Is the single self-rated health item reliable in India? A construct validity study.

INTRODUCTION: In high-income countries, the self-rated health (SRH) item is used in health surveys to capture the population's general health because of its simplicity and satisfactory validity and reliability. Despite scepticism about its use in low-income and middle-income countries, India implemented the SRH item in many of its demographic and population health surveys, but evidence of its validity is lacking. The objective was to assess the construct validity of the SRH item in India. METHODS: Data for 4492 men and 4736 women from the Indian sample of the World Health Survey (2003) were used. Overall, 43 health status indicators were grouped into health dimensions (physical, mental and functional health, chronic diseases, health behaviours) and the SRH item was regressed on these indicators by using sex-stratified multivariable linear regressions, adjusted with demographic and socioeconomic variables. RESULTS: Respondents (participation rate 95.6%; mean age 38.9 years) rated their health as very good (21.8%), good (36.4%), moderate (26.6%), bad (13.2%) or very bad (2.0%). Among men, the adjusted explained SRH variance by health dimensions ranged between 18% and 41% (physical 33%, mental 32%, functional health 41%, chronic diseases 23%, health behaviours 18%). In multivariable models, the overall explained variance increased to 45%. The 43 health status indicators were associated with SRH and their effect sizes were in the expected direction. Among women, results were similar (overall explained variance 48%). CONCLUSION: The SRH item has satisfactory construct validity and may be used to monitor health status in demographic and population health surveys of India.

Sex differences in the risk profile of hypertension: a cross-sectional study.

OBJECTIVE: To assess the socioeconomic and behavioural risk factors associated with hypertension among a sample male and female population in India. SETTING: Cross-sectional survey data from a Health and Demographic Surveillance System (HDSS) of rural West Bengal, India was used. PARTICIPANTS: 27 589 adult individuals (13 994 males and 13 595 females), aged ≥18 years, were included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Hypertension was defined as mean systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg, or if the subject was undergoing regular antihypertensive therapy. Prehypertension was defined as SBP 120-139 mm Hg and DBP 80-89 mm Hg. Individuals were categorised as non-normotensives, which includes both the prehypertensives and hypertensives. Generalised ordered logit model (GOLM) was deployed to fulfil the study objective. RESULTS: Over 39% of the men and 25% of the women were prehypertensives. Almost 12.5% of the men and 11.3% of the women were diagnosed as hypertensives. Women were less likely to be non-normotensive compared to males. Odds ratios estimated from GOLM indicate that women were less likely to be hypertensive or prehypertensive, and age (OR 1.04, 95% CI 1.03 to 1.05; and OR 1.08, 95% CI 1.07 to 1.09 for males and females, respectively) and body mass index (OR 1.64, 95% CI 1.38 to 1.97 for males; and OR 1.32, 95% CI 1.08 to 1.60 for females) are associated with hypertension. CONCLUSIONS: An elevated level of hypertension exists among a select group of the rural Indian population. Focusing on men, an intervention could be designed for lifestyle modification to curb the prevalence of hypertension.

THE APPARENT NON-SIGNIFICANCE OF SEX IN CHILD UNDERNUTRITION IN INDIA.

The lack of significance of sex in the determination of child nutrition in India, as revealed from the analysis of data from the entire population, is misleading and perplexing. Given that child nutrition is affected by all channels through which sex bias operates, scholars have sought to explain its inconclusive evidence, looking at child-specific household-level factors such as birth order and sex composition of surviving older siblings. The paper points out that sex inequality needs to be examined in the context of its intersection with other consequential social identities such as religious membership, economic status and caste group affiliation. Sex disparity in child stunting is found to be prevalent particularly among upper caste Hindus. However, the relative advantage that poor tribal girls enjoy is reversed with improvement in wealth status. Thus, children in different social settings need customized policy focus.