Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model

Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.

Decomposing rural-urban gap in unsafe disposal practice of child stool in India using nationwide sample survey data

A significant rural-urban disparity in unsafe child stool disposal practices exists in India, yet existing research falls short in identifying the contributing factors to this gap. This study addresses the research gap by contextualizing the rural-urban divide in unsafe child stool disposal using data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21). In particular, the study examines the prevalence and predictors of unsafe disposal practices, exploring associated contributing factors to this gap. The study involves a sample of 78,074 women aged 15-49 with a living child under 2 years, without any missing data related to the study interest. Employing descriptive statistics, the Pearson chi-square test, multilevel logistic regression, and the Fairlie decomposition model, the research aims to fulfill its objectives. The rural-urban gap in unsafe child stool disposal practices among the study participants was 22.3 percentage points (pp), with a more pronounced gap among the Scheduled Tribes (ST). Notably, the gap was particularly wide in Madhya Pradesh (33.9 pp), Telangana (27.5 pp), Gujarat (26.1 pp), and Rajasthan (25.8 pp). Predictors such as mother's education, mass media exposure, household wealth quintile, and sanitation facilities proved significant irrespective of residence. However, religion, social group, and water facility on household premises emerged as significant factors in rural areas only. The study identified that 67% of the explained gap in unsafe child stool disposal practices was attributed to the rural-urban difference in household wealth. Other noteworthy contributors were 'household sanitation facility' (21.3%), 'mother's education level' (3.9%), and 'water facility on household premises' (3.9%). These findings underscore the need for population and area-specific policy interventions, especially for individuals from socio-economically disadvantaged backgrounds, those with lower education levels, and limited exposure to mass media, particularly in states with a high prevalence of unsafe disposal practices. Such interventions are crucial to mitigating the existing rural-urban gap in unsafe child stool disposal practices.

Exploring drivers of unsafe disposal of child stool in India using hierarchical regression model

BACKGROUND

Disposal of children's stools is often neglected in Indian sanitation programs, putting them at higher risk of diseases transmitted through the fecal-oral route. Therefore, the current study aims to identify the socioeconomic and demographic factors associated with the unsafe disposal of child stool in India and to estimate the geographical variation in unsafe disposal.

METHODS

The study used 78,074 births under two years from the fifth round of the National Family Health Survey (2019-21). Descriptive statistics, bivariate analysis with the chi-square test, and a four-level hierarchical logistic regression model were applied to accomplish the study objectives.

RESULTS

Findings revealed a 61.3% prevalence of unsafe stool disposal nationwide, significantly varying between rural (45%) and urban (67%) areas. Multilevel logistic regression highlighted that mother's education, wealth quintile, and sanitation facility were significant predictors of unsafe disposal of child stools. Random intercept statistics revealed a substantial geographical unit-level variance in unsafe stool practice in India.

CONCLUSION

The study emphasizes the widespread unsafe disposal of child stool among Indian mothers with young children below two years, and the study underscores a range of contributing factors, including education, media exposure, prosperity, water availability, and sanitation. It also accentuates the significance of the geographical variance in the unsafe disposal of child stool in India, particularly at the household level, followed by the community level. Hence, the findings underscore the importance of focused interventions, including targeted household-level poverty alleviation programs, initiatives to enhance sanitation and water facilities, and community-level public health awareness programs.

Factors associated with public and private healthcare utilization for outpatient care among older adults in India: A Wagstaff's decomposition of Anderson's behavioural model

In India, an expanding ageing population will become a public health alarm, putting additional pressure on the healthcare system. Therefore, the current study aimed to examine the factors associated with outpatient healthcare choices among older Indian adults. We used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). A total of 34,588 individuals (age 45 years and over) who accessed outpatient healthcare services in the last 12 months during the survey were included in this research. A bivariate chi-square test was used to present the percentage distribution of types of outpatient healthcare utilisation by background characteristics. Multinomial logistic regression and Wagstaff's decomposition analyses were employed to explore the interplay of outpatient healthcare utilisation and allied predisposing, enabling, and need factors and examine these factors' contributions to the wealth-based inequalities in public, private, and other healthcare utilisation. Outpatient healthcare utilisation varied significantly according to socioeconomic and demographic factors. The findings suggest that consumption quintiles, place of residence, education, and health insurance were significant determinants of private and public healthcare utilisation and contributed to wealth-based inequalities in healthcare choices. The current study emphasises the need to strengthen and promote public healthcare services.

Contextualizing the standard maternal continuum of care in Pakistan: an application of revised recommendation of the World Health Organization

Objective

This study utilizes recent nationally representative data to contextualize the standard maternal continuum of care (SMCoC) in Pakistan. The revised SMCoC framework encompasses at least eight antenatal care visits, skilled birth attendants during delivery, and postnatal care within 48 h of childbirth.

Methods

The study used a sample of 3,887 ever-married women aged 15-49 from the latest Pakistan Demographic and Health Survey (PDHS) conducted in 2017-18. Several statistical methods were employed: descriptive statistics, bivariate, multilevel logistic regression models, and Fairlie decomposition analysis.

Results

Only 12% of women had accessed full SMCoC services in Pakistan. Education and the wealth quintile emerged as pivotal factors influencing the utilization of SMCoC. The likelihood of full SMCC utilization was more likely among higher educated women (OR: 3.37; 95% CI: 2.16-5.25) and those belonging to the wealthiest household wealth quintile (OR: 4.95; 95% CI: 2.33-5.51). Media exposure, autonomy, healthcare accessibility, residence, and region were also identified as significant predictors of SMCoC utilization among women.

Conclusion

In conclusion, while most women did not utilize full SMCoC services in Pakistan, the pattern is substantially varied by background characteristics. Education, wealth quintile, mass media exposure, and autonomy were significant factors, along with geographical aspects such as healthcare accessibility and region. The study underscores the need for a multifaceted approach to ensure equitable access to full SMCoC services for women in Pakistan, addressing individual, socioeconomic, and geographical factors.

Re-examining the Nexus Between Maternal Smoking Behavior and Under-Five Children's ARI in India: A Comprehensive Study

Background

The burden of acute respiratory infections (ARIs) among children under-five is a serious concern in lower and middle-income countries (LMICs), including India, where it is positively associated with indoor smoking exposures. This study re-examines the impact of maternal smoking on ARIs among children under 5 in India, considering other indoor air pollutant factors and covariates. The aim is to establish existing findings and capture any differentials in results using comprehensive analytical approaches.

Methods

Data from the National Family Health Survey (NFHS-5), 2019 - 21, was used. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and interaction analysis were applied to accomplish the study objective.

Results

The adjusted likelihood of ARI was 1.24 (95% CI: 1.04-1.48) times higher in under-five children with smoking mothers than those with non-smoking mothers. The result was also observed to be almost similar across all seasons. Moreover, the combined effect of maternal smoking with other household members smoking and using unclean cooking fuel without a separate ventilated kitchen escalated the risk (AOR: 2.01; 95% CI: 1.98-2.67). Breastfeeding was found to be a preventive measure for reducing the risk of indoor smoking exposure. The children who were never breastfed and were born large or small were more susceptible to maternal smoking.

Conclusion

The study highlights the association between maternal smoking and ARIs in Indian under-five children. Interventions include reducing maternal smoking, promoting breastfeeding, and improving respiratory health in fuel-exposed households.

Unveiling the spatial divide in open defecation practices across India: an application of spatial regression and Fairlie decomposition model

OBJECTIVE

The study contextualises the spatial heterogeneity and associated drivers of open defecation (OD) in India.

DESIGN

The present study involved a secondary cross-sectional survey data from the fifth round of the National Family Health Survey conducted during 2019-2021 in India. We mapped the spatial heterogeneity of OD practices using LISA clustering techniques and assessed the critical drivers of OD using multivariate regression models. Fairlie decomposition model was used to identify the factors responsible for developing OD hot spots and cold spots.

SETTING AND PARTICIPANTS

The study was conducted in India and included 636 699 sampled households within 36 states and union territories covering 707 districts of India.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome measure was the prevalence of OD.

RESULTS

The prevalence of OD was almost 20%, with hot spots primarily located in the north-central belts of the country. The rural-urban (26% vs 6%), illiterate-higher educated (32% vs 4%) and poor-rich (52% vs 2%) gaps in OD were very high. The odds of OD were 2.7 and 1.9 times higher in rural areas and households without water supply service on premises compared with their counterparts. The spatial error model identified households with an illiterate head (coefficient=0.50, p=0.001) as the leading spatially linked predictor of OD, followed by the poorest (coefficient=0.31, p=0.001) and the Hindu (coefficient=0.10, p=0.001). The high-high and low-low cluster inequality in OD was 38%, with household wealth quintile (67%) found to be the most significant contributing factor, followed by religion (22.8%) and level of education (6%).

CONCLUSION

The practice of OD is concentrated in the north-central belt of India and is particularly among the poor, illiterate and socially backward groups. Policy measures should be taken to improve sanitation practices, particularly in high-focus districts and among vulnerable groups, by adopting multispectral and multisectoral approaches.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey

Low dietary diversity significantly interplays with children’s growth failure. However, evidence of its crucial role in children’s health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015−2016. A total of 67,278 mother-child pairs of children between the ages of 6−23 months and mothers aged 15−49 years were included in this study. Pearson’s chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (<4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21−1.38), wasted (AOR = 1.29; 95% CI; 1.21−1.38), and underweight (AOR = 1.47; 95% CI; 1.39−1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.

Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen's revised healthcare utilization framework model

BACKGROUND

In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use.

METHODS

The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45 years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors.

RESULTS

About 63.7% of total older adults used a private facility, followed by 22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities.

CONCLUSION

The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and household level economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.

Examining the rural-urban divide in predisposing, enabling, and need factors of unsafe abortion in India using Andersen's behavioral model

BACKGROUND

The prevalence of unsafe abortions significantly varies with geography; therefore, more research is needed to understand the rural-urban differences in unsafe abortion practices in India. The present study aims to explore the rural-urban differences in predisposing, enabling, and need factors of unsafe abortion in India.

METHODS

The present study used the fourth round of the National Family Health Survey (2015-16) and included the women aged 15-49 who terminated pregnancies by induced abortion during the 5 years prior to the survey (N = 9113) as the study sample. Descriptive statistics, bivariate chi-square significance test and multivariate logistic regression model were used to accomplish the study objectives.

RESULTS

The findings revealed that almost one-third of pregnancies were terminated through unsafe measures with sharp rural-urban contrast. The likelihood of unsafe abortions increases with decreasing women's age and spousal level of education. Younger women in urban settings were more vulnerable to unsafe abortion practices. In rural settings, women with an uneducated spouse are more likely to have unsafe abortions (OR: 1.92). Poor households were more likely to undergo unsafe abortions, which were more common in rural settings (OR: 1.26). The unmet need for family planning was revealed to be a significant need factor for unsafe abortion, particularly in rural settings.

CONCLUSION

Although abortion is legal, India's high estimated frequency of unsafe abortions reveals a serious public health issue. Due to socio-economic vulnerability, unmet family planning needs, and a lack of awareness, significant numbers of women still practice unsafe abortions in India.

Occurrence of Diarrheal Disease among Under-Five Children and Associated Sociodemographic and Household Environmental Factors: An Investigation Based on National Family Health Survey-4 in Rural India

Diarrheal disease is a significant public health problem leading to mortality and morbidity among children aged 0-59 months in rural India. Therefore, the rationale of this study was to identify the sociodemographic and environmental predictors associated with diarrhea among under-five children in rural India. A total of 188,521 living children (0-59 months) were studied from the National Family Health Survey-4, (NFHS-4) 2015-2016. Bivariate and binary logistic regression models were carried out from the available NFHS-4 data for selected sociodemographic and environmental predictors to identify the relationship of occurrence of diarrhea using STATA 13.1. In rural India, children aged 12-23 months, 24-35 months, 36-47 months, and 48-59 months were significantly improbable to suffer diarrheal disease. Children of the female sex, as well as children of scheduled tribes (ST) and other backward classes (OBC), were less likely to experience diarrhea. The disease was more likely to occur among children of scheduled castes (SC); Muslim or other religions; children belonging to central, eastern, and western regions; children with low birth weight; as well as children with improper stool disposal and rudimentary roof materials. In the rural parts of India, sociodemographic and household environmental factors were most influential. Effective community education; improved handwashing practices; pure water supply; and proper waste disposal, including building and utilizing latrines, would help reduce the burden of diarrheal disease in children.

Perceived academic satisfaction level, psychological stress and academic risk among Indian students amidst COVID-19 pandemic

Background

The Covid-19 pandemic has a significant impact on education and mental health outcomes. This study attempts to analyze the factors associated with academic satisfaction level, psychological stress/anxiety, and future academic risk among Indian students of higher education in the wake of the Covid-19 pandemic.

Methods

An online survey was conducted through a structured questionnaire among students of higher education. Multivariate ordered logistic regression models were performed to find out the predictors of perceived academic satisfaction level, psychological stress, and academic risk among the participants.

Results

Among the 630 participants, the majority of the students (73%) had low to moderate levels of academic satisfaction. Over two-thirds of participants (68%) had a high level of stress and nearly two-fifths (38%) of the participants felt very high risk in their academic career. The multivariate logistic regression models show that the likelihood of psychological stress and academic risk was significantly higher among students aged above 25 years, researchers, and those who belong to broken families. Besides, the higher probability of satisfaction level is associated with female students, undergraduates, belonging to economically well-off families, and rural residents.

Conclusion

Our study suggests that the Covid-19 pandemic leads to a range of psychological health problems. Therefore, increase students’ satisfaction with online classes and it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of students during the Covid-19 pandemic.

Levels, patterns and determinants of using reversible contraceptives for limiting family planning in India: evidence from National Family Health Survey, 2015-16

Background

Demand for family planning is predominantly for birth limiting rather than birth spacing in India. Despite several family planning programmes in India, the use of reversible contraception for limiting family planning has been stagnant and largely depends on female sterilization. Though many researchers have examined patterns and determinants of using modern contraception for total family planning, studies on patterns and determinants of contraceptive use for birth limiting are limited in India. This paper examines the patterns of contraceptive use for liming demand and its determinants in India.

Methods

The National Family Health Survey-4, 2015–16 data was used. Bivariate chi-square significant test and multivariate binary logistic regression model used to accomplish the study objectives.

Results

Majority of women (86.5%) satisfied limiting demand (SLD) in India; the SLD was found significantly low among the women’s age 15–19 years (53.1%) and parity 0 (42%). The satisfied limiting demand by modern reversible contraception (mrSLD) was found significantly high in age group 15–19 years (49.1%), Muslims (30.6%) and North-east region (45.4%). The satisfied limiting demand by traditional contraception (tSLD) was almost three times higher in North-east region (26.1%) than national average of India (8.7%). The women’s years of schooling, wealth status, religion and presence of son child found to be significant determinants of mrSLD. The likelihood of tSLD was found significantly high among the women who had no son child (AOR = 1.41; 95% CI:1.34, 1.48), Muslim (AOR = 1.78; 95% CI:1.70, 1.87). A considerable regional variability in levels of SLD, mrSLD and tSLD was found in India.

Conclusion

Public investment in family planning is required to promote and provide subsidized modern reversible contraception (MRC) services, especially to women from North-east region, Muslim, Scheduled tribe, poor household and who had no son child. Improving the quality and availability of MRC services in public health centre will be helpful to increase SLD among the above mentioned women. Besides, the promotion of MRC will be supportive to overcome the issues of sterilization regrets in India.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01706-0.

Facilitators and Barriers to the Utilisation of Maternal Healthcare Services in Empowered Action Group States, India

The use of adequate reproductive healthcare services is critical to mothers and newborn babies. This study aimed to examine the facilitators and barriers to maternal healthcare utilisation in the Empowered Action Group (EAG) states. Data were drawn from the fourth round of the National Family Health Survey, 2015–16 ( n = 103,984). In this study, full antenatal care (ANC), delivery assistance by the skilled birth attendant (SBA) and postnatal care (PNC) within 2 days of delivery were taken as indicators of maternity care. Overall, approximately 13% of women received full ANC, 69.4% were delivered by SBA and 57.7% had PNC within 2 days of delivery. The findings of this study reveal that urban residence, higher education, wealthier economic status, exposure to mass media and contraceptive use are the facilitators of maternal healthcare utilisation. On the contrary, low levels of education, poverty, marriage during childhood, having a large number of children, belonging to socioeconomically backward castes, having difficulties related to healthcare-seeking and unwanted pregnancies are some of the major barriers to the use of maternity care. This study suggests that policymakers and public health practitioners should design proper healthcare policies and programs to provide quality reproductive healthcare services, particularly among socio-economically vulnerable women.

Exploring the Socioeconomic Factors Associated with Girl Child Marriage and its Impact on Pregnancy Outcomes: A Study from Malda District of West Bengal

Background:

Child marriage is not a new phenomenon in India. The prevalence of child marriage remains high in many districts of West Bengal.

Objectives:

The present study aims to address socioeconomic factors associated with girl child marriage and its effect on selected pregnancy outcomes among women in the Malda district of West Bengal.

Methods:

The study is based on primary data, collected from the Manikchak CD block by adopting a random sample survey technique. The participants in the study consisted of 357 ever married women aged 15–49 years.

Results:

Multivariate analysis revealed that the prevalence of child marriage was substantially higher among women who had no formal education resided in the marginalized family. Similarly, educated parents were less likely to marry their daughter at an early age. Besides, the likelihood of miscarried or stillbirth, complications during pregnancy and delivery were significantly higher among those married <18 years than those married at 18 years or later.

Conclusions:

The findings of this study suggest preventing child marriage by increasing opportunities for girls' education and employment. The targeted approach should be made among rural and poor girls to reduce the vulnerability of child marriage.

Spatial-temporal variations in community mobility during lockdown, unlock, and the second wave of COVID-19 in India: A data-based analysis using Google's community mobility reports

COVID-19 has been altering all aspects of societal life including community mobility since December 2019. This study analyzes the spatial-temporal variations in human mobility patterns as the influence of COVID-19 during different periods at the state and union territory (UT) levels in India. From the spatial and temporal perspective, we find that change of mobility patterns and variations within states and UTs. The residential mobility has been increased because the mobility towards the home increased during the lockdown and the second wave but during the unlocking period reduced to some extent. There have spatial variations in mobility towards different places within states and UTs during the lockdown and second wave (lockdown to partial lockdown) but overall mobility towards different places like retail, parks, workplace, and transit stations have been reduced in India. During unlocking, mobility has been reduced all over the states and UTs in India but there have spatial-temporal variations within.

Influence of socio-demographic factors on coverage of full vaccination among children aged 12-23 months: a study in Indian context (2015-2016)

BACKGROUND

Vaccine-preventable diseases (VPDs) are one of the key public health concerns in low and middle-income countries due to incomplete vaccination coverage. Nearly three million children up to 5 years of age die due to VPDs each year. Vaccination plays a significant role in reducing child mortality and morbidity from VPDs. Globally, full vaccination coverage efficiently saves two to three million children's lives from life-threatening VPDs.

OBJECTIVE

This study intends to inspect the influence of socio-demographic factors on full vaccination coverage of children aged 12-23 months in India.

METHODS

A cross-sectional observational study was carried out using the NFHS-4, 2015-2016 data of India. A total of 44,771 children aged 12-23 months born to the mothers aged 15-49 years in the last 5 years preceding the survey were used for this study. For the analyses of the data, Bivariate and Multivariate analyses were performed.

RESULTS

The prevalence of full vaccination coverage of children aged 12-23 months in India was 62%. The result of the study indicated that maternal educational attainment, household wealth status, child size at birth, and maternal health-care services are the main significant predictors of full vaccination coverage. Other socio-demographic factors include maternal age, sex of the household head, exposure to mass media, child birth order, social category, religion, place of residence and region also play significant role in the coverage of full vaccination.

CONCLUSION

The study found that socio-demographic factors play a significant role in full vaccination coverage children in India. Therefore, policymaker and administrators should accentuate the inventive approach for the development of women education, improvement of family income, and easy accessibility of maternal and child healthcare services to surmount the impediment of children full vaccination coverage, which eventually reduce the risk of child morbidity and mortality.

Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu

Background

Caesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively.

Methods

This study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data.

Results

Of participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31).

Conclusion

Findings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

Risk of COVID-19 Transmission and Livelihood Challenges of Stranded Migrant Labourers during Lockdown in India

The lockdown during the first phase of COVID-19 pandemic in India triggered an unprecedented humanitarian crisis. Labourers in the informal sector lost their jobs overnight and were stuck at their work places. The present study examines the risk of COVID-19 transmission among stranded migrant labourers and their livelihood challenges during  the lockdown. A telephonic survey was conducted during the lockdown of first wave of COVID-19 pandemic to collect information from the stranded migrant labourers. The non-probability snowball sampling technique and structured questionnaire were used to draw the sample. Simple frequency distribution and standard statistical methods were used to accomplish the study objectives. The factors of COVID-19 transmission such as poor housing, co-morbidities, poor practice of WASH and COVID-19 precautions were significantly high among the migrant labourers. The lockdown created livelihood crisis among them. For instance, ration shortage (86%), financial distress (82%), reduction of wages (13%), job loss (86%) and anxiety for COVID-19 infection (81%) were often seen. Many of the labourers did not receive any ration kits (30%) and financial assistance (86%) during lockdown. The governmental assistance to overcome the stranded migrant labourers’ challenges during lockdown was less than desirable. India needs to frame a sustainable and effective policy for social security for labourers, particularly in emergency situations.

Do malnutrition, pre-existing morbidities, and poor household environmental conditions aggravate susceptibility to Coronavirus disease (COVID-19)? A study on under-five children in India

BACKGROUND

The novel Coronavirus disease 2019 (2019-nCoV) outbreak, caused by severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), has become the worst serious global risk to humanity in the last century and linked with various risk factors.

OBJECTIVE

To find out the risk zone associated with Coronavirus disease among children under-five age using malnourished status, pre-existing morbidity conditions, poor household environmental conditions, and also with case fatality rate (CFR) and active case rate (ACR) of COVID-19 in India.

DATA SOURCES & METHODS

Data was collected from the 4th round of the National Family Health Survey (NFHS)-4, 2015-16, and CFR and ACR of COVID-19 related data collected from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to identify the risk factors zone and Hot Spot analysis (Getis-Ord Gi) has been done.

RESULTS

The states and union territories (UTs) which have a high composite vulnerability score (CVS) of COVID-19 among under-five children are in Meghalaya (CVS = 1), Uttar Pradesh (CVS = 0.93), Jharkhand (CVS = 0.86), Bihar (CVS = 0.74), Madhya Pradesh (CVS = 0.74), and Odisha (CVS = 0.55). The states and UTs which have low composite vulnerability score of COVID-19 among under-five children are in Sikkim (CVS = -0.90), Daman & Diu (CVS = -0.76) Lakshadweep (CVS = -0.74), Kerala (CVS = -0.72), Chandigarh (CVS = -0.71). The COVID-19 high-risk zones (hot spot: 99% Confidence interval [CI]) were observed in Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, and Meghalaya states of India, which are spatially high clustered and the low-risk zones (cold spot: 95% CI) were observed in Kerala, Mizoram states of India.

CONCLUSIONS

Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable regions of COVID-19.

Maternal determinants of low birth weight among Indian children: Evidence from the National Family Health Survey-4, 2015-16

OBJECTIVE

Low birth weight (LBW) is a serious public health problem in low- and middle-income countries and a leading cause of death in the first month of life. In India, about 18% of children are born with LBW (<2500 grams) in 2015-16. In this study, we aim to examine the influence of maternal factors and socio-demographic covariates on LBW in Indian children.

METHODS

Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A cross-sectional study was designed using a stratified two-stage sampling technique. Cross-tabulation, Pearson's chi-squared test, and multivariate logistic regression analyses were employed to assess the impact of maternal factors and other covariates on children's LBW.

RESULTS

Of total participants (n = 147,762), 17.5% of children were found to be born with LBW. The study revealed that women who had prior experience of stillbirth (Adjusted odds ratio [AOR]: 1.20, 95% CI: 1.04-1.38) and any sign of pregnancy complications (AOR: 1.08, 95% CI: 1.05-1.11) were more likely to have LBW children, even after adjusting for a range of covariates. Maternal food diversity was found to a protective factor against children's LBW. Women with underweight and anemic condition were associated with an increased likelihood of LBW children. Regarding maternity care, women who attended ≥4 ANC visits (AOR: 0.84, 95% CI: 0.80-0.88), took iron tablets/syrup during pregnancy (AOR: 0.94, 95% CI: 0.90-0.98), and delivered in a public health facility (AOR: 0.84, 95% CI: 0.79-0.88) were less likely to have LBW babies. Besides, various socio-demographic factors such as place of residence, caste, religion, education, wealth quintile, and geographical region were significantly associated with LBW of children.

CONCLUSION

Interventions are needed for adequate ANC utilization, improvement in public facility-based delivery, providing iron supplementation, and uptake of balanced energy-protein diet among pregnant mothers. Besides, special attention should be given to the socio-economically disadvantaged women to address adverse pregnancy and birth outcomes including LBW.

Are child and youth population at lower risk of COVID-19 fatalities? Evidences from South-East Asian and European countries

BACKGROUND

The coronavirus disease (COVID-19) pandemic has revealed many lacunas of public health preparedness, especially in lower and middle-income countries and fatality differentials between European and South-East Asian countries. The case fatality rate (CFR) in most of the South-East Asian countries is much lower than the European countries. The percentages of child and youth population are more in South-East countries.

OBJECTIVE

The study aims to show the impacts of age composition on fatality differentials in European and South-East Asian countries by age-structure, especially the percentage share of child and youth population.

DATA AND METHODS

This study has been done based on data provided by UNDP, WHO and worldometers. The case fatality rate (CFR) has been calculated to find out the mortality differentials of countries, and the higher fatality risk countries have been identified by the composite Z score technique.

RESULTS

It is revealed that the COVID-19 case fatality rates are substantially high in highly developed countries of the European countries compared to the South-East Asian countries. Our study shows that there is an issue of child and youth population which affects the lower CFR in SE Asian countries. In France, the CFR was 16.72% which was nearly 7 times more than India (2.31%). The COVID-19 fatality risk ratio was highest in Germany (0.77) while the lowest risk ratio was observed in Bangladesh (-0.71).

CONCLUSION

Despite of having a very high level of human development and preparedness, the current pandemic COVID-19 has revealed that there exist significant differentials among fatality status of European and South-East Asian countries. The CFR is lower in the SE Asian countries where the child and youth population are more than the older population.

Lockdown and unlock for the COVID-19 pandemic and associated residential mobility in India

BACKGROUND

As an outcome of the Coronavirus 2019 (COVID-19) pandemic, the countrywide lockdown and unlock periods altered residential mobility trends in India. The aim of this study was to investigate the impact of the COVID-19 lockdown and unlock periods on residential mobility trends, using the spatial time-series daily changes across the different states and union territories of India.

DATA AND METHODS

This study was based on time-series data of the daily percentage change in residential mobility from baseline in India. Conditional formatting techniques, box plotting, time-series trends plotting methods, and spatial kriging interpolation mapping techniques were employed to show residential mobility trends.

RESULTS

Increases in residential mobility of approximately 31.5%, 30.8%, 26.2%, 23%, 17.6%, and 18.2% from the pre-lockdown period were observed during lockdown phase 1, phase 2, phase 3, and phase 4, unlock 1.0, and unlock 2.0, respectively, in India. This was due to people moving towards home or their place of residence during the COVID-19 pandemic in India. From the time lockdown was initiated up until July 31, 2020, residential mobility increased the least in the north-eastern states of India and also the eastern and extreme northern states of India.

CONCLUSIONS

The results of this study could be used in public health strategies towards decreasing the spread of COVID-19.

Indoor air pollution (IAP) and pre-existing morbidities among under-5 children in India: are risk factors of coronavirus disease (COVID-19)?

Globally, the Coronavirus disease (COVID-19) outbreak is linked with air pollution of both indoor and outdoor environments and co-morbidities conditions of human beings. To find out the risk factor zones associated with Coronavirus disease among under-five children using pre-existing morbidity conditions and indoor air pollution (IAP) environmental factors and also with current fatality and recovery rate of COVID-19 disease in India. Data was utilized from the 4th round of the National Family Health Survey (NFHS), 2015-16, and from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to find out the risk factor zones i.e. to execute the objective. Findings of this study are, the states and UTs which have more likely to very higher to higher risk factors or zones of Coronavirus disease (COVID-19) are Mizoram (1.4), Meghalaya (1.27), Uttarakhand (0.92), West Bengal (0.73), Uttar Pradesh (0.66), Jammu and Kashmir (0.44), Odisha (0.33), Madhya Pradesh (0.21), Jharkhand (0.20), Bihar (0.19), Maharashtra (0.16 risk score), compared to UTs like Assam (-0.12), Rajasthan (-0.13), Goa (-0.14), Manipur (-0.17), Chandigarh (-0.19), Haryana (-0.22), Delhi (-0.27) have moderate risk factors of COVID-19, and the states and UTs like Daman and Diu (-1.18), Sikkim (-0.98), Andaman and Nicobar Islands (-0.84), Kerala (-0.69), Dadra and Nagar Haveli (-0.68), Arunachal Pradesh ( 0.-53), Karnataka (-0.42), and Nagaland (-0.36) have very low-risk zones of COVID-19 deaths. From a research viewpoint, there is a prerequisite need for epidemiological studies to investigate the connection between indoor air pollution and pre-existing morbidity which are associated with COVID-19. Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable areas of COVID-19.

Maternal Education and Child Mortality Differentials: An Upshot From the National Family Health Survey 2015-2016, India

Child mortality is a sociodemographical problem in India. Although nationally representative survey (National Family Health Survey) showed child mortality was gradually declining, that was not satisfactory, and child mortality differentials prevailed all over India. The study intended to identify the effect of maternal educational level along with some sociodemographical determinants on the mortality of their children. The study was run through bivariate association and logistic regression using the data from National Family Health Survey-4 (2015-2016). Findings declared that maternal education had significantly high influence (odds ratio: no education 3.9, primary 2.9, secondary 1.8; adjusted odds ratio: no education 2.9, primary 2.3, secondary 1.6) on child mortality in the Indian context.

Prevalence and correlates of menstrual hygiene practices among young currently married women aged 15-24 years: an analysis from a nationally representative survey of India

PURPOSE

This paper aims to investigate the prevalence by geographical locations and socio-demographic correlates of menstrual hygienic practices among young currently married Indian women.

METHODS

The study is based on secondary data, collected from the latest round of the National Family Health Survey (NFHS-4), conducted in 2015-16. A total of 94,034 young currently married women aged 15-24 years were utilised in this study. The prevalence of menstrual hygienic practices was portrayed across regions, states, and districts of India. Bivariate and multivariate analyses were carried out to assess the factors associated with menstrual hygienic practices.

RESULTS

Nearly half of the women (49.3%) practice hygienic methods to contain menstrual bloodstains. The prevalence of menstrual hygiene practices is lower in low-income states of central and eastern India. Multivariate analyses reveal that education of women and wealth status are found to be the most important positive factors of menstrual hygienic practices. Women's autonomy and exposure to mass media also have a positive impact on the use of menstrual hygiene practice. In contrast, women residing in rural areas, belonging in scheduled tribes and unemployed women are less likely to use hygienic methods during their menstruation.

CONCLUSION

The findings of this study suggest increasing opportunities for female education, providing economic incentives, enhancing women's autonomy could help to increase hygienic practices of women during menstruation period. Furthermore, interventions should target socio-economically disadvantaged women to raise the use of sanitary napkins.

Impact of lockdown on learning status of undergraduate and postgraduate students during COVID-19 pandemic in West Bengal, India

To assess the impact of lockdown amidst COVID-19 on undergraduate and postgraduate learners of various colleges and universities of West Bengal. An online survey was conducted from 1 May to 8 May 2020 to collect the information. A structural questionnaire link using 'Google form' was sent to students' through WhatsApp and E-mail. A total of 232 students provided complete information regarding the survey. The simple percentage distribution was used to assess the learning status of the study participants. During the lockdown period, around 70% of learners were involved in e-learning. Most of the learners were used android mobile for attending e-learning. Students have been facing various problems related to depression anxiety, poor internet connectivity, and unfavorable study environment at home. Students from remote areas and marginalized sections mainly face enormous challenges for the study during this pandemic. This study suggests targeted interventions to create a positive space for study among students from the vulnerable section of society. Strategies are urgently needed to build a resilient education system in the state that will ensure to develop the skill for employability and the productivity of the young minds.

Lockdown for COVID-19 and its impact on community mobility in India: An analysis of the COVID-19 Community Mobility Reports, 2020

BACKGROUND

Coronavirus disease (COVID-19) is a novel public health problem threatening the whole world. As an upshot, countrywide lockdown due to COVID-19 pandemic has been supportive of changing community mobility trends of various place categories including retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential in India.

OBJECTIVE

To analyze the impact of lockdown for COVID-19 on community mobility using spatial time-series change over different states and union territories (UTs) of India.

DATA & METHODS

This study has been organized based on states & UTs wise time-series data of the daily percentage of change of community mobility from baseline in India, collected from 15th February to 30th April 2020. Conditional formatting techniques, time-series trends plotting method, spatial inverse distance weighted (IDW) interpolation mapping techniques have been employed to show pre and post lockdown mobility trends due to COVID-19 i.e. to fulfill the objective.

RESULTS

Across India, retail and recreation, grocery and pharmacy, visits to parks, transit stations, and workplaces mobility dropped by -73.4%, -51.2%, -46.3%, -66% and -56.7% respectively. Visits to residential places mobility increased by 23.8% as people mostly stayed home during the lockdown. The COVID-19 lockdown started on 24 March 2020 and just gone one day (March 25, 2020) of the beginning of lockdown, there have a decreased in percentage (-70.51% in retail and recreation mobility), (-64.26% in grocery and pharmacy mobility), (-46.17% in parks mobility), (-65.6% in transit stations mobility), (-60.03% in workplaces mobility) from baseline in compared to the pre-lockdown period and residential mobility has been increased in percentage (26.32%) from baseline due to people stayed home during the lockdown for COVID-19 pandemic in India.

CONCLUSION

Study figures out mobility trends over time during pre-lockdown and after lockdown period across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential, which can be used in public health strategies to drop the spread of COVID-19.

Impact of maternal education on under-five mortality of children in India: Insights from the National Family Health Survey, 2005-2006 and 2015-2016

Under-five (U-5) mortality is a major public health problem in lower-middle income countries. The aim of this study is to examine the associations between maternal education and mortality of children below 5 years age in Indian context. We have used bi-variate and multivariate logistic regressions to assess the associations. Our study reveals that increasing level of education among women and in association with socio-economic and demographic factors significantly reduces the incidence of U-5 mortality. The findings suggest that increasing opportunities for female education and addressing socio-economic and demographic vulnerabilities could be effective strategies to combat the incidence of U-5 mortality.

Hydration of nail plate: a novel screening model for transungual drug permeation enhancers

Drug delivery by topical route for the treatment of onychomycosis, a nail fungal infection, is challenging due to the unique barrier properties of the nail plate which imparts high resistance to the passage of antifungal drugs. Permeation enhancers are used in transungual formulations to improve the drug flux across the nail plate. Selection of the effective permeation enhancer among the available large pool of permeation enhancers is a difficult task. Screening the large number of permeation enhancers using conventional Franz diffusion cells is laborious and expensive. The objective of present study was to evolve a simple, accurate and rapid method for screening of transungual drug permeation enhancers based on the principle of hydration of nail plate. The permeation enhancer which affects the structural or physicochemical properties of nail plate would also affect their hydration capacity. Two screening procedures namely primary and secondary screenings were evolved wherein hydration and uptake of ciclopirox olamine by nail plates were measured. Hydration enhancement factor, HEF(24) and drug uptake enhancement factor, UEF(24) were determined for screening of 23 typical permeation enhancers. The Pearson's correlation coefficient between HEF(24) and UEF(24) was determined. A good agreement between the HEF(24) and UEF(24) data proved the validity of the proposed nail plate hydration model as a screening technique for permeation enhancers.

Modified mandated choice for organ procurement

Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing the procurement rate. In this paper, we meet the main objections to mandated choice (namely that it undermines autonomy and that mandated donation is preferable). We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation.