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Background: The utilization of dental services among older people is an important parameter in health service planning. Studies show that the utilization of dental services among older people in India is low. This study aims to explore the barriers in the utilization of dental services among older people. Materials and Methods: A cross-sectional study was done on 399 older people to examine the barriers in the utilization of dental services among the older population, who are defined as people aged 60 years and above, in South Kerala. Circular systemic random sampling was used to recruit the sample from the district of Kollam in Kerala. All the study participants, as defined by the inclusion criteria were considered for the study. Results: The mean age of the study population was 65.3±5.5 (n=399). The main barrier that prevented older people from utilizing oral health care was their adaptation to the present health situation 343(86), followed by perceived high expense 309(77.4). The frequency of previous dental visits among participants was highest in the past year 129(33.4). More than half of the participants 244(61) had visited a dentist to extract their teeth and only 7(1.7) had visited the dentist for their routine dental check-ups. A 206(51.4) participants had visited a private clinic to receive dental care and 70(17.7) had visited a government facility to take dental care. The main reasons for visiting a particular centre among the participants were accessibility 168(42.2), and the least reported reason was the familiarity of the dentist 32(8). Conclusion: To minimize the barriers to utilization of dental services and to address the health needs of the increasing older population, the health system needs to be strengthened especially the primary health care centres with the need to integrate oral health programs and emphasis on health promotion. Keywords: Utilisation of dental services, Barriers, Dental diseases, Oral health, Dental caries, Dental visit, Ol

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Heart failure (HF), which is an emerging public health issue, adversely affects the already strained health system in India. Globally, HF unfavorably impacts the economic well-being of the affected individuals and their families, Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from low and middle-income countries. We describe the methods of a detailed economic impact assessment of HF in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition. We aim to collect data from 1800 patients who were admitted with acute decompensated HF and within 6-15 months of follow-up. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.