This study indicates that circulatory diseases, injury and malignant diseases have become the major causes of death in India, after infections. Members of social classes 1-3 died more often due to circulatory diseases and members in lower social classes died more often due to infections. Urbanization with rapid changes in diet and lifestyle in various social classes, and possibly aging of the population seem to be responsible for the double burden of diseases, related to under- and over-nutrition, causing death in a developing economy. Monitoring of blood pressure and heart rate around the clock for 7 days, with data analysed chronobiologically can detect abnormal circadian patterns associated with a large increase in cardiovascular disease risk, greater than hypertension itself, allowing the institution of prophylactic treatment. Such prehabilitation may be particularly useful to curb the increasing burden of cardiovascular diseases in both developed and developing countries.

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Background Coronary Heart Diseases (CHDs) are imminent cause of disability and death with economic adverse effects in the disadvantaged population in India. Materials and Methods This population based study was conducted from 1st December 2010 till 31st May 2011 among the adults in the slums of Patna to assess the magnitude and risk factors of CHDs concerning age, sex, tobacco use, alcohol consumption, physical activity, weight, height, waist circumference, blood pressure and random capillary blood glucose (RCBG). Results Among 3118 participants 16.36 percent (males 18.79 %, females 14.48 %) were hypertensive; 26.3 percent (males 25.94 %, females 26.58 %) had elevated RCBG; 4.46 percent were Diabetic. High body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) was noted in 31.94 percent (males 31.83%, females 32.03%), 50.45 percent (males 39.1%, females 59.17%), 86.53 percent (male 83.12%, female 89.15%) respectively; tobacco users were 12.54 percent, while 9.14 percent reported alcohol consumption; 33.64 percent were sedentary (males 30.55%, females 37.65%). BMI, WC, WHtR, tobacco use, alcohol consumption and physical inactivity were significantly associated with hypertension (p < 0.05). Elevated RCBG was significantly associated with increased BMI, WC, WHtR. Multivariate logistic regression revealed that BMI, WHtR and alcohol were associated with hypertension, not with elevated RCBG. ConclusionOur study indicated that CHDs and their risk factors are not only limited to affluent societies but also affect the underprivileged mass. Preventive care and multipronged intervention including extensive behavior change communication needs to be organized to reduce the risk of CHDs in urban poor.DOI: http://dx.doi.org/10.3126/nje.v2i3.6902Nepal Journal of Epidemiology 2012;2(3): 205-12

Burden of influenza-associated respiratory and circulatory mortality in India, 2010-2013 Background Influenza causes substantial morbidity and mortality worldwide, however, reliable burden estimates from developing countries are limited, including India. We aimed to quantify influenza-associated mortality for India utilizing 2010-2013 nationally representative data sources for influenza virus circulation and deaths. Methods Virological data were obtained from the influenza surveillance network of 10 laboratories led by National Institute of Virology, Pune covering eight states from 2010-2013. Death data were obtained from the nationally representative Sample Registration System for the same time period. Generalized linear regression with negative binomial distribution was used to model weekly respiratory and circulatory deaths by age group and proportion of specimens positive for influenza by subtype; excess deaths above the seasonal baseline were taken as an estimate of influenza-associated mortality counts and rates. Annual excess death rates and the 2011 India Census data were used to estimate national influenza-associated deaths. Results Estimated annual influenza-associated respiratory mortality rates were highest for those ≥65 years (51.1, 95% confidence interval (CI) = 9.2-93.0 deaths/100 000 population) followed by those <5 years (9.8, 95% CI = 0-21.8/100 000). Influenza-associated circulatory death rates were also higher among those ≥65 years (71.8, 95% CI = 7.9-135.8/100 000) as compared to those aged <65 years (1.9, 95% CI = 0-4.6/100 000). Across all age groups, a mean of 127 092 (95% CI = 64 046-190,139) annual influenza-associated respiratory and circulatory deaths may occur in India. Conclusions Estimated influenza-associated mortality in India was high among children <5 years and adults ≥65 years. These estimates may inform strategies for influenza prevention and control in India, such as possible vaccine introduction. Electronic supplementary material: The online version of this article contains supplementary material.

Weak linkages between health providers and slum communities hinder the improvement of health services for India's urban poor. To address this issue, an urban health programme is implementing two approaches in Indore city, Madhya Pradesh, the demandÁsupply linkage approach and ward coordination approach. The former is based on the premise that building social capital, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services for the urban poor. The latter focuses on encouraging local stakeholders to function in a coordinated manner to ensure better health service coverage in underserved slum areas. Findings suggest that the programme has enhanced utilization of services among Indore's slum communities and helped improve immunization coverage and other maternal and child health indicators.