Rural Governorate Research Articles

Retrospective Study of Patients with Forgotten Ureteral Double-J Stents in Aden, Yemen

Background: Double-J stents are among the basic and commonly used tools in urology. Objective: To study the morbidity associated with forgotten ureteral stents and to describe the variables of the reason for prolonged indwelling time, complications and treatment Materials and method: This is a retrospective observational study, which conducted in Aden, during the period January 2019 to December 2020. The records of all patients diagnosed with forgotten ureteral stents reviewed, and obtained the following data: sex, age, governorates, medical history, presenting complaints, total indwelling time of the stent, the reason for prolonged indwelling time, the x-ray, ultrasound investigations, complications and treatment. Fisher test was used and p-value < 0.05 was considered as statistically significant. The statistical software package SPSS version 17 was used. Results: The study patients were 46 and they were 78.3% males and 21.7% females, (male:female ratio 3.6:1). The mean age of the patients was 35 ± 8.9 years, (range between 20 to 50 years). Patients of the age group < 40 years old were predominant 65.2%. Most of the patients were from rural governorates 89.1%. The mean duration of the indwelling stent in situ was 37.2 ± 13.2 months, and the duration ranged from 24 months to 60 months. Reasons for these long indwelling times were poor education of patient 37.0% and doctor did not inform the patient 37.0% followed by lack of awareness of patients 26.0%. In the treatment procedures we found cystolithotripsy with ESWL was applied in 41.3% patients followed by ureterolithotripsy with ESWL in 37.0% patients, ESWL in 15.2% patients and PCNL in 6.5% patients. The complications were stone formation 45.7% followed by the irritative lower urinary tract symptom 28.2%, renal failure 17.4% and urosepsis 8.7%. Conclusion: Using double-J stents should be accompanied with a well education of the patient to reduce forgotten double-J stents and physicians need to be sensitized towards this health problem. Keywords: Forgotten, ureteral double-J stents, Aden,

Language attitudes in Northwestern Tunisia and their implication for speech patterns

Abstract Our paper investigates the relationship between language attitudes and practices in Tunisia, particularly in the two mainly rural governorates of Siliana and Jendouba situated in Northwestern Tunisia. The data that underlie our analysis were gathered in 43 qualitative interviews and through participant observation during fieldwork in spring and summer 2019, and by methodical inquiry into salient linguistic features. First, speakers’ attitudes towards and their evaluation of (1) their own local dialect and (2) the dialect of the capital Tunis reveal that the capital Tunis and coastal towns such as Sousse are perceived as urban and advanced – in education as well as in lifestyle – whereas the central and north-western regions of Tunisia are perceived as rural and culturally backward. We show how speakers apply social meanings to certain linguistic variables such as the use of the urban [q] that is considered as fīnu ‘genteel, refined’ in contrast to the rural [g]. Others, though also clearly urban features, are not equally charged with stereotypes, among them the adoption of the urban personal pronoun of the 1st person sg. ǟna. Second, the impact these evaluations have on speech patterns and consequently on intra-dialectal levelling processes and language change is analysed and its patterns described. We show that language ideologies and attitudes are determined by the intersection of age, gender and level of education, and that young, educated women with a rural background are among the first to adopt urban features. As women in Siliana and Jendouba are expected to act more fīnu than their male peers, they are more inclined to adopt the [q]. The situation of the personal pronoun of the 1st person sg., the plural of III-weak verbs and the loss of gender distinction in verbs, however, is less clear.

Prosthetic rehabilitation modalities and their socioeconomic association in a sample of adult Egyptians

Background Teeth loss results in significant complications that can severally affect the individuals’ general health and social activities. Several studies have documented the association between socioeconomic issues and the prevalence of oral diseases and prosthetic rehabilitation. Thus, this study aimed to explore the impact of socioeconomic factors on prosthetic rehabilitation modalities in a sample of adult urban and rural Egyptian populations. Patients and methods A total of 400 adults of age over 18 years were included in this study. Half of them were from urban governorates (Cairo and Giza). And the other half were from the rural governorate (Al-Fayoum). Information concerning demographic (sex and age) and socioeconomic (education level, occupation, and income) factors were collected using the modified WHO questionnaire. In addition, prosthetic rehabilitation status was evaluated through intraoral examination. Results The percentage of female participants was higher than males in both urban and rural regions. The age range for more than two-thirds of the participants was from 30 to 60 years. In urban areas, about 39% of participants were completely dentulous, 34.5% were partially edentulous without prosthetic rehabilitation, and only 26.5% made dental prostheses. Regarding rural participants, about 35% of them were completely dentulous, 64.5% partially edentulous without prosthetic treatment, and only 0.05% received prosthesis. Comparison between the urban and rural dentition status and rehabilitation modalities showed a statistically significant difference (P<0.05). Socioeconomic factors (education, occupation, and income) affect the type of prosthetic treatment modalities, particularly fixed prostheses especially in the urban area. Conclusion Socioeconomic determinants greatly affected prosthetic rehabilitation modalities in the studied urban and rural Egyptians. In rural areas, socioeconomic factors negatively impacted the capability of prosthetic treatment.

Patterns and distribution of human exposed to rabies in Yemen, 2011–2018

Background: Rabies is a hidden health threat in developing countries. It has the highest case–fatality rate close to100%. In Yemen, Despite National Rabies Control Program (NRCP) has established since 1989, the true burden of human rabies in Yemen still not clear. The aims of this study were to describe the patterns and distribution of human exposed cases to rabies and to make necessary recommendations for improvement. Methods and materials: Soft and hard copies of the cumulative data from NRCP were obtained from 26 control units distributed in 15 governorates from January 2011 to December 2018. WHO case definition for human exposure to rabies was used .Data were analyzed using Microsoft Excel and Epi-info 7.2. Results: During eight years 2011–2018, a total of 89,590 possible exposure cases that bitten by a suspected rabid animal were reported, of them (29%) 25,574 exposed to positively confirmed rabid animal and have Post Exposure Prophylaxis (PEP), from those possible exposure cases (0.4%) 347 have human rabies and died. (68%) of exposed cases were males and (40%) were among age group of (4–15 years). More than (52%) of exposed cases were from three rural governorates Ibb, Dhamar, and Al–Hudaydah (32%, 12%, 8%) respectively. The overall incidence of person that exposed to rabies and have post exposure prophylaxis PEP was 17 per 100, 000, and the overall incidence of deaths 2 per 1000, 000. The highest incidence of exposed cases that have PEP was in 2014 with 16 per 100.000. The overall mean value of vaccines and immunoglobulins were (14425, 3481) respectively. The lowest quantity of vaccines was in 2016 with 3788 doses, and the lowest quantity of immunoglobulins was zero vials in 2017. Conclusion: Rabies is still a neglected public health problem in Yemen. Strengthening rabies surveillance to ensure proper reporting and secure availability and affordability of vaccines and immunoglobulins are crucial. Increasing community awareness on rabies at high risk areas and integrated effort of health and agriculture sector to control rabies among animals are recommended.

Spatial Distribution of Land Surface Temperatures in Kuwait: Urban Heat and Cool Islands.

The global rise of urbanization has led to the formation of surface urban heat islands and surface urban cool islands. Urban heat islands have been shown to increase thermal discomfort, which increases heat stress and heat-related diseases. In Kuwait, a hyper-arid desert climate, most of the population lives in urban and suburban areas. In this study, we characterized the spatial distribution of land surface temperatures and investigated the presence of urban heat and cool effects in Kuwait. We used historical Moderate-Resolution Imaging Spectroradiometer (MODIS) Terra satellite 8-day composite land surface temperature (LST) from 2001 to 2017. We calculated the average LSTs of the urban/suburban governorates and compared them to the average LSTs of the rural and barren lands. We repeated the analysis for daytime and nighttime LST. During the day, the temperature difference (urban/suburban minus versus governorates) was −1.1 °C (95% CI; −1.2, −1.00, p < 0.001) indicating a daytime urban cool island. At night, the temperature difference (urban/suburban versus rural governorates) became 3.6 °C (95% CI; 3.5, 3.7, p < 0.001) indicating a nighttime urban heat island. In light of rising temperatures in Kuwait, this work can inform climate change adaptation efforts in the country including urban planning policies, but also has the potential to improve temperature exposure assessment for future population health studies.

Development of two socioeconomic indices for Saudi Arabia

BackgroundHealth and socioeconomic status (SES) are linked in studies worldwide. Measures of SES exist for many countries, however not for Saudi Arabia (SA). We describe two indices of area-based SES for SA.MethodsRoutine census data has been used to construct two indices of SES at the geographically-delimited administrative region of Governorates in SA (n = 118). The data used included indicators of educational status, employment status, car and material ownership. A continuous measure of SES was constructed using exploratory factor analysis (EFA) and a categorical measure of SES using latent class analysis (LCA). Both indices were mapped by Governorates.ResultsThe EFA identified three factors: The first explained 51.58% of the common variance within the interrelated factors, the second 15.14%, and the third 14.26%. These proportions were used in the formulation of the standard index. The scores were fixed to range from 100 for the affluent Governorate and 0 for the deprived. The LCA found a 4 class model as the best model fit. Class 1 was termed “affluent” and included 11.01% of Governorates, class 2 “upper middle class” (44.91%), class 3 “lower middle class” (33.05%) and class 4 “deprived” (11.01%). The populated urbanised Governorates were found to be the most affluent whereas the smaller rural Governorates were the most deprived.ConclusionThis is the first description of measures of SES in SA at a geographical level. Two measures have been successfully constructed and mapped. The maps show similar patterns suggesting validity. Both indices support the common perception of SES in SA.

الخصائص الديموجغرافية للسکان المصابين بفيروس سى C بمحافظة کفر الشيخ دراسة فى جغرافية السکان

الخصائص الديموجغرافية للسکان المصابين بفيروس سى C بمحافظة کفر الشيخ دراسة فى جغرافية السکان

Patients' Satisfaction with Primary Health Care in Egypt: Exploring the Gap between Rural and Urban Governorates

Patient satisfaction has been frequently used as an indication of the overall quality of health care providers. Understanding patients` needs and expectations is crucial to PHC providers to improve patients` health. This study aims to explore patients' satisfaction with primary health care services in urban and rural areas in Egypt. The study shows a gap in patient`s satisfaction across Alexandria and Sohag governorates. This implies a difference in reform implementation across urban and rural governorates. More attention should be given to different dimensions of health care provision at PHC level in rural governorates including clinical and nonclinical training of nurses, improvement in amenities and other facilities, improvement of registration system, and promoting the new system.

The clinical profile of students attending informal schools in three rural governorates in upper Egypt

Combating poverty and illiteracy represents the cornerstone for promoting health among Egyptian children; yet, drop out from the elementary education is a major problem facing stakeholders in Egyptian governorates. To tackle this problem, many projects were implemented such as reading and writing classes, and Girls Education Initiatives (GEIs). The aim of the study was to construct a clinical and laboratory database for students attending the Girls Education Initiative schools in Upper Egypt. This cross-sectional study was carried out by involving schoolchildren in three Egyptian Governorates implementing the Girls Education Initiative (GEI) project in 197 schools in these governorates. For each student, a questionnaire investigated the possible predictors for intestinal parasitic infections, a stool sample was examined using the Kato-Katz technique, the hemoglobin concentration was measured, and anthropometric assessments measuring weight and height were carried out. Out of 2695 students, 898 (33.3%) students were infected by parasites; 92% of these students were infected by Enterobius vermicularis worms. The mean weight of the girls was 29.4±10.6 kg and that of the boys was 29.1±8.6 kg. The mean height of the girls was 132.5±16.9 cm and that of the boys was 132.9±16.3 cm. BMI was 16.6±6.8 and 16.7±9.5 for girls and boys, respectively. The mean hemoglobin levels were 10.6±1.37 and 10.7±1.4 mg for girls and boys, respectively. More than two-thirds of the studied group had poor hygiene habits, such as contact with canal water, not washing their hands before and after eating food, not washing their hands after bathroom visits, and not washing vegetables and fruits. The students studied had chronic nutritional deficiencies, mainly anemia. Poor hygiene habits, poor household sanitation, and lack of parents' education in rural areas were predictors for intestinal infections. It is recommended that health education campaigns be conducted to increase students' and mothers' awareness and encourage proper sanitation and hygiene habits at home and in their environment.

Profile and Predictors of Voluntary Civic Engagement at a Private University in Egypt

This study explored the characteristics and predictors of university student voluntary civic engagement. It was conducted at a private university in Egypt, a developing country where student volunteerism has the potential to significantly impact community development efforts. A total of 518 students responded to the study. Consistent with previous literature, students who chose to participate in community service clubs were more likely to be female and religious. They moreover reported greater commitment to civic service as well as pride and commitment to the university. Results suggested that volunteers fit an “Egyptianized” profile with characteristics including: Egyptian nationality, Muslim religion, attending a high-school located in a less privileged rural governorate, graduating from an Egyptian public school system, being more religious, and speaking more Arabic than English socially. Levels of depression did not differ between volunteers and non-volunteers; however, volunteers reported higher anxiety. Suggestions for future research are offered and findings are discussed in terms of their significance for community practice nationally, regionally and globally.

Findings from a needs assessment of public sector emergency obstetric and neonatal care in four governorates in Yemen: a human resources crisis

Recent reviews suggest that it is unlikely Yemen will reach Millennium Development Goal 5 on maternal health by 2015. We conducted a needs assessment in 2010 to identify the human resources constraints in delivery of emergency obstetric and neonatal care (EmONC), in one urban and three under-served rural governorates. The assessment tools were adapted from the UN Guidelines for Monitoring Availability and Use of EmONC. Findings showed that while the urban governorate (total population 666,210 with 26,648 expectant mothers yearly) had 54 obstetricians, 10 anaesthetists and 72 paediatricians, the three rural governorates (total population 1,885,371 with 75,414 expectant mothers yearly) together had only three obstetricians, three anaesthetists, and eight paediatricians. Furthermore, in the rural governorates, with an 0.5% caesarean section rate, which is far below the 5% minimum for this UN indicator, no district hospital had an operating surgeon or an anaesthetist. There was also a marked scarcity of female general physicians and a large disparity in the proportion of births with a skilled attendant between the rural (12%) and urban (34%) governorates. Findings emphasize the need for increasing the coverage of EmONC nationally, but especially in rural areas, through more equitable staff distribution and promotion of task shifting. Developing a national human resources plan and ensuring an enabling policy are prerequisites.

Spatial Variability in Fertility in Menoufia, Egypt, Assessed through the Application of Remote-Sensing and GIS Technologies

Fertility in rural areas such as the Governorate of Menoufia in Egypt may be influenced both by spatial factors (including the diffusion of innovations) and by essentially nonspatial factors (such as the availability of education for women and the percentage of adult women who are currently married). The nonspatial variables are available directly from censuses but the spatial component requires an accurate location of the villages to which the census data refer and then appropriate decomposition of the data into spatial and nonspatial components. We use IRS satellite imagery to classify the built area in a rural governorate in Egypt and then assign village-level census data to the centroids of those polygons and incorporate the data into a GIS. We then employ measures of global and local spatial statistics to conclude that in 1976 the combination of female illiteracy, proportion married, and spatial clustering accounted for 39% of the variation in fertility in Menoufia. In 1986 those same factors explained 51% of the variation in fertility. In 1976 about one third and in 1986 about half of the explained variability was due to the spatial component (‘diffusion’) and the other half due to a combination of demographic characteristics. Furthermore, between 1976 and 1986 there was a clear north-to-south drift of fertility, with lower fertility being clustered in the north and higher fertility clustered in the south.

Spectrum of β-Thalassemia Mutations in Egypt

Carrier screening and prenatal diagnosis programs have successfully reduced the incidence of β-thalassemia (thal) in countries where the carrier rates are high (1-3). The incidence of β-thal is particularly high in Egypt (4) due to the combined effects of high carrier rates (5) and consanguineous marriages (6). As a prerequisite to establishing effective programs for prenatal diagnosis, it is important to identify the spectrum of mutations within the population. To this end, we have surveyed the β-thal mutations for a cohort of 55 transfusion-dependent β-thal patients from the Alexandria region of Egypt and the adjacent rural governorates. Affected siblings were not included in the study. The patients were either Moslem (46/55, 84%) or Christian (9/55, 16%). Almost three-quarters (40/55, 73%) of the patients had consanguineous parents.

The Management Component of the Kafr El Sheikh Water Supply Project, Egypt

The Kafr El Sheikh Water Supply Project is a comprehensive endeavour to provide the physical and institutional resources for an effective and sustainable water supply system for 2 million persons in a developing rural Governorate in the Delta region of Egypt. The paper describes the aims of the Management Component, the institutional development of an integrated water supply and sewerage company and the main activities to-date. These include training, operational improvements, health education and finance development. Further support is required until all engineering and institutional development work has been completed.

An Evaluation of the Cost-Effectiveness of Mobile Family Planning Services in Tunisia

This report presents the results of a study conducted in Tunisia in 1986 to evaluate the cost-effectiveness of the 63 mobile units managed by the Tunisian Office National de la Famille et de la Population (ONFP). In 1985 the units produced one-third of the ONFP's national program output, serving 868 service sites dispersed throughout the rural governorates of Tunisia. In some governorates the mobile units contributed as much as 74 percent of program output. Overall, in 1985, the units provided over 250,000 service visits, saw almost 25,000 new acceptors, and provided approximately 34,500 couple-years of contraceptive protection (CYPs). The median cost per visit was US$4.93 and the median cost per CYP (including tubal ligations) was US$18.66. Multivariate analysis is used to identify significant variables that explain variation in unit output; among these, literacy of the population, number of centers served by a unit, and frequency with which centers were served in a month were positively correlated with unit output. Specific recommendations are made on how to improve cost-effectiveness.

Farm Size, Land Ownership, and Fertility in Rural Egypt

The purpose of this paper is to present the findings of a household level analysis of land availability and fertility variation among farm families in rural Egypt. Data were drawn from a survey conducted in 2 predominantly rural governorates in Lower Egypt in 1978 Beheira and Kafr El Sheikh. They were purposely selected in an attempt to obtain areas representing a range of socioeconomic and demographic conditions. The analytical model that underlies the study postulates that fertility variation in rural areas is influenced by family access to land for cultivation purposes and the conditions governing that access as well as socioeconomic and demographic control variables. Among the 561 households sampled the mean value for land ownership was .47. The mean value for household income measured in Egyptian pounds was 112.83 with a standard deviation of 84.76 pounds. The females had been employed 9.7% of the years since marriage. On the average women had completed less than 3 months of formal education--.32 years. Access to land cultivation was significantly related to the other variables. Land ownership increased with farm size. Family income was closely linked to cultivated area. Landless laboring families had the lowest fertility. Wives of landless laborers were on the average younger slightly better educated and less likely to have worked for wages since marriage. The results support the hypothesis that the amount of land available to the family for cultivation is positively related to fertility. Land ownership was negatively related to children ever born. Per capita family income also exerted a negative influence on the number of children ever born. This indicates that income levels were such that the positive nutrition-induced income effect on fertility does not seem to prevail. Age at marriage was negatively associated with fertility and was statistically significant. The strongest variable was the womans age.

The influence of individual and community-level child mortality on fertility in Egypt.

Child mortality was analyzed in relation to 3 dimensions of reproductive behavior: birth intervals additional children desired and contraceptive use. Study data were drawn from a 1978 survey conducted in 2 predominantly rural governorates Beheira and Kafr El-Sheikh in lower Egypt. Within each governorate 2 districts were selected on the basis of their distance from the capital of the governorate agricultural output by major crops percent of the population urban infant mortality rate and crude birthrate. Within each of the 4 districts villages were randomly drawn from 3 strata: villages lacking any governmental services; villages with limited services (health center or primary school); and villages served by a combined unit center providing integrated services. A random sample of household heads was selected from household registration records of the provision office of each district. 1200 interviews were obtained from 685 households. Restriction of the sample to women with 1 or more live births and the elimination of 13 cases with incomplete or inaccurate information yielded 1010 cases for analysis. The basic measure of actual fertility was birth intervals. For the total sample and within each age category cumulative fertility is higher the greater the number of child deaths. The data demonstrate a strong relationship between child mortality experience and cumulative fertility. The problem lies in interpreting such results. With some exceptions birth intervals increased as expected with increasing parity. Women without child death experience displayed longer birth intervals than women who had not lost a child. With the single exception of the 7th parity women all differences were statistically significant. The data fail to eliminate potential biological influences on subsequent fertility. With biological influences adequately controlled no behavioral differences remained. Women who experienced child mortality desired greater numbers of additional children than women without child death experience. 19% of respondents were ever users of contraception with women of low parity the least likely ever to have used contraception.