Temporal change in prevalence of BMI categories in India: patterns across States and Union territories of India, 1999-2021.

BACKGROUND: The problem of overweight/obesity often coexists with the burden of undernutrition in most low- and middle-income countries. BMI change in India incorporating the most recent trends has been under-researched. METHODS: This repeated cross-sectional study of 1,477,885 adults in India analyzed the prevalence of different categories of BMI among adults (age 20-54) in 4 rounds of National Family Health Surveys (1998-1999, 2005-2006, 2015-2016, and 2019-2021) for 36 states/UTs. State differences across time were harmonized for accurate analysis. The categories were Severely/Moderately Thin (BMI < 17.0), Mildly Thin (17.0-18.4), Normal (18.5-24.9), Overweight (25.0-29.9), and Obese (≥ 30.0). We also estimated change in Standardized Absolute Change (SAC), ranking of states, and headcount burden to quantify the trend of BMI distribution across time periods for all-India, urban/rural residence, and by states/UTs. RESULTS: The prevalence of thinness declined from 31.7% in 1999 to 14.2% in 2021 for women, and from 23.4% in 2006 to 10.0% in 2021 for men. Obesity prevalence increased from 2.9% (1999) to 6.3% (2021) for women, and from 2.0% (2006) to 4.2% (2021) for men. In 2021, the states with the highest obesity prevalence were Puducherry, Chandigarh, and Delhi. These states also had a high prevalence of overweight. Dadra and Nagar Haveli and Diu, Gujarat, Jharkhand, and Bihar had the highest prevalence of severe/moderately thin. Prevalence of extreme categories (severely/moderately thin and obese) was larger in the case of women than men. While States/UTs with a higher prevalence of thin populations tend to have a larger absolute burden of severe or moderate thinness, the relationship between headcount burden and prevalence for overweight and obese is unclear. CONCLUSIONS: We found persistent interstate inequalities of undernutrition. Tailored efforts at state levels are required to further strengthen existing policies and develop new interventions to target both forms of malnutrition.

Trends in prevalence of unmet need for family planning in India: patterns of change across 36 States and Union Territories, 1993-2021.

BACKGROUND: Eliminating unmet need for family planning by 2030 is a global priority for ensuring healthy lives and promoting well-being for all at all ages. We estimate the sub-national trends in prevalence of unmet need for family planning over 30 years in India and study differences based on socio-economic and demographic factors. METHODS: We used data from five National Family Health Surveys (NFHS) conducted between 1993 to 2021 for the 36 states/Union Territories (UTs) of India. The study population included women of ages 15-49 years who were married or in a union at the time of the survey. The outcome was unmet need for family planning which captures the prevalence of fecund and sexually active women not using contraception, who want to delay or limit childbearing. We calculated the standardized absolute change to estimate the change in prevalence on an annual basis across all states/UTs. We examined the patterning of prevalence of across demographic and socioeconomic characteristics and estimated the headcount of women with unmet need in 2021. RESULTS: The prevalence of unmet need in India decreased from 20·6% (95% CI: 20·1- 21·2%) in 1993, to 9·4% (95% CI: 9·3-9·6%) in 2021. Median unmet need prevalence across states/UTs decreased from 17·80% in 1993 to 8·95% in 2021. The north-eastern states of Meghalaya (26·9%, 95% CI: 25·3-28·6%) and Mizoram (18·9%, 95% CI: 17·2-20·6%), followed by the northern states of Bihar (13·6%, 95% CI: 13·1-14·1%) and Uttar Pradesh (12·9%, 95% CI: 12·5-13·2%), had the highest unmet need prevalence in 2021. As of 2021, the estimated number of women with an unmet need for family planning was 24,194,428. Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for half of this headcount. Women of ages 15-19 and those belonging the poorest wealth quintile had a relatively high prevalence of unmet need in 2021. CONCLUSIONS: The existing initiatives under the National Family Planning Programme should be strengthened, and new policies should be developed with a focus on states/UTs with high prevalence, to ensure unmet need for family planning is eliminated by 2030.

This study looked at the trends in unmet need for family planning in India, which is defined as the percentage of women of reproductive age who want to delay or limit childbearing but are not using any contraceptive method. A public dataset was used to analyze national and sub-national trends from 1993 to 2021. It was determined that although the percentage prevalence of unmet need decreased in the last 30 years, there were still a substantial number of women with unmet need in 2021. More than half of these women were in Uttar Pradesh, Bihar, Maharashtra, and West Bengal. Furthermore, it was found that percentage prevalence of unmet need was relatively higher amongst younger women and those belonging to poorer households in 2021. Initiatives and policies aimed at reducing unmet need for family planning should be implemented while considering geographic, socioeconomic, and demographic differences.

Geospatial and environmental determinants of stunting, wasting, and underweight: Empirical evidence from rural South and Southeast Asia.

OBJECTIVE: Child malnutrition, comprising of undernutrition and obesity, is a global concern with severe implications for survival, leading to acute and chronic diseases that adversely affect the productivity of individuals and society. Asia shoulders the greatest burden, with 7 out of 10 undernourished children residing in the region. Despite the decline in global child stunting, particularly in Asia, its prevalence remains significant. In 2017, an estimated 151 million children under five experienced stunting, and an additional 38 million were overweight, with Africa and Asia accounting for 25% and 46% of the global figures, respectively. Therefore, this paper aims to analyze the geospatial and environmental determinants of undernutrition in rural South and Southeast Asia. METHODS: To explore the geospatial and environmental determinants of undernutrition (stunting, wasting, and underweight), we use Poisson regression and the data from recent rounds of the Demographic and Health Survey (DHS) from India, Bangladesh, Pakistan, Nepal, Cambodia, and Timor-Leste. RESULTS: This study found a high prevalence of stunting, wasting, and underweight among children aged 0 to 59 months in rural areas of South and Southeast Asia, with considerable variation between countries and clusters/primary sampling units. Results show a positive association between child malnutrition and factors such as maternal illiteracy, unsafe drinking water, and dirty cooking fuel in South and Southeast Asia. Children from impoverished households in India, Pakistan, and Cambodia were disproportionately affected. In addition to socio-economic factors, climatic risks such as temperature increase and rainfall variations also emerged as important determinants of child malnutrition in India, Bangladesh, and Timor-Leste. CONCLUSIONS: This paper emphasizes the role of environmental and climatic factors on child nutrition, underscoring their significance regardless of socio-economic conditions. As the impacts of climate change continue to intensify, and agrarian societies bear the brunt, these factors will play a critical role in shaping child nutritional outcomes. Thus, amid growing climate change, nutritional security should be prioritized, considering the spatial domain and targeting climate distress areas along with other socio-economic and demographic aspects.

Which Intervention Synergies Maximize AGYW's HIV Outcomes? A Classification and Regression Tree Analysis of Layered HIV Prevention Programming.

INTRODUCTION: Intersecting behavioral, social, and structural factors increase adolescent girls' (AG) and young women's (YW) HIV vulnerability. Yet, understanding of optimal intervention synergies remains limited. We identified intervention combinations that statistically maximized reductions in AGYW's HIV-related risk. METHODS: Using data collected in 2018 with Zambian AG (n = 487, aged 15-19 years) and YW (n = 505, aged 20-25 years) after 12-14 months exposure to Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (multisectoral HIV program), we used classification and regression trees to explore relationships between interventions (safe space/social asset building [SAB] and provision of/linkage to youth-friendly health services [YFHS], education social protection [Educ], economic social protection [Econ]) and HIV-related outcomes (HIV testing, consistent condom use, transactional sex, and sexual violence experience from partners and nonpartners). RESULTS: Overall, 59.9% completed SAB and 81.5%, 35.4%, and 29.6% received YHFS, Educ, and Econ, respectively. For AG, HIV testing improved (from 73% to 83%) with exposure to all interventions, condom use improved with Econ (from 33% to 46%), transactional sex reduced with SAB + Educ, and sexual violence from partners and nonpartners reduced with Educ and SAB, respectively. For YW, HIV testing increased with Educ (from 77% to 91%), condom use increased with SAB + YFHS (from 36% to 52%), transactional sex reduced with combinations of all interventions, and sexual violence from partners reduced with YFHS and from nonpartners with SAB + Econ. CONCLUSIONS: Tailored interventions might be more effective than uniform combination intervention packages in reducing AGYW's HIV risk. AG benefitted most from SAB and/or Educ while YFHS, Educ, and/or SAB reduced YW's HIV-related risk. Educational and asset-building interventions could have the greatest impact on AGYW's HIV risk.

Oral Streptococcus mutans load among Indian children with cerebral palsy.

The motor impairments of cerebral palsy (CP) are typically accompanied by subsequent musculoskeletal issues, seizures, and abnormalities of sensation, intelligence, communication, and behaviour. These kids have a lower capacity for regulating oral health because of their poor voluntary movements. Poor oral hygiene brought on by insufficient brushing and flossing, increased use of sugary foods, and orally administered drugs puts people at risk for periodontal disorders and dental caries. Poor dental health and rising therapy demands establish a sadistic cycle that affects patient overall health and wellbeing. The purpose of this investigation was comparing kids with CP against healthy kids of comparable age group and demographic situation in order to evaluate status of oral heath, current caries behavior using measurement of Streptococcus mutans concentrations in saliva, and treatment required. 204 study participants were divided into two categories: Category A and category B. Both categories consisted of 102 study participants. Category A consisted of study participants having CP while category B consisted of healthy normal controls with same age of same demographic features. Malocclusion, trauma, DMFS/defs, gingival index, and Oral hygiene score (OHI), and were recorded for oral examinations of al study participants However, no radiological assistance was utilized since minimal patient compliance existed in CP patients. When compared with the control category, the CP category had a higher detection of the DMFS index in the permanent teeth. The estimated defs for the CP category did not differ noticeably from the control category. In the CP category, status of hygiene of oral cavity was discovered to be substantially subpar. In comparison to the control category, the gingival condition of the CP category was noticeably worse. Treatment requirements were seen to require greater preventative care in the control category while, stainless steel crowns, pulpectomy and extractions were needed in the CP category. S. mutans was found in high concentrations in the salivary specimens of the CP category compared to the control category, indicating active dental caries and greater probability of further development.

Sealing Ability of Different Obturating Techniques in Apically Separated Rotary Files: An In Vitro Study.

Aim: Testing whether two sealant systems (cold laterally compacted gutta-percha and Obtura II) can be used with extraction across two apically separated rotational nickel-titanium files was the primary objective of this study (RACE and K3). Materials and Methods: Both the positive and negative control teeth were randomly distributed among 62 mandibular premolars to create two groups of 30 each. Following the RACE and K3 approaches, four subgroups were created from the roots. Subgroups A1, B1, and A2, B2 (n = 10 each) were formed in the apical thirds of the canal at 3 mm from the tip. There was no division of instruments between groups A3, B3, B4, and A4. When it came to obturation, the Obtura II method was used for A2, A4, B2, B4, and A1, A3. A dye extraction process was employed to determine whether the specimens had been obliterated. Analysis of variance (ANOVA), Student t test (two-tailed, independent), and Leven's test were used to ascertain the values for each of the study groups. Results: Group A1 had a substantially lower leakage rate than group B1. Groups A2, B2 and A3, B3 had no statistically significant differences. Group A4 had a substantially lower leakage rate than group B4. Conclusion: Even when the cracked NiTi rotary system was not present, Obtura II-obturated groups had less leakage than the lateral condensation approach.

Assessing layered HIV prevention programming: optimizing outcomes for adolescent girls and young women.

OBJECTIVE: To assess how exposure to multiple, layered interventions predicts HIV-related outcomes among adolescent girls (15-19 years) and young women (20-24 years) in Kenya. DESIGN: Survey data from adolescent girls and young women (n = 736) with 14-16 months of engagement with DREAMS, a comprehensive HIV prevention program that provides a range of health education, life skills, social protection, and social and behaviour change interventions. METHODS: Nonparametric recursive partitioning technique - classification and regression tree (CART) - to identify the best predictors (DREAMS interventions) for achieving the desired HIV-related outcomes (consistent condom use and no transactional sex or sexual violence). RESULTS: Among adolescent girls, schooling support reduced the likelihood of engaging in transactional sex, whereas schooling support and exposure to parenting program reduced the likelihood experiencing sexual violence. Likelihood of consistent condom use increased among adolescent girls with exposure to preexposure prophylaxis (PrEP), schooling support, and the violence prevention programming. Among young women, multiple pathways reduced the likelihood of engaging in transactional sex: exposure to the male sexual partner program; exposure to the youth fund program; exposure to the violence prevention program; or exposure/engagement with schooling support, parenting programming, and the youth fund program. For young women, consistent condom use increased with schooling support and male partner engagement. Additionally, engagement in violence prevention program and male partner engagement increased the likelihood of not experiencing sexual violence among young women. CONCLUSION: Exposure to a combination of DREAMS interventions predicted outcomes that can reduce HIV risk among AGYW, though the pathways differed by outcome and age group.

Prevalence of prehypertension and hypertension among the adults in South Asia: A multinomial logit model.

Hypertension has been the most common non-communicable disease in low and middle-income countries for the past two decades, increasing cardiovascular and renal disease risk. Urbanization, aging, dietary and lifestyle changes, high illiteracy rates, poor access to health facilities, poverty, high costs of drugs, and social stress have contributed to an increase in the prevalence of hypertension in developing countries. Nonetheless, little is known about the comprehensive risk factors associated with prehypertension and hypertension among economically active adult populations of South Asia, such as India, Nepal, and Bangladesh. This paper uses the Demographic and Health Survey data of 637,396 individuals from India (2019-21), 8,924 from Nepal (2016), and 8,613 from Bangladesh (2017-18) to examine the prevalence and driver of prehypertension and hypertension. We analyze the prevalence of prehypertension because it leads to hypertension and is directly related to cardiovascular disease, and many people live with it for prolonged periods without realizing it. The paper finds, among other things, that the prevalence of prehypertension and hypertension among adults (18-49 years) is 43.2 and 14.9% in India, 35.1% and 19.8% in Bangladesh, and 25.2% and 13.8% in Nepal, respectively. Better educated, wealthy individuals living in urban areas of developing economies in the South Asian region are more likely to have prehypertension and hypertension. The paper suggests the urgent need to launch preventive programs to reduce prehypertension before it develops to be hypertension as a precautionary measure. Thus, such measures shall help to prevent hypertension, thereby improving the overall wellbeing of individuals and families.

Migration and family planning in the state with highest total fertility rate in India.

BACKGROUND: This study examined the relationship between male out-migration and family planning (FP) behaviour of women in rural Bihar. METHODS: Data was collected from 937 currently married women aged 15-34 years from two districts of Bihar, namely Nawada and Gopalganj. Respondents were selected through a multi-stage systematic sampling and were recruited from both low and high male out-migration blocks. Differences in FP outcomes-use of modern contraceptive methods, intention to use contraceptives in next 12 months and access to FP services-were assessed by volume of migration, husband's migration status, frequency of return, and duration of husband's stay at home during visits. RESULTS: Women with migrant husbands were about 50% less likely to use modern contraceptive methods. Further, the odds of using modern contraceptives was about half among women with migrant husbands if they resided in high out-migration areas (HMA) than low out-migration areas (LMA) (15% vs 29%, AOR: 0·50, p = 0·017). A higher proportion of women with migrant husbands, specifically from HMA, reported greater intention of using contraceptives in next 12 months than their counterparts (37% vs 23%, AOR: 1·83, p = 0·015). Similarly, access to FP services was negatively associated with the volume of male out-migration, specifically for women with migrant husbands. CONCLUSIONS: The migratory environment as well as the migration of husbands affect contraceptive use and access to FP services among women. Given that a significant proportion of married males leave their home states for work, it is imperative that FP programs in migration affected areas plan and implement migration-centric FP implementation strategies.

An epidemiological study of cervical and breast screening in India: district-level analysis.

BACKGROUND: Breast cancer and cervical cancer, the most common forms of cancer in women worldwide, are on a fast and steady rise, accounting for more deaths in women than any other cancer in the developing world. Cancer screening tests are an important tool to combat cancer-related morbidity and mortality. World Health Organization aims to accelerate action to achieve Goal 3.4 of the Sustainable Development Goals (SDG 3.4) in order to reduce premature mortality from non-communicable disease, including cancer by one-third by 2030. This study aims to examine the geospatial variation of cervical and breast screening across districts and to identify factors that contribute to the utilization of screening among women in India. METHODS: Until recently, there was no evidence pertaining to screening for cervical and breast cancers at the national level. Information on examination of the breast and cervix from over 699,000 women aged 15-49 years was collected for the first time in the fourth round of National Family Health Survey, 2015-16 (NFHS-4). For the present study, the data were aggregated for all 640 districts in India. Moran's Index was calculated to check for spatial autocorrelation. Univariate Local Indicators of Spatial Association (LISA) maps were plotted to look for spatial dependence associated with the uptake of screening practices. The spatial error model was employed to check for spatial magnitude and direction. RESULTS: The common factors associated with uptake of both cervical and breast screening at the district level were; women belonging to a general caste, residing in rural areas, being currently married, and being well-off economically. Being insured was positively associated with the uptake of cervical screening only. This study provides spatial inference by showing geographical variations in screening of cervix and breast across districts of India. CONCLUSIONS: By showing geographical disparities in screening practices across districts of India, this study highlights the importance of ensuring a region-specific and organ-specific approach towards control and prevention of cancer. The identified factors responsible for the uptake of screening could be a guiding force to decide how and where tailored interventions may be best targeted.

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.

Determinants of cardiovascular disease and sequential decision-making for treatment among women: A Heckman's approach.

•Women over age 40, from lower socio-economic status and those widowed/divorced are at elevated risk.•Diabetes, hypertension, obesity and unhealthy diet are the major risk factors.•Treatment-seeking is higher in women over age 40, from upper socio-economic status and those married.•Autonomy, accessibility, affordability and availability influence treatment-seeking behaviour.