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The impact of ill-health on labour force participation is a well-recognized concern in both developed and developing countries. However, previous studies have often overlooked age differentials in this relationship, assuming uniform effects across age groups. This study aims to fill this gap by examining how ill-health affects labour outcomes among different age segments in India. Utilizing data from the Longitudinal Ageing Study in India (LASI) Wave 1, which covers over 72,000 individuals aged 45 and above, this research investigates the linkage between health and labour force outcomes. The labour outcomes in this study includes labour force participation, labour earnings and hours worked. Present study used instrumental variable approach to mitigate endogeneity issues and establish causal relationships between health and labour outcomes. The Heckman selection model is utilized to address selection bias in analysing wage and hours worked. The study reveals several key findings. Firstly, ill-health consistently leads to a decline in labour force participation among both middle-aged (28 percent) and elderly (36 percent) individuals in India. This underscores the pervasive impact of health on workforce engagement, particularly in a context with limited social security measures. Secondly, the research identifies significant variations in the effects of ill-health on wages and hours worked based on age. Among elderly individuals, there is a pronounced reduction in both wages and hours worked due to ill-health. However, this effect is less pronounced among middle-aged adults. Furthermore, socioeconomic factors play a pivotal role in shaping how ill-health influences labour outcomes among different age groups. This study underscores the importance of considering age differentials in the impact of ill-health on labour outcomes, offering valuable insights for policymakers, practitioners, and researchers seeking to address this critical issue in India's dynamic socio-economic landscape. [ABSTRACT FROM AUTHOR]

Background: The paper aims to explore the elderly caregiving process in India from the perspective of both elderly as well as working women care providers, along with the challenges faced and the coping strategies adopted by them during the process. Methods: In-depth interviews with 48 participants (care providers and care receivers) from 25 multi-generational households were conducted in the slums of Mumbai and analysed using QSR-NVivo-10. Results: Working women care providers supported the needs of the dependent elderly along with performing household chores and paid work. However, the way the care was perceived and demanded, was not often same as delivered by the care providers. Care provider suffered silently with poor social, physical and emotional welling in absence of support system and lack of time. Sometimes, physically exhausted care providers unknowingly resorted to elderly abuse and neglect. At the same time, a bidirectional flow of support from elderly also existed in the form of childcare, household chores and financial support. Though caregiving overstrained the care providers, strong family ties, acknowledgement of the contributions of the elderly during their young days, and the desire to set a precedent for the young generation did not let them step back from their duties. The main coping mechanism for both care receivers and providers was largely centred around the notion of acceptance of their situation. Conclusion: Conversations between generations can help in enhancing family ties and reduce conflicts. The support of family and community can also ease the burden of caregiving. [ABSTRACT FROM AUTHOR]

Aim: Recent National Family Health Survey results portray striking improvements in most population and health indicators, including fertility, family planning, maternal and child health, gender treatment, household environments, and health insurance coverage of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with all India resonance. However, the prevalence of any anaemia (< 11 g/dl) among children under age five has exhibited a reversed trajectory in recent years. Therefore, the present study explores key drivers of the reversal of the trend in the prevalence of childhood anaemia between 2015 and2021. Methods: Data of four rounds of the National Family Health Survey (NFHS) were used to show the overall trend of anaemia among children. However, for the analysis of key drivers of the reversal trend of childhood anaemia, only the recent two rounds (NFHS-4 & NFHS-5) were used. Descriptive, bivariate multivariable analysis and Fairlie decomposition model were used to explore the drivers of the reversal of the trend in childhood anaemia. Results: During the past two decades, India has seen a decline in the prevalence of childhood anaemia (NFHS-2 to NFHS-4). However, a reversal of trend was observed recently. The prevalence of anaemia among children aged 6–59 months increased from 59 percent in NFHS-4 to 67 percent in NFHS-5. In addition, the prevalence of mild anaemia increased from 23.3 percent in NFHS-2 to 28.7 percent in NFHS-5. However, the prevalence of moderate and severe anaemia declined considerably from NFHS-2 (40 percent and 4.1 percent) to NFHS-4 (28.7 percent and 1.6 percent), but showed an increase in the prevalence in NFHS-5 (36.3 percent and 2.2 percent). Among others, mothers' educational attainment, anaemia status and socio-economic status emerge as the key drivers of the change in the prevalence of childhood anaemia. Conclusion: These findings may have vital implications for the ongoing Anaemia Mukt Bharat Programme, one of the government's dream projects in India. [ABSTRACT FROM AUTHOR]

Background: The present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017–18. Methods: The information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson's correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied. Results: Men have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50–54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1–4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women). Conclusion: YLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India. [ABSTRACT FROM AUTHOR]

Social participation is considered one of the central components of successful and healthy aging. This study aimed to examine the moderating role of marital status and living arrangement with social participation and its association with life satisfaction of older Indian adults. Samples of 31,464 individuals aged ≥ 60 years were extracted from the Longitudinal Ageing Study in India, wave-1. Descriptive statistics, bivariate analysis, and multivariable linear regression were performed for the analysis. The moderation effect of marital status and living arrangements on the relationship between social participation and level of life satisfaction among Indian older adults were also analyzed. Overall, life satisfaction among older men was relatively higher than older women in this study. Older adults' involvement in social participation [β = 0.39, p < 0.05], being in marital union [β = 0.68, p < 0.001] and co-residing either with spouse [β = 1.73, p < 0.001] or with other family members [β = 2.18, p < 0.001] were positively related to their greater life satisfaction. Interaction of social participation with marital status showed that participating in social activities can boost life satisfaction only among married older people. Further, moderation effect of social participation with living arrangements showed that older adults who were not involved in social participation but living with a spouse or any other household members had higher life satisfaction, and again participation in social activities increased their life satisfaction to a greater level. The establishment of social clubs and advocating social policies oriented toward meaningful social connections are highly needed, especially for older Indians living alone or currently not in a marital union, which will help to enhance their overall life satisfaction. [ABSTRACT FROM AUTHOR]

The states and districts are the primary focal points for policy formulation and programme intervention in India. The within‐districts variation of key health indicators is not well understood and consequently underemphasised. This study aims to partition geographic variation in low birthweight (LBW) and small birth size (SBS) in India and geovisualize the distribution of small area estimates. Applying a four‐level logistic regression model to the latest round of the National Family Health Survey (2015–2016) covering 640 districts within 36 states and union territories of India, the variance partitioning coefficient and precision‐weighted prevalence of LBW (<2.5 kg) and SBS (mother's self‐report) were estimated. For each outcome, the spatial distribution by districts of mean prevalence and small area variation (as measured by standard deviation) and the correlation between them were computed. Of the total valid sample, 17.6% (out of 193,345 children) had LBW and 12.4% (out of 253,213 children) had SBS. The small areas contributed the highest share of total geographic variance in LBW (52%) and SBS (78%). The variance of LBW attributed to small areas was unevenly distributed across the regions of India. While a strong correlation between district‐wide percent and within‐district standard deviation was identified in both LBW (r = 0.88) and SBS (r = 0.87), they were not necessarily concentrated in the aspirational districts. We find the necessity of precise policy attention specifically to the small areas in the districts of India with a high prevalence of LBW and SBS in programme formulation and intervention that may be beneficial to improve childbirth outcomes. Key messages: The small areas contribute the highest share of the total geographic variance of low birth weight (LBW) and small birth size (SBS) in India.A high burden of LBW is found mostly in the central‐western part of India and Odisha. The prevalence of SBS is high across the district of northern‐western regions and the north‐eastern regions of India.The mean prevalence and standard deviation are strongly correlated in the case of both LBW (r = 0.88) and SBS (r = 0.87) in India. It indicates that the districts which have a higher prevalence of LBW and SBS also have a higher between small area disparity within the districts.We find a similar pattern of distribution in LBW and SBS between the policy‐focused aspirational districts and other districts of India.Findings indicate reprioritizing the policy intervention, focusing on the small areas of India for better childbirth outcomes. [ABSTRACT FROM AUTHOR]

Child undernutrition remains high in India with far-reaching consequences for child health and development. Anthropometry reflects undernutrition. We examined the state-level trends in underweight, stunting, and wasting prevalence and inequality by living standards using four rounds of the National Family Health Surveys in 26 states in India, conducted in 1992–1993, 1998–1999, 2005–2006, and 2015–2016. The average annual reduction (AAR) for underweight ranged from 0.04 percentage points (pp) (95% CI − 0.12, 0.20) in Haryana to 1.05 pp (95% CI 0.88, 1.22) in West Bengal for underweight; 0.35 pp (95% CI 0.11, 0.59) in Manipur to 1.47 (95% CI 1.19, 1.75) in Himachal Pradesh for stunting; and − 0.65 pp (95% CI − 0.77, − 0.52) in Haryana to 0.36 pp (95% CI 0.22, 0.51) in Bihar & Jharkhand for wasting. We find that change in the pp difference between children with the poorest and richest household living standards varied by states: statistically significant decline (increase) was observed in 5 (3) states for underweight, 5 (4) states for stunting, and 2 (1) states for wasting. Prevalence of poor anthropometric outcomes as well as disparities by states and living standards remain a problem in India. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated health benefits of marriage and the potential for worse outcomes during widowhood in some populations. However, few studies have assessed the relevance of widowhood and widowhood duration to a variety of health-related outcomes and chronic diseases among older adults in India, and even fewer have examined these relationships stratified by gender.Methods: Using a cross-sectional representative sample of 9,615 adults aged 60 years or older from 7 states in diverse regions of India, we examine the relationship between widowhood and self-rated health, psychological distress, cognitive ability, and four chronic diseases before and after adjusting for demographic characteristics, socioeconomic status, living with children, and rural-urban location for men and women, separately. We then assess these associations when widowhood accounts for duration.Results: Being widowed as opposed to married was associated with worse health outcomes for women after adjusting for other explanatory factors. Widowhood in general was not associated with any outcomes for men except for cognitive ability, though men who were widowed within 0-4 years were at greater risk for diabetes compared to married men. Moreover, recently widowed women and women who were widowed long-term were more likely to experience psychological distress, worse self-rated health, and hypertension, even after adjusting for other explanatory variables, whereas women widowed 5-9 years were not, compared to married women.Conclusions: Gender, the duration of widowhood, and type of outcome are each relevant pieces of information when assessing the potential for widowhood to negatively impact health. Future research should explore how the mechanisms linking widowhood to health vary over the course of widowhood. Incorporating information about marital relationships into the design of intervention programs may help better target potential beneficiaries among older adults in India. [ABSTRACT FROM AUTHOR]

Microplastic pollution and the impacts they generate on the marine ecosystem and its biota is a major global concern of recent decades. The present study was conducted to evaluate the spatio-temporal distribution of microplastics in the surface waters, sediments, and their subsequent ingestion by the commercially important fishes of Alappuzha Mud banks, a transient ecosystem formed in the littoral zones of the southwest coast of India exclusively during the Indian summer monsoon. Sampling conducted over three periods, Pre-mud bank (Pre-MB), Mud bank (MB), and Post mud bank (Post-MB) extending over three depths (2 m, 5 m and 18 m), along the semi-circular patch of mudbanks revealed marked spatio-temporal variability in microplastic distribution. In both surface water and sediments, microplastic concentration was comparatively high during MB than in Pre-MB and Post-MB periods. Spatially, during MB, the microplastic concentration was high at 5 m where the dampening of waves occurred concomitant to the thick fluid mud formation. In contrast, during Post-MB, with the subsequent dissipation of MB's and less wave dampening, the microplastics aggregated at 5 m were transported to both inshore (2 m) and offshore (18 m), thus raising their concentration at these depths. Likewise, the microplastic ingestion was more in fishes caught during MB (41%) than Post-MB (30%) and Pre-MB (29%) periods indicating increased uptake corresponding to the higher incidences in their ambient environment. Microplastic ingestion was more among pelagic planktivores, S. gibbosa (38%), A. chacunda (20%) and R. kanagurta (13%) compared to the demersal fishes. White coloured fragments of size 1-5 mm of polypropylene were the dominant microplastic in the surface waters, sediment and fishes analysed. The present study indicates the critical role of wind speed, rainfall, wave patterns, and the fluid muddy environment in regulating the microplastics distribution in a transient ecosystem formed along the southwest coast of India., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Importance: Geographic targeting of public health interventions is needed in resource-constrained developing countries., Objective: To develop methods for estimating health and development indicators across micropolicy units, using assembly constituencies (ACs) in India as an example., Design, Setting, and Participants: This cross-sectional study included children younger than 5 years who participated in the fourth National Family and Health Survey (NFHS-4), conducted between January 2015 and December 2016. Participants lived in 36 states and union territories and 640 districts in India. Children who had valid weight and height measures were selected for stunting, underweight, and wasting analysis, and children between age 6 and 59 months with valid blood hemoglobin concentration levels were included in the anemia analysis sample. The analysis was performed between February 1 and August 15, 2020., Exposures: A total of 3940 ACs were identified from the geographic location of primary sampling units in which the children's households were surveyed in NFHS-4., Main Outcomes and Measures: Stunting, underweight, and wasting were defined according to the World Health Organization Child Growth Standards. Anemia was defined as blood hemoglobin concentration less than 11.0 g/dL., Results: The main analytic sample included 222 172 children (mean [SD] age, 30.03 [17.01] months; 114 902 [51.72%] boys) from 3940 ACs in the stunting, underweight, and wasting analysis and 215 593 children (mean [SD] age, 32.63 [15.47] months; 112 259 [52.07%] boys) from 3941 ACs in the anemia analysis. The burden of child undernutrition varied substantially across ACs: from 18.02% to 60.94% for stunting, with a median (IQR) of 35.56% (29.82%-42.42%); from 10.40% to 63.24% for underweight, with a median (IQR) of 32.82% (25.50%-40.96%); from 5.56% to 39.91% for wasting, with a median (IQR) of 19.91% (15.70%-24.27%); and from 18.63% to 83.05% for anemia, with a median (IQR) of 55.74% (48.41%-63.01%). The degree of inequality within states varied across states; those with high stunting, underweight, and wasting prevalence tended to have high levels of inequality. For example, Uttar Pradesh, Jharkhand, and Karnataka had high mean AC-level prevalence of child stunting (Uttar Pradesh, 45.29%; Jharkhand, 43.76%; Karnataka, 39.77%) and also large SDs (Uttar Pradesh, 6.90; Jharkhand, 6.02; Karnataka, 6.72). The Moran I indices ranged from 0.25 to 0.80, indicating varying levels of spatial autocorrelation in child undernutrition across the states in India. No substantial difference in AC-level child undernutrition prevalence was found after adjusting for possible random displacement of geographic location data., Conclusions and Relevance: In this cross-sectional study, substantial inequality in child undernutrition was found across ACs in India, suggesting the importance of considering local electoral units in designing targeted interventions. The methods presented in this paper can be further applied to measuring health and development indicators in small electoral units for enhanced geographic precision of public health data in developing countries.