Rural Clusters Research Articles

Relationships between Positive Deviant Behaviors and Children of Normal Growth Pattern in Poorly Resourced Rural Communities.

Background:Promotion of positive deviant behaviors (PDBs) can be crucial to bring sustainable change as these behaviors are likely to be affordable and acceptable by the wider community.Objectives:The objective of this study was to assess if any PDBs exist among poorly resourced rural mothers with young children near Vadodara.Materials and Methods:Mothers of children <5 years (n = 160) were enrolled from four rural clusters near Vadodara based on their current growth status (weight-for-age) and were categorized as PD (n = 65) and negative deviant (ND; n = 95), as per the WHO Anthro Software. Personal interviews were conducted through household (HH) visits using a semistructured questionnaire. Data were elicited on HH socioeconomic status, infant and young child feeding practices, diet pattern, and hygiene–sanitation practices. HH dietary diversity score was calculated individually after collecting data through food frequency questionnaire.Results:Mothers had several significant PDBs (P < 0.05), PD group vs. ND group, less use prelacteals to children (53% vs. 71%) and had more exclusive breastfeeding rates (44% vs. 26%), provided cleaner clothing to children (52% vs. 28%), had sufficient intra-HH food distribution (30% vs. 18%), and scored better in dietary diversity at HH level (52% vs. 28%).Conclusions:PDBs and normal growth patterns do exist in poorly resourced areas, and these mothers can be used as “change agents” by the practicing pediatricians of rural communities for improving child health and nutrition.

Examination of regional disparity in the level of tourist offer in rural clusters of Serbia

Serbia is a country known for turbulent historical events, which completely disrupted the economic and political state of the country, and which had negative effects on the country’s tourist development. In this research, the authors pointed to the current state of the level of services provided in rural parts of Serbia, and on the basis of the obtained data, found that there are disparities in the examined clusters when it comes to the level and quality of the services provided. So far, only a small number of authors have pointed to this issue, however, this research discusses a key problem that has negative implications for the development of rural tourism in Serbia. By including results in further research related to rural tourism, it is possible to develop long-term plans for removing regional disparities in rural clusters in Serbia.

Increasing prevalence of type 2 diabetes mellitus and impact of ethnicity in north Sudan

BackgroundDiabetes mellitus constitutes a global health threat, with increasing burden of disease in low and middle-income countries witnessing ongoing epidemiological transition including Sudan. AimsTo study the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes and determine the relationship to gender, age, waist circumference, body mass index, residence and ethnicity among the adult population in north Sudan. MethodsA cross-sectional, population-based study in Northern State and River Nile State using random multi-stage cluster sampling targeting 5376 participants from 14 localities divided into 60 urban and 40 rural clusters. In each cluster, 60 households were studied. Blood glucose level and anthropometric measurements were recorded and a questionnaire containing demographic data was obtained from each participant. ResultsThe prevalence of T2DM among participants was 18.7% and prediabetes was 12.9%. Among people living with T2DM, 694(71.0%) were known cases of T2DM, whereas 284(29.0%) were newly diagnosed cases. The significant associated risk factors for T2DM included urban residence (AOR 1.23, 95%CI 1.09–1.41), age above 60 years (AOR 4.77, 95%CI 4.04–5.63), obese BMI (AOR 1.26, 95%CI 1.03–1.55) and central obesity (AOR 1.39, 95%CI 1.14–1.68). Compared to indigenous population, individuals of Egyptian descents (AOR 1.28, 95%CI 1.04–1.57) and mixed origin (AOR 1.24, 95%CI 1.04–1.48) had increased risk of T2DM. ConclusionThe prevalence of T2DM and prediabetes in north Sudan have increased significantly since 1996 with variations between ethnicities which showed to be an independent risk factor for T2DM. Health authorities are recommended to set plans to meet the health needs of these communities.

“It Has Changed”: Understanding Change in a Parenting Program in South Africa

BackgroundPoor parenting that leads to child maltreatment during adolescence presents a major public health burden. Research from high-income countries indicates that evidence-based parenting program interventions can reduce child maltreatment. Much less is known, however, about how beneficiaries of these programs experience this process of change. Understanding the process that brings about change in child maltreatment practices is essential to understanding intervention mechanisms of change. This is particularly important given the current scale-up of parenting programs across low- and middle-income countries. ObjectivesThis study aimed to provide insight into how caregivers and adolescents attending a parenting program in South Africa perceived changes associated with abuse reduction. MethodsSemi-structured interviews were conducted with caregivers and adolescents (n = 42) after the intervention, as well as observations of sessions (n = 9) and focus group discussions (n = 240 people). Participants were adolescents between the ages of 10-18 and their primary caregiver residing in peri-urban and rural program clusters in the Eastern Cape Province of South Africa. Data were coded in Atlas.ti, and thematic content analysis was conducted. FindingsBased on participant perceptions, the Sinovuyo Teen parenting program workshops catalyzed change into practice by creating an environment that was conducive to learning alternatives. It did so through prioritizing a process of mutual respect, openness, and being valued by others, giving legitimacy to a respectful reciprocity and new ways of spending time together that enabled caregivers and teenagers to shift and normalize more positive behaviors. This in turn led to reductions in physical and verbal abuse. ConclusionsThis study's findings may be of use to policymakers and practitioners who need to understand how parenting programs support parents and teenagers in increasing positive parenting approaches and changing potentially harmful practices. It additionally highlights the importance of assessing the experiences of both parents and teenagers attending such programs.

Analisis Perbandingan Pemodelan Pathloss COST-231 Hata dan Walfisch Ikegami Terhadap Pathloss Pengukuran dengan Metode Drive test di Wilayah Banyumas

Abstract�¢??The Pathloss model is an important component for wireless communication network planning. This Pathloss model can predict how bad the Pathloss that occurs in the wireless communication network planning area. but predicting the pathloss need the selection of some pathloss model according the characteristic of the certain area so that when the implementation of wireless networks, the network can provide optimal wireless communication services as the planning result. In this study we compare Pathloss model COST-231 Hata and Pathloss Model Walfisch Ikegami with Pathloss Measurements in Banyumas Area to select which Pathloss model that corresponds to the characteristics of banyumas region in each Urban, Suburban and Rural Cluster. Pathloss measurement is obtained by measuring the received power of mobile phones with the Drivetest method at a frequency of 1800 Hz. In this study, we analyzed the pathloss graph and MSE (Mean Square Error) from Pathloss Measurement of each Pathloss model in each Cluster. The results of this study, Pathloss COST-231 Urban and Rural Pathloss model had compatibility with Pathloss measurement by MSE value are 18.16 dB and 10.33 dB, while in the Suburban Cluster had compatibility with Pathloss Walfisch Ikegami with MSE value 5.58 dB.

National sample survey to assess the new case disease burden of leprosy in India.

A national sample survey of leprosy was undertaken in partnership with Indian Council of Medical Research (ICMR) institutions, National Leprosy Eradication Programme (NLEP), Panchayati Raj members, and treated leprosy patients to detect new cases of leprosy in India. The objectives of the survey were to estimate the new leprosy case load; record both Grade 1 and Grade 2 disabilities in the new cases; and to assess the magnitude of stigma and discrimination prevalent in the society. A cluster based, cross-sectional survey involving all States was used for the door-to-door survey using inverse sampling methodology. Rural and urban clusters were sampled separately. The population screened for detecting 28 new cases in rural and 30 in urban clusters was enumerated, recorded and analyzed. Data capture and analysis in different schedules were the main tools used. For quality control three tiers of experts were utilized for the confirmation of cases and disabilities. Self-stigma was assessed in more than half of the total new patients detected with disabilities by the approved questionnaire. A different questionnaire was used to assess the stigma in the community. A population of 14,725,525 (10,302,443 rural; 4,423,082 urban) was screened and 2161 new cases - 1300 paucibacillary (PB) and 861 multibacillary (MB) were detected. New case estimates for leprosy was 330,346 (95% Confidence limits, 287,445-380,851). Disabilities observed in these cases were 2.05/100,000 population and 13.9 per cent (302/2161) in new cases. Self-stigma in patients with disabilities was reduced, and the patients were well accepted by the spouse, neighbour, at workplace and in social functions.

Assessment of Parents’ Knowledge, Attitude and Practice about Child Vaccination in Rural areas

Background : Vaccines have thrived as one of the most successful health interventions that have diminished occurrence of infectious diseases and improved quality of life in the population. Although the vaccination coverage has been gradually increasing, the average total immunization coverage is far less than the desired outcome. Parental decisions regarding vaccination are very vital for increasing the vaccination rate and parent compliance to the immunization schedule. Objective : To analyze the extent of parents' Knowledge, Attitude and Practice(KAP) about child vaccination in rural areas such that it can be correlated with the immunization status of their child amongst native participants of Bangalore. Methodology : A prospective cross-sectional study was carried out on 110 Parents residing in rural areas of Bangalore who had children below 5 years of age. The sociodemographic details of the parents were collected and they were made to fill a KAP Questionnaire. Each question under Knowledge and Attitude was scored to assess their KAP level regarding child vaccination. The immunization status of the child was assessed by counting on the parents' word for it. Results : A total of 110 parents participated in the study from different rural clusters of Bangalore. Assessment of the extent of Knowledge, attitude and practice about child vaccination showed that a majority of them (72.7 %,) had good knowledge score followed by average (21.8%) and poor (5.4%) whereas 85.4% of the respondents were found to have good attitude towards child vaccination. The immunization status of the child was assessed by counting on the parents' word for it and.68.1% children were completely immunized whereas 7.2 % received incomplete immunization. The immunization status of the remaining 24.5% of the children was uncertain as assessment was not possible due to lack of surety in the parents part regarding the immunization status of their child. Although parental knowledge was not found to be significantly associated with the immunization status of their child, there was a significant association between the attitude of parents towards child vaccination and the immunization status of their child. A very significant correlation was also seen between the parental knowledge and attitude score with p≤0.0001. Conclusion : The parental Knowledge, Attitude and Practice about child vaccination are important determinants of the immunization status of their child. A combined effort from the members of the healthcare team and social health workers can definitely make the attainment of the targeted immunization coverage rate in the country possible.

An Exploration of the Associations Among Hearing Loss, Physical Health, and Visual Memory in Adults From West Central Alabama.

The purpose of this preliminary study was to explore the associations among hearing loss, physical health, and visual memory in adults living in rural areas, urban clusters, and an urban city in west Central Alabama. Two hundred ninety-seven adults (182 women, 115 men) from rural areas, urban clusters, and an urban city of west Central Alabama completed a hearing assessment, a physical health questionnaire, a hearing handicap measure, and a visual memory test. A greater number of adults with hearing loss lived in rural areas and urban clusters than in an urban area. In addition, poorer physical health was significantly associated with hearing loss. A greater number of individuals with poor physical health who lived in rural towns and urban clusters had hearing loss compared with the adults with other physical health issues who lived in an urban city. Poorer hearing sensitivity resulted in poorer outcomes on the Emotional and Social subscales of the Hearing Handicap Inventory for Adults. And last, visual memory, a working-memory task, was not associated with hearing loss but was associated with educational level. The outcomes suggest that hearing loss is associated with poor physical and emotional health but not with visual-memory skills. A greater number of adults living in rural areas experienced hearing loss compared with adults living in an urban city, and consequently, further research will be necessary to confirm this relationship and to explore the reasons behind it. Also, further exploration of the relationship between cognition and hearing loss in adults living in rural and urban areas will be needed.

Menstrual hygiene management among Bangladeshi adolescent schoolgirls and risk factors affecting school absence: results from a cross-sectional survey

BackgroundMany adolescent girls in low-income and middle-income countries lack appropriate facilities and support in school to manage menstruation. Little research has been conducted on how menstruation affects school absence. This...

Coverage and compliance of mass drug administration against lymphatic filariasis in Kalaburgi district

Background: Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. Filariasis has been a major public health problem in India next only to malaria. Study was done to assess coverage and compliance of mass drug administration (MDA) against lymphatic filariasis in Kalaburgi districts.Methods: This cross-sectional coverage evaluation survey was done in one urban and three rural clusters in district.The data was compiled, tabulated and analyzed using proportions.Results: A total of 791 subjects were interviewed, male subjects constituted about 47.7%. Majority of the subjects were in the age group of 16-60 years (69.9%), while only 3.2% were in &lt;2years. 82.9% persons have received the drugs. Out of the 530 persons who have received the drugs, 86.9% persons have consumed the drugs. Only 59.9% of study subjects consumed tablets in front of health workers. A total of 69 subjects have not consumed tablets, 20.3% said told fear of side reaction, and 20.3% subjects said they don’t have faith in tablet. Only 11 persons suffered from vomiting and nausea.Conclusions: There is an urgent need for more effective drug delivery strategies and also proper IEC should be done to educate and to improve the coverage and compliance in the districts.

Private sector role, readiness and performance for malaria case management in Uganda, 2015

BackgroundSeveral interventions have been put in place to promote access to quality malaria case management services in Uganda’s private sector, where most people seek treatment. This paper describes evidence using a mixed-method approach to examine the role, readiness and performance of private providers at a national level in Uganda. These data will be useful to inform strategies and policies for improving malaria case management in the private sector.MethodsThe ACTwatch national anti-malarial outlet survey was conducted concurrently with a fever case management study. The ACTwatch nationally representative anti-malarial outlet survey was conducted in Uganda between May 18th 2015 and July 2nd 2015. A representative sample of sub-counties was selected in 14 urban and 13 rural clusters with probability proportional to size and a census approach was used to identify outlets. Outlets eligible for the survey met at least one of three criteria: (1) one or more anti-malarials were in stock on the day of the survey; (2) one or more anti-malarials were in stock in the 3 months preceding the survey; and/or (3) malaria blood testing (microscopy or RDT) was available. The fever case management study included observations of provider-patient interactions and patient exit interviews. Data were collected between May 20th and August 3rd, 2015. The fever case management study was implemented in the private sector. Potential outlets were identified during the main outlet survey and included in this sub-sample if they had both artemisinin-based combination therapy (ACT) [artemether–lumefantrine (AL)], in stock on the day of survey as well as diagnostic testing available.ResultsA total of 9438 outlets were screened for eligibility in the ACTwatch outlet survey and 4328 outlets were found to be stocking anti-malarials and were interviewed. A total of 9330 patients were screened for the fever case management study and 1273 had a complete patient observation and exit interview. Results from the outlet survey illustrate that the majority of anti-malarials were distributed through the private sector (54.3%), with 31.4% of all anti-malarials distributed through drug stores and 14.4% through private for-profit health facilities. Availability of different anti-malarials and diagnostic testing in the private sector was: ACT (80.7%), quality-assured (QA) ACT (72.0%), sulfadoxine–pyrimethamine (SP) (47.1%), quinine (73.2%) and any malaria blood testing (32.9%). Adult QAACT ($1.62) was three times more expensive than SP ($0.48). The results from the fever case management study found 44.4% of respondents received a malaria test, and among those who tested positive for malaria, 60.0% received an ACT, 48.5% received QAACT; 14.4% a non-artemisinin therapy; 14.9% artemether injection, and 42.5% received an antibiotic.ConclusionThe private sector plays an important role in malaria case management in Uganda. While several private sector initiatives have improved availability of QAACT, there are gaps in malaria diagnosis and distribution of non-artemisinin monotherapies persists. Further private sector strategies, including those focusing on drug stores, are needed to increase coverage of parasitological testing and removal of non-artemisinin therapies from the marketplace.

Limited Service Availability, Readiness, and Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population Data.

Understanding the barriers that women in Haiti face to giving birth at a health facility is important for improving coverage of facility delivery and reducing persistently high maternal mortality. We linked health facility survey data and population survey data to assess the role of the obstetric service environment in affecting women's use of facility delivery care. Data came from the 2012 Haiti Demographic and Health Survey (DHS) and the 2013 Haiti Service Provision Assessment (SPA) survey. DHS clusters and SPA facilities were linked with their geographic coordinate information. The final analysis sample from the DHS comprised 4,921 women who had a live birth in the 5 years preceding the survey. Service availability was measured with the number of facilities providing delivery services within a specified distance from the cluster (within 5 kilometers for urban areas and 10 kilometers for rural areas). We measured facility readiness to provide obstetric care using 37 indicators defined by the World Health Organization. Random-intercept logistic regressions were used to model the variation in individual use of facility-based delivery care and cluster-level service availability and readiness, adjusting for other factors. Overall, 39% of women delivered their most recent birth at a health facility and 61% delivered at home, with disparities by residence (about 60% delivered at a health facility in urban areas vs. 24% in rural areas). About one-fifth (18%) of women in rural areas and one-tenth (12%) of women in nonmetropolitan urban areas lived in clusters where no facility offered delivery care within the specified distances, while nearly all women (99%) in the metropolitan area lived in clusters that had at least 2 such facilities. Urban clusters had better service readiness compared with rural clusters, with a wide range of variation in both areas. Regression models indicated that in both rural and nonmetropolitan urban areas availability of delivery services was significantly associated with women's greater likelihood of using facility-based delivery care after controlling for other covariates, while facilities' readiness to provide delivery services was also important in nonmetropolitan urban areas. Increasing physical access to delivery care should become a high priority in rural Haiti. In urban areas, where delivery services are more available than in rural areas, improving quality of care at facilities could potentially lead to increased coverage of facility delivery.

Health, family strains, dependency, and life satisfaction of older adults

Using stress process theory and structural equation modelling, this study investigated the complex relationship between health status, family strain, dependency, and the life satisfaction of rural older adults with reported functional impairments in India. Data were extracted from a large-scale study of 903 randomly selected adults aged 61 years and older from 30 rural clusters of India. The sample for this study was confined to 653 older adults who reported functional impairments. Structural equation modelling showed that poor health status indirectly lowered the life satisfaction of older adults through family strains. Moreover, poor health status also indirectly influenced life satisfaction through dependency and family strain (poor health→dependency→family strains→life satisfaction). The findings indicate that for professionals who deal with the health of older adults, exploring relationship strains and dependency is vital to the assessment and intervention of subjective wellbeing. Inter-sectoral coordination and communication between healthcare and social service agencies might facilitate effective management of health problems among older adults. Moreover, taking family strains and dependency into account when caring for older adults with health problems is critical to help improve their quality of life and maintain their wellbeing.

The prevalence of HIV among adults with pulmonary TB at a population level in Zambia

BackgroundTuberculosis and HIV co-infection is one of the main drivers of poor outcome for both diseases in Zambia. HIV infection has been found to predict TB infection/disease and TB has been reported as a major cause of death among individuals with HIV. Improving case detection of TB/HIV co-infection has the potential to lead to early treatment of both conditions and can impact positively on treatment outcomes. This study was conducted in order to determine the HIV prevalence among adults with tuberculosis in a national prevalence survey setting in Zambia, 2013–2014.MethodsA countrywide cross sectional survey was conducted in 2013/2014 using stratified cluster sampling, proportional to population size for rural and urban populations. Each of the 66 countrywide clusters represented one census supervisory area with cluster size averaging 825 individuals. Socio-demographic characteristics were collected during a household visit by trained survey staff. A standard symptom-screening questionnaire was administered to 46,099 eligible individuals across all clusters, followed by chest x-ray reading for all eligible. Those symptomatic or with x-ray abnormalities were confirmed or ruled out as TB case by either liquid culture or Xpert MTBRif performed at the three central reference laboratories. HIV testing was offered to all participants at the survey site following the national testing algorithm with rapid tests. The prevalence was expressed as the proportion of HIV among TB cases with 95% confidence limits.ResultsA total of 265/6123 (4.3%) participants were confirmed of having tuberculosis. Thirty-six of 151 TB survey cases who accepted HIV testing were HIV-seropositive (23.8%; 95% CI 17.2–31.4). The mean age of the TB/HIV cases was 37.6 years (range 24–70). The majority of the TB/HIV cases had some chest x-ray abnormality (88.9%); were smear positive (50.0%), and/or had a positive culture result (94.4%). None of the 36 detected TB/HIV cases were already on TB treatment, and 5/36 (13.9%) had a previous history of TB treatment. The proportion of TB/HIV was higher in urban than in the rural clusters. The HIV status was unknown for 114/265 (43.0%) of the TB cases.ConclusionsThe TB/HIV prevalence in the general population was found to be lower than what is routinely reported as incident TB/HIV cases at facility level. However; the TB/HIV co-infection was higher in areas with higher TB prevalence. Innovative and effective strategies for ensuring TB/HIV co-infected individuals are detected and treated early are required.

Clustering of Bamboo Enterprises in NE India: Bairabi Cluster, Mizoram

Handicrafts of India represent our cultural tradition in the true sense, replete with products made with the help of simple, indigenous tools by crafts people who belong within a strong fabric of tradition, aesthetics and artistry. Mizoram is one of the most promising states for developing bamboo enterprise in India, with around 57 per cent of the state’s geographical area under bamboo cover. In the absence of large industries, handicraft sector plays an important role in the Mizo economy. Clusters and clustering of small firms is increasingly becoming an important tool in micro, small and medium enterprises (MSMEs) development in both developed and the developing economies. The present paper, based on a diagnostic study of the rural cluster of Bairabi in Mizoram, where craftsmen have been engaging in producing bamboo products for decades, proposes to trace the history and evaluate the growth of the cluster in terms of sales, product mix, number of enterprises and sales turnover. The researcher suggests the need to initiate cluster development activities in this cluster to enable it to sustain and grow.Ideally, implementation of centrally sponsored schemes such as Baba Sahib AmbedkarHastashilpaVikasYojana, Scheme of Fund for Regeneration of Tradional industries (SFURTI) and others would enable the cluster to progress on a growth trajectory

Livestock ownership, animal source foods and child nutritional outcomes in seven rural village clusters in Sub-Saharan Africa

BackgroundSub-Saharan Africa currently has the highest prevalence of malnutrition worldwide. In children under the age of 5 years, malnutrition can have long-term effects on physical and cognitive development, with implications at the national scale. Theoretically, livestock-based interventions are well placed to overcome constraints faced by micronutrient and/or food-based interventions. However, there is limited empirical evidence to support this hypothesis.MethodsThis study utilised agriculture, nutrition and anthropometry data from the Millennium Villages Project to investigate relationships between livestock ownership, animal source foods (ASF) consumption and child nutritional outcomes across seven rural village clusters in Sub-Saharan Africa. Village clusters were located in different agro-ecological zones and included: Bonsaaso, Ghana; Mayange, Rwanda; Mwandama, Malawi; Tiby, Mali; Pampaida, Nigeria; Potou, Senegal; and Ruhiira, Uganda. Data from 1624 households (including 1543 children) were included in the analysis.ResultsOverall, the proportion of children with stunting, underweight or wasting across the seven village clusters was 40, 18 and 5%, respectively. Livestock ownership, ASF consumption and child nutritional outcomes varied between village clusters. Households that owned livestock were generally more likely to consume associated ASF. For example, the proportion of households that consumed milk was higher in households that owned cows compared to those that did not in Pampaida, Mayange and Ruhiira (P < 0.05), while poultry meat consumption was generally higher in poultry-keeping households in Mayange and Ruhiira (P < 0.05). The relationship between ASF consumption and anthropometric measurements was complex, ranging from positively to negatively associated depending on the food commodity and village cluster. For instance, in Ruhiira, the mean weight-for-age Z score (WAZ) was significantly higher (better) in children from households that consumed eggs in the last 30 days, while in Potou, mean WAZ was significantly lower (worse) in children from households that consumed eggs in the last 30 days (P < 0.05).ConclusionsThis study contributes to the growing body of research that investigates the relationships between livestock ownership, ASF consumption and nutritional outcomes in children. Our results reveal complex patterns that vary across agro-ecological zones. More research is needed to assess seasonal variations in these factors, effects of gender roles on intra-household distribution of ASF, as well as effects of zoonotic food-borne diseases on nutritional status of children in these sites.

Do cities represent sources, sinks or isolated islands for urban wild boar population structure?

Summary Urban sprawl has resulted in the permanent presence of large mammal species in urban areas, leading to human–wildlife conflicts. Wild boar Sus scrofa are establishing a permanent presence in many cities in Europe, with the largest German urban population occurring in Berlin. Despite their relatively long‐term presence, there is little knowledge of colonization processes, dispersal patterns or connectivity of Berlin's populations, hampering the development of effective management plans. We used 13 microsatellite loci to genotype 387 adult and subadult wild boar from four urban forests, adjacent built‐up areas and the surrounding rural forests. We applied genetic clustering algorithms to analyse the population genetic structure of the urban boar. We used approximate Bayesian computation to infer the boar's colonization history of the city. Finally, we used assignment tests to determine the origin of wild boar hunted in the urban built‐up areas. The animals in three urban forests formed distinct genetic clusters, with the remaining samples all being assigned to one rural population. One urban cluster was founded by individuals from another urban cluster rather than by rural immigrants. The wild boar that had been harvested within urban built‐up areas was predominantly assigned to the rural cluster surrounding the urban area, rather than to one of the urban clusters. Synthesis and applications. Our results are likely to have an immediate impact on management strategies for urban wild board populations in Berlin, because they show that there are not only distinct urban clusters, but also ongoing source–sink dynamics between urban and rural areas. It is therefore essential that the neighbouring Federal States of Berlin and Brandenburg develop common hunting plans to control the wild boar population and reduce conflicts in urban areas.

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey

SUMMARYBackgroundHealthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions.AimTo conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy.MethodsThe 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities.FindingsMore than 96% of facilities had ‘improved’ water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78–92% of handwashing locations for doctors and nurses, but just 4–30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%).ConclusionHealthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi health-care facilities.

Exploration of indigenous knowledge systems in relation to couching in Nigeria

Background: Couching is a traditional treatment for cataracts but often has poor visual outcomes, as identified during the Nigerian National Blindness Survey.Objectives: To investigate why couching is accessed by individuals with cataracts in northern Nigeria.Methods: The ten rural clusters in Jigawa State included in the National BlindnessSurvey were revisited to trace four groups of participants: cataract blind individuals, those couched or who had undergone cataract surgery and local couchers. Additional postoperative patients were recruited from the local eye department. Semi-structured interviews were undertaken with cataract blind and cataract-operated participants, and 27 in-depth interviews were conducted with those couched and five couchers. Qualitative data were translated, transcribed and analysed after immersion and reflection using a thematic framework.Results: Half of the cataract blind attributed the cause to spiritual factors or past misdeeds, only 25% knew they had cataracts and 83% had not undergone ophthalmic examination. Cost, distance and unreliability of services were the main barriers to accessing surgery. Facilitators of couching were the responsiveness of couchers in relation to location, timing and payment, and immediate visual improvement. Couchers understood local beliefs, were itinerant and used a network of case finders.Conclusions: Couching is accepted as it is entrenched in traditional beliefs and indigenous knowledge systems, and couchers are responsive. Lack of awareness and inaccessibility were barriers to cataract surgery. Strategies to improve cataract surgery must take account of local beliefs and factors influencing health-seeking behaviour. Couchers were willing to collaborate with professional eye care providers, but this will require time, skill and mutual trust.Keywords: couching

STREAMING METHODOLOGY OF SOIL SURFACE - AN INNOVATIVE WAY OF HUMAN ECONOMIC ACTIVITY

The stream method for mapping of soil surface in agro-ecosystems is the effective tool allowing to unify its structure and to provide new opportunities for development of many directions of economic activity. The streaming methodology based on theory of physical similarity on similar objects allows significantly expand opportunities at planning both of agricultural systems and complex strategy for rural territories and agro-industrial clusters of the advancing development.