Measuring the financial impact of disabilities in India (an analysis of national sample survey data).

BACKGROUND: People with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types. AIM: The present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India. METHODS: Data for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates. RESULTS: The finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure. CONCLUSION: The study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.

Intersectional Inequalities in Anthropometric Failure among Indian Children: Evidence from the National Family Health Survey (2015-2016).

Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children.More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.

Spatio-temporal modeling for malnutrition in tribal population among states of India a Bayesian approach.

Exploring Bayesian spatio-temporal methods to analyze spatial dependence in malnutrition at the state level for tribal children (less than 3 years) population of India and change over time (three rounds of NFHS-2(1998-99),3(2005-06) and 4(2015-16)). The Bayesian model, fitted by Markov chain Monte Carlo simulation using OpenBUGS, for spatial autocorrelation (through spatial random effects modeling). The model estimated (1) mean time trend and (2) spatial random effects. Results of spatio-temporal modeling for stunting, wasting and underweight exhibited a declining mean trend across the study region from NFHS-2 to NFHS-4. Spatial random effects exhibited spatial dependence for various states in stunting, wasting and underweight tribal children. Future research should analyze spatio-temporal distribution for malnutrition at district level which will require NFHS-5 data. Also, analysis can be done capturing spatio-temporal interaction and identifying hot spots and cold spots at district level.

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

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

Does family life education influence attitudes towards sexual and reproductive health matters among unmarried young women in India?

INTRODUCTION: Inadequate efforts towards meeting the sexual and reproductive health needs of adolescents and young people, who disproportionately share the burden of unwanted pregnancies, poor maternal and child health outcomes, risks of RTI/STI and HIV/AIDS, increase the risk of losing much of the progress made towards the Millennium Development Goals over the last decade, particularly in the context of low-and-middle-income countries like India. DATA AND METHODS: Using the nationally representative data on 160551 unmarried young women aged 15-24 years from the District Level Reproductive and Child Health Survey (DLHS: 2007-2008) in India, this research evaluated the demographic and socioeconomic differentials in the access to family life/sex education (FLE) among youth in India. Using the adjusted multiple logistic regression models, the association between access to family life/sex education and attitudes towards a range of sexual and reproductive health matters among young unmarried Indian women were investigated. RESULTS: Less than half of the unmarried young women had received some form of FLE (48 percent) in India. However, there were substantial demographic and socioeconomic variations in their access to FLE, as relatively less educated women from the poorest wealth quintiles, religious and social minorities (Muslims, Scheduled Castes/Scheduled Tribes) were significantly less likely to receive FLE as compared to other women. Importantly, the likelihood of holding favourable/positive attitudes towards reproductive processes, knowledge and discussion of contraceptive methods, precise awareness about the transmission pathways of RTIs/STIs and HIV/AIDS was significantly higher among those women in India who had access to FLE. CONCLUSION: The present research underscores the protective role of family life education towards improving the sexual and reproductive life experiences of young people. It further underscores the vital need to implement a comprehensive and culturally appropriate programme of family life education in order to meet the sexual and reproductive health demands of the adolescents and young people in India.

Do tribal children experience elevated risk of poor nutritional status in India? A multilevel analysis.

Economic progress in India over the past three decades has not been accompanied by a commensurate improvement in the nutritional status of children, and a disproportionate burden of undernutrition is still focused on socioeconomically disadvantaged populations in the poorest regions. This study examined the nutritional status of children under 3 years of age using data from the fourth round of Indian National Family Health Survey conducted in 2015-2016. Child undernutrition was assessed in a sample of 126,431 under-3 children using the anthropometric indices of stunting, underweight and wasting ('anthropometric failure') across 640 districts, 5489 primary sampling units and 35 states/UTs of India. Descriptive statistics were used to examine the regional pattern of childhood undernutrition. Multilevel logistic regression models were fitted to examine the adjusted effect of social group (tribal vs non-tribal) and economic, demographic and contextual factors on the risks of stunting, underweight and wasting accounting for the hierarchical nature of the data. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and social group (tribal vs non-tribal) with the likelihood of anthropometric failure among children. The burden of childhood undernutrition was found to vary starkly across social, economic, demographic and contextual factors. Interaction effects demonstrated that tribal children from economically poorer households, with less-educated mothers, residing in rural areas and living in the Central region of India had elevated odds of anthropometric deprivation than other tribal children. The one-size-fits-all approach to tackling undernutrition in tribal children may not be efficient and could be counterproductive.

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

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

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

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

Youth in India ready for sex education? Emerging evidence from national surveys.

CONTEXT: Sex education/family life education (FLE) has been one of the highly controversial issues in Indian society. Due to increasing incidences of HIV/AIDS, RTIs/STIs and teenage pregnancies, there is a rising need to impart sex education. However, introducing sex education at school level always received mixed response from various segments of Indian society. DATA AND METHODS: We attempt to understand the expectations and experiences of youth regarding family life education in India by analysing the data from District Level Household and Facility Survey (DLHS-3: 2007-08) and Youth Study in India (2006-07). We used descriptive methods to analyse the extent of access to FLE and socio demographic patterning among Indian youth. RESULTS AND DISCUSSIONS: We found substantial gap between the proportion of youth who perceived sex education to be important and those who actually received it, revealing considerable unmet need for FLE. Youth who received FLE were relatively more aware about reproductive health issues than their counterparts. Majority among Indian youth, irrespective of their age and sex, favoured introduction of FLE at school level, preferably from standard 8(th) onwards. The challenge now is to develop a culturally-sensitive FLE curriculum acceptable to all sections of society.