Marriageable Brides in Kerala: A Feminist Critical Discourse Study of Malayalam Matrimonial Ads (2015–2024)

Abstract

Non-communicable diseases (NCDs) account for nearly 74% of global mortality and are the leading cause of premature death in India. Kerala, despite its relatively high human development indicators, exhibits a disproportionately high NCD burden due to advanced epidemiological transition, dietary shifts, and population ageing. However, the co-occurrence of major cardiometabolic conditions—hypertension, diabetes, and obesity (the “triple burden”) remains insufficiently examined. A multistage cluster-sampled cross-sectional survey was conducted from January to August 2024 among 3,540 adults aged 18–69 years across four districts of Kerala. The WHO STEPwise approach was employed, incorporating behavioural assessment, anthropometric and blood pressure measurements, and biochemical evaluation including fasting glucose and HbA1c. Standard international and Asia-Pacific criteria were used to define conditions. Multivariable logistic regression identified determinants of individual conditions and the triple-burden phenotype. Prevalence estimates were 31.4% for hypertension, 20.8% for diabetes, 42.6% for generalised obesity, and 53.1% for central obesity. The triple-burden phenotype was present in 11.7% of participants. Significant predictors included age ≥45 years (aOR 4.82), male sex (aOR 1.34), family history of NCDs (aOR 2.16), physical inactivity (aOR 1.71), and central obesity (aOR 3.04). An inverted U-shaped association between education and NCD risk was observed, with the highest burden among those with mid-level education. These findings highlight a substantial clustered cardiometabolic risk in Kerala. Integrated prevention strategies targeting sedentary lifestyles, central obesity, and high-risk households are essential, alongside strengthening primary prevention under national NCD control programmes.