Broad Access Research Articles

The Association among Malaria in Pregnancy, Neonatal inflammation, and Neurocognitive Development in a Cohort of Malawian Infants.

Malaria in pregnancy (MIP) causes poor birth outcomes, but its impact on neurocognitive development has not been well characterized. Between 2012 and 2014, we enrolled 307 mother-infant pairs and monitored 286 infants for neurocognitive development using the Malawi Developmental Assessment Tool at 6, 12, and 24 months of age. MIP was diagnosed from peripheral blood and placental specimens. Cord blood cytokine levels were assessed for a subset of neonates. Predictors of neurodevelopment were examined using mixed-effect logistic regression for developmental delay. Among the participants, 78 mothers (25.4%) had MIP, and 45 infants (15.7%) experienced severe neurocognitive delay. MIP was not associated with differences in cord blood cytokine levels or neurocognitive development. Preterm birth, low birthweight, increasing maternal education level, and increasing interleukin 6 levels were associated significantly with delay. The results highlight the prevalence of severe delay and a need for broad access to early childhood support in this setting.

The Relationship Between Access to Abortion and Mental Health in Women of Childbearing Age: Analyses of Data From the Global Burden of Disease Studies.

Background It has often been suggested that restricting access to legal abortion could have a negative impact on the mental health of women seeking this procedure. The recent judgment of the United States Supreme Court in the Dobbs case has brought the question of the psychological impactof changes in abortion policy into focus. The results of studies on the link between induced abortion and mental health are contradictory, and interpreting the results of these studies is complex due to a multitude of potential confounding factors. However, there is little data on the relationship between the availability of legal abortion and its effects onthe mental health of women of childbearing age in the general population. Objective The objective of the current study was to examine cross-sectional and longitudinal associations between access to legal abortion and the prevalence of common mental disorders in women of childbearing age at a cross-national level while correcting for potential confounding factors. Methods The current study employs both cross-sectional and longitudinal analyses of nation-level data for 197 countries and regions. As data on global abortion policy were compiled in 2009 and 2017 by the Guttmacher Institute, data on access to legal abortion for these yearswere examined in relation to the prevalence of anxiety disorders and depression in women of childbearing age for each country, obtained from the Global Burden of Disease Studies for the most recent subsequent year (2010 and 2019). The relationship between changes in abortion policy and changes in the prevalence of these disorders in each country was examined for the aforementioned period. All analyses were adjusted for the potential confounding effects of gender development, gender inequality, and intimate partner violence. Cross-sectional associations were examined using Pearson's bivariate and partial correlations, while longitudinal associations were examined using a general linear model and analyses of covariance. Results At the cross-sectional level, broad legal access to abortion was associated with a lower prevalence of depression in women aged 25-49 years, however, this association was not significant after correcting for measures of gender development, gender inequality, and intimate partner violence. At the longitudinal level, a slight but significant decrease in the prevalence of anxiety disorders in women aged 25-49 years was observed in countries where access to legal abortion was broadened in the period 2009-2017. This association remained marginally significant after adjustment for the above confounders. Conclusions The current study suggests that there is a modest relationship between access to legal abortion and its effects on themental health of women aged 25-49 years. However, this relationship appears to be largely indirect in nature and influenced by factors, such as gender development, gender inequality, and intimate partner violence. These results may lead to further exploration of the links between reproductive rights and mental health of women in the general populationand drawattention to the influence of gender inequality and intimate partner violence on mental health of women of childbearing age.

Abstract 10019: Access to Specialty Cardiovascular Care and Uptake of Cardioprotective Anti-Hyperglycemic Agents Among Adults With Type 2 Diabetes: A Cohort Study

Background: Sodium glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are the only cardioprotective anti-hyperglycemic medications, but have had limited use. We evaluated whether access to specialty cardiovascular care improves the uptake of these cardioprotective medications in type 2 diabetes (T2D). Methods: In a retrospective cohort study between Jan 2019 and Dec 2020, beneficiaries with Medicare Advantage or commercial insurance were followed using Optum Labs’ de-identified administrative claims for the initiation of SGLT-2i and GLP-1RA among eligible adults with T2D across specialty visits. Eligibility included atherosclerotic cardiovascular disease (ASCVD), heart failure, or diabetic nephropathy for SGLT-2i and ASCVD for GLP-1RA. Detailed demographic and comorbidity information was obtained from the year before cohort enrollment. Results: Among eligible individuals for SGLT-2i (N=294,988) and GLP-1RA (N=198,525), 10.4% and 16.7% initiated these medications during the study period, respectively. Overall, 57% of those with an indication for SGLT-2i and 64% for GLP-1RA had at least one visit with a cardiologist. After accounting for differences in clinical characteristics and comorbidities, those with a visit with a cardiologist had higher odds of initiating SGLT-2i (OR = 1.26 [1.21-1.30]) and GLP-1RA (OR=1.05 [1.01-1.10]). However, these were not higher than those receiving care from family medicine and internal medicine providers and were substantially lower than those receiving care from an endocrinologist (Figure). Conclusion: In 2019-2020, among insured individuals with compelling CV indications, despite broad access to cardiovascular care, receiving care from cardiologists was only modestly associated with uptake of novel therapies. Efforts to improve the use of these medications are less likely to benefit from efforts to broaden access to specialty cardiovascular care.

Influence of Selected Indicators of Healthcare System Functioning Evaluation on the Health Result.

According to the World Health Organization's statistics, 7 of the 10 main causes of death in 2019 were noncommunicable diseases. Health indicators are measures used to evaluate public health system effectiveness and functioning. Monitoring mortality rates from leading causes, life expectancy and other health indicators is essential to address their causes and adapt health systems to react adequately. The aim of this study is to present the dependencies of selected health care indicators and health outcomes. Based on the literature review conducted, selected health indicators, along with healthcare system data, were analyzed using Pearson's r correlation. The analyses included data from the Organization for Economic Cooperation and Development (OECD) presented in statistics and the Health at a Glance 2021 report and data collected as part of the preparation of the Financing Global Health 2020 report by the Institute for Health Metrics and Evaluation. Health system resources are linked to health outcomes. The number of medical consultations, the number of nurses per patient or the level of financing of services under general health insurance are related to life expectancy and deaths due to causes that could have been avoided or treated. Life expectancy is positively correlated with access to general health insurance and public expenditure on healthcare. There is a need for all countries to provide their citizens with broad access to healthcare services.

An Expanded Vision of the Value of Postsecondary Education: Regional Public Universities as Broadly Accessible Anchor Institutions

An Expanded Vision of the Value of Postsecondary Education: Regional Public Universities as Broadly Accessible Anchor Institutions

From months to minutes: Creating Hyperion, a novel data management system expediting data insights for oncology research and patient care

Here we describe the design and implementation of a novel data management platform for an academic cancer center which meets the needs of multiple stakeholders. A small, cross-functional technical team identified key challenges to creating a broad data management and access software solution: lowering the technical skill floor, reducing cost, enhancing user autonomy, optimizing data governance, and reimagining technical team structures in academia. The Hyperion data management platform was designed to meet these challenges in addition to usual considerations of data quality, security, access, stability, and scalability. Implemented between May 2019 and December 2020 at the Wilmot Cancer Institute, Hyperion includes a sophisticated custom validation and interface engine to process data from multiple sources, storing it in a database. Graphical user interfaces and custom wizards permit users to directly interact with data across operational, clinical, research, and administrative contexts. The use of multi-threaded processing, open-source programming languages, and automated system tasks (normally requiring technical expertise) minimizes costs. An integrated ticketing system and active stakeholder committee support data governance and project management. A co-directed, cross-functional team with flattened hierarchy and integration of industry software management practices enhances problem solving and responsiveness to user needs. Access to validated, organized, and current data is critical to the functioning of multiple domains in medicine. Although there are downsides to developing in-house customized software, we describe a successful implementation of custom data management software in an academic cancer center.

The Impact of Islamic Financial Inclusion on Micro-Enterprises Capital: The Case of Sumedang Regency

Financial inclusion is essential, especially for small and micro-enterprises who often experience issues accessing financial institutions. This inclusion aims to eliminate all financial barriers, including price and non-price, to public access to financial services to reduce societal inequality. This study aims to analyze the effect of Islamic financial inclusion on the capital growth of micro-enterprises in the Sumedang Regency. Employing descriptive analysis and SEM-PLS on primary data with 100 respondents from micro-enterprises who used financial services, the results show that respondents' average Islamic financial inclusion was 59 percent, above the national level. It also found that Islamic financial inclusion had a positive effect on the development of micro-enterprise capital, which indicates that people classified in the micro-business group have broad access to Islamic financial products and services might increase business capital. In addition, the influence of Islamic financial inclusion and mentoring variables on positive capital development means that any increase in the value of Islamic financial inclusion and mentoring will increase capital development.

Inovasi Pelayanan Pengaduan Masyarakat Melalui Aplikasi Wargaku Berbasis Android di Dinas Komunikasi dan Informatika Kota Surabaya

One form of effort to improve the quality of public services is to provide broad access to the public to submit complaints on public services provided by the organizers. With this wide access, it is hoped that the community can actively participate in encouraging the realization of excellent public services. Some public services that receive complaints, have not been able to answer complaints submitted from the community to optimally overcome these conditions, it is necessary to make efforts to improve the implementation of public services, especially in complaint services to achieve quality and optimal public services. As an embodiment in this case, it is necessary to make a new breakthrough in public services in the form of innovation. The Wargaku application is a breakthrough for the Surabaya City Government as a form of public service, namely a responsive and informative complaint service. The purpose of this research is to find out, describe and analyze the application of Public Complaint Service Innovation through the Android-Based Wargaku Application at the Surabaya City Communication and Information Office. The type of research used is descriptive qualitative. In this study using data collection techniques in the form of interviews with informants, observations, and documentation. Furthermore, the data analysis model in this study uses an interactive data analysis model consisting of data collection, data presentation, data condensation, and drawing conclusions. The results obtained from this study indicate that the application of the complaint service system through the Wargaku application at the Surabaya Communication and Information Service in service has experienced a good improvement. Then in terms of innovation, the application of public complaints services through the Wargaku application has fulfilled the needs of the community in facilitating complaint services in the city of Surabaya.

Preventable mortality among sexual minority Canadians

BackgroundEpidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)—i.e., bisexual, lesbian, gay—and heterosexual adults in Canada. MethodsA population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18–59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003–2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models. ResultsSM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58). ConclusionsPreventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded.

Effectiveness of Telemedicine and Teledentistry after the COVID-19 Pandemic.

Telemedicine has become increasingly important worldwide over the last two decades. As a new field, it became known especially during the COVID-19 pandemic; this review presents fields of activity with special attention to opportunities and risks. Numerous areas of application offer the possibility for broad use in the medical and dental care landscape in diagnostics, therapy, rehabilitation, and decision advice across a spatial distance. Technical and semantic standards are required, and profiles and guidelines are increasingly defined and organized. Medical/dental consultations have been established in various regions around the world as a response to pandemic challenges and have made video and online emergency consultations possible. Telemedicine applications are already regularly used in medical/dental emergencies, regardless of the pandemic situation, both for transport by train and by plane, from which patients benefit. However, legal hurdles are often still unresolved, but infrastructure challenges both for provider, user hard- and software also complicate deployment. Problems are particularly prevalent in the absence of necessary internet coverage or among socially disadvantaged and vulnerable groups who cannot afford expensive equipment or do not know how to use the technology. Broad access must be enabled, and hardware and software interfaces and updates must be regularly checked and updated. Telemedicine might also improve access to and delivery of oral and general health care support both for rural and urban areas with low costs. Even though dentistry and many medical specialties are still performed clinically by means of practical/manual examination, there are areas of diagnostics where telemedicine applications can provide good support. Therefore, as conclusions, access, and delivery of telemedicine applications in dentistry and medicine should be expanded and improved to provide access to all population groups.

NANORAY-312: A Phase III Pivotal Study of NBTXR3 Activated by Investigator's Choice of Radiotherapy Alone or Radiotherapy in Combination with Cetuximab for Platinum-Based Chemotherapy-Ineligible Elderly Patients with Locally Advanced HNSCC

<h3>Purpose/Objective(s)</h3> Elderly patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are largely underrepresented in clinical trials (CT). This population lacks broad access to CTs due to an increased prevalence of comorbidities and age-related conditions. However, as population aging increases, more elderly patients will be diagnosed with LA-HNSCC although many will not be eligible to receive standard cisplatin-based concurrent chemoradiation (CRT). Toxicities, treatment burden and compliance associated with cisplatin are a concern. NBTXR3, a first-in-class radioenhancer, is composed of functionalized hafnium oxide nanoparticles, administered by a one-time intratumoral injection and activated by radiotherapy (RT). It has EU marketing approval for preoperative treatment of locally advanced soft tissue sarcomas. NBTXR3 locally amplifies tumor-killing effects of radiotherapy without adding toxicity to surrounding healthy tissue. NBTXR3 has been shown to prime the adaptive immune response in cancer models. In a Phase I trial of NBTXR3 + RT alone in elderly LA-HNSCC patients, this combination was shown to be safe and an Objective Response Rate (ORR) of 85.4% and CRR of 51.2% was reported at ASTRO 2021. A pivotal randomized phase III study is now recruiting. <h3>Materials/Methods</h3> NANORAY-312 is a global, open-label, randomized (1:1), 2-arm, Phase III (Pivotal Stage) study to investigate the efficacy and safety of NBTXR3/RT ± cetuximab versus RT ± cetuximab (Investigator's choice) in treatment-naïve, platinum-ineligible, elderly patients with LA-HNSCC. 500 patients will be enrolled. Eligible patients are ≥65 years with at least one measurable (RECIST 1.1) biopsy-confirmed T3-4 (AJCC v8) SCC of the oral cavity, oropharynx, hypopharynx, or supraglottic larynx which is amenable for intratumoral injection. Patients will receive IMRT (70 Gy in 35 fractions / 7 weeks). For patients with oropharyngeal cancer, human papilloma virus (HPV) status must be declared. In addition to the primary tumor, a single accessible LN in the neck is considered an eligible site for intranodal injection. <h3>Results</h3> The primary endpoint is PFS. The key secondary endpoint is OS. Other secondary endpoints include ORR, safety and tolerability, and quality of life. Exploratory endpoints include tumor immune response biomarkers, and radiographic change in the size of the tumor after 50 Gy of RT. Enrollment began in January 2022 and continues. <h3>Conclusion</h3> NBTXR3/RT ± cetuximab is under investigation in elderly patients with LA-HNSCC, a population which is underrepresented in clinical trials and with limited treatment options. This study has the ClinicalTrials.gov identifier NCT04892173.

BLASTNet: A call for community-involved big data in combustion machine learning

Many state-of-the-art machine learning (ML) fields rely on large datasets and massive deep learning models (with O(109) trainable parameters) to predict target variables accurately without overfitting. Within combustion, a wealth of data exists in the form of high-fidelity simulation data and detailed measurements that have been accumulating since the past decade. Yet, this data remains distributed and can be difficult to access. In this work, we present a realistic and feasible framework which combines (i) community involvement, (ii) public data repositories, and (iii) lossy compression algorithms for enabling broad access to high-fidelity data via a network-of-datasets approach. This Bearable Large Accessible Scientific Training Network-of-Datasets (BLASTNet) is consolidated on a community-hosted web-platform (at https://blastnet.github.io/), and is targeted towards improving accessibility to diverse scientific data for deep learning algorithms. For datasets that exceed the storage limitations in public ML repositories, we propose employing lossy compression algorithms on high-fidelity data, at the cost of introducing controllable amounts of error to the data. This framework leverages the well-known robustness of modern deep learning methods to noisy data, which we demonstrate is also applicable in combustion by training deep learning models on lossy direct numerical simulation (DNS) data in two completely different ML problems — one in combustion regime classification and the other in filtered reaction rate regression. Our results show that combustion DNS data can be compressed by at least 10-fold without affecting deep learning models, and that the resulting lossy errors can even improve their training. We thus call on the research community to help contribute to opening a bearable pathway towards accessible big data in combustion.

Practical Network Modeling via Tapered Exponential-Family Random Graph Models

Exponential-family Random Graph Models (ERGMs) have long been at the forefront of the analysis of relational data. The exponential-family form allows complex network dependencies to be represented. Models in this class are interpretable, flexible and have a strong theoretical foundation. The availability of powerful user-friendly open-source software allows broad accessibility and use. However, ERGMs sometimes suffer from a serious condition known as near-degeneracy, in which the model exhibits unrealistic probabilistic behavior or a severe lack-of-fit to real network data. Recently, Fellows and Handcock proposed a new model class, the Tapered ERGM, which circumvents the issue of near-degeneracy while maintaining the desirable features of ERGMs. However, the question of how to determine the proper amount of tapering needed for any model was heretofore left unanswered. This article develops a new methodology for how to determine the necessary level of tapering and as such provides a new approach to inference for the Tapered ERGM class. Noting that a Tapered ERGM can always be made nondegenerate, we offer data-driven approaches for determining the amount of tapering necessary. The mean-value parameter estimates are unaffected by tapering, and we show that the natural parameter estimates are numerically weakly varying by the level of tapering. We then apply the Tapered ERGM to two published networks to demonstrate its effectiveness in cases where typical ERGMs fail and present the case for Tapered ERGMs replacing ERGMs entirely.

MEMPROGRAMKAN AKSES PEMBIAYAAN SYARIAH BAGI USAHA MIKRO KECIL DAN MENENGAH DESA PURASEDA, KECAMATAN LEUWILIANG, BOGOR

Efforts in alleviating poverty can be done, among others, by breaking the chain of poverty itself,for example by providing broad access to financing sources for Micro, Small and MediumEnterprises (MSMEs) which are applied by Islamic banking and Islamic microfinance institutions.One source of funding is sharia-based banking and financial institutions. Islamic banking andSharia Microfinance Institutions (LKMS) including in this case Baitul Mal wat Tamwil (BMT)have an important role in the development of MSME actors, especially in terms of funding andbusiness capital. With this in mind, access to sharia financing was programmed for MSMEs inPuraseda Village, Leuwiliang District, Bogor.

Mice in translational neuroscience: What R we doing?

Animal models play a pivotal role in translational neuroscience but recurrent problems in data collection, analyses, and interpretation, lack of biomarkers, and a tendency to over-reliance on mice have marred neuroscience progress, leading to one of the highest attrition rates in drug translation. Global initiatives to improve reproducibility and model selection are being implemented. Notwithstanding, mice are still the preferred animal species to model human brain disorders even when the translation has been shown to be limited. Non-human primates are better positioned to provide relevant translational information because of their higher brain complexity and homology to humans. Among others, lack of resources and formal training, strict legislation, and ethical issues may impede broad access to large animals. We propose that instead of increasingly restrictive legislation, more resources for training, education, husbandry, and data sharing are urgently needed. The creation of multidisciplinary teams, in which veterinarians need to play a key role, would be critical to improve translational efficiency. Furthermore, it is not usually acknowledged by researchers and regulators the value of comparative studies in lower species, that are instrumental in toxicology, target identification, and mechanistic studies. Overall, we highlight here the need for a conceptual shift in neuroscience research and policies to reach the patients.

The demand-side mitigation gap in German passenger transport

Deep transport decarbonisation requires not only technological measures, but also large-scale changes towards sustainable mobility behaviour. Researchers and decision-makers need suitable tools for corresponding strategy development on a macroscopic scale. Aiming at broad accessibility to such methods, this paper presents an open source passenger transport model for policy analysis in German medium- to long-distance transport. It discusses model design and data, limitations, alternative approaches, and its base year results and concludes, that macroscopic transport modelling is very suitable for policy analysis on national scales. Alternative approaches promise more insight on smaller scales. As an exemplary case study, the model is applied to ambitious technology projections for the year 2035, showing the ambition gap towards reaching the 1.5 degree-target of the Paris Agreements. Results indicate that 66 million tCO_{2eq} per year must be mitigated through further technological substitution or demand-side mitigation strategies.

Broadening energy access for poor households in rural malawi: How pico solar, mobile money, and cloud-based services are being combined to address energy exclusion

Solar lighting has become the primary lighting source for households within rural Malawi, where many households remain off-grid and are unable to afford the purchase of large, independent power systems. However, this success has not been without its challenges. The paradox is that, historically, even the lowest cost systems require an initial investment beyond the means of low-income households, and hence necessitate the use of expensive and exploitative financing options, such as those offered by micro-financial institutions. In this study, we explore in a case-study, how one solar company, Yellow, has overcome this structural inequity by combining three low-cost technologies, namely pay-as-you-go, mobile money (MoMo), and cloud-based services (XaaS), to develop a novel platform, referred to as Ofeefee, which is able to deliver products into a market characterized by a weak retail infrastructure and low purchasing power. The result was better quality lighting at a lower levelized cost than traditional technologies. In so doing, the paper highlights the importance of thinking not just in broad energy access terms but the importance of discriminating between energy and lighting to disaggregate the needs of energy poor communities more appropriately.

Preprints in Health Professions Education: Raising Awareness and Shifting Culture.

A preprint is a version of a research manuscript posted by its authors to a preprint server before peer review. Preprints are associated with a variety of benefits, including the ability to rapidly communicate research, the opportunity for researchers to receive feedback and raise awareness of their research, and broad and unrestricted access. For early-career researchers, preprints also provide a mechanism for demonstrating research progress and productivity without the lengthy timelines of traditional journal publishing. Despite these benefits, few health professions education (HPE) research articles are deposited as preprints, suggesting that preprinting is not currently integrated into HPE culture. In this article, the authors describe preprints, their benefits and related risks, and the potential barriers that hamper their widespread use within HPE. In particular, the authors propose the barriers of discordant messaging and the lack of formal and informal education on how to deposit, critically appraise, and use preprints. To mitigate these barriers, several recommendations are proposed to facilitate preprints in becoming an accepted and encouraged component of HPE culture, allowing the field to take full advantage of this evolving form of research dissemination.

Global perspectives on cellular therapy for children with sickle cell disease.

Low-income and middle-income countries (LMICs), primarily in sub-Saharan Africa (SSA), predominantly experience the burden of sickle cell disease (SCD). High frequency of acute and chronic complications leads to increased utilization of healthcare, which burdens fragile health systems. Mortality for children with limited healthcare access remains alarmingly high. Cellular based therapies such as allogeneic hematopoietic stem cell transplant (HSCT) are increasingly used in resource-rich settings as curative therapy for SCD. Broad access to curative therapies for SCD in SSA would dramatically alter the global impact of the disease. Currently, application of cellular based therapies in LMICs is limited by cost, personnel, and availability of HSCT-specific technologies and supportive care. Despite the challenges, HSCT for SCD is moving forward in LMICs. Highly anticipated gene modification therapies have recently proven well tolerated and feasible in clinical trials in resource-rich countries, but access remains extremely limited. Translation of curative cellular based therapies for SCD should be prioritized to LMICs where the disease burden and cost of noncurative treatments is high, and long-term quality of life is poor. Focus on thoughtful modifications of current and future therapies to meet the need in LMICs, especially in SSA, will be especially impactful.

Food security systems in rural communities: A qualitative study

Indonesia is rich in natural resources, but the problem of food insecurity is still a significant concern. However, few studies still examine the relationship of socio dynamics in contributing to local ecosystems to create food security. In this study, we discuss how social dynamics contribute to normative structures, community habits, and livelihoods to meet the living needs of rural communities in creating household food security and how they try to deal with worsening food insecurity through the local wisdom of rural communities. The research methodology is participatory qualitative, while data collection is through a Discussion Group Forum (FGD) and in-depth interviews with rural communities. Fifteen villages contributed to this study, interviewing 14 villagers individually, and the rest were grouped in FGDs based on livelihood categories and equal access to forest and coastal areas. Interview notes and transcription of citations were analyzed using the Thematic Framework Analysis (TFA). The study results illustrate that the village food system is vulnerable to human and natural capital. An adaptation of rural communities will experience food security difficulties when ecosystems do not provide sufficient protection due to a fluctuating climate, crop failure, and loss of household labor due to travel and health emergencies. In addition, food security is created through the dynamics of a well-maintained environment and rural local wisdom, which facilitates broad access to food provided by nature, agricultural land, marine resources, environmental knowledge, community relations, and labor. Our findings highlight the need for interventions that promote environmental conservation goals and introduce social structures that support food security.