Nutritional status of infants and young children in India across three decades: Analysis of five national family health surveys.

BACKGROUND: Three indicators of early childhood undernutrition and associated factors are evaluated among under-5 children in five National Family Health Surveys in India spanning 1992 to 2021. METHODS: Data for 533,495 children under 5 years of age (U-5) were analysed in the context of three commonly used indicators of early childhood undernutrition - wasting, stunting and underweight. In addition to descriptive and inferential statistics, binary logistic regression was used to estimate the effects of specific explanatory factors on the three indicators using adjusted odds ratios. RESULTS: Over the three-decade interval, stunting was reduced by 22.1% in boys and 20.9% in girls, followed by underweight, 19.3% in boys and 17.4% in girls; wasting, in contrast, was reduced to a considerably lesser extent, 2.8% in boys and 0.9% in girls. Demographic, maternal and socioeconomic factors were associated with the incidence of early childhood undernutrition, specifically among young mothers and those with less education in low-income families, and among children from Scheduled Tribes or Scheduled Castes. Stunting and underweight declined significantly over the past three decades while wasting changed negligibly. The disparity in the occurrence of early childhood undernutrition was apparent throughout socioeconomic categories and regions of India. CONCLUSIONS: The results highlight the need for special programs aimed at reducing waste among children and also the need for customized initiatives focused on the improvement of maternal education and wealth in addition to other ancillary factors related to regional variation.

Variation in body size and weight status among Hindu and Muslim Indian males born in the 1890s through the 1950s.

Hindus and Muslims represent the two largest religions in India, and also differ in nutritional status, health-related habits and standard of living associated with economic disparities. In this context, the present study considered estimated secular changes in body size, proportions, and weight status among Hindu and Muslim Indian men. The data are from anthropological surveys in the 1970s which included measurements of height, weight and sitting height of 43,950 males 18-84 years (birth years 1891-1957). Leg length was estimated; the BMI and sitting height/height ratio were calculated. Heights of men 35 + years were adjusted for estimated height loss with age. Weight status was also classified relative to WHO criteria for the BMI. Anthropometric characteristics of the two groups were compared with MANCOVA with age and geographic region as covariates. Linear regression of height on year of birth was also used to estimate secular change in each group. Heights, weights, and BMIs tended to be, on average, greater among Muslim than Hindu men at most ages, while distributions by weight status between groups were negligible. Sitting height was greater among Muslim men but estimated leg length did not differ between groups; the sitting height/height ratio thus suggested proportionally shorter legs among Muslim men. Results of the regression analyses indicated negligible differences in secular change between groups across the total span of birth years but indicated a decline in adjusted heights of men in both groups born between 1891 through 1930s and little secular change among those born in the 1930s through 1957. The variation in heights, weights and BMIs between Muslim and Hindu men at most ages suggested variation in socio-economic status and dietary habits between the groups, whereas the negligible estimated secular changes in height between groups likely reflected economic, social, and nutritional conditions during the interval of British rule and the transition to independence.

Regional variation in body size and estimated secular change among adult Indian males born in the 1890s-1950s.

Regional variation in the body size of Indian men 18-84 years of age (birth years 1891-1957) was considered. Heights, weights, and BMIs of Indian males from four regions of the country - North, East-Northeast, Central, and West were compared. Heights of men 35+ years of age were adjusted for estimated height loss with age; the estimate was added to observed height to provide an estimate of maximum height. Linear regressions of measured height and estimated maximum height on year of birth were used to evaluate secular change by region. Differences in measured and estimated maximum heights and weight among regions were significant in all age groups, while differences in the BMI were significant in all age groups except 55+ years. Men from the North region were tallest and those from the East-Northeast region were shortest, while body weight and the BMI varied among regions. Regression analyses of year of birth on measured and estimated maximum heights indicated small differences in estimates of secular change among regions but suggested a decline in estimated maximum heights with age among men in the four regions born in 1891 through the 1930s, and small but variable estimates of secular change in heights among men born in the 1930s through 1957. The variation likely reflected socio-economic disparities and ecological differences among regions, and by inference nutritional status though data are limited.

The determinants of COVID-19 vaccination intention: a meta-review.

Background: A large number of systematic reviews have been published that synthesized various determinants of COVID-19 vaccination intention (CVI). However, they reported inconsistent evidence. Therefore, we conducted a meta-review (systematic review of systematic reviews) to provide a comprehensive synthesis of factors influencing CVI. Methods: This meta-review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched for systematic reviews published from 2020 to 2022 that examined the determinants of CVI. AMSTAR-2 critical appraisal tool was used to ensure the quality of included reviews, and ROBIS tool was used to evaluate the risk of bias. Results: Globally, the average rate of COVID-19 vaccination intention was 56.97%. We identified 21 main determinants of CVI: socio-demographic, geographical location, social, political, government role, study timeline, attitude, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and perceived behavioral control, norms, trust, conspiracy theory/propaganda/misinformation, knowledge, information and communication, vaccination recommendation, vaccination history, history of COVID-19 infection, and health status and well-being. Conclusions: These results suggest that COVID-19 vaccination intention is a complex process and is affected by numerous multidimensional factors. Therefore, integrated communication strategies and multifaceted interventions may be effective for improving vaccination intention against COVID-19.

Body size and weight status of adult Indian males born in the 1890s-1950s: Age and secular change in the context of demographic, economic, and political transformation.

OBJECTIVES: To evaluate secular change in body size and weight status of adult Indian males born in 1891-1957 and surveyed in the 1970s. METHODS: Data are from Anthropological Surveys. Only men were included in the surveys due to high female illiteracy and lack of female researchers. Indian society was also strongly conservative at the time, especially in rural areas, and the measurement of women by men was not permitted. Heights and weights of 43 950 males 18-84 years (born 1891-1957) were measured. The BMI was calculated; weight status of individuals was classified relative to WHO criteria and suggested criteria for the Asia-Pacific region. Heights of men 35+ years were also adjusted for age-related stature loss. Trends in measured and adjusted heights, body weight and the BMI, and in weight status were evaluated by age groups. Linear regression of measured height and adjusted height on year of birth was used to estimate secular effects. RESULTS: Mean heights declined slightly with age to 50 years and declined sharply through 60+ years, while mean weights increased into the 40s and then declined. Mean BMIs were relatively stable from 30 to 60 years. The prevalence of thinness and normal weight was high, while that of overweight and obesity was low. Regression analyses indicated limited secular change across the total range of birth years but suggested a decline in adjusted heights among men born in 1891 through the 1930s, and little change among men born subsequently. CONCLUSIONS: Age-related trends and results of the regression analyses by year of birth indicated negligible secular change in heights of Indian men 18-84 years born between 1891 and 1957. BMIs indicated a high prevalence of thinness and normal weight and low prevalence of overweight and obesity.

How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Systematic Review on COVID-19 Primary Series and Booster Vaccines.

This systematic review synthesizes the findings of quantitative studies examining the relationships between Health Belief Model (HBM) constructs and COVID-19 vaccination intention. We searched PubMed, Medline, CINAHL, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 109 eligible studies. The overall vaccination intention rate was 68.19%. Perceived benefits, perceived barriers, and cues to action were the three most frequently demonstrated predictors of vaccination intention for both primary series and booster vaccines. For booster doses, the influence of susceptibility slightly increased, but the impact of severity, self-efficacy, and cues to action on vaccination intention declined. The impact of susceptibility increased, but severity's effect declined sharply from 2020 to 2022. The influence of barriers slightly declined from 2020 to 2021, but it skyrocketed in 2022. Conversely, the role of self-efficacy dipped in 2022. Susceptibility, severity, and barriers were dominant predictors in Saudi Arabia, but self-efficacy and cues to action had weaker effects in the USA. Susceptibility and severity had a lower impact on students, especially in North America, and barriers had a lower impact on health care workers. However, cues to action and self-efficacy had a dominant influence among parents. The most prevalent modifying variables were age, gender, education, income, and occupation. The results show that HBM is useful in predicting vaccine intention.

From little girls to adult women: Changes in age at marriage in Scheduled Castes from Madhya Pradesh and Uttar Pradesh, India.

BACKGROUND: Research confirms the negative relationship between early marriage and mothers' and children's health outcomes. This is why studies of the changes in age at marriage are an important task from the point of view of the health status and well-being of a mother and her offspring, especially in groups represented by extremely disadvantaged social strata in India. The results of such studies may influence the future family planning policy in the country. OBJECTIVES: This study aims to investigate the trend of age at marriage among the Scheduled Castes (SCs) women from two Indian states: Madhya Pradesh and Uttar Pradesh relative to the level of education and also to socioeconomic changes in the states. These states manifest the highest proportion of girls getting married below the age of 18 years-far above the proportion observed in entire India. METHODS: Women from Scheduled Caste, N = 1,612, aged 25-65, born in 1950-1990 were investigated. A modern semiparametric regression approach was used. To capture the relationship between age at marriage and year of birth, categories of women's level of education (illiterate; primary: 1st-5th standards; middle school: 6th-8th standards; high school: 9th-10th standards; higher secondary: 11th-12th standards), and categories of the profession (women working in the agricultural sector or the non-agricultural sector), flexible framework of the Generalized Additive Model (GAM) was applied. RESULTS: A significant impact of the cohort defined by the year of birth (<0.001), and women's education (<0.001) on age at marriage was noted, while the influence of women's occupation was not significant (p = 0.642). Mean age at marriage differed significantly with different education level. Women who graduated from primary school married 0.631 years later on average than illiterate ones, while those who graduated from middle schools, high schools (9th-10th standards) and higher secondary schools married significantly later than illiterate ones by 1.454 years and 2.463 years, respectively. Age at marriage increased over time: from slightly above 15 years in the cohort of illiterate women born in 1950 to almost 19 years in quite well-educated women born in 1990. The average age at marriage estimated for four education levels in 1990 ranged between 16.39 years (95%CI: 15.29-17.50) in the group of illiterate women and 18.86 years (95%CI: 17.76-19.95) in women graduated from high and higher secondary schools. CONCLUSION: The rise of age at marriage can be partly explained by the increase of females enrolled in schools, the alleviation of poverty, and the implementation of social programs for women.

Predicting Vaccination Intention against COVID-19 Using Theory of Planned Behavior: A Systematic Review and Meta-Analysis.

This study systematically analyzed the literature using the theory of planned behavior (TPB) as a theoretical framework to examine the influence of its constructs on vaccination intention against COVID-19. Quantitative studies were searched in PubMed, CINAHL, Web of Science, and Google Scholar following the PRISMA guidelines. The average rate of COVID-19 vaccination intention was 73.19%, ranging from 31% to 88.86%. Attitude had the strongest association with vaccination intention (r+ = 0.487, 95% CI: 0.368-0.590), followed by subjective norms (r+ = 0.409, 95% CI: 0.300-0.507), and perceived behavioral control (r+ = 0.286, 95% CI: 0.198-0.369). Subgroup analyses showed that the pooled effect sizes of TPB constructs on vaccination intention varied across geographic regions and study populations. Attitude had large effect sizes in Asia, Europe, and Oceania, especially among the adult general population, parents, and patients. Subjective norms had large effect sizes in Asia and Oceania, especially among parents and patients. Perceived behavioral control was the most dominant predictor of vaccination acceptance in Africa among patients. These findings suggest that TPB provides a useful framework for predicting intention to receive a COVID-19 vaccine. Hence, public awareness and educational programs aimed at promoting COVID-19 vaccination intention should consider using TPB as a framework to achieve the goal.

The Health Belief Model Applied to COVID-19 Vaccine Hesitancy: A Systematic Review.

This study systematically analyzes the research that used the Health Belief Model (HBM) as a theoretical basis to examine the influence of HBM constructs on COVID-19 vaccine hesitancy. Following PRISMA guidelines, PubMed, Web of Science, Google Scholar, and Scopus were searched for quantitative studies. Sixteen studies with 30,242 participants met inclusion criteria. The prevalence of COVID-19 vaccine hesitancy was 33.23% (95% CI 24.71-41.39%). Perceived barriers and perceived benefits were the most common HBM constructs that were significantly associated with vaccine hesitancy. While perceived benefits was inversely associated, a positive association was found between perceived barriers and vaccine hesitancy. Other HBM constructs that were frequently examined and inversely associated were perceived susceptibility, cues to action, perceived severity, and self-efficacy. The most common HBM modifying factor that was directly associated with COVID-19 vaccine hesitancy was gender, followed by education, age, geographical locations, occupation, income, employment, marital status, race, and ethnicity; however, a few studies report inconsistent results. Other modifying variables that influenced vaccine hesitancy were knowledge of COVID-19, prior diagnosis of COVID-19, history of flu vaccination, religion, nationality, and political affiliation. The results show that HBM is useful in predicting COVID-19 vaccine hesitancy.

Season of birth is not associated with age at menarche in young adults from Central India.

OBJECTIVES: We aimed to test whether birth season is associated with age at menarche in the sub-tropical climate of Central India where temperature and photoperiod differences between seasons are very small. METHODS: Date of birth and age at menarche were collected for 330 female students of Central University, Sagar. The impact of birth month and birth season on age at menarche was analyzed using ANOVA and time-to-event analysis with the use of the Kaplan-Meier curve. RESULTS: ANOVA, Kaplan-Meier estimation and Cox Proportional Hazard did not show statistically significant differences in age at menarche according to birth month and birth season. CONCLUSIONS: Constant sun exposure during the whole year, related to a stable vitamin D amount and to equal access to fruits and vegetables, may translate into a lack of association between seasons and age at menarche.

Allometric scaling of weight to height and resulting body mass index thresholds in two Asian populations.

BACKGROUND: Body mass index (BMI) represents a normalization of weight to height and is used to classify adiposity. While the capacity of BMI as an adiposity index has been experimentally validated in Caucasians, but there has been little testing Asian populations. METHODS: To determine whether weight scales to height squared in Asian Indians across the general population and in Asian Indian tribes an allometric analysis on the power law model, W = αHß, where W is weight (kg) and H is height (m) was performed on cross-sectional weight and height data from India (N = 43,880) collected through the Anthropological Survey of India. The database contained males 18-84 years of age spanning 161 districts of 14 states and including 33 different tribes (N = 5,549). Models were developed that were unadjusted and adjusted for tribe membership. The Korean National Health and Nutrition Examination Survey (KNHANES) was used to compare to height-weight data from the Anthropological Survey of India and to calculate BMI thresholds for obesity status using a receiver operating characteristic. RESULTS: The unadjusted power was ß = 2.08 (s = 0.02). The power for the general population (non-tribal) was ß = 2.11 (s = 0.02). Powers when adjusted for tribe ranged from 1.87 to 2.35 with 24 of the 33 tribes resulting in statistically significant (p < 0.05) differences in powers from the general population. The coefficients of the adjusted terms ranged from -0.22 to 0.26 and therefore the scaling exponent does not deviate far from 2. Thresholds for BMI classification of overweight in the KNHANES database were BMI = 21 kg/m2 (AUC = 0.89) for males 18 kg/m2 (AUC = 0.97) for females. Obesity classification was calculated as BMI = 26 kg/m2 (AUC = 0.81) and 23 kg/m2 (AUC = 0.83) for females. CONCLUSIONS: Our study confirms that weight scales to height squared in Asian Indian males even after adjusting for tribe membership. We also demonstrate that optimal BMI thresholds are lower in a Korean population in comparison to currently used BMI thresholds. These results support the application of BMI in Asian populations with potentially lower thresholds.

Natural selection among coastal populations of India: trend and extent.

BACKGROUND: Coastal populations have always been exposed to socio-cultural and natural vulnerability. The correlates between these coastal populations and their selection potentials have not been previously described. AIM: To describe selection potentials, their trend and extent among coastal and non-coastal populations of the Indian continent. SUBJECTS AND METHODS: Data on fertility and mortality differentials among five coastal populations were collected from 448 women of Orissa and Goa. Selection potential was computed. In addition, 48 studies among 100 different populations of India were reviewed for similar parameters, for comparison. RESULTS: Total index of selection (I(t)) varied from 0.221-0.417 in the population of Orissa; whereas the population of Goa showed a moderate index of selection. Regression analysis showed that among the coastal population the contribution of index of mortality (I(m)) is higher (92.5%) in total selection index (I(t)) as compared to non-coastal populations (56.4%). After 1991, there was a radical shift in the role of mortality in the entire region. Simultaneously, the selection intensity (I(t)) has gradually declined. CONCLUSION: There is a significant difference in the extent and process of natural selection among coastal and non-coastal populations. Mortality is playing a greater role in the total selection intensity of coastal populations, although the trend is declining in the entire region and reversal in the roles of I(m) and index of fertility (I(f)) is witnessed.

Opportunity for natural selection among the Indian population: secular trend, covariates and implications.

Crow's index is widely used for indirect quantitative estimation of natural selection using birth and death rates. The present investigation is based on 179 studies among 144 different endogamous communities belonging to nineteen states and six geographical regions of India, categorized into six social groups. These studies appeared in 33 different years over six decades (1956 to 2007). The secular trend in Crow's index (I(t)) and its mortality and fertility components (I(m) and I(f)) shows a gradual decline in I(t) and radical shift in the relative contributions of I(m) and I(f). Before 1990 the opportunity for natural selection was mainly determined by differential pre-reproductive mortality (I(m)), whereas after 1990 it has been determined by differential fertility (I(f)). To find out the covariates of I(t), I(m) and I(f) sixteen socio-demographic variables were considered, and nine were found to be significantly correlated with I(t): total dependency ratio, decadal growth rate 1991-2001, young age dependency ratio, crude death rate, total fertility rate, child mortality rate, under-5 mortality rate, old age dependency ratio and decadal growth rate 1981-1991. On the basis of multivariate stepwise regression analysis, female literacy emerged as one of the most important predictors of I(t). The declining trend of I(t), Im and I(f) shows that the Indian population is passing through the demographic transition.

Natural selection among Kinnaura of the Himalayan highland: A comparative analysis with other Indian and Himalayan populations.

The present investigation on fertility and mortality differential among Kinnaura of the Himalayan highland is based on data collected from 160 post-menopausal women belonging to the middle and high altitude region of Kinnaur district of Himachal Pradesh (Indian Himalayas). Selection potential based on differential fertility and mortality was computed for middle-and high-altitude women. Irrespective of the methodology, the total index of selection was found to be highest among middle-altitude women (0.386) as compared with high-altitude (0.370) women, whereas for the total population it is estimated to be 0.384. It was found that the Kinnaura of the Himalayan highland showing moderate index of total selection and relative contribution of the mortality component (Im) to the index of total selection is higher than the corresponding fertility component (If). The analysis of embryonic and post-natal mortality components shows that the post-natal mortality components are higher in comparison with the embryonic mortality components among highlanders and needs special intervention and health care. The present findings are compared with other Indian tribes as well as non-tribes of the Himalayan region and other parts of the country. It reveals that this index among Kinnaura is moderate than the other population groups; among the Himalayan population, the highest was reported for Galong (It = 1.07) of Arunachal, whereas the lowest was reported from Ahom (It = 0.218) of Manipur. The correlation and regression analysis between total index of selection (It) and fertility (If) and mortality (Im) components for pooled data of populations of the Indian Himalayan states show that If and Im account for 21.6 and 29.1% variability, respectively. In Crow's total index of selection (It) along with strong association, which is significant at the 1% level, this indicates that mortality plays a greater role in natural selection in comparison with fertility among populations of the Indian Himalayas.

Traditional occupations and nutritional adaptation among Central Indian caste populations.

The socioeconomic milieu has benefits and drawbacks for determining level of nutrition. The Indian population provides an excellent example of nutrition-driven adaptation. The present paper deals with the relationship between BMI (body mass index) and traditional occupation and process of adaptation among adult males of Central India. Anthropometric data collected by the Anthropological Survey of India on stature, sitting height and weight of 6663 adult males belonging to 22 castes were used for computation of BMI and Cormic index. The caste groups earning their living as labourers are found to be shortest (157.4+/-6.5 cm), and the caste group practising priesthood are tallest (168.6+/-6.6 cm). The prevalence of chronic energy deficiency is found to be highest (72%) among castes earning their living as daily wage labourers. The ANOVA on Cormic index and BMI suggests that people within the same occupational group are more homogeneous than those from different occupational groups. The t test also supports the homogeneity of the same occupational group.

Biosocial covariates of adult male body mass index in Central India.

Body mass index (BMI) is the 'measuring rod' of nutritional status. This study investigates the type and extent of correlation between adult male BMI and socioeconomic, cultural and bio-demographical variables using data from 11,496 individuals from 38 districts of Central India. For each individual, stature, body weight and sitting height data were collected, their Cormic index and BMI computed, and averages for each district calculated. Mean BMI was found to be lowest for the population of Tikamgarh (17.90+/-1.91 kg m(-2)) and highest for that of Durg district (19.33+/-2.16 kg m(-2)), whereas the mean BMI for the total population of Central India was 18.67+/-2.18 kg m(-2), which is lower than that of well-to-do individuals in India as a whole. The F ratio indicates that there is inter-district variation in anthropometric characteristics of populations. District-wise biosocial indicators were obtained, namely population density per square kilometre, percentage urban population, percentage of population that is of scheduled caste/tribe, sex ratio, average rural population per PHC/CHC (primary or community health centre), literacy rate, life expectancy, total fertility rate, infant mortality rate, gender development index and human development index. Most of these variables were found to be significantly correlated with each other, but BMI was only significantly correlated with three of them, viz. gender development index (R2=0.211), life expectancy (R2=0.130) and infant mortality rate (R2=0.128). Gender development index and life expectancy were positively correlated with BMI, whereas infant mortality rate was negatively correlated. It is concluded that if BMI increases then life expectancy will also increase. Thus better nutritional status may be a helpful tool for reducing infant mortality rate, which is an indicator of socioeconomic status, health condition, health care and ultimately overall development of a region or population.

Population, health and nutrition in central India: a situational analysis.

India is the second most populous in the world, having crossed the population mark of 1 billion in the year 2000. The different geographical regions exhibit different levels of health and nutritional status. Out of 35 states, some are identified as demographically lagging behind, called BIMARU. Central India falls in this category and the present paper provides a situational analysis of the region with respect to population growth, socio-economic condition, health scenario and level of nutrition in the region. The level of socio-economic development is relatively poor in this part when compared to other parts of the country. The population growth is higher than the national average. The Infant mortality rate (IMR) continues to be higher in Central India, varying from 70 to 164 across the districts in the region. Regression analysis shows a negative correlation between Human development index (HDI) and infant mortality rate. Considering 18.5 as a cut-off point for screening the individuals into normal and chronic energy deficiency (CED) groups, it is found that the prevalence of CED is lower among the populations of non-backward districts (50.5 %) than that in the backward districts (53.6 %). It is suggested that the overall socio-economic development should be accelerated and infant mortality controlled in order to improve the health and nutritional status of the people in Central India.

Body mass index in Central India: inter district variation.

Basic causes of poor state of nutrition and infections in developing countries are poverty, low level of hygienic conditions and little access to preventive and health care. Central India is known for its high rate of population growth and mortality, which persisted over time along with a low level of social, economic and infrastructure development. In the present study the body mass index (BMI) of 31 populations residing in 38 districts of Central India (comprising the States of Madhya Pradesh and Chhattisgarh) is assessed. Anthropometric data collected by the Anthropological Survey of India were utilized in this context. The mean body mass index values of the populations of total backward and non-backward districts are found to be lower than that of well-to-do individuals of India (Bharati 1989, Khongsdier 1997, Reddy 1998), but it is not as low as that found among the South Indian populations (Ferro-Luzzi et al. 1992). In the present investigation, it is also found that the majority of the backward districts fall in the category of different grade of chronic energy deficiency (CED), while in the non-backward districts a considerably less number of districts follows this trend. A better level of the nutritional status among the populations of the non-backward districts corroborates the findings of the Ministry of Health and Family Welfare (NFHS 1992). It reveals that the apparently healthy individuals with CED grade I in the present study may be thin but physically active and healthy. The present study, however, narrates further intensive investigations in these populations, because the BMI as a measure of the CED should incorporate the aspects like morbidity and health status of a population.