Rural Indian Population Research Articles

Design of the Mobility and Independent Living in Elders Study: An older adult cohort in rural India.

The Mobility and Independent Living in Elders Study (MILES) was established in 2012 to estimate the prevalence, incidence, and risk factors for disability and age-related disease in rural older Indians. Here we describe the main goals of MILES, the essential elements of its design and examinations, and the initial findings from the baseline visit. A random sample of 562 men and women aged ≥60 years was enrolled from the Medchal region in Telangana State. Baseline examination consisted of two separate clinical visits, and included measurements of blood pressure, anthropometry, physical function, peripheral artery disease, cognitive function, bone and muscle quality, knee osteoarthritis, carotid intima-media thickness, and blood biomarkers. A comprehensive interview was carried out for demographics, disability and disease history. Annual follow-up visits are ongoing to collect information on incident disability and disease. The median age of participants was 66 years (range 60-92 years); median body mass index 21.7 kg/m2 , median gait speed 0.67 m/s and 55% self-reported their health status as fair or poor. These findings suggest a more frail population in the MILES cohort compared with older adults in USA cohorts. MILES will provide estimates of burden of disease, and disability and risk factors in older adults. Findings will be used to identify potential interventions to prevent disability in this rural Indian population. Geriatr Gerontol Int 2017; 17: 31-40.

Survival of Patients With Cervical Cancer in Rural India

Background: Patients’ survival after diagnosis of cervical cancer is indirectly influenced by socio-economic factors. We evaluated this survival and its socio-economic determinants in a rural population in south India. Methods: We assessed 165 women diagnosed with cervical cancer from the routine care control arm of a randomized screening trial conducted in rural south India. Kaplan-Meier curves were plotted to illustrate the observed survival of cancer patients. The effect of socio-economic factors was assessed using Cox proportional hazards regression analysis. Results: The 5-year observed survival was 32.5%, ranging from 9% for stage IV to 78% for stage I cancers. Women with poor socio-economic status (SES) had up to a 70% higher risk of death. Higher household income was significantly associated with poorer survival. However, most women in the higher income group were married women and housewives, hence with no personal income. Conclusion: Cervical cancer survival was disappointingly low in these rural populations of India and stage of disease at diagnosis was the strongest determinant. A higher household income is not always associated with women being empowered in terms of seeking healthcare. The study findings further stress the importance of strengthening prevention and screening opportunities to women in rural populations. J Clin Gynecol Obstet. 2015;4(4):290-296 doi: http://dx.doi.org/10.14740/jcgo367w

Tobacco use and its impact on pulmonary health among elderly population in rural area of Muzaffarnagar – A cross-sectional study

BackgroundThe tobacco use is significant in Indian rural population. Among them, elderly people in rural area are at special risk due to ageing and other factors. The impact of tobacco use on elderly health, therefore, needs to be studied in depth in rural context. ObjectiveTo study the patterns of tobacco use and its consequent impact on pulmonary health of the elderly. Design and methodologyA community-based cross-sectional study was done (April 1st to September 30th, 2014) in the field practice area (village Bilaspur) of Rural Health Training Centre (RHTC) of Muzaffarnagar Medical College, Muzaffarnagar. A simple random sampling was used and elderly of 60 years and above were interviewed by semi-structured interview schedule. The data were analyzed by software Epi-info. version 7.1.3.3. Results and conclusionThe prevalence of tobacco usage among elderly was 56.7%, in which smoking was the dominant one (37%) and majority being in the form of Bidi (56.7%). Tobacco usage was significantly associated not only with age, sex, and caste (p<0.05 each), but occupational and socio-economic status (p<0.01 each) also; however, literacy was the most significant factor (p<0.0001) among all. The tobacco usage in smoking form was highly significantly associated with the presence of chronic obstructive pulmonary disease (p<0.0001), elucidating a significant impact on their pulmonary health. The rural elderly people need health education regarding curtailing the use of tobacco for their better health from health clinics.

Effects of Increased Protein Intake as a Variant of Rural Diet in Human Volunteers of Rural Bengal

Constant escalations in the number of diabetics’ worldwide, associated complications and financial implications, failure of conventional therapy regimen to restore normoglycemia has brought to limelight the non-pharmacologic means like lifestyle and dietary interventions as one of the effective aids to combat type 2 diabetes. Economy, education, preference plays a role in dietary selection. Prolonged intake of carbohydrate enriched diet was found to be a causative of diabetes amongst poor rural Indian population of Bengal. Contrastingly, current research of three years RCT amongst rural Bengalis have shown that a daily increase in protein intake by 25-30% when compared with standard rural diet comprising of about 70% to 80% of carbohydrate, 10% fats and 10% protein, improved insulin sensitivity and lowered fasting blood glucose level amongst experimental population significantly (p=0.04) rather than the control group. Fasting serum insulin value decreased from 47±2.2 pmol/l to 44±2.4 pmol/l (p=0.04) in the study group but amongst controls an increment from 42±2.4 pmol/l to 43±2.4 pmol/l was observed. Fasting Blood Sugar level amongst controls was initially 103±4 mg/dl and became 105±6 mg/dl but in the experimental group initial value of 109±12 mg/dl diminished to 103±8 mg/dl (p=0.04) at the end of 3 years follow up. However blood lipid parameters (TC, LDL, HDL, and VLDL) were not significantly influenced by higher daily protein intake both in control and experimental group. Thus a conclusive fact found from the trial is that protein enriched, low carbohydrate diet can offer a positive impact on glycemic control kidney functions remaining normal. (250 words)

Prevalence and risk factors of obstructive sleep apnea in a rural population in India

Prevalence and risk factors of obstructive sleep apnea in a rural population in India

Rural Livelihood Markets and Economies

The rural villages in India epitomize essence of Indian civilization as it is considered a repository of traditional mores and folkways. Rural villages are the integral part of the nation, not just as places of abode, but as the custodians of culture, tradition and the spit of the nation itself. The rural village and market is considered as static and a self sufficient unit of production and consumption but it is no longer so. The rural market in India is not a separate entity in itself and it is highly influenced by the economical, sociological and cultural factors operating in the country. Poverty and low level of literacy characterize rural population in India. Government of India had introduced a number of measures to improve the quality of life of rural masses. After agricultural revolution green and white, the yield per acre land and animal has increased substantially. The rural electrification programme also bought a new hope in rural area as did the irrigation development programme. All these factors, initiate some changes in rural life. As a result; there is a socio-economic revolution taking place in Indian villages since last few decades. Increasing knowledge of agriculture and methods of farming changed rural village economy far better than earlier. Socio-economic changes in villages have led villages to think of material well-being. The process of economic development has opened new avenues of income for rural people and education has broadened their horizons, resulting in a changed life style, and livelihood market.

Association between tooth loss and hypertension among a primarily rural middle aged and older Indian adult population.

Studies in high-income countries have reported associations between tooth loss and hypertension. There is however a lack of evidence on this association from South Asian countries especially India. The current study aimed to assess the association between self-reported tooth loss and hypertension in a primarily rural middle-aged and older Indian population. A secondary analysis of cross-sectional data from the Longitudinal Ageing Study of India - pilot survey was conducted on 1,486 adults aged 45 years and above from four states of India. The primary outcome was self-reported hypertension and the main explanatory variable was self-reported tooth loss. Multivariable logistic regression models estimated the association between hypertension and tooth loss after controlling for confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes. Compared to those without any tooth loss, individuals with partial tooth loss had 1.62 times (95% CI: 1.12-2.35) higher odds of being hypertensive after adjustment of confounders including age, sex, marital status, area of residence, educational attainment, tobacco use, alcohol use, physical activity, and self-reported diabetes. The crude significant association (OR: 2.54; 95% CI: 1.50-4.29) between edentulousness and hypertension became nonsignificant and attenuated after adjustment of potential confounders (fully adjusted model OR: 1.33; 95% CI: 0.72-2.44). Partial tooth loss was associated with a higher probability of hypertension among dentate middle-aged and older adults in four states of India.

The eye and the kidney: twin targets in diabetes

Diabetes mellitus is both defined by and is a dreaded condition because of microvascular involvement of the eye and the kidneys. The level of glucose at which retinopathy occurs forms the basis for diagnosing diabetes. Despite non-invasive methods being available for its diagnosis, retinopathy is often underdiagnosed and untreated. Eventually it leads to visual loss often in working-age populations. There appears to be ethnic variation in susceptibility to diabetic retinopathy (DR), with prevalence of DR, sightthreatening DR and macular edema being higher in people from South Asia, Africa, Latin America and indigenous tribal populations [1]. The variations are ascribed to differential susceptibility to known risk factors, as well as differences in lifestyle, access to health care and genetic and epigenetic phenomenon. A number of prevalence studies were reported from different parts of India. In a hospital-based report from Kashmir (n, 500 with diabetes), DR was identified in 27 % (n, 135) [2]. Increasing age was a risk factor, and milder forms accounted for the most cases, suggesting that early screening and treatment is necessary [3]. Prevalence studies from rural India are fewer [4]. In a population-based Central India Eye and Medical Study involving more than 4500 subjects, DR was diagnosed by fundus photography utilizing criteria of Early Treatment of Diabetic Retinopathy Study. DR was identified in 15 subjects (0.33 %) of the entire cohort. In subjects with diabetes, DR was present in 9.6 % [5]. Risk factors were increasing age and higher glucose concentrations. All eyes showed only nonsevere forms of DR. There was no significant association with other conventional risk factors or with ocular parameters. In the SN-DREAMS III report no 2 (Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study III), population-based cross-sectional screening was carried out in a rural population of south India (n, 13,079) [6]. DRwas identified using 45° four-field stereoscopic digital photography, along with 30° seven-field stereo digital pairs in those with DR. Among those with diabetes, DRwas identified in 10.3 %, with greater risk in men, insulin users, those with longer duration of diabetes, systolic hypertension and poor glycemic control [6]. In urban Chennai, the CURES Eye Study I, a populationbased screening for diabetes, was carried out in adults aged 20 years and above (n, 26,001). Among 1382 known subjects with diabetes who agreed to undergo four-field stereo colour photography, and 354 newly diagnosed subjects with diabetes, DR was present in 17.6 % [7]. The prevalence of DR was higher in men and those with proteinuria. Another population-based study in South Kerala assessed the prevalence of diabetes and DR in a community-based screening programme. One hundred and sixty camps were held in five southern districts of Kerala (Project Trinetra) [8]. In a pilot hospital-based screening for DR from western India (n, 168) using ETDRS classification, prevalence of DR was 33.9 %; non-proliferative DR was 25.5 % and proliferative DR 8.33 % [9]. The current issue of the Journal reports on the risk factors for DR in sub-Saharan Africa, prevalence in a rural south Indian population, and on biomarkers for DR and screening methods. * G. R. Sridhar sridharvizag@gmail.com

A Profile of Common Morbidities among Elderly Rural Indian Population

Understanding health problems among elderly and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. The study was undertaken to document the prevalence of common morbidities among elderly rural population A community based cross sectional study was conducted on the census population aged 60 years & above residing permanently in the rural field practice area of Katihar Medical College using predesigned and pretested questionnaire with clinical assessment of morbidity status assessed using criteria of primary care by WONCA International Classification Committee. Gastro intestinal was most common disorder which constituted 51.04 percent of total study population. Osteoarthritis was present in 49.65 percent of total study population. Cardiovascular problems were seen in 41.29 percent population. Total respiratory morbidity (ARI, Asthma, and COPD) was seen in 41 percent of total study population. Total neurological morbidity (Epilepsy, Hemiplegia & Parkinsonism) was found in only 2.5 percent of total study population. Non-specific Generalized weakness was found in 22.73 percent of population. Diabetes mellitus was recorded only in 9.51 percent of population. Majority of the study population were Independent according to the total scores obtained from instrument of Activities of Daily living (ADL), which is 91.18 percent of the total participant. Almost 9 percent elderly needs some assistance. The present study showed that Government health facility was the most frequent (54.06%) first place of contact for health care among elderly. Only 22.97 percent of population went to private physician. 7.88 percent visited AYUSH, 5.10 percent Quacks & 9.98 percent used self-medication. The present study identified a high prevalence of morbidities in elderly age. It also pointed out various socio-demographic, nutritional, and environmental modifiable risk factors which can be tackled by effective behavior change communication of the community supported models as practiced in the developed countries.

Goat value chain development for empowering rural women in India

Small land holdings, low agricultural productivity and lack of employment opportunities, have compelled over 25% of the rural population in India, to live in poverty and livestock is a major source of their livelihood. In rural India, 33.014 million households keep goats; 70% of the 135.17 million goats are maintained by the poor for milk, meat, manure and emergency cash reserve. However, they have not been able to realise the potential of goat husbandry due to lack of veterinary services, financial support and market linkage. The only existing scheme of the Government of India during the XI Five Year Plan (2007-12), spent only 10% of the budget, due to poor interaction with goat keepers. In the absence of good extension network, new technologies could not be transferred to farmers.

Prevalence of obesity in a rural Asian Indian (Bangladeshi) population and its determinants.

BackgroundObesity has reached epidemic proportions worldwide including Bangladesh. To assess the prevalence and associated factors of general and central obesity in a rural Bangladeshi population based on newly proposed cut off level for Asian population.Methods2293 subjects aged ≥20 years from rural Bangladesh were randomly recruited to participate in a population-based, cross sectional survey, conducted in 2009. Both socio-demographic and anthropometric measurements were recorded. Age adjusted data for anthropometric indices were examined.ResultsThe age standardized prevalence of overweight (BMI 23-24.9 kg/m2) and obesity (BMI ≥25 kg/m2) were 17.7 (95 % confidence interval (CI): 16.1, 19.2 %) and 26.2 % (95 % CI: 24.4, 27.9 %), respectively. The age standardized prevalence of central obesity based on WC (M ≥90 & F ≥80 cm) and WHR (M ≥0.90 & F ≥0.80) were 39.8 % (95 % CI: 37.9, 41.7 %) and 71.6 % (95 % CI: 69.8, 73.4 %) respectively. The result shows that prevalence of central obesity was more in female than male. Study shows middle age, medium and high socioeconomic status (SES), low education levels, physical inactivity, high consumption of carbohydrate, protein and fat, were significant risk indicators for general and central obesity. Smoking was shown as protective factor for both general and central obesity.ConclusionsIn rural Bangladeshi population, the prevalence of both general and central obesity was high among both sexes with the use of newly proposed cut off points for Asian population. Gender, diet, physical activity, education levels and SES were associated with the increase prevalence of obesity.

A Cross sectional study to determine the prevalence of Diabetes Mellitus and its household awareness in the rural field practice areas of a medical college in Mangalore - A Pilot Study

Abstract Introduction: Diabetes mellitus is a major clinical and public health problem accounting for 4.6 million deaths annually world-wide. According to the recent World Health Organization report (WHO), India today leads the world with over 32 million diabetic patients and this number is projected to increase to 79.4 million by the year 2030(2). The recent surveys indicate that Diabetes now affects a large part of the population i.e. 10-16% of urban and 5-8% of rural population in India(1). Objectives: This study aims at estimating the prevalence of diabetes, the household awareness, the pattern and regularity of health seeking behaviour among the households for diabetes. Methodology: This cross sectional study was conducted among 40 households of Kuttar and Manjanady village of semi urban Mangalore. Data was collected using a structured questionnaire after pre-testing. Questions on awareness were prioritised, scored and then analysed. Likert scale was used to grade the awareness score. Results: Community prevalence of diabetes was found to be 7.7%. Out of the total population 8.8% of males and 6.8% of females were diabetics. Among the diabetics male and female distribution was equal i.e. 50%. Among the 7.7% of diabetics 50% of the subjects also had Hypertension. Awareness was average among 35% of the subjects. About 27.5% had poor score and 37.5% had very poor score for the awareness. Conclusions: Community prevalence was low. Lifestyle modification was not present among Diabetics. Awareness was poor among the households.

Quality of life of people with non communicable diseases

AbstractHypertension, Diabetes mellitus or both and asthma are very common chronic diseases among Indian rural population which needs continuous monitoring and treatment. Knowledge on disease management, lifestyle, and health care facilities are available which will have direct impact on their Quality of Life. Purpose: Purpose of the study was to identify the quality of life of people living with non-communicable diseases. The study will be helpful to provide need based care and to develop strategies to improve quality of life of community. Methods: A descriptive survey to assess the quality of life of people with non-communicable diseases measured by using WHO QOL BREF scale through interview method. Purposive sampling technique was used to select 200 subjects from selected villages of Udupi District. Result: showed that majority of subjects felt their quality of life was good [Median=4, IQR=3-4]. Majority of subjects [median=3, IQR=3-4] were neither satisfied nor dissatisfied towards their health. Compare to other domains psychological domain has Median=20, IQR=19-21 represents low quality of life. Overall quality of life of subjects with median=93 and IQR= 89- 98 represents good quality of life. Analysis based on diseases showed that people with diabetes mellitus had good quality of life as compared with people with other diseases. There was significant association between quality of life of subjects and age, education, occupation and marital status (P&lt;0.05). Conclusion: Study concluded that majority of the subjects were perceived their quality of life was good especially with those who have diagnosed as diabetes mellitus.

Alcohol Use-Related Problems Among a Rural Indian Population of West Bengal: An Application of the Alcohol Use Disorders Identification Test (AUDIT).

To examine alcohol use and related problems among a rural subset of the Indian population. The Alcohol Use Disorders Identification Test (AUDIT) was used as part of Health and Demographic Surveillance of 36,611 individuals aged ≥18 years. From this survey data on 3671 current alcohol users were analysed using bivariate and multivariate ordered logit regression. Over 19% of males and 2.4% of females were current alcohol users. Mean ethanol consumption on a typical drinking day among males was estimated to be higher (96.3 gm) than females (56.5 gm). Mean AUDIT score was 11 among current alcohol users. AUDIT showed in the ordered logit regression estimated alcohol use-related problems to be low among women, Scheduled Tribes and unmarried people, whereas alcohol use-related problems registered high among Muslims. This rural population appears to be in need of an effective intervention program, perhaps targeting men and the household, aimed at reducing the level of alcohol use and related problems.

Are hepatic and soleus lipid content, assessed by magnetic resonance spectroscopy, associated with low birth weight or insulin resistance in a rural Indian population of healthy young men?

To assess young healthy men from rural India, who had normal or low birth weights, using magnetic resonance spectroscopy to determine the potential differences in ectopic fat storage between birth weight groups, and to determine if ectopic fat storage was associated with insulin resistance in this population. A total of 54 lean men with normal birth weight and 49 lean men with low birth weight (age range 18-22 years) from rural India were recruited. All the men underwent anthropometry, magnetic resonance spectroscopy, a hyperinsulinaemic-euglycaemic clamp and a dual-energy X-ray absorptiometry. The median (interquartile range) values for hepatic cellular lipids, intramyocellular lipids and extramyocellular lipids, measured using magnetic resonance spectroscopy were 0.76 (0.1-1.8)%, 1.27 (1.0-2.3)% and 1.89 (1.3-3.2)%, respectively, for the normal birth weight group and 0.4 (0.1-1.3)%, 1.38 (0.9-2.2)% and 2.07 (1.2-2.8)%, respectively, for the low birth weight group (P > 0.05). No difference in ectopic fat storage was observed between the low and normal birth weight groups, with or without adjustment for age and total fat percentage. Homeostatic model assessment of insulin resistance values were not associated with hepatic cellular, intramyocellular or extramyocellular lipid content in any of the groups. Total fat percentage was the only independent predictor of intramyocellular and extramyocellular lipid content. Young and lean men from rural India with low birth weight were not observed to have ectopic fat storage in the liver or muscle, and the amount of liver and muscle fat was unrelated to insulin resistance. Older age and/or an urban affluent lifestyle may be required to show a potential role of ectopic fat storage on insulin resistance in Indian people with low or normal birth weight.

A Clinical Study of High Volume Camp Surgeries in a Tertiary Institute of Central India

Background: Blindness is one of the significant social problems in India with 7 million of the total 45 million blind people in the world residing in our country. If there is no change in the current trend of blindness, the number of blind persons in India would increase to 31.6 million in 2020.Apart from health and status of vision, there are many other socio-economic factors and perceptions, which influence the decision making of the people for getting operated for cataract. Productivity per individual surgeon/unit should be increased through a high volume, highquality cataract surgery approach to solve the problem of India’s curable blindness. As we are working in a Medical college hospital with experienced surgeons performing surgeries by Phaco-emulsification and utilizing the technique of manual small incision cataract surgery,planned study is undertaken to evaluate the results in a systematic manner. Aims and objectives: To analyze the outcome of cataract surgeries in camps in terms of duration of surgery, visual acuity, complications and their management. Material and Methods: It was a hospital-based, descriptive study. 3000 study subjects were recruited from the Department of Ophthalmology Chirayu medical College, Hospital from cataract camps, during three year period from December 2010 to December 2014. Results: In our study Mature cataract was seen in 41.2% cases.Intra operative complications were graded according to OCTET grading and was accounting for 5.30 %. Post-operative complications seen in our study was mild iritis 2.90%, severe iritis 2.28%, transient corneal oedema 4.20%, hypheama 1.17%, hypopyon 0.40%, residual cortex 1.20% and malposition of IOL seen in 3.30%. Levels of visual acuity after cataract surgery were categorized using the WHO guidelines of good outcome being 6/6 to 6/24, borderline outcome as 6/24 to 6/60 and poor outcome as <6/60 In the present study, the majority (89.5%) had a good outcome, (8.5 %) borderline, and (1.9)% cases had poor outcome, which implies that the visual outcome was very good. Conclusion - The study shows that high volume camp surgery plays a commendable role in transferring majority of elderly rural Indian population from the category of the blind and dependant to a group that is visually rehabilitated, independent, mobile and socially productive. A good choice of surgical technique, trained surgeons and paramedical personnel and good organizational setup can provide good visual outcome and increases the productivity per individual surgeon/unit to control blindness in developing world.

Adoption behavior of rural India for mobile telephony: A multigroup study

Mobile telephony influences nearly all aspects of people׳s lives and is expected to grow in importance as a revenue and information source. Mobile phones are reported to have a positive and significant impact on the overall economic performance of individuals and the growth of a country. In India, however, the adoption pace of mobile telephony in rural regions is slower than that in urban areas. We examine the differences in the intention to adopt mobile telephony across different segments of the rural Indian population using the extended technology acceptance model (TAM), partial least squares regression, and multigroup analysis. Results suggest that gender, age, technology subscription, and region play a moderating role on the relationships in the extended TAM for rural India. These findings can help service providers design and develop group-specific offerings that lead to faster adoption of mobile telephony in rural India.

Analysis of Snake Bite Victims in a Tertiary Care Center

Background: Snake-bite is a common cause of morbidity and mortality in tropical countries. In India, there are 216 species of snakes, of which only four (cobra, krait, Russell’s viper and saw scaled viper) are venomous. Objective: The aim of the study was to evaluate the epidemiological profile, clinical features, complications and mortality rate of snake bite victims admitted in a tertiary care hospital in Andhra Pradesh, India. Methods: The study was conducted at Mamata General Hospital, khammam from June 2010 to May 2012. A total of 39 cases with history of snake bite were analysed. Results: Out of 39 cases, majority of the cases were observed in the age group 20-50 year (66%). High incidence of snake bite was observed in males 62%). The common victims were farmers and housewives. The bite was commonly encountered while walking bare foot (30%) followed by while sleeping (14%). Fifty Four percent of victim were bitten during outdoor and agriculture related activities. Maximum number of cases (54%) presented within 12 hour of snake bite and 66% cases had 1-5 days of hospital stay. Majority (82%) were bitten on the legs below knee. Localized oedema at the site of bite was present in 70% victim. Fang/teeth marks were noted in (41%) cases. There were 59% neurotoxic snake bites, 26% haemolytic, 5% mixed and 8% non-poisonous snake bites. Most of the cases developed cellulitis at the site of snake bite (21%), shock (12%), and acute kidney injury (8%). One tenth of the cases required assisted ventilation and overall mortality rate was 8%.Conclusion: Snakebites are still common in the rural population of India. There is need to educate the public about the preventive measures of snake bite, advantages of early hospital referral and treatment.DOI: http://dx.doi.org/10.3126/hren.v12i1.11981 Health Renaissance 2014;12(1):24-28

Use of Cheiloscopy as a Tool for Gender Dimorphism in a Rural Indian Population

Use of Cheiloscopy as a Tool for Gender Dimorphism in a Rural Indian Population

Bridging the Service Divide Through Digitally Enabled Service Innovations: Evidence from Indian Healthcare Service Providers

The digital divide is usually conceptualized through goods-dominant logic, where bridging the divide entails providing digital goods to disadvantaged segments of the population. This is expected to enhance their digital capabilities and thus to have a positive influence on the digital outcomes (or services) experienced. In contrast, this study is anchored in an alternative service-dominant logic and posits that viewing the divide from a service perspective might be better suited to the context of developing countries, where there is a huge divide across societal segments in accessing basic services such as healthcare and education. This research views the prevailing differences in the level of services consumed by different population segments (service divide) as the key issue to be addressed by innovative digital tools in developing countries. The study posits that information and communication technologies (ICTs) can be leveraged to bridge the service divide to enhance the capabilities of service-disadvantaged segments of society. But such service delivery requires an innovative assembly of ICT as well as non-ICT resources. Building on concepts from service-dominant logic and service science, this paper aims to understand how such service innovation efforts can be orchestrated. Specifically, adopting a process view, two Indian enterprises that have developed sustainable telemedicine healthcare service delivery models for the rural population in India are examined. The study traces the configurations of three interactional resources--knowledge, technology, and institutions--through which value-creating user-centric objectives of increasing geographical access and reducing cost are achieved. The theoretical contributions are largely associated with unearthing and understanding how the three interactional resources were orchestrated for service-centric value creation in different combinative patterns as resource exploitation, resource combination, and value reinforcement. The analysis also reveals the three distinct stages of service innovation evolution (idea and launch, infancy and early growth, and late growth and expansion), with a distinct shift in the dominant resource for each stage. Through an inductive process, the study also identifies four key enablers for successfully implementing these ICT-enabled service innovations: obsessive customer empathy, belief in the transformational power of ICT, continuous recursive learning, and efficient network orchestration.