Consanguineous marriage and associated diseases among their children and grandchildren in India: evidence from large-scale data.

Worldwide, more than 130 million infants are born each year and a considerable number of 13.5 million of these children have inbred parents. The present study aimed to investigate the association between parents' consanguinity and chronic illness among their children and grandchildren in India. The nationally representative data, Longitudinal Aging Study in India, 2017-2018, Wave 1 was used for the present study. Bivariate analysis, a probit model, and propensity score estimation were employed to conduct the study. The study observed the highest prevalence of consanguinity marriage in the state of Andhra Pradesh (28%) and the lowest in Kerala (5%) among the south Indian States. People who lived in rural areas, belonged to the richer wealth quintile and Hindu religion were the significant predictors of consanguinity marriage in India. For individuals who were in consanguineous marriages, there was 0.85%, 0.84%, 1.57% 0.43%, 0.34%, and 0.14% chances of their children and grandchildren developing psychotic disorders, heart disease, hypertension stroke, cancer, and diabetes, respectively. Moreover, around 4.55% of the individuals have a history of birth defects or congenital disorders. To address the risk of complicated illnesses due to the consanguinity of marriage, medical, genetic, and social counselling services are required.

In-utero exposure to multiple air pollutants and childhood undernutrition in India.

BACKGROUND: Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5. OBJECTIVE: This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition. METHODS: This study analysed stunting, being underweight, and anaemia of children aged 0-59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran's I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels. RESULTS: Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 µg/m-3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32-1.44), underweight (AOR:1.59; 95% CI:1.51-1.67) and anaemia (AOR:1.61; 95% CI:1.52-1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished. IMPACT STATEMENT: Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children's nutrition.

Correlates of low birth weight and preterm birth in India.

BACKGROUND: In the 21st century, India is still struggling to reduce the burden of malnutrition and child mortality, which is much higher than the neighbouring countries such as Nepal and Shri Lanka. Preterm birth (PTB) and low birth weight (LBW) predispose early-age growth faltering and premature mortality among children below the age of five. Thus, highlighting the determinants of LBW and PTB is necessary to achieve sustainable development goals. OBJECTIVE: The present study provides macro-level estimates of PTB and LBW and aims to highlight the nature of the association between various demographic, socioeconomic, and maternal obstetric variables with these outcomes using a nationally representative dataset. METHODS: Data on 170,253 most recent births from the National Family health survey (NFHS-5) 2019-21 was used for the analysis. The estimates of PTB and LBW are measured by applying sample weights. The correlates of LBW and PTB were analyzed using logistic models. RESULTS: There were cross-state disparities in the prevalence of PTB and LBW. In India, an estimated 12% and 18% of children were LBW and PTB, respectively, in 2019-21. Maternal obstetric and anthropometric factors such as lack of antenatal care, previous caesarean delivery, and short-stature mothers were associated positively with adverse birth outcomes such as LBW and PTB. However, a few correlates were found to be differently associated with PTB and LBW. Mothers belonging to richer wealth status had higher chances of having a preterm birth (OR = 1.16, 95% CI: 1.11-1.20) in comparison to poor mothers. In contrast, the odds of having LBW infants were found to be increased with the decreasing level of the mother's education and wealth quintile. CONCLUSIONS: In India, PTB and LBW can be improved by strengthening existing ante-natal care services and evaluating the effects of the history of caesarean births on future pregnancies.

Contribution of low birth weight to childhood undernutrition in India: evidence from the national family health survey 2019-2021.

BACKGROUND: Infants born with low birth weight (LBW), i.e. less than 2500g, is considered an important factor of malnutrition in Asia. In India, research related to this issue is still neglected and limited. Evidence exists that a large number of child deaths occur in India due to maternal and child malnutrition-related complications. Moreover, it has been found that the cost of malnutrition in India results in a significant reduction of the country's Gross Domestic Product (GDP). Thus, in this current context, this study aims to explore the contribution of low birth weight to childhood undernutrition in India. METHODS: The study used data from the 5th round of the National Family Health Survey (NFHS-5), a large-scale survey conducted in India. The survey collected information from 176,843 mothers and 232,920 children. The study used the last birth information (last children born 5 years preceding the survey) due to the detailed availability of maternal care information. Univariate and bivariate analyses were conducted to determine the percentage distribution of outcome variables. Multivariate logistic regression was employed to examine the association between LBW and undernutrition (stunting, wasting, and underweight). The study also used the Fairlie decomposition analysis to estimate the contribution of LBW to undernutrition among Indian children. RESULTS: The results show that childhood undernutrition was higher in states like Uttar Pradesh, Bihar, Jharkhand, Gujarat, and Maharashtra. The results of the logistic regression analysis show that infants born with low birth weight were more likely to be stunted (OR = 1.46; 95% CI: 1.41-1.50), wasted (OR = 1.33; 95% CI: 1.27-1.37), and underweight (OR = 1.76; 95% CI: 1.70-1.82) in their childhood compared to infants born without low birth weight. The findings from the decomposition analysis explained that approximately 14.8% of the difference in stunting, 10.4% in wasting, and 9.6% in underweight among children born with low birth weight after controlling for the individuals' selected characteristics. CONCLUSION: The findings suggest that LBW has a significant contribution to malnutrition. The study suggests that policymakers should prioritize strengthening maternal and child healthcare schemes, particularly focusing on antenatal and postnatal care, as well as kangaroo mother care at the grassroots level to reduce the burden of LBW and undernourished children.

Relationship between low birth weight and infant mortality: evidence from National Family Health Survey 2019-21, India.

BACKGROUND: Low birth weight (LBW) predisposes physical and mental growth failure and premature death among infants. Studies report that LBW predominately explains infant mortality. However, existing studies rarely demonstrate the phenomenon of both observed and unobserved factors, which may influence the likelihood of birth and mortality outcomes simultaneously. In this study, we identified the spatial clustering of the prevalence of LBW along with its determinants. Further, the relationship between of LBW and infant mortality, considering the unobserved factors, has been explored in the study. METHODS: Data for this study have been extracted from the National Family Health Survey (NFHS) round 5, 2019-21. We used the directed acyclic graph model to identify the potential predictors of LBW and infant mortality. Moran's I statistics have been used to identify the high-risk areas of LBW. We applied conditional mixed process modelling in Stata software to account for the simultaneous nature of occurrences of the outcomes. The final model has been performed after imputing the missing data of LBW. RESULTS: Overall, in India, 53% of the mothers reported their babies' birth weight by seeing health card, 36% reported by recall, and about 10% of the LBW information was observed as missing. The state/union territory of Punjab and Delhi were observed to have the highest levels of LBW (about 22%) which is much higher than the national level (18%). The effect of LBW was more than four times larger compared to the effect in the analysis which does not account for the simultaneous occurrence of LBW and infant mortality (marginal effect; from 12 to 53%). Also, in a separate analysis, the imputation technique has been used to address the missing data. Covariates' effects showed that female children, higher order births, births that occur in Muslim and non-poor families and literate mothers were negatively associated with infant mortality. However, a significant difference was observed in the impact of LBW before and after imputing the missing values. CONCLUSIONS: The current findings showed the significant association of LBW with infant deaths, highlighting the importance of prioritising policies that help improve the birth weight of new-born children that may significantly reduce the infant mortality in India.

Spatial shifting of COVID-19 clusters and disease association with environmental parameters in India: A time series analysis.

BACKGROUND: The viability and virulence of COVID-19 are complex in nature. Although the relationship between environmental parameters and COVID-19 is well studied across the globe, in India, such studies are limited. This research aims to explore long-term exposure to weather conditions and the role of air pollution on the infection spread and mortality due to COVID-19 in India. METHOD: District-level COVID-19 data from April 26, 2020 to July 10, 2021 was used for the study. Environmental determinants such as land surface temperature, relative humidity (RH), Sulphur dioxide (SO2), Nitrogen dioxide (NO2), Ozone (O3), and Aerosol Optical Depth (AOD) were considered for analysis. The bivariate spatial association was used to explore the spatial relationship between Case Fatality Rate (CFR) and these environmental factors. Further, the Bayesian multivariate linear regression model was applied to observe the association between environmental factors and the CFR of COVID-19. RESULTS: Spatial shifting of COVID-19 cases from Western to Southern and then Eastern parts of India were well observed. The infection rate was highly concentrated in most of the Western and Southern regions of India, while the CFR shows more concentration in Northern India along with Maharashtra. Four main spatial clusters of infection were recognized during the study period. The time-series analysis indicates significantly more CFR with higher AOD, O3, and NO2 in India. CONCLUSIONS: COVID-19 is highly associated with environmental parameters and air pollution in India. The study provides evidence to warrant consideration of environmental parameters in health models to mediate potential solutions. Cleaner air is a must to mitigate COVID-19.

Understanding the associations between maternal high-risk fertility behaviour and child nutrition levels in India: evidence from the National Family Health Survey 2015-2016.

Anthropometric markers are the most important aspect of a child's health assessment. Using large-scale nationally representative data from the National Family Health Survey (NFHS-4), 2015-2016, this study aimed to investigate the relationship between children born to women with high-risk fertility behaviours and children's health outcomes. The sample consisted of 2,55,726 children of currently married women aged 15-49 years in India. The key explanatory variable, high-risk fertility behaviour was defined by women's age at birth (below 18 or above 34 years), birth interval (less than 24 months), and higher birth orders (four and above). The key outcome variables for assessing child health outcomes were stunting, wasting, and underweight in children aged 0-59 months. We used descriptive statistics, Pearson's chi-square test and logistic regression models to analyse the objectives. Approximately 33% of children were born with any single high-risk condition in the last 5 years in India. The bivariate analysis showed that all three components of child health, stunting, wasting, and underweight, were higher among children born to women with high-risk fertility behaviour. The findings from the multivariable analysis suggest that children born with a high risk fertility behaviour were suffering from stunting (AOR = 1.30; 95% CI 1.27-1.33) and underweight (AOR = 1.23; 95% CI 1.20-1.27). In addition, children born to women of multiple high-risk categories had higher odds of stunting (AOR = 1.53; 95% CI 1.46-1.59) and underweight (AOR = 1.38; 95% CI 1.32-1.44) as compared to children born to women with no risk. Our findings highlight an urgent need for effective legislation to prevent child marriage that would be helpful in increasing the maternal age at birth. The government should also focus on the interventions in health education and improvement of reproductive healthcare to promote optimal birth spacing.

Identifying risk factors in explaining women's anaemia in limited resource areas: evidence from West Bengal of India and Bangladesh.

BACKGROUND: Anaemia among women is a public health problem with associated adverse outcomes for mother and child. This study investigates the determinants of women's anaemia in two Bengals; West Bengal (a province of India) and Bangladesh. These two spaces are inhabitated by Bengali speaking population since historic past. The study argues that open defecation, contraceptive method use and food consumption patterns are playing crucial role in explaining anaemia. METHODS: Using non-pregnant women belonging to different religious groups, we analyzed a total of 21,032 women aged 15-49 from the nationally representative cross-sectional surveys, i.e., Bangladesh Demographic Health Survey (BDHS-VI, 2011) and National Family Health Survey (NFHS round 4, 2015-16). We performed spatial, bivariate and logistic regression analyses to unfold the important risk factors of anaemia in two Bengals. RESULTS: The prevalence of anaemia was 64% in West Bengal and 41% in Bangladesh. The significant risk factors explaining anaemia were use of sterilization, vegetarian diet and open defecation. Further, women who used groundwater (tube well or well) for drinking suffered more from anaemia. Also, younger women, poor, less educated and having more children were highly likely to be anaemic. The study also indicates that those who frequently consumed non-vegetarian items and fruits in West Bengal and experienced household food security in Bangladesh were less prone to be anaemic. Hindus of West Bengal, followed by Muslims of that state and then Hindus of Bangladesh were at the higher risk of anaemia compared to Muslims of Bangladesh, indicating the stronger role of space over religion in addressing anaemia. Unlike West Bengal, Bangladesh observed distinct regional differences in women's anaemia. CONCLUSIONS: Propagating the choices of contraception mainly Pill/ injection/IUDs and making the availability of iron rich food along with a favourable community environment in terms of safe drinking water and improved sanitation besides better education and economic condition can help to tackle anaemia in limited-resource areas.

Household air pollution and cognitive health among Indian older adults: Evidence from LASI.

BACKGROUND: Previous shreds of evidence have suggested that ambient air pollution is negatively associated with cognitive health among older adults, but whether indoor air pollutants such as cooking fuel, tobacco smoke, and incense burning exposure affect the cognitive score is unknown, especially in limited-resource areas. METHOD: The study has utilized the recently released data from the Longitudinal Ageing Study of India (LASI), Wave 1, conducted from 2017 to 2018. A total of 63,883 (≥45 years) older adults were considered for the analysis. Descriptive statistics, bivariate analysis and ordinary least squares regression were employed in the study. RESULTS: The estimated mean cognitive score was 25.4 and the percentage of solid fuel users was 45.6 in India. The cognitive score gap between the two groups was more remarkable in Tamil Nadu (clean fuels: 29.7; solid fuels: 23.9). A significant cognitive score gap was observed for all indoor air pollutants, i.e., cooking fuel (clean: 29.7 and solid fuels: 23.9), exposure to tobacco smoke (not exposed: 25.7 and exposed: 24.4), and exposure to daily incense burning (not exposed: 25.9 and exposed: 24.8). The unadjusted model found that a one-unit increase of using charcoal/lignite/coal reduces the cognitive score by 5 (95% CI: -5.36, -4.61). A similar effect of exposure to tobacco smoke (ß = -0.79, 95% CI: -0.89, -0.68) and incense burning (ß = -0.28, 95% CI: -0.30, -0.26) was explored in the study. After adjusting socioeconomic and demographic characteristics, indoor air pollution was found to be a significant determinant of cognitive health. CONCLUSIONS: The study has identified exposure to indoor air pollution as a risk factor for cognitive impairment among older adults. Therefore, we suggest an urgent need of promoting existing schemes like the Pradhan Mantri Ujjwala Yojana and creating awareness about the adverse effects of indoor air pollutants for a better future.

An analytical pathway of consumption expenditure with neighborhood deprivation and depression on cognitive health among elderly in India: A moderated mediation approach.

BACKGROUND: This study aims to find the linkage between neighborhood deprivation and cognition with depression as a mediating factor while economic condition as a moderator. METHODS: We have used the recent baseline wave-1 data of Longitudinal Aging Study in India (LASI), 2017-2018. The study was restricted to 60 and above population, consisting of males (14,931) and females (16,533). We have used moderated mediating model to understand the relationship between deprivation (X), cognition (Y) mediated through depression (M), moderated by economic condition (W), while controlling all possible confounders. RESULTS: Neighborhood deprivation was positively associated with depression (ß: 0.12; SE: 0.01) and inversely linked to cognition (ß: -0.4; SE: 0.02). Deprivation had a strong indirect effect on cognition that was mediated by depression. Further, interaction of depression (M) and economic condition (W) was negatively associated (ß = -0.03; SE: 0.01) with cognition (Y), indicating that lower economic section being more depressed with lower cognitive function. LIMITATIONS: The study failed to capture other mental health aspects like stress and anxiety using the Depression, Anxiety and Stress Scale-21 items (DASS-21). CONCLUSIONS: This study has found a link between higher economic condition with low deprivation and depression. Older individuals with better financial situation have improved cognitive level than their counterparts, who are also depressed. This study provides an opportunity to conduct future research on cognitive health in the face of population aging in India.

Prevalence and potential determinants of chronic disease among elderly in India: Rural-urban perspectives.

Chronic diseases are the leading causes of disability and premature death among the elderly population in India. The study, using data from the 75th round of the NSSO survey (N = 44,631), examined the prevalence and determinants of chronic diseases among the population aged 60+ in India by applying bivariate and logistic regression analyses and used a non-linear decomposition technique to understand the urban-rural differences in the prevalence of chronic diseases. About 21% of the elderly in India reportedly have at least one chronic disease. Seventeen percent elderly in rural areas and 29% in urban areas suffer from a chronic disease. Hypertension and diabetes account for about 68% of all chronic diseases. The prevalence of chronic diseases is the highest in Kerala (54%), followed by Andhra Pradesh (43), West Bengal (36), and Goa (32). Those with higher levels of education, staying in urban areas, those who are economically dependent on others, staying alone or without spouse and children, and belonging to wealthy households have a higher likelihood of having a chronic disease. The probability of having a chronic disease is 1.15 times higher among urban residents as compared to their rural counterparts. Elderly rural women, compared to elderly rural men, and never-married, widowed, and divorced elderly urban women, compared to married elderly urban men, are significantly more likely to suffer from chronic ailments. Differences in education, wealth status, and caste are the three most significant contributors to the urban-rural gap in chronic diseases. The high risk of chronic diseases among certain subsets of the elderly population must be recognized as a key public health concern. The findings of our study will likely help promote healthy ageing in India.

Influence of agriculture on child nutrition through child feeding practices in India: A district-level analysis.

Malnutrition continues to be a primary concern for researchers and policymakers in India. There is limited scientific research on the effect of agriculture on child nutrition in the country using a large representative sample. To the best of our knowledge, no study has examined the spatial clustering of child malnutrition and its linkage with agricultural production at the district-level in the country. The present study aims to examine agricultural production's role in improving the nutritional status of Indian children through child feeding practices. The nutritional indicators of children from the National Family Health Survey-4 (2015-16) and the agricultural production data for all the 640 districts of India obtained from the District-Wise Crop Production Statistics (2015-16), published by the Ministry of Agriculture, Government of India were used for the analysis. The statistical analysis was undertaken in STATA (version 14.1). ArcMap (version 10.3), and GeoDa (version 1.8) were used for the spatial analysis. The study found a higher prevalence of malnutrition among children who had not received Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), and Minimum Acceptable Diet (MAD). Further, child feeding practices- MMF, MDD, and MAD- were positively associated with high yield rates of spices and cereals. The yield rate of cash crops, on the contrary, harmed child feeding practices. Production of pulses had a significant positive effect on MDD and MAD. Districts with high cereal yield rates ensured that children receive MMF and MAD. There is a significant spatial association between child feeding practices and malnutrition across Indian districts. The study suggests that adopting nutrient-sensitive agriculture may be the best approach to improving children's nutritional status.