Perspectives on child health and wellbeing

The coronavirus disease 2019 (COVID-19) pandemic has brought unparalleled challenges to the care of children and adolescents globally. India is currently second on the list of countries with highest case counts and third in terms of deaths. According to data from the Ministry of Health and Family Welfare, as on September 1, 2020, eight percent of the cases and one percent of deaths in India have occurred in children aged under 17 years. COVID-19 appears to be milder in children than in adults, which is quite atypical for a respiratory viral infection, commonly presenting as a self- limiting febrile upper respiratory illness. However, children are still at risk of developing severe illness and complications from COVID-19. These include respiratory failure, damage to the heart, kidneys, and multi-organ system failure, just like in adults. A minority of children can also experience a serious, post-infectious inflammatory syndrome, which is specific to children, difficult to treat and can be associated with long-term consequences. The overall mortality rate due to the disease in much lower in children compared to adults

Health in food systems policies in India: a document review

Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India.; This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated.; A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies).; We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains

Perceived health impacts of watershed development projects in southern India: a qualitative study

Watershed development (WSD) projects-planned for over 100 million ha in semi-arid areas of India-should enhance soil and water conservation, agricultural productivity and local livelihood, and contribute to better nutrition and health. Yet, little is known about the health impacts of WSD projects, especially on nutrition, vector breeding, water quality and the distribution of impacts. We conducted a qualitative study to deepen the understanding on perceived health impacts of completed WSD projects in four villages of Kolar district, India. Field data collection comprised: (i) focus group discussions with local women (; n; = 2); (ii) interviews (; n; = 40; purposive sampling) with farmers and labourers, project employees and health workers; and (iii) transect walks. Our main findings were impacts perceived on nutrition (e.g., food security through better crop survival, higher milk consumption from livestock, alongside increased pesticide exposure with expanded agriculture), potential for mosquito larval breeding (e.g., more breeding sites) and through opportunistic activities (e.g., reduced mental stress due to improved water access). Impacts perceived varied between participant categories (e.g., better nutrition in woman-headed households from livelihood support). Some of these findings, e.g., potential negative health implications, have previously not been reported. Our observations informed a health impact assessment of a planned WSD project, and may encourage implementing agencies to incorporate health considerations to enhance positive and mitigate negative health impacts in future WSD projects

Health vulnerability to heat stress in rural communities of the semi-arid regions of Maharashtra, India

Rural health infrastructure needs to be upgraded to effectively include heat stress related illnesses and to develop a health surveillance mechanism for monitoring heat-related morbidity and mortality. This policy brief highlights the risks and responses to heat stress in rural communities of the semi-arid region of Maharashtra. It identifies vulnerable groups as well as important factors that affect vulnerability to heat stress. Heat related symptoms (HRS) include: small blisters or pimples, dry mouth, fatigue, leg cramps, heavy sweating, intense thirst, rapid heartbeat, headache, leg swelling, paranoid feeling and swelling of face; and in more severe cases hallucinations, fainting and vomiting.UK Government’s Department for International Development (DfID)International Development Research Centre (IDRC

Health care equity in urban India

The report is based on the data drawn from detailed interactions with civil society organisations working on urban health in different cities and town across geographies including Mumbai, Bengaluru, Surat, Lucknow, Guwahati, Ranchi, Delhi etc., inputs from health officials in select cities, analysis of select data bases including NFHS, Census of India, government websites and secondary literature on urban health. The report focuses on a) understanding the health vulnerabilities of the urban poor b) the availability, accessibility, cost and quality of health care facilities and challenges therein c) and to propose possible pathways towards fixing the gaps in urban health care governance and provisioning. It also outlines the detailed provision and governance of health care in four different cities and towns including Bengaluru (Tier I), Thiruvananthapuram (Tier II), Raipur (Tier III) and Davanagere (Tier III)

Applying health impact assessment to watershed development projects in semi-arid areas in India: identifying prospects for health-sensitive food systems

Background Undernutrition and dietary risks are amongst the top risk factors for morbidity and mortality globally. Consequently, food systems can be considered a major determinant of population health. Action towards improving nutrition and inter-sectoral coordination for health have been strongly emphasised in contemporary developmental discourse. These approaches are especially relevant to India, where health is currently characterised by a “double burden of malnutrition”, with prevalent child undernutrition, maternal anaemia, obesity and cardiovascular diseases. Majority of India’s population is dependent on agriculture for food and livelihood. A large proportion of these households sustain themselves on wage labour. In most regions, farmers are reliant on rainfall for cultivation, and some of them, based on their ability to afford it, have turned to exploiting groundwater. Climatic models have predicted poorer rainfall and reduced crop yields in India. In this context, watershed development (WSD) projects have been supported by the government and philanthropic institutions. These projects enhance soil and water conservation, enrich the local environment and foster livelihood activities, with the aim of improving agricultural productivity, food security, access to water and income. Livestock rearing has also been promoted through WSD projects for improving livelihood security among poor households. However, few studies have been conducted to understand the types and distribution of health impacts due to WSD projects. In addition, the potential of WSD projects to improve rural health, especially nutrition, was indicated by experts, but no efforts have been made to systematically incorporate health considerations as part of WSD project-planning. Health impact assessment (HIA) has been used to incorporate health concerns in development planning in several countries. While impact assessments are conducted in India under the broader umbrella of environmental impact assessment (EIA), the practice of HIA is negligible due to the: (i) poor focus on health assessment as part of environmental impact assessment; (ii) narrow scope of projects covered under the EIA regulation, e.g., large mining projects, thermal power plants and chemical industries; and (iii) low accountability for the quality of impact assessments, and for implementing recommendations in assessment reports. The author did not find even one published case study of a comprehensive HIA from India, and none on WSD projects from anywhere worldwide. In addition, the national health policy has strongly encouraged a “Health in All” approach for addressing cross-sectoral concerns such as nutrition and sanitation. However, it is unclear to what extent this paradigm has been operationalised in policy documents addressing food systems in India. Objectives The overall aim was to deepen the understanding on how health has been considered as part of food systems decision-making, and develop a case study on how health can be systematically incorporated in the planning process of a food systems-related project. The specific objectives were to, at the policy-level, (i) examine how health has been addressed in food systems policy documents in India; and then, at project-level, (ii) study the perceived health impacts of WSD projects; (iii) conduct an HIA of a proposed WSD project; (iv) describe the baseline health conditions in the WSD project area; (v) study the association of livestock ownership with household dietary quality in a WSD project area. Methods A qualitative study design was used to examine food systems policy documents (n = 29) and relevant health policy documents (n = 6), and the data were analysed through thematic and content analysis to identify which health concerns have been addressed in policy, and mechanisms instituted in policies to incorporate health concerns. The field-based studies were located in Kolar district, southern India. A qualitative study with data collection through semi-structured interviews (n = 40), focus group discussions (n = 2) and transect walks (n = 4) was undertaken to document perceptions of local people, project staff and key informants about the health impacts of completed WSD projects. The data were collected from across four WSD projects in various sub-districts of Kolar, and analysed thematically. The HIA was conducted for a WSD project that was planned for a cluster of four neighbouring villages, using methods validated by Winkler and colleagues for projects in tropical settings, e.g., a biofuels plantation project. The health concerns included in the HIA were informed by our earlier qualitative study and the wider literature. Due to gaps in secondary data for relevant health concerns, primary data were also collected from these four villages through a household survey (n = 195 households) and an anthropometric survey (n = 83 children under the age of 5 years). All available households and children from these villages were included in the surveys. Comparison villages (n = 138 households from 2 villages for household survey; and n = 77 children from 4 villages for anthropometric survey) were also part of the baseline surveys to help with the eventual impact evaluation. The data collected from the project and comparison villages on key health concerns were described using proportions and means. The data were also used to study the association of dairy animal ownership on household dietary quality using a multivariable logistic regression model. Results At national policy level, undernutrition received relatively high attention, being explicitly mentioned in many food-related policies across sectors (agricultural, environmental, health, industrial and social). Non-communicable diseases were only addressed in health policies, and were largely missing in food policies. Agricultural injuries and mental health concerns of farmers received limited consideration. Several advisory and executive groups instituted for food systems governance by the analysed policies were found to include representation from the health ministry (nine of the 17 identified inter-ministerial groups), but the effect of this representation on health consideration in decision-making would require further research. Overall, the data revealed that health was not systematically considered in food policy-related decision-making. At the local project level, the main health impacts of WSD projects were perceived to be on household nutrition, potential for mosquito larval breeding and impacts resulting from opportunistic activities (e.g., improved water access leading to reduced mental stress). Perceived impacts varied between sub-groups of the local population (e.g., greater agricultural benefits for farmers with larger holdings; increased income through dairy for poor woman-headed households). The HIA on the planned WSD project found several opportunities for risk mitigation (e.g., larval control in water bodies to reduce vector-borne diseases, and fencing of farm ponds to prevent drowning) and health promotion (e.g., improving nutrition through provision of fruit tree saplings and awareness). The baseline survey data revealed that the local health concerns included nutritional status among children under the age of 5 years (undernutrition prevalence of 23.8%), vector-borne disease (over one in ten households reported occurrence of malaria, chikungunya and dengue during the previous year), food insecurity (experienced by over one in five households during the past 2 years) and access to potable water (almost three in five households consumed unpurified groundwater which is high in fluoride content). It was also demonstrated that, at project baseline, household ownership of dairy animals (43.1% at project baseline) was associated with household milk consumption (adjusted odds ratio (OR) 2.1, 95% confidence interval (CI) 0.9, 5.5). Households owning dairy animals were found to be richer (land ownership, access to irrigation, ownership of motorised vehicle), larger, male-headed and belonging to dominant castes. This indicated the need for context-specific understanding and reflection on livelihood support initiatives, and their potential to improve income and health in the household. Conclusions Through the case study of WSD projects, we demonstrated approaches to further understand health impacts of food systems interventions, conduct comprehensive HIAs of food production projects in semi-arid rural areas, and utilise data from baseline surveys conducted for HIAs to answer empirical research questions on linkages between agriculture and nutrition. We also showed the cross-cutting concern regarding undernutrition from local project level to national policy level. Food systems projects and policies were demonstrated to be relevant to several health concerns. Gaps were identified in health considerations of food systems policies and projects, and the utility of HIA to identify potential health impacts and facilitate risk mitigation and health promotion was exhibited. We discussed approaches to increase adoption of HIA in India by using non-controversial projects such as WSD projects to build local capacity, experience and interest. The important role of partnership with experienced non-governmental organisations, the key actors of WSD and other rural development projects, was highlighted. The potential role of academic institutions in evidence generation, capacity building and knowledge translation was also emphasised. This PhD thesis can be considered a contribution towards the operationalisation of the “Health in All” approach, mentioned in the National Health Policy of 2017, for developmental policies and projects in India

Association of Livestock Ownership and Household Dietary Quality: Results from a Cross-Sectional Survey from Rural India

Studies from India and several eastern African countries found that the impact of dairy animal ownership on household nutrition varied greatly, depending on the socio-geographic context. The purpose of this study was to examine the association between livestock ownership and household dietary quality in rural Kolar district, India. We collected data from a household survey in four study villages (n = all 195 households of the four villages) of Kolar district, applying a cross-sectional design. Kendall’s rank correlation coefficient was employed to determine the correlation between milk consumption and other dietary variables. Multivariable logistic regression was used to describe the relationship between dairy animal ownership and household milk consumption. Households owning dairy animals more often had access to irrigation (58.3% vs. 25.2%) and were less often woman-headed (2.4% vs. 22.5%). Household milk consumption was significantly correlated with consumption of vegetable variety, egg, and meat (all p-values < 0.05). After adjusting for multiple confounders, the odds ratio of milk consumption between dairy animal-owning households as compared to other households was 2.11 (95% confidence interval 0.85, 5.45). While dairy animal ownership was found to be associated with improved dietary quality, larger households were in a better position to adopt dairy animals, which, in turn, might contribute to better household nutrition

Perceived Health Impacts of Watershed Development Projects in Southern India: A Qualitative Study

Watershed development (WSD) projects—planned for over 100 million ha in semi-arid areas of India—should enhance soil and water conservation, agricultural productivity and local livelihood, and contribute to better nutrition and health. Yet, little is known about the health impacts of WSD projects, especially on nutrition, vector breeding, water quality and the distribution of impacts. We conducted a qualitative study to deepen the understanding on perceived health impacts of completed WSD projects in four villages of Kolar district, India. Field data collection comprised: (i) focus group discussions with local women (n = 2); (ii) interviews (n = 40; purposive sampling) with farmers and labourers, project employees and health workers; and (iii) transect walks. Our main findings were impacts perceived on nutrition (e.g., food security through better crop survival, higher milk consumption from livestock, alongside increased pesticide exposure with expanded agriculture), potential for mosquito larval breeding (e.g., more breeding sites) and through opportunistic activities (e.g., reduced mental stress due to improved water access). Impacts perceived varied between participant categories (e.g., better nutrition in woman-headed households from livelihood support). Some of these findings, e.g., potential negative health implications, have previously not been reported. Our observations informed a health impact assessment of a planned WSD project, and may encourage implementing agencies to incorporate health considerations to enhance positive and mitigate negative health impacts in future WSD projects

Health impact assessment of a watershed development project in southern India: a case study

A “Health in All” approach has been encouraged by India’s National Health Policy to address cross-sectoral health concerns. To illustrate how health concerns can be systematised in food system planning, we pursued a health impact assessment (HIA) of a watershed development (WSD) project in semi-arid Kolar district, India. The planned WSD project included measures for soil and water conservation, improving agricultural productivity, and enhancing livelihoods of landless and poor households. An HIA approach previously employed for an agricultural project in a tropical setting was adapted for the current HIA, to accommodate for (i) the project implementing agency being a non-profit and (ii) the HIA being conducted in-parallel with the baseline socioeconomic assessment . The HIA revealed that the WSD project might result in a range of positive (e.g. nutrition, sanitation and water quality) and negative health impacts (e.g. vector-borne diseases, pesticide exposure, drowning and zoonosis). HIA of these projects holds promise to influence health in remote drought-prone areas and build-up HIA capacity through application in non-controversial project environments