Harihar Sahoo

The emergence of non-communicable diseases (NCDs) in childhood poses a serious risk to a healthy adult life. The present study aimed to estimate the prevalence of NCDs among children and adolescents in slums and non-slums areas of four metropolitan cities of India, and in rural areas of the respective states The study further, investigated the effect of the place residence as slum vs. non-slum and other risk factors of the NCDs. Nationally representative data from the Comprehensive National Nutrition Survey (CNNS) was used.. Estimates were based on children (5-9 years) and adolescents (10-19 years) for whom biomarkers predicting diabetes, high total cholesterol, high triglycerides and hypertension were determined. Weight, height and age data were used to calculate z-scores of the body mass index. Overweight and obesity was higher in urban areas than in rural areas among children and adolescents. Regional differences in the prevalence of diseases were observed; children in Delhi and Chennai had a higher likelihood of being diabetic while children in Kolkata were at a greater risk of high total cholesterol and high triglycerides. The risk of hypertension was strikingly high among non-slum children in Delhi. Children from slums were at a higher risk of diabetes compared to the children from non-slums, while children and adolecents from non-slums were at a greater risk of high triglycerides and hypertension respectively than their counterparts from slums. Male children and adolecents had a higher risk of diabetes and high cholesterol. Screening of children for early detection of NCDs should be integrated with the already existing child and adolescent development schemes in schools and the community can help in prevention and control of NCDs in childhood.

This chapter provides a comprehensive picture of the relationships between activity status, morbidity patterns, and level of hospitalisation in India and across its six main geographical regions. Regional differences are striking, as the reported prevalence of ailments is higher in southern regions than other regions in India. The greater social and economic development, coupled with greater accessibility of healthcare services, could be responsible for the regional variations observed during the study. Alongside these regional patterns, there are wide differences in morbidity rates among different socioeconomic groups. The results also show a social pattern in health which is quite different from that usually observed in high income countries.

Abstract Background Sex preference, particularly son preference is common in India. The present study explores the trends, patterns and determinants of sex preference in India. Methods The unit level data come all the four rounds of Indian National Family Health Survey. Bivariate and multivariate analyses were used to explore the factors affecting sex preference in India. Results The results revealed that preferring of son has decreased (from 35.6% to 20.3%) while daughter preference has slightly increased in India during 1992–93 to 2015–16. The multinomial logistic regression analysis revealed that the caste, religion, mass media exposure, educational level of women, wealth index, place of residence and geographical region has a significant role in determining sex preference. Conclusion The results suggest that the national and state level policies and programmes need to be relooked for accelerating the progress of reducing son preference in India. Government should focus on the vulnerable groups identified in the study and also should emphasise the awareness programmes to combat declining child sex ratio for achieving the sustainable development goals of gender equality in India.

Background Menstruation, especially the menstrual cycle, is a vital sign for female adolescent health and maintaining menstrual hygiene is of utmost importance for menstruating girls and women. However, menstrual hygiene and management are issues that have not received adequate attention. Therefore, the present study aimed to explore spatial patterns of menstrual hygiene practices in India and to identify their socioeconomic and demographic determinants among women aged 15–24 years. Methods The study utilized data from the fifth round of the National Family Health Survey (NFHS-5) conducted during 2019–21 in India. The analysis was limited to 241,180 women aged 15–24 years. The statistical methods range from multinomial logistic regression, spatial autocorrelation in terms of Moran’s I statistics, to spatial regression in order to understand the spatial dependence and clustering in different methods of menstrual practices across the districts of India. Results Almost half of the resp...

Abstract Background Despite various health complications associated with Caesarean Section (CS) delivery, there are sizeable population in India opting for Caesarean Section in subsequent delivery. Therefore, the present study attempts to find out the different factors affecting repeated caesarean delivery and place of such delivery in India. Methods The unit level data from the fourth round of Indian National Family Health Survey is used. Bivariate and multivariate analyses are used to explore the factors affecting repeated Caesarean Section delivery in India. Results It is found that women with better economic condition, urban residence, higher caste are reported higher proportion of repeated CS delivery as compared to their counterparts. Conclusion Although repeated CS is associated with various ailments but the study revealed that substantial proportion of women undergoes CS in subsequent deliveries in India. With the growing rate of caesarean delivery, women should be counselled that repeat CS are bound with surgical difficulties and complications.

AimWomen who experience premature menopause either due to biological or induced reasons have a longer duration of exposure to severe symptoms and adverse health consequences when compared to those who undergo menopause at later age. Despite the fact that premature menopause has a profound effect on the health of women, there has been limited study on this issue. Therefore, this study attempted to determine the prevalence and factors associated with premature menopause among 302 557 women aged 25–39 years in India.MethodsThis study utilized secondary data from the fourth round of the National Family Health Survey‐IV (NFHS‐4), conducted during 2015–2016 in India. Descriptive statistics and multinomial logistic regression were used for statistical analyses of the data.ResultsThe results revealed that the prevalence of premature menopause in this sample of Indian women was 3.7%, out of which 2.1% of women had experienced natural premature menopause, whereas 1.7% had surgical premature menopause. The prevalence of premature menopause was highest in the southern region of India. Factors like age, education, wealth index, place of residence, smoking status, children ever born, age at first birth, use of hormonal contraception, sterilization, and body mass index were found to be associated with premature menopause in India.ConclusionA sizeable proportion of women in India are attaining menopause prematurely. Furthermore, the percentage and likelihood of experiencing premature menopause are relatively high among rural women, women with higher parity, early age at childbearing, and women who smoke.

The decision on the number of children is taken within the household decision making framework. One argument states that, the rising costs and declining economic value of children drives couples to go for smaller families. The other major economic argument states that, it is in parent’s best interest to have large number of children in any agrarian or poor economic setting, where children can be put to work to contribute to the household income. Therefore, in this study an attempt has been made to capture the economic effects in a poor state of India i.e. Odisha, where sustained fertility decline has occurred in spite of unfavourable conditions. Data for the study are drawn from National Family Health Survey and also from a primary survey carried in one district of Odisha. The result demonstrated that the desire to stop child bearing increases rapidly with the number of living children. Multiple classification analysis shows that caste, educational level, standard of living of the household, exposure to mass media and number of living son are important determinants of desire family size. It is also evident that in spite of widespread poverty in the state the economic provision of the government is not a precondition for the decision of number of children. The result show that the thresholds have fallen because of the changing value of children; cost of raising them has increased and child participation in work force has decreased. Such changes have occurred because of diffusion of ideas.

This paper tries to study the health status of elderly, morbid conditions, their perceptions about their own health and their treatment seeking behaviour using the data from 60th round of National Sample Survey and Census of India, 2001. Bi-variate and multi-variate techniques were used to find out the factors affecting the health and health care utilization of the elderly. Result shows that widows/widowers are having worst relative state of health as compared to currently married elderly. Monthly Percapita Consumer Expenditure (MPCE) is positively related to state of health. Dependency during old age also has significant negative impact on the state of health. Male elderly used to take more treatment as compared to their female counterparts. This is a byproduct of culture of silence and low status of female elderly. Educational level, occupation and MPCE are found to be important determinant of treatment seeking behaviour.

Fertility has declined in Odisha (an Indian state on the east coast) in spite of its agrarian economy, high level of poverty and low levels of industrialization and urbanization. This suggests that the perceived economic value of children has changed, and children being considered as economic assets by poor households have changed. Using data obtained from a field investigation in one district of Odisha, this paper examines the value of children as perceived by poor/non-poor. Results show that the perceived short-term benefits from having children have fallen, and that the perception of child labor as being economically valuable is no longer common. High aspirations for children's education have led to a gradual rise in the costs of raising children. Respondents report "economic burden" as the most common reason for not wanting to have another child, reflecting the classical "quantity-quality" trade-off.

This paper aims to study the magnitude of Kala-azar (Visceral Leishmaniasis-VL) in Bihar with a case study of Madhepura District. A community based cross-sectional study was carried out in Madhepura District in November 2014. Suspected cases were tested with rK39 kit for VL. The incidence rate, case fatality rate and seasonality analysis was carried out. The new cases of VL were added to calculate the incidence. In the year 1997, Bihar recorded 2 VL cases per 10,000 population, which declined to 1 case in the year 2013. In 2016, there were 0.6 case per 10,000 population. Case fatality rate in Bihar was 1.6 in 1997 which reduced to 0.16 in 2013. Though the disease occurred across the year, the peak of VL was observed during the month of March, April and May. In Madhepura District, the incidence rate in last two years was calculated as 45 cases per 10,000 population which was higher than the official record. The study suggests strengthening the surveillance system and active case detection to cover all the cases of the disease.

Birth spacing is of considerable importance to study the tempo and quantum of fertility. Using data from the National Family Health Survey III, this study explored the birth interval dynamics in Odisha, an eastern state of India. The life table analysis of spacing between births clearly suggests that birth spacing in the recent past has increased and the proportion of women moving to the second, third, and fourth parity has declined, leading to the decline in fertility in Odisha. From the proportional hazards model, educational level of women, age of women at previous birth, sex and survival status of the previous child, and the period effect are found to be important determinants of birth spacing at higher parities. Socioeconomic differences do not show a large effect at lower order births. This highlights the fact that most women in Odisha, regardless of their background characteristics, tend to have second births.

... FERTILITY BEHAVIOUR AMONG ADOLESCENTS IN INDIA HARIHAR SAHOO Harihar Sahoo, Asst. Professor, Department of Sociology, Dr. Babasaheb Ambedkar Marathwada University, Aurangabad - 431004, Maharashtra Page 2. Vol. 57, No.1, June - 2011 23 ...

India has become the largest populated country in the world in 2023 which has resulted in an increasing attention on India's population and its changing age structure, demo-graphic transitions, and their long-term implications. India Population Report is developed based on landmark surveys and research on population, health, ageing, fertility, nutrition, migration and women and children undertaken by the International Institute for Population Sciences (IIPS), India. This volume studies various aspects of population and health issues in India providing a holistic narrative of the current scenario and future implications. By utilizing latest data and scientific evidence, chapters in this volume explain the achievements so far and examine the challenges ahead in respective fields, while identifying thrust areas for further research and action. Contributions to the volume come from leading and renowned research and data experts in the field, bringing together a cohesive, multifacete...

Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2•5th and 97•5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13•7 million (95% UI 10•9-17•1) infection-related deaths in 2019, there were 7•7 million deaths (5•7-10•2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13•6% (10•2-18•1) of all global deaths and 56•2% (52•1-60•1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54•9% (52•9-56•9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52•2 deaths (37•4-71•5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31•1 million DALYs (of which 16•2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34•4% (from 17•5 to 11•5 per 100 000) for transport injuries, and by 47•7% (from 15•9 to 8•3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80•5% to 42 774 for transport injuries and by 39•4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16•7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48•5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0•2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.

Background Around the world, advances in public health and changes in clinical interventions have resulted in increased life expectancy. Multimorbidity is becoming more of an issue, particularly in countries where the population is rapidly ageing. We aimed to determine the prevalence of multimorbidity and disease-specific multimorbidity and examine its association with demographic and socioeconomic characteristics among older adults in India and its states. Methods The individual data from the longitudinal ageing study in India (LASI) were used for this study, with 11 common chronic conditions among older adults aged 60 and above years (N = 31,464). Descriptive statistics were used to report the overall prevalence of multimorbidity and disease-specific burden of multimorbidity. Multinomial logistic regression has been used to explore the factors associated with multimorbidity. Results Prevalence of single morbidity was 30.3%, and multimorbidity was 32.1% among older people in India....

Polygyny results in a variety of physical, sexual, and psychological consequences for women which has an impact on gender relations such as the subordination of women, unequal treatment of spouses, neglect of children, rivaling step-children, and inheritance issues among children/spouses. This study aims to explore the association between polygyny and spousal violence in India using the data from the fifth round of the National Family Health Survey-5 of India in 2019 – 2021, which provides information on both polygyny and spousal violence. To understand the effect of polygyny on spousal violence, multivariate logistic regressions were used to obtain unadjusted and adjusted odds ratios by controlling a number of explanatory factors. The results reveal that women in polygynous unions experience more spousal violence compared with those in monogamous unions. The results indicate that, since the law does not permit men to be married to more than one wife simultaneously, this form of mar...

Background: The share of out-of-pocket health spending (OOPS) to household consumption expenditure is very high, around 67 percent, making health care costs catastrophic and leading to impoverishment effects in the medium to longrun. In this study, we have examined the impoverishment effects of OOPS on households with elderly and without elderly.Methods:Our study extracted households with the hospitalized member in the last 365 days (N=80105) in the first phase and thereafter, it divided households with elderly (N = 23708), and households without elderly (N = 56397). Further, we have categorized a household’s impoverishment as a binary variable (Yes or No) after paying health services. The study has employed bivariate and logistics regression to examine the relationship between outcome variables and selected socio-demographic characteristics of households. Results. Our findings show that OOPS among elderly households is on the upswing. By controlling for other factors, households wi...

Consanguineous marriage is the legal union of male and female of a common ancestor related by blood. The most common prevailing form of consanguineous marriages is between first cousins. Middle East Asian countries and southern states in India show high prevalence. A comparative analysis between the two rounds of National Family Health Survey 1 and 4 have shown a declining trend for the practice of consanguineous marriages. The highest percentage of consanguineous marriages is seen among the first cousins from both father’s and mother’s side, most commonly practice in the southern states of Andhra Pradesh, Telangana, Tamil Nadu, and Karnataka except Kerala. Importantly, the practice of consanguineous marriage is higher among the Muslims of North India and Hindus of Southern India, among the Other Backward Classes and the less educated population of the middle and richer wealth index. A significant relationship can be noticed among consanguineous marriages and socio-economic variables.

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0•603 (0•400-1•00) standard drinks per day, and the NDE varied between 0•002 (0-0) and 1•75 (0•698-4•30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0•114 (0-0•403) to 1•87 (0•500-3•30) standard drinks per day and an NDE that ranged between 0•193 (0-0•900) and 6•94 (3•40-8•30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59•1% (54•3-65•4) were aged 15-39 years and 76•9% (73•0-81•3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation.