Low-income Rural Communities Research Articles

The WASH Benefits and SHINE Trials. Interpretation of Findings on Linear Growth and Diarrhoea and Implications for Policy: Perspective of the Investigative Teams (P10-136-19)

ObjectivesWe recently completed 3 efficacy trials (Bangladesh, Kenya, Zimbabwe) testing the independent and combined effects of improved complementary feeding (CF) and intensive household water quality, sanitation, and hygiene (WASH) on child diarrhea and length-for-age-Z-score (LAZ) at 18 to 24 mo. Intervention uptake was high. In all three trials: CF increased LAZ but WASH had no effect on LAZ. WASH reduced diarrhea in Bangladesh but not in Kenya or Zimbabwe. We present a synthesis of trial findings and their implications. MethodsReviews of the literature and reanalyses of trial data were conducted. ResultsWASH and stunting: Copious observational studies have demonstrated a strong association between household-level WASH and child LAZ. We conducted an observational anlaysis (nested birth cohort) from our control arms. In adjusted analyses of all three trials, having an improved latrine when the pregnant woman was enrolled was associated with ∼0.2LAZ increase in her child at 18–24 mo. The frequently reported association between household WASH indicators and child growth may be confounded and drawing causal inferance misguided.WASH and diarrhea: Promoters visited intervention households 6 times per month in Bangladesh and monthly in Kenya and Zimbabwe. We conducted a systematic literature review: virtually all evidence that household water chlorination and handwashing reduce diarrhea comes from studies with daily to fortnightly intervention contact. In studies with follow-up after the trial ending, behaviors steeply declined and the effect on child diarrhea disappeared. Household water chlorination and handwashing promotion implemented through sporadic message delivery may not reduce child diarrhea.Enteropathogen transmission: Despite achieving substantial contrast between WASH and non-WASH households, children in the WASH arms still experienced high enteropathogen transmission, illustrating the recalcitrance of pervasive fecal contamination in rural low-income communities to even intense intervention. ConclusionsHousehold WASH interventions are unlikely to reduce child stunting and may not reduce child diarrhea. We call for substantial investment in research to identify and in programming to deliver much more efficacious interventions. Funding SourcesBill & Melinda Gates Foundation, USAID, DFID/UKAID, Wellcome Trust.

Micro-solutions to global problems: understanding social processes to eradicate energy poverty and build climate-resilient livelihoods

This research explores the agent dynamics, learning processes, and enabling conditions for the implementation of microscale win-win solutions that contribute to energy poverty eradication and climate resilience in a selection of low-income rural and peri-urban communities in India, Indonesia, and South Africa. We define these micro-solutions as energy-related interventions and resilience services or products—used at community, household, small production unit, or business level—that yield both economic and climatic gains. Our analysis identifies five elements critical for the robust design of these interventions: (i) The ability to collaborate and share different kinds of expertise with a range of networks operating at multiple levels of activity; (ii) The application of place-based systems-learning perspectives that enable project participants to integrate different types of solutions to meet different needs at the same time; (iii) The ability to yield tangible short-term benefits as part of long-term strategic visions and commitment; (iv) The use of novel technologies and financial instruments in ways that foreground the needs of poor populations; and (v) The inclusion and empowerment of economically marginalised groups through institutional and technological innovations and responsible business models. We conclude that the most critical aspect of successful micro win-win solutions is support for communities’ own endogenous transformative capacities as this helps ensure that solutions are shared and continuously adapted to changing conditions over time.

A matrix model towards CSR – moving from one size fit approach

PurposeCorporate social responsibility (CSR) research is often dominated in a western context. Perhaps, with the rapid expansion of organisations in the context of emerging economies, there is a pressing need for the development of a new dimension. Organisations operating in emerging markets must address the social challenges of serving low-income consumers and rural communities as part of their CSR strategy. The next era of CSR should look out for a period of experimentation and innovation as organisations advance their core business objectives by addressing existing social and environmental issues, which are dependent on market and industry settings. The purpose of this paper is the requirement of careful considerations when formulating the CSR framework for different industries and markets in the global business environment and this is the focus in this paper.Design/methodology/approachThe paper provides a review and certain limitations of the literature on the highly cited works such as stakeholder theory and Carroll’s pyramid model. Following on, the proposed matrix model, related discussion of the four phases and associated propositions are explained in the paper. Finally, some concluding remarks on the need for a new look on CSR in the context of non-western markets are presented.FindingsIn this paper, the authors introduce “The matrix model of CSR” as a starting attempt and a guideline in formulating the CSR approach across industry and countries, particularly illustrating in the context of diverse organisations in different sectors. However, this model is at a conceptual level and future research could allow empirical testing and refinement of the “matrix model” in different market and industry conditions.Originality/valueA CSR model for multiple organisational contexts would provide more insight for the relevant stakeholders regarding their CSR activities. Thus, this article attempts to suggest a CSR matrix model and it takes a phased approach by classifying the CSR activities based on the degrees of CSR and altruistic nature of activities that could be adapted for other industries as well as emerging economies.

Optimal sustainable water-Energy storage strategies for off-grid systems in low-income communities

Energy-water supply in low-income rural communities is addressed using a multi-objective model for defining the configuration and size of the system. The considered objective functions are minimizing the total annual cost, water and land usage, CO2 emissions and maximizing local jobs and the social opportunity associated to technological change. The multi-objective strategy meets a trade-off solution between economic, environmental and social dimensions which are integrated by subsets of objective functions. Strategies for energy-water surplus management based on batteries and pumping systems are evaluated. Conflicts between social and economic objectives are identified. As Case Study, profiles of energy and water consumption of a rural community from Mexico are presented.

An Organized Approach to Multi-Organ Screening in Rural Honduras

Background: Poverty, poor healthcare infrastructure and geographic location contribute to a total lack of cancer screening for most residents of rural Honduras. Three projects built upon each other to develop, with local leaders, multiorgan screening events that mitigated barriers to screening-based early detection of cancers. Targeted barriers included transportation, cost, community perception and convenience. Aim: To test a novel system of multiorgan screening for feasibility, acceptability and effectiveness. Methods: Leveraging well-known brigade-style medical outreach methods, two large-scale weekend programs for women and one for men over four years in the same rural location screened women for cancers of the cervix, breast, oral cavity, thyroid; and men for cancers of the testes, oral cavity, skin, prostate and colon; and connected participants with follow-up care at a Honduran cancer center. Screening methods ranged from simple throat palpation for thyroid lesions to molecular screening for high risk HPV. Generally, screening began with low-tech methods onsite to triage the participants and identify those at high-risk for cancer who should have more technical follow-up at an equipped clinic. Well-trained Honduran medical students provided screening capacity and community leaders were solely responsible for promoting the screening opportunities. Masking was not possible onsite, but data analysis in the U.S. was anonymized. Results: Participants were accrued to each program's capacity (n=400) in 2013 and 2016 and near capacity in 2017 with high levels of participants completing the screening programs, community engagement with the process, and compliance with referrals for clinical follow-up at a collaborating cancer center located three hours away. Participants identified at the screenings for clinical follow-up included for women: breast 2.7% (2013) and 4.2% (2016), thyroid 1.7% (2016), cervix/positive for high risk HPV 8.2% (2013) and 11.8% (2016); and for men all in 2017: skin 0%, testes 7%, colorectal 1%, oropharynx 1 participant, and prostate 6.7%. The dominant local narrative predicted men would not participate in screening, yet 326 participated and of that group, 239 self-identified as having possible colorectal symptoms based on seeing an advertising flyer with questions about symptoms of constipation, bloody stools, or unintended weight loss. That self-identified subset took the initiative to see the local nurse in advance, obtain a colorectal sample kit, collect three days of stool samples, and bring them to the screening event. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening may be feasible in low-income rural communities. Funding: The Jornada studies were funded by Norris Cotton Cancer Center at Dartmouth's Geisel School of Medicine and a special grant from Geisel's Munck-Pfefferkorn Fund.

Faithful Families Cooking and Eating Smart and Moving for Health: Evaluation of a Community Driven Intervention.

Background: There is an increasing need to adapt and use community interventions to address modifiable behaviors that lead to poor health outcomes, like obesity, diabetes, and heart disease. Poor health outcomes can be tied to community-level factors, such as food deserts and individual behaviors, like sedentary lifestyles, consuming large portion sizes, and eating high-calorie fast food and processed foods. Methods: Through a social ecological approach with family, organization and community, the Faithful Families Cooking and Eating Smart and Moving for Health (FFCESMH) intervention was created to address these concerns in a rural South Carolina community. FFCESMH used gatekeepers to identify 18 churches and four apartment complexes in low-income areas; 176 participants completed both pre- and post-survey measures. Results: Paired t-test measures found statistically significant change in participant perception of food security (0.39, p-value = 0.005, d = 0.22), self-efficacy with physical activity and healthy eating (0.26, p-value = 000, d = 0.36), and cooking confidence (0.17, p-value = 0.01, d = 0.19). There was not significant change in cooking behaviors, as assessed through the Cooking Behaviors Scale. Conclusion: FFCESMH shows that a social ecological approach can be effective at increasing and improving individual healthy behaviors and addressing community-level factors in low-income rural communities.

The Willow Hill Community Education Assessment: Assessing the Education Needs of Children in a Former Slave Community

The study presents a perspective on the barriers encountered by children residing in a low-income rural community in Portal, GA. The purpose of this needs assessment (NA) is to identify educational challenges that youth in the community face. A sequential mixed method design was used. Intercept surveys were conducted followed by individual key informant interviews and a focus group. Survey data was entered into SPSS, and descriptive statistics were calculated. Audio recordings of the interviews were transcribed and uploaded into NVivo for content analysis. Overall, the results indicated a need for stronger infrastructure that better meets the needs of the youth, which can be done by engaging stakeholders in identifying and mobilizing community-based assets, thus creating local economic opportunities.

Abstract B20: Cancer screening in rural Honduras: Maximizing impact with a multiorgan screening approach

Abstract Introduction: Poverty, poor health infrastructure, and rurality contribute to lack of cancer screening for most residents of Honduras (HN). We hypothesized that if community-identified barriers were mitigated, rural Hondurans would participate in cancer screening; initial low-tech screening methods would be useful in identifying high-risk individuals in a large group; and that we could operationalize an acceptable and effective multiorgan screening program. Our objective was to test multiorgan cancer-screening strategies for challenging rural environments such as our site in rural El Rosario, Honduras and develop a strategy that would be generalizable to rural sites in other low-income countries. Methods: We conducted three cancer-screening projects (2013/n=449 women, 2016/n=389 women, 2017/n=299 men) by developing relationships with rural community leaders and Honduran oncologists. Together, we launched multiorgan screening events via a brigade-style medical outreach model designed to mitigate barriers to early detection of cancers. Key strategies: 1) a screening cascade system and low-tech methods to identify high-risk individuals for further screening; 2) triage for findings requiring additional workup, rather than focusing on making a definitive cancer diagnosis; 3) inserting cancer education into the participants' experience; and 4) multiorgan screening to maximize cancer prevention with little additional use of resources. Community-identified barriers were transportation, cost, fear, and inconvenience; we negotiated an array of minimalist and highly effective community-based strategies to mitigate the barriers. In 2013 and 2016 we screened women for cancers including cervix, breast, oropharynx, and thyroid, and in 2017 screened men for testicular, oropharynx, skin, prostate, and colon cancers. Post-study, participants with suspicious findings were connected with follow-up care at a cancer center in HN. On-site screening methods ranged from no-tech, including surveys, clinical breast exams, throat palpation for thyroid, digital rectal exam for prostate, physical exam of testes, and visual skin inspection for skin cancer; to mid-tech, including telepathology for oral cancer, fecal occult blood test for colon cancer, and PSA for prostate; and high-tech PCR screening for high-risk HPV (hrHPV). Well-trained HN medical students staffed the screening areas; their participation is intended to increase long-term screening capacity in HN. Community leaders were responsible for promoting the screening clinic by training teens who traveled to villages to introduce the opportunity. Results: Participants came via a free bus, horse, motorbike, and on foot from 31 (2013), 40 (2016), and 38 (2017) different communities. Median age and years of education were 38/5 (2013), 40/6 (2016), and 47/4 (2017). Almost every participant completed all screenings. We found 11 types of hrHPV; in 2013/8.4% and 2016/12.5% were positive for 1 or more types. Referrals for breast follow-up were 2013/2.7% and 2016/4.4%. In 2017 (men), 26 referrals were: skin screening/2; testicular exams/2; colon/2; oropharynx/0; and 20 men for clinical prostate follow-up by a screening cascade of survey, digital rectal exam, and PSA. 249 men self-identified based on ASCO colon standards and brought stool samples for FOBT/4 tested positive. We used oral consent and focus groups for post-event evaluation. Comments reflected satisfaction with the medical students, convenience of a free bus, and protection of participants' privacy. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening is feasible in low-income rural communities. Despite low expectation of male participation because it is “common knowledge” that Honduran males avoid clinics, our experience demonstrates that with mitigation of barriers, men will participate. Citation Format: Linda Skewes Kennedy, Kayla A. Marra, Ethan Phillip Marshall LaRochelle, Mary D. Chamberlin, Kathleen D. Lyons, Suyapa A. Bejarano, Gregory J. Tsongalis. Cancer screening in rural Honduras: Maximizing impact with a multiorgan screening approach [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B20.

A hybrid energy system based on renewable energy for the electrification of low-income rural communities

Electrification of low-income rural areas that have a limited connection or no access to electrical grids is one of the most demanding challenges in developing countries such as Peru. The international commitment to stop global warming and the reduction in the cost of renewable sources of energy have reduced the prices of fossil fuels in some cases. This has opened the way to the current research which proposes a hybrid energy system (HES) based on the use of renewable sources of energy. Therefore, a renewable electricity system (HRES) was set up at the village of Monte-Catache in the Cajamarca region, which is one of the poorest areas of Peru. Surveys and field studies were used to evaluate the socioeconomic characteristics, availability of renewable energy resources, and energy demand of this region. Potential energy sources were evaluated, and isolated photovoltaic systems with a battery bank were found to be the most appropriate according to the results obtained in the simulation with HOMER. This proposal constitutes an interesting contribution for future energy solutions in isolated and low-income rural areas.

Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders.

Substance use (e.g., alcohol, marijuana, opioids, cocaine., etc,) use often initiates during adolescence, a critical period of physiological and social development marked by an increase in risk-taking due, in part, to heightened motivation to obtain arousal from rewards. Substance use during adolescence has been associated with a greater risk of substance use disorders (SUD) in adulthood. Although use rates for most substances have remained relatively stable, the frequency of marijuana use and the perception that regular marijuana use is not harmful has increased in adolescents. Furthermore, the nonmedical use of opioids has increased, particularly in the South, Midwest, and rural low-income communities. Substance use in adolescence has been associated with adverse structural and functional brain changes and, may exacerbate the natural "imbalance" between frontal/regulatory and cortical-subcortical circuits, leading to further heightened impulsive and reward-driven behaviors. Exercise increases growth and brain-derived neurotrophic factors that stimulate endogenous dopaminergic systems that, in turn, enhance general plasticity, learning, and memory. Exercise may help to reinforce the "naïve" or underdeveloped connections between neurological reward and regulatory processes in adolescence from the "bottom up" and "offset" reward seeking from substances, while concomitantly improving cardiovascular health, as well as academic and social achievement. In this review, we provide an overview of the current state of substance use in adolescents and rationale for the utilization of exercise, particularly "assisted" exercise, which we have shown increases neural activity in cortical-subcortical regions and may modulate brain dopamine levels during adolescence, a unique window of heightened reward sensitivity and neural plasticity, for the prevention and adjunctive treatment of SUD.

Dementia Prevalence in a Rural Region ofSouth Africa: A Cross-Sectional Community Study.

Background:Dementia is a growing concern for low- and middle-income countries where longevity is increasing and service provision is poor. Global prevalence estimates vary from 2% to 8.5% for those aged 60 years and older. There have been few dementia studies in sub-Saharan Africa, and prevalence data are lacking for South Africa.Objective:To conduct a large dementia prevalence study in a low income rural population in South Africa.Methods:1,394 Xhosa-speaking community dwellers, aged ≥60 y (mean age±sd 71.3±8.3 y), in three clinic catchment areas, were screened at home. Trained community health workers administered the brief Community Screening Instrument for Dementia (CSID) to participants and informants to assess cognitive and functional capacity. Depressive symptoms were assessed with three questions from the EURO-D.Results:The prevalence estimate using published CSID sensitivity/specificity values was 0.8 (95% CI: 0.06–0.09). Using CSID cut-off scores the estimated prevalence was 0.12 (95% CI: 0.10–0.13), with 161 screen-positives. Both methods gave a rate of 0.11 (95% CI: 0.09–0.13) for those over 65 years (n = 1051). 68.6% of participants were female and 69.8% had less than 7 years of education. Dementia risk was associated with older age and symptoms of depression, but not with sex. The association with education was not significant when controlled for by age.Conclusions:Dementia prevalence estimates were higher than expected for this low-income rural community. There is a need for increased dementia awareness and feasible support interventions. We also need further studies of regional prevalences, dementia subtypes, and modifiable risk factors in South Africa.

Supermarket Science: Multipronged Approaches to Increasing Fresh, Frozen, and Canned Fruit & Vegetable Purchases

Conduct a randomized controlled study to determine if a supermarket double-dollar fruit and vegetable (FV) incentive program increases FV purchases among low income families. We enrolled 401 customers from a supermarket in a low-income rural community. Purchases were tracked using a loyalty card system that provided study participants with a 5% discount on all purchases during a 3-month baseline period followed by the four-month intervention. The intervention group received half-off fresh, frozen or canned FV; the control group received no incentives. Primary outcomes were changes in weekly spending on FV between baseline and intervention periods. Secondary analyses examined changes among SNAP-eligible participants. Weekly spending on total FV increased in the intervention arm, compared to control (15% increase; $1.83, 95% CI=$0.28-3.84). The largest increase was for fresh FV (18% increase: $1.97, 95% CI=$0.49-3.44) with little change for canned and frozen FV. Secondary analyses revealed even greater increases in weekly FV spending among SNAP-eligible participants compared to non-SNAP-eligible participants (45% increase; $2.37, 95% CI=$-0.04-4.78) compared to (11% increase; $1.57, 95% CI=$-0.36-3.50), and increased fresh FV spending among SNAP-eligible participants (53% increase; $2.55, 95% CI=$0.23-4.87) compared to non-SNAP eligible participants (13% increase; $1.68, 95% CI=$-0.15-3.52). A double-dollar pricing incentive increased FV supermarket purchases in a low-income community. SNAP-eligible customers had the greatest improvements. These results suggest that financial incentives could be an effective strategy for the SNAP program to improve healthy food choices.

Mobilizing Rural Low-Income Communities to Assess and Improve the Ecological Environment to Prevent Childhood Obesity

To mobilize capacity, including policy, system and environmental changes in rural communities to create and sustain an environment and culture of healthful eating and physical activity to prevent childhood obesity. A collaborative multidisciplinary team from Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin implemented a community development model testing the value of a community coach in assisting existing health coalitions in improving community environments. Two closely matched communities in each state (randomly assigned as either intervention with a hired coach or comparison with no coach) were provided with funding to support the promotion of healthy eating and increased physical activity of four-year-olds in their community. Additionally, intervention communities received assistance from a community coach. Community environments were examined before and after four years of implementation. Training on the methods of community coaching was provided to the comparison communities at the end of the project. Enhancement of a community’s capacity to prevent childhood obesity with community coaching has been and continues to be examined through a mixed methods data analysis approach. Assessments used previously validated instruments, reflections, coalition assessments, interviews and a final ripple mapping exercise. Introduction and successful use of a new community-based coaching model benefited the intervention communities and they were able to address more policy, system and environmental approaches. Best practices were identified and an online tutorial developed. Sharing of results will be ongoing.

Community factors accountable for home births in a low income rural setting in Ghana

Background: Many maternal deaths occur as a result of delivery that takes place in the home or late referral of women in labour to the health facility. This situation is further worsened in remote poor communities of the northern region of Ghana; where health care services are inequitably distributed. This study determined the factors in low income rural communities that are responsible for the high numbers of homebirths using the Bunkpurugu Yunyoo district as a case study. Methods: The study employed mixed method study that used both qualitative and quantitative methods. Three hundred women who delivered within the last one year were made to respond to a research questionnaire while four health care workers (three midwives and a general registered nurse) were engaged in an in-depth interview. Results: The study identified poor road network, inequitable distribution of health facilities, inadequate family support during labour, cultural factors like taboos and the stigma associated with FGM to be responsible for the high numbers of home deliveries. Even though women intended to give birth in the health facility during pregnancy, they are unable to do so as labour occurs when they were not expecting it. Conclusions: The study recommended the use of equipment like the ultrasound during the first trimester of pregnancy to measure accurately the expected date of delivery of each pregnant woman so as to enable them plan for birth.

The Expansion of Regional Supermarket Chains: Changing Models of Retailing and the Implications for Local Supplier Capabilities in South Africa, Botswana, Zambia, and Zimbabwe

Over the past two decades, southern African countries have experienced rapid growth in the number and spread of supermarkets. Several factors have been attributed to this growth, including increasing urbanization, increased per capita income, the rise of the middle class, economies of scale and scope, and transport economies. The format and location of supermarkets have also evolved over the years, moving away from serving the traditional highend affluent consumers in urban areas to successfully penetrating new markets in low-income rural communities, including through more efficient procurement and distribution systems. This spread into rural areas and the rapid proliferation of supermarkets generally has given rise to some important consequences for competitive rivalry between grocery retail outlets, as well as for local suppliers who want to participate in supermarket value chains in the southern African region.

Meta-analysis to estimate the load of Leptospira excreted in urine: beyond rats as important sources of transmission in low-income rural communities

BackgroundLeptospirosis is a major zoonotic disease with widespread distribution and a large impact on human health. Carrier animals excrete pathogenic Leptospira primarily in their urine. Infection occurs when the pathogen enters a host through mucosa or small skin abrasions. Humans and other animals are exposed to the pathogen by direct contact with urine, contaminated soil or water. While many factors influence environmental cycling and the transmission of Leptospira to humans, the load of pathogenic Leptospira in the environment is likely to play a major role. Peridomestic rats are often implicated as a potential source of human disease; however exposure to other animals is a risk factor as well. The aim of this report is to highlight the importance of various carrier animals in terms of the quantity of Leptospira shed into the environment. For this, we performed a systematic literature review and a meta-analysis of the amount of pathogen that various animal species shed in their urine.ResultsThe quantity of pathogen has been reported for cows, deer, dogs, humans, mice, and rats, in a total of 14 research articles. We estimated the average Leptospira per unit volume shed by each animal species, and the daily environmental contribution by considering the total volume of urine excreted by each carrier animal. Rats excrete the highest quantity of Leptospira per millilitre of urine (median = 5.7 × 106 cells), but large mammals excrete much more urine and thus shed significantly more Leptospira per day (5.1 × 108 to 1.3 × 109 cells).ConclusionsHere we illustrate how, in a low-income rural Ecuadorian community, host population demographics, and prevalence of Leptospira infection can be integrated with estimates of shed Leptospira to suggest that peridomestic cattle may be more important than rats in environmental cycling and ultimately, transmission to humans.

High Leptospira Diversity in Animals and Humans Complicates the Search for Common Reservoirs of Human Disease in Rural Ecuador.

BackgroundLeptospirosis is a zoonotic disease responsible for high morbidity around the world, especially in tropical and low income countries. Rats are thought to be the main vector of human leptospirosis in urban settings. However, differences between urban and low-income rural communities provide additional insights into the epidemiology of the disease.Methodology/Principal findingsOur study was conducted in two low-income rural communities near the coast of Ecuador. We detected and characterized infectious leptospira DNA in a wide variety of samples using new real time quantitative PCR assays and amplicon sequencing. We detected infectious leptospira in a high percentage of febrile patients (14.7%). In contrast to previous studies on leptospirosis risk factors, higher positivity was not found in rats (3.0%) but rather in cows (35.8%) and pigs (21.1%). Six leptospira species were identified (L. borgpetersenii, L kirschnerii, L santarosai, L. interrogans, L noguchii, and an intermediate species within the L. licerasiae and L. wolffii clade) and no significant differences in the species of leptospira present in each animal species was detected (χ2 = 9.89, adj.p-value = 0.27).Conclusions/SignificanceA large portion of the world’s human population lives in low-income, rural communities, however, there is limited information about leptospirosis transmission dynamics in these settings. In these areas, exposure to peridomestic livestock is particularly common and high prevalence of infectious leptospira in cows and pigs suggest that they may be the most important reservoir for human transmission. Genotyping clinical samples show that multiple species of leptospira are involved in human disease. As these genotypes were also detected in samples from a variety of animals, genotype data must be used in conjunction with epidemiological data to provide evidence of transmission and the importance of different potential leptospirosis reservoirs.

Barriers to the Delivery of Children’s Physical Activity in California’s Central Valley

The Niños Sanos, Familia Sana project is a multifaceted intervention to slow down the rate of BMI increase in young children in two Mexican-origin communities using a Community Based Participatory Research approach. This study focused on the physical activity component to examine where schoolteachers engage their students in physical activity, identify the barriers to class daily physical activity, and determine teacher’s perceptions regarding strategies to increase daily classroom physical activity. During the 2014-2015 school year, thirty-two preschool through third grade teachers from the intervention and control communities completed a Classroom Barriers to Physical Activity survey. Descriptive statistics revealed that the students in the treatment community tended to have physical activity on a playground (84.6%). A higher percentage of teachers in the control group (68.4%) reported they use the classroom for physical activity. Furthermore, teachers in the control group indicated that spending physical activity time in the classroom was a high barrier to daily physical activity. By understanding the barriers for delivering physical activity in elementary schools, we can gain a stronger understanding of the development and implementation of physical activity interventions for low-income rural communities.

Mobilizing Rural Low-Income Communities to Assess and Improve the Ecological Environment to Prevent Childhood Obesity

Mobilizing Rural Low-Income Communities to Assess and Improve the Ecological Environment to Prevent Childhood Obesity

The impact of community participation in rural water management in Ndarugu-Thiririka sub-catchment, Athi Basin, Kenya

In rural areas, water availability in the right quantity and quality is an important step towards achieving socio-economic development. Thus, the provision of sustainable water supply has been a central issue in Kenya with priority on low-income rural communities and underdeveloped areas with poor water resources. This has forced many rural communities to embrace community management model in rural water systems. Community participation in rural water management is purportedly a key element for community water projects to be sustainable. The objective of this paper was to assess the impact of community participation in rural water management in four community-managed rural water supply projects, namely Kinyathena, Juja Farm, Munyu and Kamunyaka. Different types of data were collected using household questionnaires, in-depth interviews, Focus Group Discussions (FGDs) and Participatory Rural Appraisal (PRA). The data type collected included the socio-economic characteristics of the sample households and level of community participation. . The collected data was organized in Statistical Package for Social Sciences (SPSS) version 17.0 and Microsoft Excel. Descriptive statistics, frequencies and percentages were used to describe and summarize the data while inferential statistics, chi-square and ANOVA were used to reach conclusions and make generalizations of the population. Results indicate that 56.5% of the respondents agreed that community participation in rural water management has improved their livelihoods. Therefore the study concludes that community participation in the sub-catchment has impacted on the local community livelihoods by providing constant access to adequate water for domestic, agricultural uses, construction, reducing time wastage, general development and catchment management.Keywords: Ndarugu-Thiririka sub-catchment, water management, Community participation