Households In Rural Communities Research Articles

Determinants of willingness to pay for community-based health insurance scheme among households in rural community of southern Ethiopia

BackgroundCommunity-based health insurance programs are being acknowledged as effective strategies to attain universal health coverage and mitigate the financial catastrophic shock of the community. Even though Ethiopia has been focusing on the implementation and expansion of a community-based health insurance (CBHI) program since 2011, only a small number of people are enrolled, which might be attributed to a lack of willingness towards the program. The purpose of this study is to determine the willingness to pay for community-based health insurance and associated factors among households in the rural community of Gombora District, Hadiya Zone, southern Ethiopia.MethodsUsing the multistage systematic random sampling technique, a sample of 421 households was chosen for a community-based cross-sectional study. The desired information was gathered using a pre-tested, structured, interviewer-administered questionnaire. The data was entered using Epi-Data V3.1 and exported to SPSS version 24.0 for statistical analysis. Bivariable and multivariable logistic regression analyses were performed to determine the variables associated with the willingness to pay for community-based health insurance.ResultsThe study showed that 67.1% of respondents expressed a willingness to pay for community-based health insurance. The mean amount of money they are willing to pay for the scheme is 178.41 (± 57.21) Ethiopian Birr (ETB), or 6.43 (± 2.06) USD per household per annum in 2020. Based on multiple logistic regression analysis, belonging to Rich household compared to poor (AOR: 2.78, 95% CI: 1.54, 5.03), having a household head who can read and write (AOR: 2.90, 95% CI: 1.39, 6.05), family size greater than five (AOR: 1.76, 95% CI: 1.06, 2.92), indigenous community insurance (iddir) participation (AOR: 2.83, 95% CI: 1.61, 4.96), and the presence of chronic illness (AOR: 1.94, 95% CI: 1.21, 3.12), were significantly associated with the willingness to pay for a CBHI scheme.ConclusionHouseholds’ willingness to pay for a CBHI scheme was found to be significantly influenced by poor household wealth status, household heads who cannot read and write, households with less than or equal to five family members, households who participate in greater or equal to two indigenous community insurance participations, and the absence of chronic illness within the household. Therefore, factors affecting households’ willingness to pay should be considered and massive community mobilization needs to be done to strengthen and increase household membership during the implementation of the CBHI scheme, especially in rural areas.

An agricultural community's perspectives on COVID-19 testing to support safe school reopening.

School-based COVID-19 testing may be an effective strategy for reducing transmission in schools and keeping schools open. The study objective was to examine community perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening. We conducted a qualitative study in Yakima County, an agricultural region of Washington state, where over half of residents are Hispanic/Latino. From June to July 2021, we interviewed 18 students (13 years old, on average) and 19 school employees, and conducted four focus groups (2 in Spanish, 2 in English) with 26 parents. We audio-recorded the semi-structured interviews and focus group discussions which were then transcribed. We used an inductive, constant comparison approach to code the transcripts and conducted a thematic analysis to generate themes. We identified four main themes. Students, parents, and school employees desired a return to in-person learning (Theme 1). Schools implemented numerous COVID-19 mitigation strategies (e.g., masking) to facilitate a safe return to school but felt that adding testing would not be feasible due to a lack of resources and overworked staff (Theme 2). Parents and school employees' familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4). Schools require adequate resources and medical personnel to implement COVID-19 testing. Individuals also need resources after testing positive, including physical space to isolate, financial resources for those without paid time off, and delivery of food and other necessities to households in rural communities.

The needs and opportunities for housing improvement for malaria control in southern Tanzania

BackgroundMalaria disproportionately affects low-income households in rural communities where poor housing is common. Despite evidence that well-constructed and mosquito-proofed houses can reduce malaria risk, housing improvement is rarely included in malaria control toolboxes. This study assessed the need, magnitude, and opportunities for housing improvement to control malaria in rural Tanzania.MethodsA mixed-methods study was conducted in 19 villages across four district councils in southern Tanzania. A structured survey was administered to 1292 community members to assess need, perceptions, and opportunities for housing improvement for malaria control. Direct observations of 802 houses and surrounding environments were done to identify the actual needs and opportunities, and to validate the survey findings. A market survey was done to assess availability and cost of resources and services necessary for mosquito-proofing homes. Focus group discussions were conducted with key stakeholders to explore insights on the potential and challenges of housing improvement as a malaria intervention.ResultsCompared to other methods for malaria control, housing improvement was among the best understood and most preferred by community members. Of the 735 survey respondents who needed housing improvements, a majority needed window screening (91.1%), repairs of holes in walls (79.4%), door covers (41.6%), closing of eave spaces (31.2%) and better roofs (19.0%). Community members invested significant efforts to improve their own homes against malaria and other dangers, but these efforts were often slow and delayed due to high costs and limited household incomes. Study participants suggested several mechanisms of support to improve their homes, including government loans and subsidies.ConclusionAddressing the need for housing improvement is a critical component of malaria control efforts in southern Tanzania. In this study, a majority of the community members surveyed needed modest modifications and had plans to work on those modifications. Without additional support, their efforts were however generally slow; households would take years to sufficiently mosquito-proof their houses. It is, therefore, crucial to bring together the key players across sectors to reduce barriers in malaria-proofing housing in endemic settings. These may include government subsidies or partnerships with businesses to make housing improvement more accessible and affordable to residents.

Large-scale agricultural investment and female employment in African communities: Quantitative and qualitative insights from Nigeria

This study examines how large-scale agricultural investments (LSAIs) affect employment outcomes of female-headed households in Nigeria. It focuses on wage income and labour allocations of households in communities where LSAIs occurred in comparison with households in communities where LSAIs did not occur. It engages a mixed method approach, which involves the quantitative and qualitative. The quantitative data was sourced from the Living Standards Measurement Study-Integrated Surveys on Agriculture (LSMS-ISA), which was analysed using Propensity Score Matching (PSM). The qualitative analysis entails in-depth interviews (IDIs) and focus group discussions (FGDs). The results show a positive relationship with the household income living in communities with LSAIs, but a negative association with labour allocation to agricultural activities. Also, the findings indicate that households in communities where LSAIs took place received higher wages and spent fewer hours in agriculture. Though, female-headed households spent more time on agricultural activities than the male-headed households, they earn less. The analysis from the qualitative study show, among others things, that female-headed households spent more time on off-farm business despite the fact that they earn less. The study concludes by recommending that the possible adverse employment effects of LSAIs could be reduced by optimising its positive impact, especially with respect to female-headed households in rural communities where most of such investments occur.

Does their Geography Matter? Assessing the Impact of Geographical Factors on Development of Rural Communities in Benue State, Nigeria

The study assessed the impact of geographical factors on the development of rural communities in Benue state. Primary data (on living standard, employment, social inclusion, climate, location, resources, and environmental stability) were generated through mixed questionnaires administered to the respondents in a household survey. A random selection of nine (9) LGAs in the State was done, with three (3) LGAs selected from each of Benue North, Benue Central and Benue South. A sample of 820 was selected out of the population of 2,065,400. The logistic regression analysis was employed to examine the impact of geographical factors on economic development of rural households in Benue state with analysis done using the SPSS. Geographical factors, such as climate, location, resources and environmental stability, were found to have negative impacts on the standard of living, employment and social inclusion of households in rural communities of Benue state, thereby significantly impacting the economic development of such households in the state. It was recommended among others that, the ministries concerned with rural development should concentrate on linking the rural communities to the urban areas for the flow of goods, services and information.

Impacts of COVID-19 pandemic on the livelihoods of rural households in the community forestry landscape in the Middle Hills of Nepal

The novel coronavirus disease (COVID-19) has severely affected all sectors of the economy, and the impacts are expected to last-long. One major impact is that migrants return to their original households in rural communities due to loss of jobs. Since rural communities are highly dependent on forest and agriculture for livelihoods, an influx of return migrants likely increases the consumption of forest products and intensifies the agriculture practices, increasing the pressure on forest resources. Based on in-person interview of 215 in 2018 before the pandemic and a phone interview of the same 215 rural households in 2021 at the peak of the pandemic in Kavrepalanchowk district in Nepal, this study addresses the following research questions: (1) Does COVID-19 exert differential impacts among the socio-economic groups? (2) How do return migrants affect the rural land use? (3) Do return migrants put additional pressure on forests resources? The rare before-and-after dataset provide a precious opportunity to assess the COVID-19 impacts on the livelihoods of rural households in the community forestry landscape in the Middle Hills of Nepal. We found that the impacts of COVID-19 were severe on the households with larger family size, those belonging to the marginalized caste groups, having lower number of livestock, low wellbeing index, those who rely on daily wage-based occupation, with low level of education, and the households with return migrants. A significant number of migrants were found to return to their village of origin. As a result, there was a decrease in abandoned land and an increase in the livestock number and forest product use. These findings provide timely insights for the post-pandemic recovery efforts in better targeting needy household with limited resource in the community forestry landscape in the Middle Hills of Nepal.

Variability in the household use of cooking fuels: The importance of dishes cooked, non-cooking end uses, and seasonality in understanding fuel stacking in rural and urban slum communities in six north Indian states

Expanding the use of clean cooking fuels has been a priority for the Government of India in recent years to obtain potential public health and women’s empowerment benefits. Evidence to date suggests most recent clean fuel adopters continue to use polluting biomass for some household energy needs. However, the specific ways households use both polluting and clean fuels together, known as fuel stacking, is not fully understood.We use survey data from 2,765 households in rural communities and urban slums in six north Indian states to detail fuel stacking practices. Half of rural and one-third of urban slum households stacked a clean and polluting fuel together. We classify stackers into four groups based on their reported primary and secondary fuels (e.g., primary gas and secondary firewood). We observe significant variations in the intensity of secondary fuel use among households in the same stacking group. Across all stackers, about half use their secondary fuel daily, while about one-fifth use it less than once per week. Non-cooking energy needs, like space and water heating, motivates 40% of biomass users to use polluting fuels. Seasonality is another important consideration as 75% of fuel stackers reported switching their primary fuel across seasons of the year, with nearly 90% primarily using gas during the rainy season.Our results highlight considerable heterogeneity in fuel use behaviors among households in the same stacking category. We also underscore that cooking gas is popular and able to meet all cooking needs, but it is important to consider the use of biomass for non-cooking tasks to enable a complete transition to clean cooking fuels. These results signify the need for more nuanced fuel stacking information in policy design and program evaluation.

Willingness to pay for community based health insurance scheme and factors associated with it among households in rural community of South West Shoa Zone, Ethiopia

BackgroundOut-of-pocket payments are the major significant barrier in achieving universal health coverage, particularly in developing countries' rural communities. In 2011, the Ethiopian government launched a pilot community-based health insurance (CBHI) scheme with the goal of increasing access to modern health care services and providing financial security to households in the informal sector and rural areas. The main objective of this study is to estimate willingness to pay (WTP) for CBHI scheme and factors that influence it among rural households in the South West Shoa Zone.MethodsA household-level cross-sectional study was conducted to examine the WTP for the CBHI scheme and factors associated with it in rural communities of South West Shoa Zone. The study used a sample of 400 rural households. Systematic random sampling was employed during household selection, and double-bounded contingent valuation method was used to estimate WTP for the CBHI scheme.ResultsAbout 65 percent of the households are willing to pay for CBHI scheme. Moreover, the study found that the households were willing to pay 255.55 Birr per year on average. The result of the study also revealed that amount of bid, household income, family size, household head's education, household health status, membership to community-based health insurance scheme, membership in any association, and awareness about the scheme are factors that are significantly associated with WTP for the scheme.ConclusionsHouseholds are willing to pay a higher price than the policy price. Therefore, setting a new premium that reflects households' willingness to pay is highly valuable to policymakers. Social capital and awareness about CBHI scheme play an important role in influencing WTP. Thus, the study suggests that local communities need to strengthen their social cohesion and solidarity. It is also necessary to create awareness about the CBHI’s benefits.

Credit for households in Ghana: Has mobile money (momo) improved inclusive access?

This article interrogates the effect of mobile money on households’ access to credit services. It also compares the mobile money effect with the effect of owning account in other financial institutions (excluding commercial banks), and explores complementarity effects between them as well as heterogeneity effects across gender and locality of residence. Using treatment effect models and observational data from the seventh round of the Ghana Living Standards Surveys, the results generally show that mobile money increases the probability of applying for credit but has no effect on the amount of credit received. The effect on credit application is only found among households that also own accounts in other financial institutions, except for male headed households, of whom we observe a significant effect among those that own only mobile money accounts. The complementary effect of mobile money to the effect of other financial institutions on credit application are higher for male headed households and households in rural communities than their respective counterparts. These results are robust to different treatment effect estimators including the doubly robust augmented inverse probability estimator and the inverse probability regression adjustment estimator with several controls including health shocks in their outcome models. The findings call into question the extent to which mobile money facilitates the provision of inclusive financial services beyond serving as a tool for payments and savings. The findings bear significant policy implications with regards to how to broaden the financial inclusion impact of mobile money.

Maternal and Child Health Services in Rural Settings of The Gambia: Contextual Determinants of Postnatal Care from Mothers’ Perspectives—A Community-Based Analytical Cross-Sectional Study

Background. Maternal and child health in The Gambia is a trending public health burden. The postnatal period is critical and vital to the lives and health of the maternal mothers and their newborns, and pieces of evidence deduced that a majority of maternal and newborn deaths occur during this period. Hence, this research aimed to assess the prevalence and determinants of postnatal care utilization across women in rural Gambia. Methods. A community-based cross-sectional design was conducted in January 2020, with 265 women of childbearing age were recruited from the selected households in rural communities across the Upper River Region (URR), Gambia, using multistage sampling technique. A structured-interview questionnaire was developed to elicit contextual sociodemographic characteristics regarding the use of postnatal care. Percentages, chi-square/Fisher’s exact test for variables with p value ≤0.15 were considered for inclusion into the logistic regression model. The significance level was set at p < 0.05 . The adjusted odds ratios (aOR) with 95% confidence interval (CI) were computed to declare significance. Results. The study revealed that 90% of women utilize postnatal care (PNC) services in the rural settings of URR, Gambia. Factors such as women’s occupation, location, number of pregnancies, attending in last pregnancy, current uptake of family planning, and complication(s) in last labor were found to be associated with PNC utilization. Women who attended antenatal care (ANC) services in their last pregnancy were 10.8 times (aOR = 10.795, 95% CI: 1.025–113.694), current users of FP were 10.7 times (aOR = 10.708, 95% CI: 1.379–83.152), women’s number of pregnancies increases by a factor of 4.6 times (aOR = 4.649, 95% CI: 1.518–14.243) more likely to utilize PNC while women’s number of children alive were less likely by 76.1% (aOR = 0.239, 95% CI: 0.071–0.810) as compared to those who were not utilizing PNC services. Conclusion. The findings showed that attending ANC services, current uptake of FP, women’s number of pregnancies, and number of children alive were associated with PNC. Strengthening women empowerment and designing responsive ANC programs especially for rural women to improve PNC services are required.

Smallholder farmers’ perceptions and knowledge on climate variability and perceived effects in vulnerable rural communities in the Offinso Municipality, Ghana

The study examines the perspectives of smallholder farmers in climate variability and the perceived effect on rural agricultural activities in vulnerable communities in the Offinso Municipality of southern Ghana. The farmers' perspectives on climate variability were assessed using a mixed-method approach involving 300 randomly sampled respondents from 6 selected rural farming communities. The results show that smallholder farmers are perceiving different manifestations of climate variability in their local environment. Respondents had a good knowledge of climate variability which was influenced by their levels of education and farming experience. Respondents perceived climate variability and change to be driven by anthropogenic factors with deforestation as the principal driver in the study communities. The study further reveals that the perceived effects of climate variability, particularly on agricultural systems are multidimensional which affect the sustainability of the livelihoods of farming households in rural communities. In view of the perceived effects of climate variability on agricultural systems and livelihoods, livelihood diversification was the most preferred and prominent adaptation strategy employed by many smallholder farmers. The study suggests the need for robust efforts by local government institutions to strengthen farmers’ resilience against climate variability impacts to generate opportunities for sustainable livelihoods.

Anatomy of a Regional Civil War: Guangxi, China, 1967–1968

AbstractDuring the violent early years of China’s Cultural Revolution, the province of Guangxi experienced by far the largest death toll of any comparable region. One explanation for the extreme violence emphasizes a process of collective killings focused on households in rural communities that were long categorized as class enemies by the regime. From this perspective, the high death tolls were generated by a form of collective behavior reminiscent of genocidal intergroup violence in Bosnia, Rwanda, and similar settings. Evidence from investigations conducted in China in the 1980s reveals the extent to which the killings were part of a province-wide suppression of rebel insurgents, carried out by village militia, who also targeted large numbers of noncombatants. Guangxi’s death tolls were the product of a counterinsurgency campaign that more closely resembled the massacres of communists and suspected sympathizers coordinated by Indonesia’s army in wake of the coup that deposed Sukarno in 1965.

Learning from the grassroots: The case for the consideration of community-based agrarian and food security reforms in South Africa

Studies of projected agro-climatic variability on the productivity of small-holding farming livelihoods have been evaluated by indirect methods using simulation models on country or regional basis but few have been done at the community level. This study explores direct observation of the impact of soil and climate factors on crop and livestock livelihood systems in the three major agro-ecological zones of the Eastern Cape Province of South Africa. It also analyzed their influence on small farmers’ choices of agrarian livelihood activities and the lessons learned for the suitability of agro-ecologically integrated agriculture as part of agrarian and food security reforms needed among small farming households in rural communities of South Africa. The impact of soil and rainfall on the crop and livestock livelihood choices of small-holders in the three major agro-ecological zones were explored. A cross-sectional survey was carried out among 223 small-holding farming households during the harvesting period of rain-fed farming season. Data on household livelihood activities were processed in monetary terms and subjected to gross margin and cost/benefit analysis. Geographic information system (GIS) mapping and statistical analysis were used to determine the association of small-holder maize revenue with agro-climatic variation. The results indicated that crop-based activities performed better in the Grassland zone, while livestock activities performed better in the Savanna zone. Small farms in the Karoo can only productively engage in livestock production. The results also showed that farming activities that combined more vegetable crops yielded greater profits than other field crops. Furthermore, the results indicate that the mixed cropping method remains one of the strategies for breaking-even and risk-bearing effort used by the small-holder farmers considering its cost-sharing benefits. Geographical information system (GIS) mapping further indicates that small-holders’ farming activity was not only affected by soil-climatic factors but by their management skills as well. We recommend agro-ecologically adapted policies and incentives for agriculture-based livelihood activities and intensified mixing of cropping systems among the small-holder farming households in the study area.

Impact of COVID-19 on Smallholder Poultry Farmers in Nigeria

In sub-Saharan Africa, most households in rural communities keep smallholder poultry, and are exposed to harsh socio-economic conditions caused by COVID-19 pandemic due to the vulnerability of their production systems to crisis. This study assessed the impact of COVID-19 on 525 smallholder poultry farmers in five states of Nigeria. The study was conducted 15 months after the onset of the pandemic in Nigeria using structured questionnaires focused on socio-demography, income, production systems, markets, and food security. Average household size increased from 6.9 before COVID-19, to 8.3 during COVID-19, representing a 20.3% increase in population growth. Over half (52.6%) of this increase was due to childbirths. Average monthly income before and during the pandemic was reduced from NGN 22,565 (USD 62.70) to NGN15,617 (USD 38.10), respectively. During the pandemic, there was a 28.4% increase in the number of farmers living below the international poverty line of USD 1.90 per day. In addition, reliance on chickens for food and income was significantly (p < 0.05) impacted by gender, location, household size, and monthly income. These results show that the COVID-19 pandemic had a significant effect on the livelihoods and food security of farmers, and the findings are essential in developing appropriate post-COVID-19 interventions for smallholder poultry production in Nigeria.

Childhood vaccination uptake and associated factors among children 12\u201323\u2009months in rural settings of the Gambia: a community-based cross-sectional study

BackgroundGlobally, immunization prevents 2–3 million deaths annually from vaccine-preventable diseases such as diphtheria, tetanus, pertussis, influenza, and measles. In developing countries, several immunization programs have made progress, but the coverage remains a standstill in some areas. In order to inform policies and practices, the present study aimed at assessing vaccination uptake and contextual-associated factors among children aged 12–23 months in rural Gambia.MethodsA community-based triangulated cross-sectional design was conducted in January 2020, with 200 caregivers with children aged 12–23 months in selected households in rural communities across Upper River Region of the Gambia using multistage sampling technique were recruited. A structured interview questionnaire was developed and Infant Welfare Cards were assessed to elicit information regarding contextual household characteristics towards childhood immunization uptake. Percentages, chi-square/fisher exact test for variables with p-value ≤0.15 were considered for inclusion into logistic regression model. The significance level was set at p < 0.05. The adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI) were reported to declare significance.ResultsThe proportion of children who received all the required vaccines was 66%. At the level of antigen-specific coverage, about 88.5% received BCG, 71% received OPV 3, 82.5% received Penta 3, while 72 and 71% received Measles-Rubella and yellow fever, respectively. Caregivers who had primary education level 88.8% (aOR = 0.112; 95% CI = 0.029–0.434), secondary & above 87.2% (aOR = 0.128; 95% CI = 0.029, 0. 561) and arabic/madrassa 95.7% (aOR = 0.043; 95% CI = 0.008–1.227) were less likely to be fully vaccinated when compared to those who have never been to school. Farmers are less likely by 88.9% (aOR = 0.111; 95% CI 0.020, 0.635) while children from family size of more than 20 members had reduced odds (aOR = 0.420; 95% CI = 0.197, 0.894) for their children to complete their vaccination schedule as compared to those with at most 20 household members.ConclusionThere is moderately a burden of incomplete vaccination in rural Gambia. Vaccination programs should be constantly monitored and evaluated by the Ministry of Health, especially in rural areas. To increase societal awareness and vaccine acceptance, a robust community-based health education efforts are desperately needed as part of initiatives to increase vaccine service utilization for these high-risk classes.

Subsistence Agriculture as the Basis of Rural Livelihoods in Msinga Local Municipality, Kwazulu-Natal, South Africa

ABSTRACT Subsistence agriculture is recognised as a livelihood contributing to food security for households in rural communities. The sustainable livelihood approach is employed in this study, based on its strength and optimistic orientation to grant rural people an opportunity to improve their environment, economic standing, and social development. Data were collected from 180 households using a questionnaire analysed with the SPSS software. The subsistence agriculture sector still lacks adequate governmental support for effective operations to enhance rural livelihoods. Assisting subsistence farmers should improve productivity. The study recommends that the local municipalities should establish a marketplace that would be used as a sales point for community members and local emerging farmers to ensure an effective distribution of agricultural products. This would play a significant role in solidifying the return of the rural economy by increasing farm productivity and complimenting market opportunities.

Experimental investigation of an integrated rainwater harvesting unit for drinking water production at the household level

According to the United Nations' report, billions of people, particularly those living in regional areas (places that lay behind major cities), are still lacking access to clean drinking water. Some of them drink rainwater without any prior treatment even though water experts are campaigning against this practice for potential health risks. As most of the previous studies have focused on the use of harvested rainwater for non-potable usage, the present study reports the feasibility of producing drinking water from an integrated rainwater harvesting unit. It is found that the developed unit can produce clean drinking water for households in rural communities. The economic payback time for the proposed unit is eight years at a water production cost of AU$ 0.07/L. Important quality parameters of the produced drinking water, such as pH, electrical conductivity, ammonia, nitrite, nitrate, total organic carbon, turbidity, faecal coliforms &escherichia coli, heavy metals, and total trihalomethanes, are examined using a testing facility accredited by the National Association of Testing Authorities from Australia. It is found that the water quality complies with the requirements specified in the Australian drinking water guidelines. The developed integrated rainwater harvesting unit could produce drinking water at a capacity of 348 ± 20 L in a day. Since it is important to store the produced drinking water for potential dry periods, suitable methods for disinfection and mineral fortification of the produced water are presented. Finally, a detailed description of the step-by-step installation of the proposed system is presented. This study can potentially contribute to Goal 6: Clean water and sanitation of United Nations' Sustainable Development Goals.

Vulnerability, family assets, and income-generating strategies of households in rural Mexico

ABSTRACT This study is a first step in analyzing, on a national scale in Mexico, the assets, income and vulnerability context of households in rural communities. A multinomial logit model was used to show the impact of family labor, education, indigenous status, climate change, and access to markets on the probability of belonging to the different categories of households with diverse sustainable livelihoods. Our results provide evidence that increasing investment in human capital encourages participation by large numbers of households in the productive activities that offer the greatest returns. The findings also suggest that public policies should aim to solve structural concerns that limit the efficacy of the use of assets to promote sustainable development in rural communities in countries like Mexico.

Use of antibacterials in the management of symptoms of acute respiratory tract infections among children under five years in Gulu, northern Uganda: Prevalence and determinants.

Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34–2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34–4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36–11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.

Vulnerabilidad alimentaria en hogares rurales y su relación con la política alimentaria en México

&#x0D; El presente ensayo tuvo como objetivo identificar la vulnerabilidad alimentaria partiendo del origen del concepto ‘seguridad alimentaria’ y al mismo tiempo describir la política alimentaria mexicana. La pregunta que guió este trabajo fue ¿la situación de vulnerabilidad a los alimentos en hogares rurales mexicanos está relacionada con el sistema alimentario de los últimos años?, bajo el contexto de hogares en comunidades rurales con actividades agrícolas de subsistencia, suelos pobres en nutrientes, con alto índice de migración, escasas fuentes de empleo y con actividades artesanales para el mercado local. A través, de una revisión bibliográfica se identificó que el término de seguridad alimentaria fue acuñado por primera vez en la década de 1970, tiene cuatro dimensiones la disponibilidad se usa en escalas global y nacional, el acceso en el nivel hogar, el uso en lo individual y la estabilidad es el cruce de los anteriores. Dentro de los hallazgos se menciona que en 2010 alrededor de 49.9 millones de personas padecieron inseguridad alimentaria, las nuevas dinámicas rurales hicieron transformaciones en las actividades agrícolas que pasaron a ser complementarias, hubo una pérdida de identidad con el cambio de dietas y el alto consumo de productos externos, con una importación de al menos 35% del consumo interno en el país que ha provocado problemas de salud como el sobrepeso. Se concluye que la vulnerabilidad es la exposición de los hogares rurales a la inseguridad alimentaria, debido a la falta de recursos para comprarlos y de calidad en la dieta producto de un sistema alimentario global con efectos locales, en este sentido se deberá replantear el sistema alimentario mexicano con estructuras organizativas complejas y poner énfasis en fenómenos como la vulnerabilidad por su dinamismo a nivel hogar.