In the financial year 2021, a majority of Indian households fell under the aspirers category, earning between ******* and ******* Indian rupees a year. On the other hand, about ***** percent of households that same year, accounted for the rich, earning over * million rupees annually. The middle class more than doubled that year compared to ** percent in financial year 2005. Middle-class income group and the COVID-19 pandemic During the COVID-19 pandemic specifically during the lockdown in March 2020, loss of incomes hit the entire household income spectrum. However, research showed the severest affected groups were the upper middle- and middle-class income brackets. In addition, unemployment rates were rampant nationwide that further lead to a dismally low GDP. Despite job recoveries over the last few months, improvement in incomes were insignificant. Economic inequality While India maybe one of the fastest growing economies in the world, it is also one of the most vulnerable and severely afflicted economies in terms of economic inequality. The vast discrepancy between the rich and poor has been prominent since the last ***** decades. The rich continue to grow richer at a faster pace while the impoverished struggle more than ever before to earn a minimum wage. The widening gaps in the economic structure affect women and children the most. This is a call for reinforcement in in the country’s social structure that emphasizes access to quality education and universal healthcare services.

In the financial year 2021, the number of super-rich households earning more than ** million Indian rupees went up to **** million from **** million in the financial year 2016. This was an annual growth of **** percent. The number is expected to grow to over **** million in the financial year 2031 and ** million households in the financial year 2047. This will be the fastest growth across all income categories. On the other hand, destitute classified Indian households with earnings of less than *** thousand annually decreased only marginally to ***** million in financial year 2021 from **** million in 2016. However, it is estimated that the number of destitute households will fall to just *** million by the financial year 2047.

In 2022, the majority of Indian adults had a wealth of 10,000 U.S. dollars or less. On the other hand, about *** percent were worth more than *********** dollars that year. India The Republic of India is one of the world’s largest and most economically powerful states. India gained independence from Great Britain on August 15, 1947, after having been under their power for 200 years. With a population of about *** billion people, it was the second most populous country in the world. Of that *** billion, about **** million lived in New Delhi, the capital. Wealth inequality India suffers from extreme income inequality. It is estimated that the top 10 percent of the population holds ** percent of the national wealth. Billionaire fortune has increase sporadically in the last years whereas minimum wages have remain stunted.

By 2030, the middle-class population in Asia-Pacific is expected to increase from 1.38 billion people in 2015 to 3.49 billion people. In comparison, the middle-class population of sub-Saharan Africa is expected to increase from 114 million in 2015 to 212 million in 2030.

Worldwide wealth

While the middle-class has been on the rise, there is still a huge disparity in global wealth and income. The United States had the highest number of individuals belonging to the top one percent of wealth holders, and the value of global wealth is only expected to increase over the coming years. Around 57 percent of the world’s population had assets valued at less than 10,000 U.S. dollars; while less than one percent had assets of more than million U.S. dollars. Asia had the highest percentage of investable assets in the world in 2018, whereas Oceania had the highest percent of non-investable assets.

The middle-class

The middle class is the group of people whose income falls in the middle of the scale. China accounted for over half of the global population for middle-class wealth in 2017. In the United States, the debate about the middle class “disappearing” has been a popular topic due to the increase in wealth to the top billionaires in the nation. Due to this, there have been arguments to increase taxes on the rich to help support the middle-class.

In the 3 years to March 2021, black households were most likely out of all ethnic groups to have a weekly income of under £600.

75% of households from the Bangladeshi ethnic group were in the 2 lowest income quintiles (after housing costs were deducted) between April 2021 and March 2024.

BackgroundThe prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.Methods and findingsWe pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.ConclusionsThe study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.

Apnea of prematurity (AOP) is a common complication among preterm infants (<37 weeks gestation), globally. However, access to caffeine citrate (CC) that is a proven safe and effective treatment in high income countries is largely unavailable in low-and-middle income countries, where most preterm infants are born. Therefore, the overall aim of this study was to describe the demand, policies, and supply factors affecting the availability and clinical use of CC in LMICs. A mixed methods approach was used to collect data from diverse settings in LMICs including Ethiopia, Kenya, Nigeria, South Africa, and India. Qualitative semi-structured interviews and focus group discussions were conducted with different health care providers, policymakers, and stakeholders from industry. Additional data was collected using standard questionnaires. A thematic framework approach was used to analyze the qualitative data and descriptive statistics were used to summarize the quantitative data. The findings indicate that there is variation in in-country policies on the use of CC in the prevention and treatment of AOP and its availability across the LMICs. As a result, the knowledge and experience of using CC also varied with clinicians on Ethiopia having no experience of using it while those in India have greater knowledge and experience of using it. The in turn influenced the demand and our findings show that only 29% of eligible preterm infants are receiving CC in these countries. There is an urgent need to address the multilevel barriers to accessing CC for management of AOP in Africa. These include cost, lack of national policies and therefore lack of demand stemming from its clinical equivalency with aminophylline. Practical ways to reduce the cost of CC in LMICs could potentially increase its availability and use. Methods Study design, setting, population, sampling We conducted a landscape evaluation involving stakeholders in Africa (Ethiopia, Kenya, Nigeria, South Africa) and South Asia (India – five states of Delhi; Bihar, Uttar Pradesh, Telangana and Madhya Pradesh) on CC availability and use from 1 July 2022 to 31 December 2022. We used a mixed methods study design to understand the complexity of CC availability and use across these LMICs. We selected a geographically and culturally diverse countries with high annual preterm births (~200,000). The selection of stakeholders within each focus country was by convenience and/or purposive sampling. We selected health facilities providing care for preterm infants and were able to provide the data required to achieve the study’s objectives. Proximity and ease of data collection was also factored into selection by research teams. Data collection Qualitative The research teams conducted key informant interviews and focus group discussions (FGD’s) with stakeholders in newborn health. The interviews with healthcare providers sought to explore their experience of using CC as a treatment for AOP. Interviews with WHO and Ministry of Health officials sought to understand current global and national health policies and CC’s inclusion in the essential drug list for using CC to treat AOP. Interviews with major drug suppliers and distributors of CC aimed to determine the current local market pricing of CC and its alternatives within and between countries. Also, to evaluate the factors determining the end-customer price of CC. The available average end-customer price per country was used to determine the daily cost of managing AOP for aminophylline and CC. We compared the average daily cost between aminophylline and cc for both public and private hospitals in each country. The dosing regimen for CC was a loading dose of 20 mg/kg/dose and a daily maintenance dose of between 5 to 10 mg/kg/day. The dosing regimen for aminophylline was a loading dose of 6 mg/kg administered intravenously (IV), followed by a maintenance dose of 2.5 mg/kg/dose/IV administered every 8 hours. Interviews and FGD’s were done in person or virtually over video or audio teleconferencing based on the preferences of the participants. All interviews were conducted in English. teams were situated in each country of focus and had previous training and experience conducting qualitative interviews and FGDs and in qualitative data analysis. The interviews and FGDs were semi structured using guide with a set of open-ended questions, in a set order and allowing for in-depth insights into the subject area. These guides were pilot tested across the 3 countries prior to data collection. Quantitative Additional interviews were conducted using standard questionnaires and had been piloted and refined in these settings prior to being used for data collection.The research team surveyed 107 providers: 20 from Ethiopia, 18 from India, 23 from Kenya, 28 from Nigeria, and 18 from South Africa. Providers were from 45 private or public health facilities across the five study countries. Of these, 12 (27%) were primary or secondary public, 7 (16%) were primary or secondary private, 25 (56%) were tertiary public, and 1 (2%) tertiary private Demand forecast for caffeine citrate. A demand forecast was conducted to determine the amount of CC needed per country. Using data from demographic health survey data from each country, we estimated the proportion of infants who would be eligible for CC treatment. Given AOP risk can be as high as 80% in preterm infants with birthweight ≤1500g (very low birth weight (VLBW)), we estimated that all VLBW infants met eligibility criteria for treatment with CC. We limited this forecast to public facilities where limited government funding constrains drug availability. We applied country-specific policies and assumptions to determine the percentage of VLBW infants who received or had a missed opportunity for CC treatment. These assumptions included, availability of CC, VLBW infants born in secondary facilities will be transferred to a tertiary center capable of providing AOP treat; some transfers will be unsuccessful and even when successful, AOP treatment will be unavailable. Data management and analysis All interviews were transcribed verbatim by an experienced transcriber. Authors reviewed the interview transcripts for errors. A coding framework was generated, and an emergent thematic analysis approach was used to analyze the data, to identify patterns and themes. Descriptive statistics were used to summarize the quantitative data.

As of 2019, about ** percent of households across India were segmented as belonging to the NCCS C category of consumers. Contrariwise only **** percent of the country's population fell under the NCCS E category that year. Between 2014 and 2019, the share of population classified as category A, B, and C consumers has grown tremendously, reflecting the trajectory of the booming middle class within the Indian economy.

Where do you usually get your medical care?.

IntroductionTraumatic brain injury (TBI) is a growing public health problem around the world, yet there is little information on the prevalence of head injury in low and middle income countries (LMICs). We utilised data collected by the 10/66 research group to investigate the lifetime prevalence of head injury in defined sites in low and middle income countries, its risk factors and its relationship with disability.MethodsWe analysed data from one-phase cross-sectional surveys of all residents aged 65 years and older (n = 16430) distributed across twelve sites in eight low and middle income countries (China, Cuba, Dominican Republic, India, Venezuela, Mexico, Peru, and Puerto Rico). Self-reported cases of head injury with loss of consciousness were identified during the interview. A sensitivity analysis including data provided by informants of people with dementia was also used to estimate the impact of this information on the estimates. Prevalence ratios (PR) from Poisson regressions were used to identify associated risk factors.ResultsThe standardised lifetime prevalence of TBI ranged from 0.3% in China to 14.6% in rural Mexico and Venezuela. Being male (PR: 1.6, 95% CI: 1.29–1.82), younger (PR: 0.95, 95% CI: 0.92–0.99), with lower education (PR 0.91, 95% CI: 0.86–0.96), and having fewer assets (PR 0.92, 95% CI: 0.88–0.96), was associated with a higher prevalence of TBI when pooling estimates across sites.DiscussionOur analysis revealed that the prevalence of TBI in LMICs is similar to that of developed nations. Considering the growing impact of TBI on health resources in these countries, there is an urgent need for further research.

In 2021, 20.1% of people from the Indian ethnic group were in higher managerial and professional occupations – the highest percentage out of all ethnic groups in this socioeconomic group.

Expected provider in the ED.

If you were a patient in this hospital in the past week, where were you seen?.

Reasons for choosing the ED.

Low-middle income countries like India bear a heavier burden of maternal, childcare, and child mortality rates when compared with high-income countries, which highlights the disparity in global health. Numerous societal, geopolitical, economic, and institutional issues have been linked to this inequality. mHealth has the potential to ameliorate these challenges by providing health services and health-related information with the assistance of frontline workers in the provision of prepartum, delivery, and postnatal care to improve maternal and child health outcomes in hard-to-reach areas in low- and middle-income countries (LMICs). However, there is limited evidence to support how mHealth can strengthen maternal and child health in India. The scoping review guideline in the Cochrane Handbook was used to retrieve studies from 4 international databases: CINAHL, Embase, Medline Ovid, and PubMed. This search strategy used combined keywords (MeSH terms) related to maternal and child healthcare, mHealth, and BIMARU in conjunction with database-controlled vocabulary. Out of 278 records, 8 publications were included in the review. The included articles used mHealth for data collection, eLearning, communication, patient monitoring, or tracking to deliver maternal and neonatal care. The results of these papers reflected a favourable effect of mHealth on the target population and found that it altered their attitudes and behaviours about healthcare. Higher job satisfaction and self-efficiency were reported by mHealth user care providers. Multiple barriers to the acceptance of mHealth exist, but the majority of the evidence points towards the feasibility of the intervention in a clinical setting. The mHealth has positive potential for improving maternal and child health outcomes in low-resource settings in India’s BIMARU states by strengthening the healthcare system. The results of the study could be used in the tailoring of an effective mHealth intervention and implementation strategy in a similar context. However, there is a need for economic evaluation in the future to bridge the knowledge gap regarding the cost-effectiveness of mHealth interventions.

How patients learned about the emergency department.

a. The World Bank listing of low- and lower-middle income countries. b. The 11 trials that had sites in one or more low- or lower-middle income countries (other than India). c. The 23 publications linked to the 11 trials that had sites in one or more low- or lower-middle income countries (other than India). (XLS)