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Abstract

The fourth round of National Family Health Survey (2015-16) is discussed with a brief exposition of the trends in household environment and sanitation, fertility, child health and child mortality, nutrition, health, and status of women between 2005-06 (NFHS-3) and 2015-16 (NFHS-4)
NOTES
APRIL 22 , 2017 vol lII no 16 EPW Economic & Political Weekly
66
National Family Health
Survey-4 (2015–16)
NFHS-4 Research Collabor ators
The authors of t he article are:
F Ram ( fram@iips.net) (who was with the
International Institute for Population Sciences
or IIPS, Mumbai), B Paswan, S K Singh,
H Lhungdim, Chander Sekhar, Abhishek Singh,
Dhananjay W Ba nsod, Manoj Alagarajan,
L K Dwivedi, Sarang Pedgaonkar, Manas R
Pradhan (from IIPS, Mumbai) and Fred Arnold
from ICF International, United States.
The fourth round of National
Family Health Survey (2015–16) is
discussed with a brief exposition
of the trends in household
environment and sanitation,
fertility, child health and child
mortality, nutrition, health,
and status of women between
2005– 06 (NFHS-3) and 2015–16
(NFHS-4).
The fact sheet of the fourth round of
the National Family Health Survey
(NFHS-4) conducted during 2015–
16, containing some key indicators that
refl ect the country’s present status on
critical population and health indicators,
was released in New Delhi on 1 March
2017 by t he Minis try of Health and Fam-
ily Welfare (MHFW). This article explores
key emerging issues with policy implica-
tions essential to monitor the country’s
progress towards achieving the Sustain-
able Development Goals (SDGs) by 2030,
particularly on population and health.
Four rounds of NFHS (1992 93,
1998–99, 2005–06 and 2015–16) have
been implemented in India under the
aegis of MHFW along with additional
nancial support from international org-
anisations. As in the case of the earlier
rounds, NFHS-4 is conducted by the Inter-
national Institute for Population Scienc-
es (IIPS), Mumbai with technical support
from the ICF International (US), and t he
National AIDS Research Institute (NARI),
Pune, for the human immunodefi ciency
virus (HIV) component.
In order to better understand and
in terpret the fi ndings of the NFHS-4
(2015– 16), it is importa nt to brie y des-
cribe the survey, particularly its scope,
content, and coverage, which is distinc-
tive from previous rounds. For instance,
NFHS-4 for the fi rst time provides district-
level estimates for a number of important
indicators, which necessitated expanding
the sample size nearly sixfold compared
to NFHS-3. The NFHS-3 was conducted in
2005–06, shortly after the National Rural
Healt h Mission (NRHM) was launched.
However, the main objective of NFHS-4
remains to provide essential data on in-
dicators crucial to population and health,
including family welfare and other emerg-
ing issues like non-communicable dis-
eases. Therefore, data of the current round
will be useful in setting a benchmark
and examining the progress in health
sector that the country has achieved
over time. Besides providing evidence
for the effectiveness of the ongoing pro-
grammes, the data will also facilitate in
identifying emerging issues for new
programmes with areas of specifi c focus.
The contents of the previous rounds of
the NFHS are generally retained but ad-
ditional components are added from one
round to another. The new information
included in NFHS-4 relates to malaria
prevention, migration (in the context of
HIV), abortion, violence during preg nancy,
ownership of assets by women, etc.
Besides, the scope of clinical, anthropo-
metric, and biochemical (CAB) testing or
biomarker component is also expanded
to include measurement of blood pres-
sure and blood glucose levels.
Sampling Design and
Survey Instruments
In NFHS-4, a two-stage sampling design
is adopted in the rural and urban areas
of each district of India to provide district-
level estimates. The NFHS-4 interviewed
6,01,509 households, 6,99,686 women,
and 1,03,525 men from 28,583 primary
sampling units (PSU) composed of villages
in rural areas and census enumeration
blocks (CEB) in urban areas spread
across 640 districts of India.
Four survey schedules—household,
woman’s, man’s and biomarker—were
canvassed in local languages using
computer-assisted personal interview-
ing (CA PI) technique. In the household
schedule,
information was collected on
all usual members of the household and
visitors who stayed in the household the
previous night. In addition, information
was collected on the socio-economic char-
acteristics of the household, water and
sanitation, health insurance, number of
deaths in the household in the three years
preceding the survey, etc. Information
on the woman’s characteristics, marriage,
fertility, children’s immunisations and
childcare, nutrition, contraception, repro-
ductive health, sexual behaviour, HIV/
acquired immune defi ciency syndrome
(AIDS), domestic violence, and other
NOTES
Economic & Political Weekly EPW A PRIL 22, 2017 vol lI I no 16 67
important issues was canvassed in the
woman’s schedule. The man’s schedule
covered the characteristics, marriage,
number of children, contraception, ferti-
lity preferences, nutrition, sexual behav-
iour, attitudes towards gender roles, and
HIV/AIDS details of men. The biomarker
schedule covered measurements of hei ght,
weight and haemoglobin levels for chil-
dren; measurements of height, wei ght,
haemoglobin levels, blood pressure, and
random blood glucose level for women
aged 15–49 years and men aged 15–54
years. In addition, women and men were
requested to provide a few drops of
blood from a fi nger prick for laboratory
testing of HIV.
Survey Results
Household Environment
and Sanitation
An important indicator of improved
household environment is the type of
fuel used for cooking. The NFHS-4 reveals
that the percentage of households using
clean fuel for cooking has increased
by 18 percentage points at the national
level between 2005–06 (NFHS-3) and
2015–16 (NFHS-4). The percentage of
households using clean fuel has also in-
creased in most states. The increase
ranges bet ween 42 percentage points in
Tamil Nadu and 1 percentage point in
Meghalaya. Kerala and Punjab also reg-
istered higher impro vements in use of
clean fuel for cooking.
The NFHS-4 shows substantial increase
in the proportion of households using
improved sanitation facilities in India
since 2005–06, by 19 percentage points
at the national level. The increase in the
proportion of households using an im-
proved sanitation facility ranges from a
ma ximum of 39 percentage points in Har-
yana, followed by Himachal Pradesh (34%
points) and Punjab (31% points), to 8 per-
centage points in Kerala and Mizoram
(both states that already had a very high
proportion of households using impro-
ved sanitation facilities in 2005–06).
Maternal Healthcare
The Government of India has launched a
number of programmes like the Janani
Suraksha Yojana (JSY), Ja nan i Shishu
Suraksha Karyakram (JSSK), etc , t o
improve the maternal and child health
in the country in keeping with the SDGs.
NFHS-4 shows some improvement in both
antenatal care and institutional births
compared to NFHS-3.
Antenatal care visits: The proportion
of women who received at least four
antenatal care visits for their last birth
has increased by 14 percentage points at
the national level between 2005–06
and 2015–16. In fact, this proportion
went up in almost all the states with a
substantial part in rural areas compared
to urban areas. The increase is substan-
tial (10–20 percentage points) in 10
states and by more than 20 percentage
points in six states—West Bengal, Chha tti-
sgarh, Himachal Pradesh, Odisha, Assam
and Jammu and Kashmir (J&K). A few
states—Kerala, Goa, Uttarakhand and
Tamil Nadu—registered a decline in the
proportion of women receiving four or
more antenatal visits.
The utilisation of antenatal care varies
signifi cantly by the socio-economic cha-
racteristics of the mothers. For example,
mothers who have completed secondary
or more schooling are far more likely to
avail four or more antenatal visits (68%
versus 28%) than mothers who have no
schooling. The utilisation of antenatal care
also depends on the wealth status of the
household. Mothers residing in lowest
wealth quintile households (bottom 20%)
are far less likely to avail four or more
antenatal visits compared to mothers re-
siding in the highest wealth quintile house-
holds (25% versus 73%). Interestingly, the
utilisation of antenatal care is consider-
ably higher for mothers not belonging to
Scheduled Caste (SC), Sc he duled Tribe
(ST) and Other Backward Classes (OBCs)
compared to the other three groups.
Instit utional delivery: Institutional bir ths
have increased by 40 percentage points
since 2005–06. The Empowered Action
Group (EAG) states and Assam have ex-
perienced more than 40 percentage
point increase in institutional births. A
substantial proportion of institutional
births that took place in a private health
facility were caesarean. Notably, the pro-
portion of caesarean deliveries exceeded
70% in J&K, Telangana, Tripura and
West Benga l.
Institutional births vary considerably
by the mother’s schooling. Of the moth-
ers with no schooling, 62% delivered in
a medical institution. In comparison, 90%
of women who completed secondary
education delivered in a medical institu-
tion. Institutional births is seen to vary
by the wealth status of the household. In
the lowest wealth quintile households,
60% of mothers delivered in a medical
institution as opposed to 95% of moth-
ers residing in the highest wealth quin-
tile households (top 20%).
Fertility and Family Planning
Age at marriage: The NFHS-4 reveals
substantial increase in women’s age at
marriage in India and its states. At the
national level, the proportion of women
aged 20–24 years who got married before
age 18 years has declined by 21 percent-
age points since 2005– 06. Particularly
large declines are noted in Chhattisgarh
(34 percentage points), Rajasthan (30),
Jharkhand (25), Madhya Pradesh (23),
Haryana and Bihar (21 each).
Family planning methods: There is
only a little change in the use of various
methods of family planning in the
country since 2005–06. The contracep-
tive prevalence rate (CPR) has decre ased
by 2 percentage points, and the decline
is noticed in 20 states. Manipur and
Mizoram witnessed maximum decline
(25 percentage points each) with Goa
(22 percentage points). An increase in CPR
is noticed in Punjab, Rajasthan, Odisha,
J&K and Jharkhand.
Sex ratio: For children under six, NFHS-4
shows a minor increase in sex ratio at
birth, from 914 to 919 (female per 1,000
male) at the national level since 2005–06.
It is encouraging to note that the sex
ratio at birth has improved in 14 of
the 30 states of India. The sex ratio at
birth is the highest in Kerala (1,047),
followed by Meghalaya (1,009) and
Chhattisgarh (977), and lowest in Sikkim
(809), D e lhi (817), Ha r yana (836), Punjab
(860), Raj a s than (887) and Uttarakhand
(888).
NOTES
APRIL 22 , 2017 vol lII no 16 EPW Economic & Political Weekly
68
Total fertility rate: At the national
level, fertility has declined from 2.7
children per woman to 2.2 children per
woman since 2005–06. There has been
a considerable decline in total fertility
rate (TFR) in all the 30 states of India.
The maximum decline in TFR is obser ved
in Uttar Pradesh (1.1), followed by Naga-
land (1.0), Arunachal Pradesh and Sik-
kim (0.9 each) and Rajasthan, Madhya
Pradesh and Meghalaya (0.8 each). The
level of fertility declined by 0.5 children
per woman between 2005–06 and
2015–16. Overall, the TFR has declined
by 1.2 children per woman between
1992–93 (NFHS-1) and 2015–16.
Child Health and Nutrition
Immunisation is one of the most cost-
effective public health interventions to
prevent a series of major illnesses among
children and is responsible for improv-
ing nutritional status. NFHS-4 provides
detailed information on child health
based on children born in last fi ve years
preceding the NFHS-4.
Childhood vaccinations: At the na-
tional level, the percentage of children
aged 12–23 months who are fully immu-
nised (one dose of Bacillus Calmette–
Guérin (BCG), three doses of diphtheria,
pertussis and tetanus (DPT) vaccine,
and one dose of measles vaccine) incre-
ased by 18 percentage points from 44%
in 2005–06 to 62% in 2015–16. The
percentage of children who are fully
vaccinated ranges between 36% in
Nagaland and 89% in Punjab. The cover-
age of full immunisation has improved
since 2005–06 in all states except
Haryana, Tamil Nadu, Uttarakhand,
Maharashtra and Himachal Pradesh.
Full immunisation coverage has incre-
ased substantially in Punjab, Bihar and
Meghalaya (29 percentage points each),
followed by Rajasthan, Uttar Pradesh,
Jharkhand and Chhattisgarh (28), Odisha
(27) and West Bengal (20).
Full immunisation coverage varies
substantially by socio-economic groups.
Of children with unschooled mothers,
52% are fully immunised, as against
67% of children with mothers who have
com pleted secondary schooling. Among
the STs, 56% children rece ived full
vaccination compared to 62%–64% of
children of other castes. The coverage of
full vaccination increases with incre asing
wealth status of household—63% of
children from those in the lowest wealth
quintile households are fully vaccinated
compared to 80% of children from house-
holds in the highest wealth quintile.
Anaemia: Anaemia is characterised by
a low level of haemoglobin in the blood,
and is a major health problem in children
in developing countries. The NFHS-4
sho ws substantial decline in the preva-
lence of anaemia in children aged 6–59
months in India, down from 69% in
2005–06 to 58% in 2015–16. However,
the prevalence of anaemia is particularly
high in several states. It ranges from as
high as 72% in Haryana, followed by
70% in Jharkhand, 69% in Madhya
Pradesh and 64% in Bihar, to 18% in
Mizoram, followed by 22% in Nagaland,
and 24% in Manipur. In 19 out of 30
st ate s in I ndia , ov er ha lf of childr en ag ed
659 months are anaemic. It is worth
noting that there has been a considerable
decline in the prevalence of childhood
anaemia since NFHS-3, with the maxi-
mum decrease in Assam (34 percentage
points), followed by Chhattisgarh (30),
Mizoram (26) and Odisha (20). A decline
of 10 or more perce ntage point s i n chi ld-
hood anaemia is noted in 10 states
during this period.
Breastfeeding: In the past one decade,
the percentage of children under three
years who are breastfed within one hour
of birth has increased substantially at the
national level (by 19 percentage points).
The proportion has also increased
considerably in almost all the states of
India. However, the current levels are
stil l quite low in many s tates like Del hi,
Punjab, Raj asthan, Uttar Pradesh and
Uttarakhand, where less than one-third
of children are breastfed within an
hour of birth.
Malnutrition in children: The data on
the nutritional status of children are
colle cted by measuring the height and
weight of all the children under fi ve
years in the surveyed households. The
NFHS-4 shows that the percentage of
children under fi ve years who are stunted
and underweight has declined in India
(by 10 and 7 percentage points respec-
tively) and in all the states of India since
2005–06, showing improvement in the
nutritional status of the children. The
maximum decline in stunting is found
in Chhattisgarh (15 percentage points),
followed by Arunachal Pradesh (14),
Gujarat (13), Himachal Pradesh, West
Bengal, Maharashtra, Mizoram and
Haryana (12 each), and Tripura, Megha-
laya, Punjab, Odisha, Uttarakhand and
Uttar Pradesh (11 each). The decline is
lowest in Tamil Nadu (4), Jhar khand,
Rajasthan, Kerala and Goa (5 each). The
maximum decline in the percentage of un-
derweight children is found in Megha-
laya (20 percentage points), Madhya
Pradesh (17), Tripura (16) and Himachal
Pradesh (15), Arunachal Pradesh (13)
and Bihar (12). The smallest decline is
noted in Maharashtra and Goa (1 per-
centage point each), followed by Karna-
taka (2), and Uttar Pradesh, Punjab and
Raja s t han ( 3 eac h).
Stunting and underweight vary consid-
erably by mother’s schooling and wealth
stat us of households. Of children of moth-
ers with no schooling, 51% are stunted
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Economic & Political Weekly EPW A PRIL 22, 2017 vol lI I no 16 69
compared with 31% of children whose
mothers have secondary (or more) sch oo-
ling. Likewise, 47% of children of mothers
with no schooling are underweight com-
pared to only 29% of children of mothers
having secondary (or more) schooling.
The prevalence of stunting and under-
weight is highest in children of SC and ST
mothers compared to their counterparts.
The level of stunting and underweight
are highest in children residing in lowest
wealth quintile households.
Infant mortality rate: The infant mortal-
ity rate (IMR) in India has declined from
57 per 1,000 live births to 41 bet ween
2005–06 and 2015–16. IMR has decreased
substantially in almost all the states dur-
ing this period. IMR has dropped by more
than 20 percentage points in Tripura,
West Bengal, Jhar khand, Aru n achal
Pradesh, Raj asthan, and Odisha.
Non-communicable Diseases
Due to the ongoing demographic and epi-
demiological transitions in the country,
India is currently experiencing a major
shift in disease pattern. The prevalence
of non-communicable diseases is incre-
asing and the prevalence of communica-
ble diseases is decreasing. For the fi rst
time in the NFHS series, NFHS-4 meas-
ured blood pressure and random blood
glucose of eligible men and women resi-
ding in sampled households using port-
able devices. Likewise, NFHS-4, for the
rst time in the NFHS series, collected
information on tobacco and alcohol con-
sumption by eligible adult men and
women. Like in the previous rounds of
the survey, NFHS-4 measured the height
and weight of eligible men and women
in the sampled households.
Tobacco use: Smoking and use of smoke-
less tobacco, which is one of the leading
causes of cancer among adult men and
women in India, has declined substan-
tially in India since the previous round
of survey. At the national level, use of
any kind of tobacco among men aged
15–49 years declined from 57% to 45%
bet ween 2005–06 and 2015–16. Among
men, the maximum decline in use of
an y ki nd of tobac co is reported i n Sikkim
(22 pe rcen tage points) followed by Kerala
(18) and Bihar (16). The decline in the
prevalence of use of any tobacco among
men is the least in Arunachal Pradesh and
Mizoram (3 percentage points each).
Notably, the prevalence of any tobacco
use among men has increased since NFHS-
3 in Megh alaya, Nagaland, Manipur and
Himachal Pradesh (1–3 percentage
points). Only 7% of women use any type
of tobacco in NFHS-4, down from 11%
in NFHS-3.
High blood glucose: The prevalence of
very high blood glucose levels (more
than 160 mg/dl) in India is 4% for men
and 3% for women aged 15–49 years.
The highest prevalence among men is
found in Goa (7%), followed by Kerala,
West Bengal, Odisha and Tamil Nadu
(6% each). The prevalence of high blood
glucose among adult women aged 15–49
years is lower than that for adult males
in all the states of India. Statewise varia-
tion in prevalence of very high blood
glucose among women aged 15–49 years
reveals a similar pattern with higher
prevalence in Goa and Kerala (5% each),
followed by Delhi, Tripura, Tamil Nadu
and Mizoram (4% each).
Hypertension: Hypertension is consid-
ered as a precursor of cardiovascular
disease. According to NFHS-4, 2% of
women and 3% of men aged 15–49 years
have moderately high or very high lev-
els of hypertension. The prevalence of
moderately high and very high hyper-
tension among men aged 15–49 years is
considerably higher in Nagaland (6%),
Telangana and Arunachal Pradesh (6%
each), and Andhra Pradesh, Assam,
Himachal Pradesh and Mizoram (5%
each). The prevalence of hypertension
among men is lowest in Delhi (1%). The
estimated prevalence of hypertension
among adult women aged 15–49 years is
lower than that of men in all the states
of India, except Meghalaya and Delhi.
Among women, the prevalence of
moderately high or very high levels of
hypertension is highest in Nagaland
(6%), Sikkim and Arunachal Pradesh
(5% each), and Assam (4%).
Overweight and obesity: Being over-
weight or obese increases vulnerability
to various non-communicable diseases/
illness. The prevalence of being over-
weight or obese among men and women
aged 15–49 years has increased in India
and all its states between 2005–06 and
2015–16.
Among women aged 15–49 years, it
has increased by 8 percentage points
(from 13% in NFHS-3 to 21% in NFHS-4),
and is highest in Delhi (35%), followed
by Goa (33%), Kerala (32%), Punjab and
Tamil Nadu (31% each). It is lowest in
Jharkhand (10%), followed by Bihar,
Chhattisgarh and Meghalaya (12% each),
Assam (13%), Madhya Pradesh and Raja-
sthan (14% each). It has increased by 15
percentage points in Himachal Pradesh,
which is the highest, followed by Goa
and Manipur (13 each).
The prevalence of being overweight
or obese among men aged 15–49 years has
doubled from 9% in 2005–06 to 19% in
2015–16 in India, and is the highest in
Sikkim (35%), followed by Goa (33%),
Kerala (29%), Tamil Nadu and Punjab
(28%). Overweight and obesity are lowest
in Meghalaya and Chhattisgarh (10%),
followed by Madhya Pradesh and
Jhar khand (11% each); and Uttar Pra desh,
Bihar, Assam, and Rajasthan (13% each).
Over the last decade, Sikkim has experi-
enced the highest increase of 23 percent-
age points in the prevalence of over-
weight or obesity among men, followed
by Goa (17 percentage points), J&K,
Arunachal Pradesh and Tamil Nadu (14
percentage points each).
Empowerment of Women
An important indicator of women’s em-
powerment is whether women have a
bank account or a savings account that
they themselves use. The percentage of
women aged 15–49 years having a bank
or savings account that they operate has
increased by 38 percentage points since
2005–06. The proportion of such women is
highest in Goa (83%), foll owed by Tamil
Nadu (77%), Kerala (71%), Himachal
Pradesh (69%), and Delhi (64%). Since
2005–06, the maximum increase is no-
ticed in Tamil Nadu (61 percentage points),
followed by Raja sthan (51), Mizoram (49),
Himachal Pradesh (47), Odisha (46),
Punjab (44), and Kerala (44). The smallest
increase in the proportion of women
NOTES
APRIL 22 , 2017 vol lII no 16 EPW Economic & Political Weekly
70
having a bank or saving account that
they themselves operate is in Bihar (18
percentage points), Maharashtra (25),
Manipur (27), and Madhya Pradesh (28).
The NFHS-4 shows substantial incre ase
in the proportion of women who partici-
pate in household decision-making. Bet-
ween 2005–06 and 2015–16, the percent-
age of currently married women who
usually participate in household deci-
sions has increased considerably in India
(by 7 percentage points), and across all
states, with over 80% of women report-
ing that they participate in household
decision-making. This is true for all
states except Har yana (77%), Bihar (75%),
and Delhi (74%).
The NFHS-4 shows a small decrease in
the proportion of ever-married women
aged 15–49 years reporting spousal phy-
sical or sexual violence. Spousal violen-
ce decreased by 4 percentage points,
from 33% to 29%, at the national level,
and declined in all states except Megha-
laya, Delhi, Manipur, Chhattisgarh and
Haryana. The decline in spousal violence
is highest in Rajasthan (21 percentage
poi n ts), followed by Tripura and Bihar
(16 percentage points each) and Assam
and Uttarakhand (15 percentage points
ea ch).
Key Policy Concerns
The NFHS-4 data shows considerable im-
provements in the key indicators of popu-
lation and hea lth i n Ind ia. However, there
are a number of pressing issues which the
policymakers and progra mme managers
must take note of. In spite of implementa-
tion of the Swac hh Bharat A bhiyan by the
Government of India, many states still
lack basic household sanitation, improved
sou rce of drinki ng water, and use of clean
fuel, which have direct linkages with
health of women and children.
With respect to maternal healthcare
conditions, a substantial improvement is
refl ected in the last one decade. However,
tremendous inequality by wealth and so-
cial groups still prevails. The use of mod-
ern methods of contraceptives has rem a-
ined almost unchanged at the national
level and declined in a number of states.
Hence, there is a need to reposition family
planning programme with special focus
on modern spacing methods.
There has also been a sizeable impro-
vement in childhood vaccinations among
children under fi ve years. However,
the percentage of children not getting
the recommended doses of vaccinations
varies considerably across states and
among socio-economic groups. In par-
ticular, about half of the children of STs
did not receive the recommended child-
hood vaccinations. The current level of
initiation of breastfeeding within an
hour is still quite low, despite a remark-
able increase in institutional deliveries
across the states. Although there is a
decline in malnutrition among children
below age fi ve during the last decade,
the levels are still considerably high,
parti cularly in certain socio-economic
groups.
The NFHS-4 results illustrate that
India has made considerable progress
in many domains, yet there are grey
areas that need further attention. In
particular, the pervasive inequality
among socio-economic groups is a
matter of great concern, and needs at-
tention if India aims to achieve the
SDGs by 2030.
Review of Rural Affairs
January 7, 2017
Making Pulses Affordable Again: Policy Options from the Farm to Retail in India – P K Joshi, Avinash Kishore, Devesh Roy
Reconsidering Women’s Work in Rural India: Analysis of NSSO Data, 2004–05 and 2011–12 – Mohammed Zakaria Siddiqui,
Kuntala Lahiri-Dutt,Stewart Lockie, Bill Pritchard
Making Smallholder Farming Climate-smart: Integrated Agrometeorological Services – Crispino Lobo, N Chattopadhyay, K V Rao
Understanding Open Defecation in Rural India: Untouchability, Pollution, and Latrine Pits – Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears,
Nikhil Srivastav, Sangita Vyas
Energy, Gender and Social Norms in Indigenous Rural Societies – Govind Kelkar, Dev Nathan, Patricia Mukhim,
Rosemary Dzuvichu
‘Do Only Girls Suffer? We Too!’ Early Marriage Repercussions on Boys in Rural India – Aparna Mukherjee, T V Sekher
Transitions in Rice Seed Provisioning in Odisha: Constraints and Reform Agenda – Sushil Pandey, Debdutt Behura, Maria Lourdes Velasco
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... 3,4 In India, anaemia in children aged 6-59 months was recorded at 58% in the National Family Health Survey 2015-2016. 5 Russia has no current survey data on child, adolescent and/or adult anaemia prevalence despite the country reporting challenges with iron deficiency disorders. 6 From the afore-mentioned BRICS countries, only India report anemia prevalence among adolescent males and females, while South Africa reports adolescent anaemia only in the [15][16][17][18][19] year age group and iron deficiency in females only. ...
... The NFHS-4 shows a substantial decline in anaemia between the age of 6-59 months in children, down started 69% in 2005-2006 to 58% in 2015-2016. 5 Anaemia prevalence in children between the ages of 6-59 months has been persistently higher among rural children. 3-Similarly, the NFHS 4 (2015-16) reveals that anaemia is more prevalent among children than among older children. ...
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Anemia prevalence, especially among children and adolescents, is a serious public health burden in the BRICS countries. This article gives an overview of the current anaemia status in children and adolescents in three BRICS countries, as part of a study that utilizes an artificial intelligence approach for analyzing anaemia prevalence in children and adolescents in South Africa, India and Russia. It posits that the use of machine learning in this area of health research is still novel. The weightage assessment of the crosslink between anaemia risk indicators using a machine learning approach will assist policy makers in identifying the areas of priority to intervene in the BRICS participating countries. Health interventions utilizing artificial intelligence and more specifically, machine learning techniques, remains nascent in LMICs but could lead to improved health outcomes.
... hypertension among males and 8.8% hypertension among females aged 15-49 and 15-54 respectively (Ram et al., 2017). Hypertensive diseases of pregnancy (HDP) precede 10% of early neonatal deaths and a significant fraction of late neonatal deaths (Lawn et al., 2014). ...
Thesis
This research is not only required for partial fulfilment of my degree, but also for a valuable contribution in the field of women health. The post pregnancy health informations were very scanty and literature about its relationship with reproductive outcome was far from my sights. Here, I considered cardiometabolic risk factors as a post pregnancy health issue to have a better insight into various lifestyle factors explaining pregnancy outcomes. Several polices and government plans are in action since past few decades but not seems to achieve their target so efficiently. Since, post pregnancy period is also very important for a child growth and development so, it must not be overlooked. Cardiac diseases still hold the top position for causing maximum numbers of deaths worldwide. The current outgrowth of Indian population is undergoing through epidemiological and demographic transition which is affecting the range of population.
... The key indicators include infant and child mortality rates, maternal and child health, child immunization and vitamin A supplementation, child feeding practices, nutritional status and many more. . 24 As per the analysis of NFHS-4, infant mortality rate (IMR) has reduced from 57 to 41 per thousand live births and a higher reduction has been seen in under-5-mortality rate from 74 to 50 per thousand live births. The state with the highest IMR was Uttar Pradesh (64 per 1000 live births) and that with the lowest IMR was Kerala (6 per 1000 live births). ...
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The government of India introduced mission Indradhanush (MI) to strengthen the routine immunization planning and delivery mechanism. It was launched on 25th December 2014 with an objective to achieve more than 90% full immunization (FI) coverage in the country. To evaluate universal immunization coverage, barriers encountered for not achieving the target and problem solving in removing the barriers. PubMed and google scholar were used to search the relevant articles. PRISMA tool was used for the review process and for in­clusion of potential articles. The studies conducted in Manipur, Madhya Pradesh, Bihar and south Kerala reported successful achievement of MI goal. The minimum FI percentage was 57% and the maximum was 96.4%. The most common reason for not achievement of the goal was lack of awareness, illiteracy, child illness, fear of adverse effects.
... For the first time, this survey also determined prevalence of hypertension among young and middle-aged men and women in India using a representative sampling across the country [2]. The survey was performed in urban and rural areas of the country [22]. A uniform sampling method was adopted in all districts of the country. ...
Article
Hypertension is the most important risk factor for chronic disease burden in India. Studies from various parts of India have reported high prevalence of hypertension. These studies have also reported that hypertension is increasing and there is low awareness and control. Two recent studies have been conducted with uniform tools and nationwide sampling to determine the true prevalence of hypertension in the country. Fourth National Family Health Survey evaluated hypertension in a large population based sample (n = 799,228) and reported hypertension in 13.8% men vs. 8.8% women (overall 11.3%) aged 15–49 and 15–54 respectively. More representative data (age > 18 years, n = 1,320,555) in Fourth District Level Household Survey reported hypertension in 25.3% with greater prevalence in men (27.4%) than women (20.0%). This translates into 207 million persons (men 112 million, women 95 million) with hypertension in India. Prevalence would be much higher using 2017 American guidelines. Global Burden of Diseases study reported that hypertension led to 1.63 million deaths in India in 2016 as compared to 0.78 million in 1990 (+108%). The disease burden (DALYs) attributable to hypertension increased from 21 million in 1990 to 39 million in 2016 (+89%). Social determinants of hypertension are important and Indian states with greater urbanization, human development and social development have more hypertension. There is poor association of hypertension prevalence with healthcare availability although there is positive association with healthcare access and quality. The health system in India should focus on better hypertension screening and control to reduce cardiovascular morbidity and mortality.
Chapter
The dimensions of ageing research and the challenges senior citizens in India face form the rationale behind both the present study and the significance of this book in the contemporary world, particularly in the midst of the vast knowledge of geriatric research. Specifically, the awareness of the plight of senior citizens and the major data sources available in the country regarding this segment of the population are the two aspects explored in this chapter. The gaps in the present knowledge pool and the ways to plug some of these loopholes using the information available are also discussed. Finally, a brief description of the contents of the book is enclosed to convey a comprehensive idea of the work.
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Objective To determine trends in ischemic heart disease (IHD) mortality and burden among women in India we performed a study. Methods Data were obtained from three publicly available resources. Cardiovascular disease (CVD) and IHD mortality were obtained from 2017 Global Burden of Diseases (GBD) Study. Metabolic risk factor data (body-mass index, blood pressure and diabetes) were obtained from Non-Communicable Disease Risk Factor Collaboration (NCDRiSC) and lifestyle factors were obtained from National Family Health Surveys (NFHS). Descriptive statistics are reported. Results GBD study reported that in year 2017 in India CVD caused 2.64 million deaths (women1.18, men1.45 million) and IHD 1.54 million (women0.62, men0.92 million). Burden of IHD related disability adjusted life years (DALYs) was 36.99 million (women13.80, men23.19 million). From 2000 to 2017 annual IHD mortality increased from 0.85 to 1.54million (+81.1%) with greater increase in women 0.32 to 0.62million (+93.7%) compared to men (0.53 to 0.92million, +73.6%). Increase in age-adjusted IHD mortality rate/100,000 was also more in women (62.9 to 92.7, +47.4%) than men (97.5 to 129.5, +32.8%). Trends in cardiometabolic risk factors from 2000 to 2015 showed greater increase in body-mass index, diabetes, tobacco-use and periodontal infections among women than men. Conclusion IHD is increasing more rapidly among women than men in India and there is gender-related convergence. This is associated with greater increase in overweight, diabetes, tobacco use and periodontal infections in women.
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Background and objectives: Hypertension is an important disease of public health concern. Awareness and medication adherence with diet modification have an important effect on the control of blood pressure and its associated morbidity and mortality. Therefore, this study was conducted to assess the awareness of hypertension, medication adherence, and dietary pattern in hypertensive population of western Rajasthan. Materials and methods: The study was hospital based cross-sectional. Blood pressure measurements were taken in a sitting position in right arm after a 5-min rest using nonmercury sphygmomanometer and required cuff size. A prevalidated and pretested questionnaire for the assessment of awareness of hypertension was used. Results: Out of the total 384 patients, the majority of the patients were males (62.5%). There was a statistically significant difference found in awareness of hypertension among rural and urban patients. Nonadherence to antihypertensive medications was seen more in males (60.0%) as compared to females (40.0%). The most common reason for nonadherence was found to be forgetfulness (27.6%) followed by poor knowledge about the hypertension and ignorance of long-term treatment (22.9%). Out of the total hypertensive patient studied, 54.9% were taking normal salt intake and 45.1% of the subjects were found to be taking excess intake of salt. Interpretation and conclusions: In the present study, good awareness about hypertension was found with urban patients. Among all the variables, education and employment status showed a positive and significant association with awareness. The most common reason of poor adherence was found to be forgetfulness behavior followed by poor knowledge and lack of awareness about hypertension.
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The chapter addresses a unique technique of school-wide behaviour management in education. The findings are generated from a pilot project that was implemented at a public girls' school as a novel strategy to address indiscipline, rampant riots and unrest by students in public secondary schools in Kenya.
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Purpose of review: Hypertension is the most important noncommunicable disease risk factor in India with an estimated burden of 200 million persons. Nationwide studies and meta-analyses have reported increasing prevalence. We summarize unique features of hypertension in India. Recent findings: Two recent nationwide studies to determine hypertension prevalence have been performed-Fourth National Family Health Survey and Fourth District Level Health Survey/Annual Health Survey. Age-adjusted hypertension was more in men (24.5%) than women (20.0%). Hypertension is more common in developed states of the country, urban populations and better socioeconomic status individuals. Urban-rural convergence and greater hypertension in younger men and women are unique findings. There is low status of its awareness, treatment and control. Diabetes prevalence is high in hypertension suggesting importance of insulin resistance. Prevalence of resistant hypertension is high. Pharmacoepidemiology studies have reported widespread use of all classes of antihypertensive drugs with increasing use of renin-angiotensin system blockers. There are limited studies focused on genetic epidemiology. Summary: Hypertension is widely prevalent in India with large regional variation, greater prevalence in urban areas and the young. Treatment and control status are low. Diabetes is important comorbidity and resistant hypertension is frequent. There is widespread use of newer antihypertensive drugs.
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The Sustainable Development Goals (SDGs) are increasingly being used to measure developmental progress among and within countries. Achieving the health-related SDGs remains a primary concern of many developing countries. This study measured the progress in selected health-related indicators of SDGs in the states of India by social and economic groups, and predicted their likely progress by 2030. The health indicators analysed included health outcomes, nutrition, health care utilization and determinants of health. Data from the Census of India, Sample Registration System (SRS), National Family and Health Surveys (NFHSs) and National Sample Survey Organization (NSSO) were used in the analysis. Annual rate of progress (ARP) and the required rate of progress (RRP) were computed for selected indicators over the period 2005–06 to 2015–16. A Composite Index of Health (CIH) was used to understand the state of health of populations. The ARP was higher than the RRP in maternal care and reduction of under-five mortality, while ARP was lower than the RRP in undernutrition and sanitation. The ARP for health-related indicators showed a mixed pattern across religion and caste groups. The ARP for medical assistance at birth and immunization was highest among Scheduled Castes and that for reduction of under-five mortality was highest among Scheduled Tribes. The CIH was lowest in Uttar Pradesh (0.26) and highest in Goa (0.81). The association between the CIH and the Human Development Index (HDI) was significant, suggesting interlinkage between health and development. Notable improvements were observed in maternal and child health and maternal health care utilization across social groups in India over the period 2005–06 to 2015–16, and if the trends continue the country can achieve the SDG target in maternal health by 2030. However, progress in nutrition and other health indicators has been slow and uneven.
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