Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21.

BACKGROUND: Increasing disability is of global and national concern. Lack of evidence on disability across socioeconomic groups and geographic levels (especially small areas) impeded interventions for these disadvantaged subgroups. We aimed to examine the socioeconomic and geographic variations in disabilities, namely hearing, speech, visual, mental, and locomotor, in Indian participants using cross-sectional data from the National Family Health Survey 2019-2021. METHODS: Using data from 27,93,971 individuals, we estimated age-sex-adjusted disability rates at the national and sub-national levels. The extent of socioeconomic variations in disabilities was explored using the Erreygers Concentration Index and presented graphically through a concentration curve. We adopted a four-level random intercept logit model to compute the variance partitioning coefficient (VPC) to assess the significance of each geographical unit in total variability. We also calculated precision-weighted disability estimates of individuals across 707 districts and showed their correlation with within-district or between-cluster standard deviation. RESULTS: We estimated the prevalence of any disability of 10 per 1000 population. The locomotor disability was common, followed by mental, speech, hearing, and visual. The concentration index of each type of disability was highest in the poorest wealth quintile households and illiterate 18 + individuals, confirming higher socioeconomic variations in disability rates. Clusters share the largest source of geographic variation for any disability (6.5%), hearing (5.8%), visual (24.3%), and locomotor (17.4%). However, States/Union Territories (UTs) account for the highest variation in speech (3.7%) and mental (6.5%) disabilities, where the variation at the cluster level becomes negligible. Districts with the highest disability rates were clustered in Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Telangana, and Punjab. Further, we found positive correlations between the district rates and cluster standard deviations (SDs) for disabilities. CONCLUSIONS: Though the growing disability condition in India is itself a concerning issue, wide variations across socioeconomic groups and geographic locations indicate the implementation of several policy-relevant implications focusing on these vulnerable chunks of the population. Further, the critical importance of small-area variations within districts suggests the design of strategies targeting these high-burden areas of disabilities.

Supramolecular Engineering of Alkylated, Fluorinated, and Mixed Amphiphiles.

The rational design of perfluorinated amphiphiles to control the supramolecular aggregation in an aqueous medium is still a key challenge for the engineering of supramolecular architectures. Here, the synthesis and physical properties of six novel non-ionic amphiphiles are presented. The effect of mixed alkylated and perfluorinated segments in a single amphiphile is also studied and compared with only alkylated and perfluorinated units. To explore their morphological behavior in an aqueous medium, dynamic light scattering (DLS) and cryogenic transmission electron microscopy/electron microscopy (cryo-TEM/EM) measurements are used. The assembly mechanisms with theoretical investigations are further confirmed, using the Martini model to perform large-scale coarse-grained molecular dynamics simulations. These novel synthesized amphiphiles offer a greater and more systematic understanding of how perfluorinated systems assemble in an aqueous medium and suggest new directions for rational designing of new amphiphilic systems and interpreting their assembly process.

Prevalence and predictors of elective and emergency caesarean delivery among reproductive-aged women in Bangladesh: evidence from demographic and health survey, 2017-18.

BACKGROUND: Over the years, an increasing trend of unnecessary caesarean section (c-section) deliveries has raised concerns in Bangladesh. So far, many studies have reported the risk factors of c-section delivery in Bangladesh. However, most of these studies did not estimate the predictors of the two c-section procedures (i.e., emergency and elective) separately based on the timing of the c-section decision. This study solely brings forward the role of socio-demographic and economic factors that may be associated differently with emergency and elective c-section deliveries. METHODS: Data for the study were drawn from the 2017-18 Bangladesh Demographic and Health Survey with 5,299 women aged 15-49 years who gave birth at a health facility during three years preceding the survey. Descriptive statistics along with bivariate analysis were used to fulfill the study objectives. Further, multivariable logistic regression analysis was conducted on binary outcome variables of elective/emergency c-section deliveries. RESULTS: Approximately one-third of women in the reproductive-age group opted for delivery through c-section. Out of them, 18.7% of women had elective c-sections, and 14.1% had emergency c-sections. Women who had mass media exposure were 32% more likely to deliver through elective c-sections than women who had no exposure [AOR: 1.32; CI: 1.02-1.72]. Women with higher education had a 56% lower likelihood of delivering through emergency c-section than women with no educational status [AOR: 0.44; CI: 0.24-0.83]. Children from the third or higher birth order were significantly more likely to be delivered through elective c-sections than those from the first birth order [AOR: 2.67; CI: 1.75-4.05]. In contrast, children with higher birth order had fewer chances of emergency c-section than children with first birth order [AOR: 0.29; CI: 0.18 -0.45]. Both elective and emergency c-section deliveries were significantly higher among private health facilities. CONCLUSION: Although c-section delivery has emerged as a life-saving intervention, the overuse of such practice has created lucrative risks for the mother and unborn child. Proper sensitization of mothers and families can enhance the knowledge of the unsafe nature of unnecessary c-section deliveries. Authorizations in case of over-use of elective and emergency c-sections should be observed to minimize the unnecessary c-sections and related complications and to increase normal institutional deliveries in Bangladesh.

Decomposition of caste differential in life satisfaction among older adults in India.

BACKGROUND: Being a multi-cultured country, India has varied social groups which largely shape the lives of individuals. Literature has shown that life satisfaction is highly associated with the social status of individuals. However, changing age dynamics (growing older) and definition of life among people presses the need to understand whether the additional years of life in older adults are manifested with the disparity in life satisfaction among the Scheduled Caste (SC)/ Scheduled Tribes (ST) and non-SC/ST social groups in recent years. The present study explored the factors contributing to such differences in life satisfaction across social groups. METHODS: This study used data from the Longitudinal Aging Study in India conducted during 2017-18. The analytical sample of the study was 30,370 older adults. Life satisfaction was the outcome variable with a score ranging from 5 to 35. Descriptive statistics and bivariate analysis were conducted. Simple linear regression analysis was used to establish the association between the outcome and explanatory variables. Further, the Blinder-Oaxaca decomposition model was used to analyse the role of explanatory factors in the caste difference in life satisfaction among older people. RESULTS: Overall, the life satisfaction score among older adults in the study was 23.9 (SD- 7.3). Older adults from non-SC/ST group had significantly higher likelihood of having life satisfaction in comparison to older adults from SC/ST group [Coef: 0.31; CI: 0.14, 0.49]. The decomposition results showed that the model explained 74.3% of the caste gap (between SC/ST and non-SC/ST) in life satisfaction among older adults in India. Subjective social status (39.0%) was widening the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. Similarly, level of education (15.2%) followed by satisfaction with living arrangement (13.2%) and place of residence (5.3%) contributed for widening the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. Region of country (- 11.5%) followed by self-rated health (- 3.0%) and major depression (- 2.7%) contributed for narrowing down the gap for life satisfaction among older adults from SC/ST and non-SC/ST group. CONCLUSION: Older adults belonging to non-SC/ST groups were more likely to have a higher level of life satisfaction than those from the SC/ST group. Factors like subjective social status, educational level, living arrangement satisfaction, and place of residence explained the caste differential in life satisfaction among older adults. In addition, factors such as psychological health and perceived health status should be the area of concern and special focus for policy makers and researchers in terms of reducing social inequalities in wellbeing among older population.

Association of mass media exposure with combustible and smokeless tobacco use among Indian population: findings from a panel survey.

BACKGROUND: Despite introducing different policies and initiatives, India is recognized as one of the global players in the tobacco epidemic race. Our study explores the association between tobacco consumption and mass media exposure among the Indian population, considering the contextual factors affecting the clustering at the community and state levels. METHODS: Using two waves of the India Human Development Survey (IHDS) conducted in 2005 and 2012 for 16,661 individuals, the present study explores the association of mass media exposure and tobacco consumption in the short-term and the long-term period of Cigarettes and Other Tobacco Products Act (COTPA) implementation, which came into existence in 2004. Bivariate analysis using the chi-square test for association showed the correlation of tobacco consumption with its respective predictors. Multivariable analysis using three-level random intercept logit models showed the adjusted association between tobacco consumption and its relevant covariates and the extent of clustering of tobacco consumption behaviour of persons in the communities and states. RESULTS: We found that watching television (TV) [(OR:1.03; CI:0.92-1.15) in 2004-05 and (OR:0.99; CI:0.88-1.12) in 2011-12], listening radio [(OR: 0.99; CI:0.90-1.10) in 2004-05 and (OR:1.04; CI:0.94-1.15) in 2011-12] and reading newspaper [(OR:1.02; CI:0.91-1.15) in 2004-05 and (OR:0.96; CI:0.87-1.06) in 2011-12] did not have any significant effect on consumption of combustible tobacco. Similarly, no effect of mass media was found on smokeless tobacco consumption. Further, the clustering of combustible and smokeless tobacco usage was higher at the community level than at the state level. In both rounds, smokeless tobacco consumption was found to be higher than combustible tobacco. DISCUSSION: The present study provides evidence that COTPA has achieved its aim of nullifying the significant effect of mass media on combustible and smokeless tobacco consumption among the Indian population. However, the influence of state- and community- level clustering had failed in curbing the increment of smokeless tobacco consumption. There is a need for policy reforms to curb the significant impact of factors that promotes smokeless tobacco consumption in India. Further, initiatives must focus on specific communities from high-risk states, reducing the time and cost required for implementation.

Socioeconomic inequalities in non- coverage of full vaccination among children in Bangladesh: a comparative study of Demographic and Health Surveys, 2007 and 2017-18.

BACKGROUND: Vaccination is considered as a powerful and cost-effective weapon against many communicable diseases. An increase in full vaccination among the most vulnerable populations in Bangladesh was observed in the last decade. This study aimed to capture the socioeconomic inequalities in non-coverage of full vaccination among children aged 12-23 months using the nationally representative data from the Bangladesh Demographic and Health Surveys (BDHS). METHODS: Data for this study have been drawn from the 2007 and 2017-18 BDHS, which covered 10,996 and 20,127 ever-married women aged 15-49 years in 2007 and 2017-18, respectively. Binary logistic regression analysis was performed to find the factors associated with children who did not receive full vaccination. Further, the concentration index was used to observe the socioeconomic inequality for the outcome variable. RESULTS: The proportion of children who did not get fully vaccinated decreased by more than 6 points (18.2 percent to 11.8 percent) between the years 2007 and 2017-18. In 2017-18, the odds of children who were not fully vaccinated were 58 percent and 53 percent less among mothers who had primary education in 2007 [adjusted odds ratio (AOR): 0.42; confidence interval (CI): 0.24-0.73] and 2017-18 [AOR: 0.47; CI: 0.23-0.94] respectively, compared to mothers with no education. The inequality for children who were not fully vaccinated had declined between two survey periods [concentration index (CCI) value of - 0.13 in 2007 and -0.08 in 2017-18]. The concentration of inequality in children with higher parity who did not receive full vaccination had increased from 5 percent in 2007 to 16.9 percent in 2017-18. There was a drastic increase in the socioeconomic inequality contributed by place of delivery from 2.9 percent (2007) to 60.5 percent (2017-18) among children who did not receive full vaccination. CONCLUSIONS: The present study provide eminent evidence that non-coverage of full vaccination is more prevalent among children from poor households in Bangladesh, which is mainly associated with factors like mother's education, father's education and working status and household wealth index across the two rounds. These factors suggest multifaceted pro-poor interventions that will protect them from hardship and reduce their socioeconomic inequalities in coverage of full vaccination.

Indigenous population and major depressive disorder in later life: a study based on the data from Longitudinal Ageing Study in India.

BACKGROUND: Existing evidence suggests that the indigenous older population who live with their families and friends might experience lesser depressive symptoms due to better emotional support and well-being. The present study aimed to investigate the differentials in the prevalence of the major depressive disorder among tribal and non-tribal older populations in India and to explore the contribution of socio-demographic, health-related, and household factors in such disparities. METHODS: A cross-sectional study was conducted using data from the Longitudinal Aging Study in India (2017-18). The analytical sample included 30,637 older adults, among whom 5,025 and 25,612 belonged to the Scheduled Tribe (ST) and non-Scheduled Tribe (non-ST) social groups, respectively. Major depressive disorder assessed by the Composite International Diagnostic Interview short-form (CIDI-SF) scale was the outcome variable. Descriptive statistics, bivariate and multivariable regression and, decomposition analyses were conducted. RESULTS: About 4.8% and 8.9% of older adults from the ST and non-ST social groups had major depression. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression. Findings from differences due to characteristics (E) revealed that if the regional differences were minimized, it would decrease the ST-non-ST gap in major depression by about 19.6%. Similarly, equal self-rated health status and chronic conditions among ST and non-ST groups would decrease the gap in major depression by almost 9.6% and 7.9%, respectively. Additionally, an equal status of Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) among older adults would decrease the gap in major depression by about 3.8% and 3% respectively. Also, findings from differences due to coefficients (C) revealed that if older adults from the ST group had the same status of ADL as of older adults from the non-ST group, it would decrease the gap in major depression by about 11.8%. CONCLUSION: The findings revealed a greater prevalence of major depression in older adults belonging to the non-ST group than the ST group. For both tribal and non-tribal groups, older adults who were unmarried, dissatisfied with living arrangements, and those who faced lifetime discrimination were at increased risk of major depression and these factors along with health-related variables contributed to significant ST-non-ST gap in depression, advantageous to tribal population; suggesting further research on the coping mechanisms of mental illnesses among indigenous population in India.

Determinants of multimorbidity of infectious diseases among under-five children in Bangladesh: role of community context.

BACKGROUND: The presence of more than one morbid condition among children has become a global public health concern. Studies carried out in Bangladesh have primarily focused on diarrhoea and acute respiratory tract infections independently without considering their co-occurrence effect. The present study examines the multimorbid conditions of infectious diseases in under-five Bangladeshi children. It explores multimorbidity determinants and the role of community context, which are often overlooked in previous literature. METHODS: Utilizing the most recent Demographic and Health Survey of Bangladesh (2017-18), we used mixed-effects random-intercept Poisson regression models to understand the determinants of multimorbidity of infectious diseases in under-five Bangladeshi children considering the community-level characteristics. RESULTS: The present study found that 28% of the children experienced multimorbidity two weeks prior to the survey. Community-level variability across all the statistical models was statistically significant at the 5% level. On average, the incidence rate of multimorbidity was 1.34 times higher among children from high-risk communities than children from low-risk communities. Moreover, children residing in rural areas and other urban areas involved 1.29 [CI: 1.11, 1.51] and 1.28 [CI: 1.11, 1.47] times greater risk of multimorbidity respectively compared to children from city corporations. Additionally, the multimorbidity incidence was 1.16 times [CI: 1.03, 1.30] higher among children from high-altitude communities than children living in low-altitude communities. CONCLUSION: The significant effect of public handwashing places suggests community-based interventions among individuals to learn hygiene habits among themselves, thus, the severity of coexistence nature of infectious diseases. A higher incidence of coexistence of such infectious diseases in the poor and semi-urban populace further recommends a targeted awareness of a clean environment and primary healthcare programmes.

Old-age dependency and catastrophic health expenditure: Evidence from Longitudinal Ageing Study in India.

BACKGROUND: Out-of-pocket (OOP) payments and catastrophic health expenditure (CHE) have a strong age gradient. Though studies have examined the socio-demographic and geographic inequality in OOP payments and CHE in India, the role of old-age dependency in financial catastrophe remains unclear. Disaggregated estimates of CHE by the level of old-age dependency of households may help identify the most vulnerable sub-group and provide evidence for specific policies for the financial protection and health care of the elderly. The present study aims to estimate the incidence and intensity of CHE by the old-age dependency of households among middle-aged adults and the elderly in India. METHODS: A total of 42,949 households from the Longitudinal Aging Study in India (LASI), 2017-18, covering households with at least one-member aged 45+ years, were included in the analysis. Households were classified into three mutually exclusive groups: no old-age dependency, low old-age dependency, and high old-age dependency. The incidence and intensity of CHE were estimated using the capacity-to-pay (CTP) approach. Concentration indices and concentration curves examine the extent of socioeconomic inequality in CHE. Binary logistic regression helps to understand the potential predictors of CHE across each type of old-age-dependent household. RESULTS: We estimated the overall incidence of CHE at 24.6% (95% CI: 23.3-25.8) among middle-aged adults and the elderly in India. The incidence was 33.2% (95% CI: 31.4-35.1) among households with high old-age dependency, 23.1% (95% CI: 20.8-25.5) among those with low old-age dependency, and 20.4% (95% CI: 19.0-21.7) among no old-age dependency households. CHE intensity was highest among households with low old-age dependency compared to those no old-age dependents. Catastrophic health expenditure was higher among the poorer households in each type of old-age dependency. Among all households, the odds of incurring CHE were higher among households with high old-age dependency (AOR: 1.52; 95% CI: 1.36-1.69) than those with no old-age dependency. Lower-income households, households with pensions as the main source of income, households belonging to scheduled castes, and households residing in rural areas had higher odds of incurring CHE. The co-variates of CHE varied significantly across the type of old-age dependency households. A household's enrolment into a health insurance scheme did not necessarily lower its CHE. CONCLUSION: Households with high old-age dependency had a higher probability of incurring CHE in India. Providing preventive and curative geriatric care in primary health centres (PHC) is recommended.

Determinants of acquired disability and recovery from disability in Indian older adults: longitudinal influence of socio-economic and health-related factors.

BACKGROUND: There is a higher burden of functional disability for Indian older adults with substantial variations across different geographic regions and socioeconomic groups as compared to other ageing Asian countries. Thus, using a national sample of older adults aged 60+ years, we aim to explore how common is acquiring of disability and recovery from disability among the older population of a developing country like India, and how do the various socioeconomic and health-related conditions impact this transition in disability status. METHOD: The current study uses two waves of the India Human Development Survey (IHDS) and is based on panel data of 10,527 older adults. Both bivariate and multiple variable regression analysis were performed using two binary outcome variables in this study - whether older adults acquired disability and recovered from disability between round-I and round-II, respectively. RESULTS: Nearly 31.5% and 4.4 % of older adults have acquired and recovered disability across the two rounds respectively. About 38.5%  and 45.8 % of female older adults' disability status changes to disable and recovered in round-II respectively. A lesser proportion of older adults have recovered from a disability who have a chronic disease in round-I. Cataract chronic conditions among older adults in round-I had shown 1.45 times (CI: 1.07-1.97) a significantly higher likelihood of acquiring disability in round-I. Older adults who were unmarried and were not working in round-I have 1.12 times (CI: 1.01-1.25) and 1.21 times (CI: 1.06-1.39) higher likelihood of acquiring disability in round-II respectively. Recovering from disability was mostly seen among older adults who belong to the richest (OR: 2.38, CI: 1.31-4.33) and medium (OR: 2.16, CI: 1.27-3.69) wealth quintile households. Older adults residing in the central region of India have 2.72 times (CI: 2.31-3.19) significantly higher chance of acquiring disability than those who were residing in northern regions. CONCLUSION: Appropriate measures are required to highlight the importance of chronic physical diseases and several socio-demographic factors that may negatively affect the trajectory of disability in older ages.

Differential in infant, childhood and under-five death clustering among the empowered and non-empowered action group regions in India.

BACKGROUND: With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0-11 months), children (12-59 months) and under-five (0-59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India. METHODS: The study used data from the National Family Health Survey (2015-16) which includes all the birth histories of 475,457 women aged 15-49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity. RESULTS: About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55-1.80] and 1.46 times [CI: 1.37-1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32-1.44] and 1.24 times [CI: 1.20-1.29] higher for infant and under-five mortality respectively in the EAG regions. CONCLUSION: The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood.

Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017-18.

BACKGROUND: Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017-18. METHODS: The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017-18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017-18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting. RESULTS: The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017-18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother's characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father's characteristics, such as education explained 9% of this change. CONCLUSION: The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children's height and weight, and aim to significantly reduce inter-household inequalities.

Understanding socio-economic inequalities in the prevalence of asthma in India: an evidence from national sample survey 2017-18.

BACKGROUND: Today, over 300 million people reside with asthma worldwide and India alone is home for 6% of children and 2% of adults suffering from this chronic disease. A common notion of disparity persists in terms of health outcomes across the poor and better-off section of the society. Thus, there is a need to explore socio-economic inequality in the contribution of various factors associated with asthma prevalence in India. METHODS: Data for the study were carved out from the 75th round of National Sample Survey (NSS), collected by the National Sample Survey Organization (NSSO) during 2017-18. The sample size for this study was 555,289 individuals, for which data was used for the analysis. Descriptive statistics were used to show the distribution of the study population. Further, bivariate and multivariate analysis was performed to identify the factors associated with Asthma prevalence. The concentration index was used to measure the inequality. Further, we used decomposition analysis to find the contribution of factors responsible for socio-economic status-related inequality in asthma prevalence. RESULTS: The prevalence of asthma was 2 per 1000 in the whole population; however, the prevalence differs by age groups in a significant manner. Age, sex, educational status, place of residence, cooking fuel, source of drinking water, household size and garbage disposal facility were significantly associated with asthma prevalence in India. It was found that asthma was more concentrated among individuals from higher socioeconomic status (concentration index: 0.15; p < 0.05). While exploring socio-economic inequality for asthma, richest wealth status (53.9%) was the most significant contributor in explaining the majority of the inequality followed by the urban place of residence (37.9%) and individual from age group 45-65 years (33.3%). Additionally, individual aged 65 years and above (27.9%) and household size less than four members (14.7%) contributed in explaining socio-economic inequality for asthma. CONCLUSION: Due to the heterogeneous nature of asthma, associations between different socio-economic indicators and asthma can be complex and may point in different directions. Hence, considering the concentration of asthma prevalence in vulnerable populations and its long-term effect on general health, a comprehensive programme to tackle chronic respiratory diseases and asthma, in particular, is urgently needed.

Neonatal and Postneonatal Death Clustering Among Siblings in Bangladesh: Evidence from Bangladesh Demographic and Health Survey 2017-2018.

Despite knowledge of neonatal and postneonatal mortality determinants in Bangladesh, some families continue to lose a larger share of children, a phenomenon known as early-life mortality clustering. This study uses the random intercept Weibull survival regression model to explore the correlation of mortality risk among siblings at the family (or, mother) and community levels. Utilizing the Bangladesh Demographic and Health Survey 2017-2018, we found evidence of death scarring, where children whose previous sibling was not alive at the time of conception had significantly higher odds of neonatal mortality. Moreover, the neonatal (and postneonatal) mortality hazard was highest for children with a birth interval of fewer than 19 months, corresponding to the preceding sibling. The intraclass correlation coefficient's statistically significant values show that neonatal and postneonatal mortality risk is correlated among children of the same family and community. The findings suggest focusing on high-risk families and communities to reduce the mortality level effectively.

The Spectrum of Central Nervous System Tumors at a Tertiary Care Center Primarily Serving a Rural Population.

Background Central nervous system (CNS) tumors cause significant mortality and morbidity in all age groups. There was no data about the histological spectrum of all CNS tumors in the tertiary care center serving primarily the rural population of Uttar Pradesh. Aims and objectives The present study aimed to describe the histopathological spectrum of all CNS tumors reported in a rural tertiary care center at Saifai, Uttar Pradesh. It also aimed to provide an overview of the descriptive epidemiology of CNS tumors. Material and methods This was a retrospective, cross-sectional study. The study duration was three years. A total of 115 cases of CNS tumors were studied during that period. Cases were classified according to their histological types, and results were analyzed. Results The most common histological group was neuroepithelial tumors, with 53 cases (46.08%). This group had 36 cases of astrocytic tumors (31.3%), three cases of oligodendroglial tumors (2.6%), five cases of oligoastrocytic tumors (4.34%), five cases of ependymal tumors (4.34%), and four cases of embryonal tumors (3.47%). The second most common tumor was meningeal tumors, with 32 cases (27.82%). The male/female ratio (M/F) ratio was 0.7. Females were found to be more affected by almost all histologic categories. Most meningiomas (89.6%) were of World Health Organization (WHO) grade I (26 cases out of 29). Astrocytic tumors showed WHO grade I, II, III, and IV tumors in two cases (5.5%), twelve cases (33.3%), four cases (11.1%), and eighteen cases (50%), respectively. In the younger age group (0-20 years), ependymoma and medulloblastoma were most common, followed by pilocytic astrocytoma and schwannoma. Conclusion In this region, neuroepithelial tumors were seen more commonly than meningioma. Females were found to be more affected by CNS tumors. This study has provided relevant data, which can be used for research and better patient management. Further studies with the incorporation of advanced radiological investigation and immunohistochemistry have been recommended.

Examining chronic disease onset across varying age groups of Indian adults using competing risk analysis.

In low-and-middle-income countries, people develop chronic diseases at a younger age, leading to health-and-economic loss. Estimates of the age of onset of chronic disease provide evidence for policy intervention, but in the Indian context, evidence is limited. The present study aims to explore the onset of seven chronic diseases across adults and the elderly, along with the prognostic factors of chronic disease onset. Using Wave 1 data of the Longitudinal Ageing Study in India (LASI), we estimated the statistical distributions, the median age at onset, and Loglogistic and Weibull accelerated failure time model to understand the onset of seven medically diagnosed self-reported chronic diseases across age groups. We also obtained the sub-distribution hazard ratio (SHR) from the Fine-Gray model to determine the risk of contracting selected chronic diseases in a competing risk setup. The seven chronic diseases- hypertension, diabetes, lung disease, heart disease/stroke, arthritis, neurological disease, and cancer- were developing early, especially in individuals aged 45-54 and 55-64. Arthritis risk was higher in rural areas, and physically active adults and elderly were 1.32 times (95% CI 1.12-1.56) more likely to develop heart disease/stroke. The emerging evidence of the early onset of neurological diseases in middle-aged adults (i.e., among the 45-54 age group) reminds us of the need to reinforce a balance between the physical and mental life of individuals. The early onset of chronic diseases in the independent and working-age category (45-54 years) can have many social and economic implications. For instance, it can create a greater healthcare burden when these individuals grow older with these diseases. Further, disease-specific interventions would be helpful in reducing future chronic disease burden.

Depression by gender and associated factors among older adults in India: implications for age-friendly policies.

Inspite of implementing policies to control mental health problems, depression remains a severe health concern among older adults in India. We examined self-reported differences in the depression among older men and women in India and examined associated factors for gender differences in depression at the population level. We utilized nationally representative data from the Longitudinal Aging Study in India (LASI) wave I, for years 2017-2019. Our analytical sample comprised of 30,637 older adults ages 60 years and above (14,682 men and 15,655 women). We conducted descriptive statistics and Chi-Square tests followed by binary logistic regression and multivariate decomposition analyses to examine our study objectives. Depression was reported in - 7.4% (95% CI 7.0, 7.8) of older men and 9.5% (CI 9.1, 10.0) of older women. Poor self-rated health, multimorbidity status, physical activity, difficulty in activities of daily living (ADL) and instrumental ADL (IADL) were the significant health-related factors associated with depression among older men and women. Not being satisfied with one's life, not being satisfied with their present living arrangement, receiving any type of ill-treatment, and being widowed were the significant factors associated with depression among older men and women. We found gender disparity in self-reported depression. Marital status contributed-to 36.7% of the gender gap in depression among older adults. Additionally, ADL and IADL difficulties among men and women contributed to 17.6% and 34.0%, gender gap, self-rated health contributed to 18.8% gap, whereas not having equal social participation (4.4%) and not satisfied in present living arrangements (8.1%) were other factors that contributed to gender gap for depression in India. Depression is a critical and persistent public health problem among-older females in India. Our findings provide a broader framework for policymakers and health practitioners to focus on gender-specific strategies to mitigate this highly emergent problem.

Fluorinated dendritic amphiphiles, their stomatosome aggregates and application in enzyme encapsulation.

Enzymes are more selective and efficient than synthetic catalysts but are limited by difficult recycling. This is overcome by immobilisation, namely through encapsulation, with the main drawback of this method being slow diffusion of products and reactants, resulting in effectively lowered enzyme activity. Fluorinated dendritic amphiphiles were reported to self-assemble into regularly perforated bilayer vesicles, so-called "stomatosomes". It was proposed that they could be promising novel reaction vessels due to their increased porosity while retaining larger biomolecules at the same time. Amphiphiles were synthesised and their aggregation was analysed by cryogenic transmission electron microscopy (cryo-TEM) and dynamic light scattering (DLS) in buffered conditions necessary for enzyme encapsulation. Urease and albumin were encapsulated using the thin-film hydration method and investigated by confocal and time-gated stimulated emission depletion microscopy (gSTED). Their release was then used to probe the selective retention of cargo by stomatosomes. Free and encapsulated enzyme activity were compared and their capacity to be reused was evaluated using the Berthelot method. Urease was successfully encapsulated, did not leak out at room temperature, and showed better activity in perforated vesicles than in closed vesicles without perforations. Encapsulated enzyme could be reused with retained activity over 8 cycles using centrifugation, while free enzyme had to be filtrated. These results show that stomatosomes may be used in enzyme immobilisation applications and present advantages over closed vesicles or free enzyme.

Early childhood circumstances and educational wellbeing inequality among tribal and non-tribal children in India: evidence from a panel study.

Despite efforts towards bridging the education gap between tribal (Scheduled Tribe) and non-tribal (Non-Scheduled Tribe) children, contrasting poor-quality education questioned the tribal children's educational wellbeing in India. Early childhood circumstances render a remarkable impact on the educational wellbeing of children in later years. This study examined the influence of early childhood circumstances (child, household and community characteristics) during 2005 on the educational wellbeing inequality (among India's tribal and non-tribal children) during 2012 using the India Human Development Survey panel dataset of 8611 children. The Educational wellbeing score was obtained from reading, mathematical and writing test scores using Principal Component Factor Analysis. We performed the Blinder-Oaxaca decomposition of the educational wellbeing inequality among India's tribal and non-tribal children. The ST children's average educational wellbeing score (-0.41) was much lower than the Non-ST children (0.04). Findings from the Blinder-Oaxaca decomposition show that the household economic condition in children's early ages contributed to 24% of educational wellbeing inequality among tribal and non-tribal children. Further, the education status of males and female adults and the sanitation condition of families considerably impacted educational wellbeing. The present study concludes that caste antagonism has not reduced with time. The missing focus on the minority groups resulted in a deteriorated educational wellbeing.

Examining sex disparity in the association of waist circumference, waist-hip ratio and BMI with hypertension among older adults in India.

Hypertension is a public health issue touted as a "silent killer" worldwide. The present study aimed to explore the sex differential in the association of anthropometric measures including body mass index, waist circumference, and waist-hip ratio with hypertension among older adults in India. The study used data from the Longitudinal Aging Study in India (LASI) conducted during 2017-18. The sample contains 15,098 males and 16,366 females aged 60 years and above. Descriptive statistics (percentages) along with bivariate analysis were presented. Multivariable binary logistic regression analyses were used to examine the associations between the outcome variable (hypertension) and putative risk or protective factors. About 33.9% of males and 38.2% of females aged 60 years and above suffered from hypertension. After adjusting for the socioeconomic, demographic and health-behavioral factors, the odds of hypertension were 1.37 times (CI: 1.27-1.47), significantly higher among older adults who were obese or overweight than those with no overweight/obese condition. Older adults with high-risk waist circumference and waist-hip ratio had 1.16 times (CI: 1.08-1.25) and 1.42 times (CI: 1.32-1.51) higher odds of suffering from hypertension, respectively compared to their counterparts with no high-risk waist circumference or waist-hip ratio. The interaction effects showed that older females with overweight/obesity [OR: 0.84; CI: 0.61-0.74], high-risk waist circumference [OR: 0.89; CI: 0.78-0.99], and high-risk waist-hip ratio [OR: 0.90; CI: 0.83-0.97] had a lower chance of suffering from hypertension than their male counterparts with the similar anthropometric status. The findings suggested a larger magnitude of the association between obesity, high-risk waist circumference, high-risk waist-hip ratio and prevalent hypertension among older males than females. The study also highlights the importance of measuring obesity and central adiposity in older individuals and using such measures as screening tools for timely identification of hypertension.