Poor Rural Areas Research Articles

Impact of the COVID-19 Pandemic on the Financial Situation of Rural and Urban Households in Poland

The COVID-19 pandemic not only caused a global health crisis but also had a huge impact on household finances. This research aimed to examine the financial situation of rural and urban households in Poland between 2018 and 2022 from a multidimensional perspective. In a unidimensional approach, the financial situation of households was analyzed separately for their income, expenditures, savings rate, and shares of fixed expenses. In a multidimensional approach, the analysis used a synthetic index constructed for all these variables combined, employing the TOPSIS method and drawing on microdata from the Polish Central Statistical Office that totaled approximately 150,000 households. It was found that despite the pandemic outbreak, which led to major changes in the labor market, government-introduced organizational and legal measures protected the income of Polish households from decline. Indeed, income was increasing up until 2021, with a modest fall in 2022, which was less severe in rural households (by about 2%) than in urban ones (by 6%). A more immediate response to the outbreak was observed in consumer spending, which fell sharply, while the food share in consumption increased at similar levels in rural and urban areas. Regression analysis showed that compared to 2019, the pandemic worsened the financial situation of Polish households, but only in 2020 and 2022 were these changes statistically significant. In 2021, the financial situation improved slightly, but the change was not statistically significant. Before the pandemic, the synthetic assessment of the financial situation in rural areas was lower than in urban ones, and the pandemic period did not reduce these differences, showing no convergence between poorer rural areas and richer urban ones. Diagnosing and monitoring the household financial situation are crucial steps for achieving the social dimension goals of sustainable development. Research on the pandemic’s effects on household finances provides valuable information that can help develop effective strategies to counter future crises while supporting the social dimension of the sustainable development strategy.

First detection of Leishmania major in dogs living in an endemic area of zoonotic cutaneous leishmaniasis in Tunisia

BackgroundDogs are considered the main domestic animals that may be a reservoir for Leishmania infantum, the agent of zoonotic visceral leishmaniasis (ZVL) in several countries of the world. The dog may host other Leishmania species, but its epidemiological role in the maintenance and spreading of these parasites is not completely elucidated. Zoonotic cutaneous leishmaniasis (ZCL), caused by Leishmania major, affects thousands of people every year and is particularly diffused in many countries of North Africa and Middle East Asia. In ZCL endemic countries, few reports of L. major-positive dogs have been reported, probably because most human cases occur in poor rural areas where the social role of the dog and its medical management is not well considered. The aim of the present study is to better understand the possible involvement of domestic dogs in the epidemiology of ZCL.MethodsOur research focused on a well-established endemic focus of ZCL, in the area of Echrarda, Kairouan Governorate, central Tunisia. A total of 51 dogs with no or mild clinical signs of vector borne diseases were selected in small villages where human cases of ZCL are yearly present. All dogs were sampled for the Leishmania spp. diagnosis, by using the following procedures: blood sample for serology and buffy coat quantitative polymerase chain reaction (qPCR), popliteal fine needle aspiration, and cutaneous biopsy punch for lymph node and skin qPCR.ResultsThe results demonstrated a high percentage (21.6%) of dogs positive at least at one or more test; the most sensitive technique was the lymph node qPCR that detected 8/11 positive dogs. Nine, out of the eleven positive dogs, resulted as infected by Leishmania infantum; ITS1-PCR-sequencing allowed Leishmania major identification in the remaining two cases, both from the popliteal lymph node samples, which can suggest a possible visceral spread of a cutaneous Leishmania species in the dog. Interestingly, one of the two L. major-positive dogs was living in the same house where 6-year-old children showed cutaneous lesions referred to as ZCL.ConclusionsTo our knowledge, this is the first report of L. major-positive dogs in Tunisia, the epidemiological role of which remains under investigation.Graphical

Assessment of Caesarean Section Outcomes for Preterm Pregnancies in a Tertiary Care Hospital in Bangladesh

A cross-sectional, observational study was conducted in the Department of Obstetrics and Gynaecology at Community Based Medical College, Bangladesh (CBMC,B), Mymensingh, Bangladesh, to evaluate the indications and feto-maternal outcomes of Caesarean section operation among preterm pregnant women. A total of 120 patients were enrolled between January and December of 2023. Data collection involved a structured questionnaire, file review, historical inquiry, and monitoring of mother and baby. Most individuals were aged 15-20 (37.50%) and had tertiary education (75.00%). Majority were from poor socio-economic backgrounds (76.67%) and rural areas (70%). Primigravida cases were predominant (65.00%), and multiparous accounted for 36.67%. Eclampsia (21.67%) and preeclampsia (20.83%) were common indications for cesarean section. Most procedures were emergency (93.33%). Maternal complications were low, with 64.17% having none. Most infants had low birth weight (62.50%) and experienced live births (91.67%), with a notable stillbirth rate (8.33%). Fetal complications included low birth weight (88.33%) and prematurity (20%). No complications were noted in 31.67% of cases. The study examined the complexities of Cesarean section (CS) for preterm births, highlighting maternal-fetal factors, varied indications, and outcomes, urging tailored interventions. CBMJ 2024 July: vol. 13 no. 02 P: 243-250

Edutainment and Dwelling-Related Assets in Poor Rural Areas of Peru

Abstract We exploit a field experiment by (Chong, A., and M. Valdivia. 2023. “Edutainment, Savings, and Generational Differences in Rural Areas of Peru.” In Working Paper. Department of Economics, Georgia State University) and test whether poor women from rural areas in developing countries that are able to save seek dwelling-related assets and find causal evidence that this is indeed the case. Furthermore, we also find that the older cohort of women, those aged forty and higher, also prioritize material assets related to health-related expenditures, in particular, access to public sewerage system.

Food Transfers, Cash Transfers, Behavior Change Communication and Child Nutrition: Evidence from Bangladesh

Abstract This paper reports the results of two 2-year randomized control trials in two poor rural areas of Bangladesh. Treatment arms included monthly cash transfers, monthly food rations of equivalent value to the cash transfers, and mixed monthly cash and food transfers, and treatment arms—one with food and one with cash—that combined transfers with nutrition-behavior communication change (BCC). This design enables a comparison of transfer modalities within the same experiment. Intent-to-treat estimators show that cash transfers and nutrition BCC had a large impact on nutritional status, a 0.25 standard deviation increase in height-for-age z-scores and a 7.8 percentage point decrease in stunting prevalence. No other treatment arm affected anthropometric outcomes. Mechanisms underlying these impacts are explored. Improved diets—particularly increased intake of animal source foods in the cash plus BCC arm—are consistent with the improvements observed in this paper.

Exploring the “Urban Advantage” in Access to Immunization Services: A Comparison of Zero-Dose Prevalence Between Rural, and Poor and Non-poor Urban Households Across 97 Low- and Middle-Income Countries

Urban children are more likely to be vaccinated than rural children, but that advantage is not evenly distributed. Children living in poor urban areas face unique challenges, living far from health facilities and with lower-quality health services, which can impact their access to life-saving vaccines. Our goal was to compare the prevalence of zero-dose children in poor and non-poor urban and rural areas of low- and middle-income countries (LMICs). Zero-dose children were those who failed to receive any dose of a diphtheria-pertussis-tetanus (DPT) containing vaccine. We used data from nationally representative household surveys of 97 LMICs to investigate 201,283 children aged 12–23 months. The pooled prevalence of zero-dose children was 6.5% among the urban non-poor, 12.6% for the urban poor, and 14.7% for the rural areas. There were significant differences between these areas in 43 countries. In most of these countries, the non-poor urban children were at an advantage compared to the urban poor, who were still better off or similar to rural children. Our results emphasize the inequalities between urban and rural areas, but also within urban areas, highlighting the challenges faced by poor urban and rural children. Outreach programs and community interventions that can reach poor urban and rural communities—along with strengthening of current vaccination programs and services—are important steps to reduce inequalities and ensure that no child is left unvaccinated.

Neuropsychiatric Manifestations and Neuroimaging Changes of Neurologic Wilson Disease–A Cross Sectional Study

Background: Wilson disease is genetic disorder of copper metabolism which causes hepatic & neurologic manifestation mainly. Chelator therapy is usually given as first line treatment in symptomatic wilson disease. Objective: Objective of our study was to evaluate the neuropsychiatric menufestations of wilson disease. Methods: A Cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, a tertiary care premier Postgraduate Medical Institution of Bangladesh. Forty five (45) patients of neurologic wilson disease were evaluated at In-patient department of Paediatric Neurology, during the period of January 2015 to December 2020. Diagnosis of Neurologic wilson disease was done, based on the characteristic clinical features of progressive deterioration of scholastic performances, dysarthria and gait disorder along with ophthalmologic findings, biochemical & neuroimaging findings. Results: Total numbers of studied cases were 45. Mean age was 124.65± 20.69 months and male to female ratio was 1.8:1. Most of the patient (83.33%) arrived from poor socio-economic background and rural area (66.67%) of Bangladesh. Among them 20.0% had history of consanguineous mating parents and 17.78% had another affected sibs. Common presenting features were progressive deterioration of school performance (89.74%), gait disturbance (92.31%), dysarthria (92.31%) and dystonia (41.03%) of our studied children. Neuropsychiatric manifestations were very common among the affected children. Changes in behavior was present in 62.22% cases, and among them mania were present in 57.77% children. Other common neuropsychiatric manifestations were depression (35.55%), generalized anxiety disorder in 31.11% and loss of memory in 20% cases. Ophthalmological manifestations like KF ring (83.33%) also found in majority of patient. Neuroimaging study showed basal ganglia hyperintensity in 63.63.% , white matter hyper intense signal changes 18.18% cases and ischemic change in grey matter in 18.18% cases. Conclusion: In our study about two third cases of Neurologic Wilson diseases may present with Neuropsychiatric manifestations in children. Behavior changes were commonest neuropsychiatric manifestations which includes depression, mania, generalized anxiety disorder and loss of memory.In neuroimaging study bilateral basal ganglia hyperintensity were found in about three-fourth cases of our studied children. J Bangladesh Coll Phys Surg 2024; 42: 144-148

Explore Agenda Setting of Targeted Poverty Alleviation Policy: An Analysis Based on Difference-in-Difference Regression Model and Multiple Streams Framework

Although China's economy has developed rapidly in the past few decades, meanwhile, the poverty alleviation policies in China for poor rural areas have been adjusted and improved to achieve common prosperity. In particular, the targeted poverty alleviation policy has eliminated absolute poverty, which is a remarkable achievement in history. Therefore, why the targeted poverty alleviation policy emerged and how it was agenda-setting are the research questions of this article. An analysis combining the Difference-in-Difference Model and the Multiple Streams Approach is used to explain the agenda-setting of targeted poverty alleviation policy in China. The study concludes that although the poverty alleviation policy of the previous stage has promoted the economic development of poor counties, there was an increasingly widening economic development gap between urban and rural. This paper suggests that the strong political stream is a significant factor for policy change and the political elite leads the people to unite to get rid of absolute poverty and improve the quality of life of the poor people, which explains the agenda setting of targeted poverty alleviation policy.

Can Multiple Shocks Affect Household Income? Evidence from Poor Rural Areas in China

Can Multiple Shocks Affect Household Income? Evidence from Poor Rural Areas in China

Changes of sweet beverage and unhealthy food consumption among infant and young child aged 6-24 months old in China

To describe the change of sweet beverage and unhealthy food consumption among infant and young child aged 6-23 months in 2013, 2016-2017, China. Data was from the China Nutrition and Health Surveillance among Children and Lactating Women in 2013, 2016-2017.9983, 20 423 children aged 6-23 months old were involved respectively. The sweet beverage and unhealthy food consumption was analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. The proportions of sweet beverage consumption among children aged 6-23 months was 20.2%(95%CI 16.0%-24.4%) in 2013; it was 29.6% in large cities, and 14.0% in poor rural areas, but there was no significant difference in different areas. Compared with 2013, the proportions of sweet beverage consumption increased significantly in 2016-2017, reaching 51.7%(95%CI 48.9%-54.4%); it was 54.1% in medium and small cities, and 44.3% in large cities. The proportions of unhealthy food consumption among children aged 6-23 months was 31.2%(95%CI 23.2%-39.3%) in 2013; it was 46.3% in medium and small cities, and 16.3% in poor rural areas. Compared with 2013, the proportions of unhealthy food consumption was 35.6%(95%CI 33.6%-39.3%) in 2016-2017, and no significant difference was observed(Rao-Scott χ~2=0.96, P=0.33); It was 38.6% in medium and small cities, and reached 30% in large cities and poor rural areas. For those 2 indicators at the same survey, no consistent differences were observed between boys and girls and there was significant difference in various months of age(P<0.01). In China, the proportion of sweet beverage consumption among children aged 6-23 months has increased significantly, and the intake of unhealthy food is relatively stable. Children aged over 12 months and in rural areas need to be concerned about.

Performance and bacterial community analysis of multi-stage A/O biofilm system for nitrogen removal of rural domestic sewage

Rural domestic sewage was difficult to collect, and there was a lack of skilled professionals for its treatment. This study constructed a high-efficiency anaerobic- aerobic (A/O) biofilm reactor with multi-stage free combination, simple operation, and low consumption. The nitrogen removal capacity of the system was enhanced by changing the number of A/O stages, influent, and hydraulic retention times (HRT). The most economical system with the required total nitrogen (TN) removal loading is tertiary A/O with a step-feed ratio of 1:1:1 and HRT = 36 h. At this time, the TN removal rate could reach 71.29 %. Realizes high-efficiency nitrogen removal with low consumption and unattended operation. Increasing the influent carbon to nitrogen (C/N) ratio could effectively enhance the nitrogen removal capacity. In addition, chemical oxygen demand (COD) removal was better under various operating conditions. Pseudomonas was the dominant genera in the anaerobic zone, contributing to organic pollutant removal and denitrification. The aerobic zone was enriched with Nitrospira, related to the nitrification and denitrification process. The anoxic zone contained more heterotrophic denitrifying bacteria genera such as Denitratisoma. The system had excellent performance with the synergistic effect of the above microorganisms. The efficient and low-consumption biofilm system developed in this study suits engineering applications in poor rural areas.

Strengths, weaknesses, opportunities and threats of a community-based egg program in rural Honduras

Abstract Background Young children living in poor rural areas in Honduras are susceptible to suffering from undernutrition. About 1 in every 4 children under age 5 have stunting. Stunting during early childhood has negative consequences on an individual's life that can have short-term and lasting effects. This study's purpose was to explore the perceptions of the mothers of children that participate in a community-based nutrition-agriculture program that offers 1 egg daily to all children ages 6 to 24 months in 13 communities. Methods Using community-engaged methods, we implemented a SWOT analysis to identify strengths, weaknesses, opportunities, and threats using a semi-structured guide to conduct in-depth interviews in n = 14 participating mothers in the Hens Hatching Hope project (ClinicalTrials.gov Identifier: NCT04721197). Interviews were performed by a local community health worker in Spanish, translated to English, and analyzed via content analysis by a researcher. Main themes were identified and synthesized. Results Some of the identified strengths were the “improved community access to eggs” and “financial assistance that offset burdening household expenses”. For weaknesses “expansion of program age eligibility to accommodate multi-child households” and “no control over parent's use of eggs”. For opportunities “Implementation of external community resources” and “improve water and sanitation initiatives”, for threats “changes in political climate” and “frail farm infrastructure”. Conclusions Perception of the program is positive among all mother participants. This analysis identified multiple strengths and opportunities to 1) improve the program locally, and 2) expand the program's scope and reach. Further, this analysis identified weaknesses and potential threats that will serve to modify and improve the delivery and uptake of the intervention. Key messages • Explore program strengths, weaknesses, opportunities, and threats perceived by particpating mothers of a community-based nutrition agriculture program that provides 1 egg a day to their child's diet. • The swot analysis of participating mothers’ interviews serves in the developing contingency plans to continue the Hens Hatching Hope program.

Can government support improve households’ ability to resist natural disaster shocks? Evidence from poor rural areas in China

Can government support improve households’ ability to resist natural disaster shocks? Evidence from poor rural areas in China

Effects of apparent temperature on cardiovascular disease admissions in rural areas of Linxia Hui Autonomous Prefecture

Cardiovascular disease (CVD) is a major threat to public health worldwide. The relationship between CVD and temperature has been widely reported in developed countries and regions. However, there are few studies of severe CVD in poor rural areas of developing countries. Therefore, this study aimed to explore the relationship between CVD and apparent temperature (AT) in a rural area of Linxia Hui Autonomous Prefecture, China. Daily CVD admission data and meteorological data were collected from Linxia between 2014 and 2015. The media of AT was used as the reference temperature to estimate the cumulative relative risk (RR) of CVD admission. The distributed lag non-linear models were used to examine the association between AT and cumulative RR of CVD admission at lag 0–21 days. In Linxia, high AT (20 °C) had a persistent adverse effect on cumulative RR of CVD admissions, and the RR increased with increasing lag days. Cold (− 10 °C) had a protective effect on the first and later lag days (lag 0–14 and lag 0–21). Adults (aged < 65 years) and females were more susceptible to the effects of heat than males and the elderly (aged ≥ 65 years). In Linxia, China, extremely high AT is an important risk factor for CVD hospitalizations in suburban and rural populations.

Status of infant and young child feeding in China in 2016-2017

To describe the feeding status and related factors of infant and young child aged 6-23 months in China. Data was from the China Nutrition and Health Surveillance among 0-17 Years Old Children and Lactating Women in 2016-2017, and 20 423 children aged 6-23 months were involved in 275 surveillance sites from 31 provinces(autonomous regions and municipalities). The introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency were analyzed with WHO and UNICEF 2021 updated infant and young child feeding indicators. Data analyses were conducted using the complex weight based on national census from National Bureau of Statistics in 2010. Rao-Scott Chi-square was used test for statistical difference. The percentage of infants 6-8 months of age who consumed solid, semi-solid or soft foods was 83.2%(95%CI 80.5%-85.9%) in 2016-2017. No significant difference were observed between boys and girls; there was significant difference in different areas(Rao-Scott χ~2=30.85, P&lt;0.01), it was 90.3% in medium and small cities, and reached 75.0% even in poor rural areas. The proportions of children aged 6-23 months meeting minimum dietary diversity(MDD) was 60.6%(95%CI 58.1%-63.1%). It was 71.1% in medium and small cities, and 50.5% in poor rural areas. Except for breast milk, the percentage of eggs(34.4%) and legumes(19.0%) consumption was low, the percentage of grains, vitamin A-rich fruits or vegetables consumption was 89.7%(95%CI 88.4%-91.1%). The percentage of consuming egg and/or flesh food was 76.4%(95%CI 74.2%-78.7%). The percentage of zero vegetables or fruits consumption was 9.1%(95%CI 7.8%-10.4%). The proportions of children aged 6-23 months meeting minimum meal frequency(MMF) was 72.4%(95%CI 70.1%-74.7%). It was over 70% in large cities, medium and small cities, general rural areas; and 60.2% in poor rural areas. The proportions of children aged 6-23 months meeting minimum acceptable diet was 43.4%(95%CI 40.7%-46.1%), it was over 50% in urban areas, and less than 40% in rural areas, 30.1% in poor rural areas. No consistent differences were observed between boys and girls for all 3 indicators(MDD, MMF and MAD), and there was significant difference in different areas and various months of age(P&lt;0.01). There was no gender difference in the feeding status of children aged 6-23 months in China, the complementary feeding was relatively timely, and the minimum dietary diversity and meal frequency of children were relatively ideal, but the minimum acceptable diet of children in poor rural areas was poor.

The relationship between early childhood development and feeding practices during the dietary transitional period in rural China: a cross-sectional study.

Early childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described. This study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD. The results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53-0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52-0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50-0.88). According to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention.

A social emotional learning intervention to reduce psychosocial difficulties among rural children in central China.

Programmes based on social emotional learning (SEL) have been effective in reducing psychosocial difficulties in a number of countries. In Mainland China, there has been no empirical research on the prevention of children's psychosocial difficulties using the SEL approach. This study aimed to assess whether an adapted version of the SEL programme can reduce psychosocial difficulties of primary school children in rural China. The intervention consisted of 16 weekly 90-min class sessions, conducted among 206 children aged 8-12 years (with 290 controls) in a poor rural area of Central China. Self-report questionnaires were administered at baseline, post-intervention and 5-month follow-up. The results suggested that the programme (1) can reduce children's total difficulties (measured using the Strength and Difficulties Questionnaire) at post-intervention (d= -0.18) and 5-month follow-up (d= -0.19), (2) was more effective among children experiencing verbal abuse (d= -0.21) or physical abuse (d= -0.24) from caregivers and (3) was popular among more than 90% of the participants. The programme is cheap, easy to implement and can be delivered in school hours. Therefore, it has clear potential for replicability and sustainability.

Anaemia prevalence and risk factors among children aged 6 to 23 months in rural China.

Anaemia is a global public health problem among children. However, few studies have examined anaemia prevalence and risk factors among Chinese children of different ages, particularly in poor rural areas. This study investigated these two aspects among children aged 6 to 23 months in poor rural areas of China. This cross-sectional study included 1132 children aged 6 to 23 months in three prefectures of the Qinba Mountains area. A finger prick blood test for haemoglobin and anaemia was conducted, along with household surveys of socio-demographic characteristics, illness characteristics, and feeding practices. Multiple linear and logistic regression analyses were used to determine predictors of anaemia. Overall, 42.6% of children in the study displayed anaemia. Children aged 6 to 11 months had the highest anaemia prevalence (53.6%). Anaemia risk factors differed among age-groups and throughout the overall sample. Bivariate and multivariable regression results showed that continued breastfeeding, any history of formula feeding, and consumption of iron-rich or iron-fortified foods were prominent risk factors for anaemia. However, continued breastfeeding and any history of formula feeding had the greatest impact across age-groups (both P<0.05). Anaemia remains a severe public health problem among children aged 6 to 23 months in rural China. Healthy feeding practices, nutritional health knowledge, and nutrition improvement projects are needed to reduce the burden of anaemia among children in rural areas of China.

Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study.

The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica. A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'. Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas.

Does financial inclusion improve household drinking water source? An application to the case of Togo

ABSTRACT This study investigates the impact of financial inclusion in bringing the financing gap of water infrastructure in developing countries using Togo as case study. Using a number of robust estimation techniques, we found that financial inclusion is associated with an increase in access to improved drinking water and a decline in the travel time to the water source, especially among the rural poor areas, female heads households and the northern part of the country. The influence of formal inclusive finance is higher and significant in contrast to informal financial inclusiveness, which has no significant impact. Policy implications are discussed.