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This folder includes datasets that were produced to assess flood hazards and exposure in the Ayeyarwady Delta in Myanmar by applying the new standardised, integrative approach of Seeger, K., Peffeköver, A., Minderhoud, P. S. J., Vogel, A., Brückner, H., Kraas, F., Nay Win Oo, Brill, D. (2024): Evaluating flood hazards in data-sparse coastal lowlands: highlighting the Ayeyarwady Delta (Myanmar). Environmental Research Letters. The README includes the names of files to be used for citation as well as a brief explanation when necessary. All processing details are given in the paper and related supplementary material.

Coastal lowlands and river deltas worldwide are increasingly exposed to coastal, pluvial and fluvial flooding as well as relative sea-level rise (RSLR). However, information about both single and multiple flood-type hazards, their potential impact and the characteristics of areas, population and assets at risk is often still limited as high-quality data either does not exist or is not accessible. This often constitutes a main barrier for generating sound assessments, especially for scientific and public communities in the so-called Global South. We provide a standardised, integrative approach for the first-order assessment of these single and multiple flood-type hazards and show how this can be conducted for data-sparse, hardly accessible and inaccessible coastal lowlands such as the Ayeyarwady Delta in Myanmar by using only open accessible and freely available datasets of satellite imagery, global precipitation estimates, satellite-based river discharge measurements, elevation, land use, and population data. More than 70% of the delta, mainly used for agriculture, and about 40% of its present population are prone to flooding due to either monsoon precipitation and runoff, storm surge, and RSLR, or their combination, jeopardising food security and economic development in the region. The approach allows for the integration and combination of various datasets, combined in a highly flexible workflow that performs at low computational capacities, supporting the evaluation of flood-prone areas on regional and local scale for data-sparse coastal lowlands worldwide. It thereby allows to attribute different types of flood hazards, complements concepts of vulnerability and risk, and supports risk-informed decision making and development of effective multi-flooding adaptation strategies.

The local digital elevation model (DEM) of the Ayeyarwady Delta, referred to as AD-DEM, was generated based on elevation data of topographic maps at scale of 1:50,000 published in 2014 while source data was compiled between 2000 and 2004. Empirical Bayesian Kriging with empirical data transformation and exponential modelling was applied to interpolate ~5100 elevation points (spot heights) and ~13600 elevation points extracted from contour data of the topographic maps. Elevation values higher than 10 m were excluded from interpolation and the SRTM water body mask created in 2000 was applied to the processed AD-DEM. The AD-DEM was transformed from its original vertical reference of local mean sea level at Kyaikkhami tide gauge to continuous mean sea level based on the mean dynamic topography data (CNES-CLS18 dataset of Mulet et al. (2021; https://doi.org/10.5194/os-17-789-2021) that we transposed to EGM96) in order to account for sea level variations along the Myanmar coast. The AD-DEM contains itself some uncertainty due to the lack of evenly distributed spot heights in areas of the upper delta, for which a separate shapefile is provided. However, we highlight to consider the AD-DEM as being the currently best available model against the background of the lacking possibility of ground truthing and being independent from satellite-based measurements. For further information on data processing, including DEM interpolation, determination of local mean sea level and vertical datum conversions, as well as DEM performance, see the corresponding paper and supplementary material. File name: ADDEM_Con250m_lesseq10_MDT_AD_MMR2000_masked_maskedSRTM.tif File format: GEOTIFF file Spatial reference: MMR2000_46N Vertical reference: local continuous mean sea level, i.e., mean dynamic topography (CNES-CLS18 dataset of Mulet et al. (2021; https://doi.org/10.5194/os-17-789-2021) transposed to EGM96 Cell size: 750 × 750 m File name: DataPoorAreas_MMR2000.shp File format: ESRI Shapefile

This digital elevation model is a version of the FABDEM V1-0 of Hawker et al. (2022; https://doi.org/10.1088/1748-9326/ac4d4f) that was adjusted for the Ayeyarwady Delta in Myanmar by local spot height data from topographic maps (scale 1:50,000) published in 2014 while source data was compiled between 2000 and 2004. The FABDEM V1-0 (Laurence Hawker, Jeffrey Neal (2021): FABDEM V1-0. https://doi.org/10.5523/bris.25wfy0f9ukoge2gs7a5mqpq2j7; CC BY-NC-SA 4.0) was projected to the Myanmar 2000 datum and clipped to the Ayeyarwady Delta region of interest. The vertical reference of the FABDEM V1-0 was transformed to EGM96 before applying a conversion to continuous mean sea level based on mean dynamic topography data (CNES-CLS18 dataset of Mulet et al. (2021; https://doi.org/10.5194/os-17-789-2021) that we transposed to EGM96). Subsequently, inland water bodies were masked using the water body mask of the Copernicus DEM (Airbus Defence and Space, 2020: Copernicus Digital Elevation Model Product Handbook Version 3.0, Airbus, 38 pp.) and cell values with an elevation of more than 7 m below mean sea level were removed. From the topographic maps, the local spot heights outside of areas masked in the AD-DEM (Seeger et al. (2023): Local digital elevation model for the Ayeyarwady Delta in Myanmar (AD-DEM) derived from digitised spot and contour heights of topographic maps. Doi; CC-BY 4.0) were subtracted from elevation values of the FABDEM V1-0 at the same locations (~3630 spot heights). Empirical Bayesian Kriging with empirical data transformation and exponential modelling was applied to interpolate the height residuals and export the raster data at ~30 m grid cell resolution. The mask layer of the AD-DEM was applied to the height residual raster in order to correct for interpolations in areas of data paucity. Subsequently, the interpolated height residuals were subtracted from the pre-processed FABDEM. In delta areas outside the masked regions of the height residual raster, the

With their low lying, flat topography, river deltas and coastal plains are extremely prone to relative sea level rise and other water-related hazards. This calls for accurate elevation data for flood risk assessments, especially in the densely populated Southeast Asian deltas. However, in data-poor countries such as Myanmar, where high accuracy elevation data are not accessible, often only global satellite-based digital elevation models (DEMs), suffering from low vertical accuracy and remote sensing artefacts, can be used by the public and scientific community. As the lack of accurate elevation data hampers the assessment of flood risk, studying available information on land elevation and its reliability is essential, particularly in the context of sea level rise impact. Here, we assess the performance of 10 global DEMs in the Ayeyarwady Delta (Myanmar) against the new, local, so-called AD-DEM, which was generated based on topographical map elevation data. To enable comparison, all DEMs were converted to a common vertical datum tied to local sea level. While both CoastalDEM v2.1 (Kulp and Strauss, 2021) and FABDEM (Hawker et al., 2022) perform comparably well, showing the highest correspondence in comparison with AD-DEM and low-elevation spot heights, FABDEM outperforms CoastalDEM v2.1 by the absence of remote sensing artefacts. The AD-DEM provides a high-accuracy, open and freely available, and independent elevation dataset suitable for evaluating land elevation data in the Ayeyarwady Delta and studying topography and flood risk at large scale, while small-scale investigations may benefit from a FABDEM locally improved with data from the AD-DEM.Based on the latest Intergovernmental Panel on Climate Change (IPCC) projections of sea level rise, the consequences of DEM selection for assessing the impact of sea level rise in the Ayeyarwady Delta are shown. We highlight the need for addressing particularly low-lying populated areas within the most seaward districts with

Resilience has become important in disaster preparedness and response. Unfortunately, little is known about resilience at the household level. This study presents the results of a survey into individual and household level preparedness to disaster events in Yangon, Myanmar, which is prone to natural disasters such as tropical cyclones, flooding, and earthquakes. The study aimed to understand societal resilience and to provide information that could be used to develop a holistic framework. In four different Yangon townships, 440 households were interviewed. The results of the survey indicate how risk preparedness could be improved by specific measures related to the following five factors: (1) increasing the general public's knowledge of first aid and its role in preparedness; (2) improving mobile phone infrastructure and capacity building in its usage so that it can be used for communication during disasters, along with building up a redundant communication structure; (3) better use and organisation of volunteer potential; (4) more specific involvement of religious and public buildings for disaster response; and (5) developing specific measures for improving preparedness in urban areas, where the population often has reduced capacities for coping with food supply insufficiencies due to the high and immediate availability of food, shops and goods in regular times. The findings of this survey have led to specific recommendations for Yangon. The identified measures represent a first step in developing a more general framework. Future research could investigate the transferability of these measures to other areas and thus their suitability as a basis for a framework.

Land-use and land-cover change (LULCC) dynamics significantly impact deltas, which are among the world's most valuable but also vulnerable habitats. Non-risk-oriented LULCCs can act as disaster risk drivers by increasing levels of exposure and vulnerability or by reducing capacity. Making thematically detailed long-term LULCC data available is crucial to improving understanding of those dynamics interlinked at different spatiotemporal scales. For the Ayeyarwady Delta, one of the least studied mega-deltas, such comprehensive information is still lacking. This study used 50 Landsat and Sentinel-1A images spanning five decades from 1974 to 2021 in five-year intervals. A hybrid ensemble model consisting of six machine-learning classifiers was employed to generate land-cover maps from the images, achieving accuracies of about 90%. The major identified potential risk-relevant LULCC dynamics include urban growth towards low-lying areas, mangrove deforestation, and the expansion of irrigated agricultural areas and cultivated aquatic surfaces. The novel area-wide LULCC products achieved through the analyses provide a basis to support future risk-sensitive development decisions and can be used for regionally adapted disaster risk management plans and models. Developed with freely available data and open-source software, they hold great potential to increase research activity in the Ayeyarwady Delta and will be shared upon request.

The catastrophic storm surge of tropical cyclone Nargis in May 2008 demonstrated Myanmar's exposure to coastal flooding. The investigation of sediments left by tropical cyclone Nargis and its predecessors is an important contribution to prepare for the impact of future tropical cyclones and tsunamis in the region, because they may extend the database for long-term hazard assessment beyond the relatively short instrumental and historical record. This study, for the first time, presents deposits of modern and historical tropical cyclones and tsunamis from the coast of Myanmar. The aim is to establish regional sedimentary characteristics that may help to identify and discriminate cyclones and tsunamis in the geological record, and to document post-depositional changes due to tropical weathering in the first years after deposition. These findings if used to interpret older deposits will extend the existing instrumental record of flooding events in Myanmar. Evaluating deposits that can be related to specific events, such as the 2006 tropical cyclone Mala and the 2004 Indian Ocean tsunami, indicates similar sedimentary characteristics for both types of sediments. Landward thinning and fining trends, littoral sediment sources and sharp lower contacts allow for the differentiation from underlying deposits, while discrimination between tropical cyclone and tsunami origin is challenging based on the applied methods. The modern analogues also demonstrate a rather low preservation potential of the sand sheets due to carbonate dissolution, formation of organic top soils, and coastal erosion. However, in coastal depressions sand sheets of sufficient thickness (>10 cm) may be preserved where the shoreline is prograding or stable. In the most seaward swale of a beach-ridge plain at the Rakhine coast, two sand sheets have been identified in addition to the deposits of 2006 tropical cyclone Mala. Based on a combination of optically stimulated luminescence, radiocarbon and Cs-137 dati

The catastrophic storm surge of tropical cyclone Nargis in May 2008 demonstrated Myanmar's exposure to coastal flooding. The investigation of sediments left by tropical cyclone Nargis and its predecessors is an important contribution to prepare for the impact of future tropical cyclones and tsunamis in the region, because they may extend the database for long-term hazard assessment beyond the relatively short instrumental and historical record. This study, for the first time, presents deposits of modern and historical tropical cyclones and tsunamis from the coast of Myanmar. The aim is to establish regional sedimentary characteristics that may help to identify and discriminate cyclones and tsunamis in the geological record, and to document post-depositional changes due to tropical weathering in the first years after deposition. These findings if used to interpret older deposits will extend the existing instrumental record of flooding events in Myanmar. Evaluating deposits that can be related to specific events, such as the 2006 tropical cyclone Mala and the 2004 Indian Ocean tsunami, indicates similar sedimentary characteristics for both types of sediments. Landward thinning and fining trends, littoral sediment sources and sharp lower contacts allow for the differentiation from underlying deposits, while discrimination between tropical cyclone and tsunami origin is challenging based on the applied methods. The modern analogues also demonstrate a rather low preservation potential of the sand sheets due to carbonate dissolution, formation of organic top soils, and coastal erosion. However, in coastal depressions sand sheets of sufficient thickness (>10 cm) may be preserved where the shoreline is prograding or stable. In the most seaward swale of a beach-ridge plain at the Rakhine coast, two sand sheets have been identified in addition to the deposits of 2006 tropical cyclone Mala. Based on a combination of optically stimulated luminescence, radiocarbon and Cs-137 dati

The article focuses on the immigrant economy of the Tibetan exile community in India's capital by examining the development of the settlement Majnu Ka Dila at the flood plains of the Yamuna River. Majnu Ka Tilla developed from a squatter settlement in the 1960s into the Indian centre of Tibetan commerce in exile and a tourist hotspot. The economic development potential of Majnu Ka Tilla - within the legal framework of Delhi - is investigated by analysing the data of a qualitative and quantitative field study grounded in concepts of ethnic economies. The collected data show that the first migrants started with very simple businesses like food stalls, small pubs, brewing of Tibetan beer, and small-scale textile enterprises - mostly sweater-selling'- which enabled them to survive in the city. The second generation, better educated than their parents, was already able to open stores allowing them to achieve greater financial independence. With increased options, economic activities became more diverse as demonstrated by the opening of travel agencies, beauty parlors and hotels. The 'microcosm' of their own ethnic businesses forms the foundation for integration into urban society, a further economic diversification based on better education and the establishment of international economic networks.

Urban health in India is gaining increasing attention due to the growing share of urban population and the changing living conditions caused by the rapid urbanization process. The rising prevalence of non-communicable diseases (NCDs) such as diabetes is partly attributed to this process making NCD prevention and control one of the biggest public health challenges in the 21st century. Though public health programs in India are increasingly targeting NCDs, data quality and availability to budget scarce resources remains a challenge. The objective of the study was to conceptualize a prototype for an urban NCD sentinel surveillance system to capture data on newly diagnosed NCD cases, taking also into account socio-spatial intraurban differences. As preliminary steps, two systematic literature reviews, mapping of healthcare providers and a knowledge attitude practice survey on disease surveillance were conducted. In total, 258 private primary healthcare providers ( allopathy, ayurveda, homeopathy and unani) participated in the survey, out of these 127 agreed to participate in the six months surveillance study, providing data on a monthly basis. The study indicates that, despite the small size and low level of infrastructure in the private clinics, these practitioners play an important role in diagnosing and treating NCDs. They can be involved in NCD surveillance, if the following major barriers are addressed: lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. Based on our findings, a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care might be an adequate approach to monitor NCD related health trends.

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative part

The Indian city of Pune witnessed rapid growth and deep transformation processes in the last three decades. This paper assesses past developments and recent structures and processes against the concept of urban sustainability. Following an overview of the historical development, the dimensions of sustainability are discussed separately, based on empirical findings. Urban growth puts enormous pressure on Pune's land and water resources, changing the ecology of the area. The increasing water demand of Pune's growing population competes with growing energy and water demands. An assessment of future climate change impacts indicates that the storage capacity of the reservoirs is more frequently not met during the rainy season. In addition, extreme dry years can aggravate the effects of land use change on water resources in the future. The city's growth and especially the large in-migration has also changed Pune's social fabric significantly. Wealth is distributed unevenly in the city and social disparities can be observed along two fault lines, namely along classes and caste groups. The population development and the increasing socioeconomic polarization are linked to the economic development of the city. Pune's formal economy has a robust base. However, as in many cities of the Global South, the informal economy is the most relevant source of income for large parts of the population. Pune's development is challenged by informality, poor infrastructure and inadequate planning and governance. Recently new approaches towards urban renewal and smart city development were launched. These new approaches aim at overcoming blockades in the traditional planning. A special challenge for urban planning is the transformation of urban fringe areas of the city, as this process is currently taking place in an unsustainable manner. The paper concludes that urban development has to become holistic, integrative and participative and should abandon the stereotype vision of the world class

Urban health in India is gaining increasing attention due to the growing share of urban population and the changing living conditions caused by the rapid urbanization process. The rising prevalence of non-communicable diseases (NCDs) such as diabetes is partly attributed to this process making NCD prevention and control one of the biggest public health challenges in the 21st century. Though public health programs in India are increasingly targeting NCDs, data quality and availability to budget scarce resources remains a challenge. The objective of the study was to conceptualize a prototype for an urban NCD sentinel surveillance system to capture data on newly diagnosed NCD cases, taking also into account socio-spatial intraurban differences. As preliminary steps, two systematic literature reviews, mapping of healthcare providers and a knowledge attitude practice survey on disease surveillance were conducted. In total, 258 private primary healthcare providers ( allopathy, ayurveda, homeopathy and unani) participated in the survey, out of these 127 agreed to participate in the six months surveillance study, providing data on a monthly basis. The study indicates that, despite the small size and low level of infrastructure in the private clinics, these practitioners play an important role in diagnosing and treating NCDs. They can be involved in NCD surveillance, if the following major barriers are addressed: lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. Based on our findings, a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care might be an adequate approach to monitor NCD related health trends.

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative part

The Indian city of Pune witnessed rapid growth and deep transformation processes in the last three decades. This paper assesses past developments and recent structures and processes against the concept of urban sustainability. Following an overview of the historical development, the dimensions of sustainability are discussed separately, based on empirical findings. Urban growth puts enormous pressure on Pune's land and water resources, changing the ecology of the area. The increasing water demand of Pune's growing population competes with growing energy and water demands. An assessment of future climate change impacts indicates that the storage capacity of the reservoirs is more frequently not met during the rainy season. In addition, extreme dry years can aggravate the effects of land use change on water resources in the future. The city's growth and especially the large in-migration has also changed Pune's social fabric significantly. Wealth is distributed unevenly in the city and social disparities can be observed along two fault lines, namely along classes and caste groups. The population development and the increasing socioeconomic polarization are linked to the economic development of the city. Pune's formal economy has a robust base. However, as in many cities of the Global South, the informal economy is the most relevant source of income for large parts of the population. Pune's development is challenged by informality, poor infrastructure and inadequate planning and governance. Recently new approaches towards urban renewal and smart city development were launched. These new approaches aim at overcoming blockades in the traditional planning. A special challenge for urban planning is the transformation of urban fringe areas of the city, as this process is currently taking place in an unsustainable manner. The paper concludes that urban development has to become holistic, integrative and participative and should abandon the stereotype vision of the world class

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n = 622, 41%) and diabetes (n = 460, 30%). Dropout rate was 10% (n = 13). The monthly reporting consistency was quite constant, with the majority (n = 63, 50%) submitting 1-10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n = 104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack o

Internal migration within Asian countries and international migration to, within, and out of Asia have been on the rise throughout the past decades. As types and pathways of migration, migrants' sociocultural and socioeconomic backgrounds, and their transnational and translocal trajectories become increasingly diverse, a majority of them move to cities. Diverging power geometries and relations are constantly negotiated and (re)produced in the socio-spatial dialectic of the city. Through their individual and collective agency, assets, and knowledge, mobile subjects have become important agents in the (re)production of spaces in cities, whereas the socio-political and physical conditions of spaces frame their livelihoods, opportunities, and agency. Research on migrants' agency has intensified recently, but the specific modes through which agency operates in the socio-spatial dialectic still need to be conceptualised. We develop a framework that outlines different modes through which agents and space interact. The framework is exemplified through papers on case studies from Dhaka and the Pearl River Delta (PRD) that are part of this special issue. Dhaka and the PRD have been characterised by accelerated growth throughout the past decades, particularly due to the influx of rural-to-urban migrants, but they also receive an increasing number of international migrants. We conclude that through their diverse, multi-sited, and translocal relations and activities stretching beyond the receiving cities in a context of constant transformation, migrants' practices contribute to the emergence of a specific type of urban spaces that we delineate as transient urban spaces. Copyright (c) 2014 John Wiley & Sons, Ltd.

This paper investigates how China's heterogeneous African population contributes to shaping new types of social spaces in Chinese cities. We analyse how their different types of collective (primary and corporate) agency work in the creation of transient spaces, that is, translocal and transforming spaces in Guangzhou and Foshan, China. A mixed-methods research approach was applied to cover the breadth and depth of African merchants' social spaces in both cities. The results indicate that many African merchants are mobile individuals linked across China and across national borders to their home countries and other countries in which they have lived and worked. Whereas other authors have looked into traders' migration pathways via Southeast Asia, Hong Kong, and Macao to China, our results also stress the importance of previous intermediate stations, particularly in West African states, South Africa, and Dubai. The transiency of the social spaces of Africans is underlined by the high mobility of many of them, including the great inflow of new migrants with trajectories that are often informed by living in or experiencing a variety of other societies, business environments, and living and working conditions. Through their translocal and transnational activities, experiences, and trajectories, African merchants contribute to the emergence of new transient spaces in both cities, as well as to successful business performance, which also benefits the Chinese economy and society. Copyright (c) 2015 John Wiley & Sons, Ltd.

Worldwide, high mountains are characterised by an ethnic, linguistic and socio-cultural, sometimes also religious variety. Thus, in addition to other regions mostly situated in national peripheries, they figure among the last retreats of traditionally ethno-linguistic diversity. According to estimates, about 250 million people belong to the so-called "indigenous" peoples living predominantly in peripheral regions; this figure amounts to between 70 and 80 million in Europe. Using the example of the Rhaeto-Romanic people of Graubünden (Grisons), it is possible to follow in detail the different phases of the territorial retreat as well as the causes accelerating and supporting that development. When the Rhaeto-Romanic area was at its largest, it extended from Regensburg to Trient and from Constance to Kufstein. The current area occupied is the result of a long shrinking process. In the Alps region, there are still three regions separated from each other, which are still settled by the Rhaeto-Romanish people: the district of Friuli (about 500 000 people; Italy), the Ladin region in the Dolomites (about 30 000 people; Italy) and the Romance Grisons region (about 40 000 people; canton of Graubünden (Grisons)/Switzerland). Since the end of the 19th century, the Rhaeto-Romanish language has increasingly been pushed back by the linguistic switch to the German or to the Italian languages, and the linguistic area has been subdivided into different sections. The effects of increasing development of the economy and transport communications in the mountain areas have especially favoured the peripheralisation process. The causes and reasons responsible for the peripheralisation of the Rhaeto-Romanish people are in detail as follows: The Rhaeto-Romanish people are linguistically subdivided into five main idioms, and by religious denomination into further fragments. The Rhaeto-Romanish population is very unevenly distributed within the canton, and in many communities it is demograph

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n = 622, 41%) and diabetes (n = 460, 30%). Dropout rate was 10% (n = 13). The monthly reporting consistency was quite constant, with the majority (n = 63, 50%) submitting 1-10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n = 104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack o

Internal migration within Asian countries and international migration to, within, and out of Asia have been on the rise throughout the past decades. As types and pathways of migration, migrants' sociocultural and socioeconomic backgrounds, and their transnational and translocal trajectories become increasingly diverse, a majority of them move to cities. Diverging power geometries and relations are constantly negotiated and (re)produced in the socio-spatial dialectic of the city. Through their individual and collective agency, assets, and knowledge, mobile subjects have become important agents in the (re)production of spaces in cities, whereas the socio-political and physical conditions of spaces frame their livelihoods, opportunities, and agency. Research on migrants' agency has intensified recently, but the specific modes through which agency operates in the socio-spatial dialectic still need to be conceptualised. We develop a framework that outlines different modes through which agents and space interact. The framework is exemplified through papers on case studies from Dhaka and the Pearl River Delta (PRD) that are part of this special issue. Dhaka and the PRD have been characterised by accelerated growth throughout the past decades, particularly due to the influx of rural-to-urban migrants, but they also receive an increasing number of international migrants. We conclude that through their diverse, multi-sited, and translocal relations and activities stretching beyond the receiving cities in a context of constant transformation, migrants' practices contribute to the emergence of a specific type of urban spaces that we delineate as transient urban spaces. Copyright (c) 2014 John Wiley & Sons, Ltd.

This paper investigates how China's heterogeneous African population contributes to shaping new types of social spaces in Chinese cities. We analyse how their different types of collective (primary and corporate) agency work in the creation of transient spaces, that is, translocal and transforming spaces in Guangzhou and Foshan, China. A mixed-methods research approach was applied to cover the breadth and depth of African merchants' social spaces in both cities. The results indicate that many African merchants are mobile individuals linked across China and across national borders to their home countries and other countries in which they have lived and worked. Whereas other authors have looked into traders' migration pathways via Southeast Asia, Hong Kong, and Macao to China, our results also stress the importance of previous intermediate stations, particularly in West African states, South Africa, and Dubai. The transiency of the social spaces of Africans is underlined by the high mobility of many of them, including the great inflow of new migrants with trajectories that are often informed by living in or experiencing a variety of other societies, business environments, and living and working conditions. Through their translocal and transnational activities, experiences, and trajectories, African merchants contribute to the emergence of new transient spaces in both cities, as well as to successful business performance, which also benefits the Chinese economy and society. Copyright (c) 2015 John Wiley & Sons, Ltd.

Background: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. Design: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS (TM) Inc., Chicago, IL, USA, version 17.0.1. Results: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234-7.915, p = 0.016] and availability of a computer (OR 3.670, 95% CI 1.237-10.889, p = 0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998-14.557, p = 0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. Conclusions: The high response rate and the practitioners' willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that t

One of the unintended effects of China's health care reforms is the emergence of unregistered practitioners. We discuss reasons for their development and their role in the urban health care provision system under consideration of general developments in health care provision and health governance - thereby drawing scientific attention to a by far under-researched topic. We analyse the basic characteristics and strategies of clinic-based unregistered practitioners in Guangzhou and examine their perception and utilisation by rural-to-urban migrants. The research design followed a qualitative dominant mixed methods research approach, which included expert interviews with representatives of administration, indepth interviews with practitioners and migrants, a quantitative survey with 450 migrants and field observations. According to our results, gaps in the formal health care system - especially lack of access of marginalised population groups and inadequate responsiveness - poor enforcement of regulation and corrupt executive personnel are responsible for their emergence and prevalence.

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low-and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low-and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low-and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources.

Background: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. Design: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS (TM) Inc., Chicago, IL, USA, version 17.0.1. Results: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234-7.915, p = 0.016] and availability of a computer (OR 3.670, 95% CI 1.237-10.889, p = 0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998-14.557, p = 0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. Conclusions: The high response rate and the practitioners' willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that t

One of the unintended effects of China's health care reforms is the emergence of unregistered practitioners. We discuss reasons for their development and their role in the urban health care provision system under consideration of general developments in health care provision and health governance - thereby drawing scientific attention to a by far under-researched topic. We analyse the basic characteristics and strategies of clinic-based unregistered practitioners in Guangzhou and examine their perception and utilisation by rural-to-urban migrants. The research design followed a qualitative dominant mixed methods research approach, which included expert interviews with representatives of administration, indepth interviews with practitioners and migrants, a quantitative survey with 450 migrants and field observations. According to our results, gaps in the formal health care system - especially lack of access of marginalised population groups and inadequate responsiveness - poor enforcement of regulation and corrupt executive personnel are responsible for their emergence and prevalence.

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low-and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low-and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low-and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources.

Background: Rapid urbanization in low-and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holi

Internal migration within Asian countries and international migration to, within, and out of Asia have been on the rise throughout the past decades. As types and pathways of migration, migrants’ sociocultural and socioeconomic backgrounds, and their transnational and translocal trajectories become increasingly diverse, a majority of them move to cities. Diverging power geometries and relations are constantly negotiated and (re)produced in the sociospatial dialectic of the city. Through their individual and collective agency, assets, and knowledge, mobile subjects have become important agents in the (re)production of spaces in cities, whereas the socio-political and physical conditions of spaces frame their livelihoods, opportunities, and agency. Research on migrants’ agency has intensified recently, but the specific modes through which agency operates in the socio-spatial dialectic still need to be conceptualised. We develop a framework that outlines different modes through which agents and space interact. The framework is exemplified through papers on case studies from Dhaka and the Pearl River Delta (PRD) that are part of this special issue. Dhaka and the PRD have been characterised by accelerated growth throughout the past decades, particularly due to the influx of rural-to-urban migrants, but they also receive an increasing number of international migrants. We conclude that through their diverse, multi-sited, and translocal relations and activities stretching beyond the receiving cities in a context of constant transformation, migrants’ practices contribute to the emergence of a specific type of urban spaces that we delineate as transient urban spaces. Copyright © 2014 John Wiley & Sons, Ltd. Accepted 04 September 2014

Background: Rapid urbanization in low-and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holi

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative part

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low- and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low- and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low- and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources. Electronic supplementary material: The online version of

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative part

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low- and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low- and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low- and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources. Electronic supplementary material: The online version of

Background: Private practitioners are the preferred first point of care in a majority of low and middle-income countries and in this position, best placed for the surveillance of diseases. However their contribution to routine surveillance data is marginal. This systematic review aims to explore evidence with regards to the role, contribution, and involvement of private practitioners in routine disease data notification. We examined the factors that determine the inclusion of, and the participation thereof of private practitioners in disease surveillance activities. Methods: Literature search was conducted using the PubMed, Web of Knowledge, WHOLIS, and WHO-IRIS databases to identify peer reviewed and gray full-text documents in English with no limits for year of publication or study design. Forty manuscripts were reviewed. Results: The current participation of private practitioners in disease surveillance efforts is appalling. The main barriers to their participation are inadequate knowledge leading to unsatisfactory attitudes and misperceptions that influence their practices. Complicated reporting mechanisms with unclear guidelines, along with unsatisfactory attitudes on behalf of the government and surveillance program managers also contribute to the underreporting of cases. Infrastructural barriers especially the availability of computers and skilled human resources are critical to improving private sector participation in routine disease surveillance. Conclusion: The issues identified are similar to those for underreporting within the Integrated infectious Disease Surveillance and Response systems (IDSR) which collects data mainly from public healthcare facilities. We recommend that surveillance program officers should provide periodic training, supportive supervision and offer regular feedback to the practitioners from both public as well as private sectors in order to improve case notification. Governments need to take leadership and foster collaborative part

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of

BACKGROUND: Participation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts. DESIGN: A questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1. RESULTS: Knowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting. CONCLUSIONS: The high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a

Background: The rising global burden of non-communicable diseases (NCDs) necessitates the institutionalization of surveillance systems to track trends and evaluate interventions. However, NCD surveillance capacities vary across high- and low- and middle-income countries. The objective of the review was to analyse existing literature with respect to structures of health facility-based NCD surveillance systems and the lessons low- and middle-income countries can learn in setting up and running these systems. Methods: A literature review was conducted using Pub Med, Web of Knowledge and WHOLIS databases to identify citations published in English language between 1993 and 2013. In total, 20 manuscripts met inclusion criteria: 12 studies were analysed in respect to the surveillance approach, eight supporting documents in respect to general and regional challenges in NCD surveillance. Results: Eleven of the 12 studies identified were conducted in high-income countries. Five studies had a single disease focus, three a multiple NCD focus and three covered communicable as well as non-communicable diseases. Nine studies were passive assisted sentinel surveillance systems, of which six focused on the primary care level and three had additional active surveillance components, i.e., population-based surveys. The supporting documents reveal that NCD surveillance is rather limited in most low- and middle-income countries despite the increasing disease burden and its socioeconomic impact. Major barriers include institutional surveillance capacities and hence data availability. Conclusions: The review suggests that given the complex system requirements, multiple surveillance approaches are necessary to collect comprehensive information for effective NCD surveillance. Sentinel augmented facility-based surveillance, preferably supported by population-based surveys, can provide improved evidence and help budget scarce resources. Electronic supplementary material: The online version of