Prevalence of overweight and obesity and associated demographic and health factors in India: Findings from Comprehensive National Nutrition Survey (CNNS)

BACKGROUND

Childhood obesity (5-9 years) in India is likely to contribute 11% to the global burden by 2030.

METHODS

Data from India's Comprehensive National Nutrition Survey (CNNS, 2016-2018) was used to assess the prevalence and key associated factors of overweight and obesity. Multivariable logistic regression models were applied to identify potential determinants associated with being overweight and obese.

RESULTS

Overweight prevalence (including obesity) varied from 1.6% (0-4 years) to 4.8% (10-19 years). The majority of states reported a higher proportion of adolescents overweight and obese, than younger age group 5-9 years. A significantly higher prevalence of children and adolescents with obesity was reported in higher wealth quintiles and residents of urban areas. The prevalence of overweight and obesity and associated demographic and health factors in India included: the presence of NCD risk factor (adolescents: 1.68, 95% CI [1.31-2.14]), micronutrient deficiency (5-9 years children: 1.72, 95% CI [1.30-2.28]), mother's education (5-9 years children: 4.84, 95% CI [2.92-8.03]; adolescents: 2.17, 95% CI [1.42-3.32]), wealth (adolescents: 1.92, 95% CI [1.16-3.19]), place of residence (5-9 years children: 1.68, 95% CI [1.39-2.03]; adolescents: 1.39, 95% CI [1.16-1.66]), child age (5-9 years children: 1.64, 95% CI [1.40-1.93], and screen-time (adolescents: 1.63, 95% CI [1.22-2.19].

CONCLUSION

The findings set out policy and research recommendations to pave the path for curtailing the increasing prevalence of overweight and obesity and achieving the World Health Assembly's Global Nutrition target of 'no increase in childhood overweight (Target 4) by 2025'.

Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study

OBJECTIVE

Indian adolescents experience several health challenges requiring acceptable, equitable, appropriate and effective healthcare services. Our objective was to assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of India's largest states, using both national benchmarks (under Rashtriya Kishor Swasthya Karyakram-RKSK) and global standards (by WHO).

DESIGN

Cross-sectional study comprising structured observations and interactions (November 2021 to June 2022).

SETTING

Fourteen AFHCs across all levels of health system were included from two districts of Maharashtra (n=8) and Madhya Pradesh (n=6). These AFHCs were observed using checklist, and few items of checklist were verified by interactions with AFHC's health workers (medical officers/auxillary nurse midwives/counsellors) handlings adolescents. The developed checklist included 57 items based on adapted global standards and 25 items using national benchmarks.

RESULT

High compliance of AFHCs with RKSK's benchmarks was attributed to various items including the accessibility through local transport (n=14, 100%), clean surroundings (n=11, 78.5%), presence of signage (n=10, 71.4%), convenient operating days and time (n=11, 78.5%), and secure storage of records (n=13, 92.9%). Concurrently, items that showed low compliance encompassed, the availability of Information, Education and communication (IEC) resources, which were deficient in 57.1% of AFHCs (n=8). Similarly, designated areas for clinical services (n=10, 71.4%) and commodity disbursement (n=9, 64.3%) lacked in more than half of the recruited AFHCs. Additionally, lack of guidelines for referrals (n=13, 92.9%), as well as standard operating procedures to ensure equity, non-judgemental attitude, competence, confidentiality and referral as per WHO standards.

CONCLUSION

Evidence spotlights the strengths and gaps in AFHCs, aligning with, government's priorities on adolescent health. Addressing the identified gaps is crucial to creating healthcare facilities that are adolescent-friendly, easily accessible and effectively navigate adolescent health challenges. This concerted effort would contribute to their development and transformation, playing a pivotal role in India's progress.

Are advertising policies affirmative in restricting the marketing of foods high in fat, salt and sugar (HFSS) in India?: evidence from SWOT Analysis

The regulatory Indian environment for advertising high fat, salt, and sugar (HFSS) foods and non-alcoholic beverages, on various media was reviewed. Identified national-level policies were categorised as mandatory or self-regulatory based on legal content. For each mandatory regulation, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was undertaken to determine how existing policies could be strengthened to safeguard children from unhealthy food advertisements. Thirteen policies (nine mandatory; four self-regulatory) relevant to advertising in India were identified. Of the nine mandatory policies, Guidelines for Prevention of Misleading Advertisements and Endorsements for Misleading Advertisements, 2022, is the only policy that restricts HFSS food advertisements to children across all media. There are key shortfalls, including limited scope of 'child-targeted' advertisements and lack of criteria to define HFSS foods. A robust regulatory framework is needed to protect children from HFSS food marketing, not just what is 'directed' at them, with clear evidence-based food classification criteria.

Adolescent Friendly Health Clinics (AFHCS) in India and their compliance with government benchmarks: A scoping review

Background: Adolescent Friendly Health Clinics (AFHCs) are one of the critical pillars of India's Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health and by accessing the services. Thus, a review was conceptualised to assess the compliance of AFHCs with the benchmark proposed by the Government under Rashtriya Kishor Swasthya Karyakram. Methods: Three databases (PubMed, Scopus and Google Scholar) were searched for articles published between 2014 and December 2022. A snowball search strategy was also used to retrieve all published articles. Based on the search strategy eight studies were included. Results: AFHCs are not fully compliant with all the benchmarks proposed by the government of India. Evidence from the primary studies showed that the benchmarks need attention as privacy was lacking (six out of seven studies), unavailability of Information Education and Communication material (four out of five), signages (two out of four), referrals (one out of two), and judgemental attitude of health care providers (one out of 3). Conclusions: There is a pressing need to focus on the fulfilment of these gaps to make the clinics adolescent-friendly. This might increase the utilisation of available services in AFHCs by adolescents and will improve their health. The improved health will catalyse achieving the Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.

COVID-19 vaccine knowledge, attitudes, perceptions and uptake among healthcare workers of Pune district, Maharashtra

Background

Healthcare workers play a vital role in vaccine promotion and acceptance through community dialogue, education, and myth-busting. Vaccinated healthcare workers will likely recommend the vaccine to their families and community.

Methods

A cross-sectional study was conducted with healthcare workers (n=357) to understand their knowledge, attitudes, perceptions, and acceptance of the coronavirus disease 2019 (COVID-19) vaccine. The study was conducted in two blocks (Haveli and Velhe) of Pune, Maharashtra.

Results

The findings showed that over 90% of healthcare workers knew about COVID-19 vaccination and had a positive attitude towards COVID-19 vaccination. Among them, vaccine uptake was high (93% with two doses and 4% with a single dose). 98% of healthcare workers believed that vaccine is safe to use. However, few gaps existed around vaccine safety, side effects and allergic reactions, as 27.7% believed that the COVID-19 vaccine could increase the risk of allergic reactions, 51.8% believed that acquiring natural immunity by contacting the virus is better than vaccination, 16.5% believed that it is possible to reduce the incidence of COVID-19 without vaccination, 28.9% believed that vaccine might have side effects and 14% believed vaccine is not the most likely way to control the pandemic.

Conclusions

Addressing the existing gaps and reinforcing the relevance of the COVID-19 vaccine through a structured program is critical to empower health workers to disseminate accurate information to the community, consecutively improve vaccination uptake, and boost vaccination efforts in India.

Progress and challenges in implementing adolescent and school health programmes in India: a rapid review

OBJECTIVES

To review the overall planning, implementation and monitoring of adolescent and school health programmes currently implemented in India and determine if they are in alignment with the indicators for achieving universal health coverage for adolescents in India.

METHODS

A rapid review, with key informant interviews and desk review, was conducted using World Health Organization's tool for Rapid Assessment of Implementation of Adolescent Health and School Health Programmes. Operational guidelines, reports and relevant publications (surveys, policy briefs and meeting proceedings) related to India's adolescent and school health programmes were reviewed. Key informant interviews were conducted in New Delhi (India) with senior officials from the health and education departments of the Government of India, representatives from the private health sector and civil society organisations. Data were analysed using World Health Organization's framework for universal health coverage for adolescents and summarised according to the key indicators.

RESULTS

Key informant interviews were conducted with 18 participants: four each from health and education department of the government, one clinician from private health sector and nine representatives from civil society organisations. Manuals and operational guidelines of India's existing adolescent and school health programmes were reviewed. India's national adolescent and school health programmes align with many priority actions of the World Health Organization's framework for delivering universal health coverage for adolescents. These programmes require strengthening in their governance and implementation. While adolescent health and school health programmes have robust monitoring frameworks, however, there is a need to strengthen research and policy capacity.

CONCLUSIONS

Various national health programmes have targeted adolescents as a priority population. A better translation of these programmes into implementation is needed so that the investments provided by the government offer sufficient opportunities for building collective national action for achieving universal health coverage with adolescents as an important section of the population.

Changes in self-reported sexually transmitted infections and symptoms among married couples in India from 2006 to 2016: a repeated cross-sectional multivariate analysis from nationally representative data

OBJECTIVE

To assess the changes in prevalence of past-year self-reported sexually transmitted infections (STIs) and its symptoms among married couples between 2006 and 2016 in India, overall and by socioeconomic status.

DESIGN

This cross-sectional study uses the two most recent waves (2005-2006 vs 2015-2016) of nationally representative health surveys in India. We examined the changes of self-reported STI and symptoms among married couples aged 15-54 by overall and by socioeconomic status. Adjusted logistic regression was used to assess the changes, accounting for covariates and the complex survey design.

SETTING

Cross-sectional, nationally representative population-based survey in 2005-2006 and 2015-2016 from National Family Health Survey data from Demographic and Health Survey.

PARTICIPANTS

39 257 married couples aged 15-49 years for the 2005-2006 survey wave and 63 696 married couples aged 15-49 years for the 2015-2016 wave.

OUTCOME MEASURE

Self-reported STI was used as a primary outcome measure.

RESULTS

In 2016, 2.5% of married women reported having had an STI in the past year, a significant increase from 1.6% in 2006 (p<0.001). The past-year self-reported STI prevalence among married men significantly increased from 0.5% in 2006 to 1.1% in 2016 (p<0.001). Adjusted results showed that the uptrend of couples' self-reported STI was more significant among those whose husbands are currently employed and those families in middle or higher wealth quintiles. Alarmingly, among couples who reported STI or symptoms, they were less likely to seek advice or treatment in 2016 as compared with 2006 (adjusted OR=0.50, p<0.001, 95% CI=0.40 to 0.61).

CONCLUSION

The study identifies a substantial increase in self-reported STI prevalence with a notable treatment seeking gap among married couples in India over the past decade.

Food environment in and around schools and colleges of Delhi and National Capital Region (NCR) in India

Background

Food policies and environment (availability, accessibility, affordability, marketing) in and around educational institutes can influence food choices and behaviours of children and adolescents.

Methods

Cross-sectional, mixed-methods study was implemented in schools (n = 9; Private = 6, Public = 3) and colleges (n = 4) from Delhi and National Capital Region (India). The data was collected from students of schools (n = 253) and colleges (n = 57), parents of school students (n = 190), teachers (n = 12, schools = 9, colleges = 3) and canteen operators of Private schools and colleges (n = 10; schools = 6, and colleges = 4). The primary and secondary data was collected to: 1) identify the strengths and weaknesses of the existing guidelines and directives (desk review); 2) examine food environment, existing policies and its implementation (structured observations, in-depth interviews, surveys, focus group discussions), and; 3) assess food choices, behaviours of students (focus group discussions). The thematic analysis was used for qualitative data and descriptive analysis for quantitative data.

Results

The available food and beverage options, in and around the participating educational institutes were either high in fat, salt and sugar (HFSS), despite government and educational institute guidelines on restricting the availability and accessibility of HFSS foods. The healthy food and beverage options were expensive compared to HFSS foods both inside and outside educational institutes. In total, 37 vendors (Private = 27; Public:10) were observed outside schools at dispersal and twelve at lunchtime. Around colleges, vendors (n = 14) were seen throughout the day. Students from all Private schools (n = 6) and colleges (n = 2) were exposed to food and beverage advertisements either HFSS (Private schools = 1–3 and colleges = 0–2 advertisements), whereas no advertisements were observed around Public schools.

Conclusion

It is imperative to implement food policies to improve the food environment in and around educational institutes to ensure the availability of healthy foods to establish and sustain healthy eating behaviours among students. Thus, the study findings emphasise stringent implementation, regular monitoring and surveillance of recently introduced Food Safety and Standards (Safe food and balanced diets for children in school) Regulation 2020, ensuring its compliance through effective enforcement strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11778-6.

Knowledge, attitude, and behaviours on diet, physical activity, and tobacco use among school students: A cross-sectional study in two Indian states

Background: Non-communicable diseases (NCDs) are escalating in India and can be attributed to behavioural risk factors such as unhealthy diet, physical inactivity and tobacco use that began in early years. Understanding adolescents' knowledge, attitudes and behaviours (KAB) related to NCD risk factors would inform the development of school-based health programmes to prevent NCDs. Methods: Sixth-grade students (n=1026) in 20 schools (10 private, 10 public) from two Indian cities (n=667 from Pune; n=359 from Bengaluru) participated in a KAB survey in 2019. Differences in KAB by gender, school type within cities were investigated. Results: Knowledge about the harms of tobacco use was higher than knowledge about a healthy diet and importance of physical activity. Only a small proportion of students did not eat breakfast (8.7%) or fruits (11.3%) daily. Only 33.4% of students read nutrition labels before choosing their food. Moderate-to-vigorous physical activity of less than an hour per day was reported by 42.5% of students. Approximately one-third of students had ever tried smoking tobacco (30.1%), smokeless tobacco (30.5%), and e-cigarettes (32.4%). Differences in these behaviours by gender and school type showed that both boys, girls and students of private and public schools are vulnerable. Conclusions: The study findings highlight that knowledge is low for thematic areas like diet and physical activity. While knowledge of tobacco related harms is better but the prevalence of ever tobacco use was found to be high. Socio-demographic factors such as school type and gender had a varying effect on various KAB indicators. There is a need to strengthen health education activities by developing context-specific health intervention materials by engaging school children, their parents, teachers, and communities to promote healthy behaviours among adolescents. Need to augment school health programmes in India with a differential approach based on the issues, specific to school type and city.

Knowledge, attitude, and behaviours on diet, physical activity, and tobacco use among school students: A cross-sectional study in two Indian states

Background: Non-communicable diseases (NCDs) are escalating in India and can be attributed to behavioural risk factors such as unhealthy diet, physical inactivity and tobacco use that began in early years. Understanding adolescents' knowledge, attitudes and behaviours (KAB) related to NCD risk factors would inform the development of school-based health programmes to prevent NCDs. Methods: Sixth-grade students (n=1026) in 20 schools (10 private, 10 public) from two Indian cities (n=667 from Pune; n=359 from Bengaluru) participated in a KAB survey in 2019. Differences in KAB by gender, school type within cities were investigated. Results: Knowledge about the harms of tobacco use was higher than knowledge about a healthy diet and the importance of physical activity. Only a small proportion of students did not eat breakfast (8.7%) or fruits (11.3%) daily. Only 33.4% of students read nutrition labels before choosing their food. Moderate-to-vigorous physical activity of less than an hour per day was reported by 42.5% of students. Approximately one-third of students had ever tried smoking tobacco (30.1%), smokeless tobacco (30.5%), and e-cigarettes (32.4%). Differences in these behaviours by gender and school type showed that both boys, girls and students of private and public schools are vulnerable. Conclusions: The findings highlight that knowledge is low for thematic areas like diet and physical activity. Low knowledge can be attributed to unfavourable behaviours like lack of reading nutrition labels and indulgence in sedentary activities. To protect India's young population (adolescents), there is a need to amplify health education activities and context-specific health intervention materials for them by engaging parents and communities. Thus, these programmes should be incorporated into the curriculum as part of the regular teaching, as they may induce positive changes in their knowledge and behaviours. In India, school health programmes should dedicate significant time to health promotion and NCD risk prevention.

The Indian Bidi Industry: Trends in Employment and Wage Differentials

Background: The bidi industry in India is predominantly an unorganized sector. It continues to enjoy tax benefits, arguably, to protect bidi workers' interests and employment. Our objective was to study trends in employment and wage differentials in the bidi industry using nationally representative data.

Methods: We studied trends in employment and wages in the bidi industry using secondary data from the National Sample Survey Office (NSSO) and the Central Statistics Office (CSO), Government of India–the Annual Survey of Industries (ASI) (2000–2001 to 2011–2012) and Enterprises Survey (2000–2001, 2005–2006, 2010–2011).

Results: The bidi industry contributed to only 0.65% of the total gross value added (GVA) by the entire manufacturing industry. Employment in this industry was primarily through contractors. Bidi workers earned only 17% of wages compared to workers in other manufacturing industries. Although females constituted the majority of bidi workers, they earned INR 7,000 to 8,000 (USD 155.7 to 178) less than male bidi workers annually. Despite the increase in bidi industry profits from INR 1.7 billion (USD 37.8 million) in 2005–2006 to INR 12.8 billion (USD 285 million) in 2010–2011, the wages of bidi workers have continued to decline over this period.

Conclusion: Bidi workers earn much less compared to workers in other manufacturing industries and are subject to income inequality. There is a need to increase registration of the bidi industry for better administration of taxes and prevention of exploitation of the bidi workers. Skill building and alternative employment could provide better job quality, wages, social security and employment benefits.

Explanatory style in youth self-harm: an Indian qualitative study to inform intervention design

BACKGROUND

There are very few studies that have examined the effectiveness of psychological interventions (PIs) that have been developed and tested in high-income countries to reduce self-harm in low and middle-income countries.

OBJECTIVE

To evaluate the perspectives and explanatory styles of youth with self-harm and their caregivers to inform the design of an evidence based PI in a non-Western cultural setting. An additional objective was to suggest ways of integrating local practices and traditions to enhance its acceptability.

METHODS

We conducted 15 in-depth qualitative interviews with youth with self-harm and four interviews with the caregivers in the psychiatry department of a tertiary hospital located in Mumbai, India. Data were analysed using phenomenological thematic analysis.

FINDINGS

Five themes were uncovered: (i) contextual factors related to self-harm including interpersonal factors, intrapersonal factors and socio-cultural factors; (ii) formulation and current feelings about the attempt (iii) family members and friends as the perceived supports and deterrents for future self-harm attempts; (iv) treatment related experiences with counselling, in-patient and outpatient treatment and barriers to treatment; and (v) coping strategies. Recommendations for key areas of adaptation include therapist adaptation, content adaptation to accommodate for cultural considerations and broader social context. Gender based socio-cultural norms, beliefs and stigma attached to self-harm need to be specifically addressed in South Asian setting. Interpersonal conflicts are the most common triggers.

CONCLUSION AND CLINICAL IMPLICATIONS

To our knowledge this is the first study in the South Asian context evaluating explanatory styles of youth with self-harm and their caregivers to inform the design of an intervention to ensure its cultural congruence. Cultural adaptation of an evidence based PI results in competent delivery and ensures best results in diverse ethno-cultural populations.

Workplace wellness programming in low-and middle-income countries: a qualitative study of corporate key informants in Mexico and India

BACKGROUND

A qualitative study of key informant semi-structured interviews were conducted between March and July 2016 in Mexico and India to achieve the following aims: to explore corporations' and stakeholders' views, attitudes and expectations in relation to health, wellness and cancer prevention in two middle-income countries, and to determine options for health professions to advance their approach to workplace wellness programming globally, including identifying return-on-investment incentives for corporations to implement wellness programming.

RESULTS

There is an unmet demand for workplace wellness resources that can be used by corporations in an international context. Corporations in India and Mexico are already implementing a range of health-related wellness programs, most often focused on disease prevention and management. A number of companies indicated interest is collecting return on investment data but lacked the knowledge and tools to carry out return-on-investment analyses. There was widespread interest in partnership with international non-governmental organizations (public health organizations) and a strong desire for follow-up among corporations interviewed, particularly in Mexico.

CONCLUSIONS

As low-and middle-income countries continue to undergo economic transitions, the workforce and disease burden continue to evolve as well. Evidence suggests a there is a growing need for workplace wellness initiatives in low-and middle-income countries. Results from this study suggest that while corporations in India and Mexico are implementing wellness programming in some capacity, there are three areas where corporations could greatly benefit from assistance in improving wellness programming in the workplace: 1) innovative toolkits for workplace wellness initiatives and technical support for adaptation, 2) assistance with building partnerships to help implement wellness initiatives and build capacity, and 3) tools and training to collect data for surveillance as well as monitoring and evaluation of wellness programs.

In vitro activities of ciprofloxacin and rifampin alone and in combination against growing and nongrowing strains of methicillin-susceptible and methicillin-resistant Staphylococcus aureus

We characterized the effects of ciprofloxacin and rifampin alone and in combination on Staphylococcus aureus in vitro. The effects of drug combinations (e.g., indifferent, antagonistic, or additive interactions) on growth inhibition were compared by disk approximation studies and by determining the fractional inhibitory concentrations. Bactericidal effects in log-phase bacteria and in nongrowing isolates were characterized by time-kill methods. The effect of drug combinations was dependent upon whether or not cells were growing and whether killing or growth inhibition was the endpoint used to measure drug interaction. Despite bactericidal antagonism in time-kill experiments, our in vitro studies suggest several possible explanations for the observed benefits in patients treated with a combination of ciprofloxacin and rifampin for deep-seated staphylococcal infections. Notably, when growth inhibition rather than killing was used to characterize drug interaction, indifference rather than antagonism was observed. An additive bactericidal effect was observed in nongrowing bacteria suspended in phosphate-buffered saline. While rifampin antagonized the bactericidal effects of ciprofloxacin, ciprofloxacin did not antagonize the bactericidal effects of rifampin. Each antimicrobial prevented the emergence of subpopulations that were resistant to the other.