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Research Article
Current Trends in Low Back Pain Diagnostics in India: A Five-Year Scenario Analysis (2020-2024)
Atul Kapoor*
Issue:
Volume 10, Issue 4, December 2025
Pages:
140-150
Received:
1 September 2025
Accepted:
10 September 2025
Published:
26 September 2025
Abstract: Background: Low back pain (LBP) represents a significant healthcare burden in India, with prevalence rates ranging from 6.2% to 92% across different populations. Despite evidence-based guidelines recommending conservative management and selective imaging, diagnostic overutilization remains a challenge across healthcare sectors. This study analyzed diagnostic utilization patterns and referral trends from various healthcare settings over a five-year period to evaluate the extent of inappropriate imaging use and its economic implications. Objective: To evaluate diagnostic imaging trends, referral patterns, guideline adherence, and positivity rates for lower back pain across different healthcare sectors in India, assess the extent of diagnostic overuse, and analyze cost-effectiveness patterns across private practice, specialist care, and insurance/government healthcare schemes. Methods: A retrospective analysis of simulated data representing diagnostic trends from to 2020-2024 across primary care practices (n=1,200), inpatient departments from secondary and tertiary care hospitals (n=450), insurance-covered services (n=850,000), and social organization healthcare programs (n=320) was conducted. Cases were classified using evidence-based clinical categories following the PRISMA guidelines, with outcome measures including diagnostic referral patterns, guideline adherence rates, positivity rates for actionable findings, and comprehensive cost-effectiveness analysis using Quality-Adjusted Life Years (QALYs). Results: Significant overutilization of imaging studies was observed across all sectors, with total LBP cases increasing by 71% over five years, while CT+MRI imaging rates rose dramatically from 70% to 88%. MRI utilization increased by 115% (1,512 to 3,252 studies), whereas cost-effective X-ray utilization declined by 31% (720 to 494 examinations). Total imaging costs escalated from ₹92.76 lakhs in 2020 to ₹1.95 crores in 2024, representing a 110% increase that substantially outpaced the case volume growth. Adherence to clinical guidelines remained consistently poor at 23-34% across sectors, with insurance/government schemes showing the worst compliance (15.2%) despite the highest imaging approval rates (95.8%). Cost-effectiveness analysis revealed stark disparities: private practice achieved ₹85,000 per QALY, while insurance/government sectors reached ₹1.65 lakhs per QALY, indicating poor economic efficiency despite subsidized rates. Conclusions: The analysis revealed a healthcare system paradox, wherein increased imaging intensity correlated with poorer clinical outcomes and economic efficiency. Urgent reforms, including MRI utilization controls, mandatory clinical reasoning documentation, and guideline-based audit programs, are essential to restore value-based care delivery.
Abstract: Background: Low back pain (LBP) represents a significant healthcare burden in India, with prevalence rates ranging from 6.2% to 92% across different populations. Despite evidence-based guidelines recommending conservative management and selective imaging, diagnostic overutilization remains a challenge across healthcare sectors. This study analyzed ...
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Research Article
Impact of Delayed Desired Job Employment of Trained Nurses on Job Satisfaction in Ghana
Issue:
Volume 10, Issue 4, December 2025
Pages:
151-166
Received:
1 September 2025
Accepted:
15 September 2025
Published:
30 September 2025
Abstract: The study focused on the impact of delayed desired job employment on job satisfaction among trained nurses. Data were collected from nurses currently in post across the Greater Accra Region, Ashanti Region and Northern Region. A total of 1093 trained nurses from these three regions were sampled. Primary data were collected through structured questionnaire. Principal Component Analysis was employed to group the items into three principal components namely, professional achievement, performance management and job stability. The delayed desired job employment was measured as number of years spent at home after completing nursing training (either at the college or university, following national service) until the time of government posting. The study estimated the impact of job satisfaction on each of the principal job satisfaction components and on the overall job satisfaction, using Ordinary Least Square Regression Model. The results showed that delayed desired job employment significantly reduced all the job satisfaction components and the overall job satisfaction. Educational level did not have significant role in the relationship between delayed desired job employment and job satisfaction. The study recommends that Government of Ghana through Ministry of Health should align the number of nurses trained with its annual recruitment capacity. Moreover, the Ghana of Ghana through Ministry of Health should consider facilitating the export of surplus trained nurses to countries in need of healthcare professionals. This would not only allow Ghana to benefit from her investment in nursing education but also help unemployed trained nurses to secure livelihoods.
Abstract: The study focused on the impact of delayed desired job employment on job satisfaction among trained nurses. Data were collected from nurses currently in post across the Greater Accra Region, Ashanti Region and Northern Region. A total of 1093 trained nurses from these three regions were sampled. Primary data were collected through structured questi...
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Research Article
State Heterogeneity in Public Health Expenditure Effects on Mortality in India: The Role of Institutional Quality
Bhabesh Hazarika*,
Ankit Singh
Issue:
Volume 10, Issue 4, December 2025
Pages:
167-184
Received:
1 October 2025
Accepted:
14 October 2025
Published:
22 November 2025
Abstract: Debates around the effectiveness of public health expenditure remain unresolved, particularly in low- and middle-income countries where fiscal space is limited and health inequalities are stark. This study investigates how state-level public spending influences mortality in India, while explicitly accounting for governance quality and subnational heterogeneity. Using microdata from the National Family Health Survey 5 combined with state-level fiscal and institutional indicators, the analysis applies a multilevel probit model with random intercepts and slopes to capture both baseline mortality differences and variation in the returns to health spending across states. The results show that public expenditure significantly lowers mortality probabilities, but its impact is highly uneven. States with stronger governance, especially higher government effectiveness and adherence to rule of law, achieve greater health gains from similar spending levels, while weaker states lag behind. Mortality disparities are also evident across socio-economic groups, age cohorts, gender, and rural–urban locations, with evidence that public spending helps narrow gender gaps in survival outcomes. These findings underscore that expanding health budgets alone is insufficient. Effective mortality reduction in India requires parallel investments in governance, institutional capacity, and accountability, alongside reorienting spending to address emerging challenges such as non-communicable diseases and neglected urban health systems. The paper contributes to the literature on fiscal federalism and health by demonstrating that while financial resources matter, their effectiveness is fundamentally shaped by the quality of institutions at the state level.
Abstract: Debates around the effectiveness of public health expenditure remain unresolved, particularly in low- and middle-income countries where fiscal space is limited and health inequalities are stark. This study investigates how state-level public spending influences mortality in India, while explicitly accounting for governance quality and subnational h...
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Research Article
Study of the Direct Medical Costs Incurred by Women Diagnosed with Cervical Cancer and Followed up at the Institute Curie of Aristide Le Dantec Hospital
Issue:
Volume 10, Issue 4, December 2025
Pages:
185-193
Received:
24 October 2025
Accepted:
7 November 2025
Published:
20 December 2025
DOI:
10.11648/j.hep.20251004.14
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Abstract: Introduction: Cervical cancer constitutes a major public health challenge, both in terms of its morbidity and its financial burden on health systems and patients. This study aimed to assess the direct medical costs incurred by women diagnosed with cervical cancer and managed at the Institute Curie of Aristide Le Dantec Hospital in Dakar, as well as to identify the main cost drivers. Methodology: A retrospective, cross-sectional, descriptive and analytical study was conducted from January to April 2018, including 94 patients. Data were collected from medical records and entered into Microsoft Excel. Statistical analyses were performed using the Analysis module of SPSS version 18 (Statistical Package of Social Science). Results: Among the 94 patients included in the study, 67.0% were diagnosed at a locally advanced stage, 20.2% at an advanced stage, and 10.6% at an early stage. The majority of patients originated from outside Dakar. Squamous cell carcinoma accounted for 83% of cases. Stage IIb was the most frequently observed stage, and the mean delay between the onset of initial symptoms and the first oncology consultation was 6 months. The average duration of symptoms before consultation was 8.7 months. A combination of chemotherapy, radiotherapy and surgery was administered to 31 patients, chemotherapy alone to 32 patients, while 17 patients did not receive active treatment. The main cost drivers for both national and non-national patients were medical imaging and radiotherapy. The average direct medical cost of cervical cancer management was estimated at 371,804 FCFA per patient, with a standard deviation of 174,205 FCFA. Medical imaging represented the largest cost component, followed by the cost of radiotherapy. The annual mean costs of hospitalization and endoscopic examinations were significantly higher among patients diagnosed with adenocarcinoma or other histological types, with p-values of 0.035 and 0.04, respectively. Similarly, the annual mean costs of consultations, hospitalizations, and histopathological examinations were significantly higher among patients diagnosed at stages III and IV, with p-values of 0.046, 0.027, and 0.021, respectively. Conclusion: Primary and tertiary prevention strategies, based on the effective implementation of policies aimed at reducing risk factors and providing financial support to patients, represent the most effective approach to lowering the burden of cervical cancer morbidity.
Abstract: Introduction: Cervical cancer constitutes a major public health challenge, both in terms of its morbidity and its financial burden on health systems and patients. This study aimed to assess the direct medical costs incurred by women diagnosed with cervical cancer and managed at the Institute Curie of Aristide Le Dantec Hospital in Dakar, as well as...
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Research Article
Determinants of Child Stunting in Madhya Pradesh:
The Role of Household Infrastructure and Dietary Practices in Achieving Zero Hunger
Ankit Singh*,
Shweta Sudele
Issue:
Volume 10, Issue 4, December 2025
Pages:
194-201
Received:
26 October 2025
Accepted:
8 November 2025
Published:
30 December 2025
DOI:
10.11648/j.hep.20251004.15
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Abstract: Child stunting, which is defined as low height for age, is one of the critical public health issues in Madhya Pradesh, India, with alarmingly high prevalence rates. This study examines the impact of household infrastructure and dietary practices on stunting, using district-level data from the National Family Health Survey (NFHS-5). Poor access to sanitation, clean drinking water, and proper dietary diversity emerged as significant determinants of stunting, compounded by socioeconomic disparities and maternal education levels. Logistic regression analysis shows predictors such as the wealth index, maternal BMI, and extended duration's of breastfeeding all have significant effects in protection against stunting. On the contrary, high fruit intake and grain consumption indicated high odds ratios for stunting. Significant predictors of child stunting in Madhya Pradesh are identified by logistic regression analysis. Children from particular castes had lower odds of stunting (adjusted odds ratio of 0.95, p = 0.03), indicating a weak but statistically significant caste effect. Mothers' education significantly lowered the chances of stunting, with an adjusted odds ratio of 0.87 and a p-value of less than 0.001. Higher Maternal BMI has been demonstrated to correlate with reduced odds of stunting, with an adjusted odds ratio of 0.97 (p < 0.001). Male children are considerably more prone to stunting compared to females, with an adjusted odds ratio of 0.85 and a p-value of less than 0.001. Sanitation and access to clean drinking water significantly decrease stunting, with adjusted odds ratios of 1.00 (p < 0.001) for sanitation and 0.99 (p = 0.01) for water. Housing quality, demonstrates a modest yet significant impact on reducing stunting (adjusted odds ratio of 0.99, p = 0.01). These findings indicate that certain pivotal factors, including maternal education, health, wealth, sanitation, and clean water consumption, are essential to child growth and stunting. Regression analysis revealed both significant and subtle findings regarding the relationship between dietary practices and child stunting. An extended breastfeeding period demonstrates a protective effect against stunting, evidenced by an adjusted odds ratio of 0.99 (95% CI: 0.99-0.65, p < 0.001). Collectively, these findings call for targeted policy intervention to improve infrastructure facilities in households; promote dietary diversification (vegetables, legumes, and grain, home gardening, and animal-source food); and enhance education to achieve the goal of sustainable development related to zero hunger and clean water and sanitation.
Abstract: Child stunting, which is defined as low height for age, is one of the critical public health issues in Madhya Pradesh, India, with alarmingly high prevalence rates. This study examines the impact of household infrastructure and dietary practices on stunting, using district-level data from the National Family Health Survey (NFHS-5). Poor access to s...
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