Remote Rural District Research Articles

Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda

IntroductionNeonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings...

Strategies to Prevent Children from Dropping Out of School in the Lautem Municipality of Timor-Leste

This research project aimed to gather data that could be used when developing strategies to prevent children from dropping out of a new school that is now under construction in a remote rural district of Timor-Leste. Twelve (12) people living in this district – three (3) teachers, three (3) parents, and six (6) adults who dropped out of school when they were children – participated in this project by completing a questionnaire and later being interviewed about their experiences of children not completing their primary school courses. The findings reveal a lengthy list of the difficulties that all children face in their daily lives in this district, including long distances from school, lack of transport, health issues related to poverty and malnutrition, family and cultural obligations, the need to earn money and a lack of support for education. When children eventually arrive at school, they find that conditions are not helping them to remain there and continue their learning. Schools lack facilities and are poorly maintained. Teachers need to be well-trained in modern methods of learning and teaching. The research concludes that strategies to prevent children from dropping out of school will require serious and sustained work to deal with the many existing difficulties by using partnerships and collaboration between families, schools, communities, government departments, government programs, donors, international agencies, and churches.

Building inclusive early learning environments for children with a disability in low-resource settings: Insights into challenges and opportunities from rural Zimbabwe

The majority of young children with a disability live in low- and middle-income countries, where access to inclusive early learning programs supported by governments or non-government organizations is usually unavailable for the majority of the population, who live in rural areas. This study explored the feasibility of leveraging materials and personnel available within local communities to provide inclusive early learning programs in rural Zimbabwe. Caregivers of young children with some disability were given the opportunity to describe their experienced challenges; ways in which they informally support their children’s early learning; and the types of skills and resources they were able and willing to offer to support the establishment and operation of a more formal group-based inclusive early learning program. Qualitative data were generated from a purposive sample of caregivers of children with diverse impairments (n = 12) in two remote rural districts in Zimbabwe. Themes were identified in the rich qualitative data caregivers provided during individual interviews. The challenges caregivers experienced included the failure of interventions to improve their children’s level of functioning, the lack of access to assistive devices, the perception that the local school would be unable to accommodate their children, and worry about the future. Despite these stressors, caregivers actively supported their children’s self-care, social, moral and cognitive development and sought ways to save the funds that would be needed if their children could attend school. Caregivers were also willing and able to provide diverse forms of support for the establishment and operation of an inclusive early education program: food, funding, teaching and learning materials, and free labor. The insights obtained from these data informed the design of local community-controlled inclusive early education programs and the types of support caregivers and children may need to participate fully in these.

Telemedicine Leveraged by Smart Glasses to Improve Primary Healthcare Services in a Remote Rural District, Kingandu, Drc, 2019–2020

Background: Telemedicine enables new forms of medical consultation and is expanding worldwide. Patients in sub-Saharan Africa could potentially benefit substantially from telemedicine. Objective: To improve primary healthcare services, especially referrals to the district hospital, for the population in three health centres in the rural district Kingandu in the Democratic Republic of the Congo (DRC) by introducing a telemedicine intervention leveraged by Smart Glasses. Methods: The project involved the design and introduction of an intervention combining community engagement with technological innovation (Smart Glasses, communication equipment, moto-ambulances, and new diagnostic tests), and with staff training. Utilisation of the intervention, use of the health centres, and referrals to the hospital were monitored through the routine health information system and project-specific registers. Key stakeholders were interviewed and the project costs were analysed. Results: The use cases for the intervention were defined in consultation with the stakeholders. Extensive training and troubleshooting were needed throughout the project period. The total number of consultations increased significantly in the intervention health centres. The number of referrals to the hospital remained relatively stable, but an increased proportion effectively arrived in the hospital. The Smart Glasses and moto-ambulance greatly facilitated emergency referrals, often requiring a potentially life-saving intervention in the hospital. All stakeholders involved highly valued the intervention. Conclusion: Telemedicine can contribute to improving primary healthcare services in a remote rural area, as part of a more comprehensive intervention and with intensive participation of all stakeholders. It can increase acceptability and use of the existing services; improve diagnosis, treatment, and referral of patients; and can also facilitate on-the-job training and supportive supervision.

Access to wheelchairs by persons with mobility impairment in a remote rural district of KwaZulu-Natal, South Africa: therapists' perspectives

The WHO has estimated that 1% of the world's population need a wheelchair, but few have access. Access to wheelchairs for most of the South African poor population is through accessing rehabilitation services at public health facilities. This study explored access to wheelchair services from the perspective of rehabilitation therapists, within the uMkhanyakude district of KwaZulu-Natal. Therapists' perceptions on access, and its impact on service delivery is under-explored in the literature. Semi-structured interviews with 11 rehabilitation therapists in the uMkhanyakude district directly involved with wheelchair services were conducted. Levesque et al's conceptual framework of access to health care was used to analyse the data. Themes consistent with these dimensions - approachability, acceptability, availability and accommodation, affordability and appropriateness - were identified from the data. Access to wheelchairs was perceived to be facilitated by the establishment of meaningful relationships with wheelchairs users, the ability to eventually provide an appropriate wheelchair for all users, the provision of services close to where people live, the training of caregivers and the use of local peer trainers. Perceived barriers were limited outreach by the rehabilitation staff, poor screening of those with mobility impairment by other categories of staff, and limited space and time to provide services. Further barriers linked to the therapists included their uncertainty about their level of competency in the context and lack of peer support for the rehabilitation staff, especially those working alone. Barriers associated with clients were the limited understanding of wheelchairs, and what was perceived to be a lack of responsibility to look after the wheelchairs, which led to poor maintenance. The aspects of the five dimensions of access of Levesque et al's framework were identified as both facilitators and barriers.The therapists working in this remote rural area have a a strong sense of responsibility about the wheelchair service delivery process and offered clients the best they could with limited human and financial resources. They have a good understanding of the wheelchair users and the environment they function in, which enabled constant adaptation of the services to meet the needs of that specific community.

Indigenous agency in global systems

The article addresses expanding of global economic systems by studying Sámi strategies addressing Norwegian High Northern Policies (NHNP) launched by the Norwegian Ministry of Foreign Affairs from 2005. NHNP attracted global economy, labour and knowledge to the Arctic region. The Sámi responding are analysed by using agency theories in economic geography, and contributes to expand the content of agencies e.g. by understanding its embedding in specific historical shaped structures as well as in debates on new opportunity spaces in the wake of globalism.The study demonstrates three strategies debated and launched by the Sámi Parliament: (i) In grounding its resistance the Sámi Parliament argued that the entry of international industries into areas with Sámi population threaten the fundamental conditions for Sámi livelihood. (ii) By entering global governance the parliament emphasized the importance of Sámi negotiation with multinational companies in global governance frameworks. (iii) And by changing the historical understanding of Sámi territories in order to include research and higher education milieus outside remote rural districts.

Telemedicine Leveraged by Smart Glasses To Improve Primary Healthcare Services in a Remote Rural District, Kingandu, DRC, 2019–2020

Telemedicine Leveraged by Smart Glasses To Improve Primary Healthcare Services in a Remote Rural District, Kingandu, DRC, 2019–2020

Leveraging smart glasses for telemedicine to improve primary healthcare services and referrals in a remote rural district, Kingandu, DRC, 2019–2020

ABSTRACT Background Telemedicine enables new forms of medical consultation and is expanding worldwide. Patients in sub-Saharan Africa could potentially benefit substantially from telemedicine. Objective To improve primary healthcare services, especially referrals to the district hospital, for the population in three health centres in the rural district Kingandu in the Democratic Republic of the Congo (DRC) by introducing Smart Glasses, and leveraging them for telemedicine. Methods The project involved the design and introduction of an intervention combining community engagement with technological innovation (Smart Glasses, communication equipment, moto-ambulances, and new diagnostic tests), and with staff training. Utilisation of the intervention, use of the health centres, and referrals to the hospital were monitored through the routine health information system and project-specific registers. Key stakeholders were interviewed and the project costs were analysed. Results The use cases for the intervention were defined in consultation with the stakeholders. Smart Glasses were used in 10% of consultations in the health centres mostly for advice during curative consultations. The total number of consultations increased significantly in the intervention health centres. The number of referrals to the hospital remained stable, but an increased proportion effectively arrived in the hospital. The Smart Glasses and moto-ambulance greatly facilitated emergency referrals, often requiring a potentially life-saving intervention in the hospital. All stakeholders involved highly valued the intervention. Conclusion Telemedicine can contribute to improving primary healthcare services in a remote rural area, as part of a more comprehensive intervention and with intensive participation of all stakeholders. It can increase acceptability and use of the existing services; improve diagnosis, treatment, and referral of patients; and can also facilitate on-the-job training and supportive supervision.

Oral Health Status of Schoolchildren Living in Remote Rural Andean Communities: A Cross-Sectional Study.

ABSTRACTObjective:Oral health promotion (OHP) was introduced in Peruvian primary schools in 2013, and no evaluation has been undertaken in rural areas since then. To measure OHP outcomes, this cross-sectional study aimed to assess the oral health (OH) status of schoolchildren living in a remote rural area of the Cusco region.Materials and methods:Sixty-six children were recruited in three remote rural communities and in a rural district capital. Six dimensions of OH (knowledge, attitudes, behaviors, dental plaque, dental caries, and quality of life related to OH) were measured using self-administered questionnaires and dental examinations. Wilcoxon–Mann–Whitney tests were conducted to compare outcomes between two types of settings (remote rural community and district capital). Multiple linear regression models were fit to identify which variables can explain the variance observed in the decayed, missing, and filled teeth (DMFT) index.Results:The median percentage of dental plaque in remote rural communities was 78.7+ (interquartile range [IQR] 71.5–82.8) and 78.6+ (IQR 72.7–82.2) in the district capital (P = 0.90). The prevalence of dental caries was estimated to be 94.1+ (95+ confidence interval [CI] 71.1–>99.9) in the district capital and 98.0+ (95+ CI 88.3–>99.9) in remote rural communities (P = 0.43).Conclusion:These results suggested that OHP interventions had not reached their full potential. Identifying different factors that influence the reported outcomes would provide a more comprehensive understanding and help to tailor OHP interventions.

Understanding Women’s Aspirations: A Study in Three Indian States

This study provides an insight to the aspirations of women and girls in three states in India. This study is a product of primary research, based on focus group discussions and interviews, that highlights the voices of women in remote rural districts as well as tribal areas where women want jobs, security, savings, education and a happy life. Women in peri-urban areas are more confident of realizing their aspirations than those in rural areas. Younger women are more aspirational, and thus they are less willing to do manual labour. They aspire for white-collar jobs with the government and the security that the jobs provide. As girls get more educated, it is important to match their skills with the labour market, ensure safe and reliable transport and public spaces so that they can achieve their aspirations. Big hurdles to achieving their dreams are the mindsets at home—notably that of parents, husbands and in-laws—that continue to determine how far they will be educated and whether they will have jobs and careers.

High Wind Power Penetration Large-Scale Hybrid Renewable Energy System Design for Remote Off-Grid Application

This study looks into the resource assessment, technology economics and modeling of different energy alternatives and proposes a rechargeable battery storage-based large-scale wind/photovoltaic hybrid power system to meet an average electrical load demand of 2.4 MW and peak load of 2.9 MW for a remote rural district in Ethiopia called Geladin. The district is 682 km away from nearby grid. The site enjoys high solar and wind resources that can be harnessed for electric power generation to electrify the community. HOMER simulation software is used for optimal sizing and techno-economic analysis. The diesel generator is used as back up to fill the gaps in case both resources are out. Average monthly solar irradiation data of 6.2 kWh/m2 is determined from measured sunshine duration data by implementing a suitable specific model for the site. NASA satellite based estimated wind speed data of 10 years average at hub height of 50 m for the site in question is extracted from the SWERA (Solar and Wind Energy Resource Assessment) database (with annual average of 6.1 m/s) and its weigh-bull distribution parameter, k of 1.98 is estimated which indicates a fair wind speed distribution of the site to generate electric power using wind turbine. The proposed optimal system results electricity generation indicates that 92% from wind turbine, 3% from photovoltaic, 5% from diesel generator and managed to obtain a much lower cost of energy (COE = 0.11USD/kWh) than other alternatives investigated in this study such as grid extension and diesel generator.

Effects of diet on the childhood gut microbiome and its implications for atopic dermatitis

Effects of diet on the childhood gut microbiome and its implications for atopic dermatitis

Increasing Usage of ESL Instructional Practices in a Rural County Elementary School

The study setting is one elementary school located in a remote rural county school district in a mountain western state. Implementing a specific set of procedures, ESL Instructional Improvement Process, educators examined and increased use of research-based ESL instructional practices in the education of English learners (ELs). A key feature of the piloted process is educator self-assessment of instructional practices, resulting in the development of workshop sessions and action items, and completion of classroom observations. Researchers found that the process proved effective in increasing rural educators’ knowledge and application of ESL best practices. Self-assessment was highly effective in helping educators examine existing instructional practices, leading to relevant workshop sessions and classroom implementation of ESL action items. Numerous examples of the use of research-based ESL instructional practices as a result of this project are provided, along with suggestions for further research to improve the education of ELs in rural county schools.

Implementing Culturally and Linguistically Responsive Special Education Eligibility Assessment in Rural County Elementary Schools: Pilot Project

Consideration of cultural and linguistic features is mandated by law and one of the most important contributors to the appropriate placement of diverse learners for special education services. This article describes the results of a pilot project designed to assist rural educators to deliver an equitable and unbiased assessment process for English learners (ELs) in Grades K–5. Project setting was a remote rural county district in a mountain Western state with a significant percentage of ELs in special education. Project findings illuminate the importance of incorporating cultural and linguistic features into the special education assessment process for ELs. Results also include a process for examining an assessment body of evidence from competing perspectives to increase objectivity. Recommendations for rural educator preparation and district assessment processes are provided.

An experiment in strengthening the networks of remote communities in the face of environmental change: leveraging spatially distributed environmental memory

Agrarian communities in different regions develop diverse coping strategies to address the environmental changes they face. In this work, we test how to stimulate farmers’ social learning across diverse regions to promote informed responses to soil degradation. We invited 117 randomly selected members of 16 randomly selected Sumatran communities to three 3-day networking and training events in regions with diverse socio-environmental histories. One event was held in the respondents’ remote rural district (Tanggamus), the second was held in a more densely populated region on Sumatra Island (Kalianda), and the third was held in a heavily populated region on Java Island (Garut and Ciamis). Eighteen months later, we surveyed the information-sharing networks and agricultural practices of 370 members of these communities. The participants had become popular sources of agricultural advice, but the strength of this impact depended on the region in which their networking intervention was conducted. The participants in the event on Java had become the most central members of their communities. Although all the participants received the same formal information, those who interacted with the farmers in a region with the longest history of population pressure and land degradation management were more likely to adopt the recommended practices. The participants in this intervention doubled their odds of adopting organic fertilizers compared with those who networked only with peers in their local environment. Environmental memory of coping with change can be shared between regions through social learning, which can be stimulated by simple interventions.

Rural versus urban differences in end-of-life care for lung cancer patients in Germany.

To assess rural-urban differences in healthcare utilization and supportive care at the end-of-life in German lung cancer patients. We identified 12,929 patients with incident lung cancer in 2009 from claims data and categorized them to four district types (major city, urban, rural, remote rural). We compared site of death, unplanned hospitalizations, hospital days, outpatient doctor, general practitioner (GP) and home visits, structured palliative care, therapy with antidepressants, pain relief medication and chemotherapy, and therapeutic puncturing in the last 30 and 14days of life using mixed models with logistic link function for binary outcomes and log link function for count data. We adjusted all models by age, sex, comorbidities, metastases location and presence of multiple tumors at diagnosis, survival in months, and type of tumor-directed treatment. We found significant differences in two of the outcomes measured. The likelihood of > 14 hospital days in the last 30days was significantly higher in rural districts than in remote rural districts (1.27 [1.05, 1.52], p = 0.0003). The number of visits to the GP in the last 30days of life was significantly lower in urban districts than in remote rural districts (β = - 0.19 [- 0.32, - 0.06], p = <0.0001). No other endpoints were associated with regional differences. Triggering factors for high and low utilization of healthcare were mostly age, comorbidities, and prior anticancer treatment. Healthcare utilization and supportive care did not differ significantly between different district types. Results reject the hypothesis of regional inequity in end-of-life care of lung cancer patients in Germany.

Retaining Science Teachers in Rural School Districts: Examining the Unintended Consequences of the No Child Left Behind Act

Previous case studies find that rural school districts have been struggling to recruit and retain high quality teachers after the implementation of the No Child Left Behind Act (NCLB). Scholars and practitioners argue this labor market problem is even more dire in hard-to-recruit subject areas such as science and mathematics. While there is ample antidotal evidence, there is still no empirical studies that have leveraged a longitudinal dataset to estimate the impact of NCLB on teacher retention in rural school districts. To better examine the intended and unintended consequences of NCLB, this study leverages a longitudinal statewide panel dataset at the district level to examine the capability of rural school districts to recruit and retain science teachers. We find that rural school districts near metropolitan or micropolitan statistical areas employed fewer science teachers after the NCLB passage, while remote rural school districts did not experience a decline. This article highlights that rural school districts have differential effects on their ability to recruit and retain science teachers based on their proximity to urban areas.

How to Maximize Financial Literacy in a Remote Rural District (A case of District Pithoragarh in Uattrakhnad)

Inclusive growth has direct link with financial inclusion and this financial inclusion is straightforward connected with financial literacy. Financial illiteracy is the main reason of failures of lot of development initiatives of government. This research is focusing on the maximizing output of financial literacy program through customizing inputs and tailored execution. A difficult geography (Pithoragarh Distrtc of Uttrakhnad) is taken as a study area.

Culturally Responsive Special Education Referrals of English Learners in One Rural County School District: Pilot Project

The project setting was a remote rural county school district located in a mountain western state with some overrepresentation of English Learners (ELs) in special education. Referral issues are especially prominent in rural school systems due to continued challenges associated with limited resources and lack of contemporary professional development. This article describes the efforts of one rural school district to improve its referral process for ELs in grades K-5 implemented through a university-school district partnership. We developed and piloted a culturally responsive referral guide with findings, providing promising implications for appropriate referrals of ELs in rural county school districts.

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.