The document summarizes a study on out-of-pocket expenditures for non-communicable diseases (NCDs) among households in the Indian state of Punjab. Key findings include:
- Punjab has higher prevalence of NCDs than the national average in India.
- Households in Punjab incurred higher out-of-pocket expenditures for NCD treatment and hospitalization than the all India levels.
- The poorest households in Punjab spent the highest share of their total consumption on out-of-pocket health expenditures for NCDs.
- The results indicate that due to high out-of-pocket costs, NCDs place a large economic burden on households in Punjab
Policy Brief-Costly Disease: How to reduce out of pocket expenditure in Diabe...Anupam Singh
This policy brief assignment was submitted to instructor during my masters program in Development at AzimPremji University. This brief reflects upon the current status of diabetes in country with graphs and data points,and how it is addressed specially in the public health domain.
Disclaimer - this are the authors personal opinion and reflections build upon the data researched for academic submission purpose . it is in no way is exhaustive and claiming anything in particular in the health system. Feedback are welcome to construct and improve more on this academic assignment (Policy Brief).
Research is essential to guide improvements in population health,but developing countries have since long faced under-investment in health research in relation to their health needs.1,2 Better
estimates of trends in global and national expenditures on health
research are needed to formulate informed health policies.2–8
Expenditure data on research on specific diseases highlight the
gaps in investment in less-developed settings.9,10
India’s National Health Policy 2017 and other analyses have
noted that the modest public expenditure on health research has
resulted in limited progress for an informed policy action to
improve population health.4,7,8,11–13 In India, there is limited
information of how much is spent on health- and disease-related
research and where it is coming from. To address this gap, we aimed to map health research funding through a survey of health research institutions across India on funding over a 5-year period, estimate of funding by the industry, and assess health research funding trends in India 2001 onwards by major funding agencies to get an improved understanding of total health research funding in India
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
A presentation for undergrad students visited Wolrd Health Organization (WHO) to understand what universal health coverage (UHC) is and how WHO works for UHC.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Policy Brief-Costly Disease: How to reduce out of pocket expenditure in Diabe...Anupam Singh
This policy brief assignment was submitted to instructor during my masters program in Development at AzimPremji University. This brief reflects upon the current status of diabetes in country with graphs and data points,and how it is addressed specially in the public health domain.
Disclaimer - this are the authors personal opinion and reflections build upon the data researched for academic submission purpose . it is in no way is exhaustive and claiming anything in particular in the health system. Feedback are welcome to construct and improve more on this academic assignment (Policy Brief).
Research is essential to guide improvements in population health,but developing countries have since long faced under-investment in health research in relation to their health needs.1,2 Better
estimates of trends in global and national expenditures on health
research are needed to formulate informed health policies.2–8
Expenditure data on research on specific diseases highlight the
gaps in investment in less-developed settings.9,10
India’s National Health Policy 2017 and other analyses have
noted that the modest public expenditure on health research has
resulted in limited progress for an informed policy action to
improve population health.4,7,8,11–13 In India, there is limited
information of how much is spent on health- and disease-related
research and where it is coming from. To address this gap, we aimed to map health research funding through a survey of health research institutions across India on funding over a 5-year period, estimate of funding by the industry, and assess health research funding trends in India 2001 onwards by major funding agencies to get an improved understanding of total health research funding in India
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
A presentation for undergrad students visited Wolrd Health Organization (WHO) to understand what universal health coverage (UHC) is and how WHO works for UHC.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Vital statistics is accumulated data gathered on live births, deaths, migration, fetal deaths, marriages and divorces. The most common way of collecting information on these events is through civil registration, an administrative system used by governments to record vital events which occur in their populations.
Factors Associated with Enrolment of Households in Nepal’s National Health In...Prabesh Ghimire
Abstract
Background: Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.
Methods: A cross-sectional household survey using face to face interview was carried out in 2 Palikas (municipalities) of Ilam district. 570 households were studied by recruiting equal number of NHIP enrolled and non-enrolled households. We used Pearson’s chi-square test and binary logistic regression to identify the factors associated with household’s enrolment in NHIP. All statistical analyses were performed using IBM SPSS version 23 software.
Results: Enrolment of households in NHIP was found to be associated with ethnicity, socio-economic status, past experience of acute illness in family and presence of chronic illness. The households that belonged to higher socio-economic status were about 4 times more likely to enrol in the scheme. It was also observed that households from privileged ethnic groups such as Brahmin, Chhetri, Gurung, and Newar were 1.7 times more likely to enrol in NHIP compared to those from underprivileged ethnic groups such as janajatis (indigenous people) and dalits (the oppressed). The households with illness experience in 3 months preceding the survey were about 1.5 times more likely to enrol in NHIP compared to households that did not have such experience. Similarly, households in which at least one of the members was chronically ill were 1.8 times more likely to enrol compared to households with no chronic illness.
Conclusion: Belonging to the privileged ethnic group, having a higher socio-economic status, experiencing an acute illness and presence of chronically ill member in the family are the factors associated with enrolment of households in NHIP. This study revealed gaps in enrolment between rich-poor households and privileged-underprivileged ethnic groups. Extension of health insurance coverage to poor and marginalized households is therefore needed to increase equity and accelerate the pace towards achieving universal health coverage.
Sri Lanka has achieved strong health outcomes over and above what is commensurate with its income level. The country has made significant gains in essential health indicators, witnessed a steady increase in life expectancy among its people, and eliminated malaria, filariasis, polio and neonatal tetanus. The Sri Lanka HiT review presents a comprehensive overview of the different aspects of the country’s health system, and the background and context within which the health system is situated. The review also presents information on reforms to address emerging health needs such as the growing challenge of noncommunicable diseases (NCDs) and serving a rapidly ageing population
Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Zone. Innovative Financial Healthcare in India.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
WHAT IS HEALTH?
The word "health " refers to a state of complete emotional and physical wellbeing. Healthcare exists to help people
maintain this optimal state of health.
In 1948, the World Health Organization (WHO) defined health with a phrase that is still used today. "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." WHO, 1948.
In 1986, the WHO further clarified that health is: "A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."
This means that health is a resource to support an individual's function in wider society. A healthful lifestyle provides the means to lead a full life.
TYPES OF HEALTH
Mental and physical health are the two most commonly discussed types of health.
We also talk about "spiritual health," "emotional health," and "financial health," among others. These have also been linked to lower stress levels and mental and physical well being.
Physical health
Physical health involves proper functioning of all body parts. When they are all working at peak performance due not only to a lack of disease, but also to regular exercise, balanced nutrition, and adequate rest.
Mental health
Mental health refers to a person's emotional, social, and psychological wellbeing. Mental health is as important as
physical health to a full, active lifestyle. Mental health is not only the absence of depression, anxiety, or another
disorder.
It also depends on the ability to: enjoy life , bounce back after difficult experiences, achieve balance, adapt to adversity, feel safe and secure, and achieve your potential.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Level and Determinants of Medical Expenditure and Out of Pocket Medical Expen...inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Factors Associated with Enrolment of Households in Nepal’s National Health In...Prabesh Ghimire
Abstract
Background: Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.
Methods: A cross-sectional household survey using face to face interview was carried out in 2 Palikas (municipalities) of Ilam district. 570 households were studied by recruiting equal number of NHIP enrolled and non-enrolled households. We used Pearson’s chi-square test and binary logistic regression to identify the factors associated with household’s enrolment in NHIP. All statistical analyses were performed using IBM SPSS version 23 software.
Results: Enrolment of households in NHIP was found to be associated with ethnicity, socio-economic status, past experience of acute illness in family and presence of chronic illness. The households that belonged to higher socio-economic status were about 4 times more likely to enrol in the scheme. It was also observed that households from privileged ethnic groups such as Brahmin, Chhetri, Gurung, and Newar were 1.7 times more likely to enrol in NHIP compared to those from underprivileged ethnic groups such as janajatis (indigenous people) and dalits (the oppressed). The households with illness experience in 3 months preceding the survey were about 1.5 times more likely to enrol in NHIP compared to households that did not have such experience. Similarly, households in which at least one of the members was chronically ill were 1.8 times more likely to enrol compared to households with no chronic illness.
Conclusion: Belonging to the privileged ethnic group, having a higher socio-economic status, experiencing an acute illness and presence of chronically ill member in the family are the factors associated with enrolment of households in NHIP. This study revealed gaps in enrolment between rich-poor households and privileged-underprivileged ethnic groups. Extension of health insurance coverage to poor and marginalized households is therefore needed to increase equity and accelerate the pace towards achieving universal health coverage.
Sri Lanka has achieved strong health outcomes over and above what is commensurate with its income level. The country has made significant gains in essential health indicators, witnessed a steady increase in life expectancy among its people, and eliminated malaria, filariasis, polio and neonatal tetanus. The Sri Lanka HiT review presents a comprehensive overview of the different aspects of the country’s health system, and the background and context within which the health system is situated. The review also presents information on reforms to address emerging health needs such as the growing challenge of noncommunicable diseases (NCDs) and serving a rapidly ageing population
Out-of-Pocket Spending on Out-Patient Care in India: Assessment and Options Based on Results from a District Zone. Innovative Financial Healthcare in India.
The Kingdom of Bhutan has made great achievement in establishing and sustaining public financed and managed health system in the past five and a half decades. As enshrined in the Constitution, health services are free in the integrated traditional and allopathic medicines. The report also notes the epidemiological and health system challenges and the way forward to overcome in line with achieving SDGs.
WHAT IS HEALTH?
The word "health " refers to a state of complete emotional and physical wellbeing. Healthcare exists to help people
maintain this optimal state of health.
In 1948, the World Health Organization (WHO) defined health with a phrase that is still used today. "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." WHO, 1948.
In 1986, the WHO further clarified that health is: "A resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities."
This means that health is a resource to support an individual's function in wider society. A healthful lifestyle provides the means to lead a full life.
TYPES OF HEALTH
Mental and physical health are the two most commonly discussed types of health.
We also talk about "spiritual health," "emotional health," and "financial health," among others. These have also been linked to lower stress levels and mental and physical well being.
Physical health
Physical health involves proper functioning of all body parts. When they are all working at peak performance due not only to a lack of disease, but also to regular exercise, balanced nutrition, and adequate rest.
Mental health
Mental health refers to a person's emotional, social, and psychological wellbeing. Mental health is as important as
physical health to a full, active lifestyle. Mental health is not only the absence of depression, anxiety, or another
disorder.
It also depends on the ability to: enjoy life , bounce back after difficult experiences, achieve balance, adapt to adversity, feel safe and secure, and achieve your potential.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Level and Determinants of Medical Expenditure and Out of Pocket Medical Expen...inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
13 – impact of social media on health in punjab,South India(Current), Riya(PW...ashimasahni3
A sound health and effective mental care are essential part of nation state system. In-fact
Economy and Social goal of any nation depends on the health of the people. Health is
measured by different variables like access to quality health care, genetic inheritance and the
factors comprised with the quality of water, air, environment conditions etc. However recent
researches in related filed indicates correlation between mass media and health. Mass
media plays very important role in diffusing health messages and generating awareness
about health information which guides in attitude and behavior change of the audience to
ascertain a good health. Thus, Mass media guides health officials to reach the general
people, that is very important for health communication. Hence, mass media, radio,
television, and online media are the useful ways to make up mind of the the target people to
imbibe a new life-style and to alarm them with needful information because this is the only
way which is used to pursued the public about a particular disease or epidemic. The current
study intends to find out the level of awareness of health issues among the people and to
find out the most effective mode of health communication. The present research leads to the
findings that people of Punjab are aware of health issues but not fully aware about the health
schemes initiated by government of India. The mainstream media like radio and television
are doing very good job on national level to make people aware about government related
schemes but local channels are least interested to do a job for health awareness. It has also
come into light that private media is not very serious for spreading health related information
The Dire Need and Rise of Digital Chronic Disease Management in IndiaRedSeer
India’s healthcare suffers from a substandard infrastructure and limited insurance coverage, leading to inferior healthcare quality in the
country, as confirmed from multiple global indicators (ranked 145 out of 195 countries on healthcare access & quality, as per the Lancet study in 2016; ranked 66 out of 195 countries on healthcare security, as per Global Health Security Index 2021). The poor
condition of India’s healthcare system was recently exposed as the system collapsed during the COVID-19 pandemic (especially the period of second COVID-19 wave).
It’s 2019 and still, affordable healthcare seems to be a distant dream. Assessing the current healthcare costs is a hornet’s nest. This white paper provides a break down the trends in the cost of treatment, the rural-urban comparison healthcare costs and how to insulate against such rises in cost.
Evaluation of Agro-morphological Performances of Hybrid Varieties of Chili Pe...Premier Publishers
In Benin, chilli pepper is a widely consumed as vegetable whose production requires the use of performant varieties. This work assessed, at Parakou and Malanville, the performance of six F1 hybrids of chilli including five imported (Laali, Laser, Nandi, Kranti, Nandita) and one local (De cayenne), in completely randomized block design at four replications and 15 plants per elementary plot. Agro-morphological data were collected and submitted to analysis of variance and factor analysis of mixed data. The results showed the effects of variety, location and their interactions were highly significant for most of the growth, earliness and yield traits. Imported hybrid varieties showed the best performances compared to the local one. Multivariate analysis revealed that 'De cayenne' was earlier, short in size, thin-stemmed, red fruits and less yielding (≈ 1 t.ha-1). The imported hybrids LaaliF1 and KrantiF1 were of strong vegetative vigor, more yielding (> 6 t.ha-1) by developing larger, long and hard fruits. Other hybrids showed intermediate performances. This study highlighted the importance of imported hybrids in improving yield and preservation of chili fruits. However, stability and adaptation analyses to local conditions are necessary for their adoption.
An Empirical Approach for the Variation in Capital Market Price Changes Premier Publishers
The chances of an investor in the stock market depends mainly on some certain decisions in respect to equilibrium prices, which is the condition of a system competing favorably and effectively. This paper considered a stochastic model which was latter transformed to non-linear ordinary differential equation where stock volatility was used as a key parameter. The analytical solution was obtained which determined the equilibrium prices. A theorem was developed and proved to show that the proposed mathematical model follows a normal distribution since it has a symmetric property. Finally, graphical results were presented and the effects of the relevant parameters were discussed.
Influence of Nitrogen and Spacing on Growth and Yield of Chia (Salvia hispani...Premier Publishers
Chia is an emerging cash crop in Kenya and its production is inhibited by lack of agronomic management information. A field experiment was conducted in February-June and May-August 2021, to determine the influence of nitrogen and spacing on growth and yield of Chia. A randomized complete block design with a split plot arrangement was used with four nitrogen rates as the main plots (0, 40, 80, 120 kg N ha-1) and three spacing (30 cm x 15 cm (s1), 30 cm x 30 cm (s2), 50 cm x 50 cm (s3)). Application of 120 kg N ha-1 significantly increased (p≤0.05) vegetative growth and seed yield of Chia. Stem height, branches, stem diameter and leaves increased by 23-28%, 11-13%, 43-55% and 59-88% respectively. Spacing s3 significantly increased (p≤0.05) vegetative growth. An increase of 27-74%, 36-45% and 73-107% was recorded in number of leaves, stem diameter and dry weight, respectively. Chia yield per plant was significantly higher (p≤0.05) in s3. However, when expressed per unit area, s1 significantly produced higher yields. The study recommends 120 kg N ha-1 or higher nitrogen rates and a closer spacing of 15 cm x 30 cm as the best option for Chia production in Kenya.
Enhancing Social Capital During the Pandemic: A Case of the Rural Women in Bu...Premier Publishers
Social capital plays an essential role in empowering people for social and economic change even during the pandemic. A livelihood project of the government was implemented among the members of a women’s association of a disadvantaged upland community in Bukidnon province, Southern Philippines for inclusive development. This study was conducted to determine the influence of some socio-economic attributes and the change in the knowledge level on the social capital of the rural women amidst the pandemic. The activities of the project were implemented considering the health protocols imposed by the government during the health crisis. The findings revealed that the trainings conducted resulted to a positive change in the knowledge level among the rural women. This facilitated the production of vegetables for their households and generated additional income very necessary during the pandemic especially that other economic activities were hindered. Similarly, there was a significant increase in the social capital of the rural women during the last two years. The main occupation, sources of income and their ethnicity significantly influenced the social capital of the rural women. The rural development workers and policymakers must consider the social capital of the group in the implementation of poverty alleviation programs.
Impact of Provision of Litigation Supports through Forensic Investigations on...Premier Publishers
This paper presents an argument through the fraud triangle theory that the provision of litigation supports through forensic audits and investigations in relation to corporate fraud cases is adequate for effective prosecution of perpetrators as well as corporate fraud prevention. To support this argument, this study operationalized provision of litigation supports through forensic audit and investigations, data mining for trends and patterns, and fraud data collection and preparation. A sample of 500 respondents was drawn from the population of professional accountants and legal practitioners in Nigeria. Questionnaire was used as the instrument for data collection and this was mailed to the respective respondents. Resulting responses were analyzed using the OLS multiple regression techniques via the SPSS statistical software. The results reveal that the provision of litigation supports through forensic audits and investigations, fraud data mining for trends and patterns and fraud data collection and preparation for court proceedings have a positive and significant impact on corporate fraud prevention in Nigeria. This study therefore recommends that regulators should promote the provision of litigation supports through forensic audits and investigations in relation to corporate fraud cases in publicly listed firms in Nigeria, as this will help provide reports that are acceptable in court proceedings.
Improving the Efficiency of Ratio Estimators by Calibration WeightingsPremier Publishers
It is observed that the performances of most improved ratio estimators depend on some optimality conditions that need to be satisfied to guarantee better estimator. This paper develops a new approach to ratio estimation that produces a more efficient class of ratio estimators that do not depend on any optimality conditions for optimum performance using calibration weightings. The relative performances of the proposed calibration ratio estimators are compared with a corresponding global [Generalized Regression (GREG)] estimator. Results of analysis showed that the proposed calibration ratio estimators are substantially superior to the traditional GREG-estimator with relatively small bias, mean square error, average length of confidence interval and coverage probability. In general, the proposed calibration ratio estimators are more efficient than all existing estimators considered in the study.
Urban Liveability in the Context of Sustainable Development: A Perspective fr...Premier Publishers
Urbanization and quality of urban life are mutually related and however it varies geographically and regionally. With unprecedented growth of urban centres, challenge against urban development is more in terms of how to enhance quality of urban life and liveability. Making sense of and measuring urban liveability of urban places has become a crucial step in the context of sustainable development paradigm. Geographical regions depict variations in nature of urban development and consequently level of urban liveability. The coastal regain of West Bengal faces unusual challenges caused by increasing urbanization, uncontrolled growth, and expansion of economic activities like tourism and changing environmental quality. The present study offers a perspective on urban liveability of urban places located in coastal region comprising of Purba Medinipur and South 24 Parganas districts. The study uses the liveability standards covering four major pillars- institutional, social, economic and physical and their indicators. This leads to develop a City Liveability Index to rank urban places of the region, higher the index values better the urban liveability. The data for the purpose is collected from various secondary sources. Study finds that the eastern coastal region of the country covering state of West Bengal depicts variations in index of liveability determined by physical, economic, social and institutional indicators.
Transcript Level of Genes Involved in “Rebaudioside A” Biosynthesis Pathway u...Premier Publishers
Stevia rebaudiana Bertoni is a plant which has recently been used widely as a sweetener. This medicinal plant has some components such as diterpenoid glycosides called steviol glycosides [SGs]. Rebaudioside A is a diterpenoid steviol glycoside which is 300 times sweeter than table sugar. This study was done to investigate the effect of GA3 (50 mg/L) on the expression of 14 genes involved in Rebaudioside A biosynthesis pathway in Stevia rebaudiana under in vitro conditions. The expression of DXS remarkably decreased by day 3. Also, probably because of the negative feedback of GA3 on MEP-drived isoprenes, GGDS transcript level reached its lowest amount after GA3 treatment. The abundance of DXR, CMS, CMK, MCS, and CDPS transcripts showed a significant increase at various days after this treatment. A significant drop in the expression levels of KS and UGT85C2 is detected during the first day. However, expression changes of HDR and KD were not remarkable. Results revealed that the level of transcript of UGT74G1 and UGT76G1 up regulated significantly 4 and 2 times higher than control, respectively. However, more research needs to shed more light on the mechanism of GA3 on gene expression of MEP pathway.
Multivariate Analysis of Tea (Camellia sinensis (L.) O. Kuntze) Clones on Mor...Premier Publishers
Information on genetic variability for biochemical characters is a prerequisite for improvement of tea quality. Thirteen introduced tea clones characterized with objective; assessing tea clones based on morphological characters at Melko and Gera research stations. The study was conducted during 2017/18 cropping season on experimental plots in RCBD with three replications. Data recorded on morphological traits like days from pruning to harvest, height to first branch, stem diameter, leaf serration density, leaf length, leaf width, leaf size, petiole length, leaf ratio, internode length, shoot length, number of shoot, canopy diameter, hundred shoot weight, fresh leaf yield per tree. Cluster analysis of morphological trait grouped into four clusters indicated, the existence of divergence among the tested clones. The maximum inter-cluster distance was between clusters I and IV (35.27) while the minimum inter cluster distance was observed between clusters I and II (7.8).Principal components analysis showed that the first five principal components with eigenvalues greater than one accounted 86.45% for 15 morphological traits. Generally, the study indicated presence of variability for several morphological traits. However, high morphological variation between clones is not a guarantee for a high genetic variation; therefore, molecular studies need to be considered as complementary to biochemical studies.
Causes, Consequences and Remedies of Juvenile Delinquency in the Context of S...Premier Publishers
This research work was designed to examine nature of juvenile offences committed by juveniles, causes of juvenile delinquency, consequences of juvenile delinquency and remedies for juvenile delinquency in the context of Sub-Saharan Africa with specific reference to Eritrea. Left unchecked, juvenile delinquents on the streets engage in petty theft, take alcohol or drugs, rape women, rob people at night involve themselves in criminal gangs and threaten the public at night. To shed light on the problem of juvenile delinquency in the Sub-Saharan region data was collected through primary and secondary sources. A sample size of 70 juvenile delinquents was selected from among 112 juvenile delinquents in remand at the Asmara Juvenile Rehabilitation Center in the Eritrean capital. The study was carried out through coded self-administered questionnaires administered to a sample of 70 juvenile delinquents. The survey evidence indicates that the majority of the juvenile respondents come either from families constructed by unmarried couples or separated or divorced parents where largely the father is missing in the home or dead. The findings also indicate that children born out of wedlock, families led by single mothers, lack of fatherly role models, poor parental-child relationships and negative peer group influence as dominant causes of juvenile infractions. The implication is that broken and stressed families are highly likely to be the breeding grounds for juvenile delinquency. The survey evidence indicates that stealing, truancy or absenteeism from school, rowdy or unruly behavior at school, free-riding in public transportation, damaging the book of fellow students and beating other young persons are the most common forms of juvenile offenses. It is therefore, recommended that parents and guardians should exercise proper parental supervision and give adequate care to transmit positive societal values to children. In addition, the government, the police, prosecution and courts, non-government organizations, parents, teachers, religious leaders, education administrators and other stakeholders should develop a child justice system that strives to prevent children from entering deeper into the criminal justice process.
The Knowledge of and Attitude to and Beliefs about Causes and Treatments of M...Premier Publishers
Stigma and discrimination associated with mental illness are a common occurrence in the Sub-Saharan region including Eritrea. Numerous studies from Sub-Saharan Africa suggest that stigma and discrimination are major problems in the community, with negative attitudes and behavior towards people with mental illness being widespread. In order to assess the whether such negative attitudes persist in the context of Eritrea this study explored the knowledge and perceptions of 90 Eritrean university students at the College of Business and Economics, the University of Asmara regarding the causes and remedies of mental illness A qualitative method involving coded self-administered questionnaires administered to a sample of 90 university students to collecting data at the end of 2019. The survey evidence points that almost 50% of the respondents had contact with a mentally ill person suggesting that the significant number of the respondents experienced a first-hand encounter and knowledge of mental illness in their family and community. The findings show an overall greater science-based understanding of the causes of mental illness to be followed by recommended psychiatric treatments. The survey evidence indicates that the top three leading causes of mental illness in the context of Eritrea according to the respondents are brain disease (76%), bad events in the life of the mentally ill person (66%) and substance abuse or alcohol taking, smoking, taking drugs like hashish. (54%). The majority of the respondents have a very sympathetic and positive outlook towards mentally ill persons suggesting that mentally illness does not simply affect a chosen individual rather it can happen to anybody regardless of economic class, social status, ethnicity race and religion. Medical interventions cited by the majority of the respondents as being effective treatments for mental illness centered on the idea that hospitals and clinics for treatment and even cures for psychiatric disease. Changing perceptions of mental illnesses in Eritrea that paralleled the very caring and sympathetic attitudes of the sample university students would require raising public awareness regarding mental illness through education, using the mass media to raise public awareness, integrating mental health into the primary health care system, decentralizing mental health care services to increase access to treatment and providing affordable service to maintain positive treatment outcomes.
Effect of Phosphorus and Zinc on the Growth, Nodulation and Yield of Soybean ...Premier Publishers
An investigation was carried out at Kogi State University Student Research and Demonstration farm Anyigba during the 2019 wet season to observe the effect of phosphorus and zinc on the growth, nodulation and yield of soybean. The treatments comprised three levels: phosphorus and zinc (0, 30 and 60 kg P2O5/ha; 0, 5 and 10kg Zn/ha) and two varieties TGX 536 – 02D and Samsoy 2. The investigation revealed that application of phosphorus affected growth, nodulation, yield and some yield components of soybean while zinc application, apart from the plant height, which is reduced significantly, had no significant effect on other growth characters, nodulation, yield and yield components. However, it was generally found to decrease most of the characters. Application of 60 kg P2O5/ha gave the highest growth and yield, while 30 kg P2O5/ha gave the highest nodulation. Application of 60 kg P2O5/ha significantly increased yield to 1.9t/ha, which was significantly higher over the control plots, which gave 1.7t/ha. Crude protein and oil contents of the seeds were not significantly affected by phosphorus application but were significantly affected by zinc application, which significantly decreased protein content as its amount an increase from 0 to 10 kg/ha, and significantly increased oil content from 0 to 5kg/ha and decreased it below 5kg/ha. It was also revealed that the two varieties responded similarly to phosphorus and zinc in terms of growth, grain yield and crude protein content of the seeds.
Influence of Harvest Stage on Yield and Yield Components of Orange Fleshed Sw...Premier Publishers
A field experiment was conducted at Adami Tullu Agricultural Research Center in 2018 under rainfed condition with supplementary irrigation to determine the influence of harvest stage on vine yield and tuberous root yield of orange fleshed sweet potato varieties. The experiment consisted of four harvest stages (105, 120, 135 and 150 days after planting) and Kulfo, Tulla and Guntute varieties. A 4 X 3 factorial experiment arranged in randomized complete block design with three replications was used. Interaction of harvest stage and variety significantly influenced above ground fresh biomass, vine length, marketable tuberous root weight per hectare, commercial harvest index and harvest index. The highest mean values of above ground fresh biomass (66.12 t/ha) and marketable tuberous root weight (56.39 t/ha) were produced by Guntute variety harvested at 135 days after planting. Based on the results, it can be recommended that, farmers of the study area can grow Guntute variety by harvesting at 135 days after planting to obtain optimum vine and tuberous root yields.
Performance evaluation of upland rice (Oryza sativa L.) and variability study...Premier Publishers
This study aimed at assessing genetic variability and to evaluate the performance of 13 improved upland rice varieties for yield and its components based on morphological traits. The field experiment was conducted using a randomized block design at Guraferda and Gimbo districts in the 2019 main cropping season. The analysis of variance (ANOVA) over the two locations revealed significant differences (p≤ 0.05) among varieties for days to 50% heading, days to 85% maturity, panicle length, thousand-grain weight, and grain yield. Similarly, the ANOVA for variety by location interactions depicted significant differences among the tested varieties for days to 50% heading, days to 85% maturity, and thousand-grain weight. High heritability was obtained from days to heading (88.5%), panicle length (85.0%), and grain yield (85.2%), which indicates these traits can be easily improved through selection. High to medium broad sense heritability and genetic advance as percentage of the mean for days to heading, thousand-grain weight, and grain yield indicates a good opportunity for improvement through selection using their phenotypic performance. This is mainly due to the high role of additive gene action in the expression of such traits. This study confirmed the presence of variability among varieties for most of the studied traits, which will create an opportunity for breeders to improve rice yield and other attributes.
Response of Hot Pepper (Capsicum Annuum L.) to Deficit Irrigation in Bennatse...Premier Publishers
This study was conducted at Enchete kebele in Benna-Tsemay Woreda, South Omo Zone to evaluate the response of hot pepper to deficit irrigation on yield and water productivity under furrow irrigation system. The experiment comprised four treatments (100 % of ETc, 85% of ETc, 70 % of ETc and 50% of ETc), respectively. The experiment was laid out in RCBD and replicated four times. The two years combined yield results indicated that, the maximum total yield (20.38 t/ha) was obtained from 100% ETc while minimum yield (12.92 t/ha) was obtained from 50% of ETc deficit irrigation level. The highest WUE 5.22 kg/ha mm-1 was obtained from 50% of ETc. Treatment of 100% ETc irrigation application had highest benefit cost ratio (4.5) than all others treatments. Applying 50% of ETc reduce the yield by 37% when compared to 100 % ETc. Accordingly, to achieve maximum hot pepper yield in areas where water is not scarce, applying 100% ETc irrigation water application level throughout whole growing season under furrow irrigation system is recommended. But, in the study area water scarcity is the major limiting factor for crop production. So, it is possible to get better yield and water productivity of hot pepper when we apply 85% ETc irrigation water throughout growing season under furrow irrigation system.
Harnessing the Power of Agricultural Waste: A Study of Sabo Market, Ikorodu, ...Premier Publishers
Nigeria is still burdened with huge responsibilities of waste disposal because the potential for benefits of proper waste management is yet to be harnessed. The paper evaluates the capacity of the Sabo Cattle market in producing the required quantities of waste from animal dung alongside decomposed fruits with a view to generating renewable energy possibilities for lighting, security and other business activities of the market. It is estimated that about 998 million tons of agricultural waste is produced yearly in the country with organic wastes amounting to 80 percent of the total solid wastes. This can be categorized into biodegradable and non-biodegradable wastes. The paper evaluates the capacity of the Sabo Cattle market in producing the required quantities of waste from animal dung alongside decomposed fruits with a view to generating renewable energy possibilities for lighting, security and other business activities of the market. The Sabo market was treated as a study case with the adoption of in-depth examinations of the facility, animals and products for sale and waste generated. A combination of experimental, interviews (qualitative) and design simulation (for final phase) was adopted to extract, verify and analyse the data generated from the study. Animal waste samples were subjected to compositional and fibre analysis with results showing that the sample has high potency for biogas production. Biodegradable Wastes are human and animal excreta, agricultural and all degradable wastes. Availability of high quantity of waste generated being organic in Sabo market allows the use of anaerobic digestion to be proposed as a waste to energy technology due to its feasibility for conversion of moist biodegradable wastes into biogas. The study found that at peak supply period during the Islamic festivities, a conservative 300tonnes of animal waste is generated during the week which translates to over 800kilowatts of electricity.
Influence of Conferences and Job Rotation on Job Productivity of Library Staf...Premier Publishers
The general purpose of this study is to investigate the influence of conferences and job rotation on job productivity of library staff in tertiary institutions in Imo State, Nigeria. The survey research design was used for this study using questionnaire as an instrument for data collection. This study covered the entire population of 661. Out of these, 501 copies of the questionnaire representing 75.8% were duly completed and returned for analysis. Student’s t-test was used to analyze the research questions. The finding showed that conferences had no significant influence on the job productivity of library staff in tertiary institutions in Imo State, Nigeria (F cal= 7.86; t-vale =6.177; p >0.005). Finding also showed that job rotation significantly influences job productivity of library staff in tertiary institutions in Imo State, Nigeria (F-cal value= 18.65; t-value = 16.225; P<0.05). This study recommended that, government should ensure that library staff participate in conferences with themes and topics that are relevant to the job they perform and also ensure that there should be proper evaluation and feedback mechanism which aimed to ensuring control and minimize abuse of their development opportunities. Again, there should be written statement of objectives in order to sustain job rotation programmes. Also, that training and development needs of library staff must be identified and analyzed before embarking on job rotation processes as this would help to build skills, competences, specialization and high job productivity.
Scanning Electron Microscopic Structure and Composition of Urinary Calculi of...Premier Publishers
Microscopic examination of urine samples collected from geriatric dogs revealed increased numbers of erythrocytes, leucocytes, epithelial cells and pus cells along with casts, bacteria, spermatozoa and crystals of various shapes. Among the different crystals, triple phosphate or struvite were predominant, followed by calcium oxalate dihydrate, calcium oxalate monohydrate and ammonium urate or biurate. The struvite crystals were, coffin-lid shape and while calcium oxalate dihydrate were octahedron or envelope and monohydrate crystals demonstrated “picket fence” and “dumbbell” and “hemp seed” appearance. Brown or yellow-brown spherical bodies with irregular borders with thorn-apple appearance were shown by ammonium urate or biurate crystals. SEM aspects of magnesium ammonium phosphate crystals revealed perpendicular columnar strata, few with scattered hexa or octa-hedral coffin-lid shaped crystals and calcium phosphate crystals were like cracked eggshells. Presence of wavy phases with sundry areas (uric acid), picket fence (calcium oxalate monohydrate) and typical envelope (calcium oxalate dehydrate) were electron microscopic appearance of various crystals.
Gentrification and its Effects on Minority Communities – A Comparative Case S...Premier Publishers
This paper does a comparative analysis of four global cities and their minority districts which have been experiencing the same structural pressure of gentrification. The main contribution of this paper is providing a detailed comparison of four micro geographies worldwide and the impacts of gentrification on them: Barrio Logan in San Diego, Bo-Kaap in Cape Town, the Mission District in San Francisco, and the Rudolfsheim-Fünfhaus District in Vienna. All four cities have been experiencing the displacement of minority communities due to increases in property values. These cities were chosen because their governments enacted different policies to temper the gentrification process. It was found that cities which implemented social housing and cultural inclusionary policies were more successful in maintaining the cultural and demographic make-up of the districts.
Oil and Fatty Acid Composition Analysis of Ethiopian Mustard (Brasicacarinata...Premier Publishers
The experiments was conducted at Holetta Agricultural Research Center, to analyze forty nine Ethiopian Mustard land races for oil and fatty acid composition traits The experiment was carried out in a simple lattice design. The analysis of variance showed that there were highly significant differences among genotypes for all oil and fatty acid traits compared. The significant difference indicates the existence of genetic variability among the land races which is important for improvement
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
2. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Das and Das. 139
for quality of life. Currently India is undergoing major
epidemiological transition and the disease patterns have
shifted as evident from various studies reporting wide
interstate variations in the NCD burden in India, with some
states reporting largest dominance of NCD and injuries in
total disease burden. It has been shown previously that
OOPE varies enormously by type of disease, as well as by
the health care provider and this is in addition to the large
variations present due to varying socio-economic
conditions, negligible financial risk protection and health
system inequalities within different geographical areas of
India. Often such interstate differences are overlooked by
researchers and policymakers while studying economic
impact of non-communicable diseases (Sharma D et al
2017); (ICMR, PHFI, & IHME 2017).
While majority of past studies have estimated the
economic impact of non-communicable diseases at the all
India (national) level, with few focusing randomly on one
or two states of India; studies on the high non
communicable disease prevalent states of India are
negligible or almost nonexistence. Analysis of the
economic impact of NCD in high prevalent states of India
will reflect the true picture of the costs associated with their
management and its impact on households. Further the
results of this study would help provide empirical evidence
in support of the need for prioritized protection against
financial risks from NCD in high prevalence states as they
face huge economic burden from such diseases as
compared to states with lower prevalence of NCD.
From a policy point of view, it is necessary to assess the
magnitude of economic impact of NCD in those states
which have high prevalence of such diseases as ‘health’ is
a state subject in India, so majority of the public spending
on health needs to be borne by the state governments.
The measure and distribution of out of pocket expenditure
(OOPE) have been widely used as key indicator in
understanding health sector reforms by various authors.
And with this backdrop, the present study estimates OOPE
on treatment and hospitalization of NCD and its impact on
households in one of the high NCD prevalent state of India.
As most of government health programmes of India
encourage decentralized health planning process, it is
important to generate evidence on out of pocket
expenditure and distress financing at state level.
Therefore, we estimated out of pocket expenditures due to
non-communicable diseases as well as various financing
mechanisms and coping strategies used by households to
meet such expenditures in the state of Punjab, one of the
high NCD prevalent states of India. The state of Punjab
has 157 percent higher per person burden from diabetes
and 134 percent higher burden from ischemic heart
disease than most other states, indicating high NCD
burden (ICMR, PHFI, & IHME 2017).
Punjab is a state in northwest region of India. As per
census 2011, the population of Punjab is 27,743,338, with
62.5 percent rural population and 37.4 percent urban
population. For better understanding of the health
systems, information on health financing is needed. The
following table gives information on the key indicators of
health financing in the state of Punjab (Table 1).
Table 1: Key health financing indicators for Punjab
Total Health Expenditure (THE) Government Health Expenditure Out of pocket expenditure
In INR
crore
Per capita in
INR
As % of
GSDP
In INR
crore
Per capita in
INR
As % of
THE
In INR
crore
Per capita in
INR
As % of
THE
15138 5220 4.1% 2578 889 17.0% 12001 4138 79.3%
Source: National Health Systems Resource Centre (2017); National Health Accounts Estimates for India (2014-15)
Our study aims to provide estimation of economic impact
of non-communicable diseases by estimating the out of
pocket expenditure, share of such expenditure in total
household consumption expenditure and the financial
strategies used to cope up with such expenditure in high
non communicable disease prevalent state of Punjab,
India.
METHODS
Study design and Data: This is a cross sectional study
involving secondary data analysis. The data source is the
unit level data from the household health survey of the 71st
round of NSSO titled as ‘Social consumption: Health’
which was conducted from January 2014 to June 2014. A
nationally representative survey, the survey period was of
six months. A stratified multi stage design was used and
the survey covered a total of 65,932 households all over
India. First stage units were census villages in rural areas
and urban frame survey blocks in urban areas. The survey
collected details from households regarding any aliments
in the last 15 days amongst the members of the household,
whether admitted in hospital in last 365 days, type of health
care sought i.e. public or private, the expenditures incurred
as a result of ill health and financing of such expenditures.
Further with regards to cost of treatment, information was
collected on expenses incurred, separately for outpatient
(15 days recall) and inpatient treatment (365 days recall).
In the state of Punjab, the survey covered 1,529
households amongst which 768 were rural households
and 761 were urban households. In terms of number of
persons, a total of 7,797 persons were covered in the
survey, out of which 4044 were from rural areas and 3753
were from urban areas of Punjab. Detailed information can
be found in the survey report which is freely available in
the website of Indian Ministry of Statistics and Program
Implementation.
3. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Int. J. Public Health Epidemiol. Res. 140
Disease and condition classification: The health conditions
provided in the household survey are self-reported. We
matched the health condition categories in the survey to
board ICD-10 classification to distinguish between major
non communicable disease conditions and communicable
diseases (Annexure I). As some of the disease categories
in the survey could include both non communicable
diseases and communicable diseases, so this study
focused on the categories that were clearly non
communicable diseases.
Next in order to find out the states with high prevalence of
non-communicable disease conditions, the prevalence of
self-reported morbidity was calculated based on the
information available in the survey. Prevalence of
morbidity was calculated per thousand populations. The
following formula was used.
Prevalence of morbidity (Pi) = Ai/Ti * 1000
Where,
Ai= Number of ailing persons and
Ti= total population in the sample
On the basis of results of prevalence of morbidity, the
states which have prevalence of NCD conditions higher
than the all India average are considered as high
prevalence states. This study purposively selected the
state of Punjab as it has high prevalence of NCD (Refer to
Annexure II) and there is paucity of studies analyzing
economic burden of non-communicable diseases.
Outpatient visits and hospital stays (Inpatient): Information
about all hospital stays during the last 365 days preceding
the survey and outpatient visits during last 15 days for
NCD were calculated. In case of outpatient visits query
was made about aliments during the 15 days prior to the
survey. In order to estimate the annual number of
outpatient visits for the population, the number of visits
reported in the last 15 days reference period were
multiplied by 24.33(=365/15) following the method of
Engelgau, Karan A & Mahal A(2012).
Financing of healthcare services for non-communicable
diseases:
Different studies have defined out of pocket expenditure
(OOPE) as expenditure on outpatient or inpatient care net
of reimbursement. Estimation was made regarding how
households financed their overall health expenses related
to NCD. For in patient, each episode of hospitalization was
considered for calculating expenses. In case of outpatient,
expenses were calculated irrespective of the number of
spells of aliment. Thus, the expenses included
expenditures on doctor’s/surgeon’s fees, costs of
medicines, diagnostic tests, bed charges and any other
charges like on medical appliances, blood, oxygen etc.
and it was termed as “medical expenditures”. Calculation
of any other expenses other than medical expenses was
also undertaken and it included transport charges, food,
lodging charges during the reference period and referred
to as ‘non-medical expenditure’. The estimate of total
expenditure for health care (both outpatient and inpatient)
was arrived at as the sum of ‘medical expenditure’ and
‘non-medical expenditure’.
Estimation of how the households financed their health
expenses related to NCD was also made. The burden of
such financing across different economic groups was also
analyzed. For analyzing the burden of NCD across
different economic groups the entire population was
divided into 5 groups (quintiles) ranked by monthly per
capita household expenditure. Assessment was made of
how health spending varied across quintiles. To find out
how out of pocket spending affected the household’s other
consumption, the share of out of pocket spending on total
on total household spending was calculated. The analyses
were carried out by applying sampling weights provided by
the NSSO.
The indicators for analysis of the economic implications of
non-communicable diseases were selected on the basis of
information collected in the survey.
Statistical analysis: All the analysis was performed using
STATA 13.1.
Ethical considerations
This study used anonymous survey data collected by the
National Sample Survey Organization (NSSO). It is a
department of the Indian Ministry of Statistics and Program
Implementation. The data is openly available and is
available to the public free of cost. The study was
approved by Institutional Ethical Committee.
RESULTS
Analysis of unit data from the NSSO 71st survey showing
number of persons reporting chronic ailments,
hospitalization rate and type of care at the all India level
and in the state of Punjab are presented in Figure 1 & 2.
Figure 1: Prevalence of non-communicable diseases and
hospitalization rate (reference period-365 days) in India
and Punjab- 2014
Note: * Prevalence calculated per thousand population
4. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Das and Das. 141
Figure 2: Percentage distribution of inpatient treatment for non communicable diseases (365 days recall) by public and
private-India and Punjab, 2014
Next the estimates of expenditures on non-communicable
diseases were analyzed. Estimations were made for both
outpatient and inpatient treatment of non-communicable
diseases as well as for different components like
expenditure on drugs, diagnostics, fees (Table 2 & 3).
Table 2: Mean cost of treatment per ailing person on different items related to outpatient treatment (reference period-15
days) of non communicable diseases- India and Punjab, 2014; in INR (USD)
*Cons
fees
**Exp medicine Exp
diagnostics
^Exp
Others
#Exp medical Exp
transport
Exp
non-medical
Exp
Total
Insurance
Reimbursement
Punjab 47.08
(0.65)
505.05
(7.04)
96.36
(1.34)
25.81
(0.36)
674.32
(9.41)
34.97
(0.48)
9.24
(0.12)
718.55
(10.02)
0.021
(0.00)
All
India
75.71
(1.05)
458.43
(6.39)
62.68
(0.87)
22.78
(0.31)
619.61
(8.64)
51.78
(0.72)
28.90
(0.40)
700.30
(9.77)
3.4
(0.04)
*Cons-consultation;**Exp-expenditure; #Exp medical sums up expenditure on consultation fees, medicine/drugs ,
diagnostics ;^Exp others includes-all expenses relating to treatment of an ailment incurred by the household other than
the medical expenditure proper like food and lodging charges for escort, cost of transport other than ambulance.
$USD; exchange rate-71.65
Table 3: Per episode cost of treatment on different items
related to hospitalized treatment of non communicable
diseases-India and Punjab, 2014; in INR (USD)
Items Cost in INR(USD)
Punjab All India
Consultation
fees
5,001.64(69.80) 4,241.61(59.20)
Expenditure
medicine
6,079.19(84.84) 5,550.23(77.46)
Expenditure
diagnostics
3,235.22((45.15) 2,237.95(31.23)
Bed charges 3,054.18(42.62) 2,256.02(31.48)
Expenditure
other
2,509.4(35.02) 2,119.96(29.58)
Expenditure
medical
35,451.13(494.78) 23,919.00(333.83)
Expenditure
transport
688.37(9.60) 799.91(11.16)
Expenditure non-
medical
1,833.17(25.58) 1,713.76(23.91)
Hospital
expenditure
37,972.68(529.97) 26,432.67(368.92)
Insurance
reimbursement
1,233.73(17.21) 1,763.03(24.60)
Next, we analyzed the out of pocket expenditure for
outpatient and inpatient treatment of NCD (Figure 3& 4).
Figure 3: Per person monthly out-of-pocket expenditure
on outpatient treatment for non-communicable diseases
(last 15 days recall) by sector -Punjab and All India, 2014;
in INR (USD)
Figure 4: Per person monthly out-of-pocket expenditure
on in-patient treatment for non-communicable diseases
(last 365 days recall) by sector- Punjab and All India, 2014;
in INR (USD)
36.3%
63.6%
Public
Private
India
28.83%
71.17%
Punjab Public
Private
5. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Int. J. Public Health Epidemiol. Res. 142
When faced with OOPE, the financing strategies used by
households show a similar pattern for outpatient and
inpatient expenditures (Figure 5&6).
Figure 5: Percentage distribution of major sources of
financing for outpatient treatment of non-communicable
diseases- Punjab 2014
*Others source of financing includes-contribution from friends &
relatives and sale of ornaments and other physical assets,
draught animals.
Figure 6: Percentage distribution of major sources of
financing for inpatient treatment of non communicable
diseases by sectors- Punjab 2014
Further we also analyzed income quintiles pattern in
utilization of healthcare services, OOPE and financing
strategies (Table 4 and Figure 7).
Table 4: Percentage distribution of outpatient treatment for
non-communicable diseases by public and private across
income quintiles -Punjab, 2014
Income Quintiles &
Social groups
Public (in %) Private (in %)
Poorest 16.03 83.97
2nd poorest 27.69 72.31
Middle 33.65 66.35
2nd richest 22.45 77.55
Richest 22.62 77.38
Figure 7: Percentage distribution of inpatient treatment of
non-communicable diseases by public and private across
income quintiles -Punjab, 2014
Analysis of OOPE by income quintiles showed that in
Punjab, the poorest income quintile’s share of out of
pocket expenditure for outpatient care in total household
expenditure is nearly 14.3 percent.
Table 5: Per person monthly out-of-pocket (OOPE)
expenditure on outpatient and inpatient treatment of non-
communicable diseases for income quintile groups-
Punjab, 2014; in INR (USD)
Punjab
Quintiles
Mean OOPE
Outpatient
Mean OOPE
Inpatient
poorest 147.03(2.05) 34.64(0.48)
2nd poorest 134.02(1.87) 64.25(0.89)
middle 229.05(3.19) 69.96(0.97)
2nd richest 306.31(4.27) 106.82(1.49)
richest 448.38(6.25) 213.49(2.97)
Table 6: Out of pocket expenditure (outpatient) on non-
communicable diseases as percentage share of total
household consumption expenditure across income
quintiles- Punjab, 2014
Punjab
Quintiles
Percent share in
total household
consumption-
Outpatient (in %)
Percent share in
total household
consumption-
Inpatient (in %)
poorest 14.3 3.3
2nd poorest 7.7 3.6
middle 9.6 2.9
2nd richest 10.1 3.5
richest 8.9 4.2
In case of financial strategies for all of the income quintiles
using own income or savings is the major source of
financing healthcare expenditure with borrowing coming a
close second as seen from figure 8.
Figure 8: Percentage distribution of major sources of
financing for outpatient and inpatient treatment of non-
communicable diseases across quintiles-Punjab, 2014
6. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Das and Das. 143
DISCUSSION
Estimation of the prevalence of non-communicable
diseases and the utilization pattern showed high
prevalence of non-communicable diseases in the state of
Punjab. Studies by Barik &Arokiasamy, 2016 and Paul &
Singh, 2017, using NSSO data also reported high
prevalence of non-communicable diseases in Punjab. In
the type of facilities used for management of NCD, it was
found that predominantly private facilities were visited for
both outpatient and inpatient treatment.
Estimations of financial implications of non-communicable
diseases showed that per person average cost is higher in
Punjab than all India average cost of INR 700.30(USD
9.77). Considering the fact that non communicable
diseases are chronic in nature and require frequent
outpatient medical consultation and long-term
medications, even a fraction of increase in per person
average cost can significantly lead to higher financial
burden. Further in case of inpatient treatment in Punjab,
highest expenditure is found to be incurred on medicines
with approximately INR 6,079.19(USD 84.84) being spent
only on medicines out of the total per episode medical
expenditure of INR 35,451.13(USD 494.79), which
indicates a high financial burden on households with NCD
in Punjab.
Our analyses also pointed out the fact that households in
Punjab overwhelmingly depend on private facilities for
their health care needs. Now as utilization pattern of
healthcare services can act as major driver leading to
increased medical expenditure, the high dependence on
private facilities could be one of the main factors
contributing towards high OOPE in the state of Punjab.
When compared to all India per capita monthly out of
pocket expenditure (INR 114.26; USD1.59) for non-
hospitalized care of NCD, the state of Punjab was found to
have much higher out of pocket expenditure. As expected,
the urban areas had higher per capita OOPE for
hospitalized care as well as outpatient care of NCD. This
could be a significant finding considering the fact that NCD
are mostly long standing in nature and require frequent
medical care which may push up the medical
expenditures. Further it is also seen that the largest
component of expenditure is on medicines.
As medicines play a critical role in treatment and
prevention of complications in case of non-communicable
diseases, if these are forgone because of lack of financial
resources, a higher mortality and morbidity will result from
such diseases. Studies by Engelgau et al, 2012,
Shobhana et al, 2000, Gupta et al, 2006, Murthy& Sastry,
2005, too reported high out of pocket expenditure on NCD
and Kankeu et al, 2013 reported that the expenditure on
medicines is the largest component of OOPE.
Amongst the income quintiles it was found that the poorest
quintile spends the least for hospitalized care, suggesting
that the ability to pay is closely linked to utilization of health
care services and expenditure on health care. As
expenditure on healthcare can take up a significant
proportion of household’s financial resources and in order
to understand the extent of financial burden of OOPE, the
share of out of pocket expenditure in total consumption
expenditure of a household was estimated. For the poorest
even the smallest out of pocket expenditure on health care
can drastically alter their overall consumption pattern. Our
analyses showed that the share of OOPE for outpatient
care in households total consumption expenditure is 14.3
percent for the poorest income quintile while for the richest
quintile it is 8.9 percent. Similar economic gradient is seen
in case of out of pocket expenditure for inpatient care of
NCD.
The results of our study also show that majority of the
households in India have to depend upon own income or
savings for financing of healthcare expenses for
management of NCD. Various authors have reported that
coping strategies such as using savings, borrowing, and
the sale of assets are used to finance three‐fourths of the
cost of inpatient care in rural areas and two‐thirds of the
cost in urban areas in India (Dilip T & Duggal R .2002);
(Flores G, Krishnakumar J,O’Donnell & Van Doorslaer E.
2008).
All the income quintiles used income or savings as source
of finance for meeting out of pocket expenditures. The
findings with regards to coping mechanisms are in
concurrence with earlier study by Rao et al, 2011, wherein
income and savings were found to be the most commonly
used financial strategies to meet out of pocket
expenditure. The heavy reliance on income or savings in
the state of Punjab to finance health care expenditure and
to cope up with out of pocket expenses for NCD care
reduces the ability of the households to save and for
capital formation, which can have long term implications
for the economic wellbeing of the households. This
situation can be financially disastrous for the economically
vulnerable sections.
Strengths of the present study include the use of nationally
representative household survey data and being the first
of its kind in focusing on OOPE and financing mechanisms
of non-communicable diseases in one of the highest non
communicable disease prevalent states of Punjab. There
are certain methodological limitations to our study. The
use of self-reported disease conditions and expenditure for
treatment could potentially under or overestimate the
analyses of prevalence and the financial implications of
NCD.
CONCLUSION AND POLICY IMPLICATIONS
The prevalence of non-communicable diseases is much
higher in the state of Punjab with per person average cost
of treatment being more for outpatient care than in patient
7. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Int. J. Public Health Epideiol. Res. 144
care. This finding is important considering that the current
public health protection scheme mainly focuses on
secondary and tertiary level in patient care for different
diseases.
Our study also found that the share of out of pocket
expenditure in total household consumption expenditure is
highest for the poorest income quintiles indicating large
financial burden on the poorest. The results of this study
underline the importance of protecting households with
more focus on poorest households in high non
communicable disease prevalent states of India from the
financial burden associated with NCD in patient care and
treatment. Cost effectiveness and targeting of the poorest
groups need to be primary considerations when prioritizing
services that are included in insurance programs to
achieve universal health coverage, which is a part of
Sustainable Development Goal -3 through financial risk
protection, access to quality essential healthcare services
and essential medicines.
DECLARATION
Funding: No funding sources
Conflict of interest: None
Ethical Approval: The study was approved by IEC. The
study was approved by the Institution Ethics Committee,
Indian Institute of Public Health- Delhi, Gurgaon
Haryana,India.
Acknowledgement: The authors acknowledge the
guidance and support provided for the study by Dr. Anup
Karan, Associate Professor, IIPH-D,PHFI ,Haryana, India.
REFERENCES
Barik D and Arokiasamy P (2016) Rising Health
Expenditure Due to Non-Communicable Diseases in
India: An Outlook.Front. Public Health4:268. doi:
10.3389/fpubh.2016.00268
Berman P, Ahuja R, Bhandari L. (2010). The
impoverishing effect of healthcare payments in India:
new methodology and findings. Economic and Political
Weekly,45(16),65-71
Dilip T & Duggal R .(2002).Incidence of non fatal health
outcomes and debt in urban India.Mumbai:CEHAT
Engelgau M, Karan A, Mahal A(2012).The Economic
impact of Non-communicable Diseases on households
in India. Global Health.2012;8:9.April 25.doi:
10.1186/1744-8603-8-9
Flores G, Krishnakumar J,O’Donnell and Van Doorslaer E.
(2008). Coping with healthcare costs: Implications for
the measurement of catastrophic expenditures and
poverty. Health Economics, 17(12),1393-1412
Flores G,KrishnakumarJ,O’Donnell,VanDoorslaer E
(2008). Coping with healthcare costs: Implications for
the measurement of catastrophic expenditures and
poverty. Health Economics,17(12),1393-1412
Gupta I, Kandamuthan S, Upadhaya D. (2006). Economic
impact of cardiovascular diseases in India. New Delhi:
Institute of Economic Growth University of Delhi; 2006
ICMR, PHFI, and IHME (2017) Indian Council of Medical
Research, Public Health Foundation of India, and
Institute for Health Metrics and Evaluation. India:
Health of the Nation's States - The India State-level
Disease Burden Initiative. New Delhi,
India:[Online].Available:http://www.healthdata.org/sites
/default/files/files/policy_report/2017/IndiaHealthoftheN
ation27sStatesReport2017.pdf [Accessed 12 February
2019]
K. Murthy, J. Sastry. (2005a). “Economic burden of chronic
obstructive pulmonary disease,” In Background papers:
The Burden of Disease. New Delhi: Ministry of Health
and Family Welfare, National Commission on
Macroeconomics and Health, pp. 265-74
Kankeu HT, Saksena P, Xu K, Evans DB. (2013) The
financial burden from non-communicable diseases in
low- and middle-income countries: a literature
review.Health Res Policy Syst. 2013 Aug 16; 11:31.
doi: 10.1186/1478-4505-11-31.
Kastor A, Mohanty SK (2018). Disease-specific out-of-
pocket and catastrophic health expenditure on
hospitalization in India: Do Indian households face
distress health financing? PLoSONE 13(5): e0196106.
https://doi.org/10.1371/journal.pone.019610
Kruk ME, Goldmann E, Galea S. (2009) Borrowing and
selling to pay for health care in low- and middle-income
countries.Health Aff (Millwood). 2009; 28: 1056–66.
Leive A & Xu K.(2008).Coping with out of pocket health
payments: Empirical evidence from 15 African
countries. Bulletin of the World Health
Organisation,86(11),849-856
Ministry of Health and family welfare (2016). National
Health Accounts 2013-14. New Delhi: MoHFW, India
O’Donnell,VanDoorslaer,Rannan-
EliyaE,SomanathanA,AdhikariS,AkkazievaB,Herrin
AN(2008).Who pays for healthcare in Asia? Journal of
Health Economics,27(2),460-475
Paul and Singh (2017). Emerging trends and patterns in
self-reported morbidity in India- evidence from three
rounds of National sample survey. Journal of Health,
Population and Nutrition (2017) 36:32
DOI10.1186/s41043-017-0109
Pradhan J, Dwivedi R. (2017) Do we provide affordable,
accessible and administrable health care? An
assessment of SES differential in out of pocket
expenditure on delivery care in India. Sex
ReprodHealthc. 2017; 11:69–78
R. Shobhana, P. Rama Rao, A. Lavanya, R. Williams, V.
Vijay, A. Ramachandran. 2000. “Expenditure on
healthcare incurred by diabetic subjects in a developing
country – a study from southern India.” Diabetes
Research and Clinical Practice 48(1):37-42
8. Out of Pocket Expenditure on Non-Communicable Diseases among Households: Evidence from a State of India
Das and Das. 145
Rao KD, Bhatnagar A, Murphy A (2011): Socio-economic
inequalities in the financing of cardiovascular &
diabetes inpatient treatment in India.Indian J Med Res
2011, 133:57–63.PMCID: PMC3100147
Sauerborn R, Adams A, Hien M. (1996) Household
strategies to cope with the economic costs of illness.
Soc Sci Med. 1996; 43: 291–301
Sharma D, Prinja S, Aggarwal AK, Bahuguna P, Sharma
A, Rana SK.(2017). Out-of-pocket expenditure for
hospitalization in Haryana State of India: Extent,
determinants & financial risk protection. Indian J Med
Res 2017;146:759-67
Singh P, Kumar V. (2017) The rising burden of healthcare
expenditure in India: a poverty nexus. Soc Indic Res.
2017;133(2):741–62
APPENDICES
Annexure I: Classifying the NSSO 71st survey response categories into communicable, non communicable and other
conditions
I. Communicable , Gynecological and diseases of children
• Diarrhea ,Dysentery, Gastritis/peptic ulcer, worm infestation, Amoeboisis, Hepatitis/Jaundice
• Malaria, Mumps, Diphtheria, Whooping cough, Fever of unknown origin
• Tetanus
• Filariasis
• Diseases of the skin
• Gynecological disorders
• Under nutrition, anemia
• Sexually transmitted diseases
• Respiratory (including ear/nose/throat)aliments for ages less than 15 years
• Tuberculosis
II. Non communicable diseases
• Heart disease, Hypertension
• Bronchial asthma
• Respiratory (including ear/nose/throat)aliments for ages more than 15 years
• Disorders of joints and bone
• Disorders of kidney /urinary system
• Neurological disorder
• Psychiatric disorder
• Diabetes
• Cancer and other tumors
• Accidents /injuries/burns/fractures/poisonings
III. Other conditions
• Goiter
• Eye aliments
• Disorders of mouth ,teeth ,gum
• Disabilities: locomotor, visual,speech
• Other undiagnosed aliments