OBJECTIVE— This study aimed to assess the direct cost incurred by diabetic subjects who were in different income groups in urban and rural India, as well as to examine the changing trends of costs in the urban setting from 1998 to 2005. RESEARCH DESIGN AND METHODS— A total of 556 diabetic subjects from various urban and rural regions of seven Indian states were enrolled. A brief uniform coded questionnaire (24 items) on direct cost was used. RESULTS— Annual family income was higher in urban subjects (rupees [Rs] 100,000 or $2,273) than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P < 0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Lower-income groups spent a higher proportion of their income on diabetes care (urban poor 34% and rural poor 27%). After accounting for inflation, a secular increase of 113% was observed in the total expenses between 1998 and 2005 in the urban population. The highest increase in percentage of household income devoted to diabetes care was in the lowest economic group (34% of income in 1998 vs. 24.5% in 2005) (P < 0.01). There was a significant improvement in urban subjects in medical reimbursement from 2% (1998) to 21.3% (2005). CONCLUSIONS— Urban and rural diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families in developing countries is rising, and the total direct cost has doubled from 1998 to 2005.

This paper examined inadequate library services as a challenge to 21st century education in a developing economy. The paper portrayed the library as a collection of books and other information materials in various formats, properly arranged for the promotion of human knowledge, stressing that the 21st century library, with the integration of ICT and as a custodian of both books and non-book materials in diverse formats, is expected to have quantum of information available to users at all times, in order to promote constructive education. The paper takes the position that for Nigeria’s educational system to impact the knowledge and skills desired for development that endures, adequate library services must be provided at all levels of education. The paper reviewed that most libraries in Nigeria are plagued with outdated materials and lack the required facilities and resources to satisfy users’ needs, which result in inadequate library services, poor academic performance in entrance examinations, and poor reading culture which negatively affects educational development. This paper presents the absence of technological literacy, inadequate workforce, scarcity of sufficient resources, poor funding and power outage as causes of inadequate library services. The paper therefore recommends that the library staff should be trained and retrained to initiate and manage technological tools. The library should be stocked with required materials. Inter-library services should be upheld and an alternative means of power should be provided to avoid power interruption and its associated consequences on library services for the proper functioning of 21st century education.