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National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation.

COVID-19 has become one of the most significant events in the history of globalization. The prolonged ‘lockdown’ adopted across various countries in the world as a countermeasure for containing the spread of the virus profoundly brought forth socio-economic and infrastructural vulnerabilities in urban as well as rural parts of India. While urban and rural areas have been greatly studied with respect to the environment, human health, safety, livelihoods, associated risks, etc., in the context of pandemics, many of these studies seldom accommodate their interdependency as a pragmatic approach to planning. This is observed to be primarily due to the dynamic and diverse nature of interactions coupled with the development disparities between rural and urban areas, thereby adding complexity to development decision making. The present study, therefore, applies the lens of the circulating and ecological sphere (CES), introduced by the Japanese government for the localization of resource flows between urban–rural regions, to consider possible alternative development approaches to achieve smooth transitions during pandemics through the case study area located in Hingna tahsil in the Nagpur Metropolitan Area, India. The methodology uses the critical examination of rural–urban linkages amidst the crisis through key-informant surveys involving representatives from local governments. Using this feedback and spatial analysis tools, the research identifies probable entry points in post-pandemic regional planning. The research contributes to understanding the impact of spatial development during pandemics through ground-based evidence. The findings from this research highlight the need to manage rural dependencies on urban areas and underline the potential of the rural–urban linkage as an approach, acknowledged and emphasized through CES, for managing such regional-scale hazards. The investigation concludes with the discussion and future research scope for achieving the pronounced needs reflected through the study.

The world’s urban population is expected to nearly double by 2050, making urbanization one of the most disruptive developments of the 21st century. On a global-to-local scale, ensuring a secure and reliable supply of food energy and water (FEW) resources for all humans is a major challenge in such a scenario. While much attention has recently been focused on the concept of FEW security and the interactions between the three sectors, there is no universally acceptable framing of the concept due to the fact that latest studies are mainly focused on individual FEW sectors, with not much investigation into how they interact. This research aims to create a localized framework based on the principles of the emerging concept of the Circulating Ecological Sphere (CES), introduced by the government of Japan, for a limited number of security indicators and dimensions. It began with a thorough study of the relevant literature using the PRISMA method, identification of gaps in local indicators for urban areas in each of the existing frameworks, and the proposal of a new indicator framework that tackles collective FEW security in urban environments is made accordingly. The authors have applied a special mechanism for filtration of this literature dataset in the context of Nagpur City in accordance with data availability and case study context. To test the applicability of the indicator set, it has been applied to the specific case of Nagpur. Both online and offline surveys were conducted to collect data, and subsequently a weighted mean method was adopted to analyze the data and derive values for the indicator set.

Background: Leprosy is a chronic granulomatous disease mainly affecting the peripheral nerves and skin. Any communities including the tribals are susceptible to leprosy. Very few studies on clinico-epidemiological patterns of leprosy have been reported in the tribal population, especially in the Choto Nagpur plateau. Aims: To observe clinical types of newly diagnosed leprosy cases among the tribal population and demonstrate bacteriological index, frequency of deformity, and lepra reaction at presentation. Methods: An institution-based cross-sectional study was conducted with consecutive newly diagnosed tribal leprosy patients attending the leprosy clinic of a tribal-based tertiary care center of Choto Nagpur plateau of eastern India, from January 2015 to December 2019. Thorough history taking and clinical examination were done. A slit skin smear for AFB was performed to demonstrate the bacteriological index. Results: There was a steady rise in total leprosy cases from 2015 to 2019. Borderline tuberculoid (BT) was the commonest form of leprosy (64.83%). Pure neuritic leprosy was not uncommon (16.26%). Multibacillary leprosy was noted in 74.72% of cases and childhood leprosy was observed in 6.70% of cases. The commonest nerve involved was the ulnar nerve. Garde II deformity was noted in around 20% of cases. AFB positivity was observed in 13.73% of cases. A high bacteriological index (BI ≥3) was noted in 10.65% of cases. Lepra reaction was observed in 25.38% of cases. Conclusion: BT leprosy, pure neuritic leprosy, childhood leprosy, grade II deformity, and higher AFB positivity were prevalent in this study. The tribal population required special attention and care for the prevention of leprosy amongst them.

Quality assessment as well as hydrogeochemical characterization of 45 representative groundwater samples around Umrer coal mine area was undertaken. The pH of the water lies in the normal range i.e. from 7.5 to 8.5, the electrical conductivity varies from 826 to 1,741, the total hardness varies from 289 to 1,302 and the TDS values range from 528.6 to 1,114.2 mg/l which reflects variation in lithology and thus, the distinction in hydrogeological regime. The cation chemistry is dominated by Ca 2+ and Mg 2+ while anion chemistry is dominated by Cl − and HCO 3 − . Out of total ten hydrochemical facies, the two dominant facies are Mg–Ca–HCO 3 (37.7 %) and Ca–Mg–SO 4 –HCO 3 (17.7 %). The groundwater in the study area, in general, is useful for drinking and domestic use; however, it has marginal utility for irrigation purpose. Standard US Salinity Laboratory classification shows that water of the study area belongs to C2–S1 and C3–S1 classes. The concentration of 9 trace elements analysed from 18 samples did not exceed the desirable limit.

Water scarcity has resulted in lower yield (7–8 t ha−1) and a decline in citrus orchards in central India. In this scenario, optimal deficit irrigation (DI) is a potential option to sustain citrus production. To optimize the DI schedule in relation to yield, water productivity, fruit quality and production economics, water was applied at 30% of full irrigation (FI, 100% crop evapotranspiration), 50% of FI and 70% of FI and compared with FI in drip-irrigated citrus at Nagpur, India during 2008–2010. Fruit yield under 50% FI (11.48 t ha−1) was statistically at par with FI (13.14 t ha−1). However, a 50% reduction in water supply (1,343 m3 ha−1) resulted in a 75% improvement in water productivity in DI at 50% FI than FI (water productivity, 4.89 kg m−3). The fruit quality in DI at 50% FI (acidity, 0.83%; total soluble solids, 10.3 °Brix) was superior to FI (acidity, 0.85%; total soluble solids, 9.80 °Brix). The highest net profit (INR 94,300 ha−1) and net economic water productivity (70.19 INR m−3) were generated under DI at 50% FI. The study inferred that irrigation at 50% FI could be a water-saving and profitable option for citrus production in central India.

Nitrate pollution in drinking water poses a hidden, worldwide health risk, affecting people of all ages. Consumption of nitrate-contaminated groundwater can lead to methemoglobinemia in infants and gastric cancer in adults. This study examines nitrate contamination in dug well water and its health impact in urban Nagpur, India. The nitrate pollution index (NPI), an effective tool for evaluating the pollution of groundwater due to NO 3 − content, which we have utilized in city area and in our study the NPI has found to vary from 0.76 to 11.54 with an average value of 4.81. As per NPI, 70%, 5%, 5%, 15% and 5% of groundwater samples are very significantly polluted, significantly polluted, moderately polluted, slightly polluted and unpolluted. The chronic health risk (CHR) for infants, children, adult males and females varies from 0.07—3.52, 0.08—4.07, 0.06—3.01 and 0.06—2.85 and covers 87%, 90.5%, 89% and 85.5% of the study area respectively. The geo-statistical regression and correlation studies significantly divulged that the NO 3 − pollution of groundwater is mostly due to man-made activities. The samples, in which the computed values of ‘t’ exceeded the critical value (1.686) at 38 degrees of freedom and 0.05 significance level, the correlation coefficients are found to be statistically significant. The study uncovers human-driven NO 3 − pollution in shallow aquifers of Nagpur city, urging action to reduce contaminants. By curbing these pollutants, Nagpur can stride toward UNDP's sustainable development Goal, 2030 for a safer, healthier environment for all.

Toxoplasma gondii and Neospora caninum are cyst-forming coccidian parasites that infect both wild and domestic non-felids as intermediate hosts, with rodents serving as important reservoir hosts during their life cycles. This study was aimed at investigating T . gondii and N . caninum infections and identifying factors favouring T . gondii infection in free-ranging rats from India. A total of 181 rodents were trap-captured, and blood and brain samples were subsequently collected for serological and molecular examination of T . gondii and N . caninum . Antibodies against T . gondii and N . caninum were detected by MAT/NAT and IFAT in 13.8% (25/181) and 1.65% (3/181) of rodents, respectively. All three N . caninum samples positive by NAT/IFAT were also positive for ELISA, while for T . gondii , 19 of 25 MAT/IFAT positive samples were also positive for ELISA. The antibody titers (MAT/NAT/IFAT) of rodents seropositive for T . gondii ranged from 25 to 400, while those of rats seropositive for N . caninum ranged from 25 to 100. Also, using PCR, DNA from T . gondii (B1 gene) and N . caninum (NC5 gene) was found in 2.76% (5/181) of brain samples and 0.55% (1/181) of brain samples. All PCR positive samples were also seropositive. No mixed infections were observed in the serological and molecular detections. A Chi-square analysis revealed that older rats and rats living in urban areas are significantly associated with T . gondii infection; however, rodent species, gender, location, habitat types, and seasonality were statistically nonsignificant. Overall, this study demonstrated that T . gondii was widely distributed while N . caninum was less prevalent among free-ranging rats in the studied area.

Groundwater occurrence in continental flood basalt, where multiple lava flows separated by intertrappean and irregular patterns of lineaments govern the regional hydro-dynamics, is poorly understood. This necessitates a high-resolution hydrogeophysical investigation to devise an effective groundwater management plan. To enhance the knowledge and unravel the hydrogeological complexity of such systems, an integrated hydrogeophysical investigation consisting of local-scale vertical electrical soundings, ground-based transient electromagnetic soundings, relatively large-scale electrical resistivity tomography (ERT) and helicopter-borne transient electromagnetic (H-TEM) surveys was carried out in an area of the Deccan Traps (372 km2) near Nagpur, central India. A 14.4-km-long and almost continuous profile of ERT was conducted, with special attention to the lateral discontinuity, which was compared with the H-TEM data. The results from these studies were further supported and validated by drilling of exploratory wells at select locations, geophysical logging and pumping tests. Integration of the results successfully provided a geophysical characterization of the basalts, to develop a consistent lithological model that was finally transformed into hydrogeological sections. The pumping test (exploratory wells) derived aquifer transmissivity data that complemented the anomalies of the electrical parameters. Furthermore, the hydrogeological observations revealed that the groundwater yield is strongly correlated (R2 = 0.78) with the depth to the Basalt-Gondwana contact.

Background & objectives: An outbreak of dengue-like illness was reported from Wadi area within the Nagpur Municipal Corporation during September-October 2017 with five deaths. Major symptoms reported were high fever (103-106 oF), acute joint pains, myalgia, drowsiness, breathlessness, etc. An investigation was conducted to confirm the etiological agent, its characterization and the vectors involved in the outbreak. Methods: Serological analysis was conducted to detect dengue (DEN)/chikungunya IgM antibodies in 158 sera samples. Nested-PCR was carried out to serotype eight ELISA positive samples. Adult and larval mosquito collections were conducted in the affected areas to determine species composition and mosquito density. Results: Dengue IgM antibodies were detected in 44 sera samples. Molecular typing revealed involvement of DEN-2 and DEN-3 serotypes. Dengue hemorrhagic fever symptoms were observed in two patients. Aedes aegypti breeding was found rampant with Breteu index and house index ranging from 23 to 70 and 17 to 56, respectively. Major breeding habitats encountered were, used tyres, cement tanks and refrigerator trays. Interpretation & conclusion: Clinical symptoms, detection of anti-DEN IgM antibodies in high number of samples and heavy breeding of Ae. aegypti confirmed it was a dengue outbreak.