Annual Health Survey Research Articles

Efficient detection of data entry errors in large-scale public health surveys: an unsupervised machine learning approach

Data entry errors in large-scale public health surveys can undermine the effectiveness of data-driven interventions. Therefore, identifying these data entry errors is crucial for public health experts. In large-scale public health surveys, manually verifying the accuracy of every data point by domain experts is nearly impossible. This study evaluates unsupervised machine learning algorithms for detecting these errors, focusing on the 'weight' parameter in the Annual Health Survey (AHS) dataset. The AHS, conducted by the Ministry of Health and Family Welfare, Government of India, in collaboration with the Registrar General of India, is a large-scale, stratified, household-level survey targeting maternal and child health across nine states in India. The dataset is freely available on the Open Government Data (OGD) Platform of India for public health research. In this study, five algorithms—DBSCAN, K-Means, Gaussian Mixture Model (GMM), Isolation Forest (IF), and One-Class SVM (1C-SVM) were applied to detect erroneous data entries. The evaluation process involved comprehensive preprocessing and feature engineering to optimize detection capabilities. Performance metrics such as precision, recall, accuracy, false anomaly, and missed anomaly rates were used to assess each algorithm. Among these, DBSCAN demonstrated superior performance, achieving a recall of 94.7% and a precision of 81.9%, making it highly effective for this task. The findings underscore the potential of unsupervised machine learning in automating the detection of data entry errors, thereby improving the integrity of public health data. This research contributes to the advancement of precision public health, supporting more accurate and reliable evidence-based decision-making and policy formulation.

The association between employee lifestyles and the rates of mental health-related absenteeism and turnover in Japanese companies.

We assessed the association of employee lifestyles (e.g., smoking, exercise, drinking, and sleep habits) with mental health-related absenteeism and turnover rates utilizing data from the annual Health and Productivity Management survey by Japan's Ministry of Economy, Trade and Industry. This analysis included data from 1,748 companies, encompassing 4,199,021 employees. The average proportions of mental health-related absenteeism and employee turnover rates were 1.1±1.0% and 5.0±5.0%, respectively. In multivariable regression models that incorporated all lifestyle factors and confounders, a 1 percentage point increase in the proportion of employees who slept well was associated with reductions in their turnover rate (mean, -0.020%; 95% confidence interval [CI], -0.038 to -0.002) and in mental health-related absenteeism (mean, -0.005%; 95% CI, -0.009 to 0.001). A similar increase in the proportion of employees engaging in regular physical activity corresponded with a 0.005% decrease in the prevalence of mental health-related absenteeism (95% CI, -0.010 to -0.001). A 1 percentage point increase in the proportion of employees who smoked was associated with a 0.013% reduction in mental health-related absenteeism (95% CI, -0.017 to -0.008). Nonetheless, the current study's observational and cross-sectional design restricted the ability to establish causality between employee lifestyle factors and mental health issues.

Perceptions and preferences for environmentally sustainable food and associated factors: a cross-sectional analysis of a nationally representative survey of United States consumers

BackgroundConsumers are increasingly interested in environmentally sustainable dietary patterns. However, specific signals (e.g., language, labels, logos, or packaging) American consumers use to identify environmentally sustainable products are yet to be explored. ObjectivesTo determine perception and preferences for environmentally sustainable food and associated health and demographic factors associated with consumers’ use of signals for environmentally sustainable food products in a nationally representative survey of United States consumers. MethodsRepeated cross-sectional data were collected for the 2019 and 2020 annual online Food and Health Survey by the International Food Information Council. Three questions were analyzed: 1) the stated importance of environmentally sustainable food products, 2) signals consumers use to identify environmentally sustainable food/beverage products, and 3) the impact of environmental sustainability on food/beverage purchase decisions. Questions 2 and 3 were asked only from participants who stated environmental sustainability is important in question 1. Options provided for signals for environmentally sustainable products were recyclable packaging, minimal packaging, labeled organic, labeled locally grown, labeled sustainably sourced, and labeled non-genetically modified organisms (GMOs)/not bioengineered. Poisson regression and logistic regressions were performed to assess associations. ResultsOf 1905 completers, 1059 (55.6%) answered that it was somewhat or very important that food products purchased/consumed were environmentally sustainable. Of those, 94% used ≥1 of the 6 signals to determine environmental sustainability when shopping. Some signals were selected despite little association with environmental sustainability (e.g., locally grown and non-GMO/not bioengineered). The number of signals consumers used was associated with education, race/ethnicity, health status, and the level of impact they reported that sustainability plays in their decisions. Associations between consumer characteristics and the use of different signals for environmental sustainability were heterogeneous. ConclusionsEven among consumers who value environmental sustainability in food products, specific signals used by different respondents varied across demographics and health characteristics.

Left-digit bias in self-reported height

Left-digit bias is a cognitive bias wherein individuals assess the magnitude of numbers by emphasizing the leftmost digit. For instance, people often perceive the difference between $9.99 and $10.00 larger than that between $10.00 and $10.01, given the distinct left digits in the former two numbers. This study associates self-reported height with this cognitive bias. Taller stature is frequently associated with desirable attributes such as higher earnings and leadership positions; individuals may aspire to be taller and, consequently, report a height greater than their actual measurement. We posit that this inclination is more pronounced when combined with left-digit bias. In other words, individuals whose actual height ends in nine, such as 169 cm, are more likely to report their height as 170 cm than individuals with an actual height of 170 cm who report it as 171 cm. To conduct this analysis, we used data from an annual health survey of adolescents in grades 7–12. Our findings indicate that male adolescents exhibit a left-digit bias in reporting their height, whereas female adolescents do not. We contribute to the literature by providing new evidence of left-digit bias.

The association between cesarean birth and breastfeeding initiation in Odisha, India: A mother fixed effects analysis.

Cesarean births are becoming more common in India, with health implications for both mothers and infants. Between 2005 and 2015, the proportion of cesarean births to total births in India roughly doubled, from 9% to 17%. We analyze Annual Health Survey data from the state of Odisha in eastern India. These population-level, longitudinal data on births between 2007 and 2011 allows us to estimate the association between cesarean birth and breastfeeding outcomes using mother fixed effects. Mother fixed effects allow comparisons of siblings born to the same mother who experienced different types of births (vaginal and cesarean). This empirical strategy controls for many potential observable and unobservable confounders in the relationship. Ordinary Least Squares linear probability models without mother fixed effects find that babies born by cesarean in Odisha are about 14 percentage points (p<0.001) more likely to experience delayed initiation of breastfeeding (that is, not being breastfed in the first 24 hours) compared with babies born vaginally. After introducing mother fixed effects, we find that babies born by cesarean are 11 percentage points more likely to (p<0.001) experience delayed initiation of breastfeeding. Because breastfeeding success is important for protecting against infectious disease in this context, future research should investigate whether cesarean birth impacts other aspects of breastfeeding as well.

Interrelated feature selection from health surveys using domain knowledge graph.

Finding patterns among risk factors and chronic illness can suggest similar causes, provide guidance to improve healthy lifestyles, and give clues for possible treatments for outliers. Prior studies have typically isolated data challenges from single-disease datasets. However, the predictive power of multiple diseases is more helpful in establishing a healthy lifestyle than investigating one disease. Most studies typically focus on single-disease datasets; however, to ensure that health advice is generalized and contemporary, the features that predict the likelihood of many diseases can improve health advice effectiveness when considering the patient's point of view. We construct and present a novel knowledge-based qualitative method to remove redundant features from a dataset and redefine the outliers. The results of our trials upon five annual chronic disease health surveys demonstrate that our Knowledge Graph-based feature selection, when applied to many machine learning and deep learning multi-label classifiers, can improve classification performance. Our methodology is compatible with future directions, such as graph neural networks. It provides clinicians with an efficient process to select the most relevant health survey questions and responses regarding single or many human organ systems.

Major Determinants of Infant Mortality: District-level Evidence from Annual Health Survey States of India

The study aims to understand the major determinants of infant mortality in infant mortality-prone annual health survey states of India. The study has considered district level infant mortality rate as a dependent variable and household size, sex ratio at birth, female literacy, marriage before the legal age, birth spacing, full antenatal care, Mothers who received post-natal care within 48 hours of delivery, Children within 12 to 23 months who are fully immunised, Breastfeeding within 24 hours of birth, Children aged 6 to 35 months are only breastfed for the initial 6 months, women who are aware of HAF/ORS/ORT, and women who are aware of ARI/Pneumonia as independent variables. The study considered district-level data on the mentioned variables over nine annual health survey states over three years. The results reveal that female literacy, birth spacing, immunisation, only breastfeeding till 6 months, and awareness regarding HAF/ORS/ORT all have a statistically significant negative impact on IMR. On the other hand, post-natal care has a statistically significant positive impact on IMR. This surprising result can have two explanations. First, only those children receiving PNC who are already sick and succumbing to their sickness. Second, the patient death rate owing to hospital infection in India is very high, so it may be that infants are succumbing to this particular aspect. Identification of major determinants of infant mortality will eventually lead to actions against them, and that, in due course of time, will tame the onrush of infant mortality in Annual Health Survey States as well as other parts of India and the world. Quantification and determination of the major determinants of infant mortality for the annual health survey states are missing till date, and from that aspect, the article is novel.

Maternal healthcare use by women with disabilities in Rajasthan, India: a secondary analysis of the Annual Health Survey

BackgroundWomen with disabilities face a number of barriers when accessing reproductive health services, including maternal healthcare. These include physical inaccessibility, high costs, transportation that is not accessible, negative attitudes from family and healthcare providers, and a societal belief people with disabilities shouldn’t be parents. While qualitative studies have uncovered these barriers, there is limited quantitative research to determine their effect on use of maternal health services. This study aims to analyze associations between disability and maternal healthcare use among married women in Rajasthan.MethodsThis study is a secondary analysis of the Indian Annual Heath Survey first wave data from 2011. The sample includes 141,983 women aged 15–49 who had given birth between 2007 and 2009. Logistic regression was used to assess the association between disability and use of antenatal, delivery, and postnatal care. Stratified models were created to analyze difference based on birth order of the pregnancy and whether the woman’s place of residence is rural or urban.ResultsThe prevalence of disability was 1.23%. Attending at least three antenatal care visits was reported by 50.66% of the sample, skilled delivery use by 83.81%, and receiving postnatal care within 48 h of birth by 76.02%. In the regression model, women with disabilities were less likely to report attending the minimum antenatal care visits (OR = 0.84; CI: 0.76, 0.92). No association was found between disability and skilled delivery or postnatal care. Once the sample was stratified by birth order, women with disabilities reporting their first birth were more likely to report receiving postnatal care than women without disabilities (OR = 1.47; CI: 1.13, 1.91).ConclusionAdditional research is needed to determine use of maternal healthcare among women with disabilities in India. Maternal services need to be assessed to determine their accessibility, especially regarding recent laws requiring accessibility.

Transitioning from having no metabolic abnormality nor obesity to metabolic impairment in a cohort of apparently healthy adults

IntroductionThe global prevalence of metabolic syndrome and its association with increased morbidity and mortality has been rigorously studied. However, the true prevalence of “metabolic health”, i.e. individuals without any metabolic abnormalities is not clear. Here, we sought to determine the prevalence of “metabolically healthy” individuals and characterize the “transition phase” from metabolic health to development of dysfunction over a follow-up period of 5 years.MethodsWe included 20,507 individuals from the Tel Aviv Sourasky Medical Center Inflammation Survey (TAMCIS) which comprises apparently healthy individuals attending their annual health survey. A second follow-up visit was documented after 4.8 (± 0.6) years. We defined a group of metabolically healthy participants without metabolic abnormalities nor obesity and compared their characteristics and change in biomarkers over time to participants who developed metabolic impairment on their follow-up visit. The intersections of all metabolic syndrome components and elevated high sensitivity C-reactive protein (hs-CRP) were also analyzed.ResultsA quarter of the cohort (5379 individuals, (26.2%) did not fulfill any metabolic syndrome criteria during their baseline visit. A total of 985 individuals (12.7% of returning participants) developed metabolic criteria over time with hypertension being the most prevalent component to develop among these participants. Individuals that became metabolically impaired over time demonstrated increased overlap between metabolic syndrome criteria and elevated hs-CRP levels. The group that became metabolically impaired over time also presented higher delta values of WBC, RBC, liver biomarkers, and uric acid compared with participants who were consistently metabolically impaired. LDL-C (low-density lipoprotein cholesterol) delta levels were similar.ConclusionsRoughly one-quarter of apparently healthy adults are defined as “metabolically healthy” according to current definitions. The transition from health to metabolic dysfunction is accompanied with active inflammation and several non-metabolic syndrome biomarkers. Aggressive screening for these biomarkers, blood pressure and hs-CRP might help identify apparently healthy individuals at increased risk of developing metabolic syndrome over time.

Accessibility to Safe Drinking Water and its Impact on Health A Case Study of EAG States and Assam

The access to basic household amenities like availability of safe drinking water, toilet facility and electricity etc. are critical determinants of well being of people. Over the last three decades there have been huge changes in availability of these facilities with large regional differences. Being a country of 246,692,667 number of households, in India only 85.5 percent of households have access to safe drinking water including within premises, near premises and away from the premises in 2011 while the same was only 77 percent during 2001(Census of India, 2011). In this paper an attempt has been made to investigate the condition prevailing in the eight EAG (Empowered Action Group) states which includes Uttarakhand, Rajasthan, Uttar Pradesh, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa and Assam. The paper uses data from the Annual Health Survey 2011 (data of diarrhea) and Census 2011 (data on household amenities). The district level pattern of household’s accessibility to safe drinking water and tap water from treated source for rural and urban areas has also been analysed for the study. The result shows that the problem of safe drinking water has two interfaces. One in terms of the source of drinking water and the other is distance from the source. Study shows that most of the districts have access to safe drinking water although there is a rural urban gap still persisting. Urban areas have better coverage of provision to safe drinking water than rural counterparts. The same scenario becomes much worse for household’s access to tap water from treated source. The other finding indicates a possible association between safe drinking water and diarrhea.

Study on the obesity-related factors among primary and middle school students in Hangzhou

Objective: To explore the obesity-related factors among primary and middle school students in Hangzhou. Methods: A stratified random cluster sampling cross-sectional study was conducted using Hangzhou city's 2016-2020 annual school health survey data. Finally, 9 213 primary and secondary school students with complete data were selected as the research objects. The standard of Overweight and Obesity Screening for School-age Children and Adolescents (WS/T 586-2018) was used to verify students' obesity. SPSS 25.0 software was applied to conduct statistical analysis on the related factors of obesity. Results: The overall obesity detection rate among primary and middle school students in Hangzhou was 8.52%. The results of logistic regression analysis showed that inadequate sleep (OR=6.507, 95%CI: 2.371-17.861, P<0.001), 3- hours (OR=5.666, 95%CI: 2.164-14.835, P<0.001) and ≥4 hours (OR=7.530, 95%CI: 2.804-20.221, P<0.001) of watching video every day in the past week, being beaten and scolded by parents in the past week (OR=1.627, 95%CI: 1.161-2.280, P=0.005), parents often reduce students' exercise time in order to let students have more time to study in the past week (OR=3.310, 95%CI: 1.243-8.819, P=0.017), age 16-18 years old (OR=0.137, 95%CI: 0.050-0.374, P<0.001), often suffering from campus violence in the past week (OR=0.332, 95%CI: 0.141-0.783, P=0.012), 1 hour of watching video every day in the past week (OR=0.023, 95%CI: 0.006-0.083, P<0.001), sometimes having breakfast (OR=0.151, 95%CI: 0.058-0.397, P<0.001) and eating breakfast every day (OR=0.020, 95%CI: 0.005-0.065, P<0.001) in the past week, eating vegetables and fruits sometimes (OR=0.015, 95%CI: 0.010-0.023, P<0.001) and every day (OR=0.020, 95%CI: 0.008-0.053, P<0.001) in the past week, eating sweet food sometimes (OR=0.089, 95%CI: 0.035-0.227, P<0.001) and every day (OR=2.568, 95%CI: 1.632-4.041, P<0.001) in the past week, eating fried food sometimes (OR=0.274, 95%CI: 0.094-0.800, P=0.018) in the past week, and having three physical education classes every week (OR=0.156, 95%CI: 0.057-0.423, P<0.001) were the main related factors affecting the occurrence of obesity in primary and secondary school students. Conclusions: With the higher obesity prevalence among primary and middle school students in Hangzhou, parents and teachers should strengthen health education for primary and middle school students, help children develop scientific eating behavior, develop positive and healthy living habits of children, and effectively prevent overweight/obesity in primary and middle school students.

Occupational Exposure to Pesticides as a Risk Factor for Sleep Disorders.

Inadequate sleep has been linked to a variety of impairments in bodily functions, including endocrine, metabolic, higher cortical function, and neurological disorders. For this reason, the aim of this study was to analyze the link between occupational pesticide exposure and sleep health among farmers in Almeria. A cross-sectional study was conducted among a population living on the coast of Almeria (southeastern Spain), where about 33,321 hectares of land are used for intensive agriculture in plastic greenhouses. A total of 380 individuals participated in the study: 189 greenhouse workers and 191 control subjects. The participants were contacted during their annual scheduled occupational health survey. Data on sleep disturbances were collected using the Spanish version of the Oviedo Sleep Questionnaire. Agricultural workers were found to be at a significantly higher risk of insomnia, especially among those who did not wear protective gloves (OR = 3.12; 95% C.I. = 1.93-3.85; p = 0.04) or masks (OR = 2.43; 95% C.I. = 1.19-4.96; p = 0.01). The highest risk of insomnia related to pesticide applicators was observed in those who did not wear a mask (OR = 4.19; 95% C.I. = 1.30-13.50; p = 0.01) or goggles (OR = 4.61; 95% C.I. = 1.38-10.40; p = 0.01). This study supports previous findings indicating an increased risk of sleep disorder in agricultural workers exposed to pesticides at work.

Specchio-COVID19: a digital cohort study to improve public involvement in epidemiological research

Abstract Background To manage the sanitary crisis and rapidly assess the seroprevalence of anti-SARS-CoV-2 antibodies in the canton of Geneva, we invited previous participants of an annual health survey of the general population to a first serological test. As the pandemic progressed, it become clear that there would be a significant longer impact on health and wellbeing of population. Moreover, there was a need to assess the adherence of the population regarding COVID-19 prevention measures, over time, as well as to provide scientific knowledge about antibodies dynamics and protection from new infections. For all these reasons, a long-term follow-up has been settled via the dedicated digital platform Specchio-COVID19 and on-line questionnaires and repeated serological tests. Methods Several measures were designed to maintain high retention and involvement, including regular electronic newsletters with links to a “News” webpage, a “Research” webpage for dissemination of publications and the organization of webinars specifically dedicated to participants. A specific email address and a dedicated hotline were set up so that participants can get in touch with the Specchio-COVID19 team. Results Specchio-COVID19 was launched in November, 2020. Up to February 2022, 10'946 individuals (57% women, median age 48) joined the project. Over time, participation rate remains around 65% for each release of questionnaire. 550 participants (5%) definitely dropped out. Conclusions Our digital cohort facilitates participants’ involvement, allowing participation from remote locations, organizing webinar, promoting news and scientific information via newsletters and specific webpages and enabling interaction between researchers and participants. Key messages • When designing the Specchio-COVID19 digital cohort, the purpose was not only to collect data. • But to establish a reciprocal exchange of information between researchers and participants, fostering long-term involvement and health empowerment.

Both epicardial and peri-aortic adipose tissue blunt heart rate recovery beyond body fat mass.

BackgroundEpicardial adipose tissue (EAT) as a marker of metabolic disorders has been shown to be closely associated with a variety of unfavorable cardiovascular events and cardiac arrhythmias. Data on regional-specific visceral adiposity outside the heart and its modulation on autonomic dysfunction, particularly heart rate recovery after exercise, remain obscure.MethodsWe studied 156 consecutive subjects (mean age: 49.3 ± 8.0 years) who underwent annual health surveys and completed treadmill tests. Multi-detector computed tomography-based visceral adiposity, including EAT and peri-aortic fat (PAF) tissue, was quantified using dedicated software (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA). We further correlated EAT and PAF with blood pressure and heart rate (HR) recovery information from an exercise treadmill test. Metabolic abnormalities were scored by anthropometrics in combination with biochemical data.ResultsIncreased EAT and PAF were both associated with a smaller reduction in systolic blood pressure during the hyperventilation stage before exercise compared to supine status (β-coefficient (coef.): −0.19 and −0.23, respectively, both p < 0.05). Both visceral adipose tissue mediated an inverted relationship with heart rate recovery at 3 (EAT: β-coef.: −0.3; PAF: β-coef.: −0.36) and 6 min (EAT: β-coef.: −0.32; PAF: β-coef.: −0.34) after peak exercise, even after adjusting for baseline clinical variables and body fat composition (all p < 0.05).ConclusionExcessive visceral adiposity, whether proximal or distal to the heart, may modulate the autonomic response by lowering the rate of HR recovery from exercise after accounting for clinical metabolic index. Cardiac autonomic dysfunction may partly explain the increase in cardiovascular morbidity and mortality related to both visceral fats.

The association of pericardial fat and peri-aortic fat with severity of nonalcoholic fatty liver disease

Visceral adipose tissue (VAT) is associated with central obesity, insulin resistance and metabolic syndrome. However, the association of body-site specific adiposity and non-alcoholic fatty liver disease (NAFLD) has not been well characterized. We studies 704 consecutive subjects who underwent annual health survey in Taiwan. All subjects have been divided into three groups including normal (341), mild (227) and moderate and severe (136) NAFLD according to ultrasound finding. Pericardial (PCF) and thoracic peri-aortic adipose tissue (TAT) burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3DWorkstation, TeraRecon, SanMateo, CA, USA). We explored the relationship between PCF/TAT, NAFLD and cardiometabolic risk profiles. Patients with moderate and mild NAFLD have greater volume of PCF (100.7 ± 26.3vs. 77.1 ± 21.3 vs. 61.7 ± 21.6 ml, P < 0.001) and TAT (11.2 ± 4.1 vs. 7.6 ± 2.6 vs. 5.5 ± 2.6 ml, P < 0.001) when compared to the normal groups. Both PCF and TAT remained independently associated with NAFLD after counting for age, sex, triglyceride, cholesterol and other cardiometabolic risk factors. In addition, both PCF and TAT provided incremental prediction value for NAFLD diagnosis. (AUROC: 0.85 and 0.87, 95%, confidence interval: 0.82–0.89 and 0.84–0.90). Both visceral adipose tissues strongly correlated with the severity of NAFLD. Compared to PCF, TAT is more tightly associated with NAFLD diagnosis in a large Asian population.

Nutritional status of Indian pre-school children and WHO nutrition targets for 2025

Background: India has been food secure and has been implementing food supplementation programmes for decades but prevalence of under-nutrition in pre-school children is high. The WHO has set nutrition targets for reduction in low birthweight, stunting, wasting and halting rise in over-nutrition in children to be achieved by 2025.Methods: District level household survey 4 and annual health survey (2013-2015) undertook height and weight measurements in pre-school children (DLHS4 74717 and AHS 139157 children). Mean weight, height and BMI-for-age were computed for girls and boys in 0-5 years and compared with WHO MGRS growth standards. Prevalence of stunting, under-weight, wasting, over-nutrition, combined stunting and wasting were computed in each survey in relation to age.Results: The mean height and weight-for-age in boys and girls during 6-60 months was around the -2SD and mean BMI-for-age was between the mean and -1SD of the WHO standards. Frequency distribution of Z scores for all three indices in Indian children were to the left of the WHO standards. In under-five children stunting rates were highest, wasting rates lower and over-nutrition rates the lowest. Prevalence of stunting increased and wasting decreased with increasing age of the children. Prevalence of under-nutrition was higher in children surveyed in AHS.Conclusions: It might not be possible to achieve rapid reduction in low birthweight or stunting. It might be possible to achieve the targets for sustained reduction in wasting in some states. Early detection and management of over-nutrition in children can prevent the rise in over-nutrition.

Overnutrition in Indian Children: Challenges and Opportunities.

Global and Indian data indicate that children from all the segments of population face dual nutrition burden and related health consequences. Long-term cohort studies have shown that both the under- and overnutrition are risk factors for overnutrition and non-communicable diseases in adult life. Halting the rise in overnutrition is one of the Sustainable Development Goal (SDG) targets to be achieved by 2030. With the development and inclusion of body mass index (BMI)-for-age in the WHO child growth standards, it has become possible to assess over- and undernutrition in short-statured children. In India, the Annual Health Survey (AHS) (2014) and the District Level Household Survey 4 (DLHS4) (2013) undertook measurement of height/length and weight (AHS 557016 and DLHS4 295663) in the 0–18-year of school-age children from selected households. Prevalence of overnutrition in 0–18-year children was calculated from these two surveys by using the WHO standards for BMI-for-age (BMI-for-age z scores (BAZ) > +2 in 0–5 and BAZ > +1 in 5–18-year children) as well as uniform norms of either > +1 or > +2 BAZ across 0–18-year children. An attempt was made to explore the policy and program implications of using different norms for assessing overnutrition in preschool and school age children in the Indian context. Body mass index-for-age curve for the 0–18-year Indian children was calculated and compared with the WHO BMI-for-age curve. Across 0–18-year children, the mean BMI-for-age of Indian boys and girls was lower than the mean of the WHO standards, but the trajectory followed was similar. Therefore, Indian high-risk under- and overnourished children can be monitored by using the WHO BMI-for-age curve. Irrespective of the cutoff used for BMI-for-age, prevalence of overnutrition was higher in preschool as compared to school-age children. Overnourished school-age children outnumbered preschool children, especially if the WHO cutoffs were used. The school health system may find it difficult to implement programs that aimed at detection and management of large number of overnourished children. If uniform norm of BAZ > +1 was used, prevalence of overnutrition in preschool children was high and almost similar to undernutrition. Currently, nutrition programs for preschool children are focused on undernutrition and they may find it difficult to manage program focused on overnutrition in large number of children. If the uniform norm of BAZ > +2 was used, both the prevalence of overnutrition and number of children requiring intervention were relatively low in all the age groups. The existing preschool and school nutrition programs can take up an integrated program aimed at early detection and effective management of both the under- (BAZ < −2) and overnutrition (BAZ > +2) in 0–18-year children and strive to achieve the SDG targets.

Oral Microbiome Is Associated With Incident Hypertension Among Postmenopausal Women.

BackgroundOral microbiota are thought to influence blood pressure (BP) regulation. However, epidemiological data supporting this hypothesis are limited. We examined associations between oral microbiota, BP, and incident hypertension in postmenopausal women.Methods and ResultsBaseline (1997–2001) examinations were completed on 1215 women (mean age, 63 years) during which subgingival plaque was collected, BP was measured, and medical and lifestyle histories and medication inventory were obtained. Microbiome composition of subgingival plaque was measured using 16S ribosomal RNA gene amplicon sequencing. Baseline measured BP was defined as normotensive (systolic <120 mm Hg and diastolic <80 mm Hg, no BP medication use; n=429); elevated (systolic ≥120 mm Hg or diastolic ≥80 mm Hg, no medication use; n=306); or prevalent treated hypertension (history of physician diagnosis treated with medications; n=480). Incident hypertension (375 cases among 735 without baseline treated hypertension) was defined as newly physician‐diagnosed hypertension treated with medication reported on annual health surveys (mean follow‐up, 10.4 years). Cross‐sectional analysis identified 47 bacterial species (of 245 total) that differed significantly according to baseline BP status (P<0.05). Prospective analysis identified 15 baseline bacterial species significantly (P<0.05) associated with incident hypertension: 10 positively (age‐adjusted hazard ratios [HRs], 1.10–1.16 per SD in bacterial abundance) and 5 inversely (HRs, 0.82–0.91) associated. Associations were materially unchanged after further adjustment for demographic, clinical, and lifestyle factors; were similar when analysis was restricted to the normotensive group; and were of consistent magnitudes between strata of baseline age, smoking, body mass index, and BP categories.ConclusionsSpecific oral bacteria are associated with baseline BP status and risk of hypertension development among postmenopausal women. Research to confirm these observations and elucidate mechanisms is needed.

Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England.

BackgroundGuidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support.AimTo investigate trends in the percentage of patients with hypertension/diabetes receiving lifestyle advice versus medication.Design and settingThis was a trend analysis of self-reported data from the annual Health Survey for England (HSE) (2003–2017) and GP-recorded data from the QResearch database (2002–2016).MethodThe percentage of patients with hypertension or diabetes who received lifestyle advice or medication was calculated in each year. Associations between likelihood of receiving lifestyle advice and characteristics were assessed using multivariable logistic regression.ResultsThe percentage of patients receiving lifestyle advice was consistently lower than those receiving medication in both self-reported and medical records. There was consistent evidence of increasing trends in the percentage of patients with hypertension receiving lifestyle advice (HSE 13.8% to 20.1%; Ptrend<0.001; QResearch 11.0% to 22.7%; Ptrend<0.001). For diabetes, there was a non-significant decline in self-reported receipt of lifestyle advice (45.0% to 27.9%; Ptrend = 0.111) and a significant increase in medically recorded delivery of this advice (20.7% to 40.5%; Ptrend<0.001). Patients with hypertension who were overweight or obese were more likely to receive lifestyle advice than those of a healthy weight, whereas the opposite was true for diabetes.ConclusionOnly a minority of patients with diabetes or hypertension report receiving lifestyle advice or have this recorded in their medical records. Interventions beyond guidelines are needed to increase the delivery of behavioural interventions to treat these conditions.

Use of modern contraceptives by women with disabilities in Rajasthan, India: An analysis of the annual health survey

ObjectiveThe objective of this study is to analyze associations between disability and contraceptive use among married women in Rajasthan, India. Methods: The study uses secondary analysis of the Rajasthan dataset of the 2010–2011 Annual Heath Survey. This survey included both disability and reproductive health data. The sample includes 238,240 women aged 15–49 years. Logistic regression is used to measure associations between disability status and use of modern contraceptives and female sterilization in the sample. Stratified analyses by age and residence were also conducted. Results: The prevalence of disability among women of reproductive age was 0.9%. Modern contraceptive use was reported by 73.0% of the sample, and female sterilization by 57.7% of the sample. Women with disabilities (WWD) were less likely to report using a modern contraceptive (OR 0.87, 95% CI: 0.78, 0.95). Among modern method users, WWD were not significantly more likely to be using sterilization than another modern method; however, there were significantly higher odds of sterilization versus another modern method for urban WWD (OR 1.57, 95% CI: 1.11, 2.22). Conclusions: In this study, disability was associated with contraceptive use. Additional research is needed to determine if there is a causal relationship between disability and contraceptive use. Family planning providers should be trained to provide care to WWD and the Government of India should ensure the National Family Planning Programme is accessible to people with disabilities.