National Family Health Survey Research Articles

Determinants of household choice of cooking fuel in India: evidence from National Family Health Survey 5

Determinants of household choice of cooking fuel in India: evidence from National Family Health Survey 5

Examining the access to benefits and quality sterilization services among Muslim women in India

BackgroundThis research article examines the efficiency with which the Indian family planning programme provides care to Muslim women who opt to undergo tubectomies from public health facilities in terms of access to benefits/compensation as well as quality of services. The research subsequently intends to suggest suitable policies of affirmative action if required.MethodsThe research uses data from the women’s file from the latest round of the National Family Health Survey (NFHS-5, 2019–21). Adjusted odds ratios are used to examine the likelihood of Muslim women (i) receiving compensations offered for undergoing tubectomies in public health facilities by the government, (ii) receiving comprehensive information prior to their tubectomies and (iii) reporting a good quality of care during their procedures, in comparison with non-Muslim women.ResultsThe findings from the research indicate that Muslim women in India have lower odds of receiving state sponsored compensations in comparison with non-Muslim women in India (AOR = 0.67; CI: 0.60—0.76). Consequently, a lesser proportion of Muslim women reported receiving compensations in comparison with non-Muslim women. The difference in the receipt of compensations was 18 percentage points between both cohorts. Critically, despite their challenges in obtaining compensations, the findings from this research also indicate how Muslim women in India have higher odds of receiving comprehensive family planning information prior to their operation in comparison with non-Muslim women (AOR = 1.15; CI: 1.02—1.29).DiscussionGiven the existing dearth of evidence in family planning literature on the issue, this research article calls for greater attention and investments in understanding the reproductive health vulnerabilities of Indian Muslims, especially in the context of increasing social hostilities towards the community in India. In this regard, to promote the equitable delivery of family planning services, the findings from this research highlight the urgent need for institutional reforms that facilitate an easier access to public benefits among Indian Muslims.

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

ABSTRACT Context: 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. Aim: 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. Methods and Material: 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. Statistical Analysis Used: Various sociodemographic, lifestyle, comorbid, and fertility-related factors were considered in the Poisson regression analysis, and adjusted prevalence ratios were obtained. Results: 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. Conclusions: 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.

Minimum Dietary Diversity is Associated with Lower Risk of Childhood Underweight: Evidence from the 2019/21 National Family Health Survey of India

A lack of consumption of a diversified diet is associated with poor physical and cognitive development in children, with a negative long-term impact on their educational achievements and productivity. Evidence on the relationship between minimum dietary diversity (MDD) and childhood malnutrition remains inconclusive in India. We hypothesized that children aged 6–23 months on a diversified diet (five out of eight defined foods and beverages) are less likely to be malnourished (stunting, wasting, and underweight) compared to their counterparts who are not on a diversified diet. This cross-sectional study was based on the 2019-21 National Family Health Survey (NFHS) of India, comprising a weighted sample of 57,714 children aged 6–23 months. MDD was defined as a child consuming five or more food categories (MDD ≥ 5) out of the eight food groups recommended by the WHO's Guideline for Infant and Young Children aged 6-23 months on the previous day. Multilevel logistic regression was used to examine the association between dietary diversity and childhood stunting, wasting, and underweight. The results showed a significant protective effect of dietary diversity on underweight (OR = 0.91; 95% CI: 0.86–0.96). In addition, children who did not consume eggs (OR = 1.09; 95% CI; 1.03–1.15), dairy products (OR = 1.22; 95% CI: 1.17–1.27), or fruits and vegetables (OR = 1.11; 95% CI: 1.06–1.17) were more likely to be underweight than children who did. Children who did not consume dairy products, fruits and vegetables were also more likely to be stunted and wasted. However, we did not find significant associations of MDD with wasting and stunting. This study highlighted the need for nutritional interventions that promote daily consumption of dairy products, eggs, fruit, and vegetables to address the growing problem of childhood malnutrition in India. Regions with higher rates of malnutrition and those lacking MDD, such as Uttar Pradesh and Rajasthan, should be prioritized.

From data to decisions: Exploring family planning services utilization in Karnataka and India through the prism of NFHS-4 and NFHS-5

ABSTRACT Background: Family planning (FP) services are pivotal in assessing a country’s healthcare efficacy. Despite India’s strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka’s FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages. Methods: A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015–16) and NFHS-5 (2019–21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods. Results: Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25–29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers’ engagement with female non-users and in providing information on contraceptive side effects. Conclusion: While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.

Understanding period product use among young women in rural and urban India from a geospatial perspective

Ensuring proper menstrual hygiene management remains a significant challenge for young women in India. The term "exclusive use of hygienic period products during menstruation" refers to relying solely on period products like sanitary pads, tampons, or menstrual cups. Poor menstrual hygiene practices not only increase the risk of reproductive tract infections but also lead to various negative health outcomes, including discomfort and potential complications. This study explores factors associated with the exclusive use of period products during menstruation aged 15–24, investigates geographic disparities, examines rural–urban gaps, and assesses inequality in India. Utilizing data from the fifth National Family Health Survey (NFHS-5), responses from 2,41,180 women aged 15 to 24 were analysed using logistic regression and multivariate decomposition analyses to explore socioeconomic predictors. Moran's I statistics also assessed spatial dependency, while Lorenz curves and Gini coefficients measured inequality. Quintile and LISA maps visualized regional disparities. The study found that 76.15% of women in India reported exclusive use of hygienic period products during menstruation. Rural areas reported a lower percentage of exclusive use of hygienic period products (72.32%) during menstruation compared to urban areas (89.37%). Key factors associated with the exclusive use of hygienic period products among 15–24-year-old women in India include age, education, place of residence, wealth, access to media, and healthcare discussions. Geographically, central districts exhibited the lowest coverage (< 65%), while the Southern region reported the highest (> 85). The GINI coefficient of 0.39 highlighted moderate inequality in distribution. Decomposition analysis revealed that household wealth contributed 49.25% to rural–urban differences, followed by education (13.41%), media access (7.97%), and region (4.97%). This study highlights significant regional disparities and low utilization of hygienic period products among young women in India, particularly in central districts. Policymakers should prioritize interventions targeting these regions, addressing socio-economic disparities. Strategies to promote education, improve media access, and enhance household wealth can facilitate menstrual hygiene adoption. Initiatives to reduce sanitary napkin costs and increase accessibility, particularly in rural areas, are crucial to mitigating geographical disparities nationwide.

Health and Nutritional Status of Women in Sant Kabir Nagar, District of Uttar Pradesh: Deviation from State

This study investigates the health and nutritional status of women in Sant Kabir Nagar, Uttar Pradesh, and offers a comparative analysis with broader trends observed across the state. The research addresses significant issues related to women's health, including malnutrition, anemia, and access to delivery care services. Utilizing data from the National Family Health Survey (NFHS-5) this study explores how far the women of the district stand from state level in terms of women’s health and nutritional status. By comparing the district-specific data of Sant Kabir Nagar with state level, the study aims to identify disparities among health and nutritional status of women. The findings provide insights into regional health disparities and inform potential policy interventions to improve women's health and nutrition in both Sant Kabir Nagar and Uttar Pradesh as a whole.

The impact of health insurance on hypertension care: a household fixed effects study in India

IntroductionHypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care.MethodsWe used secondary data from the nationally representative sample of adults aged 15–49 years from the 2015–2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables.ResultsIn all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93–1.02), 0.97 (0.91–1.03), 0.95 (0.77–1.30), and 0.97 (0.65–1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings.ConclusionsHealth insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.

Beyond the biological prime: Deciphering the link between child survival and maternal age in India

This paper investigates the impact of maternal age at birth on child mortality in India, the world's most populous country burdened with significant neonatal and infant mortality. Utilizing data from the latest National Family Health Surveys, covering around 1 million children, our analysis incorporates models with household and biological-mother fixed-effects to address unobserved heterogeneity. Outcomes include neonatal mortality (<28 days), infant mortality (<12 months), and under-5 mortality. Findings reveal a U-shaped relationship between maternal age and child mortality, with the highest risk for mothers below 17 and above 40 years old. Robustness checks confirm the enduring significance of maternal age even after adjusting for socioeconomic factors and time-variant unobservables. Moreover, models with biological-mother fixed-effects suggest higher risks compared to models that only control for observables, indicating that regressions without controls for time-invariant heterogeneity may underestimate the risks of maternal age at birth.

Prevalence and Predictors of Domestic Violence in India: Complex Sample Analysis of a Nationally Representative Study Conducted Between 2019 and 2021.

Violence against women has been one of the dreaded social evils that humanity is facing. There have been concerted efforts to eliminate this evil, and sustainable development goals goal 5.2.1 gave it a timeline. The current study was carried out to estimate the burden of domestic violence (DV) against women and to investigate the sociodemographic correlates of DV victims in India. Data were drawn from the fifth National Family Health Survey round. According to Demographic Health Survey guidelines, DV is measured using a 13-item questionnaire in the women's survey. Complex sample analysis was done using a primary sampling unit, sample weight, and stratification variables to estimate the weighted prevalence. Chi-square and multivariate logistic regression determine the unadjusted and adjusted odds ratio. The analysis is carried out using SPSS version 26 (IBM Corp., Armonk, NY). The weighted prevalence of DV against women in India in 2019-2021 was 31.2%. Approximately 28.5%, 13.1%, and 5.7% of women reported experiences of physical, emotional, and sexual violence, respectively. Karnataka was the worst affected state, with 47.3% of women facing DV. Individual factors like education and occupation, household factors like husband'seducation, occupation, drinking habit, wealth index, and community-level factors like caste, religion, and place of residence were significant predictors of DV. Lower levels of education and lower socioeconomic status were essential predictors of DV. The importance of education for both females and males has repeatedly been directly associated with DV, but the interventions have failed to improve the situation and warranta new strategy. Awareness about the legal consequences of DV in lower socioeconomic classes also has the potential to cut down the numbers. Further research into the causality can improve the planning for better intervention modalities.

Examining geographic variation in the prevalence of household drainage types across India in 2019-2021

The proportion of Indian households with access to a toilet has grown considerably over the past decade. Many of these toilets rely on on-site containment, either in the form of a septic tank or soak pit. If the waste from these containers is not removed using some type of mechanized method, it can overflow into drains before flowing into treatment facilities or being discharged into water bodies. Therefore, drains are a critical part of the sanitation chain. What remains unknown, however, is what types of drains are available to households in India. Understanding this is critical given that people are at a greater risk of ingesting contaminated water and making dermal contact with pathogens if waste flows in open drains. For the first time, India’s National Family Health Survey from 2019–2021 contains data on the type of drainage available to households. Thus, the purpose of this paper is to estimate the prevalence of households relying on no drainage, open drainage, drains to soak pits, and closed drainage. We also estimate these prevalence values for each of India’s 720 districts and by urban/rural communities to understand the geographic clustering of drainage types throughout India. Overall, we found that the most common drainage type was open drains (37.5% | 95% CI: 37.3–37.6), followed by closed drains (33.9% | 95% CI: 33.7–34.0). The household prevalence of open drainage was above 42% in more than half of India’s 720 districts. Similarly, the household prevalence of closed drainage was below 24% in more than half of India’s 720 districts. We also found that open drains were more common in rural communities, while closed drains were more common in urban communities. We also found a socioeconomic gradient in terms of drainage types, with those lower on the socioeconomic spectrum more likely to have open drains or no drainage. Our results underscore the need to both geographically and socioeconomically target interventions that ensure households have access to adequate drainage. Doing so is vital to remove contamination from the environment as a means of preventing morbidity.

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.

Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey.

Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India's National Family Health Survey Fifth Round (2019-2021). The prevalence of hypertension among 204,054 older adolescents (15-19 years) was 5.08% (95% CI: 4.94-5.23%) wherein 42.26% (95% CI: 40.69-43.64%) were aware of their condition, 43.70% (95% CI: 41.73-45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83-87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.

Socioeconomic inequality in child health outcomes in India: analyzing trends between 1993 and 2021

BackgroundThe health of India’s children has improved over the past thirty years. Rates of morbidity and anthropometric failure have decreased. What remains unknown, however, is how those patterns have changed when examined by socioeconomic status. We examine changes in 11 indicators of child health by household wealth and maternal education between 1993 and 2021 to fill this critical gap in knowledge. Doing so could lead to policies that better target the most vulnerable children.MethodsWe used data from five rounds of India’s National Family Health Survey conducted in 1993, 1999, 2006, 2016, and 2021 for this repeated cross-sectional analysis. We studied mother-reported cases of acute respiratory illness and diarrhea, hemoglobin measurements for anemia, and height and weight measurements for anthropometric failure. We examined how the prevalence rates of each outcome changed between 1993 and 2021 by household wealth and maternal education. We repeated this analysis for urban and rural communities. ResultsThe socioeconomic gradient in 11 indicators of child health flattened between 1993 and 2021. This was in large part due to large reductions in the prevalence among children in the lowest socioeconomic groups. For most outcomes, the largest reductions occurred before 2016. Yet as of 2021, except for mild anemia, outcome prevalence remained the highest among children in the lowest socioeconomic groups. Furthermore, we show that increases in the prevalence of stunting and wasting between 2016 and 2021 are largely driven by increases in the severe forms of these outcomes among children in the highest socioeconomic groups. This finding underscores the importance of examining child health outcomes by severity.ConclusionsDespite substantial reductions in the socioeconomic gradient in 11 indicators of child health between 1993 and 2021, outcome prevalence remained the highest among children in the lowest socioeconomic groups in most cases. Thus, our findings emphasize the need for a continued focus on India’s most vulnerable children.

Determinants of childhood anaemia in India from 2005 to 2021: insights from the last three rounds of India National Family Health Surveys

Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning, and performance at work. This paper used data from India National Family Health Surveys (INFHS) carried out in 2005-06, 2015-16 and 2019-21 to identify the factors associated with childhood anaemia among children, adjusting for a range of covariates. In NFHS rounds of 3 and 4 after adjusting for standard covariates, in the probit model, it was found according to marginal effects, the probability of children being anaemic in urban areas is lower. Those belonging to the scheduled tribes have a higher probability of being anaemic in the two survey rounds of NFHS-3 and NFHS-4. Literate mothers were found to have a lower probability of anaemia in their children. In NFHS-5, in the binary logit model after adjusting for standard covariates, it was found that those belonging to the scheduled tribes were 1.348 times more likely to be anaemic compared to the scheduled castes. Maternal education was another significant factor determining the likelihood of being anaemic. Literate mothers were less likely to have anaemic children. This study provides crucial insights into the dynamic nature of childhood anaemia in India, utilizing data from three decades of NFHS surveys. It highlights the need for comprehensive interventions addressing socio-economic determinants, education of women, and behaviour change interventions to mitigate the burden of childhood anaemia in India.

Unwanted Family Planning Including Unwanted Sterilization: Preliminary Prevalence Estimates for India.

Estimates of unwanted family planning (UFP), which are based on a desire to have a child in the next nine months among current contraceptive users, exclude women who are sterilized since these women are not asked about their fertility preferences; all sterilized women are assumed to have a "met need" for family planning. However, the India National Family Health Survey asks sterilized women if they regret being sterilized and whether they were told that the operation would result in their permanent inability to have children. We extend the concept of UFP by classifying sterilized women who express regret or who were not informed about the procedure's permanence, as having UFP. When limiting our analysis of UFP to nonsterilized contraceptive users, we find that 0.9 percent of Indian women had UFP in 2019-2021. In this period, 29.9 percent of Indian women were sterilized. We estimate that 4.9 percent of sterilized women express regret and 16.3 percent were not told of the procedure's permanence. Adding sterilized women who express regret raises our UFP estimate in India to 2.3 percent, while also including sterilized women who were not told about the procedure's permanence yields an overall UFP estimate of 6.9 percent in India.

A comprehensive health index for India: development, validation, and spatial variation

This paper presents the development, testing, and spatial variation of an innovative India Health Index. Unlike previous approaches that focused on specific health aspects (e.g., health resources, child health, or health coverage), our index takes a comprehensive and multi-dimensional approach. It covers indicators across various life stages: child, adolescent, and adult. It encompasses six domains influencing health: socio-cultural factors, health status, health determinants (both risk and protective factors), household environment, and health system and policy. We used data from the latest round of the National Family Health Survey and employed Principal Component Analysis for constructing the India Health Index. Subsequent statistical tests confirmed its internal reliability and construct validity. External validity was indicated by its association with under-five mortality rates, and the sub-national human development index for India. Spatial analyses revealed significant inter-district and inter-state variation in India Health Index scores. The findings underscore the utility of the India Health Index as a measurement tool and its potential for tracking progress and policy intervention for improving health equity in India.

Effectiveness of "SAFAL MATRUTV GATS" (Stunting alleviation by facilitation of antenatal-postnatal-interventions for low birth weight reduction) - A peer-led self-empowerment group at rural villages in Eastern Maharashtra: Protocol for a pragmatic cluster randomized controlled trial.

Stunting or chronic malnutrition has been one of the major challenges to mankind for ages. The trends from the National Family Health surveys are more or less stagnant with a huge failure of the public health systems to tackle the problem of malnutrition. Innovative approaches are needed to tackle malnutrition. This pragmatic cluster randomized controlled trial (CTRI registration no. Trial REF/2023/08/071521) is planned to assess the effectiveness of a multifaceted antenatal and postnatal health educational intervention package implemented from the first trimester of pregnancy up to one year of infant age in reducing the rates of Low Birth Weight and improving the maternal-infant growth and developmental indicators in a cohort of rural pregnant women as compared to existing standards of care. Implication - The study emphasizes the importance of an ongoing continuum of care during the first 1000 days for effective birth weight, preventing malnutrition, and fostering infant growth and development as its programmatic pathway to impact. We anticipate that the intervention will complement the existing health programs and will be implemented through the grassroot-level workers along with a community peer named "Safalta Tai" enabling community ownership of the intervention. It also has a robust inbuilt monitoring and evaluation system through participatory action research for making it scalable and sustainable beyond the implementation period. The program leverages on the existing goverment programs like the poshan abhiyaan and the digital health mission. It has the potential to be incorporated in the exsiting health infrastructure without any additional resources and scaled up if found effective in reduction of low birth weight which is an important determinant of stunting in under five children.

Decoding India's Child Malnutrition Puzzle: A Multivariable Analysis Using a Composite Index.

This study examines the levels and predictors of malnutrition in Indian children under 5 years of age. Composite Index of Anthropometric Failure was applied to data from the India National Family Health Survey 2019-2021. A multivariable logistic regression model was used to assess the predictors. 52.59% of children experienced anthropometric failure. Child predictors of lower malnutrition risk included female gender (adjusted odds ratio (AOR) = 0.881) and average or large size at birth (AOR = 0.729 and 0.715, respectively, compared to small size). Higher birth order increased malnutrition odds (2nd-4th: AOR = 1.211; 5th or higher: AOR = 1.449) compared to firstborn. Maternal predictors of lower malnutrition risk included age 20-34 years (AOR = 0.806), age 35-49 years (AOR = 0.714) compared to 15-19 years, normal BMI (AOR = 0.752), overweight and obese BMI (AOR = 0.504) compared to underweight, and secondary or higher education vs. no education (AOR = 0.865). Maternal predictors of higher malnutrition risk included severe anemia vs. no anemia (AOR = 1.232). Protective socioeconomic factors included middle (AOR = 0.903) and rich wealth index (AOR = 0.717) compared to poor, and toilet access (AOR = 0.803). Children's malnutrition risk also declined with paternal education (primary: AOR = 0.901; secondary or higher: AOR = 0.822) vs. no education. Conversely, malnutrition risk increased with Hindu (AOR = 1.258) or Islam religion (AOR = 1.369) vs. other religions. Child malnutrition remains a critical issue in India, necessitating concerted efforts from both private and public sectors. A 'Health in All Policies' approach should guide public health leadership in influencing policies that impact children's nutritional status.

Levels, Trends and Determinants of Tobacco Quitting Behaviour in India: Findings from Two Consecutive Nationally Representative Surveys

Abstract Introduction: Quitting tobacco use is known to decrease mortality by 90% if successfully achieved before middle age. This analysis was conducted to assess the levels, trends and determinants of tobacco quitting behaviour amongst the Indian population. Materials and Methods: This was secondary data analysis of the National Family Health Survey (NFHS)-4 (2015–2016) and NFHS-5 (2019–2020) of India. Results: A rising trend (4%) in intention to quit tobacco was observed amongst women, while a decline in intention to quit (0.5%) was observed amongst men from 2015–2016 to 2019–2020. An increase in the quitting was observed amongst women with age, with higher levels of education, being married or widowed/separated/divorced, hypertensives and diabetic patients. Amongst men, a declining trend to quit was observed with increasing level of education amongst the richest and amongst smokers, alcohol users and diabetics. The trends in quitting increased amongst those who were exposed to mass media. Conclusion: This study shows an increase in tobacco quitting amongst females and a decline amongst men in the Indian population from 2015–2016 to 2019–2020.