Empowered Action Group States Research Articles

Health Care Still a Costly Affair: Covariates of Out-of-Pocket Expenditure on Health Care in India with Special Reference to Empowered Action Group States

Health Care Still a Costly Affair: Covariates of Out-of-Pocket Expenditure on Health Care in India with Special Reference to Empowered Action Group States

Association of anaemia with indoor air pollution among older Indian adult population: multilevel modelling analysis of nationally representative cross-sectional study

IntroductionAnaemia is a disease of public health importance with multi-causal pathways. Previous literature suggests the role of indoor air pollution (IAP) on haemoglobin levels, but this has been studied less due to logistic constraints. A high proportion of the population in developing countries, including India, still depends on unclean fuel, which exacerbates IAP. The objective was to study the association between anaemia and IAP among the older Indian adult population (≥ 45 years) as per gender.MethodsOur study analysed the nationally representative dataset of the Longitudinal Ageing Study in India (LASI 2017–18, Wave-1). We have documented the association of anaemia (outcome variable) with IAP (explanatory variable). To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was conducted. States and union territories were categorised cross tabulated as low, middle and high as per anaemia and IAP exposure. P value < 0.05 was considered statistically significant. SATA version 17 was used for analysis.ResultsMore than half (52.52%) of the participants were exposed to IAP (male (53.55%) > female (51.63%)). The odds of having anaemia was significantly 1.19 times higher (AOR 1.19 (1.09–1.31)) among participants using unclean/ solid fuel. The adjusted odds were significantly higher among participants exposed to pollution-generating sources (AOR 1.30; 1.18–1.43), and household indoor smoking (AOR 1.17 (1.07–1.29). The odds of having anaemia were significantly higher (AOR 1.26; 1.15–1.38) among participants exposed to IAP, which was higher in males (AOR 1.36; 1.15–1.61) than females (AOR 1.21; 1.08–1.35). Empowered Action Group (EAG) states like Uttar Pradesh, Chhattisgarh, Madhya Pradesh, Bihar had both high anaemia and IAP exposure.ConclusionThis study established the positive association of anaemia with indoor air pollution among older Indian adults through a nationally representative large dataset. The association was higher among men. Further research is recommended to understand detailed causation and to establish temporality. It is a high time to implement positive intervention nationally to decrease solid/ unclean fuel usage, vulnerable ventilation, indoor smoking, IAP and health hazards associated with these with more focused actions towards EAG states.

Does Parental Out-migration Affect Nutritional Health Status and Morbidity Among Children? Evidence From India Human Development Survey Data for the Empowered Action Group States

In India, despite having high economic growth, considerable inter-state inequality exists across states in terms of per capita income as well as employment opportunities. The eight Empowered Action Group (EAG) states, which have performed poorly on different accounts of social and physical infrastructure, are also characterised by large inter-state migration for employment. Parental out-migration from these states affects different aspects of child well-being. The present study tries to assess nutritional health status, morbidity and health care utilisation among children based on their parents’ migration status. The results show that parents’ migration status plays a vital role in influencing the prevalence of common childhood diseases and malnutrition among children in EAG states. Multi-prolonged and decentralised strategies are required towards developing and implementing comprehensive nutrition and nutrition-related education programme for the children in these states.

Anaemia prevalence and socio-demographic factors among women of reproductive age (WRA): A geospatial analysis of empowered action group (EAG) states in India

Anaemia remains a major nutritional-related health concern for women under reproductive age (WRA) in developing nations like India as well as the Indian EAG states. According to NFHS round-5, EAG states constitute 57% of WRA having any form of anaemia, higher than many other states of India and other developed and developing nations. This study aimed to assess the frequency of anaemia among the WRA in India's eight EAG states. Also, it attempts to analyse the causes associated with anaemia by the women's background characteristics with spatial correlation with its co-variates across 291 districts of the EAG states. One of the most current Demographic and Health Survey's (DHS) cross-sectional data is the NFHS-5th (2019–21) round taken, conducted by the IIPS under the administration of MoHFW, India. This study only included 315,069 women under reproductive age (WRA). The variables related to anaemia among women's (WRA) background socio-demographic characteristics were assessed using bivariate statistics and multinominal logistic regression analysis to comprehend the spatial correlation between women and their determinant factors. Among the EAG states, the overall prevalence of anaemia was 57%, varying from 42.6% in Uttarakhand to 65.3% in Jharkhand. Multinominal logistic regression analyses reveal that the chances of anaemia are remarkably more prevalent in younger women (15–19 years of age), women living in rural areas, no educated and primary level educated women, women belonging to the middle to poorest wealth quintile, women no longer living together, women of the Christian religion, women who are not exposed to reading newspapers, underweight BMI women, and scheduled tribe women. Mainly, the prevalence is observed in the North-eastern and southeastern states of Bihar, Jharkhand, Odisha, Chhattisgarh, some parts of Madhya Pradesh, Uttar Pradesh, and Rajasthan, which is shown by the hotspot map. According to the findings of this study, numerous factors like family, socioeconomic, educational, awareness, and individual characteristics such as caste and domicile all lead to a risk of anaemia. The WRA suffers from anaemia as a result of their socioeconomic background and awareness, which leads to a lack of nourishment, and they seek nutrient deficiencies. To overcome this anaemia, multiple discipline policies and initiatives need to be taken targeting women's wellness and nutritional status by increasing women's education and socioeconomic status.

Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India.

This study examines the impact of accredited social health activists (ASHAs), on increasing rates of institution-based deliveries among Indian women with a specific focus on the nine low-performing, empowered action group states and Assam (EAGA) in India. Using the latest round of the National Family Health Survey-V (2019-21), we first investigate the association between the use of ASHA services and socio-demographic attributes of women using a multivariate logistic regression. We then use propensity-score matching (PSM) to address observable selection bias in the data and assess the impact of ASHA services on the likelihood of institution-based deliveries using a generalized estimating equations model. Of the 232,920 women in our sample, 55.5% lived in EAGA states. Overall, 63.3% of women (70.6% in EAGA states) reported utilizing ASHA services, and 88.6% had an institution-based delivery (84.0% in EAGA states). Younger women from the poorest wealth index were more likely to use ASHA services and women in rural areas had a two-fold likelihood. Conversely, women with health insurance were less likely to use ASHA services compared to those without. Using PSM, the average treatment effect of using ASHA services on institution-based deliveries was 5.1% for all India (EAGA = 7.4%). The generalized estimating equations model indicated that the use of ASHA services significantly increased the likelihood of institution-based delivery by 1.6 times (95%CI = 1.5-1.7) for all India (EAGA = 1.8; 95%CI = 1.7-1.9). Our study finds that ASHAs are effective in enhancing the uptake of maternal services particularly institution-based deliveries. These findings underscore the necessity for continual, systematic investments to strengthen the ASHA program and to optimize the program's effectiveness in varied settings that rely on the community health worker model, thereby advancing child and maternal health outcomes.

OUT-OF-POCKET EXPENDITURE ON OUT-PATIENT CARE IN EAG STATES: AN ANALYSIS BASED ON NSSO 75TH ROUND DATA

Regardless of their socio-economic status, everyone has the human right to receive healthcare. Since the Indian government spends so little on health care, healthcare spending has been a major source of concern. However, most of the literature in India on determinants of health spending has focused on hospitalization, and there are relatively fewer separate studies on health-seeking behaviour and expenditure in outpatient departments. The purpose of this study was to determine the patterns of health-care-seeking behaviour and the pattern of expenditure incurred by households during outpatient care in Empowered Action Group (EAG) States. The present study used secondary data from the latest 75th round of National Sample Survey (NSS) conducted from July 2017 to July 2018 on the key indicators of social consumption in India: Health. The finding suggest that the seeking behaviour of ailing persons as outpatients, across EAG states only limited population access to public sources of healthcare (36.8% in rural and 27.3% in urban). Rajasthan (46.7%), Madhya Pradesh (41.5%), Bihar (32.9% rural), and Uttar Pradesh (31.3%) have the highest percentage of outpatient who expressed dissatisfaction with the standard of public health services in rural areas. Among EAG states of urban areas, Uttar Pradesh (42.6%) have the highest percentage of not satisfied with the quality of care by government sources. Among EAG states, Significant inter-state variation was observed, with Rajasthan (Rs. 886) reporting the highest expenditure for outpatient treatment and Chhattisgarh (Rs. 350) reporting the lowest in rural areas. However, Uttar Pradesh (Rs. 1194) reported the highest and Odisha (Rs. 508) reported the lowest expenditure incurred on outpatient care by ailing persons in urban areas. The amount that each state spends on healthcare varies greatly, which causes inter-state differences in the cost of outpatient treatment in EAG states. As a result, the government needs to control the cost of medications and diagnostic tests and ensure that plans for outpatient care include coverage. KEYWORDS: Outpatient care, out-of-pockect expenditure, EAG states,

Spatiotemporal variations and determinants of overweight/obesity among women of reproductive age in urban India during 2005-2021

BackgroundIndia has witnessed rapid urbanization in recent decades, leading to a worrisome surge in non-communicable diseases, particularly overweight/obesity, which now present a critical public health concern. Therefore, this study seeks to examine spatiotemporal variations and determinants of overweight/obesity among women of reproductive age (WRA) in urban India and its states during 2005-2021.MethodsThe study used 44,882, 171,443, and 135,272 WRA aged 15–49 from National Family Health Survey (NFHS)-3 (2005-06), NFHS-4 (2015-16), and NFHS-5 (2019-21), respectively. The outcome variable was overweight/obesity, defined as a Body Mass Index (BMI) of ≥ 25 kg/m2. Chi-squared test and multivariable logistic regression were used to identify the determinants of overweight/obesity.ResultsOverweight/obesity prevalence among WRA in urban India has risen significantly, from 23% in 2005-06 to 33% in 2019-21. This increase is particularly pronounced among SC/ST women and women with lower educational levels. During the study period, overweight/obesity rates in different states exhibited varying increases, ranging from 3 percentage points (pp) in Rajasthan to 22 pp in Odisha. Certain southern (e.g., Tamil Nadu and Andhra Pradesh) and northeastern states saw a significant 15 pp or more increase. In contrast, several northern, central, and eastern states (e.g., Punjab, Haryana, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand, West Bengal) experienced relatively smaller increases ranging from 5 to 8 pp. As of 2019-21, two regions exhibited high prevalence rates of overweight/obesity, exceeding 35%: the southern region (Tamil Nadu, Andhra Pradesh, Kerala, and Karnataka) and the northern region (Punjab, Himachal Pradesh, Uttarakhand, and Haryana). In contrast, the Empowered Action Group states had relatively lower rates (25% or less) of overweight/obesity. Regression results showed that older women [AOR: 5.98, 95% CI: 5.71–6.27], those from the richest quintile [AOR: 4.23, 95% CI: 3.95–4.54], those living in south India [AOR: 1.77, 95% CI: 1.72–1.82], and those having diabetes [AOR: 1.92, 95% CI: 1.83–2.02] were more likely to be overweight/obese.ConclusionConsidering the significant increase in overweight/obesity among urban WRA in India, along with substantial disparities across states and socioeconomic groups, it is imperative for the government to formulate state-specific strategies and policies based on determinants to effectively combat overweight/obesity.

Prevalence of Undernutrition and Change Detection among under five years Children of Empowered Action Group States in India: Scrutinizing from National Family Health Survey, 2016–2021

ABSTRACT Change detection and prevalence of child undernutrition among the Empowered Action Group (EAG) states of India were studied using National Family Health Survey-4 and 5 data. The results identified that the prevalence of undernutrition in most of the EAG states is still more than 30%. Although stunting and underweight have decreased in all EAG states, this pattern is higher than that of the national level but the prevalence of wasting has only increased in Bihar. Strengthening public health initiatives and collaborative endeavor between organizations, enhancing mother’s education, increasing awareness, and raising the economic as well as sociopolitical empowerment of mothers are essential for addressing the undernutrition issue.

Utilization of Maternal Healthcare Services Among Tribal Women in Empowered Action Group States in India

Maternal and Child Health (MCH) care services mainly focus on the utilization among tribal women in Empowered Action Group (EAG) states in India. For this study, the NFHS-4 (2015–2016) data were used. Analysis was performed on 54,448 women aged between 15–49, who have a child below 5 years of age, by using bivariate logistics regression, chi-squared test and the Moran-I (Univariate) statistical techniques. Results show that only 11% of tribal women accessed full Antenatal Care (ANC), and 54% of women received Postnatal Care (PNC) in EAG states. More than one-third (34%) of tribal women delivered in their homes compared to institutional delivery (66%). Women with higher education are significantly more likely to utilize ANC and have institutional delivery compared to the women with no-education. Also, mothers from the most abundant wealth status are significantly more likely to receive ANC and PNC and have institutional delivery compared to women with poorest wealth quintile. Considering the inter-EAG states comparison, state like Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh and Uttarakhand are performing poorly. Hence, out of all EAG states districts almost 3–7 districts from (low–high) and 8–11 districts from (high–low) groups show negative autocorrelation or outliers to received MCH care services. Despite continuous and improving efforts of the government, the utilization of MCH services is very low among tribal women in the EAG states of India.

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.

A COMPARATIVE STUDY OF INDICATORS OF WOMEN EMPOWERMENT: EVIDENCE FROM NATIONAL FAMILY HEALTH SURVEY (2015-2021)

Empowerment of women forms an important part of a developmental process of a country. The meaning of Women empowerment lies in the ability of a woman to control her destiny. The present study focuses on the EAG (Empowered Action Group) states i.e. Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand because these states have more than 40% of the total population in India and are also backward in social, economic, demographic status. Data for the EAG states from NFHS-4 and NFHS-5 was used for the analysis. We studied the level of women empowerment in these states through some indicators under broad components of evidence, sources, and settings of women empowerment from NFHS-4 to NFHS-5. Some indicators such as decision-making, family planning (evidence), employment, educational status (sources), gender-based violence, and marriage before age 18 (settings) have shown an improvement over previously conducted surveys (NFHS 4). While indicators such as the use of bank accounts, mobile phones, and maintenance of menstrual hygiene(sources) posted a considerably higher increase.

Decomposing the gap in undernutrition among under-five children between EAG and non-EAG states of India

In India, the Empowered Action Group (EAG) states (Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Uttarakhand, Odisha, Jharkhand, and Chhattisgarh, including Assam) have a higher prevalence of undernutrition among children under the age of five (U5) than non-EAG states. However, no research has attempted to explain the difference in U5 child undernutrition between EAG and non-EAG states. To fill this gap, this study used data from the fourth round of the National Family Health Survey (NFHS-4) and applied modified Blinder–Oaxaca decomposition (also known as Fairlie decomposition). This decomposition helps quantify the relative contribution of various factors explaining the gap between EAG and non-EAG states in U5 child undernutrition. In EAG states, nearly four out of ten U5 children suffered from being underweight and stunted, and one out of five suffered from wasting. The prevalence of undernutrition was relatively higher in the EAG states than in the non-EAG states. The decomposition results revealed that almost two-thirds of the gap in U5 undernutrition between EAG and Non-EAG states was explained by the variables used in the analysis. Household wealth explained about half the difference in stunting and wasting, while religion accounted for a quarter of the difference in underweight and wasting. Maternal education explained a fourth of the difference in stunting between EAG and Non-EAG states. The disparity in undernutrition between EAG and non-EAG states could be reduced by introducing suitable long- and short-term interventions and programs. Increasing access to the public distribution system (PDS), raising awareness among low-income mothers regarding optimal inter-birth intervals, proper health and hygiene, appropriate family planning, and the importance of maternal and child health care services by frontline workers (ASHAs, Anganwadi workers, etc.) could be some of the ways to bridge the gap in undernutrition between EAG and non-EAG states in the near future.

Inequalities and Policy Gaps in Maternal Health: Evidence from Empowered Action Group States in India

Background: Health inequality in maternal health is one of the serious challenges currently faced by public health experts. Maternal mortality in Empowered Action Group (EAG) states is highest and so are the health inequalities prevalent. Therefore, we examine to understand maternal health inequality and the risk factors with respect to the EAG states in India. Methods: A cross-sectional data from NFHS-4 (2015-16) for EAG states of India was used. Bi-variate, multivariate logistic regression, and probabilities were carried out to investigate the factors. Also, concentration indices were used to measure health inequality. Findings: Our finding showed four outcomes of maternal health-antenatal care of at least 4 visits (ANC 4+), institutional delivery, contraption-use, and unmet-need. Our finding revealed the average predicted probability of women currently married using ANC 4+ in rural area is 5 percent higher than that of urban areas for EAG states. Lower contraception use, institutional delivery, and unmet need are observed among urban women. The results also indicate that better maternal health is heavily concentrated among the richer households, while negative concentration index of unmet need clearly reflects the greater demand for higher unmet need among the poor households in the EAG states. Conclusions: Challenges of inequalities still persist at large in maternal health, but to achieve better health these inequalities must be reduced. Since inequality mainly affects poor households due to lower level of income. Therefore, specific measures must be taken from a demand-side perspective in order to enhance their income and reduce the disparities in the EAG states of India.

Exploring the Potential of mHealth to Improve Maternal Health in Rural Bihar

In India women suffer from poor maternal health sometime leading to maternal death. The condition is severe in Empowered Action Group states like Bihar. Caste and gender-based biases are responsible for it. Health informatics tools like mHealth is essential for disseminating useful maternal health-related information among rural women since its affordable and portable. A household survey was conducted in Malpur village, Dalsinghsarai block, Samastipur district, Bihar. Purposive random sampling was conducted. Mixed method was used for data collection and analysis. Results show that rural women have severe dependence on their immediate family members for information related to maternal health. ASHAs/AWWs too fail to generate information to lower caste women. Thus, mHealth becomes instrumental in generating maternal health education. The study contends that mHealth is promising in propagating need-based information to women in their own language, thereby becoming a harbinger of health promotion.

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.

NEONATAL DEATHS IN EMPOWERED ACTION GROUP STATES: MULTILEVEL MODELING TO STUDY THE WITHIN DISTRICT EDUCATION EFFECT ON NEONATAL SURVIVAL

Neonatal Deaths are deaths that occur during rst 28 days of life. It is still very high in demographically poor performing States in India termed as Empowered Action Group (EAG) States. Study using the National Family Health Survey-4 data suggests high neonatal death burden in EAG States including Odisha. Uttar Pradesh recorded the highest neonatal death at 51.6 deaths per 1000 live births and the lowest was recorded in Uttarakhand at 32.3 neonatal deaths per 1000 live births. Neonatal deaths in Chhattisgarh were recorded as 48.2 deaths per 1000 live births, followed by Odisha at 46.9, Madhya Pradesh at 44.9, Bihar at 41.9, Jharkhand at 39.2, Assam at 36.1 and Rajasthan at 34.4 per 1000 live births. The parametric Cox Hazard model was used to study the unobserved heterogeneity. The Weibull distribution shape parameter value greater than one suggests considerable unobserved heterogeneity in the data. Considering district as unit of analysis (group level variable), attempt was made to capture the between district individual variations in neonatal deaths with regard to women educated 12+grades within districts. The low levels of Intra Class Correlation are suggestive of individual level variations than group level differences in studying the variations in neonatal deaths.

Effect of Women's and Partners' Education on Maternal Health-care Services Utilization in Five Empowered Action Group States of India: An analysis of 13,443 Women of Reproductive Age.

Background:Suboptimal utilization of maternal health-care services is a perennial problem in Empowered Action Group (EAG) states. This study examines role of women's and partners' education on usage of antenatal, postnatal care (PNC), and skilled birth attendance in these states.Methodology:National Family Health Survey-4 (2015–2016) data for 13,443 women in reproductive age group of 15–49 years in Bihar, Madhya Pradesh (MP), Odisha, Rajasthan, and Uttar Pradesh (UP) were analyzed using logistic regression.Results:Increasing level of education had a significant impact on utilization of antenatal services in all states, highest and lowest odds being observed with higher and primary level of partner's education, respectively. Skilled birth attendance universally showed rising trend with increasing women education, while it remained substantially low even at higher level of partner's education. For PNC, utilization increased with increasing level of maternal education. While significantly lower odds of PNC were seen with primary level of partner education in Rajasthan and UP, partner's secondary education showed positive and significant association in Bihar, Rajasthan, and UP. At higher level of partner education, positive and significant effects on PNC were observed only in Bihar, MP, and UP.Conclusions:Universal education is vital to attain sustainable development goals at the grassroot level, which is happening relatively slowly in the EAG states.

Childhood undernutrition inequalities in empowered action group states of India: evidence from NFHS, 2006-2016

Background: Child undernutrition is a major public health problem in many low and middle income countries and malnutrition alone accounted for 45% (3 million deaths annually) deaths among under-five children. Malnutrition is the concealed cause of one out of every two such deaths. A study was undertaken to examine the trends, determinants and socioeconomic-related inequalities in childhood undernutrition in empowered action group (EAG) states, India. The secondary data of the two rounds of National Family Health Survey, NFHS-3 (2005-06) and NFHS-4 (2015-16) comprising of 16,802 and 128,400 children aged 0-59 months respectively was analysed.Methods: Non-linear Fairlie decomposition was used to identify and quantify the separate contribution of different socioeconomic characteristics in gap of childhood malnutrion between 2006 and 2016.Results: Results show that the prevalence of undernutrition has decreased in EAG states during the last one decade, but the prevalence of wasting is remained almost same as 10 years back. The decomposition analysis shows that maternal education, household wealth and place of residence were contributing to socioeconomic inequality in childhood undernutrition from 2006 to 2016.Conclusions: There is a need to adopt different strategies of health policy intervention. It is important to have policies towards improving female literacy in the EAG states because maternal education plays a vital role in child health and literacy rate is very low among women in EAG states. The existence of a functional health insurance system and increasing universal coverage are recommended to mitigate child undernutrition, so that the vulnerable and deprived populations who are not able to access health care facilities, can easily access health care services for early detection and treatment of undernutrition without any financial constraint.

Maternal Biophysical Influence on Low Birth Weight: A study on Empowered Action Group States in India

Maternal Biophysical Influence on Low Birth Weight: A study on Empowered Action Group States in India

Gaps in the coverage of vitamin K1 prophylaxis among newborns in India: insights from secondary analysis of data from the Health Management Information System.

Despite operational guidelines, anecdotal evidence suggests that newborn vitamin K1 prophylaxis is not practiced routinely in India. This study determined the coverage of vitamin K1 prophylaxis among newborns in the country. Nationwide cross-sectional data on live births and newborns receiving vitamin K1 during the 2019-2020 reporting period were abstracted from the Health Management Information System (HMIS). The coverage estimates of newborn vitamin K1 prophylaxis were derived nationally and also for individual states and union territories (UT). Additionally, coverage heterogeneities were investigated using classifiers, viz. geography, socio-demographic index (SDI), special developmental categories and institutional birth rate (IBR). India. 20 208 804 newborns documented with HMIS. Vitamin K1 was administered to overall 62·36 % newborns (95 % CI: 62·34 to 62·38 %). The Central zone (49·0 %), low SDI states (54·39 %), Empowered Action Group states (53·32 %) and states with low IBR (44·69 %) had the lowest coverage amongst their respective groupings. Across the individual states and UT, the coverage ranged widely from 22·18 % (in Tripura) to 99·38 % (in Puducherry), exhibiting considerable variability (coefficient of variation: 33·74 %) and inequality (Gini coefficient: 0·17). While the coverage in eight states/UT (i.e. Arunachal Pradesh, Manipur, Nagaland, Tripura, Uttar Pradesh, Uttarakhand, Telangana and Andaman & Nicobar Islands) was below 50 %; only five states/UT (i.e. Chandigarh, Gujarat, Goa, Puducherry and Tamil Nadu) achieved above 90 % coverage. Vitamin K1 prophylaxis was not practiced in more than one-third newborns in India. It calls for identifying the barriers, addressing the gaps and implementing newborn vitamin K1 prophylaxis more effectively throughout the country.