Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model.

Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.

Re-examining the Nexus Between Maternal Smoking Behavior and Under-Five Children's ARI in India: A Comprehensive Study.

Background: The burden of acute respiratory infections (ARIs) among children under-five is a serious concern in lower and middle-income countries (LMICs), including India, where it is positively associated with indoor smoking exposures. This study re-examines the impact of maternal smoking on ARIs among children under 5 in India, considering other indoor air pollutant factors and covariates. The aim is to establish existing findings and capture any differentials in results using comprehensive analytical approaches. Methods: Data from the National Family Health Survey (NFHS-5), 2019 - 21, was used. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and interaction analysis were applied to accomplish the study objective. Results: The adjusted likelihood of ARI was 1.24 (95% CI: 1.04-1.48) times higher in under-five children with smoking mothers than those with non-smoking mothers. The result was also observed to be almost similar across all seasons. Moreover, the combined effect of maternal smoking with other household members smoking and using unclean cooking fuel without a separate ventilated kitchen escalated the risk (AOR: 2.01; 95% CI: 1.98-2.67). Breastfeeding was found to be a preventive measure for reducing the risk of indoor smoking exposure. The children who were never breastfed and were born large or small were more susceptible to maternal smoking. Conclusion: The study highlights the association between maternal smoking and ARIs in Indian under-five children. Interventions include reducing maternal smoking, promoting breastfeeding, and improving respiratory health in fuel-exposed households.

Unveiling the spatial divide in open defecation practices across India: an application of spatial regression and Fairlie decomposition model.

OBJECTIVE: The study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India. DESIGN: The present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019-2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots. SETTING AND PARTICIPANTS: The study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measure was the prevalence of OD. RESULTS: The prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural-urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%). CONCLUSION: The practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.

The Health Risk and Source Assessment of Polycyclic Aromatic Hydrocarbons (PAHs) in the Soil of Industrial Cities in India.

Industrial areas play an important role in the urban ecosystem. Industrial site environmental quality is linked to human health. Soil samples from two different cities in India, Jamshedpur and Amravati, were collected and analyzed to assess the sources of polycyclic aromatic hydrocarbons (PAHs) in industrial areas and their potential health risks. The total concentration of 16 PAHs in JSR (Jamshedpur) varied from 1662.90 to 10,879.20 ng/g, whereas the concentration ranged from 1456.22 to 5403.45 ng/g in the soil of AMT (Amravati). The PAHs in the samples were dominated by four-ring PAHs, followed by five-ring PAHs, and a small percentage of two-ring PAHs. The ILCR (incremental lifetime cancer risk) of the soil of Amravati was lower compared to that of Jamshedpur. The risk due to PAH exposure for children and adults was reported to be in the order of ingestion > dermal contact > inhalation while for adolescents it was dermal contact > ingestion > inhalation in Jamshedpur. In contrast, in the soil of Amravati, the PAH exposure path risk for children and adolescents were the same and showed the following order: dermal contact > ingestion > inhalation while for the adulthood age group, the order was ingestion > dermal contact > inhalation. The diagnostic ratio approach was used to assess the sources of PAHs in various environmental media. The PAH sources were mainly dominated by coal and petroleum/oil combustion. As both the study areas belong to industrial sites, the significant sources were industrial emissions, followed by traffic emissions, coal combustion for domestic livelihood, as well as due to the geographical location of the sampling sites. The results of this investigation provide novel information for contamination evaluation and human health risk assessment in PAH-contaminated sites in India.

Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen's revised healthcare utilization framework model.

BACKGROUND: In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use. METHODS: The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45 years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors. RESULTS: About 63.7% of total older adults used a private facility, followed by 22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities. CONCLUSION: The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and household level economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.

Examining the rural-urban divide in predisposing, enabling, and need factors of unsafe abortion in India using Andersen's behavioral model.

BACKGROUND: The prevalence of unsafe abortions significantly varies with geography; therefore, more research is needed to understand the rural-urban differences in unsafe abortion practices in India. The present study aims to explore the rural-urban differences in predisposing, enabling, and need factors of unsafe abortion in India. METHODS: The present study used the fourth round of the National Family Health Survey (2015-16) and included the women aged 15-49 who terminated pregnancies by induced abortion during the 5 years prior to the survey (N = 9113) as the study sample. Descriptive statistics, bivariate chi-square significance test and multivariate logistic regression model were used to accomplish the study objectives. RESULTS: The findings revealed that almost one-third of pregnancies were terminated through unsafe measures with sharp rural-urban contrast. The likelihood of unsafe abortions increases with decreasing women's age and spousal level of education. Younger women in urban settings were more vulnerable to unsafe abortion practices. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (OR: 1.92). Poor households were more likely to undergo unsafe abortions, which were more common in rural settings (OR: 1.26). The unmet need for family planning was revealed to be a significant need factor for unsafe abortion, particularly in rural settings. CONCLUSION: Although abortion is legal, India's high estimated frequency of unsafe abortions reveals a serious public health issue. Due to socio-economic vulnerability, unmet family planning needs, and a lack of awareness, significant numbers of women still practice unsafe abortions in India.

Risk of COVID-19 Transmission and Livelihood Challenges of Stranded Migrant Labourers during Lockdown in India.

The lockdown during the first phase of COVID-19 pandemic in India triggered an unprecedented humanitarian crisis. Labourers in the informal sector lost their jobs overnight and were stuck at their work places. The present study examines the risk of COVID-19 transmission among stranded migrant labourers and their livelihood challenges during  the lockdown. A telephonic survey was conducted during the lockdown of first wave of COVID-19 pandemic to collect information from the stranded migrant labourers. The non-probability snowball sampling technique and structured questionnaire were used to draw the sample. Simple frequency distribution and standard statistical methods were used to accomplish the study objectives. The factors of COVID-19 transmission such as poor housing, co-morbidities, poor practice of WASH and COVID-19 precautions were significantly high among the migrant labourers. The lockdown created livelihood crisis among them. For instance, ration shortage (86%), financial distress (82%), reduction of wages (13%), job loss (86%) and anxiety for COVID-19 infection (81%) were often seen. Many of the labourers did not receive any ration kits (30%) and financial assistance (86%) during lockdown. The governmental assistance to overcome the stranded migrant labourers' challenges during lockdown was less than desirable. India needs to frame a sustainable and effective policy for social security for labourers, particularly in emergency situations.