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Background: The burden of cancer in India has been rising, yet testing for early detection remains low. This study explored inequalities in the uptake of breast cancer (BC) examination and cervical cancer (CC) among Indian women, focusing on socioeconomic, regional, and educational differences.Methods: Data from the 2019-21 National Family Health Survey (n=353,518) were used to assess the uptake of BC examination and CC testing. Inequalities were quantified using the slope index of inequality (SII), relative index of inequality (RII), and relative concentration index (RCI). SII measured absolute inequality, while RII and RCI assessed relative inequality between disadvantaged and advantaged groups.Results: The ever uptake of tests for early detection of BC and CC were low at 9 and 20 per 1,000 women, respectively. Higher uptake was observed among women from the richest households compared to the poorest (SII: 1.1 for BC and 1.8 for CC). The magnitude of relative socioeconomic inequalities was more pronounced in rural areas (RCI: 22.5 for BC and 21.3 for CC) compared to urban areas. Similarly, higher-educated women were 4.84 times (RII: 4.84) and 2.12 times (RII: 2.12) more likely to undergo BC examination and CC testing, respectively, compared to non-educated women. The northeastern region exhibited greater socioeconomic inequality, while the western region showed more education-based inequality.Conclusion: The lower uptake of BC examination and CC testing and the marked inequalities underscore the need for targeted interventions to improve access and utilization of testing services, especially among lower-educated women, and those in rural areas.

Background: Infertility is an escalating global concern, impacting approximately one-sixth of the reproductive age population worldwide. Employing data from the National Family Health Survey-5 (NFHS-5, 2019-21), this study assessed the prevalence of primary infertility at both national and state levels in India. Methods: The data of the study was extracted from the National Family Health Survey and Individual file (women file) of the fifth round of NFHS encompassing a sample of 491,484 currently married women in the age group of 15–49 years. Results: The findings showed that the prevalence of infertility is 18.7 per 1,000 women among those married for at least five years and currently in union. This prevalence increases as the duration of marriage decreases. On a state-level analysis, regions such as Goa, Lakshadweep, and Chhattisgarh exhibit the highest burdens. Conclusion: These findings underscore the growing challenge posed by primary infertility in India, calling for targeted interventions and policy measures. The establishment of a national infertility surveillance system is of pivotal importance in addressing this pressing public health issue.  

Despite widespread interest in son preference in India, the study of its spatial distribution and trends by parity at the district level is limited. This study investigates spatial patterns and temporal trends in son preference by parity across districts of India from 2002 to 2021. We applied model-based area-level small area estimation techniques on data from consecutive rounds of the Indian National Family Health Survey and the District Level Household Survey to derive district-level estimates of son preference by parity. Spatial patterns and clustering were examined using Moran's I and local indicators of spatial autocorrelation across multiple rounds of survey. At parity 1, only a few districts showed a strong son preference in 2002-2004, but this number steadily increased in each subsequent survey round. In contrast, the number of districts with high son preference at parity 2 rose in 2007-2008 and then declined in subsequent rounds. At parity 3 or higher, the number of districts showing a strong son preference declined consistently in each subsequent survey round. Son preference in India exhibits distinct spatial and evolving temporal patterns across parities. The increasing prevalence at parity 1 and declining trends at higher parities suggest shifting reproductive behaviours. These findings underscore the need for targeted district-level, parity-specific interventions to address persistent and emerging gender-biased norms in son preference.

Background Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts. Methods From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15–49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia. Results The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08–1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13–1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35–1.44], poorest women [AOR: 1.27, 95% CI: 1.22–1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12–1.17] were more likely to be anaemic. Conclusion The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India.

Background Prevalence of hypertension increases with age, but there is a general perception in India that women are less affected at every stage of life, although empiric evidence hardly exists regarding gender difference in hypertension in Indians of different ages. Therefore, we aimed to examine the gender difference in hypertension among Indians across various age-groups; and the contribution of variation in body mass index (BMI) to this difference. Methods Data were analysed after combining National Family Health Survey 4 ( n  = 294,584 aged 35–49 years) and Study of Ageing and Health wave 2 ( n  = 7118 aged 50 + years) datasets (NFHS-SAGE). Longitudinal Ageing Study of India (LASI) dataset ( n  = 65,900 aged > 45years) was analysed to replicate the results. Hypertension was defined if systolic and diastolic blood pressure was > 89 and/or > 139 respectively and/or if there was a history of anti-hypertensive medication. Descriptive summaries were tabulated and plotted to examine the gender difference in hypertension in various age-groups (35–39,40–44, 45–49, 50–54, 55–59, 60–64, 65–69, ≥ 70). Odds Ratios (ORs) from logistic regression models estimated the age gradient of hypertension and their male-female difference, adjusted for Body Mass Index (BMI). Results Males had a higher prevalence of hypertension up to 50 years; after that, females had higher rates. The estimates of age gradient, expressed as ORs, were 1.02 (1.02, 1.02) in males versus 1.05(1.05, 1.06) in females ( p  < 0.001) in NFHS-SAGE and 1.01(1.01, 1.02) in males versus 1.04(1.03, 1.04)in females ( p  < 0.001) in LASI;these differences marginally changed after adjustment with BMI. Conclusion This is perhaps the first study to comprehensively demonstrate that cardio-metabolic risk in Indian females surpasses males after 50 years of age, “busting the myth” that Indian females are always at much lower risk than males; and this evidence should inform the Indian healthcare system to prioritise older women for screening and treatment of hypertension.

Background In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. Methods A full sample of 707,119 women aged 15–49 and a sub-sample of 357,353 women aged 30–49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15–49 and women aged 30–49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. Results The proportion of breast and cervical cancer screening among women aged 30–49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30–49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31–1.62], aged 40–49 years [OR:1.35; 95% CI: 1.28–1.43], resided in the western [OR:1.62; 95% CI:1.4–1.87] or southern [OR:6.66; 95% CI:5.93–7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15–49 was similar to that of women 30–49. Conclusion The overall proportion of cancer screening among women in 30–49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India.

BackgroundNeurofilament proteins have been extensively studied in relapsing–remitting multiple sclerosis, where they are promising biomarkers of disease activity and treatment response. Their role in progressive multiple sclerosis, where there is a particularly urgent need for improved biomarkers, is less clear. The objectives of this systematic review are to summarise the literature on neurofilament light and heavy in progressive multiple sclerosis, addressing key questions.MethodsA systematic search of PubMed, Embase, Web of Science and Scopus identified 355 potential sources. 76 relevant sources were qualitatively reviewed using QUADAS-2 criteria, and 17 were identified as at low risk of bias. We summarise the findings from all relevant sources, and separately from the 17 high-quality studies.ResultsDifferences in neurofilament light between relapsing–remitting and progressive multiple sclerosis appear to be explained by differences in covariates. Neurofilament light is consistently associated with current inflammatory activity and future brain atrophy in progressive multiple sclerosis, and is consistently shown to be a marker of treatment response with immunosuppressive disease-modifying therapies. Associations with current or future disability are inconsistent, and there is no evidence of NFL being a responsive marker of purportedly neuroprotective treatments. Evidence on neurofilament heavy is more limited and inconsistent.ConclusionsNeurofilament light has shown consistent utility as a biomarker of neuroinflammation, future brain atrophy and immunosuppressive treatment response at a group level. Neither neurofilament light or heavy has shown a consistent treatment response to neuroprotective disease-modifying therapies, which will require further data from successful randomised controlled trials.

Maternal mortality ratio (MMR) estimates have been studied over time for understanding its variation across the country. However, it is never sufficient without accounting for presence of variability across in terms of space, time, maternal and system level factors. The study endeavours to estimate and quantify the effect of exposures encompassing all maternal health indicators and system level indicators along with space–time effects influencing MMR in India. Using the most recent level of possible -factors of MMR, maternal health indicators from the National Family Health Survey (NFHS: 2019–21) and system level indicators from government reports a heatmap compared the relative performance of all 19 SRS states. Facet plots with a regression line was utilised for studying patterns of MMR for different states in one frame. Using Bayesian Spatio-temporal random effects, evidence for different MMR patterns and quantification of spatial risks among individual states was produced using estimates of MMR from SRS reports (2014–2020). India has witnessed a decline in MMR, and for the majority of the states, this drop is linear. Few states exhibit cyclical trend such as increasing trends for Haryana and West Bengal which was evident from the two analytical models i.e., facet plots and Bayesian spatio- temporal model. Period of major transition in MMR levels which was common to all states is identified as 2009–2013. Bihar and Assam have estimated posterior probabilities for spatial risk that are relatively greater than other SRS states and are classified as hot spots. More than the individual level factors, health system factors account for a greater reduction in MMR. For more robust findings district level reliable estimates are required. As evident from our study the two most strong health system influencers for reducing MMR in India are Institutional delivery and Skilled birth attendance.

Introduction Existing evidence suggests a lower uptake of cervical cancer screening among Indian women. Coverage is lower in rural than urban women, but such disparities are less explored. So, the present study was conducted to explore the self-reported coverage of cervical cancer screening in urban and rural areas stratified by socio-demographic characteristics, determine the spatial patterns and identify any regional variations, ascertain the factors contributing to urban-rural disparities and those influencing the likelihood of screening among women aged 30–49 years factors residing in urban, rural, and overall Indian settings. Methods We did a secondary analysis of the fifth round of the National Family Health Survey in India (2019-21) data with a sample size of 3,48,882 women. The coverage of cervical cancer screening was estimated using sampling weights. Urban-rural differences were compared using the chi-square test. Spatial patterns were analysed using aggregated district-level data, and the contribution of different independent variables to the urban-rural disparities was estimated using multivariate decomposition analysis. Multivariable logistic regression was conducted using STATA 17 to obtain the significant factors of reported screening in urban and rural areas. Results The nationwide coverage of cervical cancer screening was 2.0% (95% CI: 1.9-2.0). The urban (2.4%; 2.3–2.5) participants had higher screening coverage than their rural (1.8%; 1.7–1.8) counterparts. Moran’s I statistic confirmed the presence of spatial dependence and geographical gradient. Decomposition analysis depicted small urban-rural differences in the screening coverage of 0.60% (0.4–0.8). Endowment and coefficient contributed to 88.15% and 11.85% of the disparities. Compositional changes were contributed majorly by regional differences, low education, scheduled tribes, and having living children > 2. Higher odds of having screening were associated with older age (AOR 1.45, 95% CI: 1.03–1.28), higher education (1.32; 1.13–1.55), higher age of first intercourse (1.60; 1.43–1.79), married (1.25; 1.08–1.45) and diabetic (1.39; 1.17–1.65) women, and those from South India (6.76; 5.90–7.75). The odds were lower among Muslims, scheduled tribes and participants using hormonal contraceptives. Conclusion There are significant urban-rural disparities in cervical cancer screening uptake that can be attributed to regional variation, educational inequalities, tribal groups, socio-economic inequalities and parity, necessitating the need to comprehensively design tailor-made advocacy initiatives and simultaneously address the broader determinants of health.

Background Hypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5). Methods NFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata , employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension. Results The study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension. Conclusion Hypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health.