Spatial heterogeneity in intimate partner violence across the 640 districts of India: a secondary analysis of a cross-sectional, population-based survey by use of model-based small-area estimation.

BACKGROUND: Although intimate partner violence (IPV) against women is a substantial challenge in India, response is limited by little evidence on substate prevalence. District-level IPV estimates are essential in targeted response and prevention efforts, but cannot be directly calculated from the National Family Health Surveys (NFHS), which is the main source of nationally representative IPV estimates in India. We aimed to use small-area estimation techniques to derive reliable estimates of physical, emotional, and sexual IPV for the 640 districts of India. METHODS: For this secondary analysis of a cross-sectional, population-based survey, we used model-based small-area estimation techniques linking data from the 2015-16 NFHS-4 and the 2011 Indian Population and Housing Census (2011 Indian Census) to derive district-level estimates of physical, emotional, and sexual IPV for the 640 districts of India in the previous 12 months. Only women who had ever been married aged 15-49 years, who were interviewed in NFHS-4, and who were included in the domestic violence module were eligible for inclusion in this analysis. Data collection occurred between Jan 20, 2015, and Dec 4, 2016. The 2011 Indian Census was conducted in all 640 districts from Feb 9 to Feb 28, 2011. It collected information on a range of data including sociodemographic data and housing characteristics. The primary outcomes of this analysis were the district-level mean proportions of women who experienced physical IPV, emotional IPV, and sexual IPV in the previous 12 months. This outcome was estimated for all women aged 15-49 years who had ever been married in the 640 districts of India that were included in the 2011 Indian Census. FINDINGS: 699 686 women aged 15-49 years were interviewed in NFHS-4. One woman per household in a randomly selected 15% of households was chosen for participation in the domestic violence module, resulting in 83 397 (11·9%) of 699 686 women included. Of these 83 397 women, 14 377 (17·2%) were excluded as they had never been married and 3007 (3·6%) were excluded due to privacy limitations. The mean prevalence of physical IPV in the previous 12 months was 22·5% (95% CI 21·9-23·2), of emotional IPV in the previous 12 months was 11·4% (11·0-11·9), and of sexual IPV in the previous 12 months was 5·2% (4·9-5·5). Model-based estimates revealed intrastate and interstate IPV variations. In Bihar, which had the highest state-level physical IPV prevalence (35·1%, 33·3-37·0), district-level estimates varied from 23·5% (23·0-23·9) in Siwan to 42·7% (42·3-43·1) in Purbi Champaran. In Tamil Nadu, which had the highest state-level emotional IPV prevalence (19·0%, 17·4-20·8), district estimates ranged between 13·7% (13·2-14·1) in Kanniyakumari and 30·2% (29·5-30·8) in Sivaganga. Bihar also had the highest state-level sexual IPV prevalence (11·1%, 9·9-12·4), with estimates ranging between 6·3% (6·1-6·6) in Siwan and 18·1% (17·6-18·6) in Saharsa. Across districts, there was substantial spatial clustering of IPV prevalence. INTERPRETATION: This reliable district-level estimation of IPV prevalence in the 640 districts of India has important policy implications. The ability to track substate levels of IPV over time enables the identification of progress in reducing IPV; recognises the heterogeneity of culture and context in India; and informs the targeting of resources, interventions, and prevention programmes to districts with the greatest need. FUNDING: Bill & Melinda Gates Foundation.

Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three Recent Rounds of National Family Health Survey.

INTRODUCTION: Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India. METHODS: We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12-17 months, 18-23 months (ref), 24-35 months, and 36-59 months] and five child health outcomes - neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations. RESULTS: 3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05-1.18), stunting (OR: 1.13; 95% CI: 1.08-1.18) and underweight (OR: 1.06; 95% CI: 1.01-1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12-17 months and 36-59 months had higher odds of stunting, and IPI of 12-17 months was also associated with higher odds of underweight. DISCUSSION: Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12-17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India.

Practice Patterns of Audiologists Involved in Assessment and Management of Vestibular Disorders: An Indian Cross-Sectional Survey.

BACKGROUND: As the incidence of vestibular disorders continues to rise, the role of the audiologists in assessing and providing effective intervention has become increasingly important. To date, there have been no studies investigating the practice patterns of Indian audiologists towards the assessment and management of vestibular disorders. METHOD: An electronic survey consisting of 29 questions across demographics, vestibular assessment, and management emailed to 704 members of the Indian Speech and Hearing Association (ISHA). Additionally, the questionnaire was circulated to audiologists through social media groups. The participants were provided with a two weeks' time limit for completing the survey. RESULTS: 704 participants were contacted to take part in the survey, and only 243 responses were received resulting in a 34.66 % response rate. Among the 243 participants who responded, 127 participants were currently not involved in the assessment and/or management of vestibular disorders in India. The responses were analyzed descriptively according to each section of the questionnaire. The study also sheds light on vestibular assessment, rehabilitation trends, and perceived barriers/facilitators among Indian audiologists. CONCLUSION: We observed major discrepancies between practice patterns of audiologists in India. Like any other developing nation, India has challenges of its own. Proper planning in terms of resource allocation is needed to address the barriers in access to instrumentation, and limited workforce.

How Interviewers Affect Responses to Sensitive Questions on the Justification for Wife Beating, the Refusal to have Conjugal Sex, and Domestic Violence in India.

Despite a general understanding that interviewers might cause measurement errors on sensitive questions in sample surveys, there is relatively little research on interviewer effects on responses to questions on women justifying a woman's refusal to have sex with her husband, women justifying wife beating, women's experience of physical and sexual violence, and whether the woman's father ever beat her mother. This study examines interviewer effects on these indicators that were collected in two large-scale National Family Health Surveys (NFHS) in India (2005-2006 and 2015-2016). We use cross-classified random intercept multivariable multilevel logit models to examine interviewer effects. In both surveys, we find large interviewer effects on questions about the justification of a woman refusing to have sex with her husband (32-33% in NFHS-3 and 45-46% in NFHS-4) and the justification of wife beating (27-28% in NFHS-3 and 33-34% in NFHS-4). The interviewer effects were much larger in the 2015-2016 survey than in the 2005-2006 survey. Such large interviewer effects should be considered when interpreting trends and patterns on these topics, especially since the interviewer effects might have changed between survey rounds. Understanding interviewer effects is important given the wide use of these surveys in policy formulation and monitoring in India.

Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India.

Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.

Effect of preterm birth on early neonatal, late neonatal, and postneonatal mortality in India.

Despite India having a high burden of infant deaths and preterm birth, there is a clear lack of studies documenting association between preterm birth and infant mortality in India. Additionally, existing studies have failed to account for unobserved heterogeneity while linking preterm birth with infant mortality. Hence, the present study examines association of preterm birth with early neonatal death (ENND), late neonatal death (LNND), and postneonatal death (PNND) in India. We used the reproductive calendar canvassed in the cross-sectional National Family Health Survey 2015-16 (NFHS-4) to identify preterm births. We used multivariable logistic regression to examine the associations for all births, most-, second most-, and third most- recent births occurred in five years preceding NFHS-4. We use mother fixed-effect logistic regression to confirm the associations among all recent births. Among all births, preterm births were 4.2, 3.8, and 1.7 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Among most recent births, preterm births were 4.4, 4.0, and 2.0 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Preterm births were also associated with risk of only ENND, LNND, and PNND among the second most recent births. Preterm births were associated with risk of only ENND and LNND among the third most recent births. Preterm births were also associated with ENND, LNND, and PNND in the mother fixed-effects regressions. This study establishes associations of preterm birth with ENND, LNND, and PNND in India using over 0.2 million births that occurred in 5 years preceding one of the largest population-based representative household surveys conducted in any part of the world. Our findings call for programmatic and policy interventions to address the considerable burden of preterm birth in the country.

Nutritional and physiological responses of broiler chicken to the dietary supplementation of Moringa oleifera aqueous leaf extract and ascorbic acid in tropics.

This study was intended to determine the comparative effects of Moringa oleifera aqueous leaf extract (MOALE) and ascorbic acid supplementation in the drinking water on growth performance, haemato-biochemical profile, antioxidant status and immune response of broiler chickens under tropical climate. All 135-day-old broiler chicks were divided into 3 different treatment groups. T0 served as control, T1 were fed basal ration with MOALE (90 ml/L drinking water), and T2 offered basal ration with ascorbic acid (15 mg/L drinking water) for 35-day experiment. All the standard managemental practices were followed during the experimental period. The 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity of MOALE was calculated with reference to different ascorbic acid concentration as standard. The antioxidant activity percentage of MOALE (90 µl) was 93.89%, and ascorbic acid (15 µg) was 98.76%, respectively, which was nearer to cent percent. Therefore, 90 ml MOALE and 15 mg ascorbic acid per litre drinking water, respectively, were used for supplementation in broiler chicken. The growth performance and feed efficiency were better in MOALE group followed by ascorbic acid supplemented birds without affecting the metabolism of nutrients. However, 10.71% better FCR was noted in MOALE supplemented group followed by ascorbic acid group (6.28%) in comparison with control. Most of the haemato-biochemical profiles were unaffected by the treatment except creatinine, while antioxidant profile was improved in the treatment group. Immunity status of broiler chicken against NDV was enhanced in both treatment groups; however, maximum profit is obtained in MOALE group followed by ascorbic acid supplemented birds.

Planning for work: Exploring the relationship between contraceptive use and women's sector-specific employment in India.

While the health-related benefits of contraceptive use for women are well documented, potential social benefits, including enabling women's employment, have not been well researched. We examine the relationship between contraceptive use and women's employment in India, a country where both factors have remained relatively static over the past ten years. We use data from India's 2015-16 National Family Health Survey to test the association between current contraceptive use (none, sterilization, IUD, condom, pill, rhythm method or withdrawal) and current employment status (none, professional, clerical or sales, agricultural, services or production) with multivariable, multinomial regression; variable selection was guided by a directed acyclic graph. More than three-quarters of women in this sample were currently using contraception; sterilization was most common. Women who were sterilized or chose traditional contraception, relative to those not using contraception, were more likely to be employed in the agricultural and production sectors, versus not being employed (sterilization adjusted relative risk ratio [aRRR] = 1.5, p<0.001 for both agricultural and production sectors; rhythm aRRR = 1.5, p = 0.01 for agriculture; withdrawal aRRR = 1.5, p = 0.02 for production). In contrast, women with IUDs, compared to those who not using contraception, were more likely to be employed in the professional sector versus not being employed (aRRR = 1.9, p = 0.01). The associations between current contraceptive use and employment were heterogeneous across methods and sectors, though in no case was contraceptive use significantly associated with lower relative probabilities of employment. Policies designed to support women's access to contraception should consider the sector-specific employment of the populations they target.

Factors Influencing the Sex Ratio at Birth in India: A New Analysis based on Births Occurring between 2005 and 2016.

Previous research on sex ratio at birth (SRB) in India has largely relied on macro-analysis of census data that do not contain the breadth of factors needed to explain patterns in SRB. Additionally, no previous research has examined the differentiation of factors associated with SRB across birth orders, a key determinant in societies affected by son preference. This study aims to fill these gaps using micro-data related to 553,461 births occurring between 2005 and 2016 collected as part of the 2015-2016 National Family Health Survey. Analyses used multivariable logistic regressions stratified by birth order to examine associations with SRB at the national level. The SRB at birth order 1 was outside the biological normal limit, and generally increased with birth order. First births in households with wealth in the middle and richest quintiles, with mothers who desired a higher ideal number of sons than daughters, and in lower fertility communities had a higher probability of being male. Most SRB correlates were visible at birth orders 3 or higher. Programs and policies designed to address India's male-skewed SRB must consider the diverse factors that influence SRB, particularly for higher order births.

Association between Spontaneous Otoacoustic Emission and Psychoacoustic measures.

AIM: The aim of the present study was to evaluate the association of presence and absence of spontaneous otoacoustic emissions (SOAEs) on different psycho-acoustic measures such as intensity discrimination, gap detection test, duration discrimination test, modulation detection for sinusoidal amplitude modulated noise at 8, 20, 60, and 100 Hz. METHOD: Sixty adults with hearing sensitivity within normal limits were divided into two groups; group 1 consisted of participants with SOAEs present and group 2 consisted of participants with SOAEs absent. All the participants were tested for presence of SOAEs and different psycho-acoustic measures. RESULTS: The present study results showed no significant difference on intensity discrimination, gap detection test, duration discrimination test, modulation detection for sinusoidal amplitude modulated noise at 8, 20, 60, and 100 Hz in presence and absent of SOAE. CONCLUSION: The findings reveals that the presence or absence of SOAE did not influence or enhance the psychophysical performance at most comfortable level in individuals having normal hearing.

Short interpregnancy interval and low birth weight births in India: Evidence from National Family Health Survey 2015-16.

Evidence on the effect of interpregnancy interval (IPI) on low birth weight (LBW) births is limited in developing countries including India. Our study aims to examine association between IPI and LBW births in India. We used data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015-16 with a representative sample of 52,825 most recent births for examining the association between IPI and LBW. IPI is defined as the gap between the first month in which the index pregnancy was reported in the reproductive calendar (referred to as the month of conception) and the month of pregnancy outcome (including live births and terminations) of preceding pregnancy. Reproductive calendar data were used to estimate IPI. Association between IPI and LBW were examined using multivariable binary logistic regressions. Seventeen percent of the births in our sample were LBW, and more than half (57.6%) of these were accompanied with IPI less than 18 months. Prevalence of LBW births was highest among mother's who had IPI less than six months (19.4%). Regression results, adjusted for control variables, indicate that the risk of LBW was significantly higher among births whose mothers had IPI less than six months (odds ratio: 1.19, 95% CI:1.05-1.36) compared with those whose mothers had IPI between 18 and 23 months. This study provides additional evidence on the association between short IPI (<6 months) and LBW births in India. Promoting spacing methods of family planning is an option that India may consider for increasing the IPI and thereby reducing LBW births. Ensuring recommended iron and folic acid tablets/equivalent syrup and TT injections for every pregnant woman may offset the adverse consequences of shorter IPI.

Gender bias in hospitalization financing from borrowings, selling of assets, contribution from relatives or friends in India.

BACKGROUND: Studies from India have documented gender differentials in hospitalization financing. Much of this work focused either on children or adults, but not across age-groups. No research to date has focused on gender differentials in case of catastrophic hospitalization expenditures. This study assesses gender differentials in distressed financing (borrowing, selling of assets, contributions from relatives or friends) for hospitalization in cases of catastrophic expenditures for hospitalization in India, for young, adult and older adult patients. METHODS: We conducted a cross-sectional analysis of India's 2017-18 National Sample Survey, which collected data on hospitalization and expenditures. We used multivariable probit regression and adjusted marginal effects to assess the associations between gender and the use of distressed financing for catastrophic hospitalization expenditures. Models were stratified by age, and run both with and without sample selection. Secondary analyses assessed gender differentials in the use of distressed financing for hospitalization in case of health insurance cover or not. RESULTS: Multivariable sample selection-adjusted probit regression shows that in households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization of young or older females was 10% points lower than their male counterparts. In households which did not incur severe catastrophic hospitalization expenditures, there was no significant gender differential in use of distressed financing for hospitalization for any age group. In households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization was lower for older females than for older males irrespective of health insurance cover. CONCLUSION: There appears to be a clear gender discrimination in distressed financing of hospitalization costs among younger and older individuals in households that incurred severe catastrophic hospitalization expenditures in India. Health systems should consider how to otherwise support necessary hospitalization financing for girls and older women.

Associations Between Sex Composition of Older Siblings and Infant Mortality in India from 1992 to 2016.

BACKGROUND: This study examines associations between sex composition of older siblings and infant mortality by sex, to guide efforts to address excess female infant mortality in India. METHODS: We conducted a retrospective cross-sectional study of infant mortality in India using four waves of data from the nationally-representative National Family Health Survey, collected between 1992 and 2016 (unweighted N = 338,504 for children aged 1-5). We used sex-stratified multivariable logistic regression models to assess the associations between sex composition of older siblings and risk of infant mortality. FINDINGS: Male infants with two living older sisters and no living older brothers had lower odds of infant mortality relative to those with one living older brother (e.g., 2015-16 AOR 0.62, 95% CI 0.50-0.76); this effect was significant for boys across all waves of data but was not seen for girls in any wave. Exploratory models focused on third order births found that boys were less likely than girls to die in infancy if born subsequent to two older sisters (2015-16 AOR 0.48, 95% CI 0.31-0.74); analysis of crude prevalence data indicated that this converts into a 64% greater risk for infant mortality for girls relative to boys in this third-order group. INTERPRETATION: Higher birth order males with older sisters have greater protection against infant mortality, a finding that has persisted for over 25 years. To address ongoing gender inequities in infant survival in India, greater focus is needed to support higher birth order girls and social norm movements against son preference.

What Explains the Decline in Neonatal Mortality in India in the Last Three Decades? Evidence from Three Rounds of NFHS Surveys.

Identifying the factors that have contributed to recent declines in neonatal mortality in India may help determine which policies and programs are most likely to facilitate further reductions. We use data from the 1992-93, 2005-06, and 2015-16 National Family Health Surveys (NFHS) to examine trends in neonatal mortality in India. We use multivariable decomposition to estimate the contribution of different factors to the change in neonatal mortality in India in the last three decades. When limited to most recent births in the 1-47 months preceding the surveys, 70 percent of the decline in neonatal mortality from 1992-2016 is due to changes in utilization of maternal- and child-care program factors and distribution of household, mother's, and child's characteristics. Improvement in "mother's schooling" and increase in utilization of "at least two tetanus toxoid injections" contributed the most followed by the increase in use of "at least three antenatal-care visits" and "clean fuel for cooking." The change in distribution of "birth order" also contributed significantly to the decline in neonatal mortality. Change in the benefits of "access to improved water," "delivery in a medical facility," and "mother's schooling" has led to a decline of 3 points, 2 points, and 1 point, respectively. More investments in maternal- and child-health programs (including family planning) and providing clean fuel for cooking are likely to pay higher dividends.

Epidemiological investigation and management of bloody diarrhea among children in India.

BACKGROUND: The evidence on the factors associated with childhood bloody diarrhea in developing countries in general and India, in particular, is somewhat limited. Our study, therefore, examines-the prevalence of bloody diarrhea; the magnitude of treatment of bloody diarrhea (use of both oral rehydration and antibiotics (pills, syrups, and injections)); and several other associated factors with bloody diarrhea in the youngest children under five years in the Indian context. METHODS: We used data from the National Family Health Survey (NFHS)-4 conducted in 2015-16. We used a multivariable binary logistic regression model to identify the factors associated with bloody diarrhea. We also applied a multinomial logistic regression model to identify associated factors with the treatment of bloody diarrhea amongst the youngest children below five years. FINDINGS: The overall prevalence of bloody diarrhea in the youngest children was about 9 percent in the last two weeks preceding the survey. There was a significant difference in the mean age of those children having bloody diarrhea and watery diarrhea during the same period. Children whose stools were disposed of unsafely and those who belonged to households with neither a place nor water for washing hands were more likely to suffer from bloody diarrhea compared to their counterparts with these facilities. About a little less than one-fifth of the youngest children (16%) received adequate treatment of bloody diarrhea. The treatment of bloody diarrhea was associated with the health facility and maternal and children's socioeconomic and demographic characteristics. CONCLUSION: The study shows that household environmental risk factors are important predictors of bloody diarrhea amongst the youngest children. Still, 28% of those children did not receive any treatment of bloody diarrhea in India. There is also a clear need to promote the practice of safe disposal of children's stools and handwashing among mothers and children. Mothers need to be sensitized about the necessity of an immediate visit to a health facility/center in case of bloody diarrhea.

Oral problems and associated risk indicators in adults in the Russian Federation, India, and China.

BACKGROUND: Oral problems, known as a neglected epidemic, have become prevalent in Brazil, the Russian Federation, India, China, and South Africa (BRICS) countries in last decade. The objective of the study is to examine the prevalence and associated risk indicators of oral problems in adults in the Russian Federation, India, and China in BRICS countries. METHODS: We used data from the first round of the Study of Global AGEing and Adult Health (SAGE), conducted by WHO in 2007-10 in selected BRICS countries. Oral problems are defined as if an adult had any mouth and/or teeth related problems including swallowing problems in last 1 year of the survey. We estimated the mean age of adults who had oral problems and used a t-test for comparing it by sex of adults. We determined the prevalence of oral problems in adults. We designed a hierarchical conceptual model to identify associated risk indicators with oral problems. Finally, we applied a multivariable binary logistic regression model based on a conceptual model to examine associated socioeconomic and demographic, behavioral and nutritional risk indicators and systemic diseases - diabetes, hypertension, and angina pectoris/angina with oral problems in adults. RESULTS: The mean age of adults who had oral problems is lowest in India (57 years; SD: 15) and highest in China (65 years; SD: 11). However, it does not vary by sex of adults except India. The prevalence of oral problems is highest in the Russian Federation (35%) and lowest in China (9%). Adults with body mass index (BMI) less than 25 kg/m2, age 45 years or more, diabetes, hypertension, and angina pectoris/angina have a higher risk of oral problems. Females and adults using alcohol are also more likely to have oral problems in selected countries. CONCLUSIONS: The study concludes that females, adults using alcohol and those having any systemic disease are at higher risk of oral problems in the Russian Federation, India, and China. A one-third of adults had oral problems in particularly, in the Russian Federation; thus there is an urgent need to formulate oral policy and program, which the country currently lacks in.

Association of behavioral risk factors with self-reported and symptom or measured chronic diseases among adult population (18-69 years) in India: evidence from SAGE study.

BACKGROUND: The objective is to analyze the behavioral risk factors among the adult population and to identify the determinants of and their association with self-reported and symptom or measured chronic diseases in India. METHODS: The study utilized data from the Study on Global Aging and Adult Health (SAGE), Wave 1 (2007). Logistic regression was applied to examine the association of self-reported and symptom or measured chronic diseases with behavioral risk factors and socioeconomic-demographic covariates. RESULTS: The results show that the prevalence of the symptom or measured chronic diseases was higher (41.9%) than that of the self-reported chronic diseases (24.1%). The moderate and vigorous physical activity was less likely to be associated with self-reported depression, arthritis, and stroke, but more likely to be associated with the symptom or measured based arthritis and asthma compared to physical inactivity. Adequate intake of fruits and vegetables was significantly less likely to be associated with angina, COPD, and asthma; however, it was more than three times more likely to be associated (OR: 3.45; 95% CI: 1.99-5.97) with self-reported depression. Infrequent moderate alcohol drinking was statistically two times more associated (OR: 1.83; 95% CI: 1.04-3.21) with the symptom or measured based COPD than non-drinking. Likewise, any type of tobacco use was found to be about four times more associated (OR: 3.59; 95% CI: 1.07-12.13) with self-reported stroke. Both self-reported and symptom or measured hypertension, arthritis, and diabetes were associated with overweight, while hypertension was associated with obesity. Females and increased age came out as significant predictors of both self-reported and symptom or measured chronic diseases. CONCLUSION: The prevalence of chronic diseases and their association with BRFs and socioeconomic and demographic covariates differ markedly when assessed against self-reported criteria versus symptom or measured criteria. Adequate intake of fruits and vegetables is a crucial behavior that controls and delays the onset of chronic diseases. The study suggests that the National Program should remain focused on behavioral risk factors for maximum returns on health outcomes and that proper awareness and knowledge must be spread about healthy lifestyle behaviors throughout the country.

Does owning a bank account improve reproductive and maternal health services utilization and behavior in India? Evidence from the National Family Health Survey 2015-16.

•Ownership of a bank account is associated with improved reproductive and maternal health services utilization and behaviour.•Observed associations are strongest in states where the utilization of studied services is far below the national average.•No association is found between women's ownership of a bank account and institutional delivery.

Heterogeneity in the effect of mid-childhood height and weight gain on human capital at age 14-15 years: Evidence from Ethiopia, India, Peru, and Vietnam.

BACKGROUND: Under-nutrition in early childhood has harmful impacts on human capital formation in children, with implications for educational, adult health, and labor market outcomes. We investigate the association of linear growth and weight gain in mid-childhood with years of schooling, the Peabody Picture Vocabulary Test score, and math test score during the adolescent age of 14-15 years. METHODS: Data were derived from the Young Lives study conducted in four low- and middle-income countries (Ethiopia, India, Peru, and Vietnam). The data had detailed information on the children anthropometry and characteristics of the child, household, and community. Multivariate regression analysis, adjusted for the confounding variables, was used to investigate the association between mid-childhood health, measured by conditional linear growth and relative weight gain, and human capital outcomes in adolescent age. RESULTS: After controlling for several confounders, one cm increase in conditional linear growth increased years of schooling by 0.034 years and the Peabody Picture Vocabulary Test score and math test score by 0.474 and 0.083 points respectively. Relative weight gain was negatively associated with years of schooling and math test score. There is no evidence of heterogeneous effects by rural, gender, and household wealth. In the quantile regression analyses, the association between conditional linear growth and outcomes is stronger at the lower level of years of schooling and the Peabody Picture Vocabulary Test score. CONCLUSION: Our study highlights that mid-childhood nutritional intervention targeted for students at the lower level of education distribution can accelerate the rate of human capital accumulation in low- and middle-income countries.

Nearly suppressed photoluminescence blinking of small-sized, blue-green-orange-red emitting single CdSe-based core/gradient alloy shell/shell quantum dots: correlation between truncation time and photoluminescence quantum yield.

CdSe-based core/gradient alloy shell/shell semiconductor quantum dots (CGASS QDs) have been shown to be optically quite superior compared to core-shell QDs. However, very little is known about CGASS QDs at the single particle level. Photoluminescence blinking dynamics of four differently emitting (blue (λem = 510), green (λem = 532), orange (λem = 591), and red (λem = 619)) single CGASS QDs having average sizes <∼7 nm have been probed in our home-built total internal reflection fluorescence (TIRF) microscope. All four samples possess an average ON-fraction of 0.70-0.85, which hints towards nearly suppressed PL blinking in these gradiently alloyed systems. Suppression of blinking has been so far achieved with QDs having sizes greater than 10 nm and mostly emitting in the red region (λem > 600 nm). In this manuscript, we report nearly suppressed PL blinking behaviour of CGASS QDs with average sizes <∼7 nm and emitting in the entire range of the visible spectrum, i.e. from blue to green to orange to red. The probability density distribution of both ON- and OFF-event durations for all of these CGASS QDs could be fitted well with a modified inverse truncated power law with an additional exponential model equation. It has been found that unlike most of the literature reports, the power law exponent for OFF-event durations is greater than the power law exponent for ON-event durations for all four samples. This suggests that relatively large ON-event durations are interrupted by comparatively small OFF-event durations. This in turn is indicative of a suppressed non-radiative Auger recombination process for these CGASS systems. However, in these four different samples the ON-event truncation time varies inversely with the OFF-event truncation time, which hints that both the ON- and OFF-event truncation processes are dictated by some common factor. We have employed 2D joint probability distribution analysis to probe the correlation between the event durations and found that residual memory exists in both the ON- and OFF-event durations. Positively correlated successive ON-ON and OFF-OFF event durations and negatively correlated (anti-correlated) ON-OFF event durations perhaps suggest the involvement of more than one type of trapping process within the blinking framework. The timescale corresponding to the additional exponential term has been assigned to hole trapping for ON-event duration statistics. Similarly, for OFF-event duration statistics, this component suggests hole detrapping. We found that the average duration of the exponential process for the ON-event durations is an order of magnitude higher than that of the OFF-event durations. This indicates that the holes are trapped for a significantly long time. When electron trapping is followed by such a hole trapping, long ON-event durations result. We have observed long ON-event durations, as high as 50 s. The competing charge tunnelling model has been used to account for the observed blinking behaviour in these CGASS QDs. Quite interestingly, the PLQY of all of these differently emitting QDs (an ensemble level property) could be correlated with the truncation time (a property at the single particle level). A respective concomitant increase-decrease of ON-OFF event truncation times with increasing PLQY is also indicative of a varying degree of suppression of the Auger recombination processes in these four different CGASS QDs.