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Background Low- and middle-income countries are undergoing epidemiological and demographic transitions alongside economic growth, contributing to a rise in abdominal obesity. In India, the increase in sedentary occupations and insufficient physical activity are key drivers of this growing health concern. This study investigates the relationship between occupational types and abdominal obesity markers in well-characterised adults, accounting for a wide range of confounders. Methods Using a nationally representative sample of 99,653 women and 91,990 men, occupations were categorised into sedentary work (SW), non-sedentary work (NSW), and not working (NW). Two outcomes were assessed: abdominal obesity, measured via waist-to-hip ratio (WHR) using WHO cutoffs, and a higher-risk threshold of WHR ≥ 1. Bivariate analyses and multivariable logistic regression, adjusted for socioeconomic and demographic factors, were conducted to evaluate the risk of abdominal obesity by occupation type. Results Among women, abdominal obesity prevalence based on WHO criteria was 56% (95% CI: 55.60–56.46), highest in NW (57.3%; 95% CI: 56.80–57.83), followed by SW (57.1%; 95% CI: 55.39–58.78) and NSW (51.5%; 95% CI: 50.63–52.43). Among men, prevalence was 48.9% (95% CI: 48.31–49.46), highest in SW (57.8%; 95% CI: 56.51–59.14), followed by NSW (49.9%; 95% CI: 49.15–50.63) and NW (37.3%; 95% CI: 36.14–38.43). Adjusted odds of abdominal obesity were significantly higher for SW compared to NSW (women: aOR 1.08, 95% CI: 1.02–1.14; men: aOR 1.20, 95% CI: 1.16–1.25). Conclusions High prevalence of abdominal obesity among both men and women implies an emerging health risk in India. The findings that contributed to associations between sedentary occupation and abdominal obesity may inform occupation-related health risks and development of interventions to limit daily sitting at work place which may reduce metabolic disease risk.

Background The prevalence of hypertension and diabetes, which often coexist and significantly contribute to the burden of noncommunicable diseases (NCDs), is increasing in India. This study examines the sex-stratified prevalence, coexistence, and bidirectional risks of hypertension and diabetes across states with varying epidemiological transition levels (ETLs) and identifies high-burden hotspots. Methods This study analysed data from the fifth round of the National Family Health Survey, covering 614,426 women and 556,199 men aged 30 years and above, with biomarker information on both diabetes and hypertension. The age-standardized prevalence was estimated, and adjusted risk ratios (ARRs) were obtained on multivariate logit scale. Bivariate maps, spatial autocorrelation and hotspot analyses were conducted using ArcGIS Pro to identify geographic clusters associated with twin epidemics. Results Individuals diagnosed with hypertension or diabetes were, on average, nearly a decade older than those without. Hypertension prevalence was 30.3% (95%CI:30.14–30.48) among men and 28.6% (95%CI:28.47–28.79) among women, whereas diabetes prevalence was at 19.7% (95%CI:19.58–19.88) in men and 17.4% (95%CI:17.22–17.50) in women. Among individuals with diabetes, 43.1% (95%CI:42.67–43.53) of men and 43.9% (95%CI:43.48–44.36) of women had hypertension, whereas 28.1% (95%CI:27.75–28.37) of hypertensive men and 26.6% (95%CI:26.33–26.93) of hypertensive women were diabetic. Hotspots for twin epidemics were identified in coastal regions, including the southern states with high ETLs, as well as the northern states with high-ETLs and the country’s northeastern region. ARR estimates revealed that the risk of hypertension among individuals with diabetes was 39% higher (95%CI:1.38–1.40) in men and 41% higher (95%CI:1.39–1.42) in women than in individuals without diabetes. Similarly, the risk of diabetes among individuals with hypertension was 51% higher (95%CI:1.49–1.52) in men and 55% higher (95%CI:1.53–1.57) in women than in individuals without hypertension. Conclusion Our findings highlight the progressive nature of the twin epidemics of diabetes and hypertension, with an increased risk of onset associated with advanced age. The presence of one condition substantially elevates the likelihood of developing the other, highlighting their bidirectional relationship. Achieving Sustainable Development Goal target 3.4 requires addressing these intersecting epidemics as a unified entity for effective management. Targeted interventions should prioritise high-burden hotspots for integrated care strategies to mitigate the twin epidemics of diabetes and hypertension.

Background Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored. Methods We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round ‘Social Consumption in India: Health (2017–18)’, focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs). Results Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29–45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36–35.79). Conclusions The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies.

Abdominal obesity, measured using the waist-to-hip ratio, is an emerging public health concern in India, yet national averages mask important subnational variation relevant for local policy and prevention planning. We sought to quantify district-level variation in abdominal obesity and to examine its individual- and contextual-level determinants across India. Using nationally representative data from the National Family Health Survey 2019–2021, we analysed 664,646 women aged 15–49 years and 96,010 men aged 15–54 years across 707 districts and 30,112 communities using multilevel logistic regression. Abdominal obesity was defined using WHO-anthropometric cut-offs for WHR (women: >0.85; men: >0.90). National prevalence was high, affecting 56.6% (95% confidence interval [CI]: 56.41–56.74) of women and 48.9% (95% CI: 48.31–49.46) of men, with higher levels among older adults, wealthier groups, and urban residents. Marked inter-district heterogeneity was observed, with clusters of high prevalence in northern and eastern India and distinct sex-specific spatial patterns. Variance partitioning indicated that individual-level factors accounted for about 67% of total variation among women and 70% among men, while community-, district-, and state-level factors together explained the remaining variation. These findings demonstrate the value of small-area estimates for identifying high-burden populations and informing geographically targeted public health planning.

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

Purpose The purpose of this paper is to provide a conceptual overview of potential diasporic influence in India by Indian diaspora and to outline a wide spectrum of policy interventions for better utilisation of diasporic resources, which are under-exploited. Design/methodology/approach This paper used a systematic review approach to analyze the vast empirical and theoretical literature, up to 2016, and to assess the different kinds of impacts of diaspora on the homeland. A list of top-tier journals in the field of international migration, diaspora and ethnic entrepreneurship was compiled. From there, each and every paper was identified, examined, coded and classified into high-level themes. These were then reviewed, analyzed and interpreted. Findings Indian diasporic affair has undergone numerous changes since India’s independence. This study presents a conceptual framework on the role of migration and diaspora in the country of origin with a special focus on India and point out the possible directions for future studies. Research limitations/implications The systematic review approach has a qualitative nature, in which the relevant literature was interpreted based on the authors’ domain knowledge and expertise. Practical implications Academicians and policy practitioners can gain a comprehensive understanding of the dynamic relationships among the key influential factors in migration, diaspora and its developmental role in homeland, as presented in the conceptual framework in the study. Accordingly, policymakers will be able to develop effective strategies to leverage the positive impacts of diasporic role in India and the other South-Asian developing countries. Originality/value This systematic review synthesizes the findings reported in most recent publications and government reports and develops an integrated conceptual framework, anchoring on possible positive impacts of diaspora in homeland. This framework provides a visual diagram to practitioners for a better understanding of the relevant literature and assists researchers and policymakers in developing a new strategy for future diasporic affairs.

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.

The Data Innovation, Program Implementation, and Community Action (DIPICA) Observatory for Surgical, Anesthesia, and Obstetric (SAO) Care in India convened in December 2024 in New Delhi. This two-day program brought together experts from global surgery, public health, health policy, and clinical practice to address planned challenges in SAO care, focusing on data-driven approaches, sustainable financing, and workforce development. The discussions emphasized leveraging data to strengthen SAO care systems by creating practical data products for localized planning and community engagement. Participants advocated for dynamic observatories to support data-driven research and policy implementation, making SAO care more accessible and efficient. Sustainable financing emerged as a key focus, with experts discussing innovative approaches that move beyond conventional models. Community-based solutions, decentralized funding, and performance-based models were discussed as strategies to optimize resource allocation. Establishing partnerships involving government, private, and community sectors was highlighted as crucial for achieving financial sustainability, particularly in underserved areas. Workforce development discussions addressed competency-based training and task-sharing initiatives to reduce disparities. The attendees agreed on the need for structured training to enhance surgical skills, especially for general practitioners in rural areas. Regulatory policies on task-sharing and task-shifting were considered essential to maintaining care quality while expanding access. Improving trauma care and emergency response through targeted training and rural workforce retention also remained key priorities. Advocacy efforts focused on integrating SAO care into national health priorities through data-driven communication and public engagement. The observatory aims to sustain progress through collaborative research, advocacy, and policy dialogues to ensure equitable, accessible, and high-quality SAO care across India.

Approximately one third of the food produced is discarded or lost, which accounts for 1.3 billion tons per annum. The waste is being generated throughout the supply chain viz. farmers, wholesalers/processors, logistics, retailers and consumers. The majority of waste occurs at the interface of retailers and consumers. Many global retailers are making efforts to extract intelligence from customer’s complaints left at retail store to backtrack their supply chain to mitigate the waste. However, majority of the customers don’t leave the complaints in the store because of various reasons like inconvenience, lack of time, distance, ignorance etc. In current digital world, consumers are active on social media and express their sentiments, thoughts, and opinions about a particular product freely. For example, on an average, 45,000 tweets are tweeted daily related to beef products to express their likes and dislikes. These tweets are large in volume, scattered and unstructured in nature. In this study, twitter data is utilised to develop waste minimization strategies by backtracking the supply chain. The execution process of proposed framework is demonstrated for beef supply chain. The proposed model is generic enough and can be applied to other domains as well.

Background Visceral leishmaniasis (VL) is a neglected tropical disease primarily affecting Brazil, East Africa, and India, with India accounting for 18% of the global burden. While VL typically presents with systemic symptoms like fever, weight loss, and splenomegaly, it can occasionally manifest atypically, posing significant diagnostic challenges. Neurological presentations of VL are extremely rare, making them difficult to suspect and diagnose. Cases where VL predominantly presents with neurological symptoms are particularly novel, underscoring the need for heightened awareness of such atypical manifestations in endemic regions. Clinical case A 38-year-old man with history of recurrent atypical VL presented with diffuse lower back pain, progressive tingling, numbness, weakness in the lower extremities, and double vision for one month. Clinical and radiological evaluations suggested cauda equina syndrome and cranial nerve palsy, accompanied by generalized lymphadenopathy, subcutaneous nodules, and skin papules. The differential diagnosis initially included disseminated tuberculosis, histoplasmosis, and lymphoma. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. Histopathology of lymph node and bone marrow revealed Leishmania amastigotes and subcutaneous nodule and skin biopsy revealed inflammatory cells with granulomas. Furthermore, the qPCR test on DNA from a subcutaneous nodule, lymph node, and CSF was positive for Leishmania kinetoplast DNA. The species was further confirmed as Leishmania donovani through ITS-based PCR amplification and sequencing . Finally, a diagnosis of relapse of VL with lymph node, cutaneous, and neurological involvement, including abducens nerve palsy and cauda equina syndrome, was established. He was treated with combination of liposomal amphotericin B and miltefosine, along with intrathecal hyaluronidase, resulting in significant improvement. Conclusion Unlike previously reported cases with both systemic and neurological symptoms, our patient predominantly presented with neurological manifestations, making this a unique and novel presentation of VL. This case highlights diagnostic challenges and management of atypical VL, emphasizing neurological involvement and successful therapeutic strategies.