District Level Research Articles

Dünn in der Fläche? Regionale Disparitäten in der Hospiz- und Palliativversorgung in Deutschland

IntroductionOutpatient and inpatient hospice and palliative care services have been significantly expanded in Germany in recent decades and are increasingly being supplemented by day care services. However, the availability of these services varies greatly from region to region. The extent to which the availability of these care structures is matched by a regional need based on local population structures is as yet unknown. MethodsIn four Poisson regression models, the relationship between population indicators from the areas of demographics, employment, income, education and health and the number of offers of outpatient and inpatient hospice work and palliative care is exploratively examined. The cumulated data at district level is drawn from the INKAR database of the Federal Institute for Research on Building, Urban Affairs and Spatial Development on living conditions in Germany and from the guide of the German Association for Palliative Medicine. By means of logistic regression, factors influencing the establishment of day care services will also be identified. ResultsThe analysis included 401 districts and cities in Germany. The number of inhabitants, settlement density, and the average age of inhabitants are the strongest predictors of the number of palliative care services. In metropolitan regions, both outpatient palliative care services and palliative care units tend to be more frequently available, while the number of outpatient hospice services and inpatient hospices increases in districts with a higher number of inhabitants regardless of settlement density. The regression model was unable to demonstrate a significant influence on the emergence of semi-inpatient care facilities, neither for the population indicators nor for the existing care structures. DiscussionRegional population structures can only partially explain the geographically uneven distribution of hospice and palliative care services in districts and cities in Germany. Despite an increase in hospice and palliative care services, fewer hospice and palliative care structures are available in low population density regions that tend to have a higher share of older inhabitants. ConclusionFuture health care planning should give more consideration to other population characteristics than to population size alone in order to improve care in regions with higher care needs that are, for example, due to a higher proportion of older residents. Subsequent studies should investigate which population characteristics can best describe the actual care needs.

Development of a framework for assessing climate risk in water supply and its computation for the Districts of Maharashtra, India

ABSTRACT The paper discusses the development of a composite index for assessing the risks faced by rural communities because of disruptions in water supply caused by natural hazards such as droughts, floods, and landslides. The various parameters considered for developing the three dimensions of the risk index, namely, hazard, exposure, and vulnerability, the rationale for choosing those parameters, and the manner in which these parameters influence them are discussed. The index uses 29 variables: 5 for hazard, 15 for exposure, and the remaining 9 for vulnerability. The variables are natural, physical, socioeconomic, and institutional or policy-related. The quantitative criteria for assigning values for various parameters and the analytical procedure for computing the sub-indices and the final risk index are also discussed. The paper also presents the results of a mapping of climate-induced risk to water supply in 35 districts of the state of Maharashtra in western India, done using district level data on the various parameters concerned, and identifying the district where water supply systems are highly prone to climate-induced risks.

Satellite remote sensing for monitoring citrus orchards water requirements at the irrigation district scale

In Italy, irrigated agriculture is often managed by Reclamation Consortia, but they generally lack the proper tools for monitoring the irrigation water requirements (IWR), forbidding the required sustainability level by the European Water Framework Directive. In this context, the study aims at monitoring the IWR of citrus orchards of a Sicilian irrigation district by implementing a satellite-based methodological approach, during the irrigation seasons 2019 and 2020. Firstly, neural networks were implemented to map the citrus orchards, by using Normalized Difference Vegetation Index time series as input, and obtaining accuracy values of 94% and 87%, in 2019 and 2020, respectively. Then, the satellite-based ArcDualKc model was used to estimate crop evapotranspiration (ETc) over the identified citrus orchards. The estimated ETc rates were validated at the farm scale in terms of irrigation volumes and compared to those obtained by the traditional FAO-56 approach. Then, the spatially distributed irrigation volumes estimated at district level were compared with those declared by the Reclamation Consortium, obtaining absolute error values of 3.28 Mm3 (294%) and 7.08 Mm3 (647%) for the years 2019 and 2020, respectively. The results of the study confirmed the usefulness of the satellite-based methodological approach for determining spatial distributed IWR estimates.

Investigating the association between housing mobility and self-reported adolescent suicidality and mental health.

Suicide continues to be a public health crisis among adolescents in the United States. Suicide prevention requires a comprehensive understanding of the factors that lead to death from suicide. Housing stability is an important social determinant of health, and literature has begun to describe how housing instability can affect mental health, as well as suicidal behavior. The aim of the present study was to assess the relationship between lifetime housing mobility among adolescents and suicidal behavior (both ideation and attempt). This study examines disparities in housing mobility and suicidal behavior to determine whether certain population subgroups are disproportionately impacted. We undertook a cross-sectional study using data from Wisconsin's Youth Risk Behavior Survey administered during the Fall of 2019, which assessed Wisconsin middle and high school students. We find that housing mobility, as measured in the lifetime number of residences, was associated with an increased risk of suicidal ideation and behavior. We also demonstrate disparities by race, disability status, and sexual orientation. Findings from this study can be used to not only drive change to support students at the school or school district level but also to drive policy change at the societal level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Blue Carbon Potential of Mangrove Ecosystems and Its Management to Promote Climate Change Mitigation in Indonesia

This research aimed to analyze blue carbon potential and mangrove ecosystem management in promoting climate change mitigation in Indonesia. The collected data included mangrove area data obtained through the Indonesian National Ecosystem Monitoring System (SIMONTANA). This research calculated the carbon stock using the global average of mangrove carbon stock. The results showed that the total blue carbon stored in mangrove ecosystems reached 3,267.87 Megaton Carbon (MtC). Papua and Kalimantan regions contributed the most significant potential, with 1,707.22 MtC and 608.17 MtC, respectively. The absorption of carbon dioxide (CO2) reached 11,982.21 MtCO2e. The most significant CO2 gas emissions absorption was observed in the Papua region, amounting to 6,259.80 MtCO2e, followed by Sumatra with 2,118.59 MtCO2e. This high potential value correlated with mangrove ecosystem management policies, such as conservation, restoration, and blue carbon monetization. Mangrove management for climate change mitigation was carried out through national and international cooperation to achieve the 26% to 40% emission reduction target. The existing management model of mangrove ecosystems focused on improving ecological sustainability with less orientation on improving community welfare. Implementing blue carbon monetization at the district level by involving the community as the owners or managers of the mangrove ecosystems is crucial.

Mapping the Public Health and Health Promotion Capacity in Oman

Abstract Background An essential condition to enabling people to increase control over their health is to have sufficient capacity for public health (PH) and health promotion (HP). Despite the recognition of its importance, a comprehensive view of the PH and HP capacity in the sultanate of Oman is not yet available. This study provides a mapping of the country’s PH and HP capacity at national, governorate and district levels. Methods An online quantitative survey was performed amongst 70 health policy maker and experts in PH and HP using a questionnaire based on the PH capacity framework of Aluttis et al., yielding data on the country specific context with relevance for PH and 6 PH capacity domains, each divided in subdomains: leadership and governance; organizational structures, workforce, financial resources, partnerships, and knowledge development. Internal consistencies of the scales measuring the capacity subdomains ranged from .75 to .99. Results The survey revealed relatively low scores, representing partial development of capacities, for most of the public health capacity domains. The highest levels of capacity were observed for knowledge development (health information and monitoring systems, reporting systems and knowledge infrastructure), organizational structures (institutional capacity, program delivery structures, PH within health services, and response emergencies) and partnerships (formal consortia, informal partnerships and multisectoral coordination). In contrast, leadership and governance, workforce development, and financial resources score lower. Conclusions Mapping the strengths and weaknesses of PH and HP capacity in Oman allows to make recommendations for improving population health. Whereas all domains of PH and HP capacity are partially developed, there is a need to further improve capacity in all domains. Key messages • PH and HP capacities are partially developed in Oman. • Mapping the PH and HP capacity allows to identify strengths and weaknesses and make recommendations for improving public health.

High-resolution modeling and projection of heat-related mortality in Germany under climate change

Abstract Heat is a leading cause of premature deaths during summer months. Understanding the relationship between high temperatures and excess mortality is crucial for designing effective prevention and adaptation plans. Traditional statistical methods have been repeatedly applied to analyze heat-related mortality. However, spatially and temporally high-resolution analyses are challenging due to fragmented data archives across different agglomeration levels, especially for mortality data. We propose a neural network-based model to estimate heat-related mortality. This approach allows for high temporal and spatial resolution estimations, such as regional heat risk during specific heatwaves. Using Germany as a case study, we calculated heat-related excess mortality rates at the district level and visualized the dynamics of local health risks within a heatwave. Overall, we estimated a total of 48,000 heat-related deaths in Germany over the last decade (2014-2023), with most occurring during specific heatwave events. For example, in 2023, the heatwave from July 7-14 contributed approximately 28% (1100 deaths) to the total of about 3,900 heat-related deaths for the entire year. This estimation is consistent with previously published reports from the Robert Koch Institute (RKI), considering the resolution differences in the input data. In addition, we combined our model with shared socio-economic pathways (SSPs) of future climate change, assuming a static population and baseline mortality rate. The results suggest that heat-related risk in Germany could further increase by a factor of 2.5 (SSP245) to 9 (SSP370) without adaptation to extreme heat. Our approach is a valuable tool for the monitoring of regional heat-related risks as well as scenario-based risks projections for the future. The results of the model can help develop climate-driven public health strategies, aiding in the identification of local risks during heatwaves and in long-term resilience planning. Key messages • High-resolution modeling of heat-related mortality helps us to develop targeted adaptation and prevention plans. • The majority of heat-related mortality occurs during heatwaves in summer.

Rural–Urban Divide of COVID-19 Fatalities in India—Investigating the Role of Lifestyle Disorder Diseases

AbstractUsing data on weekly COVID-19 infections and fatalities at the district level for 19 states and 4 union territories of India, we investigate the determinants of COVID-19 deaths focusing exclusively on the second wave of infections. We include several macroeconomic and structural indicators for districts namely, per capita district domestic product, the degree of urbanization, population density, percentage of aged population, share of agriculture, poverty, among several others. Our findings suggest that fatalities have a clear rural–urban divide. Rural agricultural districts with more poor people have experienced less cases and fatalities. Fatalities are more clustered in prosperous and dense industrial districts. Regions having higher COVID-19 fatalities also have a higher proportion of ageing population with urban life-style disorder related diseases such as obesity, diabetes, and hypertension. Prevalence of respiratory illnesses further aggravates the effects of some of these life-style disorder diseases on COVID-19 fatalities.

Comparative Study between Outcome of Standard and Tubeless Percutaneous Nephrolithotomy (PCNL) at District Level Tertiary Hospitals in Bangladesh

Renal calculus is one of the commonest problems of the urinary tract. Surgical approach is more effective treatment option to remove it. Among all surgical procedures, Percutaneous Nephrolithotomy (PCNL) has gradually become a preferred option in last two decades for renal calculus that has largely replaced the open approach. Currently, it is the procedure of choice for renal calculus > 2 cm, or those are refractory to ESWL. The crucial step in Standard PCNL is placing a nephrostomy tube. In recent years, it has been reformed as 'Tubeless' PCNL with some modifications in which a Double-J (D-J) stent is placed without any nephrostomy tube for internal drainage. This study was done to compare the outcomes of Standard PCNL and Tubeless PCNL at district level tertiary hospitals in Bangladesh among 46 patients with renal calculus up to 3 cm size. Many authors agree that Tubeless PCNL or its modifications are effective as well as safe. Although, nephrostomy tube is responsible for an increase of post- operative morbidity, in our study, we did not find any statistically significant difference between these two procedures.

Behaviorally informed digital campaigns and their association with social media engagement and COVID-19 vaccine uptake in Belize

BackgroundIncreasing vaccination coverage was key to curbing the COVID-19 pandemic globally. However, lack of trust in the vaccine and fear of side effects in regions like the Caribbean resulted in a low uptake despite enough vaccine supply.MethodsWe conducted two correlational analyses and one experiment between five sequential behaviorally informed Facebook campaigns, social media performance outcomes, and district-level vaccination data. First, we ran multivariate linear regression models to estimate the mean differences between the campaigns in (i) social media performance (“Clicks” and “Engagement”) and (ii) COVID-19 vaccination uptake at the district level. “Clicks” were measured by the number of people who clicked on the respective Facebook advert and visited the official vaccination site. “Engagements” were the number of people interacting with the advert through likes and emojis. Second, we took advantage of the experimental design during one of the campaigns to analyze the differential effect of messages conveying information about the number of people reporting vaccination side effects using words (“Few”/ “Majority) and numbers (“3 out of 100 “) on social media performance.ResultsThe correlational analysis showed that the number of “Clicks” and “Engagement” was similar among campaigns, except for the campaign focusing on vaccines’ effectiveness, which had 14.65 less clicks and 19.52 less engagements per advert (including controls and district-fixed effects) compared to the base “It’s safe” campaign. Vaccination rates were highest at times coinciding with campaigns focusing on vaccination safety and effectiveness. Our experimental results showed that informational messages related to side effects that were framed using words (“Majority did not report discomfort”/ “Few persons reported discomfort”) were better at generating “Clicks” compared to those using numbers (“3 out of 100 reported discomforts”).ConclusionsFacebook adverts highlighting vaccine safety had a similar level of social media performance as other campaigns, except for adverts focusing on vaccine efficacy, which performed worse. Communicating side-effect information with words instead of numbers can expand social media interest in low-uptake regions like the Caribbean. Our results serve as preliminary evidence for public health officials to encourage vaccine uptake in high-hesitancy contexts.

DISTRICT HEAD'S LEADERSHIP STYLE ENHANCES CIVIL SERVANTS' MOTIVATION FOR ACHIEVING GOOD GOVERNANCE IN NORTH SORONG

The leadership role at the district level plays a crucial part in promoting good governance, particularly in Sorong Utara District, part of Sorong City in Southwest Papua Province. This study focuses on transformational leadership and its impact on fostering motivation among civil servants within a supportive work environment. Using a descriptive-analytical method, the research aims to explore how leadership practices such as empathy, strategy development, guidance, integrity, and transparency influence civil servant motivation in achieving good governance. Findings reveal several challenges for leadership, particularly in upholding discipline, professionalism, and showing empathy towards employees' rights. Effective leadership strategies are required for developing guidance, enhancing integrity, and maintaining transparency, all of which are critical for boosting civil servant motivation. The study highlights that leaders who provide motivation, promote career development, and enable better public service delivery have a significant influence on staff performance. The research also establishes a positive link between civil servant motivation and improved performance. Motivational interventions that focus on optimizing the relationship between employees and their work environment can enhance both productivity and well-being. Ultimately, leaders who prioritize integrity, fairness, and the public interest over personal agendas can inspire staff to achieve organizational goals and help realize good governance.

Strengthening anthrax outbreak response and preparedness: simulation and stakeholder education in Namisindwa district, Uganda

BackgroundAnthrax is a zoonotic disease caused by Bacillus anthracis that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda.MethodsWe conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported.ResultsThe overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects.ConclusionWe found that the district’s preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study’s insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings.

Relationship between urban traffic crashes and temporal/meteorological conditions: understanding and predicting the effects

Urban traffic accidents pose significant challenges to public safety and transportation management. Previous studies have revealed that temporal and meteorological factors are the key contributors to accident rate. Besides the inconsistent observations or lack of exploration in some aspects such as snowfall, fog, wind and daily temperatures, it has been shown that these factors are essentially entangled. Furthermore, existing methodologies of analysis or prediction have been limited to relative risk or traditional models. Hence, this study is centered on understanding the detailed correlations between temporal and meteorological factors and accident rate of two types of crashes – moving vehicle and fixed-object crashes using the traffic accident data from Dalian. Further, by incorporating a diverse set of the features, a prediction model leveraging the random forest algorithm is proposed and proved effective in anticipating accident occurrences on the district level. The feature importance analysis has shown that time period and factors such as holiday, temperature and season are most important factors. The rate is higher on working days and in spring, and collisions of both types peak at 6–7 am. When the highest daily temperature is 27 °C and the lowest is 20 °C or -8 °C, the incidence is relatively higher. On the basis, the recommendations are aimed at optimizing transportation systems, mitigating accident risks, and enhancing public safety in urban environments.

Possibility of Substitution of LOD1 Data for LOD2 Data on Photovoltaic Potential Estimation at City Districts Level Using a 3D City Model

Abstract. We developed a system to estimate the photovoltaic (PV) potential of urban buildings using a 3D city model at level of detail 2 (LOD2), considering an arrangement of solar panels. Although the PV potential estimation of buildings at the level of city districts prefers LOD2 data, many urban city districts with buildings capable of installing solar panels on façades do not have LOD2 data owing to the high production cost of LOD2 data. Therefore, we investigated the possibility of utilising LOD1 data instead of LOD2 data in the PV potential estimation of buildings at the level of city districts. We conducted an experiment in the investigation using 3D city model data from 24 city districts, which are most of the large cities with LOD2 data in Japan. The experiment results suggest that LOD1 would not be a substitute for LOD2 data in the PV potential estimation of building roofs. The cause of the inadaptability is that most roofs in LOD2 buildings have more small polygons than LOD1 building roofs. Roofs of a LOD2 building with many small polygons have fewer solar panels than roofs of a LOD1 building with a large polygon. On the contrary, the experiment results indicate that LOD1 may be a substitute directly for LOD2 in the PV potential estimation of building façades that are expected to be used as a mounting platform for solar panels in urban buildings from now on. The average of the relative differences in the calculated PV potential of building façades between using LOD1 data and using LOD2 data is approximately 10% in the experiment.

Fusing remote and social sensing data for flood impact mapping

AbstractThe absence of comprehensive situational awareness information poses a significant challenge for humanitarian organizations during their response efforts. We present Flood Insights, an end‐to‐end system, that ingests data from multiple nontraditional data sources such as remote sensing, social sensing, and geospatial data. We employ state‐of‐the‐art natural language processing and computer vision models to identify flood exposure, ground‐level damage and flood reports, and most importantly, urgent needs of affected people. We deploy and test the system during a recent real‐world catastrophe, the 2022 Pakistan floods, to surface critical situational and damage information at the district level. We validated the system's effectiveness through various statistical analyses using official ground‐truth data, showcasing its strong performance and explanatory power of integrating multiple data sources. Moreover, the system was commended by the United Nations Development Programme stationed in Pakistan, as well as local authorities, for pinpointing hard‐hit districts and enhancing disaster response.

Assessing critical flood-prone districts and optimal shelter zones in the Brahmaputra Valley: Strategies for effective flood risk management

Frequent flooding has become a persistent issue in floodplain regions, causing significant disasters during each rainy season due to insufficient disaster management planning. This study proposes a methodology to prioritize flood susceptibility areas at the district level and identify suitable sites for flood shelters using a combination of machine learning algorithms and multi-criteria analysis, supported by geospatial technology. Flood shelter suitability mapping was conducted using the Analytical Hierarchy Process (AHP), while flood susceptibility zones were assessed using four different machine learning models: Support Vector Machine (SVM), Random Forest, Decision Tree, and Naive Bayes. The integration of machine learning models with the AHP technique is vital in situations where conventional numerical models face challenges due to limited data, such as river discharge and water levels. The methodology includes a multicollinearity assessment to ensure the independence of selected flood-causing factors, information gain ratio to identify the most influential factors, Spearman's rho test to verify correlations between the machine learning models, and ROC-AUC along with statistical regression for validating the accuracy of the flood susceptibility maps. The findings indicate that the SVM algorithm, given its strong performance and effective training datasets, is recommended for areas with similar physical characteristics. The district-wise priority map generated from the weighted results of flood susceptibility assessments will be useful for flood management and mitigation strategies. Additionally, the study found that applying the AHP technique to determine flood shelter suitability, after assessing flood-prone areas, enhanced the efficiency of the flood management process. This research offers valuable insights for authorities to better address flooding and improve flood prevention and management efforts in floodplain regions, contributing to broader climate change adaptation strategies.

Optimizing the survey design for assessing schistosomiasis at the sub-district for treatment decision making

BackgroundSchistosomiasis control programs typically launch with district-level, school-based preventive chemotherapy (PC). Recent World Health Organization recommendations are to shift to community-wide treatment where schistosomiasis prevalence is >10%. Simultaneously there is a push to move to sub-district PC to prioritize communities in need of treatment and alleviate the pressure on global praziquantel need, but few countries have sub-district prevalence data and no guidelines on how to collect this information. Methods/Principal findingsData collected from 57,161 school-aged children (SAC) across six countries (Burkina Faso, Ghana, Mali, Senegal, Sierra Leone, and Togo) to generate spatially realistic gold standard datasets that were used to evaluate different numbers of schools per sub-district (1-10) and district (5–30), number of SAC sampled per school (10–50), on accuracy of prevalence estimates. Sampling fewer children in more schools maximized accuracy of prevalence at the sub-district and district level. Surveying three schools per sub-district or 15 schools per district gave precise prevalence estimates. Increasing the number of SAC beyond 30 per school led to negligible improvements in reliably detecting schistosomiasis. Failure to detect schistosomiasis occurred more frequently in low (1–10%) prevalence and larger districts/sub-districts. ConclusionThis study provides guidelines for evaluating sub-district schistosomiasis in a range of transmission settings. Among two-stage cluster surveys for schistosomiasis, our simulations show surveying three schools per sub-district and 20-30 SAC per school optimized cost-efficiency and minimized risk of mistreatment. Population size and endemicity influenced survey estimates, with the probability of misclassification being greater as populations increased or prevalence decreased.

Spatial heterogeneity and interaction effect of urban blue and green spaces on housing prices

Rapid urbanization presents policymakers and planners with the challenge of balancing public open spaces design with the conservation and improvement of natural resources. A comprehensive understanding of the land economic value of urban blue-green spaces (UBGS) holds immense significance for urban sustainable development, urban spatial justice and the promotion of human well-being. In this study, the MGWR model is employed to discuss the heterogeneous effects of UBGS on housing prices in Hangzhou. Additionally, the interaction effect between blue space and green space was examined at the district level, and the specific locations and spatial patterns were identified. The results show that (1) different types, features and accessibility of UBGS have different degrees and spatial scale of effect on housing prices, and will be affected by other attributes of UBGS; (2) in 30.92% of the main urban area of Hangzhou, the effect of blue spaces and green spaces on housing prices exhibits an interactive effect. The spatial patterns are divided into blue-green positive synergistic, antagonistic and negative synergistic regions; (3) green space has positive and negative effects on housing prices, while blue space has positive effects on housing prices at the regional level. The existence of water bodies can promote the positive effect of green spaces on housing prices or alleviate the negative effect. The results indicate that planners must transcend the singular focus on blue or green space planning and instead consider both in an integrated manner. This outcome can provide valuable references for UBGS planning.

Adopting sustainable innovations for remote access to TB and HIV care in South Africa.

For the last decade, South Africa has made substantial progress to control the dual HIV and TB epidemics. However, disruptions in TB and HIV treatment during the COVID-19 pandemic threatened to reverse this. This study aimed to identify adaptations in HIV and TB service delivery models in response to COVID-19 and government restrictions. This information informed the development of an online survey, which was utilized as part of a consultation exercise to further capture adaptations made to HIV/TB service delivery within the South African context. The literature review involved screening 380 titles and abstracts, identifying 30 HIV and TB studies across 19 countries, and categorizing 90 individual interventions into ten thematic areas. Common themes included interventions addressing screening, testing, diagnosis, medication collection and delivery support, and virtual models. Digital health interventions and adaptations to medication collection/delivery were reported in 38% of studies. Analysis of survey responses from 33 stakeholders in South Africa revealed that 47% of interventions targeted HIV, 11% TB, and 23% HIV/TB integrated service delivery. Most interventions (81%) were integrated into the national HIV or TB program, with implementation occurring at various levels: 39% at facility level, 35% at sub-district or district level, and 18% at provincial level. Programmatic data was available for 86% of interventions, with 50% being funded. This study demonstrated that services can be delivered in locations other than in health facilities (e.g., community-based or home-based) and that integrated services can also free up additional resources. Although studies varied, COVID-19 accelerated the adoption of differentiated service delivery (DSD) models for TB care, including multi-month dispensing (MMD) for TB preventative therapy (TPT) and TB treatment, home-based or mobile outreach screening and testing, and community pickup points (PuP) for TB medications. These initiatives had previously lagged behind HIV-focused DSD models, and it is crucial to sustain these services beyond the pandemic. To achieve universal health coverage, it will also be important to capitalize on these experiences and learn from HIV-focused DSD models so programs can deliver integrated person-centered chronic care services for TB, HIV, and non-communicable diseases.

Rural household resilience to food insecurity in Mekiet district, Ethiopia

IntroductionFood insecurity remains a global issue and a top national priority in Ethiopia. However, it continues to pose a serious challenge in rural areas. Therefore, this study investigated household resilience to food insecurity among rural residents in Mekiet district.MethodsA cross-sectional research design was used, focusing on two agroecological zones of Mekiet district—lowland and midland—involving 228 respondents. The study employed both quantitative and qualitative approaches. Multistage sampling techniques were employed to select the sample households, and factor analysis was employed to analyze the data.Results and discussionThe results from the factor analysis using the TANGO approach showed that the latent variables of absorptive and adaptive capacities had factor loadings of 0.98 and 0.79, respectively. On the other hand, transformative capacity showed a negative loading (−0.78), with all variables being statistically significant. The mean household resilience capacity index was 0.51. The variables of absorptive and adaptive capacities were positively associated with household resilience capacity, while transformative capacity exhibited a strong negative association. All factor loadings were significant, exceeding the recommended absolute value of 0.364 for sample sizes of 200 or more. Additionally, these variables were also highly correlated with resilience capacity. The study recommends that resilience programs be implemented at district, community, and household levels to enhance resilience to food insecurity.