Effect of social and behavioral change interventions on minimum dietary diversity among pregnant women and associated socio-economic inequality in Rajasthan, India.

BACKGROUND: Maternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups. OBJECTIVE: To measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy. METHODS: Data from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives. RESULTS: Study finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1-1.4), community motivators (aOR = 1.9, CI: 1.7-2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women. CONCLUSION: Despite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions.

Multimorbidity combinations and their association with functional disabilities among Indian older adults: evidence from Longitudinal Ageing Study in India (LASI).

OBJECTIVE: This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability. DESIGN: A cross-sectional data were analysed in this study. SETTING AND PARTICIPANTS: The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index. RESULTS: Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively. CONCLUSION: The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.

Impact of transition in work status and social participation on cognitive performance among elderly in India.

INTRODUCTION: Transition to the oldage marks a change in work and social participation. Socio-economic and physical conditions arising from this change pose a risk for cognitive outcomes among the elderly. Gender shows different pathways to deal with the pattern of participation and to maintain cognitive health. In India, work participation in the oldage is an outcome of financial deprivations and lack of support. At the same time, alterations in social interactions can induce stress and precipitate cognitive decline in oldage. A dearth of studies in this domain motivates us to estimate the effect of change in work and social participation on cognitive performance of the elderly in the Indian context. METHODS: The study has used the cross-sectional data on 5212 elderly from the World Health Organization's Study on global AGeing and adult health (Wave 1) (2007-08) in India. A composite score for cognition was generated. Interaction between gender, work status and social participation with respect to cognition was performed using multivariate linear regression. A linear prediction of the cognitive scores across all levels of social participation was post-estimated thereafter. RESULTS: The study found that the elderly who were 'presently working' and showed 'more' social participation had a higher mean score for cognitive performance than their counterparts. Results of regression did not indicate any gender interaction with work or social participation. Participation in social activities 'sometimes' by those who were 'retired' or 'presently working' showed a positive and significant co-efficient with cognition among respondents. The post-estimated values for cognition specified that 'retired' and 'presently working' elderly had higher cognition scores. In the age group of 60-69 years, cognition scores were higher for those who were 'retired' and did 'more' social participation as compared to the other elderly. CONCLUSION: Cognitive aging is attenuated by higher participation in work and social activities. Adequate financial schemes or the pension system can protect the elderly from developing further stress. Retirement at an appropriate age, along with a reasonable amount of social participation, is a boon for cognitive wellbeing. Hence, building more support can contain the detrimental effect of participation restriction on cognitive outcome among elderly.

Temporal decomposition of life years lived with disability in India: a growing demographic concern.

BACKGROUND: To draw optimal benefits of the demographic dividend, healthy life years of the young adults is a growing concern in India. Rising prevalence of chronic non-communicable diseases among the younger population is responsible for increasing the life years lived with disability among them and for affecting their productivity in turn. This study measures the disability burden in various Indian sub-populations and assesses the contribution of disability to the change in person years lived with a disability during 2001-11. METHODS: Data from the Census of India, 2001 and 2011 was used for estimating the age distribution and disability prevalence among males and females. The Sample Registration System was used for age-specific mortality rate to calculate the life table for 15 states in India. Life years Lived with Disability (LLD) were estimated using the Sullivan method. The extension of Arriaga method was used to decompose change in life years lived with disability into Mortality and Disability Effect (ME and DE, respectively). Positive ME explains improvement in life years due to decline in mortality rate and a negative DE explains a decline in disability incidence in 2001-11. RESULTS: At national level, the disability prevalence has increased from 2001 to 2011. The prevalence of disability and the share of LLD to Life Expectancy (LE) is higher for males. High and medium fertility states scored highest on living with disability to LE ratio and measured DE in the decomposition analysis. At the national level, the DE increased in the age groups of 20-35 years. It was higher among the females. The states that are in the advanced stages of demographic transition show a negative DE. CONCLUSION: The study highlights expansion of DE in prime productive years of life, especially among females, in medium and high fertility states. Decline in skilled employment and productivity can be two major economic adversities due to increasing DE in working ages. Disability among young and working age population needs to be prioritised as most of the Indian states stand at crucial stages of demographic transitions.