BackgroundOverweight, obesity, and related chronic diseases are becoming serious public health concerns in rural areas of India. Compounded with the existing issue of underweight, such concerns expose the double burden of disease and may put stress on rural healthcare. The purpose of this article was to present the prevalence and factors associated with underweight, overweight, and obesity in an area of rural south India.MethodsDuring 2013 and 2014, a random sample of adults aged 20–80 years were selected for participation in a cross-sectional study that collected information on diet (using a food frequency questionnaire), physical activity (using the Global Physical Activity Questionnaire), socioeconomic position (using a wealth index), rurality (using the MSU rurality index), education, and a variety of descriptive factors. BMI was measured using standard techniques. Using a multivariate linear regression analysis and multivariate logistic regression analyses, we examined associations between BMI, overweight, obesity, and underweight, and all potential risk factors included in the survey.ResultsAge and sex-adjusted prevalence of overweight, obesity class I, and obesity class II were 14.9, 16.1, and 3.3 % respectively. Prevalence of underweight was 22.7 %. The following variables were associated with higher BMI and/or increased odds of overweight, obesity class I, and/or obesity class II: Low physical activity, high wealth index, no livestock, low animal fat consumption, high n-6 polyunsaturated fat consumption, television ownership, time spent watching television, low rurality index, and high caste. The following variables were associated with increased odds of underweight: low wealth index, high rurality index, and low intake of n-6 PUFAs.ConclusionUnderweight, overweight, and obesity are prevalent in rural regions of southern India, indicating a village-level dual burden. A variety of variables are associated with these conditions, including physical activity, socioeconomic position, rurality, television use, and diet. To address the both underweight and obesity, policymakers must simultaneously focus on encouraging positive behaviour through education and addressing society-level risk factors that inhibit individuals from achieving optimal health.

BackgroundIndia’s national rural prevalence of type 2 diabetes has quadrupled in the past 25 years. Despite the growing rural burden, few studies have examined putative risk factors and their relationship with glucose intolerance and diabetes in rural areas. We undertook a cross-sectional study to determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes in a rural area of south India. In addition, we determined which factors were associated with type 2 diabetes.MethodsWe sampled 2 % of the adult population from 17 villages using a randomized household-level sampling technique. Each participant undertook a questionnaire that included basic descriptive information and an assessment of socioeconomic status, physical activity, and dietary intake. Height, weight, waist and hip circumference, and blood pressure measurements were taken. An oral glucose tolerance test was used to determine diabetes status. We used stepwise logistic model building techniques to determine associations between several putative factors and type 2 diabetes.Results753 participants were included in the study. The age- and sex-standardized prevalence of IFG was 3.9 %, IGT was 5.6 %, and type 2 diabetes was 10.8 %. Factors associated with type 2 diabetes after adjusting for confounders included physical activity [OR 0.81], rurality [OR 0.76], polyunsaturated fat intake [OR 0.94], body mass index [OR 1.85], waist to hip ratio [OR 1.62], and tobacco consumption [OR 2.82].ConclusionOur study contributes to the growing body of research suggesting that diabetes is a significant concern in rural south India. Associated risk factors should be considered as potential targets for reducing health burdens in India.

Agricultural mechanization in developing countries has taken at least two contested innovation pathways—the “incumbent trajectory” that promotes industrial agriculture, and an “alternative pathway” that supports small-scale mechanization for sustainable development of hillside farming systems. Although both pathways can potentially reduce human and animal drudgery, the body of literature that assesses the sustainability impacts of these mechanization pathways in the local ecological, socio-economic, cultural, and historical contexts of hillside farms is either nonexistent or under-theorized. This paper addresses this missing literature by examining the case of Nepal’s first Agricultural Mechanization Promotion Policy 2014 (AMPP) using a conceptual framework of what will be defined as “responsible innovation”. The historical context of this assessment involves the incumbent trajectory of mechanization in the country since the late 1960s that neglected smallholder farms located in the hills and mountains and biased mechanization policy for flat areas only. Findings from this study suggest that the AMPP addressed issues for smallholder production, including gender inequality, exclusion of smallholder farmers, and biophysical challenges associated with hillside farming systems, but it remains unclear whether and how the policy promotes small-scale agricultural mechanization for sustainable development of agriculture in the hills and mountains of Nepal.

This paper argues that existing food security and food sovereignty approaches are inadequate to fully understand contradictory human development, nutrition, and productivity trends in Nepalese small-scale agriculture. In an attempt to bridge this gap, we developed a new food wellbeing approach that combines insights from food security, food sovereignty, and social wellbeing perspectives. We used the approach to frame 65 semi-structured interviews in a cluster of villages in Kaski district in the mid-hills of Nepal on various aspects of food security, agriculture, off-farm livelihood opportunities, and women's wellbeing. Our results indicate that contextspecific subjective and social relational factors highlighted by the food wellbeing approach are key to understanding a paradox of increased food security, yet decreasing sustainability of small-scale agriculture. Increased levels of male out-migration and opportunities for local off-farm work have increased local capacity to purchase food. The positive consequences for food security are indicated by evidence that households with non-farm income sources had better food sufficiency, absorption capacity, nutritional quality, and stability of food supply. These off-farm employment opportunities have also led to the greater involvement of low caste groups and women in small-scale agriculture. This has been empowering for both groups and led to an increase in wellbeing, particularly for those women who have become de facto heads of household. Yet, small landholdings, persistent patterns of unequal and absentee land ownership, sharecropping, women's overwork, and the aspirations of low caste farmers and women away from agriculture are simultaneously driving the erosion of local small-scale agricultural productivity and ecological sustainability.

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Background/Objectives To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India. Subjects/Methods We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling. Results A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (P<0.001). Prevalence of anemia increased with age among men (P<0.001) but not women (P>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (P<0.001). Factors (OR (95% CI)) associated with mild or moderate anemia among women included television ownership (0.27 (0.13, 0.58)), livestock ownership (0.46 (0.28, 0.75)), refined grain consumption (1.32 (1.02, 1.72)), meat consumption (0.84 (0.71, 0.99)), and commercial agriculture production (mild: 4.6 (1.1, 18.8); moderate: 6.8 (1.98, 23.1)). Factors associated with mild, moderate, or severe anemia among men included rurality (0.50 (0.25, 0.99)), sugar consumption (1.04 (1.01, 1.06)), egg consumption (0.80 (0.65, 0.99)), and high caste (7.3 (1.02, 52.3)). Conclusion Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.

Background: Small-scale agriculture, government entitlements, and livelihood opportunities offered by rapid economic growth shape the food security and wellbeing of people in rural India. This paper analyses this ongoing process of agrarian development from the perspective of three major approaches: the food availability approach, the entitlement and livelihood approach, and food sovereignty. We draw on quantitative and qualitative data collected from 68 households in rural Tamil Nadu on landholding and management, farm diversity, agricultural production, food availability, off-farm employment, rural out-migration, objective and subjective wellbeing, and socioeconomic and demographic profile of respondents.Results: Rural households were classified in four categories, based on their engagement in agriculture and off-farm employment, to understand the interplay between food sufficiency and wellbeing. The households solely based on small-scale agriculture were found to have higher food sufficiency, landholding, and crop diversity, but lower monthly income and wellbeing. The households that were engaged in off-farm employment in addition to agriculture were found to have lower food sufficiency, landholding, and crop diversity, yet they exhibited better wellbeing and higher income. The landless households, which were primarily engaged in off-farm labour, work in distant markets had higher income than households solely engaged in farming. However, they had the lowest wellbeing index among all household types. The findings indicated that the impacts of women's participation in local or distant employment schemes on household food security and wellbeing were complex and shaped by the household's engagement in agriculture and their aspirations for a better quality of life. Conclusions:None of the three food security approaches provides a fully satisfactory basis for interventions aimed at enhancing the capacity of small and marginal farmers to achieve food security and meet their aspirations for wellbeing in the research area, although the entitlements and livelihoods approach has had a significant impact on local possibilities for livelihoods diversification. The study demonstrates that the interaction between food security and the subjective wellbeing of farmers is complex and shaped by the productivity of small-scale agriculture and livelihood aspirations of farm households.

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