Rural Population Research Articles

Transforming health care delivery: The role of primary health care nurses in rural and remote Australia.

This paper describes the policy context and approaches taken to improve access to primary health care in Australia by supporting nurses to deliver improved integrated care meeting community needs. In Primary Health Care (PHC), the nursing workforce are predominantly employed in the general practice sector. Despite evidence that nurse-led models of care can bridge traditional treatment silos in the provision of specialised and coordinated care, PHC nurses' scope of practice varies dramatically. Nurse-led models of care are imperative for rural and remote populations that experience workforce shortages and barriers to accessing health care. Existing barriers include policy constraints, limited organisational structures, education and financing models. The Australian Primary Health Care Nurses Association (APNA) received funding to implement nurse-led clinics as demonstration projects. The clinics enable PHC nurses to work to their full scope of practice, improve continuity of care and increase access to health care in under serviced locations. We reviewed a range of peer-reviewed literature, policy documents, grey literature and APNA provided sources, particularly those relevant to rural and remote populations. We argue more focus is needed on how to address variations in the scope of practice of the rural and remote PHC nursing workforce. Despite growing evidence for the effectiveness of nurse-led models of care, significant policy and financial barriers continue to inhibit PHC nurses working to their full scope of practice. If their potential to transform health care and increase access to health services is to be realised these barriers must be addressed.

Access restrictions to forest resources, rather than COVID-19 bans, drive the selection of firewood species for bonfires during Festas Juninas in northeastern Brazil

BackgroundThe complex interplay of social and environmental factors shapes ecosystems, potentially leading to harmony or conflict, highlighting the importance of understanding these dynamics for coexistence. In developing countries, firewood serves as a primary energy source and plays a role in cultural-religious rituals and festivities. However, the specific patterns of woody species used for the latter remain poorly understood, including the impact of access restrictions to resources and local bans on practices. Therefore, our research focuses on examining how access restrictions to forest resources and bonfire bans due to the coronavirus disease 2019 (COVID-19) impact the cultural-religious tradition of bonfire making during Festas Juninas (June festivities) in northeastern Brazil.MethodsEthnobotanical fieldwork was conducted in two rural populations in northeastern Brazil between 2021 and 2022. Data were collected through semi-structured interviews, observations, and the guided tour technique. The cultural-religious tradition of bonfire making (i.e., richness of native and exotic firewood species, firewood volume, and the number of bonfires related to this practice) was compared between populations (i.e., differing in access restrictions) and years (i.e., differing in COVID-19-related bans) using Mann–Whitney U tests.ResultsResults revealed significant differences in the richness of native (p value = 0.001) and exotic (p value < 0.001) firewood species for bonfire making due to access restrictions to forest resources. The number of native species used was higher among the population residing in the area with unrestricted access than among those with restricted access, while a greater number of exotic species was used in the population with restricted access. The rest of the variables were not influenced by access restrictions, and no variables were influenced by COVID-19 bans.ConclusionsOur study demonstrated that access restrictions to forest resources, rather than COVID-19 bans, drive the selection of firewood species for bonfires during Festas Juninas in northeastern Brazil. In addition, as populations remain deeply entrenched in cultural-religious practices amid temporary bans imposed by health crises, there is a pressing need for culturally sensitive environmental policies. Fostering socio-ecological resilience demands a comprehensive approach that encompasses not only environmental factors but also cultural dimensions, which wield a pivotal influence on long-term sustainability.

The problem and countermeasures of the failure of the rural social security system to reduce poverty

The rural social security system is not only a major livelihood issue related to China's rural population, but also an important basis for the sustainable development of rural economy. This article discusses the problem of the failure of the rural social security system to reduce poverty, in a field survey and interview in a village in North China, further analyze was carried out on the derivative path of poverty caused by social security policies, and it was found that the lack of social security policies, obstacles to policy implementation, negative response policies and so on, It makes the security level and poverty reduction ability of rural social security policy appear obvious deficiencies. Based on the analysis of this paper, the corresponding governance countermeasures are put forward. By strengthening poverty governance, improving the implementation environment of poverty governance, improving cognitive bias and improving the efficiency of poverty reduction.

Primary care models and depression outcomes in rural adult populations: A systematic review.

Primary care models and depression outcomes in rural adult populations: A systematic review.

Comparison of nutritional, bioactive potential and antioxidant properties of Saba senegalensis fruit pulps from five regions of Burkina Faso.

The fruit of Saba senegalensis plays an important role in household nutrition. It is an important source of sweet carbohydrates, minerals, vitamin C, provitamin A and has many biological properties. It is also of economical importance and employment for rural populations, through the processing of fruit. Unfortunately, the lack of exhaustive data on the composition and properties of the fruit and its derivatives limits processing and marketing. The species is widespread in different climatic zones. Therefore, its composition and biological properties may vary, offering a variety of processing products to meet the specific nutritional needs. This study aimed to characterize the bioactive potential and antioxidant properties of fruit pulps of S. senegalensis in order to increase its value-added processing. Pulp samples of fruits were sampled from five regions of Burkina Faso, namely the Cascades, Sud-Ouest, Boucle du Mouhoun, Nord and Centre-Sud regions. Qualitative analysis showed the presence of alkaloids, saponins, terpenoids and steroids, anthocyanins and tannins. Quantitative analyses showed a significant variation in phenolics, tannins, lycopene, vitamin C, β-carotene and antioxidant activity among samples. However, this variation was not region-dependent. Indeed, some fruits from same region showed both the highest and lowest values for the assessed parameters. Fruits from regions of Centre-Sud and Sud-Ouest and displayed the highest and lowest levels of total phenolics (877.48 and 1142.33 mg GAE/100 g) and tannins (42.38 and 55.64 mg TAE/100 g), respectively. The high potential of S. senegalensis fruits pulp in nutritional and bioactive compounds, and antioxidant properties recorded in this study suggests that they can be used as a dietary supplement or in the formulation of energy foods and nutraceutical containing foods.

Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study.

Obstructive sleep apnea (OSA) is a highly prevalent, yet under-diagnosed condition. Due to its adverse impact on risk for cardiopulmonary disorders, there is interest in pro-active screening of OSA in hospitalized patients. We studied the long-term outcome of such screened patients who were initiated on positive airway pressure (PAP) therapy. Hospitalized patients who screened positive for OSA and were confirmed with post-discharge polysomnography (PSG) were dichotomized by PAP adherence and followed for a period of 12 months to evaluate for the composite endpoint of hospital readmissions and emergency room (ED) visits for cardiopulmonary reasons. Cost analysis between the two groups was also conducted. 2042 hospitalized patients were assessed for OSA as part of a hospital sleep medicine program from August 2019 to June 2023. Of these, 293 patients were diagnosed with OSA and prescribed PAP therapy. Of these 293 patients, 108 were adherent to therapy and 185 were non-adherent. The overall characteristics of the groups included a mean (SD) age: 58 years (12.82), mean BMI (kg/m2): 39.72 (10.71), male sex: 57%, and apnea-hypopnea index (AHI): 25.49 (26). 78%, 41% and 43% had hypertension, congestive heart failure, and diabetes mellitus, respectively. Hospitalized patients diagnosed with OSA and adherent to therapy have reduced readmissions and ED visits for cardiopulmonary reasons 12 months after discharge. Adherent patients have reduced cost of health care and length of stay during hospitalizations.

Existing Challenges and Opportunities for Advancing Drought and Health Research.

Drought is one of the most far-reaching natural disasters, yet drought and health research is sparse. This may be attributed to the challenge of quantifying drought exposure, something complicated by multiple drought indices without any designed for health research. The purpose of this general review is to evaluate current drought and health literature and highlight challenges or scientific considerations when performing drought exposure and health assessments. The literature revealed a small, but growing, number of drought and health studies primarily emphasizing Australian, western European, and US populations. The selection of drought indices and definitions of drought are inconsistent. Rural and agricultural populations have been identified as vulnerable cohorts, particularly for mental health outcomes. Using relevant examples, we discuss the importance of characterizing drought and explore why health outcomes, populations of interest, and compound environmental hazards are crucial considerations for drought and health assessments. As climate and health research is prioritized, we propose guidance for investigators performing drought-focused analyses.

An evaluation of the quality, suitability and impact on equity of clinical practice guidelines relevant to preterm birth for use in Aotearoa New Zealand

BackgroundPreterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required.MethodsGuidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology.ResultsA total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations.ConclusionsWe have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.

Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India

Combustion of Biomass Fuel and Chronic Obstructive Pulmonary Disease in Rural Population of India

Nature, prevalence, and risk factors for self-neglect among older people: a pilot study from Vellore, South India

Changes in demography in developing countries haves led to new issues among older rural populations, such as self-neglect which is under researched.Self-neglect identified as poor self-care, unsafe living quarters, inadequate medical care and poor utilization of services increase the odds of morbidity and mortality.Methods Our study was conducted in Kaniyambadi, a rural block in Vellore district in the state of Tamil Nadu, India. Ten villages were randomly selected. The study was conducted among people older than 60 years who were selected by random sampling using a computer-generated list. The following assessments were done: (i) A 19-item questionnaire was used to assess self-neglect, (ii) Katz index of daily living to assess functional activity, (iii) Mini Mental State Examination to evaluate cognition, (iv) Geriatric Depression Scale to identify depression, (v) Duke Social Support Index to measure social supports. Clinical data and anthropometric data were also collected. Data were entered into Epidata v3.1. All analyses were performed using SPSS v23.0.Results One hundred fourteen people above 60 years of age participated. The prevalence of self-neglect was 21.1% (95% CI 14.9%—29%); about half of the elderly population (47.38%) refused to seek or follow medical advice. Lower levels of education (OR 3.678, 95% CI 1.017 – 13.301), lower social class (OR 4.455, 95% CI 1.236 – 16.050) and functional impairment (3.643, 95% CI 1.373 – 9.668) were found to be significant factors associated with self–neglect. Though prevalence of comorbidities (70%) and depression (27%) were high, there was no statistical evidence of association with self-neglect.

IJCM_338A: Burden Of Common Mental Health Disorders Using GHQ-12 Scale Among The Tribal And Rural Elderly Population In Mysore District.

Background: Common mental disorders (CMD) are a group of distress states manifesting with anxiety, depressive, and unexplained somatic symptoms and are the contemporary equivalent to the older concept of neurotic disorders. Various prevalence studies have shown that elderly population are more vulnerable to such mental health disorders as compared to the younger population. The available literature indicates that there is hardly any effort to understand the morbidity and the needs of such elderly people. Objective: i. To estimate the burden of common mental disorders among tribal and rural elderly population using GHQ -12. ii. To estimate the association between common mental disorders and sociodemographic factors. Methodology: This is a community based cross sectional study. It was among the tribal and rural elderly population of Mysore district from June to September 2023 using General Health Questionnairre-12(GHQ-12). The 12-Item General Health Questionnaire (GHQ-12) is the most extensively used screening instrument for common mental disorders. The GHQ-12 has generally demonstrated good sensitivity and specificity in various populations. The sampling method adopted for this study was multistage sampling and in the final stage participants were selected using simple random sampling Results: The prevalence of common mental disorders was 35% among rural elderly population and 43% among tribal elderly population. The prevalence of common mental disorders was found to be high among women in both rural and tribal elderly population and the difference was found to be statistically significant Conclusion: There are limitations in the study as cross-sectional type of study design was used. Further, analytical studies can be conducted to prove the causative association between common mental disorders and various socio- cultural factor. However, the findings of the study can be used to plan the necessary interventions in the field of elderly mental health

Socio-Economic and Demographic Changes in Rural Development in Eastern China — Comparative Studies

Socio-Economic and Demographic Changes in Rural Development in Eastern China — Comparative Studies

IJCM_385A: Establishment of a CKD Screening and treatment program at a secondary care hospital in rural Karnataka - A case study

Background: With the rapidly increasing incidence of kidney disease due to the rise in non- communicable diseases like diabetes and hypertension in India, a felt need for easily accessible Dialysis unit was found during the community assessment. Chronic Kidney Disease (CKD) education and screening program was also proposed to be established along with this to improve awareness and early detection. This would help in health system strengthening and prevent patients from travelling to far away locations for the dialysis sessions. Objective: 1. To conduct CKD education and screening camps in rural areas of Karkala taluk Methodology: The project was implemented for a duration of 12 months starting from July 2021. Camps were held along with help from local clubs &amp; Rotary Club. The following blood tests were carried out: Glycosylated Hemoglobin, Random Blood Sugar (RBS) or Fasting Blood Sugar (FBS), Serum Creatinine and Lipid Profile. These tests were done free of cost for all camp attendees. If the parameters were found to be abnormal, they were referred to Dr TMA Pai Rotary Hospital, Karkala for confirmation of the diagnosis and further management. Along with screening, Health education sessions were also be carried out to create awareness regarding diabetes and Chronic Kidney Disease among the rural population. The Dialysis unit was set up with 3 dialysis machines with funding from Rotary International under the Global Grant scheme. Dialysis was provided at subsidized to Below Poverty Line (BPL) patients. Results: A total of 10 CKD screening &amp; awareness camps were held during the project period. A total of 588 patients were screened. 132 were referred for further management. 8 patients were referred for Dialysis. Average of 170 dialysis sessions are carried out per months. 805 participants attended the training sessions. Conclusion: Similar set ups in rural areas will help in early detection of CKD and make dialysis more affordable and accessible.

- Invited Review - Pig meat production in the European Union-27: current status, challenges, and future trends.

The main objective of this study was to present data on the current situation and future trends of pig meat production in the European Union-27 (EU). Pig production has played an important social and economic role for centuries in many states of the EU. In 2022, pig meat production in the EU reached 23 M tons, which represented 21% of total production worldwide. The two key reasons that justify such amount of pork produced, are the acceptance and high consumption of the meat by the local population and the high quality of the meat produced which facilitated pork export. However, current data show a reduction in pork production for the last three years, as a consequence of a series of events that include i) problems with the chain of ingredients supply, ii) uncontrolled increase in African Swine Fever (ASF) outbreaks, iii) fast recovery of pig production in China, iv) increasing concerns by the rural population on the high cost to meet future requirements of the EU legislation on farm management, environmental sustainability and animal welfare, v) increased cost of all inputs involved in pig production and vi) limited interest of the new farmer generation to work on the pig sector. Consequently, pork production is expected to decrease in the EU for the next years, although sales will be maintained at a relative high level because pork is the meat preferred by local consumers in most EU countries. In order to maintain the favourable position of the pork industry in the near future, strategies to implement include: i) maintain the quality of the meat destinated to export markets, ii) improve the control of outbreaks of ASF and other swine diseases, iii) implementation of technological innovations to improve working conditions making more attractive to work in the pork sector of the food chain to the new generation of farmers and workers.

IJCM_283A: Clinico-demographic profile of patients attending anti retroviral therapy centre in a tertiary care hospital: a cross -sectional study

Background: HIV is a major global public health issue, having claimed 40.4 million lives so far globally. In India the estimated number of people living with HIV (PLHIV) is 2.5 million (WHO, 2022). For planning targeted interventions, it is essential to know the socio-demographic and clinical profile of the HIV/AIDS patients in any particular area. Objectives: To study the socio-demographic and clinical profile of PLHIV attending anti-retroviral therapy (ART) centre of J.N. Medical College, A.M.U., Aligarh (U.P.). Methodology: This is a cross sectional study and data was accessed from routine records at ART centre, JNMCH, AMU, Aligarh. Records of 370 PLHIV aged =18 years attending the antiretroviral clinic were studied and analyzed. Socio-demographic characteristics, risk behaviours and laboratory investigations were studied. Anemia was defined according to WHO criteria. Data was analyzed using SPSS version 20.0. P value &lt;0.05 was considered significant. Results: Mean age of the patients was 33.6 + 10.1 years and 60.8% of them were males. Majority of the patients belonged to rural areas (60.5%). Sexual route was the most common (69.5%) mode of transmission; among which heterosexual route was the commonest (96.1%). CD4 count was found to be less than 200 cells/mm3 in 22.2% of patients. Anemia was present in 67.3% of patients, among which moderate anemia was commonest (50.2%). Prevalence of anemia was significantly higher in females (83.4%) than males (56.9%) (p&lt;0.001) and in rural population (71.9%) than urban population (60.3%) (p=0.02). Conclusion: Majority of patients were males and belonged to rural areas. Commonest mode of transmission was sexual route. Thus, IEC activities should be targeted to these particular groups and knowledge regarding safe sexual practices should be given particularly in rural areas. Prevalence of anemia is very high in PLHIV. Targeted interventions aiming to prevent anemia in PLHIV should be strengthened.

IJCM_289A: Determination of factors favouring the snake bite mortality in Himachal Pradesh

Background: Snake bite is an established important cause of morbidity and mortality among the poor and rural population across the world including India. India accounts for the highest number of snakebites and related mortality globally. Objective: Identification of factors favoring the mortality due to snake bite. Methodology: A descriptive cross-sectional study was conducted from April 2022 to March 2023, and deaths due to snake bites reported from different health care facilities and community were included in the study. Results: A case-fatality rate of 5.9% due to snake bite was documented in the study. The factors identified as favorable for mortality were delayed treatment, followed by suboptimal care at primary and secondary health care facilities and traditional beliefs of the community. Conclusion: Provision of emergency service as point of care delivery, focusing on provision of training to strength point of care emergency services, co-ordination and linkages with the community members can strengthen the efforts toward reducing the mortality due to snake bites.

Factors influencing pregnancy care and institutional delivery in rural Mali: a secondary baseline analysis of a cluster-randomised trial

ObjectiveThe vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity...

IJCM_73A: Knowledge, attitude, practice, and perception of women regarding breastfeeding- A mixed method study conducted in the tribal areas of Koraput, India.

Background: Breastfeeding is one of the most effective ways to ensure a child’s health and survival. Contrary to WHO recommendations, fewer than half of infants under 6 months old are exclusively breastfed. Although we know about breastfeeding practices in urban and rural populations, very little knowledge is available about breastfeeding practices and their correlates among the tribal population. Objectives: 1. To assess the knowledge, attitude and practices prevailing among tribal women about breastfeeding 2. To explore the facilitators and barriers to infant breastfeeding practices amongst women in tribal areas. Methodology: Study design- Mixed method study. Study period- May, 2023 to July, 2023 Study population- tribal women of Koraput district. Study setting- villages in Koraput Inclusion criteria- 1. Women belonging to Scheduled Tribe communities. 2. Having at least one living issue. 3. Residing in their respective villages during the study period. Exclusion criteria- 1. Those who did not consent to the study. 2. Not residing in their respective villages. Sampling- Multistage sampling. Sample size- 500. Results: 78.6% of mothers belong to the age group 21-30 years, 93.4% were literate whereas 6.6% were illeterate, 88% were housewives with 78.8% belonging from joint family. Majority of them had good knowledge regarding breastfeeding, though they lacked clarity on the concept of exclusive breastfeeding. Majority of their knowledge about breastfeeding was from relatives or neighbours and healthcare workers. having multiple children in quick succession serves as a major barrier to exclusive breastfeeding. Conclusion: The findings can form targeted interventions and policy initiatives to reduce the barriers and promote the facilitating factors for optimal breastfeeding practices within this unique cultural setting, ultimately contributing to improved maternal and child health outcomes.

IJCM_410A: Prevalence of metabolic syndrome in rural area of District Kangra of Himachal Pradesh

Background: Metabolic risk factors and abnormalities such as obesity and hypertension are rapidly rising in Indian population following widespread change in lifestyle and dietary habits. A study was conducted to estimate the current situation of metabolic syndrome in rural area of Kangra district of Himachal Pradesh. Objective: To find out the prevalence of metabolic syndrome in adult population in identified rural area of Kangra district of Himachal Pradesh. Methodology: A community based cross-sectional study was conducted among 177 individuals. The relevant anthropometric measurements and laboratory investigations were performed. NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines were used to diagnose the metabolic syndrome. Results: The prevalence of metabolic syndrome in our study was found to be 42.4% (34.99%-50.01%) and was higher among female population (71.8%). The proportion of metabolic syndrome was higher among older age group (66.7%) and only 2.7% in those who were less than 30 years of age. Conclusion: The present study documented 42.4% prevalence of metabolic syndrome in rural population, with more prevalence among females. The data was skewed, with more proportion of females in the study. Consequent upon this, development of health policies and protocols for the screening of metabolic syndrome would aid in early diagnosis and timely management of non-communicable disease.

A practical and pragmatic way to assess deeper motivations for ecosystems preservation in developing country – The case of banc d’Arguin National Park (Mauritania)

The core of this paper is an evaluation of the willingness to pay for non-use values of the ecosystem services related to the Banc d'Arguin National Park in Mauritania. This coastal protected area, the largest in Africa, has existed for more than forty years and plays a major role in the conservation of biodiversity. We use contingent valuation to estimate the willingness to pay by Mauritanian populations for the protection of biodiversity in the park. Results show that the non-use value accounts for 12–29% of the total economic value attributed to the park's ecosystem services. Interestingly, a correlation exists between the familiarity with the park and the living conditions of people interviewed and their willingness to pay: rural and distant populations have a lower willingness to pay than closer or urban population. The results also highlight that the protection of biodiversity is compatible with the maintenance of the Imraguen way of life since their fishing practices are based on traditional sustainable catch techniques.