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India ranks second globally in tobacco consumption, with marked disparities across socially stratified caste groups. Despite tobacco control efforts, Scheduled Tribes (ST) and Scheduled Castes (SC)-historically marginalized communities-exhibit elevated tobacco use. This study examines caste-based disparities in smoked and smokeless tobacco (SLT) use and identifies factors contributing to these inequalities. We analyzed nationally representative data from the Global Adult Tobacco Survey (GATS) 2016-17, comprising 74,037 adults aged ≥15 years. Social groups were classified as ST, SC, Other Backward Classes (OBC), and General categories. We estimated prevalence rates, used multivariable logistic regression to assess associations with socio-demographic factors, and employed multivariate decomposition analysis to quantify contributors to inter-group disparities. Overall tobacco use prevalence was 28.6%, with substantial variation: ST (36.0%), SC (28.9%), OBC (29.1%), and General (23.1%). SLT use was particularly high among ST (27.7%) and SC (20.7%) compared to General (16.0%). Men had 16-fold higher odds of SLT use (AOR: 16.4; 95%CI:15.2-17.7) and 23-fold higher odds of smoking [Adjusted Odds Ratio (AOR): 23.1; 95%CI:20.8-25.6] compared to women, with similar patterns within each social group. Lower education, older age, disrupted marriage, rural residence, and poor wealth status were independently associated with higher tobacco use. Decomposition analyses revealed that sex (38%), education (24%), and region (18%) explained most between-group differences, with substantial tobacco use concentrated in Eastern, Central, and Northeastern states. Pronounced caste-based tobacco use disparities persist in India, disproportionately affecting socioeconomically disadvantaged ST and SC populations, particularly older, less-educated in rural areas. Achieving Sustainable Development Goal 3.a requires targeted interventions addressing these structural inequalities through culturally appropriate cessation programs, enhanced health education, and region-specific tobacco control policies.

This study examines the association between quality Postnatal Care (PNC) considering timing and providers' type on neonatal mortality. The aim extends to account for regional disparities in service delivery and mortality including high and non-high focus states. Ever-married women aged 15-49 years (1,87,702) who had delivered at least one child in five years preceding the survey date surveyed in National Family Health Survey (2015-16) were included in the study. Neonatal deaths between day two and seven and neonatal deaths between day two and twenty-eight were considered dependent variables. Descriptive statistics and multivariate regression analysis were conducted. Chances of early neonatal mortality were 29% (OR = 0.71; 95%CI: 0.59-0.84) among newborns receiving PNC within a day compared to ones devoid of it while 40% (OR: 0.60; 95%CI: 0.51-0.71) likelihood for the same was noted if PNC was delivered within a week. Likelihood of neonatal mortality decreased by 24% (OR: 0.76; 95%CI: 0.65-0.88) when skilled PNC was delivered within 24 hours. Receiving quality PNC by skilled providers within a day in a non-high focus state decreased the chances of neonatal mortality by 26% (OR: 0.74; 95%CI: 0.59-0.92) compared to ones who did not receive any PNC. Neonatal deaths were significantly associated with socioeconomic and contextual characteristics including age, education, household wealth, social group and region. Timing of PNC delivered and by a skilled healthcare provider was found significant in reducing neonatal mortality.

ObjectiveStudy uses multilevel modelling to examine the effect of individual, household and contextual characteristics on chronic diseases among older Indian adults.DesignNationally representative cross-sectional study.ParticipantsData from the nationally representative, India Human Development Survey conducted in 2011–2012 was used in this study. The survey asked information related to the diagnosed chronic illnesses such as cataract, tuberculosis, hypertension, heart disease and others. The sample size of this study comprised 39 493 individuals who belonged to the age group 50 years and above.MeasuresSelf-reported diagnosed chronic illness.MethodConsidering the hierarchal structure of the data multilevel logistic regression analysis was applied to attain the study objective.ResultsOlder adults aged 80 years and older were found with three times more chances (OR: 3.99, 95% CI 2.91 to 5.48) of suffering from a chronic ailment than 50–54 years old. Lifestyle risk factors such as alcohol and tobacco (smoked and smokeless) consumption were noted to be significantly associated with the presence of chronic illness whereas older adults who have never consumed smokeless tobacco stood 20% fewer chances (OR: 0.80, 95% CI 0.68 to 0.94) of having any chronic illness. Contextual level variables such as older adults residing in the rural areas were found with 17% fewer chances (OR: 0.83, 95% CI 0.70 to 0.97) of suffering from a chronic illness.ConclusionEven after controlling for various characteristics at the individual, household and contextual levels, significant variations in chronic illness remain unexplained at the community and state level, respectively. The findings of this study could effectively be utilised to consider more contextual variables to examine the chronic health status among the growing older population of India.

Background India accounts for over a quarter of the global tuberculosis (TB) burden. Among the most affected are India’s Scheduled Tribes (STs) communities, experiencing a disproportionately higher TB prevalence compared to non-STs. Encouragingly, two successive rounds of National Family Health Survey (NFHS) showed the declined trend in overall TB prevalence in India, the rate of decline was markedly slower among STs, signalling that national gains have not translated into equitable progress. This study examines the point prevalence of TB and its determinants among STs and non-STs populations in constitutionally protected Scheduled and Non-Scheduled areas of India. Methods We analysed data from 2,077,924 individuals aged 15 and above from NFHS-5 (2019–2021) in India. Districts were stratified into: (1) Scheduled Area districts (with protections under Schedules V/VI), (2) non-Scheduled districts with > 60% STs, and (3) non-Scheduled districts with < 60% STs. We estimated TB point prevalence per 100,000 among STs and non-STs across these categories and examined associated socio-demographic, environmental, and behavioural factors. Multivariable logistic regression models assessed the adjusted odds of TB. Results STs experienced significantly higher TB prevalence (416/100,000) than non-STs (277/100,000). This disparity persisted across all district categories. STs in Scheduled area districts had the lowest TB prevalence (330 per 100,000), while non-Scheduled districts with > 60% STs populations had the highest prevalence (608 per 100,000). Tribal identity remained an independent risk factor for TB [adjusted odd ratio ( aOR ) = 1.47; 95% confidence internal ( CI ) 1.38 −1.56], even after adjusting for covariates. Additional risk factors included older age, male sex, low household wealth, adverse household environments, tobacco and alcohol consumption, and hypertension and diabetes. Conclusions Tribal communities continue to shoulder a disproportionate TB burden, reflecting deep-rooted social and structural inequities. While constitutional protections in Scheduled Areas appear to offer some safeguards, disparities between STs and non-STs remain stark. Our findings serve as evidence and a call to action to ensure that tribal communities are at the forefront of TB control initiatives, so that the burden of TB is no longer borne disproportionately by those already burdened by socio-economic disadvantage. Graphical Abstract

Despite a reduction in maternal mortality in recent years, a high rate of anaemia and other nutrient inadequacies during pregnancy pose a serious threat to mothers and their children in the Global South. Using the framework of the WHO-Commission on Social Determinants of Health, this study examines the socioeconomic, programmatic and contextual factors associated with the consumption of iron and folic acid (IFA) tablets/syrup for at least 100 d (IFA100) and receiving supplementary food (SF) by pregnant women in India. We analysed a nationally representative cross-sectional survey of over 190 898 ever-married women aged 15-49 years who were interviewed as part of the National Family Health Survey (NFHS) conducted during 2015-16, who had at least one live birth preceding 5 years of the survey. All twenty-nine states and seven union territories of India. Ever-married women aged 15-49 years. Less than one-third of women were found to be consuming IFA100, and a little over half received SF during their last pregnancy. The consumption of IFA100 was likely to improve with women's education, household wealth, early and more prenatal visits, and in a community with high pregnancy registration. Higher parity, early and more prenatal visits, contact with community health workers during pregnancy, belonging to a poor household and living in an aggregated poor community and rural area positively determine whether a woman might receive SF during pregnancy. Continuous monitoring and evaluation of provisioning IFA and SF in targeted groups and communities is a key to expanding the coverage and reducing the burden of undernutrition during pregnancy.

Sporadic evidence is available on the association of consuming multiple substances with the risk of hypertension among adults in India where there is a substantial rise in cases. This study assesses the mutually exclusive and mixed consumption patterns of alcohol, tobacco smoking and smokeless tobacco use and their association with hypertension among the adult population in India. Nationally representative samples of men and women drawn from the National Family and Health Survey (2015–2016) were analyzed. A clinical blood pressure measurement above 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) was considered in the study as hypertension. Association between mutually exclusive categories of alcohol, tobacco smoking and smokeless tobacco and hypertension were examined using multivariate binary logistic regression models. Daily consumption of alcohol among male smokeless tobacco users had the highest likelihood to be hypertensive (OR: 2.32, 95% CI: 1.99–2.71) compared to the no-substance-users. Women who smoked, and those who used any smokeless tobacco with a daily intake of alcohol had 71% (OR: 1.71, 95% CI: 1.14–2.56) and 51% (OR: 1.51, 95% CI: 1.25–1.82) higher probability of being hypertensive compared to the no-substance-users, respectively. In order to curb the burden of hypertension among the population, there is a need for an integrated and more focused intervention addressing the consumption behavior of alcohol and tobacco.

Abundant research studies has recorded availability, accessibility and quality of antenatal care and safe delivery in India but comparatively less information is known for postnatal care and furthermore limited attempts at capturing the whole spectrum of obstetric and newborn health services. Assessing discontinuity in maternal and child health service utilization provides us holistic information about existing health inequities and barriers in service provision. Current study evaluated the coverage of quality antenatal care (QANC), delivery care (QDC) and postnatal care (QPNC) in India as a part of a single continuum accounting for significant regional and sub-regional disparities. This study analyzed nationally representative data obtained from NFHS-4 (2015-16). Included in the data, were 190 898 Indian women who had a recent birth in last five years. Coverage of QANC, QDC and QPNC was examined at the national, state and district level. Bivariate association of key sociodemographic variables with coverage of services was assessed during chi-squared analysis. Multilevel logistic regression analysis examined correlates associated with coverage of services. The output was presented using odds ratios (OR) with 95% CI. About 23.5% women utilized QANC out of which 92.9% opted for QDC and 35.1% of newborns received QPNC. About 400 and 471 districts out of 640 had less than 30% coverage of QANC and QPNC, respectively. Women residing in rural regions of Bihar and Northeastern states were found with less than 10% coverage of QANC. Regression analysis shows that women with more than 12 years of education and belonging to richest households had increased odds of availing QANC (OR 1.95; 95%CI: 1.84-2.06) and QDC (OR: 2.86; 95%CI: 2.27-3.60), respectively. Focused interventions targeting the delivery of quality services especially ANC and PNC among newborns are imperative to achieve SDG-3 goals to achieve improvement in maternal and newborn health.