National Family Health Survey Data Research Articles

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.

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

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

Adolescent marriage a violation of sexual and reproductive health rights: Trend, spatial variation and covariate analysis from national family health survey

IntroductionTen-to-Nineteen-year adolescent period is a very sensitive time for both boys and girls. Especially adolescent girls suffer more due to early marriage and its consequences of unintended pregnancy, unsafe abortion, high risk for sexually transmitted disease etc. ObjectiveThis study tried to analyse trend and spatial variation of adolescent girls' marriage practice in India. Further, this study is also tried to identify major socio-economic factors responsible for adolescent girl's marriage. MethodsPresent study utilized different rounds of National Family Health Survey (NFHS) data. Trend analysis carried out with the help of 3rd, 4th and 5th round of NFHS data. Bivariate distribution and logistic regression are used for identifying determining factors for adolescent girls’ marriage. ResultsTrend analysis result reveals the declining trend of early adolescent girls' marriage in India. However, the data reveals early girl's marriage practice is still very high. This practice is more in the states of Tripura (31%) followed by West Bengal (28%). Place of residence, wealth status, education status and mass media exposure are the main determining factors in early marriage. ConclusionMost of the states in Eastern and North-Eastern states are having high prevalence of adolescent marriage. Thus, there is an urgent need to focus on these states along with addressing socio-economic disparities. Further, there is a need of effective interventions of girl specific programmes like Beti Bachao Beti Padhao, Balika Samridhi yojana etc. working for empowerment and wellbeing of adolescent girls.

Wealth inequalities in nutritional status among the tribal under-5 children in India: A temporal trend analysis using NFHS data of Jharkhand and Odisha states - 2006-21.

Undernutrition remains a major public health concern in India, especially among children belonging to the Scheduled Tribes (ST). In this study, we analyse wealth inequalities in nutritional outcomes within ST communities in two tribal-dominated states of India, namely, Odisha and Jharkhand. The study also compares the trends in nutrition outcomes between ST and Non-ST children in these states. We have conducted a trend analysis of the prevalence and inequalities in the nutritional indicators among ST children under age five using unit-level data of the National Family Health Survey (NFHS) [NFHS-3(2005-06),4 (2015-16) and 5(2019-2021)]. Wealth-related inequalities were analysed using the Slope Index of Inequality (SII), which measures absolute inequality, and the relative Concentration Index (CIX), which measures relative inequality. We have also analysed the correlation between Antenatal Care (ANC) visits and nutritional indicators using the Pearson Correlation test. The trend analysis shows that the prevalence of undernutrition remains higher among ST children in India as compared to Non-ST children between NFHS-3 (2005-06) and NFHS-5 (2019-2020) in Jharkhand and Odisha. The SII and CIX values show that statistically significant inequalities in stunting and underweight exist among children belonging to various wealth quintiles within the ST category in both states. Wasting is found to be significantly prevalent across all wealth quintiles. Also, we found a negative association between ANC visits and all three nutritional indicators. Our study highlights the importance of monitoring both the absolute and relative wealth inequalities in nutritional outcomes. This is due to the fact that while inequalities across groups may reduce, the prevalence of poor nutritional outcomes may increase among certain groups. Such observations, therefore, will enable policymakers to focus further on those groups and devise appropriate interventions.

Revisiting the predisposing, enabling, and need factors of unsafe abortion in India using the Heckman Probit model.

Unsafe abortion refers to induced abortions performed without trained medical assistance. While previous studies have investigated predictors of unsafe abortion in India, none have addressed these factors with accounting sample selection bias. This study aims to evaluate the contributors to unsafe abortion in India by using the latest National Family Health Survey data conducted during 2019-2021, incorporating the adjustment of sample selection bias. The study included women aged 15 to 49 who had terminated their most recent pregnancy within five years prior to the survey (total weighted sample (N) = 4,810). Descriptive and bivariate statistics and the Heckman Probit model were employed. The prevalence of unsafe abortion in India was 31%. Key predictors of unsafe abortion included women's age, the gender composition of their living children, gestation stage, family planning status, and geographical region. Unsafe abortions were typically performed in the early stages of gestation, often involving self-administered medication. The primary reasons cited were unintended pregnancies and health complications. This study underscores the urgent need for targeted interventions that take into account regional, demographic, and social dynamics influencing abortion practices in India.

Prevalence and associated factors of undiagnosed hypertension among women aged 15-49 years in India: an analysis of National Family Health Survey-4 data.

Hypertension is a major risk factor for cardiovascular diseases globally. Fortunately, there is a vast armamentarium of effective therapeutic options at our disposal so undiagnosed hypertension represents a missed opportunity. In a previous analysis [1] of the NFHS-4 dataset for the prevalence and risk factors for undiagnosed hypertension and its associated risk factors among Indian women aged 15-49 years, we had overestimated prevalence by inclusion of self-reported cases. We have since retracted when this anomaly was highlighted [2]. We have now re-analyzed the same database and here present these data. The current analysis shows that the overall prevalence of undiagnosed hypertension was 8.05% among women aged 15-49 years in India. In rural areas, it was 7.89% compared with 8.38% for urban areas. Factors associated with undiagnosed hypertension in rural and urban areas were age, BMI, wealth quintiles, educational level, religion, caste and geographical zones. Nearly half the women aged 15-49 years in India with hypertension are unaware and this has implications for personal and reproductive health.

Fieldworker effects on quality of data collected on sensitive questions in National Family Health Surveys: An analysis based on intimate partner violence in India

National Family Health Survey (NFHS) has played a pivotal role in formulating policies and programs by providing nationally representative data on a wide range of monitoring and impact evaluation indicators in population, health and nutrition. However, due to measurement errors resulting in misreporting, the collection of accurate data on sensitive issues in sample surveys has always been a matter of concern. This study examines the fieldworker effect on the reporting of physical, sexual, and emotional Intimate Partner Violence (IPV) using fifth round of NFHS (2019-21) data in India. The cross-classified multi-level model was used to examine the fieldworker's effect on the reporting of IPV. The fieldworker effect accounted for around 32% of total variation in the reporting of intimate partner violence. The fieldworker's effect varied from 26% to 41 % for physical violence, 29% to 33% for emotional IPV and 30%–36% for sexual IPV. It was observed that variation due to fieldworker for non-sensitive outcomes was negligible.Of total variation, only 1.6% for information related to ever attending school, 4.8% for ever given birth, 5% for currently pregnant and 8.5% for information on ever terminated pregnancy was being explained by the fieldworker. Our results indicate a significant fieldworker influence on the likelihood of reporting intimate partner violence, underlining the need for an increased understanding of the impact of fieldworkers on data outputs, especially—but not exclusively—when queries contain delicate or stigmatized themes. This study highlights the importance of providing extra guidance and special training to the fieldworkers when collecting sensitive information related to IPV.

Spatial distribution and determinants of limited access to drinking water and sanitation services of households in India

Abstract Good health and well-being require safe drinking water and improved sanitation facilities. Lack of access to drinking water and sanitation facilities poses serious health risks. There are few studies based on the NFHS-5 data in the literature. Therefore, the present study used the NFHS-5 data to investigate the spatial distribution of limited access to drinking water and sanitation facilities in India. The Stata version 14.1 software was used for statistical analysis and Arc Map 10.4 was used for spatial analysis. A binary logistic regression model was applied to investigate the association between dependent and independent variables. The prevalence of limited access to drinking water and sanitation facilities was higher in Madhya Pradesh (12.28%) and Manipur (22.65%), respectively. Besides, the spatial distribution of limited access to drinking water and sanitation facilities was spatially clustered among a few central and western Indian states. In the binary logistic regression, education, wealth index, and place of residence were significantly associated with limited drinking water and sanitation services. There is regional heterogeneity in drinking water and sanitation services. With this in mind, we suggest spatially optimized target-oriented policy measures in unprivileged areas. Improving the water distribution networks and construction of sanitation facilities is also recommended.

Assessing reduction in multidimensional childhood poverty in India: a decomposition analysis

BackgroundEmpirically, the official measurement of multidimensional poverty often shows children as the poorest age group. According to Global Multidimensional Poverty Index report, Africa and South Asia bear the highest burden multidimensional child poverty (MCP). Around one-third of children aged 0–4 are multidimensionally poor in India. Policymakers in India must have appropriate information on child poverty to alleviate poverty. The purpose of this paper is to examine MCP trends and track efforts to reduce child poverty at the national level across geographic regions, castes, and religious groups.MethodsWe used the Alkire-Foster method to calculate the MCP index (MCPI) among children aged 0–4 using the latest two rounds of National Family Health Survey data (2015–16 and 2019–21). We applied the Shapley decomposition method to analyse the marginal contribution of incidence and intensity that lead to changes in MCPI.ResultsIn India, the incidence of child poverty reduced by more than 40% between 2015–16 and 2019–21 (46.6–27.4%) and the MCPI reduced by half (24.2–12.6%). The relative decline in MCPI has been largest for urban areas, northern regions, Other Backward Classes (OBCs) and Hindus. Children from rural areas, Scheduled Castes (SCs), Scheduled Tribes (STs), and Muslim households are the poor performers. When focusing exclusively on the poor child, we found all the population subgroups and geographic locations reduced the censored headcount ratios in all 14 indicators. Across places of residence, castes, religions, and regions the, indicators like electricity, birth registration, drinking water, assisted delivery, sanitation and cooking fuel made significant improvements between 2015–16 to 2019–21.ConclusionThe study indicates that by studying the MCPI over time, one can identify the priorities in policy development to achieve the Sustainable Development Goals.

Status of Anaemia amongst women in India: trend analysis of NFHS data

The study was taken up to assess the changing trend in prevalence and severity of anaemia in women of reproductive age over the last 15 years by analyzing National Family Health Survey (NFHS) factsheet data and to draw a comparison between the prevalence of anaemia across different states/UTs of India. NFHS 3, 4 and 5 factsheets have been referred for the same. An increase in the prevalence of anaemia from 53% to 57% in all women aged 15-49 years is seen, 50.4% to 52.2% in pregnant women and 53.2% to 57.2% in non-pregnant women between NFHS 4 and 5. West Bengal has the highest prevalence of anaemia, followed by Tripura (67.2%) and Assam with 65.9% among women of 15-49 years. NFHS 5 data shows an increase in the prevalence of anaemia in all women by 4%, 1.8% in pregnant women and a increase by 4 % in non-pregnant women. Anemia Mukt Bharat campaign launched in 2019, was expected to reduce or inert the anaemia burden, but NFHS 5 data indicates a surge in anaemia incidences significantly across women of all age groups over the last five years. Hence, there is a need for revamping and implementing the programmes in a better way.

Patterns and determinants of aerated drinks consumption among adolescents in India: analysis of National Family Health Survey-5 (2019-2021) data

PurposeThis study aims to investigate the consumption pattern of aerated drinks and examine its determinants among adolescents’ boys and girls (15–19 years) in India.Design/methodology/approachThe fifth round of National Family Health Survey (2019-2021) data was examined applying sample weights. Pattern of consumption and its determinants was analysed separately for boys and girls using binary logistic regression and calculating adjusted odds ratio (AOR) at 95% confidence interval.FindingsThe daily, weekly and occasionally consumption of aerated drinks was 4.4%, 22.7%, 63% for boys and 2.9%, 14%, 70.8% for girls, respectively. Factors such as secondary/higher education [Boys AOR = 1.5, (1.2–1.9) (p = 0.001); Girls AOR = 1.2, (1.1–1.2) (p < 0.001)]; rich wealth index [Boys AOR = 1.8, (1.6–2.1) (p < 0.001); Girls AOR = 1.3, (1.3–1.4) (p < 0.001)]; fried food consumption [Boys AOR = 11.1, (9.5–12.9) (p < 0.001); Girls AOR = 11.5, (10.8–12.3) (p < 0.001)]; and watching television [Boys AOR = 1.5, (2.3–1.7) (p < 0.001); Girls AOR = 1.3, (1.3–1.4) (p < 0.001)] were found significant predictors of aerated drink consumption among adolescents.Originality/valueThe authors noted differences in consumption pattern between adolescents’ boys and girls. A shift to occasional consumption from weekly and daily was also observed. A further decrease in consumption may requires gender and region-specific health-promotion interventions. Rationalising sugar-sweetened beverages taxation adhering World Health Organisation’s recommendation to reduce affordability may be further researched in the Indian context. Furthermore, sale and consumption of traditional and locally available fruits, vegetables and healthy beverages may be warranted.

Using Machine Learning Prediction to Create a 15-question IPV Measurement Tool.

Domestic violence, especially intimate partner violence (IPV), is an important issue worldwide, especially in India. Those that experience it may not always be able to come forward or have access to the required social support to act against it. We use National Family Health Survey data (n = 66,013 women) to create machine learning models which can predict IPV instances with a recall of 78%. We use the top 15 best predicting questions that avoid sensitive issues to create a field tool that frontline health workers can use to identify women with a high risk of IPV and provide the support they need.

Are households shifting toward cleaner cooking fuel? Empirical evidence from India during 2005–2021

The natural environment is negatively impacted by the daily fuel use for domestic purposes, particularly in developing nations with large populations, such as India, where biomass is the primary source of fuel for household cooking. However, a greater understanding is needed about the trends, patterns, and factors affecting household energy consumption and choice in India over the past two decades. The National Family Health Survey (NFHS) data from the years 2005–2006, 2015–2016, and the most recent year 2019–21 are used in this study to empirically demonstrate that characteristics including gender, education, capital, social status, and geography have significant influence on a household's decision to use cleaner energy. The results report that homes in rural regions, the poorest and most impoverished households, those headed by women, and without formal education have been unable to switch to cleaner fuels such as liquid petroleum gas (LPG) over time. As the study suggests that increasing income levels and education can lead to a shift toward cleaner household energy consumption, policies promoting economic growth and education can reduce greenhouse gas emissions from household energy consumption. Thus, policies like subsidies in LPG and electricity shall explicitly aim to assist impoverished households and lower-income families in enhancing their accessibility and affordability options for cleaner energy sources. The research underscores the significance of directing efforts towards the economically disadvantaged segments of society, guaranteeing their access to more environmentally friendly energy sources.

Nutritional Status of Female Children in Comparison to Their Male Siblings in India– A Secondary Analysis of National Family Health Survey (NFHS-5) Data

Introduction: As there was little literature available about gender disparities in undernutrition within household, this secondary analysis was performed on a large representative data with an objective to evaluate the Z-score differences, viz., Weight-for-age Z-score (WAZ), Height-for-age Z-score (HAZ), Weight-for-height Z-score (WHZ) and BMI-for-age Z-score (BAZ) of the Indian female under-5 children with their male siblings within same household. Methods: Individual data of 19083 pairs of siblings was analysed from the NFHS -5 data. Differences in the Z-scores of the siblings was calculated as male’s Z-score minus female’s Z-score and factors influencing them were studied. Results: The mean HAZ and WAZ scores were less than -1.4 Standard deviations (SD) for both genders – while the means of WHZ and BAZ scores were ranging between -0.67 to -0.83. The differences in Z scores were more or less distributed equally on both sides of zero, implying no disadvantage to any of the genders. The mean differences in the Z scores were minimal (-0.07 in HAZ, -0.04 in WAZ, -0.06 in WHZ and 0.01 in BAZ). Conclusion: There was little or no difference in the mean z scores of females and male siblings and did not indicate any gender advantage or disadvantage.

Trends Of Adult Height in India Using National Family Health Survey Data: A Systematic Review

The national family health survey (NFHS) is a multi-round, large scale, survey conducted throughout India in a customary sample of households. It was first conducted in 1992-93, till then five surveys have been conducted. The survey was done using four types of questionnaires namely Men’s, Women’s, Biomarker, and household. The survey was funded by many international Funding agencies likeUnited States Agency for International Development (USAID), United Nations Children's Fund (UNICEF) etc. In India department of Ministry of Health and Family Welfare (MOHFW) has delegated the International Institute for Population Sciences (IIPS), Mumbai as a nodal agency for mutual support in the survey. Each survey of NFHS has two definite goalsi.ei) to anticipate data on family welfare and health for program and policy purposes and ii) to contribute an information on important family welfare and emerging health issues. Systematic review was conducted as per PRISMA guidelines, we carried out an extensive electronic search of PubMed, Google and Google Scholar to identify published studies on trends in adult height using NFHS India data. Out of a total 43 potential studies 38 were excluded and 5 relevant studies were used for final review. There is a decrease in average adult height in India. Despite of genetic, non-genetic factors like social, nutritional, and environmental plays a very important role in adult height.

Impact of Covid on the Trend of Domestic Violence in Indian Households

Since the onset of COVID-19 pandemic, a rising trend of domestic violence in India is reported by literature using either call/complaints data or newspaper reports. However, the complaints data could not provide an adequate measure of the effect of the pandemic on the occurrence of domestic violence, if a substantial number of cases remain unreported. Till now, national level data to capture the changes in household dynamics during pandemic time is rare. The novelty of this study comes from the use of a national level survey, National Family Health Survey data of the Fifth round (2019-21) on India, which was not specifically designed for identifying the impact of COVID, but includes many attributes of women’s life regarding demographic characteristics, health and childbirth, subjective and objective information on domestic violence among many others. The data has been collected from 2019 to 2021, with a halt due to COVID restrictions from April to September 2020. Using this break in the data this study examines whether and how the pattern of domestic violence has changed during the pandemic time. The impacts of COVID-19 pandemic on the trend and nature of domestic violence and also on the patterns of the influence of the predictors of domestic violence are measured using probit regression analysis. The findings imply that violence may decrease if women provide financial security to the family amid uncertainties during pandemic, but violence can increase if women increase the burden of the family.

Unintended Pregnancy and Domestic Violence Among Pregnant Women in Regions of India: Evidence from Large Scale Survey Data

The study examined effect of domestic violence (DV) on pregnancy intendedness among pregnant women across geographical regions in India. Using fourth wave of National Family Health Survey data, the study is confined to experience of physical/sexual violence within 12 months preceding the survey. Close to 6% of the women were found pregnant with high in the central region. Among them, 12% were having unintended pregnancy (UIP), with highest in the central (17.4%) region. UIP found 7% higher among victims of DV compared to those who did not face it (11%). Significantly, regional variation is much persisting as the regions having high prevalence of DV are also at an increased risk of UIP which hampers the notion of dignified reproductive rights. This needs region-specific policy and programme. Study push for interventions on minimising DV and reducing burden of high UIP in regions of India.

The association of household wealth and migration status on antenatal care in India, 2015-16

BackgroundAlthough Antenatal Care has long been a concern for social scientists and public health experts, most research has focused on the poor and migrants as discrete categories. Another worry is whether poorer and migrant women have double obstacles in obtaining Antenatal Care (ANC). This study aims to look into the factors that influence ANC utilization among migrant and poor women in India. MethodsThis study used the National Family Health Survey (NFHS-4) data conducted during 2015–16. Descriptive statistics and multiple logistic regression were used to investigate the association between ANC utilization and wealth and the migration status of women. ResultsAbout 10.2% of migrant and poorer women had received full ANC, compared to 30.3% of non-poorer non-migrant women. We found a significant difference in full ANC utilization across wealth and migrant groups. Non-poorer and non-migrant women had a significantly 1.31 times higher likelihood of using full ANC compared to poorer and migrant women, and 1.84 times higher likelihood of accessing four or more ANC visits. Analyses show that women's age, literacy, husband literacy, birth order, social group, religion, and type of residence were significantly associated with the gap in full ANC utilization across migrant and wealth groups. ConclusionThis study found disparities in ANC utilization across wealth and migrant groups.Poorer migrant women were at higher risk of receiving inadequate care. Therefore, policymakers should make an extra effort to provide ANC to these women to reduce the ANC utilization gap.