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The burden of type 2 diabetes mellitus (T2DM) in India is on the rise, with projections indicating a staggering 134 million cases by 2045. Managing T2DM demands strict adherence, often resulting in mental strain and burnout. Diabetes distress (DD), a unique psychological burden, significantly affects motivation and self-care, contributing to increased morbidity and mortality. This study was conducted by doing a comprehensive literature search using PubMed (MEDLINE) and EMBASE databases for studies published from their inception to 14th August 2023 by using relevant keywords. The protocol is registered in PROSPERO and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Selected articles were meticulously screened based on predetermined inclusion and exclusion criteria. Joanna Briggs Institute (JBI) Critical Appraisal scale for cross-sectional study was used for assessing the study quality. Data analysis was done by using Jamovi 2.3.24 software Following the systematic search and screening process, 10 cross-sectional studies were identified, comprising a total of 2,107 Type 2 Diabetes Mellitus patients. All studies employed the Diabetes Distress Scale-17 (DDS-17) for measurement. The prevalence of DD varied, ranging from 8.45% to 61.48%. The pooled prevalence of DD in T2DM patients in India was estimated at 33% (95% CI: 21%-45%) with substantial heterogeneity observed (I 2  = 97.33%, P < 0.001). While an asymmetric funnel plot suggested potential publication bias, sensitivity analysis reinforced the robustness of our findings. Policymakers, clinicians, and researchers can leverage these insights to prioritize the psychological well-being of T2DM patients, ultimately improving their overall health outcomes. This study aligns with the Sustainable Development Goals (SDGs) and India's national health policy, emphasizing the urgency of screening and treating diabetes-related distress by 2025.

IntroductionPrevious studies have found positive associations between higher geographical altitude and increased risk of stunting in children under 5 years old, but little evidence exists on this relationship in the Indian context specifically. Chronic exposure to high altitudes can impair food security, healthcare access, oxygen delivery and nutrient absorption, potentially increasing malnutrition.ObjectiveTo investigate the association between geographical altitude and stunting among children aged under 5 years in India.MethodsUsing data from the 2015–2016 National Family Health Survey, logistic regression was conducted to estimate the relationship between altitude and stunting, adjusting for child, maternal and household characteristics. The analysis included over 167 555 children under 5 years old.ResultsChildren at higher altitudes had a significantly greater risk of stunting. Those at >2000+ metres had 40% higher adjusted odds of stunting than children below 1000 metres. The altitude–stunting association was stronger among rural children.ConclusionsThis study provides robust evidence that higher geographical altitude is an important risk factor for stunting among young children in India, especially those in rural areas. Targeted interventions to improve food security, healthcare access and nutrition in high-altitude regions could help to mitigate the higher burden of stunting in these areas.

Background Timely breastfeeding initiation within one hour of birth is recommended to reduce neonatal and early infant mortality. However, rates of early breastfeeding remain suboptimal in India, especially among marginalized tribal communities, which continue to experience disproportionately high infant mortality. The study investigated the association between the late breastfeeding initiation and infant mortality among the tribal population in India. Method The study utilized data from the fifth round if the National Family Health Survey, which provided a sample of 232,920 most recent live births in the past five years with data on breastfeeding initiation time and infant mortality. Associations between late initiation (> 1 hour) and mortality were analysed using Cox proportional hazards regression and Kaplan-Meier survival curves. Results The results showed that infants breastfed after the first hour of life had a 30% higher risk of infant mortality compared to those breastfed within an hour of birth (aHR: 1.30, 95% CI: 1.06–1.60). The Kaplan-Meier curves further highlighted the lower chances of survival when breastfeeding was delayed. Conclusion These findings underscore the need for promoting early breastfeeding initiation through culturally appropriate interventions in tribal areas as a strategy to reduce persistent child survival disparities in India.

Background Stillbirth, defined by foetal death at or beyond 28 weeks of gestation, represents a significant challenge in India, contributing to approximately 500,000 foetal deaths each year. The country’s stillbirth rate of 12.2 per 1000 births underscores the imperative to address this preventable occurrence. While maternal metabolic conditions diabetes, and hypertension, are widely recognized as established risk factors for stillbirth worldwide, the extent of their impact on India’s stillbirth burden remains inadequately elucidated due to limited evidence. Methods This cross-sectional study utilized NFHS-5 data to examine stillbirths in the most recent pregnancy outcomes of 204,723 women aged 15–49 years, sampled from all states and union territories of India. The primary exposures assessed were diabetes, and hypertension. Descriptive analyses were conducted to determine the prevalence of diabetes, hypertension and stillbirths. Logistic regression was used to quantify the association between diabetes, hypertension and the risk of stillbirth, indicated by adjusted odds ratios (AOR) with 95% confidence intervals (CI). The study also assessed effect modification by maternal age, education, wealth quintile, and social category. Results The prevalence of diabetes and hypertension was 1% and 3% respectively, while the stillbirth rate was 1%. diabetes conferred a significantly higher risk of stillbirth with an increase of 74% (AOR 1.74, CI 1.14–2.67) as compared to women without diabetes. The risk was potential among mothers with hypertension with an increase of 50% (AOR 1.50, CI 1.16–1.95) on contrary to women without hypertension. The combined model (i.e. having diabetes or hypertension) also showed a significant risk of stillbirth with a higher risk of 58% (AOR 1.58, CI 1.25–1.99) indicating a synergistic interaction. Stratified analyses revealed the stillbirth risk among mothers belonging to the scheduled caste category (AOR 1.30, CI 1.10–1.53). Conclusion Diabetes, and hypertension, increase stillbirth risk in India, highlighting the need for better metabolic health management pre- and during pregnancy. Our research highlights the need of integrated care for diabetes and hypertension is crucial. Targeted interventions for high-risk mothers and improved screening are vital to reduce stillbirth rates. More research is needed to understand these risks better. Collaboration across medical fields is essential to save lives and improve pregnancy outcomes.

(i) To assess diagnostic accuracy of mid-upper arm circumference (MUAC) for screening thinness and severe thinness in Indian adolescent girls aged 10-14 and 15-19 years compared with BMI-for-age Z-score (BAZ) <-2 and <-3 as the gold standard and (ii) to identify appropriate MUAC cut-offs for screening thinness and severe thinness in Indian girls aged 10-14 and 15-19 years. Cross-sectional, conducted October 2016-April 2017. Four tribal blocks of two eastern India states, Chhattisgarh and Odisha. Girls (n 4628) aged 10-19 years. Measurements included height, weight and MUAC to calculate BAZ. Standard diagnostic accuracy tests, receiver-operating characteristic curves and Youden index helped arrive at MUAC cut-offs at BAZ < -2 and <-3, as gold standard. Mean MUAC and BMI correlation was positive (0·78, P = 0·001 and r 2 = 0·61). Among 10-14 years, MUAC cut-off corresponding to BAZ < -2 and BAZ < -3 was ≤19·4 and ≤18·9 cm. Among 15-19 years, corresponding values were ≤21·6 and ≤20·7 cm. For both BAZ < -2 and BAZ < -3, specificity was higher in 15-19 v. 10-14 years. State-wise variations existed. MUAC cut-offs ranged from 17·7 cm (10 years) to 22·5 cm (19 years) for BAZ < -2, and from 17·0 cm (10 years) to 21·5 cm (19 years) for BAZ < -3. Single-age area under the curve range was 0·82-0·97. Study provides a case for use of year-wise and sex-wise context-specific MUAC-cut-offs for screening thinness/severe thinness in adolescents, rather than one MUAC cut-off across 10-19 years, depending on purpose and logistic constraints.

Women face multiple socio-economic, cultural, contextual, and perceived barriers in health service utilization. Moreover, poor autonomy and financial constraints act as crucial factors to their healthcare accessibility. Therefore, the objective of the present study is to study the association between health care utilization barriers and women empowerment, including asset ownership among currently married women in Afghanistan. Data of 28,661 currently married women from Afghanistan demographic health survey (2015) was used to carry out this study. Barriers to access healthcare were computed based on problems related to permission, money, distance, and companionship, whereas women empowerment and asset ownership were computed as potential covariates along with other socio-economic risk factors. Bivariate and logistic analysis was carried out to study the association and odds of explanatory variables. Our results confirm the significant and strong association between the barriers to access healthcare and various explanatory variables. Women having any decision-making autonomy are less likely to face any odds [(AOR = 0.56, p  < 0.001), CI: 0.51–0.61] among the currently married women than those who don’t have any decision-making authority. Similarly, women who justify their beating for some specific reasons face the greater difficulty of accessing health care [(AOR = 1.76, p  < 0.001), CI: 1.61–1.93]. In terms of asset ownership, women having any asset ownership (land or household) are less likely to face any barriers in health services utilization given the lower odds [(AOR = 0.91, p  < 0.001), CI: 0.90–0.98]. Accessing maternal health is a crucial policy challenge in Afghanistan. A substantial proportion of women face barriers related to approval, money, distance, and companionship while accessing the health services utilization in Afghanistan. Similarly, women empowerment and asset ownership are significantly associated with health service accessibility. This paper therefore suggests for some policy interventions to strengthen the healthcare needs of women and ensure healthcare accessibility by scaling down these potential barriers like poor autonomy, asset ownership and domestic violence.

Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. This paper uses data from the Study on Global Ageing and Adult Health conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007-10 and examines the disability-based disparity in outpatient HSR among the older adults in the above-mentioned countries. Disability and HSR scores have been constructed using Item Response Theory Partial Credit Model. Also, the paper uses bivariate and multivariate analysis and finds that the HSR is significantly and substantially lower among the disabled and severely disabled older adults in all the study countries (except Ghana) as compared with those older adults who are not (or mildly) suffering from any form of disability. The policy efforts in the studied countries should focus on monitoring and reducing these disparities for improving HSR in order to make it inclusive.

Purpose Nearly 200m people in the world experience considerable functioning difficulties. Also, more than three-fourth of the population aged 50 years and over is suffering from some kind of disability in India, China, Ghana, Russia, Mexico and South Africa. Despite the compelling nature of this issue, evidence on socioeconomic disparity in the occurrence of disability is lacking throughout the world and particularly in the aforementioned countries. The purpose of this paper is twofold – first, to examine the socioeconomic inequalities in the prevalence of disability in the selected countries; and second, to investigate the cross-country differentials in the prevalence of disability by socioeconomic characteristics. Design/methodology/approach The authors use data from the Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007–2010. Disability scores have been constructed using Item Response Theory Partial Credit Model based on eight health and functioning domains. Bivariate analysis, concentration curves, concentration indices and multivariate regressions have been used in the analysis presented in this paper. Findings The authors find that the prevalence of disability varied considerably across sociodemographic groups. Moreover, this variation is not uniform across all countries. Also, age, Sex, work status, years of schooling and economic status emerged out as significant predictors of disability among the studied countries. Originality/value This is perhaps the first study which examines the socioeconomic inequality in disability conceptualized in a comprehensive manner among older adults spread across low to upper middle income countries. The alarming level of prevalence of disability among sociodemographic disadvantage groups calls for immediate attention in terms of detailed study of risk factors, effective policy and timely intervention.

Purpose Disabled are often vulnerable to social exclusion due to the lack of social protection schemes. Therefore, in the absence of adequate social welfare systems, social cohesion is of enormous importance for the disabled older adults. That said, the purpose of this paper is to explore the link between disability and social cohesion among the older adults in China, Ghana, India, Mexico, Russia and South Africa. Design/methodology/approach Data from the Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007–2010 have been used for the analysis. Disability scores and social cohesion scores have been constructed using the Item Response Theory Partial Credit Model. Also, bivariate, multivariate and path analyses have been used for the examination. Findings Results show that disability substantially and significantly restricts social cohesion of the older adults in the selected countries. Moreover, path analysis indicates that, among others, disability affects physical activity which, in turn, leads to a lower socially active life. In addition, social cohesion is significantly lower among the older adults who are females, residing in urban areas, in poorer classes, widowed, not working and not having formal education. Originality/value To the best of the authors’ search, this study is perhaps the first attempt to look into the association between disability and social cohesion in a comprehensive and holistic manner in a multi-country context. A socially cohesive society provides a sense of belonging, participation, inclusion, and recognition to all. So, it is high time to create a socially as well as economically sensitive environment which can provide due recognition and inclusion to the disabled older adults.

Though a continued increase in life expectancy is a significant public health achievement, keeping older adults active and maintaining their well-being is challenging. Active aging requires physical health, mental health, functional independence, economic stability, social participation, and spiritual identification. Among all these factors, social cohesion has significant importance, but there is a dearth of studies focusing on older adults' social cohesion. Thus, the present study focuses on the level of social cohesion among older adults and its variation among the different economic classes. This article uses data from the Study on Global AGEing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa during 2007–10. Social cohesion scores have been constructed using Item Response Theory Partial Credit Model. Also, bivariate analysis, concentration curves, concentration indices, and multivariate regressions have been used for the analysis presented in this paper. This study confirms the strong predictive power of age, wealth, education, and working status of older adults on their social cohesion across the countries. Higher social non-cohesion is found among the economically poor older adults in Mexico, Russia, India, and China. In contrast, it is just opposite in the case of older adults in South Africa. Governments should develop policies to foster a society with a high level of social inclusion, social capital, and social diversity, to achieve further advancement in social cohesion.