Introduction
Located in South East Asia, India remains the second populous nation in the world, following China. It consists of Muslims and the Hindu religious communities residing in 7 union territories and 29 states forming the federal republic (Haub & Sharma 2015). The country is a multi-party democracy led by a prime minister who is elected after every 5 years. Further, with 1.366 billion people, it accounts for 17 percent of the global population and seventh by land size (Scott, 2020). As such, it has been struggling with food challenges for many years. Similarly, in 1977 its poverty index was 63.1 percent which decreased to 22.5% in 2011, but currently, over 296 million people live on $1.90 a day or less, with 287 million being illiterate (Scott, 2020). This has resulted in the inclusion of the aforementioned populations among the global extreme poor groups. Besides, the fertility rate has declined from 5.6 in 1969 to 2.3 in 2019 per woman with a life expectancy of 69 years (Press Trust of India, 2019). This paper explores the healthcare system among women and children, the environment, and natural disasters in India.
The Health Care System
According to the country’s expenditure on the public care system, there has been a slight improvement over the years in its allocations for the well-being of the growing population. For instance, Angell et al. (2019) assert that in 2018 around ₹1.58 trillion were budgeted for health which was equivalent to 1.28% of India’s GDP, making the budget among the lowest in the globe. Furthermore, the sector is characterized by shortcomings such as infrastructure, workforce, poor and ineffective services. In addition, the country’s average health per capita expenditure in the aforementioned year was ₹1,600, with some regions such as Uttar Pradesh and Maharashtra spending up to 180 billion rupees (Statista Research Department, 2019). However, in the poor north-eastern region, the expenditure was less than ₹6 billion, showing the disparities between the wealthy and the poor in the country.
Public Health and Population Growth
The latest report released by the United Nations Populations Fund (UNEP) in 2019, India’s care system was improving despite facing overwhelming challenges from its population. Consequently, the UNEP asserted that there was a decrease in the country’s Maternal Mortality Rate from 488 in 1994 to 174 in 2015 in deaths per 100,000 live births, respectively (Press Trust of India, 2019). On the contrary, the report expounded that the figures above were discouraging. Therefore, it was essential for the elevation of awareness among females and the provision of essential health care services not only for Indian women but also across the world (Press Trust of India, 2019). Furthermore, inadequate reproductive and sexual rights among ladies lead to negative consequences on their incomes, education, and safety, resulting in the inability to decide and shape one’s future. Besides, around 500 million girls and women die during childbirth and pregnancies due to emergencies and lack of skilled midwives in developing countries, including India (Press Trust of India, 2019). In addition, it has been noted that the majority of the above groups in the country are unable to make key decisions regarding contraceptives, health care, and sexual intercourse.
Universal Health Coverage (UHC) in India
Health coverage by the country has remained an elusive undertaking with a system affected by a myriad of challenges despite the numerous promises by successive governments. As such, there are inadequate qualified medical personnel, dilapidated infrastructure, and substandard service provision. In addition, with an expenditure of 1% of its GDP on health, the country depends on the patients’ payments at the health centers. This has resulted in an estimated fifty to sixty million individuals becoming very poor due to medical costs (Angell et al., 2019). Similarly, universal provision of care services through the private sector has been perceived as a success, although expenditure on healthcare in India by the state is low. To curb the shortage, the country approved the Ayushman Bharat (AB-PMJAY) private health providers in 2018. This was aimed at providing funding for the services to reach more than 500 million, equivalent to 40% of the total population (Angell et al., 2019). Conversely, in 2005, a program was launched to assist in subsiding the burden encountered by people in accessing health services.
The Rural Health Mission by the state was viewed as a remedy for care for the remote residents. This was accompanied by the increase of primary and community centers. In addition, the 2007 “Rashtriya Swasthya Bima Yojana” scheme initiated funding for hospital services of up to $420 for poverty-stricken families (Angell et al., 2019). However, this was not fully realized due to limited and insufficient resources, resulting in coverage gaps. Furthermore, while the initiative was viewed as ambitious, it initiated the coverage of approximately 25 percent of the poor Indians in 2010 (Angell et al., 2019). Currently, the Indian government spends $64 on healthcare per person, whereby a large part of the financing comes from an individual’s fees. As a result, the UHC program augments the above-mentioned state initiatives in Telangana, Andhra Pradesh, Tamil Nadu, Kerala, and Karnataka (Angell et al., 2019). As such, it has been lauded as an ambitious program in alleviating health challenges and eradicating poverty.
Communicable Diseases
Across the world, communicable diseases such as tuberculosis, malaria, and HIV/Aids are common, especially in developing countries. These are infections spread from an individual to the other indirectly or directly through an insect bite, contaminated water, or blood (Elflein, 2020). Similarly, India is affected by diseases due to poor hygiene and sanitation, a prevalent characteristic among poor states. Also, inadequate public health awareness exacerbates the situation, as many cases are unreported until they are symptomatic and fatal (Elflein, 2020). As a result, scientists have highlighted that in many developing countries, populations die from communicable diseases. For instance, in 2016, it was noted that 75.8 and 58.2 deaths per 100,000 people resulted from respiratory infections and diarrhea, respectively (Elflein, 2020). However, these calamities are not experienced in high-income states across the world.
Malaria
Among communicable infections, malaria remains a major contributor to suffering and health burdens. It has been cited as the main cause of death among children in developing countries annually, with 228 million cases occurring in 2018 globally (Rahi & Sharma, 2020). Furthermore, there is a high likelihood of an individual getting Malaria in states such as Orissa, Pradesh, Maharashtra, Karnataka, Assam, Rajasthan, Andhra Pradesh, and Gujarat. Besides, South-Eastern Asia has been highlighted by the World Health Organization (WHO) to be contributing 3.4% of the cases, where India accounts for 47 percent of all Malaria incidences in the world (Rahi & Sharma, 2020, p. 1). Therefore, it has become one of the most common diseases that affect many people.
Although the government launched a robust framework in 2016 to eradicate malaria by 2030, nothing much has been achieved as there are discrepancies in the reports by the Ministry of Health. For example, in 2017, the ministry indicated 194 deaths and 0.84 million cases, while WHO’s estimations were over 16.7K deaths and 9.6 million cases (Rahi & Sharma, 2020, p. 1). This shows that the country is insincere in showing its progress. Similarly, in a 2015/2016 nodal research organization, findings indicated that Malaria infections were fourfold of the state’s one million cases while deaths were 93 more compared to the reported 313 (Rahi & Sharma, 2020). Also, the disease incidence data is not accessible below the district level, and this inhibits getting vital information to the deserving population.
Tuberculosis
It is infectious, affecting the lungs, and has the potential to spread to the spine and the brain. It comprises two strains, active and latent tuberculosis which remain inactive in a human body and is not contagious as compared to the other type. It is transmitted through the air and has symptoms such as weight loss, coughing, chest pain, fever, night sweats, and fatigue (Elflein, 2020). Tuberculosis has been highlighted as one of the most dangerous diseases in the world. It is estimated that around 1.2 million people die from its resultant infections yearly (Elflein, 2020). In addition, it affects the lungs, and it disproportionately impairs the developing and poor countries in the globe, especially Southern Asia and Africa. For example, in 2019, India reported 436,000 deaths resulting from the aforementioned disease, becoming among the highest numbers in the world (Elflein, 2020). This has been exacerbated by the large population and poverty in many regions.
HIV and AIDS
HIV and AIDS have afflicted many populations in the world, causing millions of deaths. It is primarily spread through blood by an infected person, injected drug use, and unsafe sexual intercourse (Elflein, 2020). Discovered in 1981 in the United States, mortality resulting from the disease has been decreasing. However, in 2019 there were 38 and 20.7 million people with the virus in the world and South and East African countries, respectively (Elflein, 2020). In addition, twenty-five states with high prevalence were found in the above continent. However, among the Southern Asia countries, India is leading in HIV infections. As such, it is estimated that 2.14 million people live with HIV, making it the third-highest prevalence in the world (Elflein, 2020). Further, studies done in most regions of the country have shown illiteracy, urbanization, and low socioeconomic status as common contributing factors in high prevalence areas.
Cholera
Cholera affects people, especially in low-income countries where there is a lack of proper sanitation. Recent research showed that about 400 hundred million people were at the risk of contracting the disease, with 675,188 cases likely to be sick and resulting in 20,256 deaths yearly (Panda et al., 2020, p. A149). However, data on the population suffering in India from Vibrio Cholera is scarce. According to a 3-year study by the Global Enteric Multi-center, annual cholera incidences per 100 children in the age of less than a year was 0, while in those in 12-23 and 24-59 months, it was 1.6 and 1.8 respectively (Panda et al., 2020). Also, there are monetary costs associated with treatment.
In ten years ranging from 2007 to 2016, it was established that in Kolkata, the average expenditure by a patient was $35 due to hospitalization (Panda et al., 2020, p. A150). Conversely, the frequency of annual outbreaks reported across the country varies greatly. As such, 19 of the total 685 districts in seven states were described as non-endemic regions, while 85% of the above regions were endemic (Panda et al., 2020). This shows the prevalence of the disease in the country. In addition, other 34 areas reported double or triple cholera outbreaks annually in 5 years (Panda et al., 2020). It has been highlighted that all confirmed and published outbreaks occur in remote and rural areas.
COVID-19
COVID-19 is the latest crisis that has reigned havoc across India. Originating in China in late 2019, coronavirus 2 (SAR-CoV-2) became a pandemic in 2020 after the declaration by the World Health Organization (WHO). By March 2020, there were 11.2 million cases and over 529,000 deaths resulting from the disease in the world (Acharya & Porwal, 2020). Consequently, in July 2020, India had confirmed patients, and this resulted in emergencies throughout its districts. Also, there were 648 300 reported occurrences, 394, 227 had recovered, and 18, 655 deaths with 36 states and 627 districts reported cases (Acharya & Porwal, 2020). Combined with the demographic features of the country, politics, and the cultural aspect of the population, the disease has spread rapidly. Currently, there is a new variant B.1.1.7 in the country, killing 3,300 people daily, with new infections reaching 357,700 and 201,200 total deaths occurring (Gettleman et al., 2021). The situation is worsening, with hospitals unable to cope with a large number of sick people and food supplies running low among the general population.
Unintentional Injuries in India
Unintentional injuries across the world have become a health concern for many countries. As such, childhood wounds are the current problems that require concerted efforts by governments in curbing their occurrences. According to WHO, they cause more than 3.8 million deaths annually in every country, which accounts for 90% of cases in developing countries (Joseph et al., 2019, p. 114). Also, the vulnerability and susceptibility to accidents in the lower-income states exacerbate the already fragile conditions therein. Furthermore, every year, around 875 thousand kids die as well as ten to thirty million people are affected globally by nonfatal injuries (Joseph et al., 2019). As a result, it has become a major cause of disabilities among people. Conversely, more than four million people lose their lives worldwide, with India reporting 413,457 deaths from accidents in 2015 (Yadav, 2019, p. 15). Also, the manufacturing sector has been cited as the main contributor to mortality and morbidity. Further, unintentional injuries contribute to more than 5.9 percent of all deaths in India (Joseph et al., 2019). However, government health facilities and police records under-report the incidents.
Similarly, studies carried out by WHO on community-based injuries among children in one of the slums in India revealed that they had become a major public health problem. In Ujjain, a survey was carried out on 2518 households comprising of 6308 children and young people below 18 years, where 2907 were from urban settings while 3401 came from rural households (Mathur et al., 2018, p. 23). The research identified factors such as the occurrence, type, and risks associated with unintentional accidents that result in wounds among the victims. Consequently, the annual incidence was 16.6%, with boys having 20.2% while girls had 12.7% (Mathur et al., 2018, p. 23). However, there were differences between the pattern of injuries between the rural with poisoning and agricultural accidents being common as compared to suffocation and drowning in urban areas. Conversely, in another study done in New Delhi, 7.1% of injuries were reported, with another one indicating 11 percent in the same region (Mathur et al., 2018). This confirmed the early WHO study findings on accidental wounds among children in India, suggesting that they are a health concern.
Noncommunicable Diseases
Noncommunicable Diseases (NCDs) have burdened the already vulnerable populations across lower-income countries, with such cases occurring in India for many decades. Besides, multiple undiagnosed chronic conditions due to insufficient care systems and inadequate awareness have exacerbated these problems. In addition, parasitic and infectious diseases add to the overwhelmed public health sector resulting in more medical condition burdens. Therefore, among the leading cause of death in India, cardiovascular ailments, especially stroke and ischemic heart disease, were found to be the main cause of mortality in 2016 at 28.1% (Arokiasamy, 2018). Further, the trend in its fatality has been increasing gradually. For example, in 2019, NCDs accounted for 65 percent of all fatalities, changing the narrative of over 26 years that most deaths were caused by communicable diseases (Mathur et al., 2021). While there is a correlation between the increase in its severity with age, young people are becoming prone to the ailments. Studies have shown that from 1990 to 2016, cardiovascular deaths were 34.3 percent (Arokiasamy, 2018). Conversely, cases are highly predictable in posh, high and middle-income regions across the country.
Besides, states such as Goa, Andhra Pradesh, Kerala, Himachal Pradesh, Tamil Nadu, Maharashtra, West Bengal, and Punjab form the most prevalent areas. Also, air pollution, high cholesterol, systolic blood pressure, and excess body mass are some of the factors that enhance the conditions. Similarly, chronic respiratory ailments are the other type that affects the population. Asthma and obstructive pulmonary disease (COPD) make the list of the top 3 contributors at 10.9% to the total mortality in India. (Arokiasamy, 2018). Highlighting its crude prevalence, studies have indicated that more people are affected. As a result, it has increased tremendously with 29.2 percent and 8.6% for COPD and Asthma, respectively (Arokiasamy, 2018). The northern states such as Uttarakhand, Himachal Pradesh, Jammu, Haryana, and Kashmir have high cases of the aforementioned conditions.
Lately, diabetes has been highlighted as a health challenge facing people. Consequently, it contributes 3.1 percent of the total deaths, with women leading by 3.4% as compared to men at 2.9 percent (Arokiasamy, 2018). In addition, it is common among middle-aged women with their male counterparts the following suit slightly. Also, the prevalence of the disease has been on a trajectory from 1990 to 2016, where it rose by an average of 29.7 percent (Arokiasamy, 2018). Furthermore, the above 3 fatalities lead to premature deaths of Indians. For instance, in 2016, they killed 4 million people who comprised between the ages of 30-70 years (Arokiasamy, 2018). The inactivity of the majority of the people has led to led not only overweight but also obesity. Consequently, a blood pressure survey carried out in 2019 across India found out that 30.7 percent of those sampled suffered from hypertension. In addition, while 6.1 million deaths resulted from NCDs in 2019, those caused by diabetes mellitus accounted for 2.7 % of the total fatalities (Mathur et al., 2021). This has an enormous ramification as the above ages are the source of a country’s human capital.
On the contrary, cancer has been attributed to tobacco smoking and has led to many disabilities. Further, research has highlighted it as the cause of more than 1.3 million deaths in India (Mathur et al., 2021). Also, alcohol consumption by young people has been attributed to be another cause. According to the adjusted life years for disabilities by NCDs, it was estimated to be 30.5%, increasing to 55.4 percent in 1990 and 2016, respectively (Mathur et al., 2021). However, the government has launched national programs for the prevention of diabetes, cancer, and cardiovascular diseases.
Child Health and Nutrition in India
Around the world, child undernutrition has been a significant problem for many decades among public health practitioners in middle-income and developing countries. According to the recent research on global disease burdens, there a slight decline in stunting from 2000 to 2017 from 36.9% to 26.6 percent, respectively (Wali et al., 2020). On the contrary, the observed decline has little impact on low-income states, which continue recording high prevalence. As such, although there is a decrease in stunted growth in South Asia from 89 million children to 59 million children in 2000 and 2017, it is below the international health requirements (Wali et al., 2020). Furthermore, it impairs the development and growth of children resulting in long-term effects that culminate during their adult life. In addition, it is linked to low productivity and poor school performance (Wali et al., 2020). Among kids, it has been associated with overweight, cancer, chronic diseases, and mental health problems.
Besides, the South East Asia countries have become a hub for global malnutrition of under 5. For instance, in 2017, stunted growth in the region accounted for 35% of all children in the world suffering from the aforementioned condition (Wali et al., 2020). Studies done have highlighted the complex and multi-dimensional individual, community, household, and national factors that correlate with kid’s under-development. Furthermore, recent economic stagnation in India has resulted in chronic nutrition challenges, including stunting and hunger. Consequently, according to the 2020 Global Hunger Index, the country was number 94 out of 107 states (Chatterjee, 2021). As a result, it lags behind many other poor states in the African continent.
Conversely, new data on child malnutrition paints a bleak future with an ever-worsening situation. In India, although there are fewer deaths reported, the country has cases of numerous anemic and inadequate food secure states (Chatterjee, 2021). Similarly, in 2017, it was found to be the major cause of death in infants. Dandona (2019) asserts that malnourishment accounted for more than 68% of all fatalities in under-5, and it led to 17.3 percent disabilities among other ages. However, the condition of undernutrition is prevalent in Uttar Pradesh Assam and Rajasthan. Moreover, low birth weight has been identified as a challenge experienced among Indian women while giving birth. As such, a combination of various challenges such as child wasting 15.7%, stunting 39.3%, underweight 32.7 percent, and anemia 59.7% have bedeviled the health sector for long (Dandona, 2019). Notwithstanding, breastfeeding and overweight among children are some of the prevalent indicators of malnutrition.
Women Health in India
Women’s health remains an integral part of the contribution of a country’s economic development and the well-being of its population. In India, they face many challenges such as malnutrition, domestic violence, inadequate health services, and diseases. Although there has been an improvement for some years, mortality remains high when you compare it with other low-income countries (Singh, 2020). In addition, gender disparity, illiteracy, poverty, early marriages, and sexual abuse continue impeding their progress. Also, around 800 million women die daily as a result of childbirth and pregnancy around the world, with 20% of these deaths happening in India (Singh, 2020). Furthermore, as aforementioned, NCDs such as stroke, respiratory diseases, and heart attack account for the demise of most females in the country. According to research carried out in 2016, noncommunicable diseases accounted for 10% of all deaths among Indian women, with anemia affecting a majority of them (Singh, 2020). Combined with the government’s misplaced priorities, the majority, especially those in rural areas, face an uphill task in accessing services.
As a result, many scholars have highlighted the inequality in service delivery perpetuated by many countries. For instance, 75% of the country’s healthcare infrastructure is concentrated in towns and cities, while the remote regions are allocated 1.3% of its GDP, which is below the required global standard of 6% (Singh, 2020). This leads to poor services in these areas, with some ladies being abused and mistreated during childbearing and pregnancy. Similarly, according to the United Nations Population Fund, maternal complications in India are worrying. Although the mortality ratio in the country has decreased from 488 in 1994 to 174 deaths in 2015 per 100,000 births, there is a need to promote accessibility (Press Trust of India, 2019). Furthermore, there is a lack of reproductive and sexual rights among females, and this has negative impacts on their incomes, education, and safety, making them unable to make personal decisions about the future.
Environmental Health in India
The environment forms the backbone for human existence on earth. Consequently, about 23% of all deaths across the world result from pollution, with over 3 million children dying yearly (Sarkar, 2020). Furthermore, air contamination has been highlighted as the major cause of ailments and fatalities. It has led to 7 million mortalities globally, with 3.8 resulting from smoke where 9 in 10 people breathe toxic oxygen (Sarkar, 2020). As such, countries from South Asia and Western Pacific are affected by pollution-related diseases. For example, 700,000 people die from contaminated water in India every year (Sarkar, 2020). Further, the depletion of the Ozone layer as a result of climate change increases the vulnerability of people to ultraviolet rays leading to cancer.
According to the World Health Organization, the majority of the populations in the world live in surroundings with impure air. Thereby, 91% of these people inhabit such places where they suffer from diseases such as stroke, lung cancer, heart diseases, and other respiratory infections (Sarkar, 2020). Besides, pollution has become a growing concern for many countries. It causes 620,000 deaths among citizens in India annually, with recent estimates indicating that 6.4% of all disabilities and 30 percent of cardiovascular fatalities result from exposure to contaminated air (Walia et al., 2020). This has worsened with rapid urbanization in developing countries that has led to congestion and mushrooming of slums in industrial areas that are laden with fumes.
While on the one hand, India has a large landmass, on the other hand, its populous nature makes the territory inadequate, thus leading to soil degradation and pollution. Being 7th in size with 328 million hectares, 43.6% of the total area is used for agriculture (Sarkar, 2020). As such, the constant improvement in crop husbandry has led to the use of insecticides and herbicides by farmers. For instance, in 2019, two hundred and seventeen thousand tons of pesticides, equivalent to ₹70 billion was used (Sarkar, 2020). This has seen an annual constant growth in their consumption across the country. Similarly, the Environmental Pollution Index and Pesticide Action Network (PAN) have identified some states that are highly polluted due to the use of the chemicals led by Maharashtra, Uttar Pradesh, and Punjab (Sarkar, 2020). However, there is a need for the populations to shift to inorganic farming.
Natural Disaster in India
In the last three decades, India has encountered many challenges resulting from calamities that have led to the loss of properties and lives. Also, natural hazards such as floods, abnormal weather, and storms have caused irreparable large-scale damage to the country. Furthermore, according to the United Nations, 79,732 persons have died in India from 321 incidents, with 108 crore people being affected (Sharma, 2021). In addition, the recent occurrence at Uttarakhand’s Chamoli area where the glacier burst highlighted the Indian government’s fragile and inadequate ecosystem. For instance, it has been ranked number three among nations that are prone to natural disasters. Further, the massive population in the country makes it vulnerable, and together with the US and China, they accounted for more than 70% of the global incidents between 2000 to 2019 (Sharma, 2021). Similarly, extreme climatic conditions have deteriorated across the region during the 21st century.
As a result of heavy rains, cyclones, cold and heat waves are prevalent in India. Besides China, the country has experienced 17 floods per year, affecting over 34 crore people (Sharma, 2021). Consequently, there have been numerous losses resulting from the aforementioned hazard. For instance, in 2013, the region of Uttarakhand lost 6,054 lives, while in 2018, Kerala was devastated by flash floods that led to the death of 504 people, with a 2.3 crore population being affected (Sharma, 2021). Conversely, the country has been affected by many storms since 2012. In the same year, there were 41, where 28 became severe, while in 2020, five cyclones caused havoc as the government was in turmoil due to the COVID-19 pandemic (Sharma, 2021). Notwithstanding, drought has had negative impacts on India from the year 2002 to 2015. Although it is prevalent around the world, 30% of the core affected people came from the country, which was also affected by the 2004 tsunami that led to the loss of 2.26 lakh (Sharma, 2021). Therefore, the various disasters have increased the susceptibility of the poor to risks and hazards in the region.
Conclusion
In summation, found in South East Asia, India is the second populated country on earth after China. While there has been a tremendous decrease in food insecurity, 296 million people live below the poverty line, thus painting a gleam picture about the poor. Besides, little expenditure on health by the government has led to inadequate services to the public. As such, it has exposed the inability to provide maternal care to all people, leading to the death of women at childbirth. Furthermore, the country is ranked 94th in the Hunger Index, which has resulted in a lack of enough food, especially for children under 5. However, the country’s life expectancy is ever-increasing, thereby indicating an improvement in the general well-being of their citizen.
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