Introduction: Caesarean section (C-section) delivery is a critical maternal health intervention when medically indicated; however, its rapid increase beyond recommended levels (range of 10–15%) raises concerns about unnecessary surgical births. India has witnessed a substantial rise in C-section deliveries, with pronounced urban–rural differentials, reflecting inequalities in healthcare access, service provision, and socioeconomic status. Understanding how place of residence interacts with demographic and socioeconomic factors is essential for addressing inequities in delivery care. Data and Methods: This study used data from the National Family Health Survey (NFHS-5, 2019–21), covering 155,624 most recent institutional births among currently married women aged 15–49 years in India. Descriptive and bivariate analyses were followed by stratified (urban, rural and total) multilevel logistic regression models (individuals nested within PSUs, districts, and states) to assess contextual variation and determinants. Model fit was evaluated using AIC, BIC, and intra-class correlation coefficients (ICCs). Furthermore, to understand the factors associated with differential pattern in Caesarean delivery in rural and urban Fairlie decomposition technique has been applied. Results Overall, 26.6% of deliveries occurred by C-section, with a substantially higher prevalence in urban areas (36.6%) compared to rural areas (22.3%). Multilevel analysis showed significant clustering at PSU, district, and state levels. Deliveries in private hospitals had markedly higher odds of C-section (AOR = 5.02; 95% CI: 4.84–5.20). Higher maternal age, education, wealth status, ≥ 4 ANC visits, and pregnancy complications increased the likelihood of C-section, while higher birth order and longer birth intervals reduced it. Even after adjustment, rural residence remained associated with lower odds of C-section. Fairlie decomposition analysis revealed that 93.8% of the urban–rural gap in caesarean section deliveries is explained by observed characteristics, with maternal factors contributing the largest share. Place of delivery alone accounted for nearly half of the explained disparity (49.9%), followed by household wealth (15.7%) and region (8.3%). Conclusion C-section delivery in India is strongly patterned by place of residence, healthcare sector, and socioeconomic advantage. The findings highlight growing urban–private sector dominance in C-section use and persistent contextual inequalities. Policy efforts should focus on regulating private facilities, improving quality of obstetric care in rural areas, and promoting evidence-based delivery practices to ensure medically appropriate and equitable maternal healthcare.

Over the years, the elderly population is growing in India. Compared to the developed nations, the Indian elderly suffer from socio-economic support. From an economic perspective, it is important to understand the extent to which the elderly is economically independent to lead their normal lives. This study aims to identify the impact of economic dependency on the perceived health status of the elderly in India. Data from the 71st and 75th rounds of the National Sample Survey are used for the analysis. Bivariate analysis is used to know the status of economic dependency and perceived health status of elderly in India. To examine the effect of economic dependency on perceived health status, ordered logit models are used. Results indicate that 30.1% of the elderly in India were economically independent, while 22.9% were partially and 47% were fully dependent on others. The likelihood of reporting excellent health was significantly low among those who partially (OR = 0.62, CI = 0.58, 0.66) and fully dependent (OR = 0.39, CI = 0.36, 0.4) on others compared to those of economically independent. The findings of this study highlight the problems of economically dependent elderly. It also indicates that several socio-economic variables are strongly related to the perceived health status of the elderly. Furthermore, it also suggests some policy measures for the betterment of the vulnerable elderly in India.

Leishmaniasis, a vector-borne disease, remains one of the most significant parasitic disease with potential outbreak and high mortality. Despite improvements in living standards and health infrastructure, there has been a territorial expansion in the incidence and lethality of the disease. However, evidence regarding its control, prevention, and eradication remains limited. Given an understanding of the present status of the disease, this study assesses the trends and patterns in the incidence and mortality of this endemic in India from 1990 to 2019. This study obtained Visceral Leishmaniasis (VL) incidence and mortality data (1990–2019) from the Global Burden of Disease (GBD) study 2019, provided by the Institute for Health Metrics and Evaluation (IHME). To capture the overall changes and sex-specific changes in ASIRs and ASMRs of VL, joinpoint regression analysis was employed for all ages by using joinpoint regression programme version 4.5.0.1. Age-period-cohort analysis is used to estimate the net age, period, and cohort effects on the incidence and mortality of VL from observed age-specific incidence and mortality rates. The APC model was implemented using Stata 16.0, and its fit was assessed using Akaike’s Information Criterion (AIC) and Bayesian Information Criterion (BIC). Findings indicate a significant decline in the age-specific incidence and mortality rates for both sex. The highest annual percentage decline in VL incidence and mortality was observed during 2011–2016 for both males and females. (Table 1). Results from the age effect show that the risk of VL incidence and mortality among both genders decreased sharply with advancing age. Period effect indicated a sharp decline in incidence and mortality risk from the period 1990–94 to 2000–04. The cohorts effect showed that compared to earlier birth cohort (1900–04),, the relative risk (RR) of VL incidence increased by 1.5 in male and 1.7 times in females in more recent birth cohort (2015–19), whereas mortality risk decreased by 48

This study evaluates the trends in tuberculosis (TB) incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in India over a 30-year period, from 1990 to 2019. This study leverages data from the Global Burden of Disease Study 2019. We employed Joinpoint regression analysis to determine the average annual percent changes (AAPCs) and their corresponding confidence intervals for age-standardized rates. Our findings reveal a significant reduction in the overall TB burden, with incidence declining from 390.22 to 223.01, prevalence from 707.94 to 390.03, mortality decreasing from 121.72 to 36.11 per 100,000, and DALYs reducing at an average annual rate of 4.01

BACKGROUND:During the coronavirus pandemic, misinformation was circulated through technology and social media on a large scale. Since people rely on media to keep connected and informed, misinformation can prevent them from staying safe. OBJECTIVES:To examine the quality of information reaching Pakistanis, the effect of information/misinformation on people's perception, and its relationship with risky health behaviours in different demographical groups. METHODS:A community sample of N= 103 Pakistanis was assessed using a mixed-method cross-sectional survey research design to investigate their sources of knowledge/information, perceptions of coronavirus-related facts, and risky health behaviours. RESULTS:Content analysis of the material that participants read/watched indicated the possible effect of media on people's perception of COVID-19. Specific demography (e.g., increasing age) and people's tendency to believe misinformation/information may indicate risky health behaviours pertaining to coronavirus infection. DISCUSSION:Findings showed how the models considered (social cognitive theory, biological warfare conspiracy theory, theory of planned behaviour, protection motivation theory, the health belief model, and biopsychosocial model) may be relevant to examination of the effects of misinformation on different demographic groups. CONCLUSION:The findings and models need to be verified on larger, more representative samples of Pakistanis using a large-scale survey based on the insights obtained from this pilot study.

Foundational literacy is a key lever for achieving higher levels of learning and societal wellbeing. However, with an enrolment of over 250 million children in schools, India is currently challenged by learning deprivation. Growing uptake of English-medium education along with less-than-optimal English literacy instruction practices present an urgent need for improving classroom instruction. Further evidence is required on the efficacy of computer-assisted game-based learning and phonics instruction over the alphabet-spelling method in literacy learning. The current intervention study examined whether classroom phonics instruction combined with GraphoLearn, a computer-assisted reading tool, supports the English phonological awareness and reading skills better than phonics instruction alone. Participants were 6–7 year-old, Grade 2 students (N = 54) attending an English-medium public school in India. All students were non-native English speakers and received phonics instruction in their classroom for 35 min thrice a week. In addition, students were randomly allocated to play either GraphoLearn-Rime (n = 28) or a math control game (n = 26) for 15–20 min every day. Both the GraphoLearn-Rime and the math control group made significant improvement in English literacy skills over the period of intervention and the amount of exposure to phonics classroom instruction predicted gains in phonological awareness skills. The GraphoLearn-Rime group gained more than the math control group in the in-game measures. In the oral-and paper-based measures, both groups showed skill development, but the groups were not significantly different in the gains (d = .04 − .29). Overall, the study indicated the potential in the integrated approach and thus the need for more research on the effects of integrating classroom phonics instruction and GraphoLearn for supporting struggling readers of English.

Background:Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar.Methods:This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied.Results:Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression.Conclusions:This study confirms the pre-existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers.

Abstract Background Around the world, advances in public health and changes in clinical interventions have resulted in increased life expectancy. Multimorbidity is becoming more of an issue, particularly in countries where the population is rapidly ageing. We aimed to determine the prevalence of multimorbidity and disease-specific multimorbidity and examine its association with demographic and socioeconomic characteristics among older adults in India and its states. Methods The individual data from the longitudinal ageing study in India (LASI) were used for this study, with 11 common chronic conditions among older adults aged 60 and above years (N = 31,464). Descriptive statistics were used to report the overall prevalence of multimorbidity and disease-specific burden of multimorbidity. Multinomial logistic regression has been used to explore the factors associated with multimorbidity. Results Prevalence of single morbidity was 30.3%, and multimorbidity was 32.1% among older people in India. Multimorbidity was higher among females and in urban areas and increased with age and among those living alone. Hypertension, arthritis and thyroid were highly prevalent among females and chronic lung diseases and stroke were highly prevalent among males. The older people in the state of Kerala had a high prevalence of multimorbidity (59.2%). Multimorbidity was found to be more likely in older age groups of 75–79 years (RR-1.69; CI: 1.53–1.87) and 80 years and above (RR-1.40; CI: 1.27–1.56) and in the Western (RR-2.16; CI: 1.90–2.44) and Southern regions (RR-2.89; CI: 2.57–3.24). Those who were living with a spouse (RR-1.60; CI: 1.15–2.23) were more likely to have multimorbidity. Disease-specific multimorbidity was high in chronic heart disease (91%) and low in angina (64.8%). Conclusions The findings suggest that multimorbidity has a positive relationship with advancing age, and disease-specific burden of multimorbidity is higher among chronic heart patients. Comorbidity, especially among those who already have chronic heart disease, stroke, cholesterol or thyroid disorder can have severe consequences on physical functioning, therefore, disease-specific health management needs to be enhanced.

BACKGROUND:The impact of COVID-19 pandemic on the provision of drug and alcohol (D&A) services and associated outcomes have been under-researched.AIM:This study aimed to understand the experiences of service providers in relation to how drug and alcohol (D&A) services were affected during COVID-19 pandemic, including the adaptations made and lessons learnt for the future.METHOD:Focus groups and semi-structured interviews were conducted with participants from various D&A service organisations across the UK. Data were audio recorded, followed by transcription and thematic analysis.RESULTS:A total of 46 participants representing various service providers were recruited between October and January 2022. The thematic analysis identified ten themes. COVID-19 required significant changes to how the treatment was provided and prioritised. Expansion of telehealth and digital services were described, which reduced service wait times and increased opportunities for peer network. However, they described missed opportunities for disease screening, and some users risked facing digital exclusion. Participants who provided opiate substitution therapy service spoke of improving service provider/user trust following the shift from daily supervised treatment consumption to weekly dispensing. At the same time, they feared fatal overdoses and non-adherence to treatment.CONCLUSION:This study demonstrates the multifaceted impact of the COVID-19 pandemic on UK-based D&A service provisions. The long-term impact of reduced supervision on Substance Use Disorder treatment and outcomes and any effect of virtual communications on service efficiency, patient-provider relationships and treatment retention and successes are unknown, suggesting the need for further study to assess their utility.

Background Monitoring the transmission patterns of human immunodeficiency virus (HIV) in a population is fundamental for identifying the key population and designing prevention interventions. In the present study, we aimed to estimate the gender disparities in HIV incidence and the age, period, and cohort effects on the incidence of HIV in India for identifying the predictors that might have led to changes in the last three decades. Data and methods This study utilizes data from the Global Burden of Disease Study for the period 1990–2019. The joinpoint regression analysis was employed to identify the magnitude of the changes in age-standardized incidence rates (ASIRs) of HIV. The average annual percentage changes in the incidence were computed, and the age–period–cohort analysis was performed. Results A decreasing trend in the overall estimates of age-standardized HIV incidence rates were observed in the period 1990–2019. The joinpoint regression analysis showed that the age-standardized incidence significantly declined from its peak in 1997 to 2019 (38.0 and 27.6 among males and females per 100,000 in 1997 to 5.4 and 4.6, respectively, in 2019). The APC was estimated to be 2.12 among males and 1.24 among females for the period 1990–2019. In recent years, although the gender gap in HIV incidence has reduced, females were observed to bear a proportionately higher burden of HIV incidence. Age effect showed a decline in HIV incidence by 91.1 and 70.1% among males and females aged between 15–19 years and 75–79 years. During the entire period from 1990–1994 to 2015–2019, the RR of HIV incidence decreased by 36.2 and 33.7% among males and females, respectively. Conclusion India is experiencing a decline in new HIV infections in recent years. However, the decline is steeper for males than for females. Findings highlight the necessity of providing older women and young women at risk with effective HIV prevention. This study emphasizes the need for large-scale HIV primary prevention efforts for teenage girls and young women.

Purpose We aim to identify the most accurate model for predicting adolescent (Grade 9) reading difficulties (RD) in reading fluency and reading comprehension using 17 kindergarten-age variables. Three models (neural networks, linear, and mixture) were compared based on their accuracy in predicting RD. We also examined whether the same or a different set of kindergarten-age factors emerge as the strongest predictors of reading fluency and comprehension difficulties across the models. Method RD were identified in a Finnish sample (N approximate to 2,000) based on Grade 9 difficulties in reading fluency and reading comprehension. The predictors assessed in kindergarten included gender, parental factors (e.g., parental RD, education level), cognitive skills (e.g., phonological awareness, RAN), home literacy environment, and task-avoidant behavior. Results The results suggested that the neural networks model is the most accurate method, as compared to the linear and mixture models or their combination, for the early prediction of adolescent reading fluency and reading comprehension difficulties. The three models elicited rather similar results regarding the predictors, highlighting the importance of RAN, letter knowledge, vocabulary, reading words, number counting, gender, and maternal education. Conclusion The results suggest that neural networks have strong promise in the field of reading research for the early identification of RD.

Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global health burden. Considering the widely known importance of the negative impact of adolescent pregnancy, motherhood at an early age, and adverse pregnancy outcomes, this paper aims to provide insight into correlates of teen pregnancy, adolescent motherhood and adverse pregnancy outcome. This study utilizes the data from UDAYA survey conducted in Uttar Pradesh and Bihar. The eligible sample size for the study was 4897 married adolescent girls between the ages of 15 and 19 years. Bivariate analysis with a chi-square test of association and Multivariable logistic regression analysis was performed to fulfill the aim of the study. Our study shows that a major proportion of married adolescents (61%) got pregnant before the age of 20 years and around 42% of all adolescent married women gave birth to a child before reaching the age of 20 years. Adolescents who married before the age of 18 years were 1.79 times more likely to experience pregnancy (OR: 1.79; CI: 1.39-2.30) and 3.21 times more likely to experience motherhood (OR: 3.21; CI: 2.33-4.43). In the present study, women who experienced physical violence were at higher risk for having an adverse pregnancy outcome (OR: 1.41; CI: 1.08-1.84) than those who did not experience physical violence. To conclude, regional and national level efforts focused on improving early marriage, education and empowering women and girls can be beneficial.

This study examined within and cross-language relations, and specifically, the role of phonological awareness (PA) skills in reading among young Hindi-speaking children (L1) who were learning to read English (L2) in Delhi, India. Data was collected from 143 children in Grades 1 and 2 using measures validated for this population. The analyses examined the associations between L1 and L2 PA and decoding, both within and across the two languages. The results showed that PA skills within each language significantly predicted decoding in that language. Furthermore, there was evidence of cross-language transfer with Hindi PA significantly predicting English word reading even after controlling for English PA. English PA also significantly predicted Hindi decoding, however, these effects decreased once Hindi PA was added to the model. These findings emphasize the important role that both L1 and L2 PA plays in reading among emergent Hindi–English bilinguals. The theoretical and practical implications of these findings on literacy instruction in India are discussed.

Information technology and software services are pervasive, occupying the centre of most aspects of contemporary societies. This has given rise to commonly expected norms and expectations around how such systems should work, appropriate penalties for violating these expectations, and more importantly, indicators of how to reduce the consequences of violations and sanctions. Evidence for expectation violations and ensuing sanctions exists in a range of portals used by individuals and groups to start new friendships, explore new ideas, and provide feedback for products and services. Therein lies insights that could lead to functional socio-technical systems, and general awareness and anticipations of human actions (and interactions) when using information technology and software services. However, limited previous work has examined such artifacts to provide these understandings. To contribute to such understandings and theoretical advancement we study expectation violations in mobile apps, considered among the most engaging socio-technical systems. We used content analysis and expectancy violation theory (EVT) and expectation confirmation theory (ECT) to explore the evidence and nature of sanctions in app reviews for a specific domain of apps. Our outcomes show that users respond to expectation violation with sanctions when their app does not work as anticipated, developers seem to target specific market niches when providing services in an app domain, and users within an app domain respond with similar sanctions. We contribute to the advancement of expectation violation theories, and we provide practical insights for the mobile app community.

Background In 2018, it was found that only a quarter of Grade 3 children in India were reading at grade level. A growing demand for English education has further limited children's literacy achievement. Despite a strong evidence base in favour of using systematic phonics for building English literacy skills, many teachers in India continue to use rote-methods of literacy instruction. Objectives We aimed to examine the efficacy of GraphoLearn (GL) English Rime, a computer-assisted reading intervention, in improving the foundational literacy skills of 1st and 2nd grade students who were attending an English medium school in India. Methods A total of 136 students across 6 classrooms were randomly allocated to play either GL or a control math game over a 5-week intervention period. Students were pre- and post-tested on various English literacy skills using tasks built into the GL software as well as through oral and paper-based tasks. Results and Conclusions Students who played GL showed significantly greater and faster development on in-game measures of letter-sound knowledge, rime unit recognition, and word recognition as compared to students who did not play GL. In addition, GL resulted in greater effects on these measures for students with stronger English literacy skills prior to the start of the intervention. No differences were found between groups on the oral and paper-based tasks. Implications GL was able to quickly and effectively teach critical sub-skills for reading. However, a lack of effects on the out-of-game measures opens the door for further discussion on the successful implementation of such interventions.

Abstract Background: Cervical cancer is the fourth most common cancer that occurs to women worldwide. This study aims to assess trends in incidence and mortality of cervical cancer in India and its states over past three decades for tracking the progress of strategies for the prevention and control of cervical cancer. Methods: Data on cervical cancer incidence and mortality from 1990 to 2019 for India and its states were extracted from Global Burden of Disease study and were utilized for the analysis. Spatial and rank map has been used to see the changes in incidence and mortality of cervical cancer in different Indian states. Further, joinpoint regression analysis is applied to determine the magnitude of the time trends in the age standardized incidence and mortality rates of cervical cancer. We obtained the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI) for each state. Results: Overall, from 1990 to 2019 Jharkhand (Incidence: -50.22%; Mortality: -56.16%) recorded the highest percentage decrement in cervical cancer incidence and mortality followed by the Himachal Pradesh (Incidence: -48.34%; Mortality: -53.37%). Tamilnadu (1st rank), Jammu & Kashmir and Ladakh (32nd rank) maintained the same rank over the period of three decade for age standardized cervical cancer incidence and mortality. The regression model showed a significant declining trend in India between 1990 and 2019 for age standardized incidence rate (AAPC: −0.82; 95%CI: −1.39 to −0.25; p < 0.05) with highest decline in the period 1998-2005 (AAPC: −3.22; 95%CI: −3.83 to −2.59; p < 0.05). Similarly, a significant declining trend was observed in the age standardized mortality rate of India between 1990 and 2019(AAPC: −1.35; 95%CI: −1.96 to −0.75; p < 0.05) with highest decline in the period 1998-2005 (AAPC: −3.52; 95%CI: −4.17 to −2.86; p < 0.05).Conclusion:Though the incidence and mortality of cervical cancer declined over past three decades but it is still a major public health problem in India. Information, education and communication activities for girls, boys, parents and community for the prevention and control of cervical cancer should be provided throughout the country.

Introduction The study explored the socioeconomic and demographic factors that determine the onset of difficulty, recovery from difficulty and difficulty remaining in functional activity in later years of life. Additionally, the study examined the effects of several combinations of chronic diseases on the changes in later-life functional difficulty. Methods We used data from two rounds of India Human Development Survey (IHDS) conducted during 2004-2005 and 2011-2012. A sample of 13,849 respondents aged 55 years and above with a seven year follow-up was considered for this study. The Katz Index of Independence in activities of daily living (ADL) was used to measure the functional disability as an outcome variable. Multinomial logistic regression has been conducted to fulfil the study objectives. Results The overall functional difficulty among older adults was 27.3% and onset of functional difficulty (23.5%) was higher than the recovery from difficulty (2.1%) and remaining with difficulty (1.7%). Onset of functional difficulty in second round was higher among women (27.3%) than men (19.3%). Bivariate and multivariate analyses showed that single and multi-morbidity had a positive significant association with all categories of functional difficulty. Female sex, increasing age and rural place of residence had positive association with onset of difficulty and difficulty remaining in second round. The combinations of morbidities were also found to have positive significant association with functional difficulty i.e., the relative risk (RR) of onset of difficulty in second round is higher among those who had diabetes with high blood pressure (RR-1.7; CI: 1.4-2.0), cataracts with high blood pressure (RR-2.0; CI: 1.5-2.6) and cataracts with asthma (RR-3.1; CI: 2.1-4.6) compared to those with no diabetes and cataract but with high blood pressure or asthma, respectively. Conclusion The findings suggest that the risk of onset of functional difficulty is higher among older individuals with single and multiple morbidities compared to their healthy counterparts. It is also found that functional difficulty increased with age and was more prevalent in older women and rural residents, suggesting the need for appropriate policy interventions with special focus on the vulnerable senior adults.

Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18–0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27–0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24–0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52–0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65–1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.

Abstract Background: Depression has been identified as a leading cause of disability, and studies suggest that people who have experienced depression at a young age are more likely to have depression throughout their lives. This study aims to assess the prevalence and determinants of depression among adolescents in Bihar and Uttar Pradesh states of India which holds the majority of adolescents in the country.Method: We have utilized data from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey which was conducted in Bihar and Uttar Pradesh among 10-19 years old in 2016. Descriptive statistics, Bivariate analysis and multinomial logistic regression analysis were used to fulfill the objective of this study. Results: Prevalence of depression was found to be higher among married female adolescents 49.6% (aged 15-19 years) in comparison to unmarried males 36% (10-19 years) and female adolescents 42.4% (10-19 years). Among adolescent males who ever seriously consider attempting suicide was 8.44 times (RR: 8.44; CI: 4.5-15.81) more likely to have minimal to mild depression and 22.74 times (RR: 22.72; CI: 7.74-66.7) more likely to have moderate to severe depression. Also, Adolescent males who were substance users were 2.35 times (RR: 2.35; CI: 1.24-4.43) more likely to have moderate to severe depression. Adolescent unmarried females who were not currently attending school was 39% more likely (RR: 1.39; CI: 1.06-1.83) to have moderate to severe depression; whereas adolescent unmarried females who ever attempt suicide was 42.21 times (RR: 42.21; CI: 26.39-67.51) more likely to have moderate to severe depression. For married adolescent females having premarital relationship (RR: 1.78; CI: 1.25-2.54), substance use in family (RR: 1.85; CI: 1.28-2.67), faced physical violence (RR: 1.59; CI: 1.09-2.34), faced emotional violence (RR: 1.93; CI: 1.31-2.82), faced dowry related abuse (RR: 3.33; CI: 2.43-4.57) and ever attempted suicide (RR: 56.85; CI: 26.57-121.66) were significant predictors of facing moderate to severe depression. Conclusion: Results highlight the need of targeting adolescents’ behaviour and depressive symptoms especially in rural areas. Further, this study raises the prevalent issues such as violence, lack of freedom, suicidal ideation which adversely impacts the mental health of adolescents and draws our attention towards the urgent need of addressed.

Introduction: Pregnancy loss is a public health issue throughout the world. Miscarriage and induced abortion are the two main dimensions of pregnancy loss. The prevalence of early pregnancy loss due to miscarriage and abortion is mostly unknown due to the lack of early registration of pregnancies in most places, and especially in low- and middle-income countries. In a country like India, not enough attempts have been made to recognize pregnancy loss by weeks of gestational age. Objective: This study aims to know about the age-pattern of gestational termination using the calendar information from the fourth round of the National Family Health Survey. Statistical Methods: A generalized linear model with a binomial distribution assumption and Kaplan-Meier survival model with left truncation was used for statistical analysis. Results: The age-pattern of miscarriage produces a vertical convex shape curve when age is drawn at y-axis and the miscarriage rate at x-axis. There is a high relative risk of miscarriage to women age below 20 years and age 35 years onwards, whereas abortion risk was high among women age 30 and above years. Among women age 15-19 years, the abortion rate at 27 abortions per thousand pregnancies was the highest in the northeast region, and the miscarriage rate at 67 miscarriages per thousand pregnancies was estimated to be the highest in the western region among all the regions. A sizeable proportion of miscarriages and induced abortions also occurred in the second trimester and all the region. Conclusion: This article brings out that miscarriage is more commonly prevalent among women in the adolescence age 15-19 years and in the latter half of the reproductive span, whereas the incidence of abortion increases with age. The western and the northeast regions registered maximum miscarriage and abortion rates among women age 15-19, respectively. The central region as a whole showed the highest rate of miscarriage, whereas the abortion rate was the highest in the northeast region in India. The findings of the study will be beneficial in making appropriate policy provisions for postponing pregnancies among women in their adolescence and preventing the occurrence of miscarriages among more vulnerable age groups of women and regions by providing a complete package of high-quality antenatal care services.