Utilization of Integrated Child Development Services in India: Programmatic Insights from National Family Health Survey, 2016

The Integrated Child Development Services (ICDS) program launched in India in 1975 is one of the world’s largest flagship programs that aims to improve early childhood care and development via a range of healthcare, nutrition and early education services. The key to success of ICDS is in finding solutions to the historical challenges of geographic and socioeconomic inequalities in access to various services under this umbrella scheme. Using birth history data from the National Family Health Survey (Demographic and Health Survey), 2015–2016, this study presents (a) socioeconomic patterning in service uptake across rural and urban India, and (b) continuum in service utilization at three points (i.e., by mothers during pregnancy, by mothers while breastfeeding and by children aged 0–72 months) in India. We used an intersectional approach and ran a series multilevel logistic regression (random effects) models to understand patterning in utilization among mothers across socioeconomic groups. We also computed the area under the receiver operating characteristic curve (ROC-AUC) based on a logistic regression model to examine concordance between service utilization across three different points. The service utilization (any service) by mothers during pregnancy was about 20 percentage points higher for rural areas (60.5 percent; 95% CI: 60.3; 30.7) than urban areas (38.8 percent; 95% CI: 38.4; 39.1). We also found a lower uptake of services related to health and nutrition education during pregnancy (41.9 percent in rural) and early childcare (preschool) (42.4 percent). One in every two mother–child pairs did not avail any benefits from ICDS in urban areas. Estimates from random effects model revealed higher odds of utilization among schedule caste mothers from middle-class households in rural households. AUC estimates suggested a high concordance between service utilization by mothers and their children (AUC: 0.79 in rural; 0.84 in urban) implying a higher likelihood of continuum if service utilization commences at pregnancy.

Download Full-text

Missed opportunities for delivering nutrition interventions in first 1000 days of life in India: insights from the National Family Health Survey, 2006 and 2016

BMJ Global Health ◽

10.1136/bmjgh-2020-003717 ◽

2021 ◽

Vol 6 (2) ◽

pp. e003717

Author(s):

Phuong Hong Nguyen ◽

Rasmi Avula ◽

Lan Mai Tran ◽

Vani Sethi ◽

Alok Kumar ◽

...

Keyword(s):

Health Survey ◽

Urban Areas ◽

Family Health ◽

Universal Coverage ◽

National Family Health Survey ◽

Nutrition Interventions ◽

Missed Opportunities ◽

Health And Nutrition ◽

National Family ◽

Opportunity Gaps

ObjectivesExisting health and community nutrition systems have the potential to deliver many nutrition interventions. However, the coverage of nutrition interventions across the delivery platforms of these systems has not been uniform. We (1) examined the opportunity gaps between delivery platforms and corresponding nutrition interventions through the continuum of care in India between 2006 and 2016 and and (2) assessed inequalities in these opportunity gaps.MethodsWe used two rounds of the National Family Health Survey data from 2005 to 2006 and 2015–2016 (n=36 850 and 190 898 mother–child dyads, respectively). We examine the opportunity gaps over time for seven nutrition interventions and their associated delivery platforms at national and state levels. We assessed equality and changes in equality between 2006 and 2016 for opportunity gaps by education, residence, socioeconomic status (SES), public and private platforms.ResultsCoverage of nutrition interventions was consistently lower than the reach of their associated delivery platforms; opportunity gaps ranging from 9 to 32 percentage points (pp) during the pregnancy, 17 pp during delivery and 9–26 pp during childhood in 2006. Between 2006 and 2016, coverage improved for most indicators, but coverage increases for nutrition interventions was lower than for associated delivery platforms. The opportunity gaps were larger among women with higher education (22–57 pp in 2016), higher SES status and living in urban areas (23–57 pp), despite higher coverage of most interventions and the delivery platforms among these groups. Opportunity gaps vary tremendously by state with the highest gaps observed in Tripura, Andaman and Nicobar islands, and Punjab for different indicators.ConclusionsIndia’s progress in coverage of health and nutrition interventions in the last decade is promising, but both opportunity and equality gaps remained. It is critical to close these gaps by addressing policy and programmatic delivery systems bottlenecks to achieve universal coverage for both health and nutrition within the delivery system.

Download Full-text

The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16)

Epidemiology and Health ◽

10.4178/epih.e2019050 ◽

2019 ◽

Vol 41 ◽

pp. e2019050 ◽

Cited By ~ 4

Author(s):

Mili Dutta ◽

Y Selvamani ◽

Pushpendra Singh ◽

Lokender Prashad

Keyword(s):

Health Survey ◽

Urban Areas ◽

Multinomial Logistic Regression ◽

Family Health ◽

National Family Health Survey ◽

Double Burden ◽

Cross Sectional ◽

Men And Women ◽

National Family ◽

Dual Burden

OBJECTIVES: India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.METHODS: Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.RESULTS: The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.CONCLUSIONS: In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.

Download Full-text

The Prevalence of Overweight, Obesity, Hypertension, and Diabetes in India: Analysis of the 2015–2016 National Family Health Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16203987 ◽

2019 ◽

Vol 16 (20) ◽

pp. 3987 ◽

Cited By ~ 2

Author(s):

Vishal Vennu ◽

Tariq A. Abdulrahman ◽

Saad M. Bindawas

Keyword(s):

Health Survey ◽

Urban Areas ◽

National Level ◽

Family Health ◽

National Family Health Survey ◽

National Family ◽

Obesity Hypertension ◽

Group Sex ◽

Public Health Strategies ◽

National Prevalence

Overweight, obesity, hypertension, and diabetes increase the risk of non-communicable diseases and all-cause mortality worldwide. Previous studies have not determined the prevalence of these conditions/diseases throughout India. Therefore, this study was aimed to address this limitation. Data on these conditions/diseases among men and women aged ≥ 18 years were obtained from the fourth National Family Health Survey conducted throughout India between January 2015 and December 2016. The prevalence and prevalence rate per 100,000 population were calculated at the national level and by age group, sex, and type of residence for each state and union territory. The national prevalence of overweight, obesity, hypertension, and diabetes were 14.6%, 3.4%, 5.2%, and 7.1%, respectively. The highest prevalence of these conditions/diseases at the national level was seen among those aged 35–49 years (54 years for men), especially women living in urban areas. In India, 1 out of every 7, 29, 19, and 14 individuals at the national level had overweight, obesity, hypertension, and diabetes, respectively—between 2015 and 2016. These results are important for the healthcare system and government policies in the future. Moreover, targeted efforts are required to establish public health strategies for the prevention, management, and treatment of these conditions/diseases throughout India.

Download Full-text

Scenario of under nutrition among under five years children in India and its states: findings from National Family Health Survey

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203382 ◽

2020 ◽

Vol 7 (8) ◽

pp. 3087

Author(s):

Piyush Kumar Mishra ◽

Vijay Kumar Mishra

Keyword(s):

Logistic Regression ◽

Mass Media ◽

Health Survey ◽

Family Health ◽

National Family Health Survey ◽

Multiple Logistic Regression ◽

Indian States ◽

Under Nutrition ◽

National Family ◽

Current Scenario

Background: The status of undernutrition among under 5years children living in India is a public health concern. Our study identified contributed factors of undernutrition and current scenario of undernutrition among children living across Indian states. Objective of the study was to know the current scenario of undernutrition among under 5 years children across Indian states and to examine the associated factors with this.Methods: This study used data from 4th round of National Family Health Survey (NFHS-4) that was coordinated by International Institute for Population Sciences (IIPS) during 2015-16 under the ministry of health and family welfare, GoI. Multiple logistic regression model was done to study the association between outcome (under nutrition) and socio-economic and bio-medical predictors.Results: This study identified four empowered action group (EAG) states as the problem states because of the greater number of undernourished children living in these states than other Indian states. The children whose mothers were fully exposed to mass media like newspapers/radio/television, have lower prevalence of undernutrition (50.6%). The results of multiple logistic regression revealed that the children belonging to poorest households were 2 times more likely [OR-CI, 2.35 (2.27-2.44)] to be undernourished than those belonging to richest.Conclusions: Undernutrition can be reduced through awareness with the help of mass media, providing higher education to women and reducing socio-economic inequalities. It is necessary to re-think about nutritional policy with respect to children under 5 years and frame a full proof implementation plan to reduce undernutrition in India.

Download Full-text

Can Health Systems Platforms Do More for Nutrition in India? Insights on Missed Opportunities from India's National Family Health Survey, 2015–2016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_079 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 874-874

Author(s):

Phuong Nguyen ◽

Purnima Menon ◽

Rasmi Avula ◽

Lan Mai Tran ◽

Alok Kumar ◽

...

Keyword(s):

Early Childhood ◽

Health Systems ◽

Health Survey ◽

Scale Up ◽

Family Health ◽

National Family Health Survey ◽

Nutrition Interventions ◽

Health And Nutrition ◽

Childhood Care ◽

National Family

Abstract Objectives Most nutrition interventions can be delivered through health systems. However, the progress to scale up effective nutrition interventions and achieve universal health coverage has not been uniform. We aimed to 1) examine the opportunity gaps (OGs) between delivery platforms and corresponding nutrition interventions through the continuum of care (from pregnancy up to early childhood) in India between 2006 and 2016; and 2) assess inequalities in these OGs. Methods We used two rounds of National Family Health Survey data collected in 2005–06 and 2015–16 (n = 36,850 and 190,898 mother-child dyads with the last child aged of 0–5 years, respectively). We examine the OGs over time for a set of seven nutrition interventions and their associated delivery platforms during antenatal, delivery, postnatal and early childhood care at the national, state and district levels. We then assessed equality and changes in equality between 2006–2016 for the OGs by education, residence, socioeconomic status, public and private platforms. Results Coverage of nutrition interventions was consistently lower than the reach of their associated delivery platforms, with the OGs ranging from 9–32 percentage points (pp) during pregnancy, 17pp during delivery, and 9–26pp during childhood in 2006. Between 2006 and 2016, coverage improved for most indicators but the OGs became wider. The OGs were larger among women with higher education, higher SES status and living in urban areas, despite higher coverage of most interventions and the delivery platforms among these groups. Compared to private facilities, public facilities performed better in counseling/support for breastfeeding but were poorer in iron and folic acid supplementation. OGs vary tremendously by state and district, highlighting governance and implementation successes and challenges. Conclusions India's progress in coverage of health and nutrition interventions in the last decade is promising, but both opportunity and equity gaps must be closed by addressing policy and programmatic health systems bottlenecks to achieve universal coverage for both health and nutrition. We recommend this analytic approach to track and assess OGs in scaling up nutrition through health systems in India and worldwide. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by IFPRI.

Download Full-text

Sex differences in prevalence and risk factors of hypertension in India: Evidence from the National Family Health Survey-4

PLoS ONE ◽

10.1371/journal.pone.0247956 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0247956

Author(s):

Krishna Kumar ◽

Sheuli Misra

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Health Survey ◽

Public Awareness ◽

Family Health ◽

Vegetarian Diet ◽

Bivariate Distribution ◽

National Family Health Survey ◽

Lifestyle Risk Factors ◽

National Family

To estimate sex-specific prevalence and associated socio-economic, demographic, and lifestyle risk factors of hypertension in India. We used data from the National Family Health Survey (NFHS-4) of 2015–16. The analysis based on 6,99,686 women (15–49 years) and 1,12,122 men (15–54 years) whose blood pressure (BP) were measured during the survey. Bivariate distribution was used to show the prevalence of hypertension and, maps were used to present its spatial patterns. Logistic regression model was used to identify sex-specific association between risk factors and hypertension. Results show that the overall prevalence of hypertension was 16.32% among men and 11.56% among women. We also found that the prevalence of hypertension across selected socio-economic, demographic and lifestyle background characteristics and in a majority of the states was higher among men compared to women. Odds ratios from logistic regression analysis direct sex-related differences in risk factors. Hypertension increases with an increase in age and the risk is higher among older women (AOR, 5.58; 95% CI, 5.16–6.03 for women aged 40–49 and AOR, 4.24; 95% CI, 3.94–4.57 for men aged 50–54) compared to men. Education, types of jobs (specially technical, administrative and managerial), marital status and non-vegetarian diet were significantly associated with hypertension in men. While other than age; non-working, consumption of alcohol, and being a diabetic was found to be major risk factors for this disease among women. There are sex-related differences in prevalence as well as risk factors of hypertension in India. In order to prevent early developments of hypertension, awareness related to changing lifestyles such as a diet rich in fruits, vegetables as well as screening to control BP should be promoted among youths and adults in India. The study also recommends sex-specific approaches in health infrastructure and policies besides increasing public awareness.

Download Full-text