National Family Health Survey Data Research Articles

Women’s Empowerment and Son Preference: The Case of India

The purpose of this article is to explore the changing patterns of women’s empowerment and son preference at the Indian sub-national level. We have measured the state-level degree of women’s empowerment and son preference for two different periods, that is, 2015–2016 and 2019–2020 using the fourth and fifth rounds state-level National Family Health Survey data. The sample of the study consists of women who can potentially have son preference. The study has examined whether the mean level of women’s empowerment and son preference has changed significantly between the two concerned time periods. The categorisation and cluster analysis of the states is done based on the degree of women’s empowerment and son preference. To explore the degree of association between son preference and women’s empowerment and its indicators, a correlation matrix is formed. No significant increase in the mean level of son preference is found whereas the average value of the degree of women’s empowerment increased significantly in 2019–2020 compared to 2015–2016. Further, the states categorised as having comparatively strong women’s empowerment do not necessarily have a comparatively low level of son preference. No significant association between women’s empowerment and son preference is explored through the correlation matrix as well. Thus, the study leads to the conclusion that son preference in India has no significant association with women’s empowerment.

Anaemia among lactating adolescents (15–19 years) in India: a repeated cross-sectional analysis of the NFHS data (2005–2021)

BackgroundAnaemia continues to be a pressing public health concern in India. Despite the high burden of anaemia among lactating adolescents in the country, research addressing this concern among this population remains scarce. Hence, this study attempted to examine the prevalence and determinants of anaemia among lactating adolescents in India.MethodsWe used data from three latest rounds of the National Family Health Survey (NFHS) carried out in 2005-06, 2015-16, and 2019-21 and analysed a pooled sample of 10,689 lactating adolescents aged 15–19 years from these three rounds. Bivariate statistics was used to analyse the prevalence of anaemia according to the background characteristics of lactating adolescents. Further, binary multivariate logistic regression was carried out to examine the factors associated with anaemia in the study population.ResultsThree in every five lactating adolescents from the pooled sample were found to have anaemia (66.98% in NFHS-3, 61.08% in NFHS-4 and 66.27% in NFHS-5). Lactating adolescents with a higher education had a 30% lower likelihood [adjusted odds ratio (AOR): 0.70, 95% CI: 0.49–1.01, p = 0.050] of being anaemic compared to those with no education. The likelihood of being anaemic among the poorest quintile was 41% (AOR: 1.41, 1.12-1.77; p = 0.003) higher than those from the richest quintile. Lactating adolescents from the Scheduled Tribe category had higher odds (AOR: 1.29, 95% CI: 1.01–1.46, p = 0.001) of anaemia than those categorised as ‘Others’. Those living in rural areas were 22% more likely to suffer from anaemia (AOR: 1.22, 95% CI: 1.00-1.26, p = 0.050) compared to their urban counterparts. Additionally, underweight lactating adolescents were 15% more likely (AOR: 1.15, 95% CI: 1.05–1.26, p = 0.002) to be anaemic than those with normal BMI. Odds of being anaemic were higher among the ones receiving supplementary nutrition during pregnancy (AOR: 1.18, 95% CI: 1.08–1.29, p < 0.001) in contrast to those not receiving.ConclusionThe consistently high prevalence of anemia among lactating adolescents, especially among those with lower education level, rural residence, underweight status, and belonging to ST category and poorest quintile, underscore the urgent need for targeted public health interventions to address and reduce anemia in this population.

Domestic Violence in India- Issues and Challenges

Domestic violence is violence or abusive behaviour which is used by one partner to control another partner in any relationship. Domestic violence can be physical, sexual, emotional, and psychological or any pattern. For example, it may take the form of sexual assault psychological abuse or verbal abuse to anyone. It affects people of all socioeconomic backgrounds and education levels. Domestic violence not only affects those who are abused, but also affects family members, friends, co-workers, other witnesses, and the community at large. According to the National Family Health Survey (NFHS), 2019-2021, 29.3% of married Indian women between the ages of 18 and 49 have experienced domestic or sexual violence in India. That is only the number of cases reported by women, there are frequently many more that never make it to the police. According to NFHS data, 87% of married women are victims of marital violence. The National Commission for Women said in 2020-21, it received 26,513 complaints from women, an increase of 25.09%, compared with the 20,309 complaints registered in 2019-20. The Indian legal system has formed Section 498A of the Indian Penal Code according to the Criminal Law (Second Amendment) Act, 1983 (46 of 1983), especially for dealing with domestic violence. 498A IPC states that “Husband or relative of husband of a woman subjecting her to cruelty. —Whoever, being the husband or the relative of the husband of a woman, subjects such woman to cruelty shall be punished with imprisonment for a term which may extend to three years and shall also be liable to a fine. Sec 498A IPC is cognizable, non-compoundable and non-bail able. Even though the law provides for the security of women, there is a big loophole; a lack of awareness among the victims, most of whom do not know that they have the option to approach the law. In this paper, the researchers have tried to explore the issue and challenges for stopping domestic violence in India.

Self-reported prevalence of tuberculosis: unveiling spatial representation in the districts of Tamil Nadu.

The objective of the current study was to estimate the self-reported individual-level crude prevalence and cluster-level adjusted prevalence of TB for the districts of Tamil Nadu and to understand the spatial distribution of TB cases through spatial autocorrelation and hotspot analysis. National Family Health Survey (NFHS) data, gathered during 2014-2015 (NFHS-4) and 2019-2021 (NFHS-5), were used in the current study to estimate district-wise, individual-level crude and cluster-level adjusted TB prevalence per 100 000 population in Tamil Nadu. This was illustrated with the help of spatial geographic representation for various districts of Tamil Nadu using SPSS and QGIS software. The spatial autocorrelation and hotspot analysis were performed using Geoda software. The overall self-reported individual-level crude prevalence of TB was 337 (95% CI 302 to 375) and 169 (95% CI 144 to 197) per 100 000 population, whereas the cluster-level adjusted prevalence of TB was 356 (95% CI 311 to 405) and 184 (95% CI 154 to 219) per 100 000 population in NFHS-4 and NFHS-5, respectively. This study highlights those geographical areas with high rates of TB prevalence. This information would be useful for the state and district programme managers to identify areas of high TB prevalence where interventions can be focused.

Trends and predictors of severe and moderate anaemia among children aged 6–59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data

BackgroundChildhood anaemia remains a significant public health problem in India, as it adversely affects child development and overall health outcomes. This study aimed to analyse the prevalence of severe and moderate anaemia among children aged 6–59 months and identify consistent predictors of this condition over the past 15 years.MethodsData from the three most recent rounds of the NFHS were used for this analysis. The final weighted sample included 40,331 children from the NFHS-3 (2005–2006), 200,093 from the NFHS-4 (2015–2016), and 178,909 from the NFHS-5 (2019–2021). Descriptive and bivariate analyses were conducted, followed by binary logistic regression to identify factors associated with severe and moderate anaemia in children aged 6–59 months. All statistical analyses were performed using Stata version 14.ResultsOver the past 15 years, the prevalence of severe and moderate anaemia among children in India has shown a slight decline. However, the influence of various predictors has changed over time. Young children (aged 6–23 months), those from Scheduled Caste (SC) and Scheduled Tribe (ST) communities, and children born to mothers with high parity and low educational attainment remain particularly vulnerable to anaemia. Additionally, short-term illness significantly increases the risk of anaemia. Furthermore, women’s autonomy, indicated by higher education and lower fertility rates, along with maternal nutrition education, have emerged as key factors in reducing anaemia burden in the future. Notably, children whose mothers had no education were 1.4 times more likely to suffer from severe or moderate anaemia. Similarly, children born to mothers with four to five children (OR 1.1, p < 0.05) and those with six or more children (OR 1.2, p < 0.05) had an elevated risk of anaemia.ConclusionThe findings highlight three key areas for programmatic focus to accelerate anaemia reduction in India: [1] targeting young children (aged 6–23 months); [2] ensuring the inclusion of SC and ST communities in all relevant interventions; and [3] promoting women’s autonomy. These strategies are essential for reducing the burden of anaemia across the country.

Age at marriage and its determinants in Kerala and Bihar

BackgroundMarriage is a significant milestone in one’s life, and the age at which individuals choose to get married can have various implications. By examining the age at marriage and its determinants in different regions, such as Kerala and Bihar, we can gain insights into Socio-demographic factors that influence this decision.MethodsThe National Family Health Survey (2019–2021) data was used. A total of 41,392 ever married women from Kerala (8, 579) and Bihar (32,813) were analysed using bivariate and multiple binary logistic regression approaches to meet the study aim.ResultThe significant association was found between explanatory factors and age at first marriage in Karala and Bihar. In Bihar, educated women from the poorest families had a higher rate of early marriages. Conversely, in Kerala, uneducated women from non-majority religions and larger households (more than 6 members) were more likely to be married before18. After accounting major effects of background characteristics, the adjusted odds ratio showed that In Kerala Muslim religion women have significantly higher odds of getting married before 18 (OR: 3.09, CI 2.67–3.57) then the Hindu women whereas in Bihar Muslim religion women has the significantly lower chance of getting married before turning 18 (OR: 0.87, CI 0.81–0.93) compared to Hindu. In both the states Kerala and Bihar General social group women had the significantly lower odds of getting married below 18 (OR: 0.73, CI 0.57–0.93 and OR: 0.88, CI 0.81–0.96) with respect to SC/ST social group women’s.ConclusionWomen in Bihar usually marry in younger age due to socioeconomic and traditional reasons, whereas in Kerala reverse is true, because of a greater emphasis on education and a more progressive social outlook. These regional variations reflect different cultural norms and socioeconomic environments, shape different marriage age patterns between the two regions.

Patterns and Predictors of Educational Hypogamy in India

Educational hypogamy among women is inadequately explored in the Indian context. Based on National Family Health Survey (2019–21) data, this study elucidates the pattern and predictors of educational hypogamy and the role of caste in determining educational hypogamy in the country. Binary logistic regression and ordered logistic regression were applied using Stata. Fifteen percent of the women were in educationally hypogamous marriages, and there was an upward trend in its prevalence. The main determinants of educational hypogamy were lower age at marriage, backward caste, Hindu religion, rural residence, the educational achievement level of the bride, and higher age difference with the husband. Moreover, within educational hypogamy, caste hypergamy was preferred, primarily by socially backward groups.

Risk and protective factors of miscarriage: Evidence from a nationally representative sample of women in India.

Miscarriage is the most distressing complication in early pregnancy, with one in every five pregnant women ending in a miscarriage, and its causes are multifactorial. This study aimed to find the risk and protective factors of miscarriage among women aged 15-49 years in India by using the National Family Health Survey (NFHS-5) data. The data were taken from NFHS-5; 53,560 women aged 15-49 years who had reported either a miscarriage (n = 5104) or livebirth (n = 48,456) during the last 12 months preceding the survey were included in the study. Various sociodemographic, lifestyle, comorbid, and fertility-related factors were considered in the Poisson regression analysis, and adjusted prevalence ratios were obtained. Significant sociodemographic risk factors were age less than 20 years or more than 34 years, urban residence, primary and higher education levels, wealth index middle and above, and occupation as employed. Muslim religion, Scheduled Tribe, and Other Backward Class castes were statistically significant protective factors. Obesity, severe anemia, hypertension, and thyroid disorder were the significant comorbid risk factors, whereas tobacco chewing was the only significant lifestyle risk factor. A higher number of ever-born children was the fertility-related risk factor, whereas the use of intrauterine devices was a significant protective factor for miscarriage. To reduce the incidence of miscarriage in developing countries like India, the respective governments and healthcare providers should develop intervention programs targeting women in well-educated and high-income families.

Prevalence and sociodemographic factors associated with double burden of malnutrition among children under 5: a cross-sectional analysis of NFHS-4 data in India

BackgroundThe double burden of malnutrition (DBM), characterised by the coexistence of undernutrition and overnutrition, poses a significant public health challenge, particularly in low- and middle-income countries. India, being one of...

Penalized estimation in parametric frailty model

Frailty model examines the effect of observable and non-observable factors on time to event data. Presence of collinearity produces unstable estimates of parameters. Therefore, this research focus on the penalized estimation of frailty model and proposed the new estimator which is the extension of ridge and principal component estimators. Simulation is run to reveal the performance of proposed estimator. Moreover, the technique is applied on NFHS (National Family Health Survey) data to examine the infant mortality in India.

Health impact evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

The Aspirational District Program (ADP) is a unique initiative of Government of India launched in 2018 that aims to reduce inter-district multidimensional inequality. ADP aims to bring the least developed districts to catch up with the rest of the other districts in the country. The program is comprehensive in its scope as it targets improvement of several key development indicators spanning health and nutrition, education, agriculture and water resources, financial inclusion and skill development and basic infrastructure indicators. Aspirational districts (ADs) are eligible for enhanced funding and priority allocation of various initiatives undertaken by the central and the state governments. Our research estimates the causal impact of ADP on the targeted health and nutrition indicators using a combination of propensity score matching and difference-in-differences (PSM-DID). We use the fourth and fifth rounds of National Family Health Survey (NFHS) data collected in 2015–16 and 2019–21 respectively which serve as the pre and post-treatment data for our analysis. Moreover, we take advantage of the transparent mechanism outlined for the identification of ADs under ADP, which we use for propensity score matching for our PSM-DID. While we observe negative impact of ADP on early initiation of breastfeeding, we believe that the impact is confounded with the effects of Covid-19 since part of NFHS-5 data was collected during the pandemic. However, the negative impact of ADP on early initiation of breastfeeding disappears when we only use pre-covid data (i.e. data for districts from states surveyed before the pandemic). Additionally, using pre-covid data we find a reduction in the prevalence of underweight children younger than 5 years to an extent of 2 to 4 percentage points in ADs as an impact of ADP, which is robust across multiple specification. We do not find evidence of a positive or a negative impact of ADP on any other health and nutrition indicators. Future research efforts should be made towards impact evaluation of all the targeted indicators in order to get a comprehensive unbiased evaluation of ADP.

Analysis of anthropometric outcomes in Indian children during the COVID-19 pandemic using National Family Health Survey data

BackgroundDisruptions in food, health, and economic systems during the COVID-19 pandemic may have adversely affected child health. There is currently limited research on the potential effects of the COVID-19 pandemic on stunting, wasting, and underweight status of young children.MethodsWe examine the short-term associations between the pandemic and anthropometric outcomes of under-5 children (n = 232,920) in India, using data from the National Family Health Survey (2019–2021). Children surveyed after March 2020 are considered as the post-COVID group, while those surveyed earlier are considered as pre-COVID. Potential biases arising from differences in socioeconomic characteristics of the two groups are mitigated using propensity score matching methods.ResultsPost-COVID children surveyed in 2020 and 2021 have 1.2% higher underweight rates, 1.2% lower wasting rates, 0.1 lower height-for-age z-scores (HAZ), and 0.04 lower weight-for-height z-scores as compared with matched pre-COVID children. Post-COVID children surveyed in 2020 have 1.6%, 4.6%, and 2.4% higher stunting, underweight, and wasting rates, respectively, and 0.07 lower HAZ, as compared with matched pre-COVID children. Reductions in nutritional status are largest among children from households in the poorest wealth quintiles.ConclusionsThese findings indicate a trend towards a recovery in child anthropometric outcomes in 2021 after the initial post-pandemic reductions. The resilience of health and food systems to shocks such as COVID-19 should be strengthened while immediate investments are required to decrease child malnutrition and improve broader child health outcomes.

Deconstructing the sex gap in child undernutrition in India: Are Indian boys at elevated risk of anthropometric failure than the girls?

The privileging of boys in immunization coverage, breastfeeding, and other child care practices in Indian patriarchal society raises questions about whether there are sex differences in the prevalence of undernutrition among children. This study evaluates the sex gap in the prevalence of Composite Index of Anthropometric Failure (CIAF) among Indian children from 2015-16 to 2019-21. Additionally, it seeks to identify the sex-specific determinants and persistent sex gap at national and subnational levels (social, economic, religious, and geopolitical regions) in anthropometric failure among the children from 2015-16 to 2019-21. The study utilizes the 4th (2015-16) and 5th (2019-21) rounds of the National Family Health Survey data. Logistic regression models and the Fairlie decomposition technique were employed to explore the persistent and significant sex gap in the prevalence of CIAF, as well as the sex-specific determinants of CIAF among children in 2015-16 and 2019-21. The study reveals a significant sex gap (approximately 4%-points), with boy's disadvantage in the prevalence of CIAF from 2015-16 to 2019-21 at both the national and subnational levels (social, religious, socioeconomic groups, and geopolitical regions). The gap is more pronounced in the first year of life and decreases in later stages. A comparatively faster CIAF decline among girls from 2016 to 2021 has widened the sex gap in final year than the previous. Child, mother, household, community, and geographic backgrounds explains about 5%-6% of the sex gap in the prevalence of CIAF from 2015-16 to 2019-21. The remaining 94%-95% of the unexplained sex gap may be attributed to biological factors or other factors. Currently, a heightened boy's disadvantage in CIAF risk is observed in ST community, wealthiest families, and the northern India. The findings suggest a special attention for boys under 3 years to offset biological disadvantages like greater disease sensitivity and fragility compared to girls early on.

IJCM_86A: Assessment of Breastfeeding practices in a Tribal District of Maharashtra: A Cross-sectional study.

Background: As the WHO aptly puts it, breastfeeding is the cornerstone of child survival, nutrition and development, as well as maternal health. However, contrary to the WHO recommendations, fewer than half of infants under 6 months of age are exclusively breastfed (1) According to the National Family Health Survey data of India, only 71% of children under 6 months are exclusively breastfed in Maharashtra. (2) This may be seen more in the tribal communities due to their geographical location and strong cultural norms. This study aims to assess the breastfeeding practices that are prevalent in a tribal district. Objectives: 1) To estimate the prevalence of exclusive breastfeeding in the tribal population. 2) To determine the factors associated with exclusive breastfeeding in the tribal population. Methodology: This is a community based cross-sectional observational research project. The study population is mothers belonging to the Scheduled Tribes Category with infant in the age group of 6 months to 1 year. 161 women were selected by simple random sampling using a random number table. A structured interview schedule was used to conduct the interviews. Data was analysed using appropriate statistical test. Results: The overall prevalence of exclusive breastfeeding is 63%. 72.7% of mothers belonging to the Warli tribe and 91% of mothers of the age under 20 years followed the recommended exclusive breastfeeding. Even the place of delivery of the child was found to be significantly associated with the exclusive breastfeeding. Conclusion: The prevalence of breastfeeding in the tribal population is less than the overall prevalence of the entire state. More efforts are needed to create awareness about the concept and the benefits of exclusive breastfeeding.

Prevalence and determinants of gestational diabetes mellitus among pregnant women in India: an analysis of National Family Health Survey Data

BackgroundGestational diabetes mellitus (GDM) is a type of diabetes with its first recognition during pregnancy. GDM is a high-risk maternal and neonatal condition which increases the risk of Type 2 diabetes in mothers and their infants. It is essential to detect and treat GDM since its inception when mothers suffer from Type 1 diabetes while carrying the foetus during the gestational period.MethodsThe study analysed individual data from the National Family Health Survey (NFHS) surveyed in 2015–2016 (4th round) and 2019–2021 (5th round) covering a total of approximately 6 lakhs and 7 lakhs women, respectively. Among them, 32,072 women in 2015–2016 and 28,187 in 2019–2021 were pregnant, of whom 180 women in 2014–2015 and 247 women in 2019–2021 had diabetes during their gestational periods, allowing the percentage prevalence calculation of GDM. The analysis of Poisson regression estimates examined the socioeconomic and demographic risk factors for GDM among pregnant women.ResultsThe overall prevalence of GDM in women showed an increase from 0.53% in 2015–16 to 0.80% in 2019–20 at the national level, and a similar increase in many states of India was witnessed, with a few exceptions. The GDM prevalence has shown a gradient over age, with a low prevalence in 15–19- and 25–29-year-olds and the highest prevalence in 40–44-year-olds. Concerning the rural and urban divide, its prevalence in both urban and rural areas has increased from 0.61 to 0.85% and 0.51 to 0.78% between 2015 and 16 and 2019–21. The results of the Poisson regression analysis reveal that older adults with high Body Mass Index (BMI), thyroid disorder, and heart disease have a greater risk of GDM among pregnant women in India. The states of Kerala, Meghalaya, and Goa show a high prevalence of GDM.ConclusionThe low prevalence of GDM may not be clinically significant but has negative repercussions on the mother and her child cannot be overlooked. Thus, it is essential to curb GDM since its inception and save a generation ahead from the risk of diabetes and other diseases.

Does Public Spending Reflect the Need for Health: A Cross-sectional Analysis at District Level in India.

There is mixed evidence on the extent of association between the allocation of public revenue for healthcare and its indicators of need. In this study, we examined the relationship between allocations through state health financing (SHF) and the Central Government with infant mortality. District-wise infant mortality rate (IMR) was computed using National Family Health Survey-4 data. State-wise data for health budgets through SHF and National Health Mission (NHM, a Centrally Sponsored Scheme), were obtained for the year 2015-16. We used a multivariable analysis through generalized linear model method using identity-link function. We found per capita SHF (₹3169) to be more than 12 times that of public health spending per capita through NHM (₹261). IMR was lower in districts with higher SHF allocation, although statistically insignificant. The allocation through NHM was higher in districts with higher IMR, which is statistically significant. Every unit percentage increase in per capita net state domestic product and female literacy led to 0.31% and 0.54% decline, while a 1% increase in under-five diarrhoea prevalence led to 0.17% increase in IMR. The NHM has contributed to enhancing vertical equity in health-care financing. The States' need to be more responsive to the differences in districts while allocating health-care resources. There needs to be a focus on spending on social determinants, which should be the cornerstone for any universal health coverage strategy.

Oral rehydration therapy and Zinc treatment among diarrhoeal children in India: Exploration from latest cross-sectional National Family Health Survey.

Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24-35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains.

Trends and Causes of Increasing Child Anaemia: Secondary Analysis of NFHS 5 Data- India

National Family Health Survey (NFHS) data of 2019-2020 indicates that prevalence of anaemia among children aged 6-59 months is 67.1%, while among women aged 15-49 years, it is 57%. These figures highlight the significant burden of anaemia in India. This number has increased from 2015-16 to 2019-21. The cause of anaemia can be attributed to two main factors: autonomous factors and induced factors. Furthermore, there are considerable regional disparities in child anaemia within India. The southern part of the country exhibits a lower prevalence of malnutrition in comparison to the northern part. The statistical analysis of 707 districts of India reveals that child malnutrition is influenced by socio-economic, nutritional, and health-related factors. The incidence of anaemia can be passed on to her offspring. While certain socio-economic factors may overlap in both cases, the underlying causes of anaemia differ significantly. This paper provides a comprehensive review of anaemia of children and mothers, covering prevalence, causes, consequences, diagnosis, management, and challenges in prevention. The result suggests for district level policy and targeted interventions to address this critical public health issue.

High ambient air pollution erodes the benefits of using clean cooking fuel in preventing low birth weight in India

A large fraction of the population in rural India continues to use biomass fuel for cooking and heating. In-utero exposure to the resulting household air pollution (HAP), is known to increase the risk of low birth weight (LBW). Mitigating HAP, by shifting to clean cooking fuel (CCF), is expected to minimize the risk associated with LBW. However, India also has high levels of ambient air pollution (AAP). Whether exposure to AAP modifies the effect of reducing HAP by switching to CCF on LBW is not known. The present study addressed this knowledge gap by analyzing the National Family Health Survey (2019–21) data of the most recent full-term, singleton, live births from rural households born after 2017 (n = 56 000). In-utero exposure to AAP was calculated from satellite-derived ambient fine particulate matter (PM2.5) concentration at the level of the primary sampling unit for the pregnancy duration of the mothers. The moderation by ambient PM2.5 level on the odds of LBW among CCF users was examined by logistic regression analysis with interaction. The adjusted odds ratio (aOR) of LBW was 7% lower among users of CCF. At the lowest Decile (20–37 μg m−3) of ambient PM2.5 exposure, the aOR of LBW among CCF users was 0.83 (95% CI:0.81–0.85). At every 10th percentile increase in ambient PM2.5 exposure (in the range 21–144 μg m−3), aOR increased gradually, reaching the value of 1 at PM2.5 level of 93 μg m−3. Our results, therefore, suggest that the benefit of using CCF during pregnancy may be downgraded by moderate to high ambient PM2.5 exposure.

Association of Intimate Partner Violence and Nutritional Status of Women (aged 15-49 years) in West Bengal, India

Background: Violence against women- especially Intimate Partner Violence (IPV) and sexual violence is one of the major public health problems in both developing and developed countries. The aim of the present study was to investigate IPV and nutritional status of women ages 15-49 years in West Bengal, India. Methods: We used National Family Health Survey data, 2015-2016 of West Bengal, India. 1981 sample was used for the present study. Nutritional status was measured by Body Mass Index (BMI) and anemia. IPV included physical, emotional and sexual violence with or without controlled behavior. Other socio economic and demographic factors like educational attainments, age of the respondent, occupation, caste, religion, wealth index, residential pattern etc. were considered in this study for possible predictors of IPV. Results: The study revealed that prevalence of underweight and anemia among women in West Bengal, India was 20% and 20.1% respectively. More prevalence of underweight and anemia were observed among women who were exposed to physical, emotional and sexual violence by their intimate partner. Though we did not find any significant association of IPV and nutritional status, however a significant association was found between educational attainment and IPV. Study revealed that chances of underweight and anemia among women decreased with increased educational level of women. Respondents belonging in rich family were more likely to have better health status among women in West Bengal. No significant association was found between anemic status of women and their age, educational attainment and occupation. However, logistic regression model demonstrated that Muslim and other women were more likely to have anemia than Hindu women. Conclusion: The study concluded that IPV played an important role in increasing likelihood of women’s nutritional and anemic status. The study also showed that some socio-economic and demographic factors were predictors of women’s nutritional and anemic status. Our findings can help government and NGOs for taking health policy to improve the health status of women aged 15-49 years.