Remote Populations Research Articles

Unmasking the Hidden Morbidity of Ocular Diseases in Primary Care Through a Collaboration with Specialists in Remote Areas: A Cross-Sectional Study from Rural Crete, Greece

Background: Ocular disorders are not frequently addressed in primary care, which is more visible in remote rural settings. The aim of the study was to assess the prevalence and pattern of eye diseases in a remote rural population of Crete and to explore whether they represent a hidden morbidity. Materials and Methods: A community-based, cross-sectional study based on data collected through a comprehensive clinical investigation conducted by a mobile ophthalmological unit. Permanent inhabitants, aged over 40 years, living in one remote rural community located on the highest mountain of Crete, were invited to participate. The prevalence of eye diseases was measured during the comprehensive ophthalmological examination. Patients’ medical records were used to assess hidden morbidity. The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was applied to measure self-reported vision-targeted health status. Results: A total of 239 individuals agreed to participate; 54.9% were females (n = 151), with a mean ageof 66.13 years (±14.56). The most common diagnoses were refractory errors (59%), cataract (21.7%), glaucoma (11.7%), maculopathy (8.8%), and dry eyes (8.8%). A previously undiagnosed eye disorder was detected in 34.3% (n = 82). Total scores of NEI VFQ-25 measured quality of life were highand significantly lower in Known Cases of eye diseases compared to patients with New or Without diagnosis (76.6 vs. 84.1 and 84.6, respectively, p = 0.009). Conclusions: Our study highlighted the need for increased awareness of primary care in rural areas concerning eye disorders. Local policies should focus on implementing public health interventions and encouraging close cooperation with specialists to overcome accessibility issues.

Overcoming Barriers to Human Papillomavirus Vaccination in Guangdong Province, China

Human papillomavirus (HPV) infection remains a critical public health challenge in China, particularly in Guangdong Province, where HPV-52, 16, and 58 genotypes predominate, and male infection rates exceed 40%. Despite the successful implementation of a government-funded school-based program that has achieved 88% HPV vaccine coverage among adolescent girls, several persistent barriers, including genotype mismatch (the free HPV vaccine covers < 50% of high-risk local strains), regional disparities (80% vs. 60% for first-dose coverage), and exclusion of males, thwart progress toward herd immunity. Financial sustainability risks pose an even more significant threat to the expansion of HPV vaccination programs, especially in Guangdong province where annual expenditures exceed CNY 200 million. This review delves into Guangdong’s pioneering efforts and proposes practical solutions: accelerating domestic multivalent HPV vaccine development, adopting gender-neutral vaccination policies, and leveraging mobile clinics for remote populations. These strategies not only provide a roadmap for China but also serve as valuable insight for other LMICs striving to overcome HPV-related inequalities.

Subnational variations in the quality of household survey data in sub-Saharan Africa

Nationally representative household surveys collect geocoded data that are vital to tackling health and other development challenges in sub-Saharan Africa. Scholars and practitioners generally assume uniform data quality but subnational variation of errors in household data has never been investigated at high spatial resolution. Here, we explore within-country variation in the quality of most recent household surveys for 35 African countries at 5 × 5 km resolution and district levels. Findings show a striking heterogeneity in the subnational distribution of sampling and measurement errors. Data quality degrades with greater distance from settlements, and missing data as well as imprecision of estimates add to quality problems that can result in vulnerable remote populations receiving less than optimal services and needed resources. Our easy-to-access geospatial estimates of survey data quality highlight the need to invest in better targeting of household surveys in remote areas.

Dynamics of anti-Strongyloides IgG antibody responses and implications for strongyloidiasis surveillance in rural Amazonians: A population-based panel data analysis.

Human strongyloidiasis was recently incorporated into the World Health Organization roadmap for neglected tropical diseases targeted for control in 2021-2030. However, the prevalence, incidence, and clinical burden of Strongyloides stercoralis infection remain understudied in remote communities across the Amazon due to its chronic nature, usually with absent or unspecific clinical manifestations, and the lack of practical and sensitive diagnostics for large-scale use. Here, we apply repeated antibody testing to estimate the prevalence of anti-Strongyloides IgG responses and identify incident infections in five farming settlements in the Amazonas State of Brazil. We used an in-house enzyme immunoassay, with a S. venezuelensis larval extract as the solid-phase antigen, to detect specific IgG antibodies in 898 plasma samples collected during consecutive cross-sectional surveys over 4 years from 426 study participants aged >3 months, with an average of 35.9 years. Overall, 465 (51.8%) samples tested positive. However, only two infections that had been detected by fecal microscopy at survey 1 (March-May 2010) were treated with ivermectin. Antibody prevalence rose from 45.9% in 2010 to 61.1% in 2013, consistent with an increased (re)exposure to infective larvae over time. On average, there were 24.5 seroconversion events (a proxy of recent exposure to infection) per 100 person-years of follow-up, with 18.1 seroreversion events per 100 person-years. Nearly all participants with high antibody levels (i.e., above the median absorbance of seropositive tests) remained seropositive over the next years, with a single instance of high-to-nil antibody transition. Long-lasting high-level IgG responses were most likely due to frequent re-exposure to infective S. stercoralis larvae, chronic carriage of adult worms in the absence of treatment, or both. Conversely, over one-third of participants with low anti-Strongyloides antibody levels had transient IgG responses and seroreversed within 12 months. The results support the use of repeated antibody testing for monitoring temporal changes in S. stercoralis transmission in remote populations.

Breast Cancer-related Lymphedema in Valle del Cauca, Colombia: Prevalence, Risk Factors, and Characterization.

Breast cancer-related lymphedema (BCRL) significantly affects patients' quality of life. Prevalence estimates in Latin America, particularly Colombia, remain inconsistent because of the limited research. This study aimed to determine the prevalence of BCRL and characterize its clinical and surgical aspects, as well as potential risk factors, in southwestern Colombia. This multicenter case-control study included 334 women diagnosed with unilateral breast cancer between 1997 and 2019. The patients underwent standardized medical interviews, physical examinations, and data collection regarding clinical variables. Statistical analyses included descriptive statistics, bivariate logistic regression, and multivariable logistic regression to identify risk factors. The prevalence rate of BCRL was 23.9%. Patients with BCRL had a significantly higher body mass index and were more likely to have infiltrating ductal carcinoma. The surgical and treatment characteristics did not differ significantly between the groups. Multivariate analysis identified body mass index and arm swelling as risk factors for BCRL. This study provides crucial data on the prevalence and risk factors of BCRL in Colombia, which will guide future research in developing a reproducible, easily accessible method for early lymphedema detection in remote populations. This, in turn, will enable timely referrals to centers equipped for proper management. Additionally, the findings can inform public policies aimed at preventing and improving the treatment of this complication.

Rehabilitation Needs Across Heterogenous Brazilian Regions: Secondary Analysis of the Global Burden of Disease Study

Aim: This study aimed to determine the evolving rehabilitation needs in Brazil, considering five main impairment categories for nationwide health-service planning, stratified per age groups, as well as Brazilian regions with inequitable development. Methods: Secondary analysis of the Global Burden of Disease study (1990–2019), using Years Lived with Disability (YLD) rates for all ages and age-standardized metrics. The set of health conditions amenable to rehabilitation were selected and organized based on the five impairment types, derived from Brazil’s public-based Care Network for People with Disabilities. Results: A Brazil-wide 24% growth (1990–2019) in overall rehabilitation needs per capita (i.e., YLD rates per 100,000 population) was observed, in addition to a 6% negative growth for age-standardized YLD rates. “Physical” impairments accounted for 77% of the Brazilian rehabilitation needs in 2019; 69% of these impairments come from musculoskeletal conditions. Rehabilitation needs growth was also observed across the five Brazilian regions, ranging from 16% to 25%. Conclusions: Rehabilitation needs are growing across Brazil and its regions as a result of population ageing and epidemiological transition. Brazilian regions with lower income and lower population density (e.g., with more rural or remote populations) also experienced growth in rehabilitation needs, even though these regions are often underserved by rehabilitation professionals.

The Role of Large Language Model Chatbots in Sexual Education: An Unmet Need of Research

Large language model (LLM) chatbots have demonstrated significant capability in patient education by offering accessible, consistent, and personalized information. Their ability to interact in real-time and adapt responses based on user input makes them valuable tools in enhancing patient knowledge and engagement. Sexual education in developing countries faces substantial challenges. Sociocultural barriers, limited access to comprehensive educational resources, and stigmatization surrounding sexual health contribute to inadequate sexual education. Traditional methods often fail to reach remote or underserved populations, and there is a general shortage of qualified educators and resources. Chatbots present a promising solution to these challenges. They can offer anonymous, culturally sensitive information on sexual health, overcoming barriers related to stigma and privacy. While LLM chatbots hold significant potential to improve sexual education in developing countries, their implementation must be carefully managed to address challenges such as ensuring information accuracy and cultural sensitivity. There is dearth of research on LLM in sexual education. Hence, there is unmet need of research on the accuracy and reliability of the information, maintaining cultural sensitivity, assessing user engagement, capability of integration with traditional education methods, and exploring the long-term impact on improving knowledge.

Challenges for remote patient monitoring programs in rural and regional areas: a qualitative study

BackgroundAccess to healthcare significantly influences health outcomes, and rural, regional and remote populations face greater challenges in accessing healthcare than urban populations. Digital health tools, such as remote patient monitoring (RPM), have significant potential to address these healthcare challenges, yet there is little research on the facilitators and barriers of RPM in these regions.AimThis study aims to identify and understand the facilitators and barriers healthcare staff face implementing RPM in rural and regional Australia, with focus on challenges that arose after the onset of the COVID-19 pandemic.MethodsSemi-structured focus groups were conducted with healthcare professionals from publicly funded health services in western rural and regional Victoria, Australia. An open-ended interview guide based on the Consolidated Framework for Implementation Research (CFIR) was used to identify key themes and strategies for effective RPM implementation. The analysis considered barriers and facilitators at micro, meso, and macro levels.ResultsSeveral barriers to RPM implementation were identified across different levels: (1) Micro-Level Factors, such as perceived low digital literacy and language barriers among individuals; (2) Meso-Level Factors, including disparities in IT infrastructure and device availability, limited training opportunities, and the need for enhanced governance within healthcare settings; and (3) Macro-Level Factors, encompassing evolving funding models and the reliability of service providers. Despite these challenges, participants acknowledged potential benefits such as improved technological interoperability, enhanced community engagement, and a data-driven approach to quality improvement. Importantly, a flexible, tailored RPM approach to accommodate specific rural and regional needs was deemed valuable.ConclusionEffective RPM deployment in rural and regional areas is viewed by health professionals as crucial for bridging healthcare divides. However, if strategies developed for urban settings are not recalibrated to address rural challenges, the risk of RPM failure may escalate. Future initiatives must prioritize region-specific strategies and policy reforms aimed at ensuring equitable digital infrastructure and financial resource allocation to enhance healthcare access in rural and regional settings. This approach may ensure that RPM solutions are both adaptable and effective, tailored to the unique needs of each community.

Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.

Investment in Community Health Worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia. After establishing the resource requirements for delivering 25 evidence-based maternal and neonatal interventions, we used the Lives Saved Tool (LiST) and optimization techniques to determine the package of care that leads to the most projected lives saved. With a cadre of 1,450 Female Health Workers and a budget of $435,000 for maternal and neonatal health commodities and programming over one year, we calculated that the optimized set of interventions for Galmudug could avert 15% of the 4,132 projected maternal and neonatal deaths in 2024. We also conducted sensitivity analyses to show how the optimal combination of interventions and the number of lives saved change as the resource levels change. The model provides practitioners with a new tool and accompanying approach to evaluate possible packages of community health interventions with competing resource requirements.

Community Rehabilitation for Rural and Remote Australia: Measuring What Matters Based on the International Classification of Functioning, Disability and Health (ICF): A Scoping Review.

To review the quantitative outcome measures that have been used to evaluate community rehabilitation services delivered across rural and remote Australia. A scoping review was completed and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Peer-reviewed, original research published between January 2010-September 2023 was searched using MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Cochrane database, Joanna Briggs Library, PsychINFO, Web of Science and Google Scholar. Studies were selected if they involved allied health outpatient, subacute or nonacute services for Australian rural or remote dwelling populations. Participants were required to have an underlying impairment. Face-to-face or telehealth delivery in a rural and remote location was included. Measures were identified and then mapped to the ICF domains of activity and participation, as well as quality of life. A total of 27 studies were included that yielded 40 different outcome measures of activity, participation and/or quality of life. Few measures, however, were used consistently across studies, and even fewer demonstrated a significant change across more than one study. Most studies evaluated single interventions, and few studies evaluated the service model as a whole. To ensure robust evaluation of community rehabilitation services in rural and remote Australia, a core data set and common framework for evaluation of community rehabilitation services is required. The evaluation framework must ensure consistency in measurement that reflects rural and remote service models and takes into account the environment in which services are delivered.

Cancer-related care for rural and remote populations in Canada: A scoping review

Background: Synthesizing unique barriers to cancer-related care among rural and remote populations would be useful to inform future research and health service priorities. To fill this gap, the overall goal of this review is to synthesize the cancer literature about those living in rural and remote locations in Canada. Methods: Using JBI scoping review methods, we extracted the following: definition of rural or remote; phase of cancer care continuum (screening, diagnosis, treatment/care, post-treatment, outcomes); province(s) and/or territory(ies) of the sample; and cancer diagnosis(es). Results: Within the 45 studies, definitions of rural and remote varied widely. The treatment/care phase was most often reflected (n = 18) followed by screening (n = 12). All provinces were represented and data from the Yukon Territory was lacking. Breast and colorectal cancer diagnoses were most common (n = 20 and n = 18, respectively) and most studies (n = 31) used quantitative designs. Conclusion: Review results illuminate the state of cancer-related research of rural and remote populations across Canada and highlight implications for further examination.

Channels for Promoting Health Literacy on Family Planning Among Pregnant Women in Akheri Ward, Arumeru District

The study assessed the channels utilized to enhance family planning literacy among pregnant women in Akheri Ward, Arumeru District, Tanzania, between February and April 2024. The research focuses on hospital-registered pregnant women and employs a mixed-methods approach to address the central question of how family planning information is effectively disseminated. A total sample of 269 respondents was selected using a combination of probability and non-probability sampling techniques. Data collection involved structured interviews with key informants, including Reproductive and Child Health Officers, as well as questionnaires administered to the target population.The findings reveal that antenatal clinic mobilization by health professionals serves as the most effective channel for disseminating family planning information. This approach is particularly valued for fostering trust, offering personalized education, and facilitating informed decision-making among pregnant women. Social media platforms, especially WhatsApp groups, emerge as the second most effective channel, providing convenient access to information. Additionally, mass media, such as radio, plays a significant role in reaching broader and often remote populations. However, barriers such as limited internet access, inadequate digital literacy, and time constraints pose challenges to the efficacy of these channels, particularly in rural settings. The study underscores the critical importance of a multi-channel communication strategy to ensure comprehensive dissemination of family planning knowledge, particularly for underserved rural communities. Recommendations include increased investment in both traditional media, such as radio, and digital platforms to expand access and overcome infrastructural barriers. Furthermore, capacity-building initiatives for health professionals and community-based interventions are advocated to improve engagement and enhance maternal health outcomes. These findings contribute to the broader discourse on maternal health literacy, highlighting the need for context-specific, inclusive communication strategies in low-resource settings.

Cancer-related care for rural and remote populations in Canada: A scoping review

Contexte : Pour guider la recherche et les priorités en matière de services de santé, il serait utile de résumer les obstacles aux soins oncologiques que rencontrent les populations vivant en milieu rural et éloigné au Canada. L’objectif général de la présente étude est donc de synthétiser la littérature portant sur ce sujet. Méthodologie : À l’aide de la méthode de revue exploratoire de l’Institut Joanna Briggs (JBI), les données suivantes ont été extraites : définition de milieu rural ou éloigné; étapes de la trajectoire des soins du cancer (dépistage, diagnostic, traitement et soins, période post-traitement, issue de la maladie); province(s) ou territoire(s) de provenance de l’échantillon; diagnostic(s) de cancer. Résultats : Dans les 45 études retenues, la définition des termes « région rurale » et « région éloignée » variait considérablement. La phase de traitement ou de soins était la plus fréquemment étudiée (n = 18), suivie du dépistage (n = 12). Toutes les provinces étaient représentées, sauf le Yukon, pour lequel il n’y avait pas de données. Le cancer du sein et le cancer colorectal étaient les diagnostics les plus courants (n = 20 et n = 18, respectivement) et la plupart des études (n = 31) étaient quantitatives. Conclusion : Les résultats mettent en lumière l’état de la recherche sur le cancer auprès des populations des régions rurales et éloignées du Canada, et soulignent la nécessité de procéder à des études supplémentaires.

Health professional experiences of kidney transplantation in regional, rural, and remote Australia

BackgroundDespite the demonstrated improved patient survival and financial benefits for health services with kidney transplantation compared to dialysis, populations outside of urban areas face inequities in access and a more difficult journey to kidney transplantation than their metropolitan counterparts. This study aimed to explore the experiences of Australian kidney transplant health professionals regarding kidney transplantation processes for patients residing in regional, rural, and remote areas, with a focus on improving access to and experiences of transplantation for this patient cohort.MethodsSemi-structured interviews were conducted with Australian kidney transplant health professionals. Transcripts were analysed thematically.ResultsInterview participants (n = 26) consisted primarily of nephrologists from transplanting centres (15%), nephrologists from regional, rural, or remote non-transplanting centres (19%), clinical pharmacists (19%), and nursing staff (19%). Six main themes were identified regarding barriers to transplantation, including ineffective communication and education, overwhelming geographical burden, fighting for equal opportunities, paucity of social support, crushing financial peril, and deprived of adequate local care. Participants also made recommendations for new or modified service delivery models to address identified barriers, including coordination of work-up testing, outreach visits for transplant assessment, increased social and financial support, and increased and earlier provision of transplant education.ConclusionsHealth professionals described patient-specific and system level barriers to kidney transplantation for regional, rural, and remote populations in Australia that could be addressed or improved by the modification of current processes or implementation of new service delivery models for provision of transplant care.

The integration of telehealth in antenatal anesthesia consults.

Telehealth is a popular way for health care providers to connect with patients and is utilized by anesthesiologists across the world for preoperative evaluations. The purpose of this review is to outline the latest literature about telehealth use within obstetric anesthesia. Utilization of telehealth significantly increased during the Coronavirus disease 2019 (COVID-19) pandemic and has proven to be a useful and reliable way to conduct antenatal obstetric anesthesia consultations in high-risk patient groups. Recent publications indicate the reliability and utility of telehealth, especially to reach remote patient populations. This can help anesthesiologists reach patients referred to tertiary centers from remote areas, which can improve the quality and safety of patient care. Furthermore, with hospital-provided infrastructure, the majority of obstetric patients are able to connect with providers via telehealth. Obstetric anesthesiologists play a pivotal role in the perioperative planning for high-risk pregnant women, and telehealth can serve as a tool to make this easier and more efficient with high patient and provider satisfaction.

Five steps for the deployment of artificial intelligence-driven healthcare delivery for remote and indigenous populations in Canada.

The integration of artificial intelligence (AI) into healthcare delivery offers transformative potential, especially for remote and underserved populations. In rural and remote regions like northern Saskatchewan, Canada, where Indigenous communities face elevated rates of chronic conditions such as diabetes and limited access to healthcare, AI-driven virtual care can bridge critical gaps. However, a universal approach falls short of addressing the unique needs of diverse populations. This communication outlines a five-step framework to guide AI-facilitated healthcare delivery tailored to community-specific demographics and clinical priorities. Steps include building comprehensive community profiles, assessing digital readiness, prioritizing healthcare needs, deploying culturally sensitive virtual care programs, and evaluating outcomes with AI-powered analytics. By leveraging AI in a systematic and inclusive manner, this approach addresses social determinants of health, improves equity, and enhances healthcare quality, offering a scalable model to improve health outcomes in geographically and demographically diverse settings.

The Social Isolation of Native Americans: The Crow Nation

Social isolation is a significant factor to consider when assessing the health of a given population. This article reports on a study carried out during an immersion experience with graduate nursing students that considered the experiences of Native Americans on the Crow Reservation in Montana. The exploratory, descriptive qualitative design included semi-structured interviews with eight members of the Crow nation and a focus group with three graduate students. Four themes emerged from the data: Effects of Colonization, Revival of Culture and Spiritual Influences, Lack of Resources, and Societal Impact on Health. Each theme reflected the challenge of social isolation within this population. This article describes our study and focuses on this social isolation and its significant impact on the Crow People. Participants indicated that they want to rebuild their age-old cultural practices to positively impact the health of their communities. Highlighting areas of strength and recognition of history can help them to reclaim personal and national identity. Implications for nurses include exposure to cultural immersion as a learning experience and research about the social isolation in geographically remote populations.

Incidence of Tooth Loss in Remote Indigenous Populations of the Amazon Region: A 13-Year Cohort Study Before and After Belo Monte Dam.

Tooth loss among indigenous people in the Amazon emphasizes the need for culturally appropriate oral health interventions. The objective of this study was to analyze the incidence of tooth loss in two remote Amazon indigenous populations. This prospective cohort evaluated a total of 47 indigenous in the permanent dentition at T0 and thirteen years later (T1) from two villages, Arara-Laranjal (n = 28, mean age 16.1 and 29.9 years) and Assurini do Xingu (n = 19, mean age 15.9 and 29.5 years), of different ethnic groups. A multilevel Poisson regression model assessed the influence of village, sex, and age on tooth loss. At T0, the indigenous people had all their permanent teeth. Forty-two lost at least one tooth (89%), and a total of 172 teeth were lost at T1 at an incidence of 97% among females and 76% in males. There was no influence of ethnicity on tooth loss (p = 1.000). A lower risk of tooth loss was associated with male subjects (β = -0.50, p < 0.05) but not with age. In females (22/46.8%) and males (11/23.4%), the highest incidence of tooth loss was the lower second molars. The risk was higher among females, and there was no influence on age, village, or ethnicity. The second and first molars were the most affected teeth. These findings suggest an increase in tooth loss caused by close contact between indigenous and urban populations.

Adaptive management of a remote threatened-species population on Aboriginal lands

Adaptive management of a remote threatened-species population on Aboriginal lands

A sentinel survey in remote Western Thailand indicates that school-aged children and reproductive-aged women of the Indigenous Pwo Karen community are iodine sufficient.

Indigenous peoples are often not routinely included in iodine programmes because of language barriers and remote access and may thus be at higher risk of iodine deficiency disorders, which could adversely impact their quality of life. We conducted this cross-sectional study in the remote Pwo Karen community of Thailand to determine the urinary iodine concentration of school-aged children and women of reproductive age and investigate the iodine content in household salt. We measured urinary iodine concentration in spot urine samples from healthy school-aged children and women of reproductive age, administered a questionnaire, estimated daily iodine intake and collected household salt samples to determine salt iodine concentration. The median urinary iodine concentration (range) of school-aged children (n 170) was 192 (136-263) µg/l, which was significantly higher than women of reproductive age (n 306) (147 (89-233) µg/l) (P < 0·001). The estimated daily iodine intake in school-aged children and women of reproductive age were 135 and 195 μg/d, respectively. The median (range) iodine concentration in rock and granulated salts consumed in the households were 2·32 (0·52-3·19) and 26·64 (20·86-31·01) ppm, respectively. Surprisingly, the use of iodised salt and the frequency of seafood consumption were NS predictors of urinary iodine concentration in these two groups. Our data suggest that school children and women of the Pwo Karen community have sufficient iodine intake, indicating the Thai salt iodisation programme is effectively reaching even this isolated Indigenous community. Sentinel surveys of remote vulnerable populations can be a useful tool in national iodine programmes to ensure that programme coverage is truly universal.