Latent class analysis of chronic disease co-occurrence, clustering and their determinants in India using Study on global AGEing and adult health (SAGE) India Wave-2.

Background: Understanding chronic disease prevalence, patterns, and co-occurrence is pivotal for effective health care planning and disease prevention strategies. In this paper, we aimed to identify the clustering of major non-communicable diseases among Indian adults aged ≥50 years based on their self-reported diagnosed non-communicable disease status and to find the risk factors that heighten the risk of developing the identified disease clusters. Methods: We utilised data from the nationally representative survey Study on Global AGEing and Adult Health (SAGE Wave-2). The eligible sample size was 6298 adults aged ≥50 years. We conducted the latent class analysis to uncover latent subgroups of multimorbidity and the multinomial logistic regression to identify the factors linked to observed latent class membership. Results: The latent class analysis grouped our sample of men and women >49 years old into three groups - mild multimorbidity risk (41%), moderate multimorbidity risk (30%), and severe multimorbidity risk (29%). In the mild multimorbidity risk group, the most prevalent diseases were asthma and arthritis, and the major prevalent disease in the moderate multimorbidity risk group was low near/distance vision, followed by depression, asthma, and lung disease. Angina, diabetes, hypertension, and stroke were the major diseases in the severe multimorbidity risk category. Individuals with higher ages had an 18% and 15% higher risk of having moderate multimorbidity and severe multimorbidity compared to those in the mild multimorbidity category. Females were more likely to have a moderate risk (3.36 times) and 2.82 times more likely to have severe multimorbidity risk. Conclusions: The clustering of diseases highlights the importance of integrated disease management in primary care settings and improving the health care system to accommodate the individual's needs. Implementing preventive measures and tailored interventions, strengthening the health and wellness centres, and delivering comprehensive primary health care services for secondary and tertiary level hospitalisation may cater to the needs of multimorbid patients.

Depression among currently married ever pregnant adolescents in Uttar Pradesh and Bihar: Evidence from understanding the lives of adolescents and young adults (UDAYA) survey, India.

Background: Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar. Methods: This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied. Results: Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression. Conclusions: This study confirms the pre-existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers.

Inequalities in the prevalence of double burden of malnutrition among mother-child dyads in India.

In the midst of rapid urbanization and economic shifts, the global landscape witnesses a surge in overweight and obese individuals, even as child malnutrition persists as a formidable public health challenge in low- and middle-income countries (LMICs). This study seeks to unravel the prevalence of the double burden of malnutrition (DBM) within the context of India and delve into the associated disparities rooted in wealth. This study leverages data from the fifth wave of the National Family and Health Survey (NFHS-5), a nationally representative survey conducted in the year 2019-21 in India. This study focuses on mother-child dyads with children under the age of 3 years. Descriptive, bivariate and logistic regression analysis is used to decipher the intricate web of DBM's prevalence and risk factors, as underscored by socio-demographic attributes. Wagstaff decomposition analysis is applied to quantify the contribution of each inequality in the social determinants on the observed income-related inequality in the DBM. Result from bivariate and logistic regression indicated a heightened risk of DBM within households marked by C-section births, affluence, ongoing breastfeeding practices, advanced maternal age, and larger household sizes. Additionally, households harbouring women with abdominal obesity emerge as hotspots for elevated DBM risk. Notably, the interplay of abdominal obesity and geographical disparities looms large as drivers of substantial inequality in DBM prevalence, whereas other factors exert a comparably milder influence. As India grapples with the burgeoning burden of DBM, a conspicuous imbalance in its prevalence pervades, albeit inadequately addressed. This juncture warrants the formulation of dual-purpose strategies, and a slew of innovative actions to deftly navigate the complex challenges poised by the dual burden of malnutrition. Amidst these exigencies, the imperative to forge a holistic approach that encompasses both sides of the malnutrition spectrum remains a beacon guiding the quest for equitable health and nutrition outcomes.

Sociodemographic correlates of discrimination against PLHIV in High HIV prevalence states of India, NFHS 2016-21.

This study investigates the socio-demographic correlates of HIV discrimination among individuals aged 15-49 years. This study also aims to assess the change in discriminatory attitudes towards PLHIV in high HIV prevalence states from 2016 to 2021 using data from the national Demographic Health Survey (4th and 5th). To identify factors associated with discriminatory attitudes, a multivariable logistic regression analysis was performed. Further, predicted probabilities and average marginal effects were computed, and the difference in discriminatory attitudes across both rounds was examined using a non-linear Fairlie decomposition. Mass media exposure, improved wealth index, and comprehensive knowledge significantly reduced the discriminatory attitudes towards PLHIV. Fairlie decomposition indicated that comprehensive knowledge, knowledge of mother-to-child transmission, and mass media exposure was significant contributor to the differences observed in the discriminatory attitude towards PLHIV across survey rounds. This study emphasizes the importance of spreading accurate information about HIV transmission modes and reinforces existing programmes and policies aimed at reducing stigma and discrimination against PLHIV. These programmes' efficiency and effectiveness can be ensured by linking them with community-level programmes and activities organized by Self Help Groups (SHGs), which have resulted in a paradigm shift in empowering women in India.

Long-term trends of HIV/AIDS incidence in India: an application of joinpoint and age-period-cohort analyses: a gendered perspective.

Background: Monitoring the transmission patterns of human immunodeficiency virus (HIV) in a population is fundamental for identifying the key population and designing prevention interventions. In the present study, we aimed to estimate the gender disparities in HIV incidence and the age, period, and cohort effects on the incidence of HIV in India for identifying the predictors that might have led to changes in the last three decades. Data and methods: This study utilizes data from the Global Burden of Disease Study for the period 1990-2019. The joinpoint regression analysis was employed to identify the magnitude of the changes in age-standardized incidence rates (ASIRs) of HIV. The average annual percentage changes in the incidence were computed, and the age-period-cohort analysis was performed. Results: A decreasing trend in the overall estimates of age-standardized HIV incidence rates were observed in the period 1990-2019. The joinpoint regression analysis showed that the age-standardized incidence significantly declined from its peak in 1997 to 2019 (38.0 and 27.6 among males and females per 100,000 in 1997 to 5.4 and 4.6, respectively, in 2019). The APC was estimated to be 2.12 among males and 1.24 among females for the period 1990-2019. In recent years, although the gender gap in HIV incidence has reduced, females were observed to bear a proportionately higher burden of HIV incidence. Age effect showed a decline in HIV incidence by 91.1 and 70.1% among males and females aged between 15-19 years and 75-79 years. During the entire period from 1990-1994 to 2015-2019, the RR of HIV incidence decreased by 36.2 and 33.7% among males and females, respectively. Conclusion: India is experiencing a decline in new HIV infections in recent years. However, the decline is steeper for males than for females. Findings highlight the necessity of providing older women and young women at risk with effective HIV prevention. This study emphasizes the need for large-scale HIV primary prevention efforts for teenage girls and young women.

Changes in age at last birth and its determinants in India.

In recent years, developing and developed countries are witnessing delayed childbearing among women contributing to the overall decline in fertility rates. The age at which a woman has her last child impacts maternal and child health, especially in a country with high maternal and perinatal mortality rates. This study aims to investigate the trends of age at the last birth among Indian women and to identify the potential factors contributing towards higher maternal age. The present study uses the data from five consecutive rounds (1992-1993, 1998-1999, 2004-2005, 2015-2016, and 2019-2021) of the National Family Health Survey (NFHS). We have used descriptive statistics, bivariate, Cox proportional hazard regression analysis, multiple classification analysis (MCA), Kaplan-Meier curve, life table survival analysis, hierarchical clustered heat map, multivariate decomposition analysis (MDA) and geospatial mapping to fulfill the objective of the study. Results show that the proportion of women with age at last birth before reaching the age of 30 years was less than half (nearly 35%) during NFHS-I while during NFHS-V proportion becomes more than half and reaches 64.3% among 40-49 years women. Within three decades (1992-2021) there has been a decline of 15.8% in median age at last birth among women aged 40-49 years. Additionally, the highest percentage decline in predicted mean age at last birth was noted among individuals from rural area (10.7%, 3.3 years), Hindu religion (10.8%, 3.3 years), poor wealth quantile (12.5%, 4.0 years) and those with mass media exposure (10.6%, 3.2 years) from NFHS-I (1992-1993) to NFHS-V (2019-2021). Although there exists the need to delay age at first childbirth, the age at last childbirth also plays an important role in women's and child health status. Hence, it is important to address the healthcare needs of those delaying their childbirth.

Prevalence and Predictors of Combined Body Mass Index and Waist Circumference Among Indian Adults.

Objective: To determine the prevalence and predictors of combined BMI-WC disease risk categories among Indian adults. Methods: The study utilizes data from Longitudinal Ageing Study in India (LASI Wave 1) with an eligible sample of 66, 859 individuals. Bivariate analysis was done to get the proportion of individuals in different BMI-WC risk categories. Multinomial logistic regression was used to identify the predictors of BMI-WC risk categories. Results: Poor self-rated health, female sex, urban place of residence, higher educational status, increasing MPCE quintile, and cardio-vascular disease increased with increasing BMI-WC disease risk level while increasing age, tobacco consumption, and engagement in physical activities was negatively associated with BMI-WC disease risk. Conclusion: Elderly persons in India have a considerable higher prevalence of BMI-WC disease risk categories which make them vulnerable to developing several disease. Findings emphasize the need of using combined BMI categories and waist circumference to assess the prevalence of obesity and associated disease risk. Finally, we recommend that intervention programs with an emphasis on urbanites wealthy women and those with a higher BMI-WC risk categories be implemented.

Patterns in age at first marriage and its determinants in India: A historical perspective of last 30 years (1992-2021).

Reproductive health and well-being of a woman are associated with factors such as menarche, first marriage, first sex, first birth, and menopause. The beginning of these events also brings about significant changes in women's lives. Despite marrying early being acknowledged as a detrimental and discriminatory socio-cultural global practice, a huge proportion of girls are being married at an early age, often detrimental to maternal and child health. Adding to the current national debate for the revision of the minimum age at marriage for girls from 18 to 21 years it becomes important to understand the past scenario and current situation of age at marriage in India. In this study, first five rounds of the National Family Health Survey (NFHS) have been used as a data source. Cox Proportional Hazard Model, Multiple Classification Analysis (MCA), Kaplan Meier Curve, Life table survival analysis, hierarchical clustered heat map, Multivariate Decomposition Analysis (MDA), and geospatial mapping were used to fulfill the objective of the study. The results showed that almost 65.9% of women got married before reaching the age of 18 years in the year 1992-93 which reduced to 23.2% among women aged 20-24 years in 2019-21. Region, respondent's level of education, caste, religion, wealth, and mass media exposure were significantly associated with the age at first marriage. The hazard of age at marriage declined significantly with higher educational attainment [higher education- AHR:0.37; CI:0.36 to 0.37], improving household wealth [richest wealth- AHR:0.91; CI:0.90 to 0.91], and mass media exposure [AHR:0.96; CI:0.95 to 0.96]. Since, the age at marriage has a substantial impact on fertility pattern and has a strong association with maternal & child health, policies regarding improving the age at marriage and better enforcement of the concerned laws are required to meet the SDG targets.

Prevalence and correlates of adolescent pregnancy, motherhood and adverse pregnancy outcomes in Uttar Pradesh and Bihar.

Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global health burden. Considering the widely known importance of the negative impact of adolescent pregnancy, motherhood at an early age, and adverse pregnancy outcomes, this paper aims to provide insight into correlates of teen pregnancy, adolescent motherhood and adverse pregnancy outcome. This study utilizes the data from UDAYA survey conducted in Uttar Pradesh and Bihar. The eligible sample size for the study was 4897 married adolescent girls between the ages of 15 and 19 years. Bivariate analysis with a chi-square test of association and Multivariable logistic regression analysis was performed to fulfill the aim of the study. Our study shows that a major proportion of married adolescents (61%) got pregnant before the age of 20 years and around 42% of all adolescent married women gave birth to a child before reaching the age of 20 years. Adolescents who married before the age of 18 years were 1.79 times more likely to experience pregnancy (OR: 1.79; CI: 1.39-2.30) and 3.21 times more likely to experience motherhood (OR: 3.21; CI: 2.33-4.43). In the present study, women who experienced physical violence were at higher risk for having an adverse pregnancy outcome (OR: 1.41; CI: 1.08-1.84) than those who did not experience physical violence. To conclude, regional and national level efforts focused on improving early marriage, education and empowering women and girls can be beneficial.

Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015-16.

BACKGROUND: One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India. METHODS: The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015-16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics. RESULTS: Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16-1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women's education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02-1.34) higher among women who faced sexual violence. The inclusion of women's educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant. CONCLUSION: Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women's reproductive health should investigate the different dimensions of sexual IPV in India.

An association between multi-morbidity and depressive symptoms among Indian adults based on propensity score matching.

Keeping in view the cascade of disturbances caused by the co-existence of multi-morbidity and depression among aged population, this study aims to ascertain the independent impact of multi-morbidity as a risk factor for the development of depressive symptoms among adults living in India. The present study utilizes data from the nationally representative survey "Longitudinal Ageing Study in India" (LASI, Wave-1, 2017-2018). The eligible sample size was 62,244 adults aged 45 years and above. Descriptive statistics along with bivariate analysis was used to understand the prevalence of depressive symptoms. Further, binary logistic regression and Propensity Score Matching (PSM) methods were applied to examine the independent effect of multi-morbidity on depressive symptoms while controlling the selected background characteristics. Overall, around one-third respondents had at least one chronic disease and one-fifth had multi-morbidity. The most prevalent chronic disease reported in the sampled population was hypertension followed by diabetes and joint disease. It is observed that older adults with multiple chronic diseases had 77% higher odds of having depressive symptoms as compared to those without a history of chronic disease in the multivariable logistic regression model. Results obtained from PSM indicate that the risk of having depressive symptoms was 3.7% higher for adults with multi- morbidity. Depressive symptom was identified to be associated with a wider range of multiple physical health problems and people with multi-morbidity are at a higher risk of having depressive symptoms. It is imperative that multi-morbidity can be used as a screener for identifying people with depressive symptoms.

Secular trends in incidence and mortality of cervical cancer in India and its states, 1990-2019: data from the Global Burden of Disease 2019 Study.

BACKGROUND: Cervical cancer is the fourth most common cancer that occurs to women worldwide. This study aims to assess trends in incidence and mortality of cervical cancer in India and its states over past three decades for tracking the progress of strategies for the prevention and control of cervical cancer. METHODS: Data on cervical cancer incidence and mortality from 1990 to 2019 for India and its states were extracted from Global Burden of Disease study and were utilized for the analysis. Spatial and rank map has been used to see the changes in incidence and mortality of cervical cancer in different Indian states. Further, joinpoint regression analysis is applied to determine the magnitude of the time trends in the age standardized incidence and mortality rates of cervical cancer. We obtained the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI) for each state. RESULTS: Overall, from 1990 to 2019 Jharkhand (Incidence: -50.22%; Mortality: -56.16%) recorded the highest percentage decrement in cervical cancer incidence and mortality followed by the Himachal Pradesh (Incidence: -48.34%; Mortality: -53.37%). Tamilnadu (1st rank), Jammu & Kashmir and Ladakh (32nd rank) maintained the same rank over the period of three decade for age standardized cervical cancer incidence and mortality. The regression model showed a significant declining trend in India between 1990 and 2019 for age standardized incidence rate (AAPC: -0.82; 95%CI: -1.39 to -0.25; p < 0.05) with highest decline in the period 1998-2005 (AAPC: -3.22; 95%CI: -3.83 to -2.59; p < 0.05). Similarly, a significant declining trend was observed in the age standardized mortality rate of India between 1990 and 2019(AAPC: -1.35; 95%CI: -1.96 to -0.75; p < 0.05) with highest decline in the period 1998-2005 (AAPC: -3.52; 95%CI: -4.17 to -2.86; p < 0.05). CONCLUSION: Though the incidence and mortality of cervical cancer declined over past three decades but it is still a major public health problem in India. Information, education and communication activities for girls, boys, parents and community for the prevention and control of cervical cancer should be provided throughout the country.

Relationship between height and hypertension among women in India: Evidence from the fourth round of National Family Health Survey.

BACKGROUND AND AIMS: Hypertension (HTN) is associated with significant morbidity and mortality, especially among women. Literature suggests an association between height and hypertension. We did this study to ascertain an association between hypertension and height and explore their determinants among Indian women of reproductive age group (15-49 years). METHODS: We did a secondary data analysis of the National Family Health Survey-4 (2015-16) and included 5,36,093 women between 20 and 49 years. Blood pressure and height were measured using the standard procedures. Weighted analysis was done to depict the association between the two variables. RESULTS: Overall prevalence of HTN was 13.49%. We observed an inverse association between height and mean blood pressure of the women, and shorter women had a higher prevalence of HTN. The height of women was found to be associated with lower systolic blood pressure but not with diastolic blood pressure. Women's height depicted significant associations with age and other socio-economic and geographical parameters. Prevalence of HTN depicted a significant association with height and across other subgroups stratified by these parameters. CONCLUSION: We observed a positive association between the systolic BP and the height of the female. Height is one of the most convenient forms of identifying target groups that should not be missed during screening women for NCDs, especially during pregnancy to prevent premature morbidity and mortality. We recommend disseminating this concept to our primary health care workers, who are also the point of first contact for early screening and halt the burden of disease.

Correction to: Trends in the diabetes incidence and mortality in India from 1990 to 2019: a joinpoint and age­period­cohort analysis.

[This corrects the article DOI: 10.1007/s40200-021-00834-y.].

Trends in the diabetes incidence and mortality in India from 1990 to 2019: a joinpoint and age-period-cohort analysis.

Introduction: Globally, a metabolic disorder like Diabetes is considered as one of the largest global health issues, as it accounts for the majority of the disease burden and happens to be one of the leading causes of mortality as well as reduced life expectancy across the world. As in 2019, India is home to the second-largest number (77 million) of Diabetic adults and the number of people affected has been increasing rapidly over the years. Termed as "the diabetes capital of the world," with every fifth diabetic in the world being an Indian, there is an urgent need to address many critically significant challenges posed by Diabetes in India, like, increasing prevalence among young people in urban areas, less awareness among people, high cost of disease management, limited healthcare facilities, suboptimal diabetes control etc. In Indian context, not enough attempts have been made to observe and understand the long-term pattern of diabetes incidence and mortality. This study aims to provide deep insights into the recent trends of diabetes incidence and mortality in India from 1990 to 2019. Materials and methods: This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of diabetes (from 1990 to 2019) from the Global Health Data Exchange. The average annual percentage changes in incidence and mortality were analysed by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality were estimated by age-period-cohort analysis. Results: During the study period, age-standardized incidence and mortality rates of diabetes in India experienced an upsurge in numbers, the incidence rate increased from 199.14 to 317.02, and consequently, mortality increased from 22.30 to 27.35 per 100,000 population. The joinpoint regression analysis showed that the age-standardized incidence significantly rose by 1.63 % (95 % CI: 1.57 %, 1.69 %) in Indian males and 1.56 % in Indian females (95 % CI: 1.49 %, 1.63 %) from 1990 to 2019. On the other hand, the age-standardized mortality rates rose by 0.77 % (95 % CI: 0.24 %, 1.31 %) in Indian males and 0.57 % (95 % CI: -0.54 %, 1.70 %) in Indian females. For age-specific rates, incidence increased in most age groups, with exception of age groups 5-9, 70-74, 75-79 and 80-84 in male, and age groups 5-9, 75-79 and 80-84 in female. Mortality in male saw a decreasing trend till age group 20-24, whereas in female, the rate decreased till age group 35-39. The age effect on incidence showed no obvious changes with advancing age, but the mortality significantly increased with advancing age; period effect showed that both incidence and mortality increased with advancing time period; cohort effect on diabetes incidence and mortality decreased from earlier birth cohorts to more recent birth cohorts, while incidence showed no material changes from 1975 to 1979 to 2000-2004 birth cohort. Conclusions: Mortality of diabetes decreased in younger age groups but increased in older age groups; however, Incidence increased in most age groups for both male and female. The net age or period effect showed an unfavourable trend while the net cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of diabetes. Timely population-level interventions aiming for health education, lifestyle modification with special emphasis on the promotion of physical activity and healthy diet should be conducted, especially for male and earlier birth cohorts at high risk of diabetes.

Effect of food insecurity on the cognitive problems among elderly in India.

BACKGROUND: Food Insecurity (FI) is a crucial social determinant of health, independent of other socioeconomic factors, as inadequate food resources create a threat to physical and mental health especially among older person. The present study explores the associations between FI and cognitive ability among the aged population in India. METHODS: To measure the cognitive functioning we have used two proxies, word recall and computational problem. Descriptive analysis and multivariable logistic regression was used to understand the prevalence of word recall and computational problem by food security and some selected sociodemographic parameters. All the results were reported at 95% confidence interval. RESULTS: We have used the data from the first wave of longitudinal ageing study of India (LASI), with a sample of 31,464 older persons 60 years and above. The study identified that 17 and 5% of the older population in India experiencing computational and word recall problem, respectively. It was found that respondents from food secure households were 14% less likely to have word recall problems [AOR:0.86, 95% CI:0.31-0.98], and 55% likely to have computational problems [AOR:0.45, 95% CI:0.29-0.70]. We also found poor cognitive functioning among those experiencing disability, severe ADL, and IADL. Further, factors such as age, education, marital status, working status, health related factors were the major contributors to the cognitive functioning in older adults. CONCLUSION: This study suggest that food insecurity is associated with a lower level of cognition among the elderly in India, which highlight the need of food policy and interventional strategies to address food insecurity, especially among the individuals belonging to lower wealth quintiles. Furthermore, increasing the coverage of food distribution may also help to decrease the burden of disease for the at most risk population. Also, there is a need for specific programs and policies that improve the availability of nutritious food among elderly.

The association of widowhood and living alone with depression among older adults in India.

Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2-1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.

A situation analysis of child delivery facilities at primary health centers (PHCs) in rural India and its association with likelihood of selecting PHC for child delivery.

BACKGROUND: Primary Health Centers (PHCs) are crucial in providing primary and secondary level healthcare services in rural India. Despite immense efforts and huge funding, a very small proportion of deliveries are carried out at PHCs. The present study aims to explore the availability of facilities at PHCs and its association with likelihood of delivering the child at PHC. METHODS: We extracted PHC level health infrastructure data from Health Management and Information system (HMIS) and created 'Facility Index' using exploratory factor analysis. We merged the 'Facility Index' with data of the 4th National Family Health Survey (NFHS-4) to explore the relationship between availability of facilities and healthcare-seeking behavior. Bivariate analysis and multilevel logistic regressions were employed to analyze the association between Facility Index and the likelihood of delivering the child at PHC. RESULTS: Availability of facilities (Facility Index) was found to be positively associated with utilization of PHC for childbirth but up to only a certain level of Facility Index. Women living in districts with 'good' Facility index were having 2.45 (OR = 2.45; 95% CI: 2.12-2.84) times higher odds of delivering the child at PHC compared to women living in districts with 'very poor' Facility Index; however, the odds ratio decreased to 2.11 (95% CI: 1.83-2.43) for 'Very Good' Facility Index. The regression line and predicted probabilities also exhibited similar results. CONCLUSION: Based on the findings, we conclude that improvement in availability and quality of facilities might help in improving healthcare utilization from PHCs up to a certain level.

Association of intimate partner violence and other risk factors with HIV infection among married women in India: evidence from National Family Health Survey 2015-16.

BACKGROUND: Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women's human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India. METHODS: This study is based on data from the India National Family Health Survey (2015-16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women. RESULTS: Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08-4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87-10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21-4.16]. CONCLUSIONS: The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.