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ABSTRACTThe dynamics of urban settings can increase health disparities. This paper explores techniques for examining urban health inequities of non-communicable disease risk, using data from the city of Indore, Madhya Pradesh, India as an example. We analyzed non-communicable disease indicators by gender, wealth, education, slum status, housing type, and location, using a 2018 city-level dataset collected in Indore with a final sample size of 3,070. Four techniques for equity analysis were used including bivariate ratios, concentration indices, geographic information system heat mapping, and multivariate regressions. We found that in Indore, behavioral risk factors such as tobacco, alcohol, and salt intake were more likely to be borne by those with low education and income, slum status and temporary housing type, while diseases such as hypertension were borne more equally over the population. This analysis has shown techniques that urban health researchers and planners can use to understand differentials of non-communicable disease risk and where action can be taken to reduce inequities. Use by city planners will be limited by technical feasibility and production of understandable information. We discuss implications and next steps for Indore as an example for other cities.

Supplemental Digital Content is available in the text.The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world’s population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment–elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate. Compounding the problem, outcomes remain suboptimal because of a lack of awareness and a severe paucity of resources. Guideline-based treatment has dramatically improved the outcomes of STEMI in high-income countries. However, no such focused recommendations exist for LMICs, and the unique challenges in LMICs make directly implementing Western guidelines unfeasible. Thus, structured solutions tailored to their individual, local needs, and resources are a vital need. With this in mind, a multicountry collaboration of investigators interested in LMIC STEMI care have tried to create a consensus document that extracts transferable elements from Western guidelines and couples them with local realities gathered from expert experience. It outlines general operating principles for LMICs focused best practices and is intended to create the broad outlines of implementable, resource-appropriate paradigms for management of STEMI in LMICs. Although this document is focused primarily on governments and organizations involved with improvement in STEMI care in LMICs, it also provides some specific targeted information for the frontline clinicians to allow standardized care pathways and improved outcomes.

Byline: G. Murthy, Sanjeev. Gupta, Damodar. Bachani, Lalit. Sanga, Neena. John, Hem. Tewari PURPOSE: To systematically evaluate the quality of ophthalmology training in India. METHODS: Questionnaires were sent to existing [...]

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016.

Cervical cancer is one of the leading cancers among Indian women with estimated 123,000 new cases and 67,477 deaths in 2012. Cervical cancer is a multi-etiological disease. Factors such as low socioeconomic status, tobacco use, sexual and reproductive factors, HIV and other sexually transmitted diseases and long-term oral contraceptive use have been suggested as determinants. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings. This hospital-based cross-sectional study was undertaken at a tertiary healthcare institute at New Delhi, India. Sixty-seven newly diagnosed women with advanced cervical cancer (stage 2B–4B), who were undertaking radio- and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile. The mean age of women at the time of detection of cervical cancer was 52.28 ± 11.29 years (range 30–75 years). More than 60 % of patients were illiterate and belonged to middle socioeconomic status. Thirty-nine percentage of the study subjects had their first sexual experience before 15 years of age. Nearly 54 % women had 5 or more pregnancies. Nearly 73 % of women had all deliveries at home. Majority (69 %) of women had symptoms suggestive of reproductive tract infection. Among them, unusual discharge from vagina (73.13 %) followed by bleeding after menopause (55.10 %) and pain in abdomen (44.77 %) were the most common presenting complaints. Pallor was present in nearly two-third (63.93 %) study subjects. More than half (56.72 %) study subjects had moderate anemia, and 7.46 % had severe anemia before treatment. Mean hemoglobin level of the study subjects was 10.35 ± 1.72 gm% before treatment and 9.69 ± 1.29 gm% after treatment. This difference was statistically significant. Around 97 % of the study subjects had squamous cell carcinoma of the cervix. Majority (53.73 %) of the study subjects were in stage 3B of cervical cancer. Combination of radiotherapy and chemotherapy was the most common (77.67 %) modality of treatment. Illiteracy, low socioeconomic status, early sexual debut, high fertility, home delivery, reproductive tract infections, use of insanitary clothes during menstruation and anemia were observed in majority of women with advanced cancer cervix. Presence of these factors indicates possible risk of cervical cancer and should be kept in mind when women seek health services. Early diagnosis through high risk or opportunistic screening and timely management of cervical cancer needs to be ensured for better outcomes.

Cervical cancer is the fourth commonest cancer across the globe. Although various health programs initiated to screen and treat this cancer in developed countries have reaped benefits in terms of reduction in mortality, yet poor access to screening and to management services continues to account for the vast majority of deaths in women living in low and middle income countries. The present review highlights the various risk factors that predispose adolescents to cervical cancer and the ‘risk reduction’ strategies that need to be implemented for the benefit of ‘next generation’ women.