Respondents In Rural Areas Research Articles

Inequities in Adequacy of Prenatal Care and Shifts in Rural/Urban Differences Early in the COVID-19 Pandemic

BackgroundAdequate prenatal care is vital for positive maternal, fetal, and child health outcomes; however, differences in prenatal care utilization exist, particularly among rural populations. The COVID-19 pandemic accelerated the adoption of telehealth in prenatal care, but its impact on the adequacy of care remains unclear. MethodsUsing Pregnancy Risk Assessment Monitoring System (PRAMS) data, this study examined prenatal care adequacy during the early-pandemic year (2020) and pre-pandemic years (2016–2019) and investigated rural-urban inequities. Logistic regression models assessed the association between the pandemic year and prenatal care adequacy, and considered barriers to virtual care as a covariate. ResultsThe sample consisted of 163,758 respondents in 2016–2019 and 42,314 respondents in 2020. Overall, the study participants were 12% less likely to receive adequate prenatal visits during the early-pandemic year (2020) compared with 2016–2019 (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] [0.86, 0.91]). Respondents in rural areas had lower odds of receiving adequate prenatal care compared with those in urban areas during both pre-pandemic years (aOR = 0.90; 95% CI [0.88, 0.93]) and the early-pandemic year (aOR = 0.94; 95% CI [0.88, 0.99]). However, after adjusting for barriers to virtual care, the difference between rural and urban areas in the early-pandemic year became nonsignificant (aOR = 0.93; 95% CI [0.78, 1.11]). Barriers to virtual care, including lack of phones, data, computers, internet access, and private space, were significantly associated with inadequate prenatal care. ConclusionDuring the early-pandemic year, PRAMS respondents experienced reduced adequacy of prenatal care. Although rural-urban inequities persisted, our results suggest that existing barriers to virtual care explained these inequities. Telehealth interventions that minimize these barriers could potentially enhance health care utilization among pregnant people.

Multiple Correspondence Analysis for Assessment of the Socioeconomic and Social Impact of the COVID-19 Pandemic in Gezira State, Sudan

Background COVID-19 spread in Sudan like other countries in the world. The first COVID-19 case in Sudan was confirmed on 13 March 2020. It has been shown that Sudan's economy was affected before the COVID-19 pandemic because of currency increases, high inflation, and the incapability of the authorities to propose support. Methods The study aimed to assess the economic and social influence of COVID-19 in Al Gazira State, Sudan. This study used the primary data collected from Gezira state in Sudan. A structured questionnaire was used for data collection in 2020-2021, and the sample size was 800 participants. An analysis of multiple correspondences was used to analyze the data concerning COVID-19. The study was validated by ensuring that the survey follows sound research methodologies. This includes clearly defining research questions, using appropriate data collection methods, and applying rigorous analytical techniques. Besides that, it is important to explore the impact of the socioeconomic, demographic, and geographic variables. Results The educational level distribution shows that 36.7% of urban and 26.6% of rural residents have completed secondary education. Furthermore, all participants, 100% in urban regions and 99% in rural areas, were aware of the COVID-19 epidemic. Likewise, all participants in urban areas and 99.5% in rural areas were informed about the lockdowns and measures to curb the spread of COVID-19. Concerning the decision to refrain from attending social gatherings amid COVID-19, 87.6% of participants in urban areas and 75.3% in rural regions opted to cancel such events. Similarly, 86.2% in urban areas and 73.4% in rural areas believe avoiding handshakes is necessary to mitigate the spread of COVID-19. Regarding concerns about job loss during the COVID-19 lockdown period, 52.4% of rural participants did not express anxiety about potential job loss. Conversely, 55.3% of respondents in rural areas were indeed anxious about possibly losing their jobs. The results obtained from the multiple correspondence analysis revealed a relationship between the socioeconomic and demographic variables concerning COVID-19 epidemics. Conclusion This study concluded that socioeconomic, demographic, and geographic variables have a combined influence on the COVID-19 epidemic. One potential technical contribution to the assessment of the economic and social impact of the COVID-19 pandemic could be the application of sophisticated data analysis and modeling techniques to comprehend the complex interrelationships among the numerous components impacted by the pathogen. Predictive models, machine learning, data analytics, simulation studies, and geographic analysis are a few examples of similar techniques.

Determinant factors of under-five years severely wasted children in rural and sub-urban areas of Indonesia.

Understanding the determinant factors contributing to severely wasted is crucial in decreasing the problem and meeting the World Health Global Nutrition Target by 2025. This study investigated the determinants of severely wasted among children under five years old in Indonesia's rural and sub-urban areas. This was a cross-sectional study of severely wasted children in rural and sub-urban areas in East Java, Indonesia. Collected data on individual characteristics, socio-economic status, nutrient intake, environmental and food sanitation, and health service utilization were obtained by structured questionnaires. An ordinal regression and Chi-square test were applied to determine the factors with a significance level 0.05. As many as 25 respondents in rural areas and 30 in sub-urban areas were included after receiving informed consent. Age and household environmental and food sanitation were associated with severely wasted in rural and sub-urban areas, with P < 0.05. Meanwhile, family members, income, and calcium intake were only in rural areas. Birth spacing, nutrient intake, except calcium intake, and health care utilization were the only factors in sub-urban areas. The low-birth-weight history, sex, mother's education, and the parent's occupation did not correlate with the severely wasted in rural and sub-urban areas. The determinant factors of under-five years of severely wasted children in rural and sub-urban areas of Indonesia are different, so it is vital to design regional-based approaches to tackle the problem.

Dietary diversity, hygiene, and lifestyle practices among adult residents during COVID-19 pandemic: A cross-sectional study from Bangladesh

BackgroundCOVID-19 is an international emergency public health concern that poses significant challenges. Intake of adequate immune-boosting nutrients from natural sources, proper hygiene practices, and ideal lifestyle practices must be adhered to during this condition, along with the discovery of protective vaccines. The purpose of the current study was to evaluate the dietary, hygiene, and lifestyle practices among adult residents during the COVID-19 pandemic situation in the Jashore district, Bangladesh. MethodologyThis cross-sectional study was conducted through face-to-face interviews with 500 adult respondents of both genders (age ≥ 18 years). A structured and validated questionnaire was used to collect data on socio-demographic information, dietary diversity, hygiene, and lifestyle practices. Multivariate logistic regression was employed to evaluate and predict factors that influence the study variables. ResultsThe study found that about 44.60% had medium, 27% had low, and 28.40% had high dietary diversity. Regarding the dietary practices, age (p = 0.001), education (p = 0.005), occupation (p = 0.015), and COVID-19 experience (p = 0.001) of respondents were significantly associated with both residential. Hygiene practices such as using a face mask, hand sanitizer use, covering the face during coughing, and hand shaking were significantly associated (p < 0.05) with respondents in both residential areas. In logistic regression analysis, factors associated with poor hygiene practices were being male, illiterate, > 40 years of age, smokers, malnourished respondents in rural areas, obese, > 40 years of age, and having income < 10000 BDT in urban areas. About 40.4% of urban and 45.6% of rural respondents were found to be engaged in physical activity. ConclusionThe study found that the respondents mostly had access to medium dietary diversity, and rural residents maintained a better lifestyle while urban respondents practiced better hygiene. Based on the findings, the study suggests increasing public awareness regarding dietary diversity, hygiene, and lifestyle practices in both rural and urban areas to mitigate the consequences of COVID-19.

Gestational Weight Gain Among Urban and Rural Pregnant Individuals Who Smoke or Quit Smoking

Approximately 7.2% of individuals in the U.S. smoke during pregnancy, and cessation is associated with excessive gestational weight gain (GWG). Weight gain is a common reason for not quitting smoking or relapsing. The current study aimed to characterize who is at risk for excessive GWG and determine the moderating effect of rurality given the higher smoking rates and lower access to healthcare services in these areas. Data from the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS; years 2009-2020) were used to assess the association between participant characteristics, smoking behaviors, and rurality by excessive GWG status in 2023. Almost half (44.0%) of participants experienced excessive GWG; 9.8% of participants quit smoking while 6.9% continued smoking. Respondents who quit during pregnancy had higher odds of excessive GWG than non-smoking respondents (OR=1.83, 95% CI: [1.24, 2.71]). Among those who were non-smoking, respondents in rural areas, compared to urban areas, had a higher probability of experiencing excessive GWG (0.46 vs 0.44, p<0.001). For those who quit smoking (0.60 vs 0.41, p<0.001) or continued to smoke during pregnancy (0.46 vs 0.33, p<0.001), urban residence was associated with a higher likelihood of excessive GWG compared to rural residence. Smoking cessation and weight management during pregnancy are critical to promoting infant and maternal health. Targeted interventions combining weight management and smoking cessation have been successful among the general population and could be adapted for pregnant individuals who smoke to facilitate cessation and healthy GWG in both urban and rural areas.

Dominant Aspects of Family Support of Menstrual Attitudes in Adolescent Girls

Adolescents are defined as individuals with an age range of 10-19 years. In Indonesia, 63.9% of girl adolescents had bad behavior in menstrual hygiene. This study will analyze the relationship between family support and menstrual hygiene attitudes of adolescent girls and the dominant aspect of family support in Jember and Bondowoso. This study uses an observational design using a cross-sectional approach and data were analyzed using multiple linear regression. The sampling technique used was proportional stratified random sampling with a total sample of 300 female adolescent respondents in rural areas of Jember and Bondowoso. Data retrieval was done by questionnaire via google form link. The results showed that there was a statistically significant relationship between family support and attitudes about menstrual hygiene (p-value = 0.012). The most dominant indicator of family support is the instrumental aspect by providing material or physical support that can support adolescent menstrual hygiene.

Perspectives and challenges of common service centres towards e-governance

Common service centres (CSC) run by village level entrepreneurs (VLEs) are expected to contribute significantly towards e-governance by providing government services. Even after 12 years of their inception, rural people are not much aware about facilities in these centres vis-a-vis VLEs running them are still facing a lot of challenges. The study was conducted in the year 2019-2020 by conducting a survey of 200 respondents in rural areas supported by both qualitative and quantitative data. The present study is aimed to investigate the reasons for poor performance of CSC. Challenges and problems faced by VLEs running them. The study contributes towards interdisciplinary study of digital initiatives to serve rural, semi urban population in India and challenges of micro entrepreneurship.

Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study.

(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.

Factors Associated with Low Uptake of Medical Male Circumcision Among Adolescent Boys in Tanzania: A Multinomial Logistic Regression Modeling.

Human immunodeficiency virus (HIV) remains the leading cause of years of life lost among adolescent boys in eastern and southern Africa. Medical male circumcision (MMC) is a cost-effective one-time intervention that can reduce the risk of heterosexual HIV acquisition in men by approximately 60%. Despite its importance in HIV prevention, the uptake of MMC remains suboptimal among adolescent boys. This study aimed to identify factors associated with low MMC uptake among adolescent boys in Tanzania. This study was a secondary analysis of the 2016-17 Tanzania HIV Impact Survey. Descriptive statistics were used to summarize the participants' characteristics. Unadjusted and adjusted multinomial logistic regression models were fitted to identify factors associated with low MMC uptake among adolescent boys. A total of 2605 older adolescents (15-19 years) and 1296 young adolescents (10-14 years) were analyzed. The MMC uptake rates among older and young adolescents were 56.5% and 45.1%, respectively. Lower MMC uptake was found among respondents in rural areas (adjusted relative risk ratio [aRRR] = 0.40, 95% CI: 0.28-0.57), in the traditionally non-circumcising zone (aRRR = 0.30, 95% CI: 0.23-0.41), participants with no formal education (aRRR = 0.32, 95% CI: 0.23-0.41), and those living in lower wealth quintile households (aRRR = 0.20, 95% CI: 0.11-0.36). Respondents who were not covered by health insurance (aRRR = 0.67, 95% CI: 0.48-0.94) and those who had no comprehensive HIV knowledge (aRRR = 0.55, 95% CI: 0.44-0.70) were also found to have lower uptake of MMC. To achieve and maintain high MMC coverage, MMC interventions for HIV prevention should focus on uncircumcised adolescent boys who are rural residents, of lower socioeconomic status, and residing in traditionally non-circumcising communities. Furthermore, dissemination of HIV knowledge and increasing health insurance coverage may encourage more adolescent boys to undergo MMC.

Fertilne razlike u ruralno-urbanoj zoni Semberije

For decades, there has been talk of changing the reproductive pattern of women's behavior according to their place of residence. Starting from the period of industrialization and urbanization, there was first a reduction of rural areas in favor of urban areas. Fewer and fewer inhabitants were engaged in agriculture, which deepened the process of deagrarization by destroying agricultural land, turning into residential or industrial zones. It was considered that the carriers of reproduction were precisely rural households that initially gave birth to children not only because of family ambition but also because of the need to work on large arable land. The number of family members in the middle of the last century was far greater than today. In other words, the size of the family decreased with the move to the cities. Even if Semberija is an exceptionally agrarian area, it has undergone the same transformation, both demographically and spatially. The aim of this paper is to determine fertile differences in the rural-urban zone of Semberija. Using the survey questionnaire, we included 1000 women of childbearing age, of which 357 respondents in rural areas, 575 in urban areas and 68 in suburban areas. The stability of the statistical significance of fertility according to the type of settlement was examined by parametric analysis of variances. The results of the research indicate that the carriers of reproduction are still women who live in rural areas, but with a far smaller number of children and family members than before. According to this analysis, there are statistically significant differences between villages and cities, as well as between villages and suburbs, while such a difference does not exist between cities and suburbs. The average number of children in the countryside is around 2, 17. While the urban zones keep the total fertility rate below 2.

Satisfaction of Old Age Allowance among Senior Citizen in Lamjung District, Nepal

The old age allowance is the non-contribution allowance provided by the government of Nepal to improve the social and economic status of older people. The purpose of this study was to compare the social and economic impact of old age allowance and its satisfaction on older people in rural and urban areas in Nepal. A cross sectional, quantitative study was conducted in two different areas (Sunderbazar municipality and Kwholasothar rural municipality) in Lamjung. The information was collected from 202 elderly people (55.4%) from urban and 90 (44.6%) from rural areas) to know about their satisfaction in various aspects like social, economic, health, etc. regarding allowance by face-to-face interview. Chi-square test, t-test as well as One-way ANOVA tests were applied to find the factors associated with the satisfaction of elderly people among rural and urban areas. Elderly in rural were more satisfied than elderly from urban areas. The respondents in rural areas were satisfied in all five domains social, health, economic, basic needs and self-esteem but the respondents in urban areas were found to be satisfied only in two domains; self-respect and economic. The satisfaction of respondents with OAA is different in urban and rural areas. People who were satisfied with this allowance reported that it was an honor from the government and they can use this money on their own. It is an important contribution to keeping older people connected with family and community.

Type 2 Diabetes In Urban and Rural Areas: A Comparative Study

Diabetes mellitus type 2 is one of the degenerative diseases whose mortality and morbidity rates continue to increase, both in urban and rural areas. Bulukumba Regency is one of the areas with the highest prevalence of type 2 diabetes mellitus. This study aimed to determine the differences in the determinants of the incidence of type 2 diabetes mellitus in urban and rural areas of the Bulukumba Regency in 2021. The type of research used is quantitative with an observational analytic approach and a cross-sectional study design. The population in this study were all people with type 2 diabetes mellitus in urban and rural areas of the Bulukumba Regency. The sample of this study amounted to 210 respondents consisting of 140 respondents in urban areas and 70 respondents in rural areas who were taken using purposive sampling technique with inclusion criteria, namely patients who do not have comorbidities or complications such as coronary heart disease, stroke, and kidney failure as well as patients who are not pregnant at the time of this study. Data were analyzed using the chi-square test. The results of this study indicate that there are differences in consumption of sugar-sweetened beverages (p = 0.032), consumption of fast food (p = 0.044), physical activity (p =0.001), and economic status (p=0.04) of people with type 2 diabetes mellitus in urban and rural areas. Meanwhile, there was no difference in smoking behavior (p=0.404) with type 2 diabetes mellitus in urban and rural areas of the Bulukumba Regency. Management of type 2 diabetes mellitus is important as early as possible so that the morbidity rate due to diabetes can be reduced in the future. The different risk factors between urban and rural areas should be taken into account.

Penganekaragaman Konsumsi Pangan Berdasarkan Pola Pangan Harapan Di Wilayah Perdesaan Dan Perkotaan Kabupaten Serang

Diversity of Food Consumption Based On Hope Food Patterns in Rural and Urban Area of Serang Regency. The objectives of the study are: To determine the diversity of food consumption based on the expected food patterns, the energy consumption of the people, what factors are hindering food diversification, formulate models for diversifying consumption patterns in rural and urban areas. The research is conducted in a span of 8 (eight) months, starting from May to December 2020. The study is conducted in Serang Regency, Banten Province. The research location is chosen deliberately. The research method used a survey, with sampling is cluster sampling, where 100 people as the sample taken (50 people in urban areas and 50 people in rural areas). The data collection method used is the 1x24 hour recall method and the frequency questionnaire method, then analyzed with the PPH software from the Food Security Agency. Data processing and analysis are carried out using the help of the SPSS (Statistical Product and Service Solution) and LISREL (Linear Structural Relationships) programs. The results showed that the levels of energy and protein consumption of respondents in rural areas were 90.60% and 110.46%, while in urban areas it was 93.21% and 124.27%. The energy consumption level for energy is in the medium category and the level of protein consumption is good. The diversity of food consumption based on PPH is still below the standard, namely PPH in rural areas 63.25 and urban areas 71.22.

Comparative Study of Risk Profiles for Non-Communicable Diseases in Urban and Suburb Adolescents in Padang City (Indonesia)

Adolescence is when we still like to experiment and often develop bad habits which may lead to non-communicable diseases (NCDs) in the future. This study aimed to understand the lifestyle at risk of non-communicable diseases in adolescents that live in the urban and rural areas of Padang city. This research method is comparative descriptive with a descriptive-analytical approach, with a total sample of 788 people. The study was conducted from March 2019 to November 2019. Results: A total of 57.77% of respondents in urban areas and 69.54% of respondents in rural areas like to eat junk food. 45.35% urban respondents and 60.21% rural respondents like to consume high-sweetened beverages. 73.4% of urban respondents and 7.6% of rural respondents like to smoke. 80.6% of urban respondents and 87.8% of rural respondents lack physical activity. 59.9% of urban respondents and 49.05% of rural respondents do not like to exercise. 67% of urban respondents and 80.2% of rural respondents sleep late at night. Conclusion: The risk behavior of non-communicable diseases in rural adolescents is higher than in urban adolescents. It is recommended that parents, teachers, and health workers work together to carry out intervention activities for healthy lifestyles for all adolescents.

Rural-Urban Disparities in the Acceptance and Adoption of Family Planning among Couples in Oyo State, Nigeria

Modern contraceptive use can enhance the living standard and reduce mortality among people living in rural and urban areas. However, contraceptive use tends to be low in the rural than the urban populace. A descriptive, cross-sectional study of systematic sampling technique was used to select 570 persons of reproductive age in the rural and urban communities of Oyo State. A semi-structured questionnaire on socio-demographic characteristics, knowledge, attitude and factors influencing uptake of modern contraceptives was administered to respondents. of the 570 respondents, the mean age was 34.3 ±8.4 years. The majority (63.3%) were female compared to 36.7% male respondents. Most (97.0%) of respondents had heard of family planning in the past. The result shows significant differences in location, gender, marital status, occupation, ethnicity, and a number of children (P&lt;0.001). The majority (33.3%) of the respondents sourced family planning information from health care providers, while 31.3% sourced theirs from mass media – Radio, TV, or newspapers. Respondents in urban areas were currently using family planning methods than respondents in rural areas (61.8% vs. 38.2%). People in the urban area are 2.344 times the odds of utilizing any family planning compared to people in rural area (95% CI 1.495, 3.676). Urban and rural disposition to modern contraception services is influenced by economic, socio-cultural, environmental factors, location, age, educational, traditional beliefs, religion, family type, and level of knowledge. Although some signs of progress have been made in family planning at the communities, more work needs to be done. Men need to be actively involved, and other fears about family planning addressed. Keywords: Acceptance, Disparity, Family Planning, Rural, Urban.

Assessing the Level of Satisfaction of Patients with TB-DOTS Implementation in Rural and Urban Centres of Selected Dots accredited facilities in Anambra State, Nigeria

Background: This study assessed the level of satisfaction of patients with TB implementation in selected DOTS accredited facilities.&#x0D; Methodology: A comparative cross-sectional analytic study involving rural and urban areas implementing DOTS for TB in Anambra State was done. A total of 354 respondents (177 per sub population) were enrolled in the study. By exit interview respondents were administered the questionnaire that bordered on services rendered and cost implications of accessing treatment at the facilities.&#x0D; Results: A total of 162(91.5%) rural respondents were satisfied with appropriateness of working hours compared to 166(93.8%) participants in urban areas. Also 141(79.7%) respondents in rural areas were satisfied with waiting time compared to 155(87.6%) in urban areas and this was statistically significant p&lt;0.004. For the cleanliness of the specimen bottle 138(77.8%) rural respondents compared to 148(83.6%) in urban areas were satisfied and this was statistically significant, p&lt;0.001. Majority of the urban respondents 123(68.9%) were satisfied with respect offered by health workers compared to rural 114(64.4%), and this was also significant, p&lt;0.000. Concerning cost incurred and information given by health workers more urban respondents 5(2.8%) were dissatisfied compared to rural 2(1.1%) though not statistically significant p= 0.378. However, satisfaction was slightly higher in urban (82.8%) compared to rural (80.8%) respondents, while the overall satisfaction in this study was 81.8%.&#x0D; Conclusion: Patient`s satisfaction is a panacea for successful DOTS implementation. We therefore recommend that satisfaction could be improved by provision patient-centred requests such as provision of multivitamins, transport, food among others to help improve DOTS because it will encourage attendance and adherence with better outcomes.

Medical, transportation and spiritual out-of-pocket health expenditure on outpatient and inpatient visits in Bhutan.

Understanding the determinants of out-of-pocket health expenditure (OOP) is important for achieving and sustaining universal health coverage, as well as ensuring that no one is left behind. Focusing on major types of spending, including healthcare-related transportation and spiritual expenses, this study analyses OOP on outpatient and inpatient visits in Bhutan, using a two-part model and data from the nationally representative 2017 Bhutan Living Standards Survey. While OOP based on standard estimates is relatively low in Bhutan, the survey data show that expenses for healthcare-related transportation and spiritual ceremonies are substantive and by far exceed other components of OOP. Demographic, socio-economic, geographic and morbidity-related factors are found to affect the probability of incurring medical, transportation and spiritual OOP, as well as amounts spent. Disaggregating healthcare-related spending into its key components further reveals that living in rural areas increases the probability of incurring expenses for transportation and spiritual ceremonies, but decreases the odds of experiencing positive medical expenditure. Monthly equivalised household expenditure, functional disability, frequency of visits and length of stay are positively associated with total OOP, especially for transportation and spiritual expenses. Going to a public primary healthcare provider for the first outpatient visit, on the other hand, significantly decreases likelihood and amount of medical, transportation and spiritual OOP. These key results highlight the importance of understanding context-specific drivers of healthcare-related spending. In Bhutan, the financial burden particularly impacts respondents in rural areas and those with higher needs for healthcare services. A clear implication of the findings is that primary care and gatekeeping mechanisms need to be strengthened, especially considering that cost pressures have been growing which could lead to higher OOP in the future. Moreover, closer examination of the role of spiritual practices in the provision of health services is needed.

Sociodemographic Determinants of COVID-19 Vaccine Hesitancy, Fear of Infection, and Protection Self-Efficacy.

Objectives:Arkansas COVID-19 vaccine uptake has been lower than the national average. This study examined associations between sociodemographic factors and COVID-19 vaccine hesitancy, fear of infection, and protection self-efficacy.Methods:Adults either residing, having employment, or receiving health care in Arkansas (n = 754) participated in an online survey between October 30, 2020 and January 16, 2021. Participants were recruited in both rural and urban areas from 6 Arkansas primary care clinics. Survey questions addressed sociodemographic factors, COVID-19 infection fear, protection self-efficacy, and COVID-19 vaccine attitudes. Bivariate and multivariable logistic regression models were used to assess associations between dependent variables and respondents’ sociodemographic characteristics, COVID-19 infection fear, and COVID-19 protection self-efficacy.Results:About 38% of participants reported COVID-19 vaccine hesitancy. Age, sex, race, and education were significantly associated with COVID-19 and general vaccine attitudes. Odds of COVID-19 vaccine hesitancy decreased as age increased (OR = 0.98; P < .01). Women had higher odds of COVID-19 vaccine hesitancy than men (OR = 1.52; P < .05). Respondents with a high school diploma and below and respondents with some college or a technical degree had greater odds of COVID-19 vaccine hesitancy (OR = 2.58; P < .001; and OR = 1.97; P < .01, respectively) compared to respondents with a 4-year college degree. Black/African American respondents had greater odds of COVID-19 vaccine hesitancy compared to White respondents (OR = 3.08; P < .001). No significant difference was observed among rural and urban respondents regarding COVID-19 vaccine hesitancy; however, respondents in rural areas were more likely to report low general vaccine trust compared to those in urban areas (OR = 1.87; P < .01). Respondents reporting no fear (OR = 5.51; P < .001) and very little fear (OR = 1.95; P < .05) of COVID-19 had greater odds of COVID-19 vaccine hesitancy compared to respondents who feared COVID-19 infection to a great extent.Conclusions:COVID-19 vaccine hesitancy and general trust in vaccines differ significantly among age, sex, race, and education. These trust and hesitancy patterns are challenges for achieving population immunity and follow similar patterns of vulnerability to COVID-19. Vaccination programs and interventions must consider these differences in COVID-19 vaccine hesitancy and general vaccine trust to alleviate COVID-19 disparities. Findings make a significant contribution in evaluating vaccine hesitancy among a large, diverse sample from a rural state.

A Comparative Study of Knowledge, Attitude, and Determinants of Tuberculosis-Associated Stigma in Rural and Urban Communities of Lagos State, Nigeria.

Background Tuberculosis (TB) is an important public health concern in Nigeria. TB-associated stigma could lead to delayed diagnosis and care, treatment default, and multidrug resistance. Understanding of TB-associated stigma is therefore important for TB control. The study is aimed at determining and comparing the knowledge, attitude, and determinants of TB-associated stigma. Methodology. This was a comparative cross-sectional study among adults in urban and rural areas of Lagos State, Nigeria. Respondents were selected through a multistage sampling technique and interviewed using a semistructured questionnaire, which contained the Explanatory Model Interviewed Catalogue (EMIC) stigma scale. IBM SPSS Statistics Software package version 20 was used for analysis. Results A total of 790 respondents were interviewed. High proportions of respondents in rural and urban areas were aware of TB (97.5% and 99.2%, respectively). Respondents in the urban areas had overall better knowledge of TB compared to the rural areas (59.4% vs. 23%; p < 0.001), while respondents in the rural areas had a better attitude to TB (60.5% vs. 49.9%; p = 0.002). The majority of respondents in rural and urban areas had TB-associated stigma (93% and 95.7%, respectively). The mean stigma score was higher in the urban compared to rural areas (17.43 ± 6.012 and 16.54 ± 6.324, respectively, p = 0.046). Marital status and ethnicity were the predictors of TB-associated stigma in the rural communities (AOR-0.257; CI-0.086-0.761; p = 0.014 and AOR–3.09; CI-1.087-8.812; p = 0.034, respectively), while average monthly income and age of respondents were the predictors of TB-associated stigma in urban areas (AOR–0.274; CI–0.009-0.807; p = 0.019 and AOR-0.212; CI–0.057-0.788; p = 0.021, respectively). Conclusion TB-associated stigma is prevalent in both rural and urban areas in this study. There is therefore a need to disseminate health appropriate information through the involvement of the community. Also, innovative stigma reduction activities are urgently needed.

Solar House System Adoption among Rural Community

West Bandung Regency experiences inequality in access to electricity due to difficulties in the distribution process. One possible solution to overcome this problem is to utilize solar energy. Therefore, the purpose of this research is to determine importance of Solar House to be done with the intention of identifying the factors that influence the adoption of SHS technology among the public. This study used a modified TAM model consisting of perceived usefulness, perceived ease of use, social factors, and resource factors. The method of data collection is through the distribution of questionnaires to 185 respondents in rural areas of West Bandung Regency. Furthermore, Partial Least Square Modeling is used as an analytical method to test hypotheses. The results reveal that social factors are the most important determinant for the adoption of SHS. From a theoretical perspective, this study broadens our understanding of the adoption of SHS technology customers in rural areas. Furthermore, from managerial applications, this research suggests a social marketing strategy that can be carried out by solar panel entrepreneurs and the government to encourage rural communities to adopt SHS technology by expanding their existing knowledge.