National Family Health Survey Research Articles

The burden and care cascade in young and middle-aged patients with diabetes hypertension comorbidity with abdominal obesity in India: A nationally representative cross-sectional survey.

We ascertained the burden, determinants, and care cascade in the young and middle-aged patients having co-existing hypertension (HTN), Diabetes Mellitus (DM), and abdominal obesity in India from a secondary data analysis of nationally representative data. The study examined cross-sectional data from the National Family Health Survey (NFHS-5) conducted in India from 2019 to 2021 in 788974 individuals aged 15-49 years including 695707 women and 93267 men. The weighted prevalence of DM-HTN comorbidity with high waist circumference in the sample was 0.75% (95% CI: 0.71 to 0.79) including 46.33% (95% CI: 44.06 to 48.62) newly diagnosed cases detected for HTN and high blood sugars. The weighted prevalence of Metabolic syndrome as per NCEP ATPIII criteria was found to be 1.13% (95% CI: 1.08 to 1.17). Only 46.16% existing cases were treated with both anti-diabetes and antihypertensive medication (full treatment), while 34.71% cases were untreated. On adjusted analysis, increasing age, females, higher wealth index, high fat diet, obesity and comorbidities were significantly associated with having DM-HTN comorbidity along with high-waist circumference. More than half of young and middle aged-population in India with DM-HTN-abdominal obesity triad are not initiated on treatment for DM and HTN comorbidities, while a majority of the previously diagnosed cases have uncontrolled blood pressure and poor glycemic control. The poor cascade of care for DM and HTN in these high-risk group of patients may substantially increase their risk for early progression and severity of microvascular and macrovascular complications especially cardiovascular disease.

Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5

BackgroundShort birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India.MethodsWe used information on 109,439 women of reproductive age (15–49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India.ResultsIn India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15–24 (OR: 12.01, p < 0.001) and 25–34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI.ConclusionThe significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country.

An analysis of predictors and wealth-based inequality in internet use among women in India: aiming for better digital health outcomes

BackgroundDigital health, aiming to boost healthcare accessibility, is an emerging concept in the domain of healthcare administration and delivery in developing countries. In India, according to the National Family Health Survey (NFHS-5), more than half (55%) of the men have reported ever using the internet, while only one-third (33%) of the women have done so. This gendered digital divide is further complicated and worsened by the fact that individuals in the lowest wealth quintile exhibit significantly lower internet usage rates, with only 9% of women and 26% of men. Such intersectionality of the gendered digital divide might prove a barrier to realizing the full potential of digital health in India. Eliminating digital inequalities in all forms and ensuring universal digitalization is essential for desired digital health outcomes.MethodsThis study aims to explore India’s readiness for digital health in terms of access to basic digital infrastructure, i.e., the internet. We analyze access to the Internet among Indian women of reproductive age using pan-India survey data from the fifth round of the National Family Health Survey (2019–21). We investigate predictors of Internet use in a regression model and apply the Erreygers Concentration Index (ECI) to examine inequalities in Internet access. Using decomposition analyses, we analyze factors contributing to digital inequality in terms of internet use.ResultsOur inequality analysis based on the ECI [ECI- 0.4444 (p < 0.001)] suggests that a significant inequality exists in internet access. Furthermore, the decomposition analyses in the study find women’s educational level to be the most prominent (28.19%) contributing factor to internet inequality, followed by wealth (25.67%), place of residence (23.16%), and caste (1.10%).RecommendationWe suggest a comprehensive readiness and need assessment, revamping of digital infrastructure, and moving with caution in implementing digital health innovation in the country as it may further exacerbate the existing healthcare access inequities.

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 Age Appropriate Measles Immunisation among the Eligible Children in India: A Cross-Sectional Analysis of National Family Health Survey–5

Analysis of Age Appropriate Measles Immunisation among the Eligible Children in India: A Cross-Sectional Analysis of National Family Health Survey–5

Water, Sanitation and Hygiene (WASH) Facilities in Sikkim: Findings from National Family Health Survey (NFHS) 5

ABSTRACT The UN General Assembly has recognized access to improved drinking water and sanitation as a fundamental right. Despite this, a significant portion of the global population lacked access to safely managed drinking water (around 25%) and improved sanitation (around 50%) in 2020. India, the second most populous country, has approximately 3.7% of its population without access to improved drinking water and 31% without access to improved sanitation. This article examines factors influencing household access to improved drinking water and sanitation in Sikkim, India, using National Family Health Survey (NFHS) 5 data. The findings reveal that urban households, older, unmarried, female-headed households, with smaller families, earning higher incomes, located in the North, West and South districts, were more likely to have access to improved drinking water. Similarly, households with unmarried heads, located in higher wealth quintiles, located in the East district, were more likely to have access to improved sanitation facilities. The study suggests subsidizing the cost of improved water and sanitation services for poor rural households and increasing public investment to make these facilities more affordable for them.

Women's Empowerment in India: State-Wise Insights From the National Family Health Survey 5.

Background Women's empowerment is critical for achieving gender equality and societal progress. Despite various efforts, significant disparities in women's empowerment persist across different states in India. This study aims to provide a comprehensive assessment of women's empowerment using data from the National Family Health Survey 5 (NFHS-5). Methods Data from the NFHS-5, collected between June 2019 and April 2021, were used. The Women's Empowerment Index (WEI) was calculated for each of the 28 states based on four dimensions: economic empowerment, decision-making, health and nutrition, and gender roles. Statistical analysis, including Pearson and Spearman correlations, was conducted to assess associations between WEI and various socioeconomic variables. Results The WEI ranged from 17.4 to 27.4, with a mean of 21.3 ± 2.6. Goa, Sikkim, and Himachal Pradesh had the highest WEI scores, while West Bengal, Andhra Pradesh, and Telangana had the lowest. Economic empowerment was highest in Karnataka, Sikkim, and Arunachal Pradesh. Decision-making scores were highest in Nagaland, Mizoram, and Goa. Health and nutrition scores were highest in Goa, Sikkim, and Uttarakhand. Positive gender roles were most prominent in Himachal Pradesh, Nagaland, and Goa. Significant correlations were found between WEI and per capita net state domestic product, literacy rates, median age at marriage, and total fertility rate. Conclusion The study highlights substantial variations in women's empowerment across Indian states, influenced by socioeconomic, health, and educational factors. Targeted interventions are needed to address specific barriers and promote gender equality. Future research should evaluate the effectiveness of these interventions and explore additional factors influencing women's empowerment.

Trend, Pattern, and Prevalence of Adverse Pregnancy Outcomes among Women of Reproductive Age in India, 1992-2021.

Adverse pregnancy outcomes (APOs) are the most important vital statistics used to assess maternal health and child health statistics. They are an indicator of the quality of maternal and child health care services, i.e., antenatal care, intrapartum care, and medical services. The objective of the study is to analyze the trend, pattern, and prevalence of APOs among women of reproductive age group at the national level over successive NFHS rounds. The current study uses data from the National Family Health Survey (NFHS), conducted during 1992-2021. The study uses geo-spatial mapping techniques through QGIS software and report analysis to arrive at definitive conclusions. The study finds that the incidence of APOs among women of reproductive age (15-49 years) has increased over the years. Twenty states and union territories have APOs that are below the national average. On the other hand, States like Madhya Pradesh, Meghalaya, Sikkim, Goa, Maharashtra, Andhra Pradesh, Karnataka, and Kerala have witnessed their APOs worsening as per NFHS-5 vis-à-vis NFHS-4. The study also finds that apart from the Himalayan belt and the east coast of India, APOs are more prominent in the contiguous regions adjoining these areas. The findings of the study have thrown on very interesting facts. Despite rapid economic development during the intervening period between NFHS-4 and NFHS-5, rising APOs are a testament to the fact that the policymakers in the country need to be more target-oriented and get their acts together.

High non-use of contraception among tribal and non-tribal women in North-Eastern India: alarming but neglected.

Limited evidence exists about the contraception uptake in indigenous tribal groups of the north-eastern region of India. This study based on the National Family Health Survey (NFHS) IV (2015-2016) reports aimed to describe the pattern and factors associated with contraceptive non-use in the tribal women of the north-eastern part of India. The study was a cross-sectional analytical study based on secondary analysis of NFHS-IV data. All women in the age group of 15-49 years from the north-eastern part of India were included. Data were extracted and analysed using modified STATA-14 software. The association of socio-demographic and economic characteristics with contraceptive non-use was assessed using logistic regression. The inter-group differences of population characteristics for non-use contraceptives were assessed by modified Blinder-Oaxaca decomposition technique using 'Fairlie decomposition'. A total of 65,941 women were included, of whom 34,936 (52.9%) were tribal women. The proportion of contraceptive non-use was higher in tribal women. Tribal women with age at marriage above 30 years, Christian community, and women from Assam and Manipur state had higher odds of contraceptive non-use. The decomposition analysis showed that geographical variations, parity, and Christian religion contributed the most to contraceptive use disparity in the population. A huge gap was observed in contraceptive non-use among tribal and non-tribal women in the north-eastern part of India. The healthcare system must involve community representatives in designing context-specific community-based initiatives to increase the uptake of contraceptive use in these remote vulnerable communities.

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.

Health and its relationship with women empowerment: Evidences from National Family Health Surveys

Health and its relationship with women empowerment: Evidences from National Family Health Surveys

Understanding Contraceptive Utilisation Patterns in Kerala: Insights from NFHS-5

Background: In the past decade, Kerala has witnessed an increase in the number of sexually transmitted diseases and unmet family planning needs. This study examines the knowledge of modern contraceptives, their use, and the current use of modern Keralite contraceptives against selected indicators. Methodology: The dataset from the fifth round of the National Family Health Survey was used for this study (N=10969). To analyse the factors associated with and affecting knowledge and use of contraceptives (current use of modern and ever use of any), chi-square test and binary logistic regression were used. Results: Wealth, age, and education level were positively associated with knowledge of modern contraceptives, whereas tribals were less aware than other castes. Wealthier, older, and less educated individuals had higher odds of using any/modern contraceptives than poor, younger, and higher educated individuals (odds&lt;1). Muslims are likely to use contraceptives but are less likely to use modern methods than other religions (odds ratio: 1.67 and 0.78). Tribals had higher odds of using contraceptives (odds: 2.13). Urban respondents had lower odds of using modern contraceptives than rural respondents (odds: 0.751). Conclusions: The higher odds of older, less-educated respondents using sterilisation over reversible contraceptives are likely due to social insecurities and misconceptions. Awareness and promotion of contraceptive use at the government level would help boost its use.

Regional Disparity of Anemia among Children and Its Determinants: A Study of National Family Health Survey-5.

This study analyzes data from India's National Family Health Survey to assess the prevalence of anemia among children aged 6-59 months. Over the past decade, the prevalence increased from 59% to 67%, remaining a significant public health concern. Gujarat has highest rates, and Kerala has lowest among major states in India. The Western region tops in prevalence (75.70%), whereas the Northeast has the lowest (56.20%). Factors such as lower maternal education, poverty, religion, rural residence, poor child nutrition, low birth weight, and stunting contribute to higher odds of anemia. Improved socioeconomic conditions and maternal nutrition are recommended for risk reduction.

District-level epidemiology and sociodemographic determinants of noncommunicable diseases - results the National Family Health Survey −5 (2019–21)

BackgroundNoncommunicable diseases (NCDs) are the leading cause of adult mortality in India. However, the data regarding the prevalence of NCD risk factors at district level is scarce. This study aims to analyse and map NCD risk factors at the state and district levels, exploring sociodemographic influences on these risks in Indian males and females. MethodsWe analyzed National Family Health Survey-5 database and used the prevalence estimates to create choropleth maps, enabling us to examine the geographical variations in NCD risk factors at the district level in India. ResultsDistricts in the Satluj-Yamuna plains, western Rajasthan, and the northeastern regions exhibited clusters with a prevalence of high blood pressure exceeding 30.1 %. Northeastern districts showed over 40 % prevalence of current tobacco use, while high alcohol consumption clusters were observed in the northeastern and Telangana districts. Southern districts showed clusters of both obesity (as measured by BMI) and highest rates of oral, breast, and cervical cancer screening, moreover districts in Tamil Nadu exhibited notable clusters of raised blood glucose prevalence. ConclusionOur analysis revealed variations in the prevalence of NCD risk factors at both the state and district levels. Accordingly, this study ranks districts based on the NCD burden, offering valuable insights to state and district teams to devise targeted measures for the prevention and control of NCDs, particularly in the most heavily affected districts.

Socio-demographic Determinants of Caesarean Section Deliveries in India: Descriptive analysis of Cross-sectional data from National Family Health Survey

Background: Increase in global rate of Caesarean deliveries poses significant public health concerns as it is associated with high costs and risks for maternal, new born health. In India understanding determinants of Caesarean deliveries is of paramount importance in order to prevent maternal and child health morbidity and mortality. Aims and Objective: To investigate the socio-demographic determinants of Caesarean deliveries in India using cross-sectional data from National Family Health Survey. Methodology: The present study is a cross-sectional record based study using data from National Family Health Survey conducted in India between 2019 and 2021. The primary outcome variable is Caesarean delivery, while predictors are socio-demographic and obstetric factors. Frequency analysis used for socio-demographic variables and binary logistic regression was used to determine the determinants of Caesarean deliveries among women in the reproductive age group. The analysis was done using IBM SPSS Statistics 26.0 Software. Results: The socio-demographic and obstetric factors like maternal age, residence, education, employment, BMI, Birth order, number of Antenatal visits, place of delivery, wealth index, and media exposure are associated with Caesarean delivery. Conclusions: The study provides insights into the factors influencing Caesarean deliveries rates among women in India.

A comparative study on prevalence of life-style diseases for National Family Health Survey five and four in Uttar Pradesh

Background: The starting points that setting off the lifestyle disease come with substantial passiveness, crummy food practices, tense biorhythm, incorrect way of body gait etc. NCDs account for 41 million annual deaths, or 74% of all deaths worldwide. Due to NCDs, 86% of these premature fatalities take place annually in low- and middle-income nations. Aim &amp; Objective: To compare the prevalence of obesity, high blood pressure, and diabetes in Uttar Pradesh. Methodology: A cross-sectional study, which was community-based, probability sampling, was employed. Each unit in the survey population had an equal chance of being chosen throughout the sampling process. The NFHS 4 and NFHS 5 surveys' publicly available data served as the study's foundation which maintain participant confidentiality and are readily available from the NFHS website. MS words excel sheet Results: In Uttar Pradesh, the BMI for men and women in urban areas has grown from the NFHS-4 to the NFHS-5 survey. Comparatively, the prevalence of diabetes among women is 6.3% in urban areas and 5.6% in rural ones, whilst the prevalence among males is 8.2% in urban areas and 7.5% in rural areas. In women, the prevalence of hypertension is 20.6%, whereas in men it is 30%. Conclusions: Lifestyle-related disorders are becoming more prevalent leads to the socioeconomic threat to population as well as nations. It is very important that drift of NCDs and their confederated risk factors play a very critical for making policies and guidelines for preventive and curative management.

A Study on Obstacles in Considering Marital Rape as Rape in India

Marital Rape is the word which depicts the sexual demonstrations committed against the wish of spouse's assent and makes the trepidation in the psyche of females that the actual aggravation would proceed assuming she stands up to 32% of ladies in India who have at any point been hitched have encountered spousal physical, sexual, or close to home viciousness, as per the most recent fifth round of the National Family Health Survey (NHFS-5).It further uncovered that 25% of hitched ladies in the 18-49 years age bunch who have encountered spousal physical or sexual brutality report having actual wounds, including seven percent who have had eye wounds, injuries, separations, or consumes and 6 percent who have had profound injuries, broken bones, broken teeth, or some other serious injury. Objectives that have been put sent by the scientist, for example, to know individuals' viewpoint about conjugal assault and the purpose for why it is as yet detailed least in ammount and battles in considering conjugal assault as rape

Knowledge, Attitude and Practices- A Concept

The current article deals with the concept of Knowledge, Attitude&amp; Practices (KAP) that emerged from the family planning programs after independence of the nation. Further, the concept of KAPGap emerged regarding the improvement of quality of the family planning programs. Development of the concept of KAP gap helped improved the quality of the family planning program &amp; the program name changed to Family Welfare program. Further, it also provided a cafetoria approach of family planning methods where the people had to choice to chose from the available basket of methods of family planning/welfare. The current article traverses the history of the KAP approach, thereafter it sees how it sailed through finally reaching the current status of the KAP approach through the indicator of unmet need of family planning through the National Family Health Surveys of 4th&amp; 5th rounds.

Contributing factors for reduction in maternal mortality ratio in India

Maternal mortality ratio (MMR) estimates have been studied over time for understanding its variation across the country. However, it is never sufficient without accounting for presence of variability across in terms of space, time, maternal and system level factors. The study endeavours to estimate and quantify the effect of exposures encompassing all maternal health indicators and system level indicators along with space–time effects influencing MMR in India. Using the most recent level of possible -factors of MMR, maternal health indicators from the National Family Health Survey (NFHS: 2019–21) and system level indicators from government reports a heatmap compared the relative performance of all 19 SRS states. Facet plots with a regression line was utilised for studying patterns of MMR for different states in one frame. Using Bayesian Spatio-temporal random effects, evidence for different MMR patterns and quantification of spatial risks among individual states was produced using estimates of MMR from SRS reports (2014–2020). India has witnessed a decline in MMR, and for the majority of the states, this drop is linear. Few states exhibit cyclical trend such as increasing trends for Haryana and West Bengal which was evident from the two analytical models i.e., facet plots and Bayesian spatio- temporal model. Period of major transition in MMR levels which was common to all states is identified as 2009–2013. Bihar and Assam have estimated posterior probabilities for spatial risk that are relatively greater than other SRS states and are classified as hot spots. More than the individual level factors, health system factors account for a greater reduction in MMR. For more robust findings district level reliable estimates are required. As evident from our study the two most strong health system influencers for reducing MMR in India are Institutional delivery and Skilled birth attendance.

Prevalence of intimate partner violence among Indian women and their determinants: a cross-sectional study from national family health survey – 5

IntroductionIntimate partner violence (IPV) can be described as a violation of human rights that results from gender inequality. It has arisen as a contemporary issue in societies from both developing and industrialized countries and an impediment to long-term development. This study evaluates the prevalence of IPV and its variants among the empowerment status of women and identify the associated sociodemographic parameters, linked to IPV.MethodsThis study is based on data from the National Family Health Survey (NFHS) of India, 2019-21 a nationwide survey that provides scientific data on health and family welfare. Prevalence of IPV were estimated among variouss social and demographic strata. Pearson chi-square test was used to estimate the strength of association between each possible covariate and IPV. Significantly associated covariates (from univariate logistic regression) were further analyzed through separate bivariate logistic models for each of the components of IPV, viz-a-viz sexual, emotional, physical and severe violence of the partners.ResultsThe prevalence of IPV among empowered women was found to be 26.21%. Among those who had experienced IPV, two-thirds (60%) were faced the physical violence. When compared to highly empowered women, less empowered women were 74% more likely to face emotional abuse. Alcohol consumption by a partner was established to be attributing immensely for any kind of violence, including sexual violence [AOR: 3.28 (2.83–3.81)].ConclusionsOur research found that less empowered women experience all forms of IPV compared to more empowered women. More efforts should to taken by government and other stakeholders to promote women empowerment by improving education, autonomy and decision-making ability.