: CRD42020198743.

Increasing breast cancer awareness and breast examination practices among women through health education and capacity building of primary healthcare providers: a pre-post intervention study in low socioeconomic area of Mumbai, India.

OBJECTIVES: The present study aimed to improve breast cancer (BC) awareness and practices using Information, Education and Communication (IEC) modules and health educational sessions for women and primary healthcare providers in low socioeconomic community of Mumbai. DESIGN: Pre-post quasi-experimental design. SETTING: The study was conducted in a lower socioeconomic area of G-South ward of Mumbai, Maharashtra. The baseline and endline survey was conducted using structured interview schedules. PARTICIPANTS: 410 women were selected, aged between 18 and 55 years who were not pregnant, lactating or diagnosed with BC. INTERVENTION: A health education-based intervention module was developed to educate women through group and individual sessions. OUTCOMES: Summative indices were constructed to understand the net mean difference in knowledge of signs, symptoms and risk factors. Analysis of variance (ANOVA) and paired t-test were used to check the significant improvement of intervention. RESULTS: Our results showed statistical significance in difference in mean knowledge scores for both signs and symptoms (mean difference (MD) 4.09, SD 4.05, p<0.00)) and risk factors of BC knowledge (MD 5.64, SD 4.00, p<0.00) among women after intervention. There was a marked improvement in the knowledge of BC among women with low education category. A significant improvement in knowledge of symptoms and risk factors among health workers was also observed. Our interventions resulted in positive change in breast examination practices. The breast self-examination (BSE) practices improved from around 3% to 65% and around 41% additional women went for clinical breast examination after intervention. CONCLUSIONS: This study found a significant improvement in knowledge of BC signs and symptoms, risk factors and BSE practices among study participants following our health education interventions among these subpopulations. This evidence calls for inclusion of similar interventions through health education and capacity building of primary healthcare providers in national programmes.

Self Reported Health Status and its Determinants among Elderly Widows in Puducherry, India.

BACKGROUND: Aging of population is a worldwide phenomenon of the 21st century, which leads to many socioeconomic consequences including their health status. Hence, this study tries to assess the self-reported health status (SRHS) of elderly widows (60+ years) and its principal determinants. MATERIALS AND METHODS: A cross-sectional study was conducted among 360 elderly widows from Puducherry district, 260 urban and 130 from rural areas. The sociodemographic information and the self-rated health status of elderly widows were collected with semi-structured interview schedule. Data were analyzed adopting descriptive statistics and multivariate analysis making use IBM-SPSS software 22 version. RESULTS: Thirty-seven percent each of the elderly widows felt to be in "fair" and "good" health status, respectively, whereas 26% of them stated to be living with "poor" health status. Results of multinomial regression analysis showed that multinomial regression analysis showed that the odds of "poor" and "fair" SRHS (as against "good" SRHS) of elderly widows are conspicuously higher among those who are suffering from 2 or more chronic morbidities, whereas such odds are significantly lower among those who have 2 or more sons, educated up to middle school level and above, and who have higher functional ability. Urban residence, middle-old ages (66-76), and moderate monthly family income (Rs. 3001-9000) have also exhibited some net effects on the "poor" and/or "fair" SRHS of elderly widows. CONCLUSION: Chronic morbidity, having son(s), education, economic status, functional ability, and urban residence are found to be the major determinants of the SRHS among elderly widows.

Knowledge of symptoms and risk factors of breast cancer among women: a community based study in a low socio-economic area of Mumbai, India.

BACKGROUND: Breast cancer (BC) is leading cancer among women in India accounting for 27% of all cancers among women. Factors that make the policymakers and public health system worried are rising incidence of breast cancer in India and more importantly high death rates among breast cancer patients. One of the leading causes of high breast cancer deaths is lack of awareness and screening leading to the late presentation at an advanced stage. Therefore, the current research aimed to understand the knowledge of breast cancer symptoms and risk factors among women in a low socio-economic area of Mumbai. METHODS: A cross-sectional study was conducted at Prabhadevi, Mumbai and primary data was collected from 480 women aged 18-55 years. Structured questionnaire was used to collect quantitative data pertaining to awareness, signs and symptoms of breast cancer. Bivariate and multivariate regression techniques were used for understanding of the socio-demographic differentials in breast cancer awareness among women. RESULTS: The study found that around half (49%) of the women were aware of breast cancer. The women who were aware of breast cancer considered lump in breast (75%), change in shape and size of breast (57%), lump under armpit (56%), pain in one breast (56%) as the important and common symptoms. Less than one-fifth of the women who were aware of breast cancer reported early menstruation (5.6%), late menopause (10%), hormone therapy (13%), late pregnancy (15%) and obesity (19%) as the risk factors for breast cancer. The multivariate regression analysis showed women who had more than 10 years of schooling (Adjusted Odds Ratio: 3.93, CI: 2.57-6.02, P < 0.01) were about 4 times more likely to be aware of breast cancer than women who had less than 10 years of schooling. CONCLUSION: In conclusion, knowledge of danger signs and risk factors of breast cancer were low among women in the community. This may lead to late detection of breast cancer among women in the community. Therefore, the study calls for advocacy and larger intervention to enhance knowledge of breast cancer among women in the particular region with a special reference to women with low education.

Predictors of hysterectomy among married women 15-49 years in India.

BACKGROUND: In India, community based studies and media reports indicate a surge in the number of young women undergoing hysterectomy in the past few years. This has led to suspicion on the misuse of procedure, and intense debates on its potential ill health-effects on young women. However, there are no population-based studies that provide insights into hysterectomy prevalence and its determinants at the national level. DATA AND METHODS: This study used data from India's District Level Household Survey that involved a sample of 3, 16,361 married women in the age group of 15-49 years spread across 21 States and Union Territories of India. Bivariate and multivariate regression analysis was performed to estimate hysterectomy prevalence and identify its predictors. RESULTS: The study estimated hysterectomy prevalence of 17 per 1000 ever married women. The number of women undergoing hysterectomy ranged from 2 to 63/1000 across different states. A little more than one-third of women who had undergone hysterectomy were under the age of 40 years. The proportion of women below 40 years of age who had had hysterectomy was much higher in southern states of Andhra Pradesh (42%) and Telangana (47%). The likelihood of hysterectomy was higher among women belonging to households with health insurance (OR: 1.88, CI: 1.77-2.00) and women who were sterilized (OR 1.55; CI 1.45-1.67) than uninsured and unsterilized women, and lower among women with education level of matriculation and above (OR 0.47; CI 0.42-0.50) than those with no and/or low education. CONCLUSIONS: A sizable proportion of young women undergoing hysterectomy in India may have severe ill-health effects on their physical, reproductive and socio-psycho health. As women with low or no education are also more prone to hysterectomy, providing more information and education to them on the possible after-effects of hysterectomy and alternative options will enable them to make more informed choices.

Use of contraceptives and unmet need for family planning among tribal women in India and selected hilly states.

The paper provides a comprehensive picture of knowledge and use of contraceptives among scheduled tribes of India and selected central hilly states where tribal population contributes more than 30% of the total tribal population of the country. An attempt is also made to know how far scheduled tribes differ from non-tribes in the states, namely Jharkhand, Madhya Pradesh, and Chhattisgarh, using information collected in the third round of District-level Household Survey (DLHS-RCH III: 2007-2008). Bivariate analysis was used for understanding the level of knowledge, use of and unmet need for contraception among different tribal and non-tribal groups. Binary logistic regression was used for understanding the factors associated with the use of contraception and unmet need for family planning among tribal women. Knowledge and use of temporary contraceptive methods are considerably lower among tribal women compared to their non-tribal counterparts in the three states under study. Low acceptance due to phobia of adverse health consequences, accessibility to and lack of sound knowledge of contraception are the leading reasons for not using contraceptives. The unmet need for family planning among them was quite high, especially in the state of Jharkhand. Multivariate analysis substantiated the role of women and husbands' education, age of women, and number of surviving boys in the use of any modem method of contraception. Educating women and their respective husbands about proper use and benefits of modem contraceptives is important to solve the problem of high unmet need for family planning among these tribal women. A simultaneous attention to the health systems strengthening component is crucial for ensuring sustained delivery of good-quality family planning services.

Socioeconomic dynamics of gender disparity in childhood immunization in India, 1992-2006.

BACKGROUND: Recent evidence indicated that gender disparity in child health is minimal and narrowed over time in India. However, considering the geographical and socio-cultural diversity in India, the gender gap may persist across disaggregated socioeconomic context which may be masked by average level. This study examines the dynamics of gender disparity in childhood immunization across regions, residence, wealth, caste and religion in India during 1992-2006. METHOD: We used multi-waves of the cross-sectional data of National Family Health Survey conducted in India between 1992-93 and 2005-06. Gender disparity ratio was used to measure the gender gap in childhood immunization across the selected socioeconomic characteristics. Multinomial regression analysis was used to examine the gender gap after accounting for other covariates. RESULT: Results indicate that, at aggregate level, gender disparity in full immunization is minimal and has stagnated during the study period. However, gender disparity--disfavouring female children--becomes apparent across the regions, poor households, and religion--particularly among Muslims. Adjusted gender disparity ratio indicates that, full immunization is lower among female than male children of the western region, poor household and among Muslims. Between 1992-93 and 2005-06, the disparity in full immunization had narrowed in the northern region whereas it had, astonishingly, increased in some of the western and southern states of the country. CONCLUSION: Our findings emphasize the need to integrate gender issues in the ongoing immunization programme in India, with particular attention to urban areas, developed states, and to the Muslim community.

Overweight and obesity among women by economic stratum in urban India.

Using data of the third round of the National Family Health Survey (NFHS) 2005-2006, this study examined the prevalence of overweight and obesity among women from different economic strata in urban India. The study used a separate wealth index for urban India constructed using principal components analysis (PCA). The result shows that prevalence of overweight and obesity is very high in urban areas, more noticeably among the non-poor households. Furthermore, overweight and obesity increase with age, education, and parity of women. The results of multinomial logistic regression show that non-poor women are about 2 and 3 times more at risk of being overweight and obese respectively. Marital status and media exposure are the other covariates associated positively with overweight and obesity. Thus, the growing demand which now appears before the Government or urban health planners is to address this rising urban epidemic with equal importance as given to other issues in the past.