Objective: To assess the coverage and adequacy of antenatal care services (ANC) available to women and examine the socio‐economic determinants affecting service utilisation.Design: Secondary data analysis of a population‐based national survey.Setting: India, 2015/16.Sample: In all, 190 898 women between 15 and 49 years of age who had a live birth during the 5 years preceding the survey.Methods: Ordinal logistic regression.Main outcome variable: Adequacy of ANC services received was measured under four categories – delivery of services by skilled personnel, timely provision of services, sufficiency and appropriateness of content. Quality of care was categorised as adequate ANC, inadequate ANC and no ANC.Results: Only 23.5% (95% CI 23.1–23.9%) of all women received adequate ANC, while 58.8% (95% CI 58.4–59.2%) received inadequate and 17.7% (95% CI 17.4–18.0%) received no ANC services. Regression analysis revealed that women belonging to the adolescent age group, illiterate women, and those in the poorest wealth quintile and in rural areas were less likely to receive any ANC.Conclusion: There is a need to improve the quality of ANC services. Currently, <25% of women of all ages receive adequate ANC. Socio‐economic conditions play a vital part in determining the quality of care that women receive.Tweetable Nearly one out of four women in India received adequate ANC, nearly three in every five women received inadequate ANC and 18% lacked ANC for their recent live birth.

Objective Study uses multilevel modelling to examine the effect of individual, household and contextual characteristics on chronic diseases among older Indian adults. Design Nationally representative cross-sectional study. Participants Data 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. Measures Self-reported diagnosed chronic illness. Method Considering the hierarchal structure of the data multilevel logistic regression analysis was applied to attain the study objective. Results Older 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. Conclusion Even 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.

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.

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.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.