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This paper is an attempt to assess India's performance in generating the required quantity and quality of employment for its growing population since independence in 1947. But the exercise is set in a longer period that covers India's population growth since the turn of the twentieth century (1901) in relation to its ability to generate employment. The half-a-century preceding independence, despite a slow population growth, was a disaster in generating employment and any signs of structural change. Detailed analysis of the issue since independence shows that there was indeed a demographic burden more than the world average as well as its comparator Asian countries such as China and Indonesia. While employment generation with reference to growth—employment elasticity—was quite impressive during the first four decades of independence, it almost collapsed ever since the adoption of neoliberal economic reforms in 1991, thus entering a phase of 'jobless growth', a phenomenon that is shared by China in a more vigorous form. This has led to what may be called an exclusion of working age people from not just employment but from labour force indicating the emergence of 'discouraged workers' in a larger set that we called underutilized labour. But what about those who are included in the workforce? Does it ensure an escape from poverty for those at the bottom? Our estimates show that the pace of reduction in the incidence of poverty is so slow that a significant share of households is still below the international definition of extreme poverty. We attribute this to the quality of employment characterized by a high incidence of informal sector employment as well as low wages measured by the share of workers not receiving a recommended subsistence wage. The absence of any kind of social security to an overwhelming share of workers adds to this situation of absolute poverty. Finally we examine the question of poverty from the point of manifold inequalities by dividing the households in the economy in terms of their employment, educational, rural–urban, and social group statuses for estimating predicted probability of being poor. The results bring into sharp focus the huge variation in predicted probability that shows households with low education, disadvantaged social group status, casual nature of employment, and living in rural areas at the bottom end of the scale. These results bring out the imperative for creating more employment with better quality. [ABSTRACT FROM AUTHOR]

Poverty eradication and environmental degradation are the two crucial challenges, and they are highly interlinked in the modern era. However, countries are still more emphasized in attaining poverty alleviation and alleviating environmental pollution which require enormous attention. Our study is a novel attempt to scrutinize the effect of poverty on carbon dioxide (CO2) emissions for India and China over the sample period 1987–2019. Findings attained from the ARDL model suggest that a rise in poverty contributes to growing CO2 emissions in India only in short run. Further, findings show that poverty is the principal source of pollution in the long term in India and China. Empirical results proposed focal policy implications in the light of sustainable development goals for India and China. [ABSTRACT FROM AUTHOR]

Background: The determinants of access to immunizers are still poorly understood, leading to questions about which criteria were considered in this distribution. Given the above, the present study aimed to analyze the determinants of access to the SARS-CoV-2 vaccine by different countries. Methods: The study covered 189 countries using data from different public databases, and collected until February 19, 2021. We used eight explanatory variables: gross domestic product (GDP), extreme poverty, human development index (HDI), life expectancy, median age, coronavirus disease 2019 (COVID-19) cases, COVID-19 tests, and COVID-19 deaths. The endogenous variables were total vaccine doses, vaccine doses per thousand, and days of vaccination. The structural equation modeling (SEM) technique was applied to establish the causal relationship between the country's COVID-19 impact, socioeconomic variables, and vaccine access. To support SEM, we used confirmatory factor analysis, t-test, and Pearson's correlation. Results: We collected the sample on February 19, and to date, 80 countries (42.1%) had already received a batch of immunizers against COVID-19. The countries with first access to the vaccine (e.g., number of days elapsed since they took the first dose) were the United Kingdom (68), China (68), Russia (66), and Israel (62). The countries receiving the highest doses were the United States, China, India, and Israel. The countries with extreme poverty had lower access to vaccines and the richer countries gained priority access. Countries most affected by COVID (deaths and cases) also received immunizers earlier and in greater volumes. Unfortunately, similar to other vaccines, indicators, such as income, poverty, and human development, influence vaccines' access. Thus affecting the population of vulnerable and less protected countries. Therefore, global initiatives for the equitable distribution of COVID need to be discussed and encouraged. Conclusions: Determinants of vaccine distribution consider the impact of the disease in the country and are also affected by favorable socioeconomic indicators. The COVID-19 vaccines need to be accessible to all affected countries, regardless of their social hands. [ABSTRACT FROM AUTHOR]

Objective: Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries.Methods: Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses.Results: In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary.Conclusion: Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account. [ABSTRACT FROM AUTHOR]

Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of noise guidelines. It is unclear whether findings in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs). We conducted this systematic review to summarise noise epidemiological studies in LMICs. We conducted a literature search of studies in Medline and Web of Science published during 2009-2021, supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation Guide). 58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to 120 dB (L eq ), with over half of the studies (52%) reporting the mean between 60 and 80 dB. The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%) and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had "probably low", 18 (31%) had "probably high" and 36 (62%) had "high" risk of bias. Quality of evidence was rated as 'low' for mental health outcomes and 'very low' for all other outcomes. Strength of evidence for each outcome was assessed as 'inadequate', highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evidence base., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs).Methods: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality.Results: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education.Conclusion: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure.Implications: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are strongly influenced by SHS exposure. Using nationally representative Global Adult Tobacco Survey (2008-2011) data from 15 LMICs, we studied socioeconomic inequalities in SHS exposure at homes and at workplaces. The study showed that in most LMICs, SHS exposure at homes is higher among the poor and the less educated. At workplaces, SHS exposure is higher among the less educated groups. Accelerating implementation of pro-equity tobacco control interventions and strengthening of efforts targeted at the socioeconomically disadvantaged groups are needed to reduce inequalities in SHS exposure in LMICs. [ABSTRACT FROM AUTHOR]

Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. [ABSTRACT FROM AUTHOR]

Purpose – China and India are two of the fastest growing economies in the world, and poverty reduction has been substantial in both countries through the past few decades. Yet they have very different profiles in terms of food security and undernutrition – while at the micro-level China has performed well in terms of undernutrition, India has not. The purpose of this paper is to examine linkages between poverty, food security, and undernutrition in both countries. Design/methodology/approach – In this paper, the authors discuss the linkages between poverty, food security, and undernutrition at the micro level, describe the literature, and make inferences for targeting the remaining poor, food insecure, or undernourished in both countries. Findings – In China, there is a need for better tools for targeting the poor or malnourished. In India, more effective state-level policies should be better understood by the central government and disseminated to less successful states. Originality/value – In this paper, the authors describe data sources on poverty, food security, and undernutrition in both China and India, and correlates with changes in all three. The authors try to understand what factors appear to lead to reductions in all three, pointing out data gaps in both countries. [ABSTRACT FROM AUTHOR]

Background: Little attention has been paid to the comparison of COVID-19 pandemic responses and related factors in BRICS (Brazil, Russia, India, China, and South Africa) countries. We aimed at evaluating the association of daily new COVID-19 cases with socio-economic and demographic factors, health vulnerability, resources, and policy response in BRICS countries., Methods: We conducted a cross-sectional study using data on the COVID-19 pandemic and other indicators of BRICS countries from February 26, 2020 to April 30, 2021. We compared COVID-19 epidemic in BRICS countries and analyzed related factors by log-linear Generalized Additive Model (GAM) models., Results: In BRICS countries, India had the highest totally of confirmed cases with 18.76 million, followed by Brazil (14.45 million), Russia (4.81 million), and South Africa (1.58 million), while China (0.10 million) had the lowest figure. South Africa had the lowest rate of administered vaccine doses (0.18 million) among BRICS countries as of April 30, 2021. In the GAM model, a 1 unit increase in population density and policy stringency index was associated with a 5.17% and 1.95% growth in daily new COVID-19 cases (P < 0.001), respectively. Exposure-response curves for the effects of policy stringency index on daily new cases showed that there was a rapid surge in number of daily new COVID-19 cases when the index ranged from 0 to 45. The number of infections climbed slowly when the index ranged from 46 to 80, and decreased when the index was above 80 (P < 0.001). In addition, daily new COVID-19 cases (all P < 0.001) were also correlated with life expectancy at birth (-1.61%), extreme poverty (8.95%), human development index (-0.05%), GDP per capita (-0.18%), diabetes prevalence (0.66%), proportion of population aged 60 and above (2.23%), hospital beds per thousand people (-0.08%), proportion of people with access to improved drinking water (-7.40%), prevalence of open defecation (0.69%), and annual tourist/visitor arrivals (0.003%), after controlling other confounders. Different lag structures showed similar results in the sensitivity analysis., Conclusions: Strong policy response is crucial to control the pandemic, such as effective containment and case management. Our findings also highlighted the importance of reducing socio-economic inequalities and strengthening the resilience of health systems to better respond to public health emergencies globally.

This study explores the relationship between remittances received, education expenditure, energy use, income, poverty, and economic growth for a panel of the nine selected remittance-receiving countries (Bangladesh, China, Egypt, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines). World Development Indicator database is used for retrieving data from the period of 1990 to 2014. Panel cointegration technique is used to test the long-run relationship among studied variables. Furthermore, the autoregressive distributive lag (ARDL) model is applied to confirm the presence of a long-run and short-run relationship. The findings of the ARDL model indicate that remittances received positively influence economic growth, and there is a significant relationship between remittances received and economic growth during the long-run. Education expenditure, energy use, and income also positively and significantly impact economic growth during the long-run. In contrast, final household consumption used in this study as a proxy of poverty showed a significant negative effect on economic growth during the long-run, which indicates that increasing poverty will reduce economic growth; on the other hand, reducing poverty will boost economic growth in the selected countries during the long-run.

Background: Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels., Methods: We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007-2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities., Results: The use of gas (aOR = 1.76, 95%CI: 1.40-2.21); coal (aOR = 1.74, 95%CI: 1.22-2.47); wood (aOR = 1.69, 95%CI: 1.30-2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46-2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m2), obesity (BMI ≥30.0 kg/m2), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m2) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis., Conclusions: These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation., Competing Interests: The authors have declared that no competing interests exist.

Background: Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC., Methods and Findings: PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals., Conclusions: Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: NK chairs and contributes to a number of guidelines for self-harm and suicidal behaviour and sits on the main government advisory group for suicide prevention in England. NK and DK also advised the Sri Lankan Ministry of Health on their suicide prevention strategy. NK receives research funding from government and charity sources. NK does not receive industry funding or personal remuneration.

Background: Global commitments to reduce cardiovascular disease (CVD) burden by 2025 will require data on CVDs from lower income countries. This study aimed to estimate the prevalence of angina, and its association with hypertension, diabetes, and depression, in six low- and middle-income countries (LMICs)., Methods: Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 from China, Ghana, India, Mexico, Russia and South Africa were utilized. Multivariable logistic regression methods were used to examine the factors associated with angina., Results: A total of 31,443 respondents aged 50 years and over were included in these analyses. The prevalence of angina was highest in Russia (39%), lowest in China (8%), and consistently higher in women than men. Angina was comorbid with chronic conditions and depression but patterns varied across countries. Depression was negatively associated with angina among older adults in Ghana but was positively associated with angina in all other countries. Hypertension was associated with increased odds of angina among older adults in China (OR 1.9; 95% CI 1.59-2.25), India (OR 1.4; 95% CI 1.14-1.78) and Russia (OR 3.7; 95% CI 2.33-6.00). Diabetes was associated with higher odds of angina in China (OR 1.6; 95% CI 1.15-2.15), Russia (OR 2.5; 95% CI 1.57-3.87), and South Africa (OR 4.1; 95% CI 2.49-6.88)., Conclusions: CVD is a significant contributor to disease burden in LMICs. Angina was often co-morbid with other conditions, therefore compelling health systems to develop longer-term integrated care systems to address co- and multi-morbidity., (Copyright © 2019. Published by Elsevier B.V.)

The Global Meningococcal Initiative (GMI) is a global expert group that includes scientists, clinicians, and public health officials with a wide range of specialties. The purpose of the Initiative is to promote the global prevention of meningococcal disease (MD) through education, research, and cooperation. The first Asia-Pacific regional meeting was held in November 2014. The GMI reviewed the epidemiology of MD, surveillance, and prevention strategies, and outbreak control practices from participating countries in the Asia-Pacific region.Although, in general, MD is underreported in this region, serogroup A disease is most prominent in low-income countries such as India and the Philippines, while Taiwan, Japan, and Korea reported disease from serogroups C, W, and Y. China has a mixed epidemiology of serogroups A, B, C, and W. Perspectives from countries outside of the region were also provided to provide insight into lessons learnt. Based on the available data and meeting discussions, a number of challenges and data gaps were identified and, as a consequence, several recommendations were formulated: strengthen surveillance; improve diagnosis, typing and case reporting; standardize case definitions; develop guidelines for outbreak management; and promote awareness of MD among healthcare professionals, public health officials, and the general public., (Copyright © 2016. Published by Elsevier Ltd.)

Background and Objectives: The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world., Data and Methods: The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India., Results and Conclusions: Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population from poverty line due to OOPHE is 2% in China and 1.3% in India. Further, findings from the multivariate analysis indicate that lower wealth status and inpatient as well as outpatient care increase the odds of falling below poverty line significantly (with the extent much higher in the case of in-patient care) due to OOPHE in both China and India. In addition, having at least an under-5 child in the household, living in rural areas and having a household head with no formal education increases the odds of falling below poverty line significantly (compared to a head with college level education) due to OOPHE in China; whereas having at least an under-5 child, not having health insurance and residing in rural areas increases the odds of becoming poor significantly due to OOPHE in India.

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

Multidrug-resistant tuberculosis (MDR-TB) (resistance to at least isoniazid and rifampicin) will influence the future of global TB control. 88% of estimated MDR-TB cases occur in middle- or high-income countries, and 60% occur in Brazil, China, India, the Russian Federation and South Africa. The World Health Organization collects country data annually to monitor the response to MDR-TB. Notification, treatment enrolment and outcome data were summarised for 30 countries, accounting for >90% of the estimated MDR-TB cases among notified TB cases worldwide. In 2012, a median of 14% (interquartile range 6-50%) of estimated MDR-TB cases were notified in the 30 countries studied. In 15 of the 30 countries, the number of patients treated for MDR-TB in 2012 (71 681) was >50% higher than in 2011. Median treatment success was 53% (interquartile range 40-70%) in the 25 countries reporting data for 30 021 MDR-TB cases who started treatment in 2010. Although progress has been noted in the expansion of MDR-TB care, urgent efforts are required in order to provide wider access to diagnosis and treatment in most countries with the highest burden of MDR-TB., (The content of this work is ©World Health Organization. Design and branding are ©ERS 2015.)