Health Programmes In India Research Articles

Non-Medical Determinants of Access and Quality of Maternal Health Services in India-Protocol for a Scoping Review.

The Maternal Mortality Rate (MMR) is one of the most important health indicators of a country. In India, MMR has decline from 130 to 113 per 100,000 live births between 2014 and 2018, however, there are wide disparities in utilization of maternal health services (MHS) among different states and across different socioeconomic groups within the states. Although the government is providing MHS through various health programs in India, there are several non medical factors leading to the underutilization of MHS services. To map and summarise the non-medical determinants of access and quality of MHS in India. We are conducting a scoping review of the published literature from 2000 till date in databases such as PubMed, Cochrane, Science Direct and CINAHL by including eligible qualitative as well as quantitative studies conducted in India. Data extraction and analysis will be conducted through a narrative integrative synthesis approach to summarize the non-medical determinants of access and quality of MHS in India and understand their mechanisms of influence.At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations. We will summarise the non-medical determinants that influence the access and quality of MHS. This scoping review would help to understand and summarise the existing non-medical determinants of access and quality of MHS, highlight the research gaps and suggest potential modalities for improvement of access and quality of MHS.

Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis.

Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.

Integrating nutrition and mental health screening, risk identification and management in prenatal health programs in India.

Pregnancy is a period of major physiologic, hormonal, and psychological change, increasing the risk of nutritional deficiencies and mental disorders. Mental disorders and malnutrition are associated with adverse pregnancy and child outcomes, with potential long-standing impact. Common mental disorders during pregnancy are more prevalent in low- and middle-income countries (LMICs). In India, studies suggest the prevalence of depression is 9.8%-36.7% and of anxiety is 55.7%. India has seen some promising developments in recent years such as increased coverage of the District Mental Health Program; integration of maternal mental health into the Reproductive and Child Health Program in Kerala; and the Mental Health Care Act 2017. However, mental health screening and management protocols have not yet been established and integrated into routine prenatal care in India. A five-action maternal nutrition algorithm was developed and tested for the Ministry of Health and Family Welfare, aiming to strengthen nutrition services for pregnant women in routine prenatal care facilities. In this paper, we present opportunities and challenges for integration of maternal nutrition and mental health screening and a management protocol at routine prenatal care in India, discuss evidence-based interventions in other LMICs including India, and make recommendations for public healthcare providers.

Public health supply chain for iron and folic acid supplementation in India: Status, bottlenecks and an agenda for corrective action under Anemia Mukt Bharat strategy.

The IFA supplementation program under the Anemia Mukt Bharat (AMB) program is one of the most ambitious nutrient supplementation programs in India. The delivery of services often suffers due to frequent stock outs and shortages. It is critical to understand the bottleneck in the supply chain adversely affecting the performance and coverage of the program. The paper attempts to identify the bottlenecks of the IFA supply chain in key areas of supply chain i.e., forecasting, procurement, warehousing and inventory management, transportation, distribution, logistic information system and suggests a plan of action aimed at ensuring uninterrupted supplies to the end beneficiaries. The data source for the present paper is the nationwide IFA Supply Chain Assessment (2018-19) conducted across 29 Indian states with a total of 58 districts, 116 blocks, 232 Sub-Centres, 232 Anganwadi centres and 232 schools covered under the assessment as a multi-partner collaborative initiative. Field insights from supply chain strengthening interventions under different public health programs in India and other developing countries were taken to arrive at corrective actions and recommendations. Findings were disseminated to government and an action plan was suggested for connecting service delivery points through an app-based system, developing a micro plan for ensuring fixed distribution schedule, followed by continuous monitoring and review meetings identified for follow up. The average lead time across states was 35 weeks with top three performing states being Goa, Sikkim, and Telangana. The average per unit cost of procurement was Rs 0.35 for IFA Red, Rs 0.25 for IFA Blue, Rs 0.31 for IFA Pink and Rs 7.30 for IFA syrup. Out of the 704 districts in India, only 213 has IFA Red, only 140 had IFA Blue, 152 had IFA Pink and 163 had IFA Syrup available in four quarters of 2018-19. The key issues identified in the assessment were-a lack of standardized forecasting process, absence of inventory management techniques, no fixed distribution schedule, inadequate availability of transport vehicles and an absence of an integrated MIS. The identification of bottlenecks in the IFA supply chain and its impact on the performance of the supply chain would provide policy guidelines for the government as well as development partner agencies to design an effective and efficient supply chain. It would also enable the policy planners to understand the challenges associated with managing different components of a supply chain, their interrelation and impact on the overall performance of the supply chain. The suggested recommendations would equip program managers with the tool to devise and implement field level solutions.

Health impacting behaviour & morbidity: Implications for adolescent & youth health programmes in India.

In Himachal Pradesh (HP), a comprehensive health survey was conducted to assess the prevalent health affecting habits and issues among young individuals aged 10 to 24 yr. The study was aimed to evaluate key factors such as nutrition, substance use (including tobacco and alcohol), mental health concerns such as anxiety and depression, sexual behaviours and personal hygiene, as well as incidents of violence and injury (including road traffic and other injuries). A cross-sectional survey was conducted in HP on 2895 individuals aged between 10 and 24 yr. The survey encompassed four districts, namely Shimla, Kinnaur, Kangra, and Sirmaur, and 12 blocks (three in each district). To ensure a representative sample, a stratified multistage cluster sampling approach was used. Districts and blocks were selected purposively so as to represent the diverse sociodemographic and cultural characteristics of this region. Within each block, thirty clusters were chosen using a probability proportional to size method. Clusters were defined as villages in rural areas and wards in urban areas. The World Health Organization 30 × 7 cluster technique was employed to identify households and individuals for the study. Underweight (44.39%), risk of cell phone addiction (19.62%), feeling anxious (15.54%), unintentional injuries (14.72%) and violence (8.19%) were the top five health impacting problems among young people in HP. The leading health impacting problems identified are preventable and/or modifiable factors affecting the overall health and development of young people in HP. These need to be addressed as priority health problems for interventions with a focus on maintaining positive health through integrated approaches including care provision, risk reduction and health promotion related to these health impacting behaviours. Such interventions are likely to yield better results towards the overall health and development of young people in HP.

An Overview of SARS-CoV-2 and Technologies for Detection and Ongoing Treatments: A Human Safety Initiative

A new class of coronavirus, known as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been discovered, which is responsible for the occurrence of the disease, COVID-19. A comparative study with SARS, MERS and other human viruses was conductedand concluded that SARS-CoV-2 spread more rapidly due to increased globalization and adaptation of the virus in every environment. According to recent WHO reports, by 16 May 2021, the current outbreak of COVID-19 had affected over 174,054,314 people and killed more than 3,744,116 people in more than 222 countries acrossthe world. Finding a solution against the deadly COVID-19 has become an enormous challenge for researchers and virologists. A ring vaccination trial, which recruits subjects connected to a known case either socially or geographically, is a solution to evaluate vaccine efficacy and control the spread of the disease simultaneously, although its implementation is challenging. This review aims to summarize the noteworthy features of the world-intimidating SARS-CoV-2 global pandemic along with its evaluation, problems and challenges in the treatment strategies, clinical efficiency and detection methods proposed so far. This paper describes the impact of the lockdown in response to the COVID-19 pandemic on social, economic, health, and National Health Programs in India; possible ways to control the disease are also discussed.

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

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

Child health programmes in India

Health entitlements and wisdom pointed to expeditious identification and reverent control of diarrheal had been a crucial part of the CSSM. The health Evidence TM tool was used to 1) find and obtain relevant research evidence; 2) assess the methodological quality of the research evidence, and 3) synthesize the evidence. Individuals must make certain that their occupations do not create any health issues. All people value their jobs since they provide them with a source of money. Some people may not be content, yet they must work in order to make a living. When children work in dangerous industries, it is critical that they receive suitable training and have the necessary skills.

Integrating rare disease management in public health programs in India: exploring the potential of National Health Mission

Rare diseases (RD) are conditions that affect a small number of people and hence do not get the focus on government health priorities in a resource-constrained setting such as India. Therefore, it is essential to focus on strengthening and utilizing the existing public health framework for the optimal usage of healthcare resources. In this regard, National Health Mission (NHM) is one of the crucial programs initiated by the government of India to address the health needs of the under-served. As Phase 1 of the NHM moves towards completion, we explored the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH + A) program under NHM to assess their potential and limitations to aid RD care. We found that some of the disease-prevention initiatives of NHM address certain RDs and can easily be expanded to manage many such preventable RDs. In addition, NHM programs can provide a unique epidemiological data repository to strengthen the National Rare Disease Registry. These programs can also play important role in providing a continuum of care for many RDs that need lifelong management. However, existing programs have a limited scope to provide specialized RD-related treatments, which is better served in a more focused system. Thus, considering RDs in the design of the existing programs may help RD management better through prevention, data collection, and providing a continuum of care.

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

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

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

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

Indian Public Health Students' Perspectives on Global Health Education.

Global health discipline is of increasing interest for educators and students in public health across the world. Public health education is recently gaining momentum in India, but global health is still at an embryonic stage. Value of students as stakeholders in curriculum development is increasingly recognized but literature about perspectives of public health students regarding global health education is limited. This study aimed to explore Indian public health students' perspectives about global health education and to provide platform for the development of global health education framework for future public health professionals. This study involved a series of focus groups with students and sought to understand perceptions about global health and global health education framework. We recruited public health students at three institutes across India for focus group discussions. Focus groups questions covered current understanding of global health, opinions regarding global health education for public health curriculum and the relevance of global health competency domains for future employment. Recordings were transcribed verbatim and the transcripts were read along with field notes and then analyzed thematically. A total of 36 students participated in four focus groups. There was a general recognition that global health is transnational and that a global outlook is now essential. But there were concerns regarding local and global priorities in public health. Global health was regarded as being wider than public health by some, but others viewed public health being the umbrella term with global health as a specialization. Global health competencies were viewed as a “step up” from the public health competencies but core public health competencies were considered essential. International experiences and use of technology were key themes for delivery of global health education. Employability and career progression for global health graduates were of concern for many participants. This study provides insight into the student perspectives regarding global health education for public health programs in India. Clear direction in terms of curriculum and its utility for career growth and employability as a global health professional needs to be established for global health education in India and other similar settings.

Trends and issues in community mental health programs in India: The Ranchi Institute of Neuropsychiatry and Allied Sciences experience.

Psychiatric disorders are among the leading causes of disability the world over. With the World Health Organization, spearheading the crusade to incorporate the mental health component into primary health care, developing countries also have accepted the need for community care of patients with psychiatric disorders. Since independence various initiatives by the government has led to a significant change in the place of mental health care as part of the general health care. At the time of independence apart from mental hospitals, there was practically no organized mental health care. Since then General Hospital Psychiatry units and also Psychiatric Nursing homes have started. Currently, mental health issues are actively seen as part of the public agenda in the various forms. The overall effect has been the movement to recognize mental health as an important issue in the community and services to move beyond mental hospital care to care to the community. Majority of population in Jharkhand is residing in rural areas. Due to the lack of proper communications and infrastructure, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS) had started community outreach program way back in 1999. At present, these centers are running in four different areas of the state with great success. RINPAS experience shows that how even with resource constraints, quality services can be provided to unreached population.

COVID-19 safety guidelines for school eye health screening programs.

COVID-19 pandemic has significantly impacted every sphere of life. Health care workers, including eye care professionals, are at a higher risk of contracting infection directly or indirectly. To mitigate the risk of cross-infection among these front-line workers, it is vital to follow appropriate safety protocols. On the other hand, childhood eye conditions lead to permanent vision loss unless these are identified and treated early. School eye health programs are the best option to reach a large childhood population for early detection and treatment of vision-threatening eye conditions. While several clinical safety guidelines have been developed for ophthalmic practice, no such guidelines are available for carrying out school eye health programs. This article aims to set out COVID-19 safety guidelines for conducting school eye health programs in India.

Maternal Mental Health: A Baseline Survey of Knowledge, Attitudes and Current Practice among Auxiliary Nurse Midwives

Perinatal mental health has been gaining importance in public health programmes in India and efforts are being made to integrate maternal mental health with ongoing maternal health programmes. As part of developing a training module for auxiliary nurse midwives (ANMs), we assessed their baseline knowledge, attitude, and practice related to maternal mental health. Data was collected from ANMs (N=183) from Karnataka state using self-reported questionnaires and case vignettes. Our À ndings revealed that more than half (51.5%) of the ANMs had inadequate knowledge of maternal mental health. However, the majority of the subjects endorsed positive attitudes towards women with maternal mental disorders (65%) and were able to see their role in identiÀ cation and management (74%). The majority of the ANMs (61.5%) showed better practice in identifying and referring women with maternal mental health issues. SigniÀ cant positive correlations were observed between ANMs’ knowledge, attitude, and practice related to maternal mental health. The À ndings suggest that ANMs require further education to update their knowledge and skills to identify mental health problems in women, and refer them for early intervention.

Community stakeholders' perspectives on youth mental health in India: Problems, challenges and recommendations.

India has a large youth population whose mental health needs must be addressed. This includes promotion of positive mental health, with early detection and effective intervention for mental health disorders. Understanding the perspectives of community stakeholders working with youth is pivotal to this effort. Current study aimed to bring together a group of community stakeholders (eg, parents, teachers, policy makers) to understand their perspectives on youth mental health problems, challenges in provision of care, and to provide recommendations to address these concerns at national level. The study was conducted across two sites in India: Chennai and New Delhi. Three group meetings were conducted involving 52 participants, including governmental, non-governmental and community representatives working with youth. The proceedings were manually recorded, transcribed, and analyzed using thematic analysis method. Many youth mental health problems were similar across the two sites. The commonest drivers of mental health problems were reported to be academic pressure, substance use and problematic internet/social media use. Stigma and lack of awareness were identified as the most important challenges acting as barriers to seeking mental health help by youth. Prioritizing youth mental health as a national programmes along with strong political will were the major recommendations suggested by the stakeholders. Initial findings suggest that prioritizing youth mental health programmes in India would be advantageous. Inclusive and collaborative approach, involving community stakeholders working with youth in providing services that promote mental health and early access to care will help in developing healthy young citizens.

Evaluation of a new set of indicators for mental health care implemented in Madhya Pradesh, India: a mixed methods study

BackgroundMental health information systems are, in general, inadequate and unreliable in India. We have developed key mental health indicators for measuring mental health service coverage in primary care. This study aims to evaluate the use of these new indicators in seven health care facilities in Sehore District of Madhya Pradesh in India.MethodsThe study employed a mixed methods approach. We conducted: a qualitative study (n = 26) with health workers, Health Management Information Systems (HMIS) staff, project coordinators and supervisors; a review of case records (n = 61 at time 1 and n = 74 at time 2); and a structured questionnaire (n = 26) with health workers. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators was assessed.ResultsHigh levels of completion, and correctness of completion, of the new mental health indicators were found for the case records. The simplicity of the forms, as well as technical support from the project team, contributed to acceptability and feasibility of implementation. Perceived sustainability of the new forms was, however, affected by the overstretched primary care staff. Further work is needed to support the integration of mental health with routine HMIS.ConclusionThis study demonstrated that the implementation of key mental health service delivery indicators in Sehore District primary care facilities was feasible. Technical assistance was imperative in maintaining the performance of the indicators over the two studied time points. The integration of mental health indicators in routine health information systems, and political buy-in, are needed to monitor and sustain community mental health programmes in India.

Innovative mental health initiatives in India: A scope for strengthening primary healthcare services.

Mental health burden is a major health concern worldwide. In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context. This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery. The descriptive review of literature on innovative mental health programs in India was carried out. The initial search from google scholar and PubMed database yielded 1152 articles, of which 1114 were excluded that did not meet inclusion criteria. Full texts of 38 articles were reviewed and finally 22 studies were included for the study. Based on the review, most innovations are broadly summarized into five categories: (1) quality improvement mental health programs; (2) community-based mental health programs; 3) non-specialist mental health programs, 4) mobile-technology based mental health programs, 5) tele-mental health programs. These promising innovations in treatment and care can be customized as per the context for scale up and integrated into the primary healthcare system through District Mental Health Programme. The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

Reproductive Health Status of Indian Women: A Critical Appraisal

Reproductive health is fundamental to social and economic development of a family, community as well as nation, and a key component of an equitable society. Reproductive health is important for gender equality and women empowerment. Women’s reproductive health status is poor, and their sexual and reproductive rights are not fully raised in many countries, maternal mortality rates are higher, and women’s, chances of dying of pregnancy-related complications are almost 50 times higher in developing countries than in developed countries. Women are particularly vulnerable and also have a lack of knowledge regarding reproductive health in India. Reproductive health is a concept of human rights. Important areas of concern for reproductive health programmes in India are poor quality of reproductive health services especially in an urgent situation; lack of focus of adolescent’s knowledge on reproductive health and lack of education. Women in India and particularly the economically disadvantaged women suffer the highest rates of complications due to pregnancy such as sexually transmitted diseases, and reproductive cancers. Lack of access to comprehensive reproductive care is the main reason, and many women suffer and die. Women are deprived of access to reproductive health care services and are influenced by the socio-economic cultural factors. Which include low social status in family and community, lack of access to economic resource and education, inability to make a decision about their health, nutrition and so on? Reproductive health facilities at the community level are poorly equipped to deal with gynecological and obstetric. Reproductive health is defined as a ‘state of complete physical, mental and social well-being and not merely the absences of disease or infirmity, in all matters relating to the reproductive systems and to its functions and processes’ (United States: 1994). Reproductive health addresses the human sexuality and reproductive processes, functions and system at all stages of life and implies that people are able to have a satisfying and safe sex life and that they have the capacity to reproduce and the freedom to decide, when and how often to do so. The main objectives of this study are; to study the reproductive health situation in an Indian context, to know the problems of women in respective of their reproductive system, the study aims at assessing the reproductive health status of Indian women, and to understand the relationship between reproductive health and gender rights.

Progress in reducing child mortality and stunting in India: an application of the Lives Saved Tool.

The Lives Saved Tool (LiST) has been used to estimate the impact of scaling up intervention coverage on undernutrition and mortality. Evidence for the model is largely based on efficacy trials, raising concerns of applicability to large-scale contexts. We modelled the impact of scaling up health programs in India between 2006 and 2016 and compared estimates to observed changes. Demographics, intervention coverage and nutritional status were obtained from National Family and Health Survey 2005–6 (NFHS-3) for the base year and NHFS-4 2015–16 for the endline. We used the LiST to estimate the impact of changes in coverage of interventions over this decade on child mortality and undernutrition at national and subnational levels and calculated the gap between estimated and observed changes in 2016. At the national level, the LiST estimates are close to the actual values of mortality for children <1 year and <5 years in 2016 (at 41 vs 42.6 and 50 vs 56.4, respectively, per 1000 live births). National estimates for stunting, wasting and anaemia at are also close to the actual values of NFHS-4. At the state level, actual changes were higher than the changes from the LiST projections for both mortality and stunting. The predicted changes using the LiST ranged from 33% to 92% of the actual change. The LiST provided national projections close to, albeit slightly below, actual performance over a decade. Reasons for poorer performance of state-specific projections are unknown; further refinements to the LiST for subnational use would improve the usefulness of the tool.