Impact of social isolation and leisure activities on cognition and depression: A study on middle-aged and older adults in India.

INTRODUCTION: Recent studies highlight the negative impact of social isolation and involvement in leisure activities on enhanced well-being of individuals. However, there is dearth of evidence on relationship between social isolation and leisure activities on cognitive abilities and depression of older adults in the Indian context. The paper reports the impact of social isolation and leisure activities on cognitive functioning and depression of older adults. METHODS: Data were collected from the Longitudinal Ageing Study of India (LASI), and 63,806 participants aged 45 years or above were considered for the study with adherence to the exclusion criteria. Multivariate analysis was carried out to analyse the group-based differences. RESULTS: Social isolation (F = 102.09, p < 0.01; η2  = 0.09) and leisure (F = 224.54, p < 0.01; η2  = 0.07) had a statistically significant impact on the cognition and depressive symptoms of participants. Socially isolated older adults with little involvement in leisure activities had the worst cognitive functioning (M = 32.76, SD = 4.41), whereas middle-aged adults who were actively involved in leisure activities and experienced the least social isolation exhibited the best cognitive functioning (M = 32.76, SD = 4.41). However, leisure and age as independent factors did not have a significant impact on depression. CONCLUSION: Socially isolated participants, irrespective of age, and involvement in leisure activities exhibit poor cognitive functioning and are more likely to suffer from depression as compared to their counterparts. The findings of the study can be used to design intervention strategies aimed at reducing social isolation by incorporating leisure activities to ensure the optimal functioning of middle-aged and older adults.

Living arrangement of Indian elderly: a predominant predictor of their level of life satisfaction.

OBJECTIVE: This article aims to examine the level of life satisfaction (LS) among Indian older adults and to determine whether their living arrangement is one of the potential determinants of their level of LS. METHODS: Data was drawn from the first and most recent wave of Longitudinal Ageing Study in India conducted in 2017-18. Using the Satisfaction with Life Scale, the level of LS was assessed for 30,370 elderly aged 60 + . Bivariate analysis was carried out to see the variation in the level of LS across elderlies with different socio-demographic characteristics. To investigate the association between LS and living arrangements and the selected socio-demographic factors multinomial logistic regression model was fitted. RESULT: The findings reveal that 25.4% and 45.5% of the elderlies have reported having a low and high level of LS, respectively. Living alone was associated with low level of LS. Co-residing with a spouse was associated with a higher likelihood of reporting high level of LS. The study also found that having both spouse and children as coresident increases the likelihood of reporting high level of LS (RRR = 3.15, 95%CI = 2.3-4.28). Elderly with self-reported poor health, limitation in more than two activities of daily living and presence of depressive symptoms were significantly associated with reporting low level of LS. However, being diagnosed with more than three chronic illnesses was associated with high level of LS (RRR = 1.41, 95%CI = 1.25-1.59). Older adults with the following characteristics were more likely to report a lower level of LS: male, 60-64 years old, no or few years of schooling, unmarried, working, rural resident, living in a poor household, Scheduled Caste and Tribe. CONCLUSION: The level of life satisfaction in Indian older adults is significantly associated with their living arrangements, thus suggesting that the LS of older adults could be facilitated through interventions that consider their living arrangements. Older adults with various personal and household characteristics were identified as vulnerable groups, who should be the prime targets of the existing welfare policies.

Identifying the impact of social isolation and loneliness on psychological well-being among the elderly in old-age homes of India: the mediating role of gender, marital status, and education.

BACKGROUND: Social isolation and loneliness can be detrimental to the overall functioning of the older adults. The study examines the impact of social isolation and loneliness on the psychological well-being of older adults residing in various old-age homes in India and investigates the mediating role of gender, marital status, and education level in the way social isolation and loneliness affect psychological well-being. METHODS: Data has been collected from 320 individuals aged sixty years or above. Data were collected using standardized measures like Lubben Social Network Scale- 6, revised UCLA Loneliness Scale, and shortened version of psychological well-being scale by Ryff & Keyes (1995). Multivariate and mediation analysis were performed to understand the associations of social isolation and loneliness with psychological well-being. RESULTS: A statistically significant MANOVA effect was obtained for social isolation (F = 3.836, p < .01), and loneliness (F = 3.782, p < .01). Gender and education as independent factors were significantly associated with the psychological well-being of individuals. However, both gender and education did not mediate the impact of social isolation and loneliness on the psychological well-being of older adults. Further, marital status had a partial mediating effect on the relationship between social isolation, loneliness, and psychological well-being. CONCLUSIONS: The findings of the study can be incorporated into measures aiming at alleviation of feelings of social isolation and loneliness among the elderly. Further, the findings can be used to design various intervention strategies aimed at the reduction of social isolation and loneliness among older adults and the restoration of their psychological well-being.

Assessing reduction in multidimensional childhood poverty in India: a decomposition analysis.

BACKGROUND: Empirically, the official measurement of multidimensional poverty often shows children as the poorest age group. According to Global Multidimensional Poverty Index report, Africa and South Asia bear the highest burden multidimensional child poverty (MCP). Around one-third of children aged 0-4 are multidimensionally poor in India. Policymakers in India must have appropriate information on child poverty to alleviate poverty. The purpose of this paper is to examine MCP trends and track efforts to reduce child poverty at the national level across geographic regions, castes, and religious groups. METHODS: We used the Alkire-Foster method to calculate the MCP index (MCPI) among children aged 0-4 using the latest two rounds of National Family Health Survey data (2015-16 and 2019-21). We applied the Shapley decomposition method to analyse the marginal contribution of incidence and intensity that lead to changes in MCPI. RESULTS: In India, the incidence of child poverty reduced by more than 40% between 2015-16 and 2019-21 (46.6-27.4%) and the MCPI reduced by half (24.2-12.6%). The relative decline in MCPI has been largest for urban areas, northern regions, Other Backward Classes (OBCs) and Hindus. Children from rural areas, Scheduled Castes (SCs), Scheduled Tribes (STs), and Muslim households are the poor performers. When focusing exclusively on the poor child, we found all the population subgroups and geographic locations reduced the censored headcount ratios in all 14 indicators. Across places of residence, castes, religions, and regions the, indicators like electricity, birth registration, drinking water, assisted delivery, sanitation and cooking fuel made significant improvements between 2015-16 to 2019-21. CONCLUSION: The study indicates that by studying the MCPI over time, one can identify the priorities in policy development to achieve the Sustainable Development Goals.

Does club convergence matter in health outcomes? Evidence from Indian states.

BACKGROUND: Population health is vital to a nation's overall well-being and development. To achieve sustainable human development, a reduction in health inequalities and an increase in interstate convergence in health indicators is necessary. Evaluation of the convergence patterns can aid the government in monitoring the health progress across the Indian states. This study investigates the progressive changes in the convergence and divergence patterns in health status across major states of India from 1990 to 2018. METHODS: Sigma plots (σ), kernel density plots, and log t-test methods are used to test the convergence, divergence, and club convergence patterns in the health indicators at the state level. RESULTS: The result of the sigma convergence suggests that life expectancy at birth has converged across all states. After 2006, however, the infant mortality rate, neonatal mortality rate, and total fertility rate experienced a divergence pattern. The study's findings indicate that life expectancy at birth converges in the same direction across all states, falling into the same club (Club One). However, considerable cross-state variations and evidence of clubs' convergence and divergence are observed in the domains of infant mortality rate, neonatal death rate, and total fertility rate. As suggested by the kernel density estimates, life expectancy at birth stratifies, polarizes, and becomes unimodal over time, although with a single stable state. A bimodal distribution was found for infant, neonatal, and total fertility rates. CONCLUSIONS: Therefore, healthcare strategies must consider each club's transition path while focusing on divergence states to reduce health variations and improve health outcomes for each group of individuals.

Age-appropriate feeding practices and their association with undernutrition among children aged 6-23 months in aspirational districts of India: a multinomial analysis.

'Health and nutrition' is one among the five areas covered by the Aspirational District Programme in India, which aims to achieve the Sustainable Development Goals (SDGs). The reduction of undernutrition in under-five children has remained a major focus of the SDGs, especially at the ages of 6-23 months as this affects child development. This study used National Family Health Survey 2015-16 data to examine appropriate feeding practices and their associations with undernutrition among children aged 6-23 months in the 124 aspirational districts of India. Multinomial logistic regression analysis was used to analyse the association between feeding practices and undernutrition, adjusting for covariates. A total of 13,851 children aged 6-23 months were included in the analysis. Child nutritional outcomes, and children receiving the recommended minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD), were poorer in the aspirational compared with non-aspirational districts. However, the proportions of children who continued to breastfed, i.e. currently breastfeeding and the proportion of children who were receiving appropriate breastfeeding, i.e. receiving complementary feeding, in addition to breast milk, were higher in the aspirational districts. Appropriate breastfeeding and MDD were found to be associated negatively with undernutrition. While the continuation of breastfeeding increased the odds of children being undernourished, appropriate breastfeeding lowered the odds. The significant predictors of undernourishment among the study children were the child being male, of higher birth order, older and of smaller than average birth size; mother's lower educational level, mother's lower BMI of mothers and being a teenage mother; and poor household drinking water, sanitation facilities and lower economic status. This study suggests that educating mothers, especially illiterate and poor mothers, about appropriate breastfeeding and dietary diversity could help prevent and reduce child undernutrition in the aspirational districts of India.

Hospitalization & health expenditure in Odisha: Evidence from National Sample Survey (1995-2014).

Background & objectives: Financing healthcare services through out-of-pocket payments is common in India. Household impoverishments due to health expenditure can be daunting, especially among the economically vulnerable households. This study investigated hospitalization and patient's health expenditure in Odisha State in India. Methods: The national sample survey data were used to assess hospitalization and patient's health expenditure over two time periods (1995 and 2014). Disease classification was made following International Classification of Diseases 10th revision (ICD-10). The hospitalization rate and health expenditure were estimated for infectious, cardiovascular, non-communicable, disability and other diseases. Andersen model was used to examine the determinants of healthcare expenditure. Results: Findings of the study revealed that hospitalization in Odisha increased nearly three folds and health expenditure by more than two times between 1995 to 2014. While the hospitalization for other diseases remained consistently higher, health expenditure for disability was the highest and it increased three times within the last two decades. The socio-economic and demographic divides in the hospitalization rate and health expenditure were evident. Interpretation & conclusions: Our analysis indicated that predisposing factors such as age and marital status played an important role in hospitalization whereas, enabling factors likely determined the health expenditure. There is a need to recognize the unique vulnerabilities of older population, widowed and health financial mechanism for disability-related illness.

Does choice of health care facility matter? Assessing out-of-pocket expenditure and catastrophic spending on emergency obstetric care in India.

The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India.

Measuring catastrophe in paying for healthcare: A comparative methodological approach by using National Sample Survey, India.

Healthcare expenditure significantly varies among various segments of the population. The appropriate measures of catastrophic health expenditure (CHE) will help to unravel the real burden of spending among households. Present study provides a link between the theoretical insights from Grossman's model and various methodological approaches for the estimation of CHE by using data from the three rounds of nationally representative Consumer Expenditure Surveys, India. Statistical analysis has been carried out by using multivariate logistic regression to identify the major determinants of CHE. Findings indicate that the occurrence of CHE has increased during 1993-2012. Rural residents and households with varying age composition such as with higher numbers of children and elderly were at higher risk. Economic status is significantly associated with CHE and increased demand for healthcare. The measurements differ as per the methodological approaches of CHE and definition of household's capacity to pay. Approach-based variations in the results can be of key importance in determining trends and magnitude in CHE. Despite these variations in measurements, study finds a limited incidence of CHE among the disadvantaged segment of the population though a greater share was devoted to health expenditure in recent years. Better risk pooling mechanism is required to address the healthcare needs of the disadvantaged segment such as elderly, children, poor and rural population in India.

Reproductive health care status of the displaced tribal women in India: An analysis using Nussbaum Central human capabilities.

Scheduled Tribes (STs) of India are characterized by distinct cultures and a close relationship with the land they inhabit. Tribal people make up to 5% of the world's population but 15% of such people are living in poverty. They face deprivations caused by social, economic, and political exclusion. In India displacement due to development projects is pushing the tribals out of their habitat dispossessing them of their traditional forest resources. Women and children in displacement suffer more than the male counterpart especially in the process of moving to a new setup. The objective of the author is to study the reproductive healthcare status of displaced tribal women in India. In this paper, the author underlines the capabilities of tribal women in post displacement settings. The study was conducted in three wildlife sanctuaries in the Indian States of Odisha and Chhattisgarh namely Simlipal, Chandaka-Dampara, and Achankamar. Sequential explanatory study design was employed for collecting the data. A total of 194 displaced tribal women within the reproductive age group of 15-49 years were surveyed and Focus Group Discussion was conducted among the displaced women. Women who had given birth in the last five years were selected using a purposive sampling method. Key findings of the study suggest that women lack awareness of child spacing capabilities (57%) and the unmet need for family planning is comparatively higher. More than half of the women face domestic violence that curtails their capabilities to avail reproductive healthcare services. It also reduces the immediate wellbeing of their children. Women in this study lack control over the decision on reproductive healthcare. Due to this, women lack social and political freedom. The Government of India has taken fewer initiatives to promote effective reproductive healthcare services. Also, there is limited awareness in the rehabilitation colonies on protection from domestic violence.

Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data.

BACKGROUND: Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. METHODS: The present study uses data from the 66th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. RESULTS: The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. CONCLUSIONS: In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

SIBLING- AND FAMILY-LEVEL CLUSTERING OF UNDERWEIGHT CHILDREN IN NORTHERN INDIA.

Child undernutrition remains a major child health and developmental issue in low- and middle-income countries. The concentration (clustering) of underweight children among siblings at the family level is known to exist in India. This study examined the extent and covariates of clustering of underweight children at the sibling and family level in Uttar Pradesh, the largest state of northern India. Clustering of underweight (low weight-for-age) children was assessed using data on 7533 under-five children from the National Family Health Survey (NFHS) conducted in 2005-06, analysed using binary logistic and binomial regression models. Related bio-demographic, socioeconomic and health care variables were used as covariates in the models. The odds of being underweight for the index child were about two times higher (OR=2.34, p<0.001) if any of the siblings within the household was malnourished or underweight. A longer birth interval increased the odds of a child being underweight. The odds of underweight were significantly lower (OR=0.69, p<0.001) for children born to normal-weight mothers compared with those born to underweight mothers. Similarly, the odds of underweight were significantly lower (OR=0.49, p=0.01) for children born to educated mothers (high school and above) compared with those born to illiterate mothers. The results of the binomial regression model suggested that the deviations between observed and expected number of children were positive (3.09, 3.78 and 2.71) for 1, 2 and 2+ underweight children within the households of underweight women, indicating the concentration of underweight children among underweight/malnourished mothers. Underweight children were found to be clustered among underweight mothers with multiple underweight siblings. The findings suggest that policy interventions need to focus on underweight mothers with multiple underweight children.

Factors associated with the life satisfaction amongst the rural elderly in Odisha, India.

BACKGROUND: Life Satisfaction (LS) is an indicator of subjective well-being (SWB) among the elderly, and is directly associated with health and mortality. Present study deals with the factors associated with the LS among the rural elderly in Odisha, India. METHODS: A cross-sectional survey using multi-stage random sampling procedure was conducted among elderly (60+ years) in Bargarh district of Odisha. The survey was conducted among 310 respondents. Hierarchical regression analysis was used to assess the adjusted effect of various socio-economic, demographic, health conditions (physical and mental), social support and effects of multi-morbidity on LS. RESULTS: Cognitive health was the most influential factor in determining LS among both men (ß = 0.327) and women (ß = 0.329). Individual's social support also plays an influential role in LS among rural elderly. Elderly who are living alone and have any sort of disability and had low score of activities of daily living (ADL) have also reported significantly lower perceived LS for both the genders. CONCLUSION: It is necessary to analyze and identify the major factors which can improve upon the level of LS among the elderly population. Better understanding of these factors can help in removing the superfluous anxiety of old age in the mindset of people which is pervading in the society.

Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process.

Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005-06 with 2009-10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. As regards health financing, the government spends less than the average in sub-Saharan Africa, while donor assistance and out-of-pocket expenditure for health are high. Donor assistance to Kenya has increased over the years, but the percentage of funds devoted to reproductive health is lower than it was in 2005. We recommend an increase in the budget and spending for reproductive health in order to achieve MDG targets on maternal mortality and universal access to reproductive health in Kenya. Safety nets for the poor are also needed to reduce the burden of spending by households. Lastly, we recommend the generation of more comprehensive reproductive health accounts on a regular basis.

Health inequalities among urban children in India: a comparative assessment of Empowered Action Group (EAG) and South Indian states.

As India rapidly urbanizes, within urban areas socioeconomic disparities are rising and health inequality among urban children is an emerging challenge. This paper assesses the relative contribution of socioeconomic factors to child health inequalities between the less developed Empowered Action Group (EAG) states and more developed South Indian states in urban India using data from the 2005-06 National Family Health Survey. Focusing on urban health from varying regional and developmental contexts, socioeconomic inequalities in child health are examined first using Concentration Indices (CIs) and then the contributions of socioeconomic factors to the CIs of health variables are derived. The results reveal, in order of importance, pronounced contributions of household economic status, parent's illiteracy and caste to urban child health inequalities in the South Indian states. In contrast, parent's illiteracy, poor economic status, being Muslim and child birth order 3 or more are major contributors to health inequalities among urban children in the EAG states. The results suggest the need to adopt different health policy interventions in accordance with the pattern of varying contributions of socioeconomic factors to child health inequalities between the more developed South Indian states and less developed EAG states.

Does club convergence matter? Empirical evidence on inequality in the human development index among Indian states.

The Human Development Index (HDI) is recognised as the most commonly used composite index to assess the socio-economic progress of a country. To preserve its pioneering role in development, there has to be a reduction in inequalities and cross-state convergence by adding a sustainable dimension. This paper investigates the convergence hypothesis for the HDI in 36 Indian states and union territories (UTs) from 1990 to 2019. For that purpose, the study used the club convergence technique of Phillips and Sul (2007) and Kernel Density estimates to assess whether states converge towards a single steady-state equilibrium or multiple groups. The paper also considers the relative performance of Indian states and UTs and the comprehension of inter-regional inequality in the HDI by employing the Gini and Theil indices. Using the Phillips and Sul technique, the results reveal that all the states converged into two final clubs (i.e., Club 1 and Club 2). The rate of convergence of HDI is approximately 0.112% for club 1 and 1.135% for club 2. The findings indicate that states with the lowest HDI converge faster than those with higher HDI. The kernel density estimates demonstrate that HDI stratifies, polarises, and becomes unimodal over time, albeit with a common steady state. Further, the Gini and Theil indices suggest a significant decline trend in HDI inequality across the Indian states and UTs from 1990 to 2019. From a policy perspective, the study recommends promoting regional development and reducing inequality, considering the unique convergence paths of the clustering states. The study's findings could provide the government with a new perspective on attaining "horizontal equity" in HDI across Indian states and UTs.

A combination of moderate and vigorous physical activities reduces the burden of multimorbidity: findings from Longitudinal Ageing Study in India.

BACKGROUND: Physical inactivity is a significant factor contributing to the prevalence of non-communicable diseases (NCDs). The objective of this study is to examine the association between physical activity and multimorbidity among Indian adults aged 45 years and above by residence. METHODS: Data from Longitudinal Ageing Study in India (LASI) 2017-2018, wave 1, a nationally representative study, are used to examine the above objective. A total of 59,073 adults aged 45 years and above are enlisted in the study. Physical activities and other demographic and socioeconomic variables have been used to describe the distribution of multimorbidity and investigate their relationship. Logistic regression is employed to examine the adjusted impact of physical activity on multimorbidity among Indian adults (45 + years) by residence. RESULTS: The level of physical activity is inversely related to the prevalence of multimorbidity in India. The rate of multimorbidity ranges from 4 to 12% among moderately active individuals in rural areas, whereas it ranges from 9 to 34% in urban areas across the age groups of 45 to 75+ years. Notably, the individuals who engage in both moderate and vigorous activities have a lower prevalence of multimorbidity than those who engage in only moderate activities. CONCLUSION: Our study shows that physical inactivity has an association with the rise in multimorbidity in both rural and urban areas; however, the intensity of multimorbidity is higher in urban areas. The policymakers should consider the influence of moderate and vigorous physical activity as a key prevention measure of non-communicable disease and multimorbidity.

Food Insecurity and Malnutrition among Indian Older Adults: Findings from Longitudinal Ageing Study in India, 2017-18.

The study aims to assess the prevalence of food insecurity and malnutrition and to investigate the association between food insecurity, sociodemographic characteristics, and malnutrition among Indian older adults. Data for 28,004 older adults (60 + years) was extracted from Wave-1 of the Longitudinal Aging Study in India, 2017-18. Bivariate analysis was used for prevalence estimates. Multinomial logistic regression provided relative risk ratios (RRR) to determine the association. About 45% of older adults were food insecure and nearly half were malnourished (underweight - 26.7%, overweight - 22.2%). Overweight was widespread in southern, western, and northern India, while underweight and food insecurity were widespread in central, eastern, and north-eastern India. Food insecure older adults were significantly more likely to be underweight (mild: RRR = 1.105, 95% CI = 1.038-1.176; severe: RRR = 1.327, 95% CI = 1.186-1.485). Rather than severe food insecurity, those with moderate food insecurity have the least likelihood of being overweight. Being the oldest, male, widowed, divorced/separated/deserted, having fewer years of schooling, living in a ST or SC household, and in rural areawere associated with higher risk of being underweight; while their other counterparts were of being overweight. No association was found between working status and underweight, meanwhile the non-working older adults were less likely to be overweight (RRR = 0.804, 95% CI = 0.744-0.868). Underweight is strongly linked to food insecurity. In terms of food insecurity and malnutrition, the most vulnerable categories identified include oldest old, widowed, divorced/separated/deserted, SC, ST, economically weaker, and persons without or with only a few years of formal education.

Uneven burden of multidimensional poverty in India: A caste based analysis.

Poverty is multifaceted. The global poverty profile shows 41% of multidimensionally poor people living in South Asian countries. Though castes and tribes are a more prevalent line of social stratification in India, and their socio-economic characteristics also vary remarkably, hardly any study has explored these dimensions while analysing multidimensional poverty in India. Hence, this study attempts to assess the multidimensional status of poverty among the social groups in India. National Family Health Survey, 2015-16 (NFHS-4) is a source of rich information on 579,698 households' well-being for this analysis. Alkire- Foster technique was applied to decompose the Multidimensional Poverty Index (M0) across its dimensions and indicators for all the social groups. Three broad dimensions of deprivation-Health, Education and Standard of Living-include 12 indicators, guided by the poverty literature, data availability and the country's sustainable Development Goals (SDGs). There were three main findings in this study: (1) Scheduled Tribes (STs) are the most disadvantaged subgroup in India with remarkably high values of headcount (H = 0.444;), intensity (A = 0.486), and M0 (0.216), followed by Scheduled Castes (SCs) (H = 0.292; A = 0.473; M0 = 0.138), and Other Backward Classes (OBCs) (H = 0.245; A = 0.465; M0 = 0.114); and Others category is the most privileged with very low values of H = 0.149, A = 0.463, and M0 = 0.069; (2) STs contribute nearly twice their population share for both H and M0, and the SCs contribution is also noticeably higher than their population share; (3) States located in the central and eastern regions of India have the higher H, A and M0 for all the social groups. This suggests that there is a need for a thorough assessment of poverty at specific levels to uncover the poverty situation in society, improve the effectiveness of evidence-based planning and effective policymaking.

Prevalence and correlates of multidimensional child poverty in India during 2015-2021: A multilevel analysis.

Despite increasing research and programs to eradicate poverty, poverty still exists and is a far greater concern for children than adults, leading child poverty to become a political, economic, and social issue worldwide and in India. The current study aims to find variations in the prevalence of child poverty and associated factors in India during 2015-21. In the current study, we used two consecutive rounds of the National Family Health Survey (NFHS-4, 2015-16 & NFHS-5, 2019-21) to estimate child poverty (aged 0-59 months) using the Alkire-Foster method. The multilevel logistic regression analyses were performed to find the important cofounder and cluster level variation in child poverty. The results show that about 38 percent of children were multidimensionally poor in 2015-16, which reduced to 27 percent in 2019-21. The decomposition analysis suggests that contribution of nutrition domain to child poverty increases over time, whereas the standard of living substantially declines from NFHS-4 to NFHS-5. The multilevel analysis results show that the age and sex of the child, age and years of schooling of the mother, children ever born, religion, caste, wealth quintile and central, northeast, north and west regions are significantly associated with child poverty over time. Further, the variance participation coefficient statistics show that about 12 percent of the variation in the prevalence of child poverty could be attributed to differences at the community level. The prevalence of child poverty significantly declines over time, and the community-level variation is higher than the district-level in both surveys. However, the community-level variation shows increases over time. The finding suggests a need to improve the nutritional status and standard of living of most deprived households by promoting a child-centric and dimension-specific approach with more focus on PSU-level intervension should adopt in order to lessen child poverty in India.