Rural Locations Research Articles

Residential variations in hypertension prevalence and trends among adults in Bangladesh

IntroductionHypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018.MethodsNationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods (χ2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\chi }^{2}$$\\end{document} test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations).ResultsAccording to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents.ConclusionA large proportion of Bangladesh’s adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age.

Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study.

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

Landscape level associations between birds, mosquitoes and microclimates: possible consequences for disease transmission?

BackgroundMosquito-borne diseases are on the rise. While climatic factors have been linked to disease occurrences, they do not explain the non-random spatial distribution in disease outbreaks. Landscape-related factors, such as vegetation structure, likely play a crucial but hitherto unquantified role.MethodsWe explored how three critically important factors that are associated with mosquito-borne disease outbreaks: microclimate, mosquito abundance and bird communities, vary at the landscape scale. We compared the co-occurrence of these three factors in two contrasting habitat types (forest versus grassland) across five rural locations in the central part of the Netherlands between June and September 2021.ResultsOur results show that forest patches provide a more sheltered microclimate, and a higher overall abundance of birds. When accounting for differences in landscape characteristics, we also observed that the number of mosquitoes was higher in isolated forest patches.ConclusionsOur findings indicate that, at the landscape scale, variation in tree cover coincides with suitable microclimate and high Culex pipiens and bird abundance. Overall, these factors can help understand the non-random spatial distribution of mosquito-borne disease outbreaks.Graphical

Loneliness, social support, and social networks: urban–rural variation and links to wellbeing in Scotland

Abstract Aim Social relationships are key public health priorities, with their relevance to wellbeing amplified in recent years. Relationships are embedded within the wider environment in which they occur; however, we lack understanding of whether, and how, places may affect social relationships. This study utilises an urban vs rural framework to examine variation in three specific aspects of relationships (loneliness, social support, and social networks), and their links to wellbeing. Subjects and method Cross-sectional social network data, collected in Scotland in 2021 (N = 191), was used. Bivariate comparisons tested for differences in loneliness, social support, and social networks between urban and rural participants. Multivariable regression tested for associations between each construct and wellbeing, and interaction effects assessed differences in associations between the urban and rural locations. Results Urban participants had higher levels of loneliness and poorer wellbeing, even though reported levels of social support didn’t differ. After adjusting for sociodemographic characteristics, loneliness, social support, and perceived emotional closeness of social networks were all associated with levels of wellbeing. There was no evidence that these associations differed between participants in urban and rural areas. Conclusion Overall, findings highlight key place-based differences that inform the design of efforts to promote social connectivity and enhance wellbeing. Given that urban residents had lower wellbeing and higher levels of loneliness, coupled with evidence demonstrating the importance of close, supportive social relationships, intervention efforts that promote social connectivity in urban environments are particularly needed.

Blueprint for Rural Mathematics

This paper reports on the development and use of a Blueprint for Rural Mathematics (herein referred to as the Blueprint) in a study of middle-primary mathematics teaching. The study presented a counter-narrative to the deficit discourse around rural education outcomes through an emic perspective of middle-primary mathematics on Yorke Peninsula, a rural district in southern Australia. This study defined ‘rural’ as being both a sociological and a geographical phenomenon. It takes a sociological stance acknowledging the situatedness of the rural, and the social and cultural uniqueness of the people and their communities. Geographically, the rural locations in this study were those distanced from, and outside the commuting zone of, large urban areas and major cities. This study claimed that rural schools of Yorke Peninsula are unresearched, under-theorised and underestimated in their teaching of mathematics. Hence, very little was known about the experiences of the Yorke Peninsula teachers, or the pedagogical practices they employ in their teaching of mathematics. Yorke Peninsula people have an identity of deficit imposed on them with no opportunity to negotiate it. In understanding and addressing the accuracy of this pervasive negative framing, this study involved investigating Yorke Peninsula teachers of mathematics, and concluded that the rural social space, the identity of its members, and teacher pedagogy are essential considerations in the teaching of mathematics. The Blueprint provides a framework with which to explore these key components of rural education.

Prevalence and associations of provision of nursing home visits and home visits by early-career specialist general practitioners.

To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. A cross-sectional study. A questionnaire-based study. Australian general practice. Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. Current provision of NHV and HV. NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant. Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.

Old tech but not low tech: telephone-based treatment provision for substance use.

The future of telemedicine for substance use treatment hangs by a thread, as the United States awaits approval of proposed regulations and laws to increase care access in light of the 2022 Centers for Medicare and Medicaid Services revisions allowing for audio-only care. Telemedicine improves patient care access and outcomes. Audio-only telemedicine can be an effective and viable modality for individuals without technology resources (devices, internet services, and literacy), those with reduced telehealth service utilization (Black individuals or those with unstable housing, who are older, with low income, or with low education), and those living in rural locations. Studies suggest that telephone visits for buprenorphine treatment are well-accepted by patients and providers, making telephone visits essential in care access to reduce disparities. Telephone counseling for patients in substance use treatment is convenient, flexible, and empowering and can augment therapeutic alliances and treatment goals. Both providers and patients advocate for patient-centered hybrid care to include telephone-only treatment, which enhances service productivity and care access; reduces no-show rates, costs, and stigma; and is sustainable. Numerous solutions can expand technology access, proficiency, assimilation, and trust. Despite being "old" technology, the telephone remains an essential resource for substance use treatment.

The effectiveness of Grade 3 teachers’ implementation of poetry through play pedagogies

Background: Poetry predates all other genres of literature, and it has been argued that the relationship between poetry and language is inextricable. The ability of African people to articulate their own stories was largely silenced by colonialism. Poems and lyrics have been known to create a bridge between individuals in meaningful words and songs.Aim: This article explores Grade 3 teachers’ experiences of teaching poetry and their utilisation of play pedagogies to enhance learning and make it pleasurable.Setting: Three schools in KwaZulu-Natal, South Africa, were purposively selected because of their rural location. The sample comprised six Grade 3 teachers who worked in these three rural primary schools. The learners in the study were using isiZulu as a language of learning and teaching.Methods: Semi-structured interviews, document analysis and non-participant observations were employed to generate the data.Results: Regardless, Grade 1 teachers know their knowledge of the value of play pedagogies in the development of young children.Conclusion: Researchers suggest that Grade 3 teachers need to align their practice and lesson plans with Curriculum and Assessment Policy Statement (CAPS) proposals and guidelines. Moreover, play pedagogies need to be implemented and these need to be realistically aligned with allocated time frames and available resources to mitigate the severe restraints that impede effective poetry teaching as a tool for facilitating learning.Contribution: To ensure the success of all Grade 3 learners in the realm of poetry understanding and writing, it is imperative that Foundation Phase (FP) teachers align their teaching to the CAPS pedagogies to expose learners to various forms of poetry.

Reimagining the Rural Hinterland: an investigation of participatory digital placemaking in rural communities

Rural locations often form a hinterland – geographically and culturally - for large conurbations that dominate a particular region. They are interconnected, sometimes interdependent, but also separated by the social and spatial perceptions of a place. For urban dwellers the hinterland is a place to ‘escape to the country’; for rural dwellers the town is the place of ‘bright lights’. The norms of either location often sit juxtaposed. This sense of place may be constructed from traditional, stereotypical ways of seeing and understanding communities. Digital technology has provided a platform to challenge these norms and provide new ways of representing the physical and cultural landscape of urban and rural spaces. In this conceptual paper we explore digital placemaking in the hinterland of the North-East of Scotland. In this region, the city (Aberdeen) dominates, but it is the rural hinterland that charms. Through an examination of co-created content of rural spaces in this region we consider the role of participatory digital placemaking. Drawing on an extensive body of previous research that has explored community heritage in the North-East of Scotland, we use case studies to consider the ways in which images, iconography and language shape and inform perceptions of the rural space in the digital environment. We argue that this bottom-up approach to placemaking in rural areas can help to shape the way that places are seen, understood, and valued by communities, visitors and wider online audiences. To conclude, this paper reflects on how rural participatory digital placemaking counteracts the urban norm and connects communities across town and country through a reimagined digital hinterland.

Comparison of Presentation Types and Clinical Findings of Rural and Urban Patients with Mastalgia: A Retrospective Analysis of 730 Patients from Turkey.

BACKGROUND Breast pain, prevalent among women of reproductive age, varies during menstrual cycles and is influenced by sociodemographic and clinical factors. This study aimed to assess these demographic and clinical variables in women with breast pain, considering the spatial distinctions between urban and rural locations. MATERIAL AND METHODS This retrospective study included 730 women presenting with mastalgia between 2010 and 2023. The study evaluated patient demographics, pain characteristics (eg, breast pain duration, site, quadrant-based localization, and radiation of breast pain), radiologic findings, and the presence of comorbid medical conditions. RESULTS There were 498 patients in the urban group and 232 patients in the rural group. Among the radiologic findings, the rate of mastitis was higher in the rural group (P.

Analysis of clinical and anatomical characteristics of road transport injuries in the conditions of a rural location. Anatomical verification of damage

Analysis of clinical and anatomical characteristics of road transport injuries in the conditions of a rural location. Anatomical verification of damage

Exploring the experiences of a person with dementia and their spouse who attended a telehealth music therapy programme: Two case examples from Ireland

ABSTRACT Introduction There is an increased need for accessible psychosocial interventions that support both people with dementia and their spouses. Recent research demonstrates the benefits of music therapy and caregiver-delivered music therapy for this population. This paper contributes to the emerging evidence base on telehealth music therapy for people with dementia outside of a COVID-19 era when in-person services were available. Method This exploratory phenomenological study explores the experiences of two couples who attended a six-week telehealth music therapy programme via two detailed case examples. Online semi-structured interviews with each couple were conducted pre and post intervention and analysed using Interpretative Phenomenological Analysis. Results Three shared themes emerged from the data analysis including (1) social isolation and lack of confidence linked to dementia diagnosis is worsened in rural locations, (2) song singing and song writing enables us to revisit happy memories, and (3) telehealth delivery increases access due to geographical location. The findings are presented in a narrative case study format to provide rich detailed descriptions of the music therapy programme and to illuminate the experiences of the participants. Discussion In both examples, telehealth delivery expanded access to music therapy (which was otherwise unavailable) and stimulated reminiscence which in turn encouraged meaningful engagement between the couple. The delivery of music therapy via telehealth, alongside in-person delivery, has the potential to expand access to music therapy to those who may not have access to or are no longer able to attend community support services due to geographical location, increased cognitive decline or reduced mobility. The successful delivery of telehealth music therapy is dependent on several factors including digital literacy, access to appropriate technological devices, caregiver support and level of cognitive decline.

Mortality for Time-Sensitive Conditions at Urban vs Rural Hospitals During the COVID-19 Pandemic

COVID-19 pandemic-related disruptions to the health care system may have resulted in increased mortality for patients with time-sensitive conditions. To examine whether in-hospital mortality in hospitalizations not related to COVID-19 (non-COVID-19 stays) for time-sensitive conditions changed during the pandemic and how it varied by hospital urban vs rural location. This cohort study was an interrupted time-series analysis to assess in-hospital mortality during the COVID-19 pandemic (March 8, 2020, to December 31, 2021) compared with the prepandemic period (January 1, 2017, to March 7, 2020) overall, by month, and by community COVID-19 transmission level for adult discharges from 3813 US hospitals in the State Inpatient Databases for the Healthcare Cost and Utilization Project. The COVID-19 pandemic. The main outcome measure was in-hospital mortality among non-COVID-19 stays for 6 time-sensitive medical conditions: acute myocardial infarction, hip fracture, gastrointestinal hemorrhage, pneumonia, sepsis, and stroke. Entropy weights were used to align patient characteristics in the 2 time periods by age, sex, and comorbidities. There were 18 601 925 hospitalizations; 50.3% of patients were male, 38.5% were aged 18 to 64 years, 45.0% were aged 65 to 84 years, and 16.4% were 85 years or older for the selected time-sensitive medical conditions from 2017 through 2021. The odds of in-hospital mortality for sepsis increased 27% from the prepandemic to the pandemic periods at urban hospitals (odds ratio [OR], 1.27; 95% CI, 1.25-1.29) and 35% at rural hospitals (OR, 1.35; 95% CI, 1.30-1.40). In-hospital mortality for pneumonia had similar increases at urban (OR, 1.48; 95% CI, 1.42-1.54) and rural (OR, 1.46; 95% CI, 1.36-1.57) hospitals. Increases in mortality for these 2 conditions showed a dose-response association with the community COVID-19 level (low vs high COVID-19 burden) for both rural (sepsis: 22% vs 54%; pneumonia: 30% vs 66%) and urban (sepsis: 16% vs 28%; pneumonia: 34% vs 61%) hospitals. The odds of mortality for acute myocardial infarction increased 9% (OR, 1.09; 95% CI, 1.06-1.12) at urban hospitals and was responsive to the community COVID-19 level. There were significant increases in mortality for hip fracture at rural hospitals (OR, 1.32; 95% CI, 1.14-1.53) and for gastrointestinal hemorrhage at urban hospitals (OR, 1.15; 95% CI, 1.09-1.21). No significant change was found in mortality for stroke overall. In this cohort study, in-hospital mortality for time-sensitive conditions increased during the COVID-19 pandemic. Mobilizing strategies tailored to the different needs of urban and rural hospitals may help reduce the likelihood of excess deaths during future public health crises.

Afterword. Relations, Refusal, Reticulation

The articles in the special issue ‘Infrastructural Lives' draw attention to the ‘hidden transcript' of infrastructural practices in distinct urban and rural locations in India and Vietnam, showing technical labour, outright refusal, and improvisation across myriad reticulated connections to be elements of an ‘infrapolitics' that is practical, responsive, and reckons in various ways with the forces of calculability and control inherent in infrastructural expansion, digital surveillance, and urban redevelopment. The authors explore how roads are policed and navigated, how livelihoods are transformed by new technological systems, and how diverse tactics of negotiation and refusal can be mobilised to sustain lives. These articles demonstrate that tactics of resistance and refusal are elements in a wider infrastructural politics, sometimes ‘completing' networked systems and making them ‘work’ for marginalised populations, sometimes evading or refusing their logic of connection and circulation in preference to other patterns of circulation.

The Economic Security of Households Affected by the COVID-19 Pandemic in Rural Java and Madura

Every facet of life, including health, social, and economic aspects, has undergone a tremendous transformation due to the COVID-19 pandemic. This condition is exacerbated by socioeconomic fragility and vulnerability amid economic uncertainty, with an enormous debt burden and inequality increasingly spreading to regions. Elements of society in Indonesia experience the problem of a lack of income and capital, in addition to vulnerability and helplessness. Social, economic, community–institutional, and resource vulnerabilities are inevitable; therefore, they must be identified, anticipated, and dealt with to avoid worsening. This research aims to identify the affected households and their economic resilience when facing the COVID-19 pandemic. A mixed approach with a sequential exploratory strategy was employed, whereby qualitative data were first collected and analyzed. Based on the findings of the first stage, quantitative data were obtained and examined in the second stage. This study was conducted in two rural locations with distinct characteristics: the Gunungkidul District on Java Island and the Bangkalan District on Madura Island. These findings demonstrate the economic resilience of households in Bangkalan and Gunungkidul. The factors that significantly influence economic resilience are household income, assets, and product availability in the market.

Ten-Year Outcomes: Community Health Center/Academic Medicine Partnership for Rural Family Medicine Training.

The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates &gt;3 years from program completion. Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were &gt;3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.

Political affiliation affects spoken language processing

Listeners typically perform better on intelligibility tasks with native compared to nonnative speakers (e.g., Tsurutani, 2012). Listeners from multilingual, urban locations perform better on intelligibility tasks than those from non-multilingual, rural locations (Kutlu et al. 2022). A recent study from our lab found that listeners with more liberal political affiliation also perform better, but the study did not control for a possible relationship between more liberal political affiliation and living in an urban environment. To further investigate, 54 listeners from an urban location and 27 listeners from rural locations were recruited. Listeners heard sentences from two native (US, India) and two nonnative speakers of English (Korean, French) and typed their responses. Listeners then completed a political-affiliation questionnaire. A linear mixed-effects model with fixed effects for group, speaker, and political-affiliation score, and all interactions were fit to the data. The model revealed a significant interaction between group and political affiliation score. For the urban listeners, more liberal listeners performed better overall than more conservative listeners. For the rural listeners, political affiliation did not reach significance. Taken together, this study demonstrates that political affiliation predicts performance even when exposure (urban versus rural) is controlled.

Exploring urban-rural differences in 24-h movement behaviours among tunisian preschoolers: Insights from the SUNRISE study

Little is known about differences in physical activity among children from urban and rural areas in low-to middle-income countries and some previous investigations revealed disparities in physical activity levels among children and adolescents residing in urban and rural environments. We aimed to: (i) assess the proportion of preschool-aged children (3.0–4.9 years) meeting the global movement guidelines, (ii) evaluate the feasibility of the methods for the SUNRISE study, (iii) examine gender- and urban-rural differences in health and behavior outcomes. Urban and rural location was based on national classifications. Physical activity (waist-worn ActiGraph); sleep duration, screen time and movement behaviors; Gross and fine motor skills (Lower body strength and mobility, Supine-Timed up and go [S-TUG], One-leg standing balance test, hand grip dynamometer, 9-hole peg-board test); and executive functions (visual-spatial working memory and inhibition) were assessed in 112 preschoolers (n ​= ​50 boys, 33 urban), (n ​= ​62 girls, 41 urban). The results showed that only 18% of children met all movement guidelines, with 53% and 41% meeting the recommendations for sedentary screen time and total physical activity, respectively. A large proportion of children (81%) met the recommended sleep duration of 10–13 ​hours (h) per day. There is a clear need to promote healthy movement behaviours among preschool-aged children through targeted interventions that address their unique challenges related to gender and urban/rural residence.

Going the extra mile: Developing an interactive mobile application for maternal and infant care for tribal birth attendants.

Mobile health applications are an established tool for healthcare management, patient education, and even capacity building for healthcare providers. However, its use among traditional birth attendants (TBAs) is limited. The aim of this study is to explore the needs and bottlenecks of developing an interactive mobile application for maternal and infant care (MAI) of TBAs. It is a qualitative study having in-depth interviews (face-to-face approach) conducted among the seekers of MAI services. Setting: This study is conducted in tribal and rural locations in the district Sirohi, Rajasthan. Participants: TBAs and tribal females of reproductive age in tribal-dominated areas have participated. The development of an interactive mobile application MAI has three phases: (1) a need-based approach to identify the needs on the ground; (2) identifying intervention bottlenecks and possible solutions; (3) design and development of the mobile application. Ninety-six tribal females of reproductive age participated in the needs assessment. Eighty percent of them were ≤ 30 years of age and 40% of them were uneducated. Most participants informed that lack of information (culturally/locally appropriate content), peer advocacy, affordability, lack of transportation, and the influence of TBAs are the significant factors for less uptake of maternity and child health services in the tribal and rural areas. The MAI app has culturally/locally appropriate content and is prepared by the local TBAs and Accredited Social Health Activists, with full local character and clothing. MAI app has videos and audio in the local language (Marwari) with pictorial quizzes. Using the MAI app, TBAs may self-educate and guide tribal pregnant women about maternal hygiene and infant healthcare as needed at various stages of pregnancy and childbirth.

Impact of Race, Socioeconomic Status, and Geography on Healthcare Outcomes for Children With Sickle Cell Disease in the United States: A Scoping Review.

A large proportionof patients with sickle cell disease (SCD) identify as Black or African American (AA). Social bias and stigma in healthcare outcomes for children with SCD are impossible to explore without considering the impact of racial/cultural identity, socioeconomic status (SES), and geography. It is important to understand the current influences of social movements, expanded health insurance coverage, and telehealth on these variables when considering healthcare outcomes for patients with SCD. The objective of this study was to determine the roles of racial identity, SES, and geography in healthcare outcomes for the pediatric population of children with SCD in the United States (US). This study is a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases utilized included Cochrane, CINHAL, Medline, and Nursing and Allied Health Collection, all accessed through the EBSCO Information Services. Studies met the following inclusion criteria: published in English, pediatric patients residing in the US, and published between 2017 and 2022. Search terms included "sickle cell" AND "pediatric", which were then combined with "minority" OR "racial" OR "rural" OR "urban" OR "poverty" OR "income" OR "socioeconomic status". The initial search yielded 635 unique articles, with 17 articles meeting full inclusion criteria. Overall, it was clear that there are examples of positive effects of race, low SES, and rural geographic location on positive health outcomes, though a large number of studies oscillated between showing negative associations or no association at all. Barriers to care for patients with SCD are multifaceted, making it difficult to isolate and analyze the impact of individual variables. Many studies demonstrated the significance of family, community, and institutional relationships as positive support for patients with SCD. This review highlights the need for additional research on the healthcare outcome benefits of patient/familial support groups aiming to bring together patients who share racial experience and SCD diagnosis regardless of SES and geography.