Methods, equipment and techniques for rural health care and their evaluation

It is obvious that any strategy for village health care must involve the people actively--something that is more easily said than done. There is hardly any technology for rural health that does not have a significant software component. Why is it that so much that is known cannot be applied? What factors may be important in the diffusion of technology in a rural society? Technology must address itself to the needs as perceived by the people (in addition to what is perceived as their needs by the health care system). It must be compatible with the knowledge and skill levels of the community. Benefits must be visible to the community through appropriate assessment and feedback procedures so as to secure greater and greater involvement.     

Outness,Stigma, and Primary Health Care Utilization among Rural LGBT Populations

Background

Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.

Methodology

LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.

Results

Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.

Conclusions

The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.     

Children's Television,Radio, Internet,and Computer Usage in a City and a Village of China

A first step in understanding media consumption is to understand the time people spend using media, and how usage varies across demographic groups and in response to other factors. While there is ample research from the West, research from China is less evident. Here I provide a case study of children's media usage in a rural and an urban area in China. The findings showed that a greater proportion of children in the urban sample used media such as television, Internet, and computer games, and that rural–urban residency had the most significant influence on television viewing. Further, more urban children reported their parents had concerns about media usage, whereas a greater proportion of children in the rural area had televisions in their bedrooms and ate meals while watching television. This difference was explained by differences in socio-economic levels, traditional values, and educational background. The findings show that the rural–urban difference, and other factors such as parental concern, should be considered when conducting and interpreting media consumption. There also are implications for health because a large proportion of children in the present study had televisions in their bedrooms and ate while watching television, and such behaviors in the West have been associated with unhealthy lifestyles.     

基于GIS的农村住区生态重要性空间评价及其分区管制--以兴国县长冈乡为例

在我国加速新农村建设阶段,如何协调好村镇建设与地域生态系统的关系成为当前规划界的热点问题之一。基于GIS技术,从水资源安全、生物保护、灾害防护和人类干扰等4个方面,构建了空间尺度上的生态重要性综合指数,对兴国县长冈乡生态重要性空间进行了评价, 并制定了分区管制的措施,以便从宏观上预防乡村建设可能带来的生态安全问题。提出的评价方法将有利于指导我国新农村建设规划,开展生态保育和生态建设,维护农村生态系统健康与安全。     

A Survey of Dog Populations in Urban and Rural Areas of Yucatan,Mexico

ABSTRACT

A survey in a major Mexican city (Merida) and three rural communities was conducted to generate information regarding the size and structure of the owned-dog populations and people's opinions about the dogs and how they took care of them. Household characteristics and dog population size, health and reproductive issues were compared between the two kinds of communities: urban and rural. A telephone survey was conducted in Merida city whereas personal interviews were used in the rural communities. Local veterinarians were also interviewed to evaluate their influence on the dog populations in Merida city. The ratio of people to dogs was 3.4:1 in the city, and 1.7:1 to 4.6:1 in the different rural communities. In general it was more common to find a dog-owning household in the city of Merida (72.8%) than in the rural areas (63.6%, 65.5% and 71.1%), and in the city more households had adequate fences to restrain dogs. Larger families were more likely to own a dog than small families. Households of medium socio-economic status had a significantly higher probability of owning a dog than households of low or high socio-economic status. Of the dogs in the city, 90.1% were vaccinated against rabies compared with 62.3% of the dogs in the rural communities. Most animals were intact; the frequency of neutering/spaying was 3.1% in Merida and 1.8% in the rural communities. Few private veterinary practitioners were involved in the control of dog overpopulation. It is concluded that dogs are popular pets both in urban and rural Yucatan. People's opinions about dogs and the level of supervision varied with socio-economic status, and people in the city provided better food, shelter and preventive medicine. The veterinary practitioners did little to promote the control of dog breeding or to reduce the relinquishing of unwanted dogs in the city. Better client education and the promotion of sterilization of pets at low cost would improve the situation.     

Snakebite and Its Socio-Economic Impact on the Rural Population of Tamil Nadu,India

Background

Snakebite represents a significant health issue worldwide, affecting several million people each year with as many as 95,000 deaths. India is considered to be the country most affected, but much remains unknown about snakebite incidence in this country, its socio-economic impact and how snakebite management could be improved.

Methods/Principal Findings

We conducted a study within rural villages in Tamil Nadu, India, which combines a household survey (28,494 people) of snakebite incidence with a more detailed survey of victims in order to understand the health and socio-economic effects of the bite, the treatments obtained and their views about future improvements. Our survey suggests that snakebite incidence is higher than previously reported. 3.9% of those surveyed had suffered from snakebite and the number of deaths corresponds to 0.45% of the population. The socio-economic impact of this is very considerable in terms of the treatment costs and the long-term effects on the health and ability of survivors to work. To reduce this, the victims recommended improvements to the accessibility and affordability of antivenom treatment.

Conclusions

Snakebite has a considerable and disproportionate impact on rural populations, particularly in South Asia. This study provides an incentive for researchers and the public to work together to reduce the incidence and improve the outcomes for snake bite victims and their families.     

Maternal adverse childhood experiences,child mental health,and the mediating effect of maternal depression: A cross-sectional,population-based study in rural,southwestern Uganda

Objectives

This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health.

Methods

Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis.

Results

Among 218 mother–child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership.

Conclusions

Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.     

Rural Medicine—Making It Now,and the Problems Ahead

King City, California, a small remote town among thousands in the nation, has demonstrated that private physicians and federal funds can jointly develop effective health care delivery mechanisms to serve residents of all incomes with a full complement of hospital and outpatient services as well as community health programs. Young health care professionals can be drawn to the traditionally difficult-to-serve rural areas. Unanswered is the problem of developing and maintaining an adequate funding base for health services in rural communities in the face of a disproportionately large number of poor people with a sub-optimal job future. The dollar resources in the rural community are often simply inadequate to buy needed health and social services.     

HOW TO CONNECT BIOETHICS AND ENVIRONMENTAL ETHICS: HEALTH, SUSTAINABILITY, AND JUSTICE

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice.     

Tobacco talk: reflections on corporate power and the legal framing of consumption

This article examines how North Carolina tobacco farmers think about the moral ambiguities of tobacco business. Drawing on ethnographic research with tobacco farmers and archival research on the tobacco industry, I specify the core psychological defense mechanisms that tobacco companies have crafted for people associated with the industry. I also document local social, cultural, and economic factors in rural North Carolina that underpin ongoing rural dependence on tobacco despite the negativity that surrounds tobacco and structural adjustments. This article contributes to our knowledge about tobacco farmers and tobacco farming communities, which is important for tobacco-control strategies. I reflect on ethical and economic paradoxes related to the rise of corporate social responsibility in the tobacco industry, where an official legal framing of consumption, focused on informed adult consumer autonomy and health education, is promoted to undermine more robust public health prevention efforts.     

Community perceptions and treatment-seeking behaviour regarding reproductive tract infections including sexually transmitted infections in Lao PDR: a qualitative study

Creating community awareness of reproductive tract infections (RTI), including sexually transmitted infections (STI), and how to prevent them is essential to minimize their spread. Data on people's views about RTI/STI are entirely lacking in Laos. The aim of this study was thus to explore people's perceptions, treatment-seeking behaviour and understanding of information about RTI/STI, in urban and rural communities in two provinces in Laos. Fourteen focus group discussions and 20 in-depth interviews were held with 76 women and 56 men, selected purposively to provide diversity of socio-demographic backgrounds. Qualitative content analysis was employed for the data analysis. The major finding was that both male and female participants had a variety of misconceptions about the causes and symptoms of RTI/STI and their cure, and a reluctance to seek health care, which could cause delay in appropriate diagnosis and treatment. The most common treatment-seeking behaviour was self-medication through private pharmacies, following advice mostly given by friends and drug sellers. The main reasons for not going to health facilities were fear of social discrimination or shyness of genital examination. Complaints were also made about clinicians' negative attitudes towards 'dirty disease'. Although condom use was mentioned as a way to prevent RTI/STI, an unwillingness to use condoms was commonly expressed. The main media sources of RTI/STI information were radio and television, and access to health information was more difficult in rural areas. The health messages provided were mostly understood, except for some technical terms. The findings indicate that strengthening health education and promotion through interventions at the community level is recommended to improve quality of RTI/STI management. Health education messages should be more accessible in rural areas. There is also an urgent need to improve communication between RTI/STI patients and clinicians.     

The Medical System in Ghana

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women’s health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.     

Rural, suburban and urban differences in the self-diagnosis of coronary heart disease in the United States

This study explores rural, suburban and urban differences in coronary heart disease (CHD) using the 2005 Behavior Risk Factor Surveillance Survey conducted in the United States. Although areal context is not often considered in morbidity studies, this study evaluates the importance of place of residence given that areas offer differential access to health infrastructures and different contextual factors that could affect health. Also examined is the role of geographic heterogeneity on the recent racial divergence in CHD in the United States. Results indicate that area of residence is associated with CHD diagnosis, net of health and demographic variables. The area-stratified analysis documents that rural residents are most impacted by exercise and smoking, while being male or above age 50 are most detrimental for suburban residents. In addition, the racial divergence in CHD is driven by differences in rural locales. These findings indicate a disparate impact of geography on CHD and highlight the need for health research to take into account areal context.     

Towards Enhancing Community Health in El-Fayoum,Egypt, Using Ecosystem Approaches

Ecosystem degradation caused by factors such as improper natural resources management and contamination with agricultural, industrial, and domestic wastes often results in the creation of an unhealthy ecosystem, a main cause for the prevailing poverty and poor health in many parts of rural Egypt. In collaboration with members of the community in some villages of El-Fayoum province, an interdisciplinary research team is currently employing an ecosystem approach to arrive at an understanding of community health problems with a view to develop resource management interventions and policies aimed at enhancing community health and well-being. Participatory rural appraisal (PRA) and knowledge, attitudes, and practices (KAP) techniques were used to measure the perceptions of the community’s men and women of their health and environmental priorities, and to test their current state of knowledge and awareness of the health-related issues. The results indicate that these perceptions were gender-sensitive and were different from those of Ministry of Health. Spatial and temporal monitoring and assessment of the ecosystem components revealed considerable land and water resources degradation. Presence of water pools and waterways in the vicinity of the residential areas enhanced the risk of water-associated diseases. Although, the disease-carrying vectors of schistosomiasis and malaria were detected in the waterways, the incidence of the two diseases was relatively low in the main village in contrast to the situation in the nearby hamlets. Prevalence of schistosomiasis was substantially higher in these hamlets (20–30% compared to 2–3% in the main village). Such a highly infected community represents a continuous pool of reinfection of the waterways, an issue that needs to be further examined to determine its relation to the hamlets’ specific ecosystem characteristics. A high incidence of hepatitis C and soil transmitted-intestinal parasites were markedly detected. It is concluded that in addition to natural resources degradation, other potential health risk factors were identified including socioeconomic, cultural, and institutional factors. Further studies are being conducted to explore these potential risk factors and their links to human health and well-being.     

Behavioral risk factors for obesity during health transition in Vanuatu,South Pacific

The South Pacific archipelago of Vanuatu, like many developing countries, is currently experiencing a shift in disease burdens from infectious to chronic diseases with economic development. A rapid increase in obesity prevalence represents one component of this “health transition.” Objective: To identify behaviors associated with measures of obesity in Vanuatu. Design and Methods: Five hundred and thirty four adults from three islands varying in level of economic development were surveyed. Height, weight, waist, and hip circumferences; triceps, subscapular and suprailiac skinfolds; and percent body fat (%BF) by bioelectrical impedance were measured. Diet through 24‐h dietary recall and physical activity patterns using a survey were assessed. We analyzed prevalence of obesity and central obesity based on multiple indicators (body mass index, %BF, waist circumference, and waist‐to‐height ratio), and analyzed differences among islands and associations with behavioral patterns. Results: Obesity prevalence was lowest among rural and highest among suburban participants. Prevalence of central obesity was particularly high among women (up to 73.9%), even in rural areas (ranging from 14.7 to 41.2% depending on the measure used). Heavier reliance on animal protein and incorporation of Western foods in the diet—specifically, tinned fish and instant noodles—was significantly associated with increased obesity risk. Conclusions: Even in rural areas where diets and lifestyles remain largely traditional, modest incorporation of Western foods in the diet can contribute to increased risk of obesity. Early prevention efforts are thus particularly important during health transition. Where public health resources are limited, education about dietary change could be the best target for prevention.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems     

Perceptions of men on role of religious leaders in reproductive health issues in rural Pakistan

Religion holds unique importance in people's lives, and has been cited as an important factor in reproductive health. Pakistan has a Muslim majority and the character of the country is strongly marked by Islam. In rural areas, where the majority of the population reside, religious leaders are considered as opinion makers. The perception of adult males regarding the influence of the 'religious factor' in their use of modern contraceptive methods, and their views on the role of religious leaders in community education, were explored through a cross-sectional survey conducted in twelve rural districts of Pakistan in 2000. A sample of 180 married adult males participated in the study through consecutive sampling. The study was qualitative, utilizing tools such as in-depth and key-informant interviews. The majority of men interviewed considered that religious leaders were against fertility control, and 29% cited religion as a reason for their non-use of modern contraceptives. Respondents also suggested that the involvement of religious leaders in reproductive health programmes is essential for the programmes' effectiveness in rural areas. They thought that religious leaders could contribute positively to community education, and suggested ways in which they could educate the community in reproductive health issues. They also suggested various channels through which religious leaders could be approached to convince them to cooperate in reproductive health programmes. The study concludes that involving religious leaders in rural settings could enable reproductive health programmes and services to reach more conservative groups in society, and thus contribute effectively to bringing about positive change in the attitudes of Pakistani society towards reproductive health.     

Soil-Transmitted Helminths in Southwestern China: A Cross-Sectional Study of Links to Cognitive Ability,Nutrition, and School Performance among Children

BackgroundEmpirical evidence suggests that the prevalence of soil-transmitted helminth (STH) infections in remote and poor rural areas is still high among children, the most vulnerable to infection. There is concern that STH infections may detrimentally affect children’s healthy development, including their cognitive ability, nutritional status, and school performance. Medical studies have not yet identified the exact nature of the impact STH infections have on children. The objective of this study is to examine the relationship between STH infections and developmental outcomes among a primary school-aged population in rural China.Conclusions/SignificanceWe find that STH infection still poses a significant health challenge among children living in poor, rural, ethnic areas of southwest China. Given the important linkages we find between STH infection and a number of important child health and educational outcomes, we believe that our results will contribute positively to the debate surrounding the recent Cochrane report.     

Poverty, health infrastructure and the nutrition of Peruvian children

This paper offers empirical evidence on the impact of the expansion in health infrastructure of the 1990s upon child nutrition in Peru, as measured by the height for age z-score. Using a pooled sample of three rounds of the Peruvian DHS, I have controlled for biases in the allocation of public investments by using a district fixed effects model. The econometric analysis shows a positive effect of the expansion of the last decade in urban areas, but not in rural areas. Furthermore, the effect for urban children is highly non-linear and has a pro-poor bias, in the sense that the estimated effect is larger for children of less educated mothers. These findings support the idea that reducing distance and waiting time barriers is necessary to improve child health and nutrition in developing countries, but that we need more explicitly inclusive policies to improve the health of the rural poor, especially indigenous groups, that are caught in this type of poverty trap.     

Socio-economic transition, inequality, and mortality in Lithuania.

The study assessed inequalities in mortality of Lithuanian urban and rural populations throughout the period of socio-economic transition (1990-2000). Mortality from major causes of death, except cancers in females, was higher among the rural population. Inequality in mortality increased during the period of transition, especially among males, mainly due to more rapidly improving health of the urban population. Cardiovascular diseases and external causes made the largest contribution to the inequality. Differences in mortality of urban and rural populations point to greater social and psychological stress affecting the rural population, unhealthy life styles, inequities in accessibility of health care and lack of preventive programs in rural areas.