Rural Municipalities Research Articles

VALUE CHAIN ANALYSIS OF POTATO IN SYANGJA DISTRICT, NEPAL

A study was conducted in Galyang Municipality, Putalibazar Municipality, and Phedikhola Rural Municipality in Syangja district to analyze the potato value chain and evaluate its productivity, profitability, and marketing margins. A total of 74 potato producers, 2 aggregators, 2 wholesalers, 4 retailers, and 7 consumers were selected using random purposive sampling for data collection. The data was analyzed using SPSS and Excel software. The cost of production per ropani was NRs. 16789.60 and the productivity was 7.02 quintals per ropani. The B/C ratio obtained was 2.06 with the net margin NRs. 6710.5 per ropani. The producer’s share of the consumer’s price was NRs. 66.43% for fresh vegetables and 70.91% for tubers. The marketing margin for aggregators, retailers, and wholesalers was NRs. 834, NRs. 1270, and NRs. 946 respectively. The main constraints of potato production were the incidence of diseases and pests such as late blight and red ant, lack of technology and technical manpower, decreasing labor availability, and high production cost. Therefore, it is recommended to establish linkages between the government and different actors in production areas for proper grading and leveling of the product for quality products available in the local area as well as for enhancing export. The government and development agencies should support farmers’ organizations for integrated disease management, reduce the cost of production, and develop agricultural marketing infrastructure for easy market access to farmers.

On-farm Evaluation of Potato Genotypes at High Hills of Karnali Province, Nepal

An on-farm varietal trial was carried out to evaluate promising genotypes of potatoes received from the National Potato Research Program (NPRP), Khumaltar at Urthuchautara settlement of Patrashi Rural Municipality of Jumla, Nepal at an altitude of 2430 meters above mean sea level during two consecutive years 2019 and 2020. Four promising potato genotypes: PRP 226567.2, PRP 136769.1, CIP 395077.242, CIP 393617.1 and two check cultivars i.e. Desiree and Jumli Local were tested in Randomized Complete Block Design (RCBD). Each treatment was replicated four times. Compost was used at the rate of 20 tons per hectare (t/ha) and there was no chemical fertilizer used. Well-sprouted tubers of 25-50 g were planted at 60cm x 25cm spacing. Observations were recorded on vegetative parameters as well as yield attributes. Among different parameters observed most all the vegetative as well as yield and yield attributing parameters were found significant among each other whereas emergence at 45 DAP and plant height during 2020 were found non-significant. The highest tuber yield (30.88 t/ha) was recorded in PRP 226567.2 followed by PRP 136769.1 (23.89 t/ha). Based on the average of two-year results, PRP 226567.2(30.88 t/ha) and PRP 136769.1 (23.89 t/ha) were superior for the purpose of variety recommendation for high hills of Karnali province.

Abstract 1978: Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women

Abstract Cervical cancer incidence is 32% higher among Latina women in the United States (US) and 78% higher among women in Puerto Rico compared to non-Latina White (NLW) women, yet it is largely preventable through screening. Latina women with public insurance or uninsured are significantly less likely to have had a Pap test, undergo fewer Pap and high-Risk Human Papilloma Virus (HPV) testing than NLW and Black women, and are less likely than women of other races/ethnicities to return for recommended follow-up after an abnormal Pap test. Utilizing the PRECEDE-PROCEED model, Community Based Participatory Research strategies and the NIH I-Corps hypothesis-driven research method of customer discovery, we implemented the Community Genomic Health Promotion Program in Federally Qualified Health Centers to evaluate cervical cancer screening needs in six rural municipalities in Puerto Rico. We recently validated in clinical liquid cytology samples that the CervicalMethDx test, a precision DNA methylation test, can identify HPV positive women most likely to be diagnosed with Cervical Intraepithelial Neoplasia (CIN) grades 2 and 3. We hypothesized that a molecular pathology test which identifies advanced premalignant cervical lesions in urine, can be distributed by commercial channels targeting populations with low screening rates. The CervicalMethDx quantitative Methylation Specific PCR (qMSP) test was used to quantify ZNF516, FKBP6 and INTS1 promoter DNA methylation in well-characterized, discarded, liquid cytology clinical samples from Puerto Rico. We then tested the CervicalMethDx test concordance on paired cytobrush (n=82) and urine samples (n=82) from Chile. The CervicalMethDx test correctly classified 86% of discarded liquid cytology clinical samples from HPV-positive women, when comparing DNA methylation in CIN2/CIN3 samples (n=47) to samples with a cervical pathology diagnosis of No Intraepithelial Lesions or Malignancy (n=18), with 83% Sensitivity, 94% Specificity, Area Under the Curve (AUC) of 0.88, and 98% positive predictive value (PPV). The concordance of the CervicalMethDx test in paired brush and urine samples was moderate (rho=0.45). The Wilcoxon signed-rank test showed no statistically significant differences for the CervicalMethDx test in paired brush and urine samples (p=0.14) These encouraging preliminary results show the successful identification of advanced premalignant cervical lesions in liquid cytology media and urine samples from Latina women. The data suggests that urine should be explored as a biofluid for cervical cancer screening. Future research may lead to expanded screening options, enabling women with low access to health care (public insurance or uninsured) to collect a specimen at home, and either send it to a testing facility or perform the test at home. Citation Format: Carmen Ili, Priscilla Brebi, Jaime López, Fernando T. Zamunér, Ana Purcell-Wiltz, Amanda García-Negrón, Keilyn Vale-Lassalle, Keerthana Gosala, Mirla Otero-García, Camila Rivero-Maldonado, Teresa Torres-Rivera, Adriana Pérez-Vicente, Ashley Ramos-López, David Sidransky, Mariana Brait, Rafael E. Guerrero-Preston. Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1978.

Monitoring of COVID-19 in wastewater across the Eastern Upper Peninsula of Michigan.

Wastewater-based epidemiology is being used as a tool to monitor the spread of COVID-19 and provide an early warning for the presence or increase of clinical cases in a community. The majority of wastewater-based epidemiology for COVID-19 tracking has been utilized in sewersheds that service populations in the tens-to-hundreds of thousands. Few studies have been conducted to assess the usefulness of wastewater in predicting COVID-19 clinical cases specifically in rural areas. This study collected samples from 16 locations across the Eastern Upper Peninsula of Michigan from June to December 2021. Sampling locations included 12 rural municipalities, a Tribal housing community and casino, a public university, three municipalities that also contained a prison, and a small island with heavy tourist traffic. Samples were analyzed for SARS-CoV-2 N1, N2, and variant gene copies using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR). Wastewater N1 and N2 gene copies and clinical case counts were correlated to determine if wastewater results were predictive of clinical cases. Significant correlation between N1 and N2 gene copies and clinical cases was found for all sites (⍴= 0.89 to 0.48). N1 and N2 wastewater results were predictive of clinical case trends within 0-7 days. The Delta variant was detected in the Pickford and St. Ignace samples more than 12-days prior to the first reported Delta clinical cases in their respective counties. Locations with low correlation could be attributed to their high rates of tourism. This is further supported by the high correlation seen in the public university, which is a closed population. Long-term wastewater monitoring over a large, rural geographic area is useful for informing the public of potential outbreaks in the community regardless of asymptomatic cases and access to clinical testing.

Residential mobility and childhood inflammatory bowel disease: a nationwide case-control study.

To examine the association of residential mobility, as a proxy for environmental influences, with childhood inflammatory bowel disease (IBD) risk. Using nationwide register-based dataset, all 2038 IBD cases in Finland diagnosed at ages less than 15 years in 1992-2016 were individually matched by sex and age with five controls employing risk set sampling. Complete residential histories of the subjects were constructed from birth until the index date (diagnosis date of the case). Movement patterns were assessed by age, distance, and demographics of the departure and destination municipalities. Conditional logistic regression was employed to estimate the association between movements and IBD risk. Overall, residential movement was associated with a slightly decreased odds ratio (OR) for childhood IBD (OR 0.97,95% confidence interval (CI) 0.95-1.00 for each movement). Further examination showed reduced ORs for moving to rural municipalities (OR 0.94,95% CI 0.90-0.98) and to distances less than 50km (OR 0.96,95% CI 0.93-0.99). In disease subtype analyses, the effect mainly persisted in ulcerative colitis. Our findings suggest lower childhood IBD risk associated with residential mobility. The effect was found in ulcerative colitis, but not in Crohn's disease. Movements to nearby and rural areas may reduce IBD risk, though this requires further investigation.

Landslide susceptibility and risk analysis in Benighat Rural Municipality, Dhading, Nepal

The complex geology and undulating terrain made Nepal vulnerable to natural disasters like landslides. Benighat-Rorang Rural Municipality (RM), in the Dhading district of Nepal's Bagmati province, has experienced several minor to massive landslides that have harmed both nature and civilization. This study examines the factors influencing landslides in the Benighat-Rorang RM by analyzing soil structure, geology, land cover, geomorphology (primarily slopes and aspects), fault lines, drainage density, weather data, and road density to generate a comprehensive Landslide Susceptibility Mapping (LSM). The LSM will help in identifying landslide-prone zones (high to low), which will, in turn, enable stakeholders to implement appropriate mitigation measures across the landslide-induced rural municipality. The current study intends to create Landslide susceptibility zonation mapping within and around the studied area by applying the AHP method while taking into account the optimal set of geo-environmental parameters to identify regions at risk of future landslides. Elevation, Slope, Aspect, Drainage, Geology, Soil Classes, Fault Line, Lineaments, Land-cover, Road Networks, Population, and climatic parameters (Rainfall, Temperature, Relative Humidity, Surface Pressure, and Wind Speed) are among the fourteen geo-environmental elements used for this research. Using the field verification approach, the results of this procedure have been validated, which can be observed in an estimated success rate curve. Meteorological factors, such as temperature, rainfall, relative humidity, surface pressure, and wind speed, have been examined regarding landslide susceptibility. Thus, an integrated assessment of landslide susceptibility was applied to the area to identify inhabited areas vulnerable to or at risk of landslides. Furthermore, the placement of public amenities throughout the research zone was considered while conducting the social vulnerability risk analysis. Finally, landslide susceptibility zonation, climatic factors influencing landslide susceptibility, and social vulnerability assessment results of the study area have been combined to generate a risk map identifying landslide-prone municipal facilities and vulnerable communities. This study will help in building resilient landslide communities through effective spatial urban planning that incorporates regional risks induced by landslides with infrastructure development and management strategies.

Factors Influencing Undernutrition among Female Adolescent Students in Darchula District, Nepal

Failure to understand and address the problem of malnutrition and its associated factors among female adolescents could lead to a vicious cycle of intergenerational malnutrition. A cross-sectional study was conducted in six secondary schools of four rural municipalities in Darchula District, Nepal. Data collection for the study was conducted from November 2021 to February 2022. Four hundred female adolescent students aged 15 to 19 years old were selected using quota sampling. The study aims to examine the prevalence of malnutrition by assessing different levels of body mass index (BMI) that is thinness (BMI less than 18.5 kg/m2), normal (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) and obese (BMI more than or equal to 30 kg/m2). Along with BMI, factors associated with undernutrition, here identified as thinness, are assessed using a structured questionnaire. Additionally, key informant interviews and review of interventions was performed to understand the gaps in nutrition-related policies and programs of school going adolescents in the study district. Quantitative data analysis included a prevalence study and chi-square test along with simple and multiple logistic regression to obtain crude and adjusted odds ratio at 95% confidence interval for the significant factors with p < 0.05 identified in the chi-square test. Thematic analysis and reviews were used for the synthesis of qualitative data. The results show a 24.7% prevalence of thinness in the study participants. Pre-mensuration status (OR = 5.015, CI = 1.257-20.011, p < 0.022), father having a monthly paying job (OR = 4.384, CI = 1.135-16.928, p < 0.032), father's foreign employment (OR = 6.96, CI = 1.649-29.377, p < 0.008), household (HH) food insecurity status (OR = 2.079, CI = 1.182-3.658, p < 0.011) and grain/roots/tuber as most commonly bought food (OR = 9.487, CI = 1.182-76.138, p < 0.034) were found to be significantly associated with thinness. Information from the qualitative part identified gaps in existing interventions for an improved nutritional outcome among school going adolescent females. Further studies to understand the nutritional practices and its contributory factors in relation to thinness is encouraged. Stakeholders are urged to effectively address the shortcomings in existing interventions and adopt a more adolescent-centered approach to enhance the nutritional status of female adolescents.

QUALITY OF LIFE OF OLDER PEOPLE RESIDING IN A RURAL COMMUNITY AT BANKE DISTRICT, NEPAL

Background: The quality of life of older people reflects their health status and well-being and is an important area of concern for those involved in the care of older people. The objective of the study was to assess the quality of life of older people residing in a rural community at Banke district, Nepal. Methods: A cross-sectional study was conducted among 368 older people aged 60 years and above in ward number-3 (Karmona, Radhaypur, and Indrapur) of Janaki rural municipality of Banke district. Purposive sampling technique was used to recruit participants. Data were collected through face-to-face interviews using World Health Organization Quality of Life Scale- BREF. T-test and ANOVA test were used to compare the mean scores of different variables and domains of quality of life. The significance level was set at p &lt;0.05. Results: The mean score and standard deviation of total quality of life were 72.97±6.91. The mean quality of life score was lowest in the psychological domain (63.39±7.11) compared to environment (71.56±7.40), social (77.68±10.49), and physical domains (79.24±12.39). A statistically significant difference was observed on total quality of life scores between age groups (p=.001), sex (p=0.047), marital status (p=.001), occupation (p=.004), educational status (p=.001), living status (p=.007), source of livelihood (p=0.001), and physical health problems (p=.001) of older people. Conclusions: In older people, the psychological domain of quality of life necessitates particular attention along with their environment, social, and physical health.

Small Municipalities Attracting Rural Newcomers and Fostering Local Cohesion: Innovative Approaches for Rural Regeneration in Italy

The phenomenon of population decline—with all its associated economic, environmental and social consequences—characterizes many small rural municipalities. This study aims to discuss the role that small rural municipalities can have in addressing this phenomenon by promoting rural regeneration and attracting newcomers. The framework of the analysis is based on the neo-endogenous theories of rural development, which consider the interaction between endogenous and exogenous resources and forces. To analyse the role of small rural municipalities, this paper refers to the findings of a case study on the Italian rural village of Castel del Giudice and of the “confrontation” activities carried out in another village, Malito. The research suggests that a participatory process activated by a municipality can produce positive social and economic benefits for the local community. This process can enhance territorial cohesion, contribute to halting emigration, and favour the establishment of newcomers. Nevertheless, the research highlights that this approach requires adequate organizational knowledge, including political and administrative functionaries with appropriate skills who are also capable of experimenting with new modalities of fundraising. Moreover, it emerges that non-local resources and forces can support a solid participatory process focused on valorising local resources rather than having an extractive approach.

Socio-Demographic Status among Rural Municipalities in Humla District, Nepal: A Comparative Study

This study compares the status of rural municipalities in the Humla district of Nepal regarding various household and demographic variables. This paper aims to compare rural municipalities of the Humla district in terms of population, area, sex ratio, literacy ratio, dependency ratio, fuel used, drinking water, internet user, etc. It is based on secondary data from the central bureau of statistics (CBS). The descriptive and comparative design is used to explore the result. It analyzes the data from the perspective of rural development. Rural development is the process of creating wellbeing and ensuring the quality of life among rural people. This study revealed that there are unequal situations in rural municipalities. In some rural municipalities, there is a situation of demographic loss. There is a lack of well-being among people. Deficiencies and deprivation of socio-economic requirements are common for them. Rural areas in the northern belt have acute problems compared to the south-eastern belt of the district. Three tiers of government along with market and cooperative sectors must focus to launch their policy and program to uplift the miserable situation of rural municipalities in Humla district.

Performance of Potato Genotypes at Farmer’s Field in Jumla, Nepal

On-farm varietal trial was carried out to evaluate promising genotypes of potato received from International Potato Centre (CIP), Lima, Peru through National Potato Research Program (NPRP), Khumaltar at Guthichaur Rural Municipality in the high hills of Jumla during two consecutive years 2017 and 2018. Five promising potato genotypes and two check cultivars i.e. Desiree and Jumli Local were tested in Randomized Complete Block Design (RCBD). The treatments were replicated three times. Compost was used at the rate of 20 t/ha. Well sprouted tubers of 25-50 g were planted at 60cm x 25cm spacing. Observations were recorded on vegetative parameters and yield attributes. Tested genotypes differed significantly for emergence percentage at 30 days after planting, uniformity, ground coverage, plant height, number of main stems, total number of tubers and tuber yield per hectare. The highest tuber yield (26.14 t/ha) was recorded in CIP393073.179 followed by CIP 395112.32 (24.56 t/ha) and CIP 390478.9 (23.12 t/ha). The average results of both years showed that potato genotypes CIP393073.179, CIP 395112.32 and CIP 390478.9 were promising for commercial cultivation in Jumla and in the similar agro-ecological domains of Karnali province.

Evaluation of Garlic Genotypes under Farmer’s Field Condition of Jumla, Nepal

On-farm trial on different garlic genotypes selected from Advance Yield Trial was carried out at Patrashi Rural Municipality of Jumla (2430 masl) for two consecutive years 2017/18 and 2018/19 to evaluate garlic genotypes suitable for the high hills of Karnali region of Nepal. Twelve different garlic genotypes: ARM 01, ARM 02, ARM 03, ARM 04, ARM 05, ARM 07, ARM 09, Mugu Local, Kathmandu Local, Chinese, Holeri and Malikabota were tested on Randomized Complete Block Design (RCBD). Each treatment was replicated three times. Compost was used at 20t/ha at the time of land preparation. There was no use of chemical fertilizer. Selected cloves of garlic were planted with 15 cm x 10 cm spacing of row to row and clove to clove respectively. Planting and harvesting were done on the third week of September and first week of July respectively. Tested genotypes differed significantly for vegetative as well as yield parameters. The genotype ARM01 produced the bulbs with the highest (50.49 mm) diameter followed by ARM 04 (45.14 mm), Kathmandu Local (34.52 mm) and Chinese (33.44 mm) respectively. The highest bulb yield (29.73 t/ha) was recorded from genotype ARM 01 followed by Kathmandu Local (19.4 t/ha), ARM 04 (18.51 t/ha) and Chinese (17.59 t/ha). Based on the average result of both years, genotypes ARM 01, Kathmandu Local, ARM 04, and Chinese showing above mentioned average productivity ranging from 17.59 t/ha to 29.73 t/ha, were identified as the promising genotypes for commercial cultivation in the high hills of Karnali region of Nepal.

Bayesian spatio-temporal analysis of the incidence of lung cancer in the North West of Algeria, 2014–2020

Lung cancer is the most common type of cancer worldwide. This study assessed the spatio-temporal variations of the incidence rate of lung cancer between 2014 and 2020 in Chlef, a province in the North West of Algeria.Case data recoded by municipality, sex and age were collected from the oncology department in a local hospital. A hierarchical Bayesian spatial model, adjusted by urbanization level, with zero inflated Poisson distribution was used to study the variation of lung cancer incidence.A total of 250 lung cancer cases were registered during the study period, with a crude incidence rate of 4.12 per 100,000 inhabitants. The results of the model showed that residents in urban municipalities had a significantly higher risk of lung cancer than those in rural municipalities: incidence ratio rate (IRR) = 2.83 (95% CI: 1.91 – 4.31) and 1.80 (95% CI: 1.02 - 3.16) for men and women, respectively. In addition, the estimated incidence rate by the model for both sexes in the Chlef province indicated that only three urban municipalities had a higher incidence rate of lung cancer than the average of the province.The results of our study suggest that the risk factors for lung cancer in the North West of Algeria were mainly related to the level of urbanization. Our findings provide important information to guide the health authorities in designing measures for the surveillance and control of lung cancer.

The rural municipality in Canada: A critical overview of recent research and some perspectives on the development agenda

The rural municipality in Canada: A critical overview of recent research and some perspectives on the development agenda

Examining confidence and hesitancy towards COVID-19 vaccines: A cross-sectional survey using in-person data collection in rural Ghana.

In Ghana, as of 30 July 2022, around one-third of the eligible population are considered fully-vaccinated against COVID-19, and efforts are being made to increase coverage. Vaccine hesitancy is defined by the World Health Organization (WHO) as the delay in the acceptance, or blunt refusal of, vaccines. This study assesses vaccine hesitancy and confidence in Nkwanta South, a rural municipal in Oti region, Ghana. Data collection within Nkwanta South took place in sub-municipalities of Alokpatsa (11,028 population), Brewaniase (14,483), and Tutukpene (15,453). Data was collected by 47 local residents, known as Community-Based Surveillance Volunteers (CBSVs), using Kobo Toolbox forms on electronic devices (tablets). Information collected included numerous demographic variables, including age, gender, relationship status, and religion. Further questions covered reasons for vaccine hesitancy and COVID-19 vaccine status. Descriptive and inferential statistics assessed the association between variables to identify predictors of hesitancy. Across 1500 respondents, 700 (46.7%) reported having received at least one COVID-19 vaccine dose, and 800 (53.3%) reported being unvaccinated against COVID-19. Among unvaccinated respondents, 556 (69.4%) reported willingness to receive the vaccine once available, 190 (23.7%) said they would not be willing to be vaccinated, and 55 (6.9%) said they were unsure. Overall, this represented 30.6% hesitancy within the currently-unvaccinated group. Common reasons for hesitancy included believing that they did not need the vaccine (33.8%), believing the vaccine to be dangerous (30.6%), concerns about side effects (25.3%), and not having enough information (20.1%). Key predictors of hesitancy among our participants included high levels of mistrust, being female, greater years of education, and being Christian. The information gathered here can inform how best to target national and local health promotion strategies. Locally-tailored efforts, that understand local context and social dynamics, must remain a core component of public health activity to achieve a high vaccine uptake.

The Role of Local Action Groups (LAGs) in Facilitating Rural Economic Development in Two District Municipalities of the Eastern Cape Province, South Africa

Local Action Groups (LAGs) are a promising development approach that has gained prominence across the world. They are underpinned by participation of all local actors (community-led rural development) as the main precondition for generating and sustaining economic development in rural regions. Despite this potential, there has been a dearth of scientific studies that have investigated the potential role of LAGs as a rural transformation approach in the Eastern Cape Province of South Africa. Therefore, the current paper sought to identify existing local action groups and explore their role and potential to promote rural development. A concurrent mixed-methods approach was adopted to attain the study objective. Four hundred households were purposively drawn from two rural local municipalities, Amahlathi and Nyandeni, in the Eastern Cape Province. Survey questionnaires and semi-structured interview guides were used to collect data. Results showed that existing LAGs were mainly burial societies, cooperatives, farmers associations, women's organisations, and financial saving schemes. The main roles of these LAGs were to enhance food security, boost income generation, and foster social cohesion. However, despite their contribution, LAGs have not reached their full potential as a conduit for rural development owing to the limited involvement of relevant rural development stakeholders. Therefore, adequate targeted support is required from both the public and private sectors to unlock the potential of LAGs as a catalyst for rural development.

Atuação dos médicos na Atenção Primária à Saúde em municípios rurais remotos: onde está o território?

Abstract Resolute and comprehensive health care in remote rural municipalities (RRMs) requires Primary Health Care (PHC) with a strong community dimension anchored in the territory. This paper aims to analyze the performance profile of doctors in PHC, considering their work both in the territory and in PHC units. The perspective of doctors, critical agents in PHC, contributes to understanding whether there is an equitable and comprehensive availability of PHC. A qualitative study was carried out in 27 RRMs, with interviews with 46 Family Health doctors. Content analysis, structuring results in dimensions of arrangements in the performance of doctors in the territories and the organization of activities at the PHC units. Doctors concentrated their activities in the PHC units, primarily in municipal headquarters, with heterogeneous work agreements. Knowledge about the characteristics of the territory and the population was weak, especially those assigned at a considerable distance from municipal headquarters. In the rare work conducted within the territory, an itinerant and/or campaigning model was observed, with the mark of discontinuity. Walk-in patients were prioritized over care actions of follow-up and planning. The findings indicate the need to reinforce interaction with the territory in the provision of PHC services in RRMs.

Doctors' Work in Primary Health Care in remote rural municipalities: where is the territory?

Resolute and comprehensive health care in remote rural municipalities (RRMs) requires Primary Health Care (PHC) with a strong community dimension anchored in the territory. This paper aims to analyze the performance profile of doctors in PHC, considering their work both in the territory and in PHC units. The perspective of doctors, critical agents in PHC, contributes to understanding whether there is an equitable and comprehensive availability of PHC. A qualitative study was carried out in 27 RRMs, with interviews with 46 Family Health doctors. Content analysis, structuring results in dimensions of arrangements in the performance of doctors in the territories and the organization of activities at the PHC units. Doctors concentrated their activities in the PHC units, primarily in municipal headquarters, with heterogeneous work agreements. Knowledge about the characteristics of the territory and the population was weak, especially those assigned at a considerable distance from municipal headquarters. In the rare work conducted within the territory, an itinerant and/or campaigning model was observed, with the mark of discontinuity. Walk-in patients were prioritized over care actions of follow-up and planning. The findings indicate the need to reinforce interaction with the territory in the provision of PHC services in RRMs.

Shopping Behavior and Access to Food in the Areas of Slovakia with Dispersed Settlements: A Case Study

Abstract The aim of the research was a spatial and functional analysis of the accessibility of retail food environments in relation to the inhabitants of dispersed settlements who are socially and geographically disadvantaged in purchasing g food. The consumer behavior and food shopping habits of the inhabitants of these areas largely depend on the spatial and functional characteristics of the dispersed settlement and the surrounding area. In terms of food consumption, an important determinant is the availability of convenience stores, defined by the economic and physical ability to access food sources. The ability to access stores is strongly influenced by transport options and transport infrastructure. The investigated area belongs to a group of specific areas with dispersed settlements. This type of settlement, typical in the mountains of Slovakia and on the border with the Czech Republic, can also be found around the town of Nová Baňa, located in the west of central Slovakia. This area consists of two towns and 12 municipalities and is referred to as the “Novobanská štálová oblasť ”. These specific territories are characterized by a lack of access to fresh and affordable food, which can contribute to social disparities in diet and endanger people's health with various serious diseases. Spatial identification of areas with difficult access to food stores in the Novobanská štálová area has been a pioneering attempt to visualize areas with the highest demand for improvement in food access, and this process may be helpful in identifying other areas with similar characteristics. The methods utilized represent an accessible, transparent and reproducible process for assessing the accessibility of grocery stores. These methods can be used for cost-effective, periodic surveillance and meaningful engagement with communities, retailers and policy makers. The conclusions and results of our research should positively contribute to the growing debate on the inequality of living conditions and marginalization of rural municipalities.

Ethnobotanical study of plant resources in Dhurkot rural municipality, Gulmi district Nepal

Background. Despite easy access to modern medicines, people are still using plant-based medicine for their primary healthcare needs. People, particularly in the rural area are more dependent on herbal medicines. This study aims to explore the essential plants used in medicine locally and their uses on different ailments and diseases in Dhurkot Rural Municipality of Gulmi district, a western district of Nepal. Methodology. The study includes several visits to different community forests, interviews, and discussions with people at different time intervals from February to October 2021. Data were collected through Focus group discussion, transect walk, direct observation, and key informant interviews. Local indigenous healers, popularly known as "dhami", "pujari", "guru" and elderly people who know the uses of medicinal and aromatic plants helped us in collecting information about the utilization of plants as medicines. Results. Altogether 67 plant species belonging to 39 families and 64 genera were used by the people for their primary healthcare needs to treat different health problems. We found that the leaves are the most used parts of the plant followed by barks. During preference ranking among 484 individuals and focus group discussion people showed a preference for Cinnamomum tamala (Lauraceae) followed by Phyllanthus emblica (Phyllanthaceae), Zanthoxylam armatum (Rutaceae). Herbs are dominant among the plant forms used followed by trees, shrubs, and climbers. Conclusion. We conclude that people in this area still depend on plant-based medicine for their primary health care needs. Many people seek traditional remedies when they suffer from various common health problems. Besides this, abundance of medicinal plants in the region are declining due to various anthropogenic factors, infrastructure development, and climate change. Thus, appropriate conservation and management approaches along with proper identification and cultivation of important medicinal and aromatic plants are urgently required in the study area. Keywords: Ethnobotany, indigenous healers, focus group discussion, traditional medicines.