A qualitative perspective of working women care providers and care receivers on eldercare: a study from India.

BACKGROUND: The paper aims to explore the elderly caregiving process in India from the perspective of both elderly as well as working women care providers, along with the challenges faced and the coping strategies adopted by them during the process. METHODS: In-depth interviews with 48 participants (care providers and care receivers) from 25 multi-generational households were conducted in the slums of Mumbai and analysed using QSR-NVivo-10. RESULTS: Working women care providers supported the needs of the dependent elderly along with performing household chores and paid work. However, the way the care was perceived and demanded, was not often same as delivered by the care providers. Care provider suffered silently with poor social, physical and emotional welling in absence of support system and lack of time. Sometimes, physically exhausted care providers unknowingly resorted to elderly abuse and neglect. At the same time, a bidirectional flow of support from elderly also existed in the form of childcare, household chores and financial support. Though caregiving overstrained the care providers, strong family ties, acknowledgement of the contributions of the elderly during their young days, and the desire to set a precedent for the young generation did not let them step back from their duties. The main coping mechanism for both care receivers and providers was largely centred around the notion of acceptance of their situation. CONCLUSION: Conversations between generations can help in enhancing family ties and reduce conflicts. The support of family and community can also ease the burden of caregiving.

Social frailty among older adults in India: Findings from the Longitudinal Ageing Study in India (LASI) - Wave 1.

BACKGROUND: From an individual's perspective, social frailty may act as a key determinant of social capital, which is essential for meeting social needs and improvement of overall wellbeing. The present study aimed to understand the social frailty and its determining factors among Indian older adults. METHODS: Data from the Longitudinal Ageing Study in India (LASI)-wave 1 was used. For the assessment of social frailty the study proposed a multidimensional Social Frailty Index (SFI) score ranging between 0 and 100 using 17 indicators. Bivariate analysis and quantile regression models were applied. RESULTS: The study results indicated that on average female older adults (mean SFI = 63.7) are relatively more socially frail than male older adults (mean SFI = 59.0). Further, the quantile regression analysis revealed that at the 10th, 25th, 50th, and 75th percentiles, female older adults were significantly more likely to be socially frail than male older adults (ß = 3.80, p < .01; ß = 2.82, p < .01; ß = 1.72, p < .01; and ß = 2.62, p < .01, respectively). Educational attainment and better economic condition showed a protective effect against social frailty. CONCLUSIONS: Investment to improve geriatric health status and socioeconomic conditions shall be a key focus to reduce social frailty prevalence among the older adults. A specific consideration is needed for addressing social frailty among female older adults.

Financial stress, health and malnourishment among older adults in India.

As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20-40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.

Effect of Autonomy and Physical Activity on Self-Rated Health of Older Adults in India: Gendered Analysis Using Structural Equation Models.

The gendered expectations and responsibilities placed upon women can impede their ability to participate in social activities and engage in physical leisure pursuits, ultimately having a negative impact on their health. Our study investigates the mechanisms through which gender influences individuals' engagement with physical activity during free time and how this relates to self-rated health outcomes among adults aged 45 years or older living in India. Using cross-sectional analysis and Structural Equation Modelling, we analyzed data stratified by gender and age from the Longitudinal Ageing Study of India to examine these conceptual pathways. We found that compared to men, women face greater limitations related to decision-making autonomy, experience more functional impairments, have weaker social networks that provide less support for engaging in leisure-time physical activity, leading them to report lower levels of overall wellbeing than men. Further analyses demonstrated distinct pathways through which each gender's level of social network connectivity shapes behavior - strong connections increase opportunities for women specifically to engage positively with both peers and physically active pursuits supporting overall wellness goals.

Prevalence of dementia in India: National and state estimates from a nationwide study.

INTRODUCTION: Prior estimates of dementia prevalence in India were based on samples from selected communities, inadequately representing the national and state populations. METHODS: From the Longitudinal Aging Study in India (LASI) we recruited a sample of adults ages 60+ and administered a rich battery of neuropsychological tests and an informant interview in 2018 through 2020. We obtained a clinical consensus rating of dementia status for a subsample (N = 2528), fitted a logistic model for dementia status on this subsample, and then imputed dementia status for all other LASI respondents aged 60+ (N = 28,949). RESULTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%, with significant age and education gradients, sex and urban/rural differences, and cross-state variation. DISCUSSION: An estimated 8.8 million Indians older than 60 years have dementia. The burden of dementia cases is unevenly distributed across states and subpopulations and may therefore require different levels of local planning and support. HIGHLIGHTS: The estimated dementia prevalence for adults ages 60+ in India is 7.4%. About 8.8 million Indians older than 60 years live with dementia. Dementia is more prevalent among females than males and in rural than urban areas. Significant cross-state variation exists in dementia prevalence.

Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements.

BACKGROUND: The rural-urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements. SUBJECTS AND METHODS: The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives. RESULTS: The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural-urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region). CONCLUSION: The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.

Men and maternal health care utilization in India and in selected less-developed states: evidence from a large-scale survey 2015-16.

Male involvement in maternal health care utilization is an important contributor to maternal health, especially in male-dominated societies. This study aimed to understand the variations and determinants of women's antenatal care (ANC) utilization and institutional delivery in India and three socioeconomically less-developed states (Bihar, Madhya Pradesh and Uttar Pradesh) using NFHS-4 data (2015-16). Husband's knowledge of pregnancy care and delivery, having a non-violent marital relationship and a respectful attitude towards his wife, better education and wealth, higher exposure to mass media and fewer children substantially enhanced the probability of him being present at his wife's ANC visits. Furthermore, men's presence at any ANC visit was shown to be an important factor influencing institutional delivery in India as a whole, as well as in the three less-developed states. The two major hurdles in maternal and child health care utilization in India were incorrect perception of 'unnecessary' maternal health care by families and high cost as reported by husbands. Furthermore, the proportion of husbands who received knowledge from health workers on maternal and child health was too low to achieve the maternal health SDGs by 2030. The dissemination of knowledge on maternal care among husbands, and encouraging their presence during antenatal care, may help secure better maternal health outcomes in India. It is imperative that the husband-involvement agenda is strengthened in India if the SDGs for maternal care are to be achieved.

Concordance in spousal reports of current contraceptive use in India.

Couple-level reports of contraceptive use are important as wives and husbands may report their use differently. Using matched couple data (N = 63,060) from India's NFHS-4 (2015-16), this study examined concordance in spousal reports of current contraceptive use and its differentials. Reporting of contraceptive use was higher among wives (59.0%) than husbands (25.2%). Concordance was low; 16.5% of couples reported the current use of the same method, while 20.4% reported the current use of any method. Many husbands did not report female sterilization as a means of contraception being used by their wives. Reconstruction of contraceptive use among men, based on the 'ever-use of sterilization' question asked to men, increased concordance by 10%. Multivariate analyses showed that concordance was low in urban and southern India, among younger women and among women with a lower wealth index. Men's control over household decision-making and negative attitudes towards contraception were associated with lower concordance. The findings highlight the importance of using couple-level data to estimate contraceptive prevalence, and the role of education programmes to inculcate positive attitudes towards contraception, fostering gender equality and involving men in family planning efforts. The results also raise the issue of data quality as the survey questions were asked differently to men and women, which might have contributed to the wide observed discordance.

Unveiling the dynamics of social engagement and subjective health in older adults: A gendered perspective.

OBJECTIVES: As populations age globally, understanding the dynamics that influence the well-being of older individuals become increasingly crucial. The research employs a comprehensive approach to unravel the multifaceted interplay between social engagements and subjective health perceptions of older Indians, with a special focus on gender differences. SUBJECTS AND METHODS: This study used data from the Longitudinal Aging Study in India (LASI) wave 1, 2017-18 with a total sample of 30,533 older adults aged 60 years and above. Bivariate analysis, chi-square tests and unadjusted and adjusted average marginal effects from logistic regression models were used to assess the relationship between social engagements and subjective health among older adults, stratified by gender. RESULTS: The prevalence of poor health status decreased with higher frequency of social networks among both men (pp. (percentage point) = 6.1; CI (Confidence Interval): 10.6, 1.6) and women (pp. = 9.2; CI: 14.9, 3.4). The adjusted average marginal effects demonstrate that with an increase in the overall score of social engagement, the likelihood of poor health is almost reduced by half. For men, the prevalence of poor health was 9.8 pp. (95 % CI: 13.7, 5.8), while for women, it was 9.3 pp. (95 % CI: 15.2, 3.1). CONCLUSION: Gendered perspectives unveil unique patterns, highlighting how societal expectations and roles assigned to each gender may influence the subjective health perceptions of older individuals. This study adds to the expanding knowledge base to enhance the well-being and fulfillment of aging populations, considering the complex interplay of social dynamics and gendered perspectives.

Corrigendum to "Moderating role of functional/mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India" [Prev. Med. Rep. 38 (2024) 102589].

[This corrects the article DOI: 10.1016/j.pmedr.2024.102589.].

Moderating role of functional/ mobility limitations in the association between sleep problems and hypertension among middle-aged and older adults in India.

Hypertension has become a global health concern and is recognized as an important modifiable risk factor for cardiovascular diseases (CVDs). There are very limited studies in India and worldwide focused on sleep problems, activities of daily living (ADL), instrumental ADL (IADL) and mobility limitations, and their discrete and combined effects on hypertension. Therefore, this study examined whether sleep problems are associated with hypertension, and whether the association is more pronounced among middle-aged and older adults with functional/mobility limitations. This study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-18, with a total sample of 59,951 adults aged 45 years and above. Log-binomial regression, and interaction terms were used to assess the relationship between sleep problems and hypertension, and the moderating effect of functional/mobility limitations. Respondents with sleep problems had a 29 % higher prevalence of hypertension [PR (prevalence ratio): 1.29; CI (confidence interval): 1.20-1.39]. Those with ADL and IADL limitations had 20 % [PR: 1.20; CI: 1.09-1.32] and 9 % [PR: 1.09; CI: 1.00-1.18] greater prevalence of hypertension. Interaction analysis revealed that individuals with ADL, IADL, and mobility limitations had 58 %, 52 %, and 45 % higher prevalence of hypertension, respectively, and was especially pronounced among women. Our findings highlight that improved sleep can reduce the prevalence of hypertension in middle-aged and older adults. Individuals with functional/mobility limitations may need additional care and support from their family members or the community, which could lower the prevalence of elevated blood pressure due to their sleep problems.

Treatment-seeking behaviour among infertile tribal women of Palghar district in India.

Background: The tribal culture views health care practices differently from the mainstream. Infertile tribal women practice treatment-seeking behaviour that reflects the community's cultural access to and availability of treatment as well as customs to meet their health care needs. In the environment of rising awareness of infertility and numerous treatment options, this study aims to highlight the infertility treatment-seeking behaviour of tribal communities. Data and methods: The study employed a mix methods approach to collect data from 153 tribal couples suffering with infertility (interview schedule) and the community (in-depth interviews-14 and focus group discussions-12). The data was analyzed using Stata 13.0, and NVivo 10. Results of the quantitative data were triangulated with qualitative data for writing. Results: Many treatment options were available for infertility in the community. Generally, traditional healers (98.7%) were preferred over modern healthcare practitioners (35%). Community members usually guided infertile couples for choosing providers. Treatment practices were very different among primary infertile women than sub-fertile. Women frequently discontinued treatment and switched between providers because of unaffordability, poor connectivity, distance, travel time, time constraints, and non-supportive circumstances. The couples were advised to consume herbs, and eat or avoid certain food items, were given massage, burns on the abdomen (dagani), removed black blood (phasani) and other various rituals to appease spirits, get rid of ghosts while offering animal sacrifice, and conducting shidwa ritual. The mean expenditure on treatment was INR 18,374. If treatment did not yield any result, couple resorted to add another wife, divorce, accept childlessness and foster a child. Conclusion: Local authorities should strive to work towards the socio-economic development of the tribal communities and provide good healthcare services at their doorstep. The infertility problem needs to be understood in the context of poverty, tribal beliefs, and unequal access to healthcare resources.

Hysterectomy and women's health in India: evidence from a nationally representative, cross-sectional survey of older women.

BACKGROUND: Hysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life. METHODS: This analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being. We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility. RESULTS: The prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09). CONCLUSIONS: In India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.

Reproductive health, and child health and nutrition in India: meeting the challenge.

India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.

Hysterectomy in India: Spatial and multilevel analysis.

OBJECTIVE: Using the unit-level data of women aged 15-49 years from National Family Health Survey-IV (2015-2016), the article maps the prevalence of hysterectomy across districts in India and examines its determinants. METHODS: Descriptive statistics, multivariate techniques, Moran's Index and Local indicators of Spatial Association were used to understand the objectives. The data were analysed in STATA 14.2, Geo-Da and Arc-GIS. RESULTS: In India, the prevalence of hysterectomy operation was 3.2%, the highest in Andhra Pradesh (8.9%) and the lowest in Assam (0.9%). Rural India had higher a prevalence than urban India. The majority of women underwent the operation in private hospitals. Hysterectomy prevalence ranged between 3% and 5% in 126 districts, 5% and 7% in 47 districts and more than 7% in 26 districts. Moran's Index (0.58) indicated the positive autocorrelation for the prevalence of hysterectomy among districts; a total of 202 districts had significant neighbourhood association. Variation in the prevalence of hysterectomy was attributed to the factors at the primary sampling unit, district and state level. Age, parity, wealth and insurance were positively associated with the prevalence of hysterectomy, whereas education and sterilization was negatively associated. CONCLUSION: Hysterectomy operation in India presented the geographical, socio-economic, demographic and medical phenomenon. The high prevalence of hysterectomy in many parts of the country suggested conducting in-depth studies, considering the life cycle approach and providing counselling and education to women about their reproductive rights and informed choice. Surveillance and medical audits and promoting the judicial use of health insurance can be of great help.

Persistence of Multimorbidity Among Women Aged 15-49 Years in India: An Analysis of Prevalence, Patterns and Correlation.

Objectives: The present study has examined the patterns and possible correlates of coexisting morbidities among women aged 15-49 years based on biomarker measurement data at the national level in India. Methods: National Family Health Survey conducted during 2015-16 used in the present study. Simple disease count approach was used to calculate the multimorbidity among women. Multinomial logistic regression was applied to analyze the predictors of multimorbidity among women. Results: Almost 30% of the women had any of the selected morbidity and 9% of them had two or more morbidities. Hypertension and overweight combination (3%) was the most prevalent among women. The risk of having two or more morbidities was predominantly high among women aged above 30 years, low educated women, women from the wealthier group, ever-married women and women who were consuming tobacco as compared to their counterparts. Conclusions: From the policy perspective, the identification of groups of women vulnerable to multimorbidity will help in the selection of programmatic focus and preventive public health intervention in adult phase to reduce the multimorbidity burden among women in old ages.

Study of blood-transfusion services in Maharashtra and Gujarat States, India.

Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor.

Assessing Knowledge, Attitudes, and Preventive Practices Related to Kala-A: A Study of Rural Madhepura, Bihar, India.

To assess the knowledge, attitude, and preventive practices related to kala-azar in Madhepura district of Bihar, a community-based cross-sectional study was carried out in November 2014. A total of 353 households were interviewed from 24 villages of four blocks of Madhepura district. Data were collected using structured interview schedule. For knowledge, attitude, and preventive practice indexes, scores were assigned to individual questions based on the accuracy of responses. Univariate and binary logistic regressions were applied for the analysis. Eighty-four percent households had heard of kala-azar disease, but only 15.9% could recognize that sand flies were responsible for transmitting the disease. Overall, only 43.9% had fair knowledge on kala-azar disease (e.g., mode of transmission, signs and symptoms, and the outcome if left untreated) and the vector (breeding place, season, and biting time). Almost 48.6% had a favorable attitude toward treatability and management of kala-azar and 37.7% practiced proper mechanism to prevent and control kala-azar. Occupation emerged as a significant predictor for all three indexes. Other important predictors for the attitude index were literacy, household type, households ever had a kala-azar case, and knowledge index. Despite 61.8% of the households ever reported to have a member diagnosed with kala-azar, the overall knowledge of the disease and vector, attitude, and practices about prevention and control of kala-azar was found to be lagging. Therefore, our investigation suggests that further strengthening of comprehensive knowledge about kala-azar and preventive practices is needed.

Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India.

BACKGROUND: Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period. METHODS: Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE. RESULTS: The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE. CONCLUSIONS: Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.