Practice In Rural Communities Research Articles

Simulated GP clinic closure: effects on patient access in the Irish Mid-West.

Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access. GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic. The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31). Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

Implications of Traditional Cooking on Air Quality and Female Health: An In-Depth Analysis of Particulate Matter, Carbon Monoxide, and Carbon Dioxide Exposure in a Rural Community

Indoor air pollution, particularly in rural communities, is a significant health determinant, primarily due to the prevalence of traditional cooking practices. The WHO estimates 4.3 million annual deaths related to household air pollution. This study quantifies indoor pollutants and assesses health impacts and perceptions regarding traditional cooking. Using Extech air quality monitoring equipment, the study measured particulate matter (PM), carbon monoxide (CO), and carbon dioxide (CO2) in 48 rural homes. A survey of 39 women gathered insights on their use of wood for cooking and perceptions of air quality. This dual approach analyzed both environmental and social dimensions. Findings showed fine particulate matter (0.3, 0.5, 1.0, and 2.5 μm) exceeded safety limits by threefold, while coarser particulates (5.0 and 10 µm) were concerning but less immediate. CO levels were mostly acceptable, but high concentrations posed risks. CO2 levels indicated good ventilation. Survey responses highlighted reliance on wood and poor air quality perceptions demonstrating little awareness of health risks. Common symptoms included eye discomfort, respiratory issues, and headaches. The study emphasizes the need for interventions to reduce exposure to indoor pollutants and increase awareness of health risks to encourage cleaner cooking practices in rural communities.

Transitioning to rural practice together: a rural fellowship model (in 6 Ps).

Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Maligay: An Iconic Tausug Traditional Token for Pagtammat in the Sulu Archipelago

The Tausug reside in Lupah Sug (Sulu) and even in Northeastern Borneo, including parts of Indonesia and Malaysia. Historically, they were governed under the Sulu Sultanate. Today, the Tausug maintain a strong connection to their heritage, including the tradition of Pagtammat, using Maligay as an example of a valued cultural practice in rural communities in Sulu, Philippines. Maligay Pagtammat symbolizes the completion of Quranic studies by children, reflecting a strong attachment to traditional learning methods and the importance of Islamic education. It is largely unknown outside the Tausug community, particularly in Luzon and Visayas, due to limited available literature. Hence, this study explores Maligay Pagtammat among Tausug families in the municipalities of Parang, Panglima Estino, and Panamao in Sulu. Through participant observation and interviews with eight participants, all residents of the three localities with first-hand experience of the practice, descriptive thematic analysis of the data revealed the cultural significance, educational practices, and community values linked to Maligay Pagtammat among Tausug families. Despite challenges such as poverty and pastoral lifestyles, parents value Islamic education and express appreciation through this tradition. The ceremony involves extensive preparations, a procession, epic narratives, and a communal meal. Findings highlight the cultural and educational practices of Tausug families in rural Sulu, showcasing their resilience in preserving traditions amidst modernization. This study contributes to understanding Tausug identity and community cohesion through cultural practices.

Geospatial insights into open defecation vulnerability in Gulumbe, Nigeria

Open defecation (OD) poses a serious public health risk by exposing communities to diseases and compromising the well-being of people. One potential approach to mitigating its impact is the application of spatial planning techniques. However, spatial data paucity is one of the major problems in addressing open defecation issues in Nigeria. This study employed spatial analysis to identify areas particularly susceptible to OD using Geographical Information System (GIS) including Merginmap applications on Android and QGIS software, which were used with field observations to georeferenced residential areas, public toilets, and instances of open defecation. Proximity analysis and local indicators of spatial autocorrelation, based on Moran’s I, were employed to assess vulnerability. Buffer analysis was conducted to identify residential areas within 100 m of an OD site, and the findings indicated residential areas at high risk of experiencing negative impacts from OD. The LISA analysis revealed a high-to-high clustering pattern (p < 0.05) in the southern region of the study area, which aligns with the results of the buffer analysis and further suggests consistent spatial patterning. Furthermore, OD was more prevalent near water bodies and inner residential areas, increasing the risk of water and air pollution. This pollution could facilitate the spread of harmful bacteria, such as E. coli and Salmonella, from OD sites to nearby households, increasing the risk of disease. This study stresses the potential of GIS in evaluating areas vulnerable to OD and highlights the need to expand awareness campaigns regarding proper hygiene and sanitation practices in rural communities.

Adopting academic rank in a rural community practice affiliated with an academic medical center

BackgroundUnited States rural community-based practices are increasingly participating in undergraduate and graduate medical education to train the workforce of the future, and are required or encouraged to provide academic appointments to physicians who have typically not held an academic appointment. Mechanisms to identify faculty and award academic appointments across an entire health system have not been reported.MethodsOur rural community regional practice identified academic appointments as important for participating in medical education. Over a three-year period, our regional leadership organized a formal education committee that led a variety of administrative changes to promote the adoption of academic rank. Data on attainment of academic appointments was obtained from our Academic Appointment and Promotion Committee, and cross referenced with data from our regional human resources department using self-reported demographic data.ResultsWe describe a successful adoption strategy for awarding academic rank in a rural regional practice in which the percentage of physician staff with academic rank increased from 41.1 to 92.8% over a 3-year period.ConclusionsOur experience shows that process changes can rapidly increase and then sustain academic appointments for physicians over time. More rural health systems may want to consider the use of academic rank to support educational programs while enhancing physician satisfaction, recruitment and retention.

Indigenous Knowledge Systems of Solid Waste Management in Bushbuckridge Rural Communities, South Africa

Indigenous knowledge systems related to solid waste management in economically marginalized communities have been largely overlooked in the scientific literature, even though the indigenous communities of developing nations struggling to manage solid waste rely on these practices. It is startling that indigenous solid waste management practices are scarcely documented in the scientific literature despite their position as potential alternative disposal methods. This gap persists amid limited municipal budgets, inadequate waste collection services, and poor infrastructure in economically marginalized indigenous rural communities in developing nations. Subsequently, in the discipline of solid waste management, this obstacle impedes the recognition and inclusion of indigenous waste management practices into integrated waste management plans. As a result, this causes a delay in their progress or elevation to the same level of credibility as mainstream scientific knowledge. In the process, this relegates the waste management practices of indigenous communities to the background. Against this background, the current study sought to investigate the indigenous solid waste management practices of rural communities in Bushbuckridge Local Municipality. As such, ten cases that captured the spatial cultural diversity of indigenous communities’ practices across Bushbuckridge Local Municipality (BLM) were selected for sampling. Data were collected using ethnographic research methods. Data analysis was carried out using the thematic analysis approach. Inductive logic was used in the interpretation of the current study results. The results of the current study indicate that indigenous communities of Bushbuckridge Local Municipality, in the absence of formal waste management services from the local authority, resort to an indigenous knowledge system to manage solid waste. Waste burning (100%), open-air dumping (100%), and backyard pits (90%) are some of the indigenous waste management practices espoused by the rural communities of BLM. The similarity in practices was corroborated by statistical inferences that revealed that between BLM communities, the amount of indigenous waste management practices is not significant (p &gt; 0.05). However, there are concerns that despite the sustainability aspect associated with recycling (&lt;25%) practices, these disposal methods are not common in the rural communities of BLM. This is a setback for an indigenous knowledge system that is supposed to advance environmental sustainability practices.

Exploring unconventional food plants used by local communities in a rural area of West Java, Indonesia: ethnobotanical assessment, use trends, and potential for improved nutrition

BackgroundAs one of the world’s biodiversity hotspots, Indonesia contains over 25,000 plant species, including unconventional food plants (UFPs). These plants are integral to the dietary practices of rural communities, providing essential nutrients often overlooked in modern diets. However, the use of UFP is declining, with both their dietary and cultural values being undermined. In rural West Java, this decline in UFP biodiversity coincides with public health challenges related to malnutrition. This study aims to document the diversity of UFPs used by local communities in rural West Java, assess their nutritional value, and explore their consumption practices.MethodsData were collected using mixed methods, including interviews with 20 key informants and food frequency questionnaire administered to 107 women in three villages in the area. The nutritional compositions of documented UFPs were obtained from literature and analysis. Bivariate correlation was used to analyze the relationships between UFP consumption frequency and potential correlates.ResultsThe study documented 52 species of UFPs from 29 families, many of which are rich in nutritional value. About half of respondents (56%) consumed UFPs moderately (2–3 times a week). UFP consumption frequency had a strong correlation (r = 0.70) with associated knowledge (r = 0.70, p < 0.01) and a weak correlation with age (r = 0.240, p = 0.015), livestock possession (r = 0.260, p = 0.008), and family size (r = − 0.220, p = 0.02). Motivations for UFP consumption included availability as free food (33%), medicinal value (26%), nostalgic value (23%), and preferred taste (18%). Most respondents (92%) agreed that consumption has declined compared to the past, with perceived reduced availability and lack of knowledge cited as the primary reasons for the declining trend.ConclusionsUFP use is common in the study area, where local communities value these plants for their critical roles in diet, medicine, and culture. Given their significant potential to meet dietary needs, educating and raising awareness about UFPs can enhance their consumption and contribute to food and nutrition security.

Rural Social Work Practice in Turkey

Rural social work continues to grow in importance as a unique field of practice with unique opportunities and challenges. This qualitative research explores explore different aspects of rural social work in Turkey. To this end, the study explores social work practice in rural communities in depth, recognizing the distinctive contexts and characteristics that influence service delivery. In-depth interviews were conducted with rural social workers (n = 30) with significant knowledge and experience in addressing the social work needs of rural communities. Participants were selected through purposive sampling to ensure a broad representation of expertise and geographic diversity. Thematic analysis was used to identify recurring themes and patterns in the participants’ responses. The findings support previous studies that have argued that rural social work is a distinct field of practice. At the same time, the study shows that social work practices are shaped in an urban-centered manner, and local culture is ignored. The study concludes that rural social work should be integrated into graduate social work education, and even start during undergraduate education.

The Role of Cooperative Extension in Delivering Training and Technical Assistance to Support Evidence-Based Behavioral Health Practices in Rural Communities.

The opioid epidemic in the United States continues to disproportionately affect those in rural, compared to urban, areas due to a variety of treatment and recovery barriers. One mechanism to increase capacity of rural-serving providers is through delivery of training and technical assistance (TTA) for evidence-based programs by leveraging the Cooperative Extension System. Guided by the Interactive Systems Framework, the current study evaluates TTA delivered by the Northwest Rural Opioid Technical Assistance Collabroative to opioid prevention, treatment, and recovery providers on short- (satisfaction, anticipated benefit), medium-, (behavioral intention to change current practice), and long-term goals (changes toward adoption of evidence-based practices). We also evaluated differences in short- and medium-term goals by intensity of TTA event and rurality of provider. Surveys of 351 providers who received TTA indicated high levels of satisfaction with TTA events attended, expressed strong agreement that they would benefit from the event, intended to make a professional practice change, and preparation toward implementing changes. Compared to urban-based providers, rural providers reported higher intention to use TTA information to change current practice. We conclude with a review of remaining gaps in the research to practice pipeline and recommendations for moving forward.

For the rural curious: mixed methods evaluation of a rural pharmacy practice elective

BackgroundAs of 2020, 20% of people residing in the United States of America (U.S.) lived in rural communities. Despite rural residents tending to be older, poorer, and having greater disease burden than their urban counterparts, the number of rural primary care providers continues to decline. Nearly 66% of U.S. Primary Care Health Professional Shortage Areas are designated as rural. Pharmacists can help address this shortage of rural primary care providers, often serving as providers of first-contact care; however, only 12% of U.S. pharmacists practice in rural communities. To help address this gap, in 2022 an elective Rural Pharmacy course was created at the University of Minnesota College of Pharmacy by a faculty member who has rural practice experience.MethodsThe course combines formal lectures, guest presentations by rural pharmacists and student interviews with additional rural pharmacists. For the 42 students enrolled in the course in 2022 and 2023, non-parametric statistics were used to compare the percentage of students who were raised in rural communities or who otherwise had extensive exposure to rural, and compare student interest ratings (1 to 7) about practicing/living rural at the beginning and end of the course. Students also wrote end-of-course reflection papers, commenting on the course and their interviews with rural pharmacists.ResultsAcross both years, 45% of the enrolled students had previous experience in rural communities. The net change in Rural Interest scores among students completing both questionnaires was + 5 in 2022 and + 2 in 2023, both non-significant differences. The largest shifts in student interest were from “Not Sure” at the start of the course to “Interested” or “Not Interested” at the end of the course, and from “Interested” to “Very Interested.” In their reflection papers nearly 60% of students reported being most impressed by their interviews with rural pharmacists.ConclusionsA course addressing the benefits and challenges of practicing pharmacy in rural communities was well-received by pharmacy students. Even students who have little interest in living in a rural community can benefit from being introduced to rural culture, enabling them to provide more culturally-responsive care for patients from rural communities.

Abstract PO1-08-04: Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making

Abstract Background: Prior work from our group has shown a high rate of familial breast cancer (BC) among rural BC patients (pts), with 33% reporting &amp;gt; 1 first-degree family members with BC and 55% meeting NCCN germline genetic testing (GGT) criteria (Shelton CH et al. NC Med. J; 2022). In 2018, we increased GGT to include all BC pts and observed: 1) many pts were out-of-criteria per NCCN guidelines but had actionable pathogenic germline variants (PGVs) and 2) knowledge of GGT factored significantly into shared decision making by providers and patients, including for positive and negative results. Beginning in 2019, concurrent with the recommendation from the American Society of Breast Surgeons, we expanded this model of universal GGT to an IRB-approved study to measure the impact of prospective testing on shared decision-making. Herein we report the real-world implementation of universal GGT for patients with BC and genetics-informed treatment decision-making in a rural community practice. Methods: From 2019-2022 all BC pts at a small, rural community hospital were offered GGT. Demographics, clinical features, and GGT results were collected along with clinician-reported clinical recommendations for treatment based on GGT results. Descriptive statistics and two-tailed Fisher’s exact test were employed and significance was set at p&amp;lt; 0.05. Results: 210 BC pts were offered GGT and 192 (91%) underwent testing [97% female, 95% non-Hispanic White, mean age at diagnosis of 62, 75% Stage I], with all but 7 pts completing GGT before primary treatment decisions. 104 (54%) of patients were in-criteria (IC) and 88 (46%) out-of-criteria (OOC) with NCCN GGT guidelines. PGVs were identified in 25 pts (13%) and 15 genes, most commonly BRCA1/2 (5 pts), PALB2 (3), monoallelic MUTYH (3) and ATM, BARD1, CHEK2 (2 pts each). PGV frequencies were 15% in IC and 11% in OOC patients (p=0.495). 46 (24%) pts had only a variant of uncertain significance (VUS) results. 70% of patients had &amp;gt; 1 clinical management change based on their GGT results. Changes in breast surgery, uptake of risk-reducing bilateral salpingo-oophorectomy, surveillance and clinical follow-up were significantly higher in patients with PGV compared to those with VUS/negative results (p &amp;lt; 0.0001). Compared to those with negative results, patients with PGVs in BRCA1 and BRCA2 were significantly more likely to undergo bilateral mastectomy (BLM) while those with PGVs in other genes or with VUS were not significantly more likely to elect for BLM than those with negative results. Clinicians reported that return of GGT reinforced their recommendation for 73/138 (53%) of patients who underwent breast-conserving therapy. GGT results aided in radiation therapy strategy for 54% of pts, most often resulting in dose de-escalation (accelerated fractionation) for negative/VUS pts (Table). Conclusions: Universal GGT for patients with BC was successfully implemented in a rural community practice with &amp;gt;90% uptake. Treatment was enhanced in those with clinically actionable PGVs and de-escalated in those without PGVs. Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making Changes in Radiation Therapy Strategy based on GGT Citation Format: Charles Shelton, Sarah Nielsen, Antonio Ruiz, Lauren Shelton, Karen Freas, Sarah Poll, Brandie Heald, Daniel Pineda-Alvarez, Edward Esplin, Rachel Ellsworth, Hannah Montgomery. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-04.

Knowledge, Attitudes, and Practices of Rural Communities Regarding Antimicrobial Resistance and Climate Change in Adadle District, Somali Region, Ethiopia: A Mixed-Methods Study.

There is an urgent need for interventions in addressing the rapid and disproportionate impact of antimicrobial resistance (AMR) and climate change (CC) on low- and middle-income countries. Within this context, it is important to understand indigenous knowledge in rural communities, which are highly affected. This study examined knowledge, attitude, and practices (KAP) regarding AMR and CC in the Adadle district, Somali region, Ethiopia, utilizing mixed methods, including 362 surveys and 12 focus group discussions among rural communities. Findings showed that 39% and 63% of participants were familiar with AMR and CC, respectively. Of those surveyed, 57% attributed AMR to inappropriate antimicrobial use in animals and humans, while CC was often associated with Allah/God. Multivariable analysis indicated that males exhibited superior knowledge and a positive attitude towards AMR and CC. Additionally, individuals aged 26-35 and 36-45 years showed heightened awareness of AMR and CC, respectively. Moreover, participants who were government employees, pastoralists, and business owners showed better knowledge on CC compared to family caretaker. Religious education and households with more than six members were linked to lower AMR knowledge. This study underlines a greater awareness of CC than AMR and highlights gender-based disparities, recommending integrated educational AMR programs targeting different demographics through a One Health lens, actively involving females, and incorporating local beliefs and practices.

Abstract P302: The Mississippi Rural Community Listening Project

Background: The Appalachia and Mississippi Delta regions have the lowest life expectancy in the United States. In response, Alabama, Mississippi, Kentucky, and Louisiana were selected for The Risks Underlying Rural Areas Longitudinal (RURAL) Study. The RURAL study is an observational population-based study focused on these at-risk communities in the rural south. During the planning phase, investigators identified the need to incorporate insights from the community in the proposal. Therefore, they initiated the “Rural Community Listening Project” in the four states to seek community members’ points of view on outreach research in their communities. The objectives of this research were to hear from members of the communities their concerns and ideas about health research, approaches that would promote their willingness to participate, and their willingness to have blood drawn and x-rays taken as a part of the research process. Method: Mississippi investigators conducted four focus group interviews with 10-12 participants in each focus group. They interviewed a total of 45 men and women between the ages of 35 to 65 in county-specific focus groups. The groups represented four rural Mississippi Counties: LeFlore, Oktibbeha, Panola, and Tishomingo. The investigators digitally recorded the interviews and had them transcribed, then analyzed the transcripts using thematic analysis. Results: Two themes arose: (1) Encouragement to Participate and (2) Barriers to Participation. Encouragement to Participate included (1) having trusted community stakeholders involved, (2) helping the community, (3) promoting one’s health, and (4) receiving feedback on one’s health. Barriers included lack of trust, time, location, and transportation. Overall, the focus group interviewees had not participated in health research but would be willing to do so. Participants had little to no experience in doing health surveys or tracking their health information using mobile or electronic devices but did not raise objections to doing so. Word-of-mouth, social media, newspaper, telephone, cell phone, and mail were recommended as modes of communicating with their communities. “Relevance to the individual” arose as a more prominent encourager than monetary incentives. Focus group interviewees reported trusting doctors, nurses, and health care providers in their respective communities to collect health information. Conclusion: The in-common barriers to participation in research were time, transportation, and location. Across all focus groups, trust emerged as a requisite for research participation. The model of listening to the community’s experiences, concerns, and recommendations can potentially inform future research practices in rural communities and changes to related state and/or local policies.

Oral hygiene practices and associated factors among rural communities in northwest Ethiopia

BackgroundPoor oral hygiene affects the overall health and quality of life. However, the oral hygiene practice in rural communities and contributing factors are not well documented. Accordingly, this study was conducted to assess oral hygiene practices and associated factors among rural communities in northwest Ethiopia.MethodsA cross-sectional study was conducted among 1190 households. Data were collected using a structured and pretested questionnaire, prepared based on a review of relevant literature. The questionnaire comprises socio-demographic information, access to health and hygiene messages, oral hygiene practices, and water quality. We assessed oral hygiene practices with these criteria: mouth wash with clean water in every morning, mouth wash with clean water after eating, brushing teeth regularly, and avoiding gum pricking. Gum pricking in this study is defined as sticking needles or wires into gums to make the gums black for beauty. Multivariable logistic regression was used to identify factors associated with oral hygiene practices. Significant associations were declared on the basis of adjusted odds ratio with 95% confidence interval and p-values < 0.05.ResultsResults showed that all the family members usually washed their mouth with clean water in everyday morning and after eating in 65.2% and 49.6% of the households, respectively. Furthermore, 29.9% of the households reported that all the family members regularly brushed their teeth using toothbrush sticks and one or more of the family members in 14.5% of the households had gum pricking. Overall, 42.9% (95% CI: 39.9, 45.6%) of the households had good oral hygiene practices. Health and/or hygiene education was associated with good oral hygiene practices in the area (AOR: 1.66, 95% CI: 1.26, 2.21).ConclusionMore than half of the households had poor oral hygiene practices in the area and cleaning of teeth with toothpastes is not practiced in the area, where as gum pricking is practiced in more than one-tenth of the households. The local health department needs provide community-level oral health education/interventions, such as washing mouth with clean water at least twice a day, teeth brushing using indigenous methods such as toothbrush sticks or modern methods such as toothpastes, and avoiding gum pricking to promote oral health.

Trypanocide usage in the cattle belt of southwestern Uganda.

Systematic infrastructure and regulatory weaknesses over many decades, in communities struggling with animal African trypanosomiasis (AAT) would be expected to create an environment that would promote drug misuse and risk development of drug resistance. Here, we explore rural community practices of livestock keepers, livestock extension officers and drug shop attendants to determine whether appropriate practice was being followed in administration of trypanocides and other drugs. A questionnaire-based survey was undertaken in southwestern Uganda in 2022 involving 451 farmers who kept cattle, sheep or goats and 79 "professionals" who were either livestock extension officers or drug shop attendants. Respondents reported using one or more type of trypanocidal drug on 80.1% of the 451 farms in the last 30 days. Diminazene aceturate was used on around three-quarters of farms, while isometamidium chloride was used on around one-fifth. Homidium bromide was used on less than 1% of farms. Cattle were significantly more likely to be treated with trypanocides than sheep or goats. On around two-thirds of farms, trypanocides were prepared and injected by farmers, with extension officers administering these drugs on most of the other third, especially on cattle farms. Almost all drugs were obtained from privately-owned drug shops. For treatment of AAT with trypanocides, prescription-only medicines were routinely used by farmers without professional supervision and in the absence of a definitive diagnosis. While a far greater proportion of professionals had a better education and had received training on the use of trypanocides than farmers, there was relatively little difference in their ability to use these drugs correctly. Farmers were more likely than professionals to use only DA to treat trypanosomiasis and were more likely to use antibiotics as well as trypanocidal drugs to treat the animal. Furthermore, they estimated, on average, that twice the recommended dose of either diminazene aceturate or isometamidium chloride was needed to treat a hypothetical 400 kg bovine. A minority of both farmers and professionals reported that they observed the recommended withdrawal times following injection of trypanocidal drugs and very few of either group knew the recommended withdrawal times for milk or meat. Only one in six farmers reported using the sanative pair (alternating use of diminazene aceturate and isometamidium chloride), to reduce the risk of drug resistant trypanosome strains emerging, while this approach was more widely used by professionals. Farmers reported using antibiotics more commonly than the professionals, especially in sheep and goats, raising concerns as to overuse and misuse of this critical class of drugs. In addition to using trypanocides, most farmers also reported using a topical veterinary pesticide for the control of ticks and tsetse. On average, farmers spent 12.2% of their income from livestock sales on trypanocides. This study highlights the complexity of issues involved in the fight against AAT using drug treatment. A multistakeholder campaign to increase awareness among farmers, drug shop attendants, and extension workers of the importance of adherence to recommended drug dosing, using the sanative pair and following recommended drug withdrawal guidance would promote best practice, reduce the risk of emergence of resistant strains of trypanosomes, and support enhanced food safety.

Constraints Inhibiting Farmers’ Adoption of Cattle Feedlots as a Climate-Smart Practice in Rural Communities of the Eastern Cape, South Africa: An In-Depth Examination

The adoption of climate-smart agricultural practices is crucial for enhancing resilience to climate change in rural communities, particularly in developing regions like the Eastern Cape, South Africa. This study provides an in-depth examination of the factors constraining farmers’ adoption of cattle feedlots as a climate-smart practice in the rural communities of the Eastern Cape. The research aims to identify the barriers and challenges that hinder the widespread adoption of cattle feedlots and understand the underlying factors contributing to the farmers’ decision-making processes. The study employed a mixed-methods approach, including surveys and interviews, to gather data from 250 farmers in rural communities of the Eastern Cape. The data were analyzed using regression analysis and thematic analysis to identify the key constraints inhibiting the adoption of cattle feedlots as a climate-smart strategy. The findings revealed several significant constraints that farmers faced in adopting cattle feedlots. Financial limitations, including limited access to credit and lack of financial resources, emerged as critical barriers. Infrastructure and resource constraints, such as inadequate water supply and electricity, hindered adoption. Knowledge and skills gaps, cultural and social factors, market limitations, and environmental considerations further contributed to the constraints experienced by farmers. To address these constraints, the study proposes interventions to promote the adoption of cattle feedlots as a climate-smart practice. These interventions include improving access to affordable financing options, providing capacity-building programs on feedlot management and climate-smart practices, disseminating information on feedlot benefits and best practices, developing the necessary infrastructure, strengthening market linkages, and creating a supportive policy environment. However, it is important to note the study’s limitations, such as the small sample size and the cross-sectional nature of the data, which may limit the generalizability of the findings. Further research is needed to validate and expand upon these findings in a broader context. Overall, this study provides valuable insights into the factors constraining farmers’ adoption of cattle feedlots as a climate-smart practice in the rural communities of the Eastern Cape, South Africa.

A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a Cluster Randomized Crossover Trial.

Māori are the Indigenous people of Aotearoa (New Zealand). Despite global acceptance that cervical cancer is almost entirely preventable through vaccination and screening, wāhine Māori (Māori women) are more likely to have cervical cancer and 2.5 times more likely to die from it than non-Māori women. Rural Māori residents diagnosed with cervical cancer have worse outcomes than urban residents. Living in rural Aotearoa means experiencing barriers to appropriate and timely health care, resulting from distance, the lack of community resourcing, and low prioritization of rural needs by the health system and government. These barriers are compounded by the current screening processes and referral pathways that create delays at each step. Screening for high-risk human papillomavirus (hrHPV) and point-of-care (POC) testing are scientific advances used globally to prevent cervical cancer. This study aims to compare acceptability, feasibility, timeliness, referral to, and attendance for colposcopy following hrHPV detection between a community-controlled pathway and standard care. This is a cluster randomized crossover trial, with 2 primary care practices (study sites) as clusters. Each site was randomized to implement either pathway 1 or 2, with crossover occurring at 15 months. Pathway 1 (community-controlled pathway) comprises HPV self-testing, 1-hour POC results, face-to-face information, support, and immediate referral to colposcopy for women with a positive test result. Pathway 2 (standard care) comprises HPV self-testing, laboratory analysis, usual results giving, information, support, and standard referral pathways for women with a positive test result. The primary outcome is the proportion of women with hrHPV-positive results having a colposcopy within 20 working days of the HPV test (national performance indicator). Qualitative research will analyze successes and challenges of both pathways from the perspectives of governance groups, clinical staff, women, and their family. This information will directly inform the new National Cervical Screening Program. In the first 15-month period, 743 eligible HPV self-tests were performed: 370 in pathway 1 with POC testing and 373 in pathway 2 with laboratory testing. The positivity rate for hrHPV was 7.3% (54/743). Data collection for the second period, qualitative interviews, and analyses are ongoing. This Māori-centered study combines quantitative and qualitative research to compare 2 clinical pathways from detection of hrHPV to colposcopy. This protocol draws on rural community practices strengths, successfully engaging Māori from a whānau ora (family wellness) approach including kanohi ki te kanohi (face-to-face), kaiāwhina (nonclinical community health workers), and multiple venues for interventions. It will inform the theory and practice of rural models of the use of innovative technology, addressing Māori cervical cancer inequities and facilitating Māori wellness. The findings are anticipated to be applicable to other Indigenous and rural people in high-income countries. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000553875; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000553875. DERR1-10.2196/51643.

Determinants of rainwater harvesting practices in rural communities of Limpopo Province, South Africa

ABSTRACT Most rural parts of South Africa’s Limpopo Province are faced with limited water access, provision, and inadequate infrastructure for water reticulation. With over 80% of the provincial population living in rural areas, water availability for domestic and agricultural use has become a source of concern. Rainwater harvesting (RWH) has emerged as an important source of alternative water supply for underserved communities during the summer rainfall season. RWH refers to the collection, storage and conservation of surface runoff for agricultural production and domestic uses. This study assessed the socio-economic characteristics and determinants of RWH practices in rural communities of Limpopo Province. Descriptive statistics were used to describe households’ socio-economic characteristics and logistic regression was used to examine the determinants of RWH practices in rural communities. The analysis was based on a survey of 478 households selected using convenience and purposive sampling techniques. The key findings indicate that a significant number of households (63.8%) practised RWH to augment available water for domestic use, albeit few households used the harvested water for portable use. Further analysis showed that a majority of those who adopted RWH practices were female (64.24%). The results of the empirical models indicate that there is a statistically significant positive relationship between perception, age and level of education in determining the adoption of RWH practices. The findings underline the importance of understanding the adoption of RWH in rural communities and highlight the vital role of education, knowledge, and income in rural communities with limited or no access to a water supply. The study highlights the need for policy to promote the benefits of harvesting rainwater for domestic use.

Territory Identity and Ritual Life of Religious Spaces in Urbanized Communities: A Case Study of Jiangsu

The rapid urbanization in China has had a profound impact on religious practices of rural communities, but few study has explored the relevant dynamics. This study provides an overview of urbanization’s impact on rural religious spaces, and compares the changes of religious spaces before and after urbanization. It aims at improving the understanding of religion in urbanized communities. Phenomenological methods were employed to analyze our transcriptions of 16 interviews which were conducted in the religious spaces of 11 urbanized communities in Jiangsu, China. We also investigated the worship circle mentioned by the participants through field surveys and map analysis. Based on these, four similar themes were sorted out, namely, worship circle and environment, aging and feminizing agents, ritual and secular life, as well as religious well-being. And the results showed that: (1) passive change of worship circles would bring new sense of belonging and identity to elderly residents; (2) the new religious spaces contained a lot of local knowledge and traditional characteristics, which were evolving continuously with sites sacredness maintenance and secularization function expansion; (3) female agents were of great importance to religious spaces preservation.