Overweight/Obesity Prevalence among Under-Five Children and Risk Factors in India: A Cross-Sectional Study Using the National Family Health Survey (2015-2016).

The occurrence of overweight and obesity has increased in recent years in India. In this study, we investigate the prevalence and associated risk factors of overweight/obesity among children aged 0-59 months in India. Using data from the 2015-2016 National Family Health Survey-4 (NFHS-4), the research sample included 176,255 children aged 0 to 59 months. Bivariate and multivariate techniques were used to analyze children's risk factors for overweight/obesity. We identified that the prevalence of overweight/obesity among children aged 0-59 was 2.6% in India. The study findings reveal that factors such as child sex, age, birth weight, birth rank, maternal education, number of children, age at marriage, mother's BMI, media exposure, social group, and dietary diversity score were most significantly correlated with childhood overweight and obesity in India. Furthermore, we found that male children (ARR: 1.08) aged between 0 and 11 months (ARR: 3.77) with low birth rank (ARR: 1.24), obese (ARR: 1.81) children whose mothers married after the age of 18 (ARR: 1.15), children who belong to a scheduled tribe family (ARR: 1.46), and children who consumed 7-9 food items (ARR: 1.22) were at highest risk of being overweight and obese. However, breastfeeding (ARR: 0.85) and Muslim families (ARR: 0.87) appeared to be protective factors with respect to childhood overweight and obesity in India. Pertinent public health programs, clinical follow-up, and awareness about sedentary lifestyles can help to reduce overweight/obesity risks in children.

Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India.

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0-59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0-59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015-2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12-23 months, 24-35 months, 36-47 months, and 48-59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey.

Low dietary diversity significantly interplays with children's growth failure. However, evidence of its crucial role in children's health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015−2016. A total of 67,278 mother-child pairs of children between the ages of 6−23 months and mothers aged 15−49 years were included in this study. Pearson's chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (<4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21−1.38), wasted (AOR = 1.29; 95% CI; 1.21−1.38), and underweight (AOR = 1.47; 95% CI; 1.39−1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.

Spatial-temporal variations in community mobility during lockdown, unlock, and the second wave of COVID-19 in India: A data-based analysis using Google's community mobility reports.

COVID-19 has been altering all aspects of societal life including community mobility since December 2019. This study analyzes the spatial-temporal variations in human mobility patterns as the influence of COVID-19 during different periods at the state and union territory (UT) levels in India. From the spatial and temporal perspective, we find that change of mobility patterns and variations within states and UTs. The residential mobility has been increased because the mobility towards the home increased during the lockdown and the second wave but during the unlocking period reduced to some extent. There have spatial variations in mobility towards different places within states and UTs during the lockdown and second wave (lockdown to partial lockdown) but overall mobility towards different places like retail, parks, workplace, and transit stations have been reduced in India. During unlocking, mobility has been reduced all over the states and UTs in India but there have spatial-temporal variations within.

Do malnutrition, pre-existing morbidities, and poor household environmental conditions aggravate susceptibility to Coronavirus disease (COVID-19)? A study on under-five children in India.

BACKGROUND: The novel Coronavirus disease 2019 (2019-nCoV) outbreak, caused by severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), has become the worst serious global risk to humanity in the last century and linked with various risk factors. OBJECTIVE: To find out the risk zone associated with Coronavirus disease among children under-five age using malnourished status, pre-existing morbidity conditions, poor household environmental conditions, and also with case fatality rate (CFR) and active case rate (ACR) of COVID-19 in India. DATA SOURCES & METHODS: Data was collected from the 4th round of the National Family Health Survey (NFHS)-4, 2015-16, and CFR and ACR of COVID-19 related data collected from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to identify the risk factors zone and Hot Spot analysis (Getis-Ord Gi) has been done. RESULTS: The states and union territories (UTs) which have a high composite vulnerability score (CVS) of COVID-19 among under-five children are in Meghalaya (CVS = 1), Uttar Pradesh (CVS = 0.93), Jharkhand (CVS = 0.86), Bihar (CVS = 0.74), Madhya Pradesh (CVS = 0.74), and Odisha (CVS = 0.55). The states and UTs which have low composite vulnerability score of COVID-19 among under-five children are in Sikkim (CVS = -0.90), Daman & Diu (CVS = -0.76) Lakshadweep (CVS = -0.74), Kerala (CVS = -0.72), Chandigarh (CVS = -0.71). The COVID-19 high-risk zones (hot spot: 99% Confidence interval [CI]) were observed in Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, and Meghalaya states of India, which are spatially high clustered and the low-risk zones (cold spot: 95% CI) were observed in Kerala, Mizoram states of India. CONCLUSIONS: Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable regions of COVID-19.

Correction: Maternal determinants of low birth weight among Indian children: Evidence from the National Family Health Survey-4, 2015-16.

[This corrects the article DOI: 10.1371/journal.pone.0244562.].

Prevalence and correlates of menstrual hygiene practices among young currently married women aged 15-24 years: an analysis from a nationally representative survey of India.

PURPOSE: This paper aims to investigate the prevalence by geographical locations and socio-demographic correlates of menstrual hygienic practices among young currently married Indian women. METHODS: The study is based on secondary data, collected from the latest round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A total of 94,034 young currently married women aged 15-24 years were utilised in this study. The prevalence of menstrual hygienic practices was portrayed across regions, states, and districts of India. Bivariate and multivariate analyses were carried out to assess the factors associated with menstrual hygienic practices. RESULTS: Nearly half of the women (49.3%) practice hygienic methods to contain menstrual bloodstains. The prevalence of menstrual hygiene practices is lower in low-income states of central and eastern India. Multivariate analyses reveal that education of women and wealth status are found to be the most important positive factors of menstrual hygienic practices. Women's autonomy and exposure to mass media also have a positive impact on the use of menstrual hygiene practice. In contrast, women residing in rural areas, belonging in scheduled tribes and unemployed women are less likely to use hygienic methods during their menstruation. CONCLUSION: The findings of this study suggest increasing opportunities for female education, providing economic incentives, enhancing women's autonomy could help to increase hygienic practices of women during menstruation period. Furthermore, interventions should target socio-economically disadvantaged women to raise the use of sanitary napkins.

Lockdown and unlock for the COVID-19 pandemic and associated residential mobility in India.

BACKGROUND: As an outcome of the Coronavirus 2019 (COVID-19) pandemic, the countrywide lockdown and unlock periods altered residential mobility trends in India. The aim of this study was to investigate the impact of the COVID-19 lockdown and unlock periods on residential mobility trends, using the spatial time-series daily changes across the different states and union territories of India. DATA AND METHODS: This study was based on time-series data of the daily percentage change in residential mobility from baseline in India. Conditional formatting techniques, box plotting, time-series trends plotting methods, and spatial kriging interpolation mapping techniques were employed to show residential mobility trends. RESULTS: Increases in residential mobility of approximately 31.5%, 30.8%, 26.2%, 23%, 17.6%, and 18.2% from the pre-lockdown period were observed during lockdown phase 1, phase 2, phase 3, and phase 4, unlock 1.0, and unlock 2.0, respectively, in India. This was due to people moving towards home or their place of residence during the COVID-19 pandemic in India. From the time lockdown was initiated up until July 31, 2020, residential mobility increased the least in the north-eastern states of India and also the eastern and extreme northern states of India. CONCLUSIONS: The results of this study could be used in public health strategies towards decreasing the spread of COVID-19.

Maternal determinants of low birth weight among Indian children: Evidence from the National Family Health Survey-4, 2015-16.

OBJECTIVE: Low birth weight (LBW) is a serious public health problem in low- and middle-income countries and a leading cause of death in the first month of life. In India, about 18% of children are born with LBW (<2500 grams) in 2015-16. In this study, we aim to examine the influence of maternal factors and socio-demographic covariates on LBW in Indian children. METHODS: Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A cross-sectional study was designed using a stratified two-stage sampling technique. Cross-tabulation, Pearson's chi-squared test, and multivariate logistic regression analyses were employed to assess the impact of maternal factors and other covariates on children's LBW. RESULTS: Of total participants (n = 147,762), 17.5% of children were found to be born with LBW. The study revealed that women who had prior experience of stillbirth (Adjusted odds ratio [AOR]: 1.20, 95% CI: 1.04-1.38) and any sign of pregnancy complications (AOR: 1.08, 95% CI: 1.05-1.11) were more likely to have LBW children, even after adjusting for a range of covariates. Maternal food diversity was found to a protective factor against children's LBW. Women with underweight and anemic condition were associated with an increased likelihood of LBW children. Regarding maternity care, women who attended ≥4 ANC visits (AOR: 0.84, 95% CI: 0.80-0.88), took iron tablets/syrup during pregnancy (AOR: 0.94, 95% CI: 0.90-0.98), and delivered in a public health facility (AOR: 0.84, 95% CI: 0.79-0.88) were less likely to have LBW babies. Besides, various socio-demographic factors such as place of residence, caste, religion, education, wealth quintile, and geographical region were significantly associated with LBW of children. CONCLUSION: Interventions are needed for adequate ANC utilization, improvement in public facility-based delivery, providing iron supplementation, and uptake of balanced energy-protein diet among pregnant mothers. Besides, special attention should be given to the socio-economically disadvantaged women to address adverse pregnancy and birth outcomes including LBW.

Lockdown for COVID-19 and its impact on community mobility in India: An analysis of the COVID-19 Community Mobility Reports, 2020.

BACKGROUND: Coronavirus disease (COVID-19) is a novel public health problem threatening the whole world. As an upshot, countrywide lockdown due to COVID-19 pandemic has been supportive of changing community mobility trends of various place categories including retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential in India. OBJECTIVE: To analyze the impact of lockdown for COVID-19 on community mobility using spatial time-series change over different states and union territories (UTs) of India. DATA & METHODS: This study has been organized based on states & UTs wise time-series data of the daily percentage of change of community mobility from baseline in India, collected from 15th February to 30th April 2020. Conditional formatting techniques, time-series trends plotting method, spatial inverse distance weighted (IDW) interpolation mapping techniques have been employed to show pre and post lockdown mobility trends due to COVID-19 i.e. to fulfill the objective. RESULTS: Across India, retail and recreation, grocery and pharmacy, visits to parks, transit stations, and workplaces mobility dropped by -73.4%, -51.2%, -46.3%, -66% and -56.7% respectively. Visits to residential places mobility increased by 23.8% as people mostly stayed home during the lockdown. The COVID-19 lockdown started on 24 March 2020 and just gone one day (March 25, 2020) of the beginning of lockdown, there have a decreased in percentage (-70.51% in retail and recreation mobility), (-64.26% in grocery and pharmacy mobility), (-46.17% in parks mobility), (-65.6% in transit stations mobility), (-60.03% in workplaces mobility) from baseline in compared to the pre-lockdown period and residential mobility has been increased in percentage (26.32%) from baseline due to people stayed home during the lockdown for COVID-19 pandemic in India. CONCLUSION: Study figures out mobility trends over time during pre-lockdown and after lockdown period across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential, which can be used in public health strategies to drop the spread of COVID-19.

Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India.

To assess the impact of lockdown amidst COVID-19 on undergraduate and postgraduate learners of various colleges and universities of West Bengal. An online survey was conducted from 1 May to 8 May 2020 to collect the information. A structural questionnaire link using 'Google form' was sent to students' through WhatsApp and E-mail. A total of 232 students provided complete information regarding the survey. The simple percentage distribution was used to assess the learning status of the study participants. During the lockdown period, around 70% of learners were involved in e-learning. Most of the learners were used android mobile for attending e-learning. Students have been facing various problems related to depression anxiety, poor internet connectivity, and unfavorable study environment at home. Students from remote areas and marginalized sections mainly face enormous challenges for the study during this pandemic. This study suggests targeted interventions to create a positive space for study among students from the vulnerable section of society. Strategies are urgently needed to build a resilient education system in the state that will ensure to develop the skill for employability and the productivity of the young minds.

Indoor air pollution (IAP) and pre-existing morbidities among under-5 children in India: are risk factors of coronavirus disease (COVID-19)?

Globally, the Coronavirus disease (COVID-19) outbreak is linked with air pollution of both indoor and outdoor environments and co-morbidities conditions of human beings. To find out the risk factor zones associated with Coronavirus disease among under-five children using pre-existing morbidity conditions and indoor air pollution (IAP) environmental factors and also with current fatality and recovery rate of COVID-19 disease in India. Data was utilized from the 4th round of the National Family Health Survey (NFHS), 2015-16, and from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to find out the risk factor zones i.e. to execute the objective. Findings of this study are, the states and UTs which have more likely to very higher to higher risk factors or zones of Coronavirus disease (COVID-19) are Mizoram (1.4), Meghalaya (1.27), Uttarakhand (0.92), West Bengal (0.73), Uttar Pradesh (0.66), Jammu and Kashmir (0.44), Odisha (0.33), Madhya Pradesh (0.21), Jharkhand (0.20), Bihar (0.19), Maharashtra (0.16 risk score), compared to UTs like Assam (-0.12), Rajasthan (-0.13), Goa (-0.14), Manipur (-0.17), Chandigarh (-0.19), Haryana (-0.22), Delhi (-0.27) have moderate risk factors of COVID-19, and the states and UTs like Daman and Diu (-1.18), Sikkim (-0.98), Andaman and Nicobar Islands (-0.84), Kerala (-0.69), Dadra and Nagar Haveli (-0.68), Arunachal Pradesh ( 0.-53), Karnataka (-0.42), and Nagaland (-0.36) have very low-risk zones of COVID-19 deaths. From a research viewpoint, there is a prerequisite need for epidemiological studies to investigate the connection between indoor air pollution and pre-existing morbidity which are associated with COVID-19. Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable areas of COVID-19.