Endowments or Returns to Endowments or Both? Deciphering Disparities in Childhood Stunting in Bihar, India

Clinical prediction rules could help identify children at risk of slowed growth after an episode of diarrheal illness, and these rules may be generalizable to all children, regardless of diarrhea status.

BackgroundCaste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth.MethodsA cross-sectional analysis of National Family Health Survey (NFHS) data of 43,484 children aged 6–59 months was performed. Poisson regression analysis was conducted to study the association between caste and childhood anemia accounting for various maternal, child, and household related variables. Caste was categorized as “other caste” (least disadvantageous), “other backward caste”, “scheduled tribe” and “scheduled caste” (most disadvantageous). Anemia was defined as mild (hemoglobin level 7-11 g/dL), moderate (hemoglobin level 5-7 g/dL) and severe (hemoglobin level <5 g/dL).ResultsWe found that children in scheduled caste had higher risk of having anemia [mild anemia: RR = 1.10, 95 % CI = 1.05-1.15; moderate anemia: RR = 1.19, 95 % CI = 1.14–1.24; severe anemia: RR = 1.87, 95 % CI = 1.51 – 2.31] after accounting for child, maternal and household covariates including adult education and household wealth. The interaction of caste with adult education and household wealth was not statistically significant for any level of anemia. Sensitivity analyses for children born to mothers of age ≥ 18 years at first child birth and body mass index (BMI) ≥ 18.5 kg/m2, resulted in similar findings.ConclusionCaste is an independent determinant of childhood anemia in India. The level of adult education and household wealth did not modify the association between caste and childhood anemia. The findings may be used for countering childhood anemia and it may be beneficial to target future public health actions towards disadvantageous castes in India.

Stunting is highly prevalent in Indonesian children. The objective of this study was to identify the associations of stunting with morbidity, parental education and socioeconomic status (SES) in Indonesian children. The study population was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 2236 Indonesian children aged 0.5 to 12 years, who had participated in the SEANUTS, were included in this study. Stunting was defined as height for age Z-score (HAZ) ≤ −2 using WHO criteria and severe stunting as HAZ ≤ −3. Information on morbidity, parental education and family SES were collected by structured questionnaires. ANOVA was used for evaluating differences across groups, with or without correction for confounders. The results showed that the overall prevalence of stunting was 31.4%. HAZ in stunted children was associated with disease incidence, including frequency, parental education and family income. There were no significant differences in HAZ values in stunted children with one or more bouts of infectious, digestive tract or respiratory tract illnesses compared to stunted children with no reported illness. The prevalence of stunting in Indonesian children was high and was strongly associated with child morbidity, parental education and SES.

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

Aim:This study aimed to develop a transparent district-level Maternal and Child Health (MCH) index for Uttar Pradesh (UP), India, using a hybrid methodological framework integrating Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), and Geographic Information Systems (GIS), to support spatially targeted and equitable health planning.Background:MCH is a key indicator of equity and effectiveness within health systems, directly impacting the wellbeing of mothers and children. Despite global efforts, many low-and middle-income countries continue to face preventable maternal deaths and child illnesses. In Uttar Pradesh (UP), substantial inter–district disparities in MCH outcomes persist but are often masked by state-level averages, hindering targeted policy and resource allocation.Methods:We applied a hybrid Multi-Criteria Decision-Making (MCDM) framework. AHP was used to assign weights to nine key MCH indicators covering antenatal care, skilled birth attendance, child immunization, and nutrition based on National Family Health Survey (NFHS-5, 2019–21) data across 75 districts. TOPSIS was then employed to rank districts by overall MCH performance. GIS was used to visualize spatial disparities and identify clusters of high and low performance.Findings:The MCH Index revealed substantial spatial disparities across UP. Districts such as Barabanki, Mahamaya Nagar, and Unnao ranked highest, while eastern UP and Bundelkhand showed lower performance. AHP assigned the highest importance to skilled birth attendance (22%) and antenatal care visits (22%). TOPSIS rankings highlighted gaps in maternal health services in socioeconomically marginalized districts. GIS mapping identified clusters of vulnerability linked to infrastructure and poverty. The AHP-TOPSIS-GIS framework provides a replicable method for sub-state MCH assessment, enabling policymakers to prioritize underserved districts and reduce geographic health outcomes. The findings underscore the need for decentralized, equity-focused strategies tailored to local contexts. Future research should incorporate temporal changes and socio-environmental factors to strengthen planning and monitoring.

Though, fertility is a biological phenomenon but it depends heavily on socioeconomic, demographic and cultural factors; therefore, this article describes a regression technique to estimate the TFR under dierent proposed model assumptionsand the effects of socioeconomic and demographic factors on TFR as well. The developed methodology also leads to estimate the number of births averted due to the use of family planning methods and percent of increase in births in the absence of birth control devices for 29 states of India using three different methods of births aversion through the National Family Health Survey (NFHS-III) data. The finding shows that there is a variation in number of births averted and percent of increase in births in the absence of family planning methods at the state level in India. The effective use of contraception and maximum number of births avoided due to use of family planning is in Maharashtra and Uttar pradesh. Highest percent of increase in births in the absence of contraception is in Himachal Pradesh and Andhra Pradesh

This study investigates under-five mortality (U5M) dynamics in Odisha using National Family ‎Health Survey (NFHS) data through five models incorporating socio-economic, environmental, ‎demographic, nutritional, and media variables. Employing the Cox Proportional Hazard model ‎facilitates time-to-event analysis, accommodating censored observations and handling multiple ‎covariates. The model's assumption of proportional hazard ratios over time suits the study of ‎U5M, a time-dependent event. Table 1 presents hazard ratios from NFHS-4 to NFHS-5, ‎revealing evolving trends in U5M risk factors. Significant contributors include maternal ‎education, with hazard ratios decreasing across education levels, indicating improved ‎associations with U5M in NFHS-5. Rural areas exhibit consistently higher hazard ratios, while ‎wealthier households show potential rises in U5M risk. Varied impacts on U5M risk emerge for ‎birth-related factors. These findings underscore the changing landscape of U5M risk factors in ‎Odisha, offering a foundation for evidence-based policymaking to address evolving socio-‎demographic dynamics impacting child survival in the region‎.

Approximately 6 million neonatal deaths occur globally, with approximately 99 percent of them occurring in developing countries. This study is an attempt to examine the prevalence and influence of non-biological factors on perinatal mortality in India. National Family Health Survey (2015-2016) data and bivariate and multivariate techniques have been used to fulfill the aforesaid objectives. Findings suggest that approximately 47 perinatal deaths occurred per 1,000 pregnancies lasting seven or more months during the last five years preceding the survey in Uttar Pradesh. Parental education, wealth status, variables related to pregnancy and delivery, mother's demographic factors, mother's height, and child characteristics have shown significant impact on perinatal mortality. For a policy point of view, more emphasis is needed on quality of care of National Health Mission (NHM) strategy at times of greater risk-that is, birth and the first few days of life-which could be the way forward for reducing high perinatal deaths.

The objective of the current study was to estimate the self-reported individual-level crude prevalence and cluster-level adjusted prevalence of TB for the districts of Tamil Nadu and to understand the spatial distribution of TB cases through spatial autocorrelation and hotspot analysis. National Family Health Survey (NFHS) data, gathered during 2014-2015 (NFHS-4) and 2019-2021 (NFHS-5), were used in the current study to estimate district-wise, individual-level crude and cluster-level adjusted TB prevalence per 100 000 population in Tamil Nadu. This was illustrated with the help of spatial geographic representation for various districts of Tamil Nadu using SPSS and QGIS software. The spatial autocorrelation and hotspot analysis were performed using Geoda software. The overall self-reported individual-level crude prevalence of TB was 337 (95% CI 302 to 375) and 169 (95% CI 144 to 197) per 100 000 population, whereas the cluster-level adjusted prevalence of TB was 356 (95% CI 311 to 405) and 184 (95% CI 154 to 219) per 100 000 population in NFHS-4 and NFHS-5, respectively. This study highlights those geographical areas with high rates of TB prevalence. This information would be useful for the state and district programme managers to identify areas of high TB prevalence where interventions can be focused.

Health impact evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

Universalisation versus targeting in maternal and child health care provisioning: Evidence from India.

Introduction: Infant mortality rate (IMR) is interplay of several sociodemographic factors. There are several scopes for policymakers to bring IMR down by improving those factors. An ecological analysis was performed, with the aim to identify such factors. Methods: Data were taken from nationally-representative National Family Health Survey 4 (2015–2016). Correlation was used for the analysis. States were compared individually and in groups. Results: Female literacy (r = −0.639), improved sanitation (r = −0.604), and clean fuel (r = −0.463) were significantly related to IMR. States belonging to the Empowered Action Group performed poorly in terms of infant death and basic amenities provided to the citizens. Conclusion: Efforts should be made to improve household environments to reduce infant deaths in future.

BackgroundMaintaining an appropriate gap between childbirths is essential for promoting the health of both the mother and the child. This practice lowers the risk of adverse maternal and child health outcomes. Inadequate birth spacing is a multifaceted issue linked to increase infant mortality and has the potential to impact the health and demographic landscape of the nation. This study aims to assess the prevalence of short birth spacing (SBS) in association with demographic and socio-economic factors in India with special reference to maternal and child health.MethodsThis study investigated SBS in India using a cross-sectional design and data from the National Family Health Survey (NFHS-5). The analysis included data from 636,699 households, encompassing 724,115 women and 139,660 birth intervals. The primary outcome was SBS, and secondary outcomes included maternal undernutrition, full antenatal care (ANC), low birth weight (LBW), infant mortality, and child mortality. The analysis incorporated demographic and socio-economic variables as explanatory factors for SBS. Data analysis was conducted after checking its normality. The data characteristics were summarised and analysed using descriptive and inferential statistics.ResultsIn India, SBS is more prevalent (50.8%) with a median of 32 months. Bihar and Andhra Pradesh have shortest spacing (27 months), while Lakshadweep has longest (63.9 months). The Central zone has highest SBS prevalence (53.8%), especially in rural areas (55.9%). SBS is significantly associated with lack of maternal education, younger maternal age, unwanted pregnancies, larger families, and poor wealth index. Additionally, it is found that the explanatory variables have a significant impact on SBS, with area under the curve (AUC) covering 68% to 71% (p < 0.001). Furthermore, SBS has a detrimental effect on maternal and child health as secondary outcomes.ConclusionThis study emphasizes the substantial influence of socio-demographic factors on the practice of SBS. It is crucial to provide educational programs for mothers that focus on the importance of birth spacing and using family planning services. The study highlights the need to implement economic development initiatives within families to address the factors contributing to inadequate birth spacing. These measures enhance maternal and child health and align with the SDGs in India.

While malnutrition remains an important public health concern in poor countries, particularly among the rural and urban poor, overweight and obesity are emerging as important public health concerns for urban individuals. Globalization of the fast food industry and shifts in physical activity patterns in urban areas can result in different risks for overweight and obesity by socioeconomic status and sex for urban and rural residents. We examined Indian National Family Health Survey data, focusing on the association between urban residence and gains in body mass index among women (ages 15–49) in two survey rounds. We constructed multivariate models to assess the individual-level variation in BMI and the likelihood of becoming overweight or obese, finding that urban living is strongly associated with gains in BMI among women in India. Large cities have the highest proportions of overweight and obese women while spatial regression results suggest spatial clustering of higher BMIs in urbanized areas districts. Urban clustering of overweight and obesity may predict the future burden of chronic diseases for India but will benefit from further evaluation based on finer resolution data.

Background Adequate attention to family planning can not only reduce poverty and hunger in countries with high birth rates but also avert maternal and childhood deaths. Kerala, the southernmost state of India, has achieved its replacement level fertility rate far ahead of India. The study aims to analyze the contraceptive prevalence of the state over the years and also at the district level and the choices of different family planning methods in the state. Methodology This study is a secondary data analysis using the available information from the National Family Health Survey (NFHS) available from “The demographic health survey program’s data distribution system.” Results The contraceptive prevalence rate (CPR) of Kerala showed an initial increase followed by a sudden fall by more than 10% in 10 years period during the 2015 survey, thereafter stabilized in 2019. Among the modern contraceptive methods, the most commonly used method consistently over the years was female sterilization (46.6%) and the least common method was male sterilization (0.1%). The unmet needs in family planning in the state varied across the districts from as high as 19.3% to 5.6% though it was reduced by 1.2 percentage units as compared to NFHS-4 data. Conclusion The findings contradict the assumption that the use of modern spacing techniques will increase with female literacy and a higher standard of living. Female-oriented nature of family planning practices in the state should be revisited and strategies should be brought to bring equal participation of males and females. Districts with reduced CPR should be prioritized and region-specific policy recommendations are necessary to address specific needs.