District Level Household Survey Research Articles

Differentials in reproductive and child health status in India

Background: Inequalities in reproductive and child health (RCH) exist, in general, in different regions of India. The present study aims to investigate the current status of RCH and examine the factors responsible for it in different parts of India. Methods: This study utilized data obtained from two Indian studies – (i) National Family Health Survey – 3 (NFHS- 2005-06) and (ii) District Level Household Survey (DLHS – 2002-04). Reproductive Health Index was computed on the basis of five variables such as total fertility rate, infant mortality rate, birth order, delivery care and female educational attainment. Results: In terms of reproductive and child health, a wide range of variation exists in India in its different regions. The study reveals that among Indian states, 13 states have an index value less than the national average. On the basis of the reproductive health index, the Indian states can be divided into three categories, namely; progressive states, semi progressive states and backward states. Conclusions: The interstate differences in healthcare utilization are partly due to variations in the implementation of maternal health care programs as well as differences in availability of and accessibility to healthcare between Indian states.

Prevalence and determinants of anemia among school going children in the state of Tamil Nadu, India: applications of two-level logistic regression model

Background: Anemia still remains as one of the major public health problems in India despite implementing preventive measures. The objective was to find the prevalence and determinants of anemia among school going children in Tamil Nadu. Methods: We used the data from the fourth round of district level household survey (DLHS-4) for Tamil Nadu pertaining to the year 2012-13. Our analysis included 23997 children. Descriptive statistics, Random intercept and empty models of two-level logistic regression analysis were used. Results: The overall prevalence of anemia was found to be 41.4% (95% CI: 40.77%-42.02%). We observed a district level variation on anemia (District level variance=0.1, p<0.001) and the intra class correlation coefficient was 0.0295. The prevalence of anemia was more in coastal districts as compared to non-coastal districts (43.85% vs. 40.18%, p<0.001). Variables that are found to have significant association with anemia on multilevel analysis were younger age (Adjusted odds ratio (AOR)=1.343, 95% CI: 1.270-1.420), female children (AOR=1.462, 95% CI: 1.387-1.541), more than eight family members in the household (AOR=1.120, 95% CI: 1.008-1.245), rural residence (AOR=1.103, 95% CI: 1.038-1.172) and lower standard of living (AOR=1.203, 95% CI: 1.084-1.334). Conclusions: Half of school going children were anemic in the state. Geospatial distribution of anemia varied significantly. Governments and regional health centres should take adequate measures to avert the consequences of anemia in school going children considering these factors.

Gaps in education and marital dissolution: Evidence from India

AbstractIndia has had a low divorce rate only recently, but the divorce rate is rising following the international trend. The rising divorce rate has gained considerable attention among social scientists. The paper identifies gaps in spouses’ educational attainment as a potential cause of rising failed marriages in India. Using a nationally representative large survey dataset, namely the fourth round of the District Level Household Survey, we show that the likelihood of divorce and separation is higher among women who are comparatively more educated than their partners. Moreover, the likelihood increases as the positive education gap increases. The incidences of divorce are significant among those residing in rural areas, educated up to secondary and beyond, and unemployed despite being more educated than their husbands. Although the results show that women are gaining autonomy in deciding whether to move out of marriages, the government must provide free education for women, at least up to the secondary standard, as being more educated than their partner does not provide them the autonomy to dissolve their marriages unless they are educated at least up to secondary standard.

Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment

BackgroundIn 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified ‘health systems strengthening’ as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey − 4), to assess structural capacity and continuum of snakebite care in primary health care system in India.MethodologyWe evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not.ResultsNo state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains.ConclusionComprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.

Household Environment Status and Infant Mortality: A Study of West Bengal

The factors influencing infant mortality have been documented in a number studies. A number of individual, biological and household environmental factors were found to be the significant predictor of infant mortality in any human setting. Most existing studies on early childhood mortality in India were based on census data. Using the data from second and third rounds of District Level Household and Facility Survey of India this paper assessed the pattern and degree of association of infant mortality with household environment status at the district level in West Bengal. The estimates of infant mortality rate for districts of West Bengal were derived based on birth history data. The household environment status for each district was determined based on three selected household environment factors, namely, availability of toilet facility, availability of safe drinking water and existence of pucca house. Key findings showed that the northern and western districts of this state were backward in terms of household environment status and mostly the districts of those regions had higher levels of infant mortality. The association of availability of toilet facility with infant mortality was found to be significant and stronger, compared to that of other two household factors.

Child marriage and reproductive health of Indian women

AbstractUsing detailed data from the third round of the District Level Household Survey of India, this paper examines in detail the effect of child marriage of women on contraceptive usage and access to skilled care during pregnancy and delivery. This paper particularly focuses on sixteen different outcome variables categorized under four broad sub-groups; namely, family planning and contraceptive usage, birth history, utilization of antenatal care; and finally, natal and postnatal care. The overall results presented in the paper suggest that women who marry early, i.e. before they reach the legal age of marriage are more likely to have experienced miscarriage, give birth before they turn 18 and lose children. They also lack current contraception usage and are less likely to access public health facilities during both pregnancy and childbirth. These results, however, vary widely based on the state of residence and age of the women in question.

Understanding the Geography of Victimization: A Spatial Analysis of Intimate Partner Violence in India.

Most studies on intimate partner violence (IPV) and its drivers have focused on individual-and household-level characteristics of the victim. Recent studies have acknowledged that it is a community-level phenomenon, using spatial analytical methods to analyze community-level determinants of IPV and its geographic dimensions. Such studies provide mixed evidence on the impact of different factors and need to be supplemented by similar studies-particularly in South Asian countries where IPV is common. The present study examines district-level variations in the incidence of various forms of IPV and identifies its determinants in India, a fast-growing South Asian country with poor gender indicators. The study combines data from the National Family Health Survey, District Level Household Survey, and the decadal Census. It applies spatial analytical methods such as the Global Moran's I, Getis-ord statistic, and Multivariate Local Geary to determine the nature of the spatial distribution of different categories of IPV. Spatial regression models are used to identify the community-level predictors of each category of IPV. The study finds non-random overlapping spatial clusters in the eastern part of India. The study also finds that neighborhoods characterized by low empowerment levels, and with a high child sex ratio, road connectivity, and proportion of socially marginalized groups are more likely to exhibit high levels of all types of IPV-although the impact of these determinants varies across districts. Furthermore, spill-overs in the incidence of IPV between neighboring districts are also observed. The study concludes by recommending the use of localized policies, rather than broad national or state policies, in reducing IPV.

Pregnancy wastage and its socio-demographic determinants in Maharashtra: Analysis of a DistrictLevel Household Survey-4, 2012-13

Background: Stillbirth is a major contributor to perinatal mortality, and abortion is one of the important causes of maternal mortality. Understanding the true magnitude and associated factors is important to devise appropriate public health strategies to curb the issue. Objective: To determine the magnitude of pregnancy wastage (abortion and stillbirth) and socio-demographic factors associated with the study population. Methods: The secondary data analysis was performed on DLHS-4 data of 45,690 women in the reproductive age group in Maharashtra. Magnitude of lifetime pregnancy wastage and last pregnancy wastage was estimated as proportion and rates per 1000 pregnancies. Univariate and bivariate analysis were performed using Statistical Package for the Social Science (SPSS). The last pregnancy wastage indicator was cross-tabulated with socio-demographic indicators to understand the correlation. Results: Lifetime pregnancy wastage among the study population was found to be 12.4% (1.5% stillbirth, 3.8% induced abortion, and 7.1% spontaneous abortion). The magnitude of pregnancy wastage for the last reported pregnancy was 3.9% (0.7% stillbirth, 1.5% induced abortions, and 1.7% spontaneous abortion). Stillbirth was significantly associated with place of residence and woman remunerated in the last 12 months. Induced abortion was significantly associated with the age of woman, education, place of residence, caste, age at marriage, and husband education. Spontaneous abortion was significantly associated with age, literacy status, and remunerated in the last 12 months. Conclusion: The study finding indicates a higher number of stillbirths and abortions that emphasizes the urgent need of formulating appropriate strategies to reduce pregnancy wastage.

Understanding Differences in Behaviour Patterns of Healthcare Service Elements Among Regions Applying Data Mining

Maternal and child healthcare (MCH) has always been regarded as one of the important issues globally. The aim of this article is to find out all frequently occurring healthcare service elements along with their availability conditions and their interactions with other health system (HS) elements, when coverage of priority MCH intervention was either poor or moderate or good in any region. Association rule mining technique has been used to understand the probability of occurrences of different healthcare service elements among regions. Along with the proposed analytical framework, an interactive decision support system (DSS) has also been developed on a web platform, which would help healthcare policymakers to integrate the analytical framework easily in their processes of decision-making. The system has been developed by using Shiny package on R software. Data for all variables are collected for 584 Indian districts from the third phase of district-level household and facility survey. From results, it is observed that community healthcare services, sub-centre (SC)-level healthcare services and PHC-level healthcare services of a region are very much interlinked with each other, and their relationships define the healthcare condition of that region.

District-level religious composition and child health in India

BackgroundCommunity characteristics are a significant social determinant of child health. Little is known about the effects of social heterogeneity as a specific factor that might impact health. This paper aims to fill the void in research on the health effects of India’s district-level religious heterogeneity.MethodsWeighted state fixed effects multivariate logistic regression was applied to India’s Third District Level Household Survey (2007–2008). The dependent variables were death of a child under five and indicators of healthcare utilization. The key independent variables were the proportions in the district who were Hindu, Muslim, Christian, Buddhist, and Sikh. The analysis controlled for generic community diversity, household religion, and socioeconomic status. Separate, sub-group analysis focused on Muslims only, Christians only, and Buddhists only.ResultsMultivariate fixed effects models show that a 1% point increase in the proportion of Muslim, Christian, or Buddhist households in a community is associated with respective odds ratios of child death of 1.008, 1.009, and 1.012 of experiencing the death of a child. The impact of a household’s own religious affiliation is statistically insignificant in these models. Higher proportions of Muslims and Christians in a community lower the odds of BCG (a vaccine for childhood tuberculosis) receipt and child healthcare-seeking.ConclusionsHouseholds residing where there are higher levels of religious minorities in India experience worse child survival. These effects are not mediated by the household’s own religious affiliation. There is evidence that health system performance and quality is systematically worse in communities with higher proportions of religious minorities. Our study can help policymakers identify communities where children may be at higher risk based on community heterogeneity and the potential for insufficient collective action. Policymakers might consider flagging these communities for special attention, because social heterogeneity is likely to be of long duration.

Political competition and public healthcare: Evidence from India

• We examine the causal effect of political competition, measured as the effective number of parties (ENP), on healthcare provision in India. • We find that a 1 SD increase in ENP, raises the probability that a village has a health facility by 8%–15% across different facility-types. • By contrast, we do not observe ENP to exert a robust impact in affecting any of the indicators of health-centre capacity. • We show that prioritizing highly visible health centre access over less visible health centre capacity is electorally rewarding for incumbents. • We find that election-year cycles affect small-budget consumption items while political alignment affects sizeable public investment. In this paper, we examine the causal effect of political competition on public provision of healthcare. Specifically, we investigate whether the effect of political competition on more visible public goods (e.g. health centre access) differs from its impact on less visible public goods (e.g. health centre capacity such as doctors, medical supplies, etc.). Using granular data from three recent waves of the Indian District Level Household Survey (DLHS) during 2002–2013 and an instrumental variable approach, we find that incumbents respond to electoral competition, measured as the effective number of parties (ENP), by trading-off less visible health centre capacity for more visible access to health centres. We provide suggestive evidence that focusing on more visible health centres boosts the incumbent party’s re-election prospects providing a clear motive for incumbent’s action. In addition, we examine the effect of election-year cycles and the role of political alignment in healthcare provision and find compelling evidence of a political economic mechanism at work. By contrast, political competition has no measurable impact on key health outcomes. We conduct several robustness checks to ensure that our estimates are reliable. Thus, our results suggest that electoral competition must be accompanied by strong checks on accountability to improve health outcomes.

Comparative analysis of contraceptive use in Punjab and Manipur: exploring beyond women\u2019s education and empowerment

BackgroundWomen’s education and empowerment are important predictors of contraceptive use across countries. However, two of the Indian states, namely, Punjab and Manipur, showed large variations in contraceptive use, despite the similar level of women’s educational attainment and empowerment. Therefore, this paper attempts to understand variation in contraceptive use between these states, despite having similar level of educational attainment and empowerment among the married women.MethodsThis study primarily used cross-sectional data of the National Family Health Survey (NFHS) 2015–16 and to some extent the District Level Household Survey (DLHS) 2012–13 data. The analytical sample includes 13,730 currently married women in Punjab and 8,872 in Manipur. Modern contraceptive prevalence rate (mCPR) is the key outcome variable of this study. Bivariate, multivariate, and multilevel regression analysis are applied to understand the differences in mCPR between these states and its determinants.ResultsMean years of schooling was about 8 years among women of both the states, and about 34% of the women in Punjab and 27% of the women in Manipur have high level of autonomy. Despite this, use of modern method was 66% in Punjab and only 13% in Manipur. Coverage of family planning program indicators were significantly lower in Manipur than Punjab – frontline workers’ (FLWs) outreach for family planning was only 18% in Manipur compared to 52% in Punjab. Similarly, only 11% of the public health facilities in Manipur compared to 50% of the health facilities in Punjab were ready to provide at least one clinical method of family planning.ConclusionDespite the similar level of individual level characteristics across the two states, poor coverage of family planning programs – low outreach of FLWs, low level of facility readiness, as well as sociocultural norms discouraging contraceptive use – might be responsible for lower contraceptive use in Manipur than Punjab. This implies for strengthening the health system for family planning in Manipur to meet the contraception needs of women by addressing sociocultural barriers in the state.

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.

The Prevalence of Reproductive Tract Infections Based on the Syndromic Management Approach Among Ever-Married Rural Women in Kancheepuram District, Tamil Nadu: A Community-Based Cross-Sectional Study

IntroductionReproductive tract infections (RTIs) are endemic among developing countries and common among females specifically in the reproductive age group. The sequelae of this lead to infertility. The main reason behind the high prevalence was found to be the lack of awareness about the disease and the stigma toward the disease.Aims and objectivesThis study aims to assess the prevalence of reproductive tract infection based on the syndromic management approach among ever-married rural women in the reproductive age group in the Kancheepuram District.MethodologyThis community-based cross-sectional study was conducted in the rural field practice area of Chettinad Hospital and Research Institute during the period from March 2016 to May 2017. The sample size taken was 330, and the sample size was arrived at by multistage random sampling and population proportion to size. Data were collected using a standardized questionnaire of District Level Household Survey 4 (DLHS-4) on RTI/sexually transmitted infections (STIs). Data were then entered in Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and analyzed using SPSS version 21 (IBM Corp., Armonk, NY, USA), and results were interpreted.ResultsThe prevalence of RTI was found to be 50.3%, with the majority (61.3%) of women in the age group of 28-37 years, 52.85% among females living with spouses, and 57.9% from the Hindu community. The prevalence was high among the lower-middle-class and nuclear families. The commonest symptom is vulval itching with 74.09%, and the least is boils with 0.9%. A significant association was noted between RTI and menstrual hygiene practices and socioeconomic status (p < 0.05).ConclusionThe prevalence was high among rural females, and the main reason behind it was the stigma and the lack of awareness. Health education using various sources should be provided to get rid of these issues.

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.

Disparities in the contraceptive use among currently married women in Muslim densely populated States of India: An evidence from the nationally representative survey.

&#x0D; Background: The rationalizations for low use of contraception and high fertility among Muslims compared to other religious group in India are highly controversial. The study was aimed to explain to what extent differences in the use of contraception exist among the religious groups and also examine its associated factors in the Muslim populated States in the country.&#x0D; Methods: The third round of District Level Household and Facility Survey (DLHS-3) was used to accomplish our objectives. Bivariate analysis was used to show the religion wise distribution of limiting, spacing and traditional methods of contraceptive use in relation to socio-economic characteristics. The multivariate logistic regression was also employed to estimate the odds ratio (95% CI) for contraceptive use. SPSS 20.0 version and Arc GIS 10.0 software were employed to carry out the analyses.&#x0D; Results: The study found that the prevalence of limiting contraceptive use was comparatively much lower among Muslims (19.9%) than Non-Muslims (39.3%). In comparison to Non-Muslims, Muslims used 3.5 percentage points and 2.6 percentage points spacing and traditional methods of contraception respectively. The Muslims women from Assam (3.4%), Uttar Pradesh (4.4%) and Bihar (8.3%) reported low use of limiting contraceptive methods as compared to other Muslim populated States. The highest difference in the limiting method was observed in Bihar (21 percentage points) and followed by West Bengal (19 percentage points) between Muslim and Non-Muslim. The level of education and place of residence appeared as the main explaining factors of family planning in the study.&#x0D; Conclusion: The study concluded that the significant inequalities exist among Muslims and Non-Muslims concerning the current use of limiting methods. The policy design and programmes should make on rural, uneducated women to take into account the inequalities in the contraceptive use. &#x0D;

‘Kidney Health for All’ - Implications for India

‘Kidney Health for All’ - Implications for India

ROAD CONNECTIVITY AND PREVENTIVE HEALTHCARE IN INDIAN VILLAGES: FUZZY REGRESSION DISCONTINUITY ESTIMATION OF THE IMPACT OF NEW RURAL ROADS

The Pradhan Mantri Gram Sadak Yojana (PMGSY) programme of India provides new road connectivity for unconnected habitations with a population of at least 500. This paper evaluates the causal effect of the new road connectivity on the healthcare benefits accrued to the previously unconnected village households, specifically the pregnancy care and contraceptive use, awareness and hygiene, and social interaction. The nonparametric fuzzy regression discontinuity design (FRDD) is applied to the data derived from the 2007-2008 District Level Household Survey (DLHS-3) an d the Socioeconomic High-Resolution Rural-Urban Geographic Platform for India (SHRUG) data. The FRDD estimates show that in the treatment villages, more women seek antenatal care, have delivery conducted in hospitals and use modern contraceptive methods. In the villages newly connected with roads, awareness of government health care programmes like prevention of sex selection and female foeticide, treat water and take health insurance coverage has increased. The provision of all-weather roads to unconnected villages is also more likely to impact social interaction and more participation in women self-help groups, and village assembly takes important decisions on preventive healthcare.

Identification of Factors for Cessation of Exclusive Breastfeeding among Mothers of Infants

Background: For the healthy growth of a child, it is essential that the child be breastfed exclusively for 6 months and continued up to 2 years of their age. Although the practice of breastfeeding is common in India, the District Level Household and Facility Survey showed that the percentage of exclusive breastfeeding (EBF) dropped from 63% &lt;1 month to 49% under 3 months and 32% under 5 months. Aim: This study was undertaken to identify the factors for cessation of EBF among mothers in Puducherry. Materials and Methods: It was a hospital-based cross-sectional study where 80 mothers of infants who fulfilled the eligibility criteria were selected by purposive sampling technique. Fifteen factors addressing the main reasons for cessation of EBF were developed. Results: The results revealed that during the 1st month, 78 (97.5%) of the mothers provided EBF, during the 2nd month, 87.5% of the mothers provided EBF, and during the 3rd, 4th, and 5th month, 80%, 54%, and 26% of the mothers provided EBF, respectively. The factors leading to cessation of EBF by mothers were not having sufficient milk (77.5%), going back to work (51%), had too many household chores (60%), felt tired due to breastfeeding (42.5%) and baby-centered factors such as baby continuing to remain hungry even after taking breastfeed (51%), baby failed to breastfeed (47.5%), and baby not gaining adequate weight (48.5%). Conclusion: EBF continues to be low among the mothers. Strategies need to be undertaken to improve EBF.

Prevalence and Risk Factors of Anaemia among Adolescent Girls in Selected Schools

To assess the prevalence and risk factors which contribute to anemia among adolescent girls in selected&#x0D; Introduction: ‘Anemia is a disease in which, because of one or more vital nutrient deficiencies, the blood hemoglobin content is lower than average, irrespective of the cause of such deficiency. In Maharashtra, according to District Level Household Survey (DLHS) 2002-2006, the prevalence of moderate anemia in adolescent girls was estimated to be 53%, whereas severe anemia was 29%.&#x0D; Aims: To assess the Prevalence and risk factors which contribute to anemia among adolescent girls in selected Schools.&#x0D; Research Methodology: A cross sectional study was carried in 150 adolescent girls age between 10 to 15 years. Quantitative research approach was used. Non-probability convenience sample technique was used.&#x0D; Results: The data obtained to describe the sample characteristics including demographic variables (age of adolescent girls, education, mother education, type of family, monthly family income and type of diet), prevalence of anemia among adolescent girls, menstrual factors and dietary factors. The levels of anemia were seen into 4 categories, normal Hb% level, mild anemia, moderate anemia and severe anemia. In demographic variables, Type of family of adolescent girls (p=0.04) is statistically associated with prevalence of anemia. In menstrual factors, duration of blood flow is found to be statistically associated with menstrual factors of adolescent girls (p=0.0001). In dietary factors, it is interpreted dietary factors of adolescent girls is statistically not associated with their prevalence of anemia.&#x0D; Conclusion: The prevalence of anemia is more in adolescent girls. A statistically significant was found between nuclear family but not with the other socio-demographic factors. No association was found between status of menstrual factors except duration of blood flow.