Rural Population Research Articles

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.

Mortality variability and differentials by age and causes of death in rural South Africa, 1994–2018

IntroductionUnderstanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over...

275 Cultural Adaptation and Implementation of Cognitive Behavior Therapy in a Rural Mental Health Clinic of Puerto Rico

OBJECTIVES/GOALS: Culturally Centered Cognitive-Behavioral Therapy (CCCBT) is a therapeutic approach that acknowledges the effect of cultural values, beliefs, and norms on mental health. Study aims to develop a CCCBT for rural community by enhancing engagement, relevance, and outcomes through culturally tailored interventions, and evaluate its implementation. METHODS/STUDY POPULATION: Diverse mixed methods study with participants ages 18-65 from Partial Hospitalization Program in rural community located in Puerto Rico Mountain region. CCCBT intervention will have a span of 9 consecutive bi-weekly sessions. The study consists of 2 phases: 1. Evaluate intervention acceptability through focus groups (n=12) with repeated measures to learn about enhancing mental health outcomes, 2. Measure intervention effectiveness in reducing mild-moderate depression and anxiety symptoms using validated questionnaires (PHQ-9 and GAD-7) with a 100 participants from same region. Descriptive analysis for sociodemographic characteristics will be used to provide overview of participants characteristics. Qualitative analysis of focus groups will be obtained through feedback and content analysis. RESULTS/ANTICIPATED RESULTS: We anticipate high intervention acceptability through positive participant feedback and cultural relevance feedback from focal groups. We expect to find significant reduction in symptoms of depression and anxiety post-intervention, demonstrating the efficacy of CCCBT in Puerto Rican rural communities. These results will support the feasibility of implementing this approach, addressing mental health disparities, and enhancing treatment engagement and outcomes in underserved populations. The study will inform future research to refine and expand this intervention in rural communities of Hispanics and/or other rural underserved populations in the US. DISCUSSION/SIGNIFICANCE: This study’s success will advance culturally tailored mental health care in underserved rural Puerto Rican communities, reducing disparities and enhancing treatment relevance and engagement, with potential implications for improving mental health outcomes in similar populations in the US and worldwide.

IJCM_146A: Development and validation of an infographic educational tool for self-management of hypertension.

Background: Hypertension is a serious condition affecting 33 % of urban & 25 % of rural Indian population. It can be controlled by the antihypertensive medications, but self-management approaches also play a very important role in lowering blood pressure. Infographics are one such material which uses visuals to educate the audience. This study assesses the understandability and actionability of the newly developed infographic aimed at self-blood pressure monitoring, medication adherence and lifestyle modifications with dietary approaches and exercise. Objectives: The objectives of the study were to develop an infographic tool for educating the patients with hypertension and to validate the infographic tool using PEMAT A/V. Methodology: “The study was divided into two phases. First phase was to develop an infographic tool. An infographic was designed using Canva and Procreate. In the second phase, the infographic was validated using the Patient Education Material Assessment Tool - Audio visual (PEMAT-A/V) by 10 participants. PEMAT is a systematic method to evaluate and compare patient education materials. Result: Using Canva, the infographic tool was developed, and then PEMAT-A/V was used to validate it. In terms of understandability and actionability, the mean score was 87.8% and 89.2%. The standard deviations for understandability and actionability were 0.12 and 0.14, respectively. Conclusion: The infographic developed in the study scored a mean percentage of more than 70 in both understandability and actionability and hence, it was concluded that it can be easily understandable by the patients.

IJCM_98A: Prevalence of Non-Communicable disease in Geriatrics population of Kalaburagi District: A Cross-sectional Study in Rural Field Practice Area.

Background: Worldwide total population of geriatric was 703 million (9%) in year 2019 according to United Nation report. The geriatric population is estimated to increase to 198 million by 2030 in India. With advancing years, the incidence of communicable and non-communicable disease (NCD) increases. Most of the available studies on morbidity in India are disease specific and fail to provide comprehensive knowledge about NCD. Objectives :1. To estimate prevalence of non-communicable disease (NCD) in elderly. 2. To assess the risk factor associated with non-communicable disease. Methodology: A community based cross-sectional study was conducted among geriatric people in rural areas of Kalaburagi district, Karnataka. Study participants consisted of age =60 years were comprised in the study and a sample size of 193 was calculated. Pre-designed, pre-tested and semi- structured questionnaire was used to collect information on risk factor and morbidity status of study participants. Data was computed in Microsoft 2013 excel sheets and using SPSS version 25.0 for utilizing appropriate statistical method to calculate frequency and percentage, chi square test fisher extract test were used to find association. Results: Hypertension is the most prevalent morbidity NCD in the rural elderly population found to be 41.45% in Kalaburagi CHC Rajapur. Followed by diabetes 24.35% and other disease 1.62%. Alcohol and Chewing tobacco found to have significant associations in disease causation in the elderly population. Environment like Water Supply, Latrine, Socio-Economic Class found to be having significant association in disease causation in the elderly population. Conclusion: As age advances morbidity increases has been shown in the study. Lifestyle modification also show statistically significant association. Prevalence of NCD like Hypertension, Diabetes, MI, etc can be prevented by reduction of the high-risk factor such as Lifestyle changes, Diet Modification, and Changing Habits of alcohol and tobacco.

IJCM_136A: Prevalence Of Risk Factors For NCDs And Its Associated Factors in Rural Field Practice Area of RDJMMCH, Turki, Muzaffarpur, Bihar.

Background: Non-communicable diseases (NCDs) are diseases that are not transmissible directly from one person to another. NCDs mainly consists of cardio vascular diseases, diabetes, stroke etc. It accounts for 68% of global deaths. The prevalence rates in India is1.6% to 7.4% and 1% to 13.2% in rural and urban population respectively. Objective: To determine the prevalence and associated risk factors for NCDs in rural field practice areas of RDJMMCH, Turki, Muzaffarpur. Methodology: A cross-sectional study done among people above 30 years of age residing in study area from March to April, 2023. Data was collected using CBRA (community-based risk assessment) checklist for NCDs. Sample size of 157 was calculated assuming the prevalence of risk factor for NCDs being 30% with 95% confidence interval and absolute precision of 7.5%. Systematic random and simple random sampling was applied. Results: Mean age of participants was 47.9 years. Majority of them were females (56%) belonging to Hindu religion (98%). 41% were illiterate and major occupation practiced was farming (74%). Prevalence of risk factor for NCDs was 17.2%. On performing Chi-Square test smoking, alcohol, physical inactivity and family history of NCD’s were found to be significantly associated. Conclusion: As prevalence of risk factor for NCDs is 17.2%. Thus, it is the need of hour to have timely update about the disease and motivate them for healthy lifestyle.

Intersection of Race, Rurality, and Income in Defining Access to Minimally Invasive Lung Surgery

Race is a potent influencer of healthcare access. Geography and income may exert equal or greater influence on patient outcomes. We sought to define the intersection of race, rurality, and income and their influence on access to minimally invasive lung surgery in Medicare beneficiaries. Medicare and Medicaid Services data were used to evaluate patients with lung cancer who underwent right upper lobectomy, via open, robotic-assisted (RATS), or video-assisted thoracic surgery (VATS) between 2018 and 2020. International Classification of Diseases 10th edition was used to define diagnoses and procedures. We excluded sub-lobar, segmental, wedge, bronchoplastic, or reoperative patients with non-malignant or metastatic disease or a history of neoadjuvant chemotherapy. Risk adjustment was performed using inverse probability of treatment weighting (IPTW) propensity scores with generalized linear models and Cox Proportional Hazards models. The cohort comprised 13,404 patients, 4,291 (32.1%) open, 4,317 (32.2%) RATS, and 4,796 (35.8%) VATS. Black/Urban patients had significantly higher RATS and VATS rates (p<0.001), higher long-term survival (p=0.007), fewer open resections (p<0.001), and lower overall mortality (p=0.007). Low-income Black/Urban patients had higher RATS (p=0.002), VATS (p<0.001), higher long-term survival (p=0.005), fewer open resections (p<0.001), and lower overall mortality compared to rural white patients. (p=0.005). Rural white populations living close to the federal poverty line may suffer a burden of disparity traditionally observed among poor Black people. This suggests a need for health policies that extend services to impoverished, rural areas to mitigate social determinants of health.

Assessment of socio demographic factors on termination of pregnancy in Ghana.

Assessing the socio-demographic factors on termination of pregnancy in Ghana. Cross-sectional study, using data source from the Demographic Health Survey (DHS). Data pooled from the most recent DHS conducted in Ghana, with variables of interest with rural and urban population coverage. A systematic search of the literature was performed using PubMed, Google Scholar and Elsevier PubMed for the secondary data. Descriptive and logistic regression analysis was performed using Python Pandas' software to estimate the independent effects of the socio-demographic factors on termination of pregnancy in Ghana. Reported using odds and adjusted OR AOR at 95% confidence level and statistical significance at a p-value of (p > 0.05). Age, place of residence, occupation, currently pregnant, woman's individual sample weight, completeness of current pregnancy, living children + current pregnancy, ethnicity and number of living children significantly predicted the outcome variable. Nurses have an important role to play in providing support, education and counselling to people, and must be equipped with the knowledge and skills (including non-judgmental and compassionate care) necessary to provide care that is sensitive to the diverse needs of people from different socio-demographic backgrounds.

Территориальные особенности оказания экстренной хирургической помощи сельскому населению (на примере Республики Северная Осетия-Алания).

The need to modernize healthcare dictates the study of healthcare organization at all levels. Special attention is paid to the territorial accessibility of medical care, including to the rural population, which differs in many specific features. The purpose of the study: to study the territorial features of providing emergency surgical care to the rural population, taking into account the number, density of population settlement, road infrastructure, and transport security in the Republic of North Ossetia-Alania. Research methods. Analytical and statistical research methods were used. The performance indicators of surgical departments of rural district hospitals for 2019–2022 have been studied. The analysis of the obtained data was carried out by the method of their structural description according to the selected main characteristics affecting territorial accessibility. Results. The Republic of Ossetia-Alania is characterized by high density and compactness of population settlement in rural areas. The creation of a modern transport infrastructure ensures the territorial accessibility of medical care. The republic has a fairly high level of provision with surgeons (2,53 per 10 thousand population) and a surgical bed fund (4,7 per 10 thousand population). However, there is a need to increase the efficiency of using the bed stock of rural surgical hospitals. The organization of surgical care in the republic in 2020–2021 was extremely negatively affected by the pandemic of coronavirus infection COVID‑19. The reduction of surgical and anesthesiological teams, beds and the volume of planned care due to the opening of additional infectious diseases hospitals has reduced the availability and quality of emergency surgical care. In rural district surgical departments, the bed function decreased from 283 days in 2019 to 243 days in 2020, and surgical activity up to 38,8%. In 2020–2021, planned medical care in the «surgery» profile has significantly decreased. The share of emergency hospitalizations increased to 79,7%. Negative trends in the growth of emergency hospitalization for surgical beds led to an increase in the hospital mortality rate compared to 2019 from 0,6% to 3,1% in 2021. The postoperative mortality rate has increased by more than 5 times. Our data correlate with similar trends of 33% increase in hospital mortality in the Russian Federation during the pandemic. Due to the creation of modern road transport infrastructure in the republic, high availability of surgical beds and surgeons, there is a potential to improve the quality indicators of rural surgical hospitals by improving the material and technical equipment and qualifications of surgical personnel.

К вопросу о смертности населения и проблемах здравоохранения в сельских поселениях.

In the Russian Federation, the problem of reducing population mortality, incl. in rural settlements. Strategic guidelines and initiatives adopted in regulatory documents at the federal level do not reflect the severity and depth of demographic challenges and processes of depopulation in modern conditions. The purpose of this study is to analyze current trends and mortality trends in rural areas in Russia, as well as health problems in rural areas, and make appropriate recommendations and adjustments. Materials and methods. At all stages of the study, analytical materials from official statistics (Rosstat and the Ministry of Health of the Russian Federation), data from modern literature sources and regulatory documents were used; processing of statistical data was carried out based on modern software packages SPSS, Excel‑2007. Research methods – study and generalization of experience, statistical, bibliographic. Results. Analysis of the accumulated data showed trends in the mortality of the rural population; specific areas and features inherent in rural healthcare and requiring special attention considering new challenges in the system were clearly shown and systematized. Conclusions. The data obtained can be applied when adjusting and recommendations to existing regional programs operating within the framework of preserving and strengthening the health of the rural population in the territory.

Mapping Social Support Sources for Rural Patients with Chronic Illness

Objective: In this study, we evaluated social support sources for rural residents with chronic conditions and examined associations between support sources and self-reported health status. Methods: Adults in rural zip codes across the United States (N = 183; 48.6% female) participated in an online survey. Chronic disease status was determined through participant self-report of prior medical diagnoses. Support sources were elicited using scenarios that require illness assistance or emotional support. Self-rated physical and mental health were measured using 5-point Likert scales. Chi-square tests examined gender differences in preferred sources of social support. Ordinal logistic regressions assessed predictors of self-rated health status, including support source preferences. Results: Family and friends were found to be primary sources of social support for rural residents managing illness. Women tended to rely more heavily on close family members whereas men were open to more diverse sources. Gender differences were statistically significant (χ2(4) = 20.66, p &lt; .001). Those relying on close friends rather than family when sick also reported better physical health (B = 1.79, Wald = 4.91, p = .02). Conclusion: Findings indicate informal social ties are central for the health of rural populations. Gender differences in help-seeking patterns may necessitate tailored chronic disease interventions. Fostering community linkages and leveraging natural supports will be vital for addressing rural health disparities.

IJCM_108A: A Community Based Cross-sectional Study on prevalence of Low Social Support Status of the Geriatric Age group in a Rural population of South India.

Background: The elderly above 60 years of age constituted 10.5% of India’s population according to the United Nations Population Fund India Ageing Report 2023. Objective: To estimate the prevalence of low social support of the geriatric age group in a rural population of South India. Methodology: A community-based cross-sectional study was carried out on 200 elderly individuals including both genders in two villages of the field practice areas of the Rural Health Training Center of MAPIMS during the month of September &amp; October 2023 with the use of the Multidimensional Scale Perceived Social Support questionnaire (MSPSS). Univariate analysis and multivariate analysis were carried out using SPSS version 24 software. Results: The mean age of the study participants was 66.33 ± 8.02 years and the majority of the study participants were females (62%). Out of 200 study Participants, 110 (55%) elderly were found to have low social support, 71 (35.5%) had moderate social support and 19 (9.5%) had high social support. The result also showed that the farmers, Illiterates, people belonging to low socioeconomic status and those married were significantly having low social support. Conclusion: The study concluded the prevalence of low social support is high among the geriatric population and emphasizes the need to create awareness among the people regarding the provision of social support to the geriatric population.

IJCM_239A: Health seeking behaviour and its determinants among adult population: a comparative study between urban and rural area of western Uttar Pradesh

Background: Health seeking behaviour is remedial action undertaken by individuals for their health problem or illness. It may vary in rural and urban areas and with different sociodemographic variables. To provide adequate health care services to the community, it is essential to know about their health seeking behaviour and its determinants. Objectives: 1. To describe health seeking behaviour and determine various factors influencing it among adult population in rural and urban areas of Meerut. 2. To assess their awareness on health insurance policies. Methodology: A community based cross-sectional study among adult population was conducted in rural and urban areas of Meerut, Uttar Pradesh from 1st July to 30th September, 2023. Estimated sample size was 200 each from rural and urban areas. Study participants were selected by multistage sampling method. Data collection was done by a pre-tested and semi-structured questionnaire. Results: Among 400 study participants, 91% in urban and 60% in rural areas showed positive health seeking behaviour. In both areas, most of them preferred public health facilities. Major factor affecting health seeking behaviour in rural area was convenience of approach, while that in urban area was low cost of treatment. Majority rural population was unaware of health insurance policies, while almost half of urban population were aware of it. Conclusion: Positive health seeking behaviour and awareness on health insurance policies are seen more in urban area than rural. Awareness programmes on positive health seeking behaviour and health insurance are essential, especially in rural areas.

Socioeconomic indicators and their influence on the adoption of renewable energy technologies in rural Malawi

Purpose This study aims to examine the impact of socioeconomic factors on electricity usage and assess the feasibility of implementing a mini-grid system in Kasangazi, Malawi. The primary aim is to understand the community’s current and potential utilisation of electrical equipment. Design/methodology/approach A mixed-methods approach was used to collect quantitative and qualitative data. Information was gathered through structured questionnaires, and energy audits were conducted among 87 randomly selected households from 28 Kasangazi communities. Data analysis relied on descriptive statistics using IBM SPSS version 28. Findings The study indicates that every household in Kasangazi uses non-renewable energy sources: 60 households use disposable batteries for lighting, 20 for radios and all use firewood, freely sourced from local forests, for cooking and heating water. The study shows that firewood is the community’s preferred energy source, illustrating the challenges faced in the fight against deforestation. Most household income comes from farming, with smaller contributions from businesses, employment and family remittances. Access to higher education is scarce, with only one out of 349 family members receiving tertiary education. Despite the constraints of low education levels and income, there is a demand for larger electrical appliances such as stoves and refrigerators. This underscores the need for mini-grid solutions, even in less technologically advanced, agriculture-dependent communities. Originality/value This study underscores that in Sub-Saharan Africa, factors like household size, income and education levels do not significantly influence the electricity demand but should be taken as part of the fundamental human rights. Rural populations express a desire for electricity due to the convenience it offers, particularly for appliances like refrigerators and stoves. Mini-grids emerge as a viable alternative in regions where grid electricity provision is challenging. It is concluded from this paper that the issue of using renewable energy should not only be taken for environmental preservation but also to promote energy access, augmenting efforts in supplying electricity to the remotest parts of the country.

IJCM_249A: Assessment of availability of drugs &amp; logistics on Village Health Sanitation and Nutrition Day (VHSND) sessions of Raipur district, CG- A cross-sectional observational study

Background: Maternal and Child health remains one highly pervasive and damaging condition in low-middle-income countries. To improve the situation Govt. of India in 2007 initiated VHSND, as an effective platform for delivering healthcare services at the doorsteps of the unserved and underserved village population, improving awareness and access of the community for health services thereby leading to improvement in the health indicators.,(VHSND) are community-based health initiatives designed to bring essential healthcare services to the doorsteps of rural populations. These sessions serve as a crucial platform for promoting health, hygiene, and nutrition awareness within villages. Organized regularly, VHSNDs aim to address a spectrum of health issues, ranging from maternal and child health to sanitation and nutrition. The success of VHSNDs relies heavily on community participation. These sessions not only offer immediate health services but also empower communities by fostering a sense of ownership over their well-being. By engaging with local residents, VHSNDs contribute to the overall improvement of health indicators and the quality of life in rural areas. In summary, VHSNDs play a vital role in bridging the healthcare gap in rural communities, emphasizing preventive healthcare, and promoting a holistic approach to well-being. They embody the collaborative efforts of health professionals, community leaders, and residents to create healthier and more resilient villages. Objective: 1. To assess the status of logistic availability on VHSND sessions of Raipur District Methodology: A cross-sectional study was conducted to assess the status of logistic availability on 30 VHSND sessions of Raipur district during March- July 2023 in Chhattisgarh by observation and pre-tested pre-designed semi- structured questionnaires. Results: It was observed that out of 30 VHSND sessions site, 77 % were held as per the micro plan and from those 90% ANM, 97% ASHA, 84% Anganwadi workers, 57% Anganwadi helpers, and only 10% PRI members were present at the site of the session. Only 56% of session sites were supervised by supervisors, 28 (93.33%) session sites had drinking water facilities, 21 (70%) sites had toilet facilities, and only 25(83.33%) sites had electricity connectivity. BP Instrument, Stethoscope, Weighing scale, Hemoglobinometer, Glucometer, Disposable syringe 5ml, Disposable syringe 0.5 ml, Disposable syringe 0.1, MCP card, Examination table, were above (90%) present in most of the VHSND sessions. Out of 30 Sessions Stadiometer (19) Fetal Doppler (15), Curtains (21), Stepping stool for climbing on the examination table (17), and Referral slip (5) are present in the VHSND sessions. Nischaya kit, VDRL, HIV, and RDK for malaria kit were present in 74%,43%,97%, and 93% respectively. Iodized salt testing is not available in any sessions. All vaccines were available 100% except BCG, DPT, and Td, which were present in 87%,93%, and 90% sessions. AEFI Kit was available in 80% of sessions. Condom, OCPs, and Centchroman were present most of the site of the sessions but Inj. MPA, IUCD, and emergency contraceptive pills were available only in 14%,37%, and 14% of sessions respectively, 7.23 (77%) of the session sites have Information displayed about the day, time, and site of the VHSND session, Conclusion: Most of the session sites were held as per the micro plan, there is some lacuna in the availability of logistics although a majority of essential items were found at session sites special focus needs to be given to fetal doppler, HIV kit cold-chain maintenance, Iodized salt kit, Cotrimoxazole, Anti-malaria drugs, Td, and BCG vaccine. Satisfactory maternal and child health services were provided in many sessions.

Heat literacy and adaptation among semi-rural community in Malaysia

BackgroundHeatwaves present health risks globally but there is limited evidence on how temperature perceptions affect activities. This study aimed to examine community perceptions of heat as a potential health hazard and ascertain the current heat protection measures of the residents of the South East Asia Community Observatory (SEACO) in Malaysia. MethodsIn this longitudinal study, we randomly selected community members aged between 18 and 70 years who resided in Segamat district of Johor state, Malaysia. Over 21 days, we conducted three home visits to each participant. During each visit, participants completed a questionnaire consisting of Likert scale, multiple choice, and free text questions and we collected quantitative and qualitative data. These inquiries assessed the participants' perception of heat as health threat, whether or not they took heat preventive measures, and the specific protective measures they routinely employed. Descriptive data analyses were conducted and patterns of protective measures were investigated. FindingsBetween March 29 and July 31, 2023, 120 participants (72 women and 48 men) completed 360 questionnaires over three home visits. Initially, 58% participants recognised heat hazards to daily activities, decreasing to 42% and 35% by visits 2 and 3. Participants took preventive measures throughout the day, which was consistently high between 1200 h and 1400 h, with 77% of participants taking preventive measures on visit 1, 82% on visit 2, and 82% on visit 3. Use of preventive measures was also high between 1400 h and 1730 h, with 77% using preventive measure on visit 1, 81% on visit 2, and 79% on visit 3. The most common protective measures were fans (used by 68–88% of participants), drinking more water (70–78% of participants), and resting (44–72% of participants). The least common were relocating to cooler places, removing clothes, and using wet towels (0–2·5%). Despite high temperatures, perceptions of heat risks decreased over time. Participants took basic protections, especially at midday, but improved literacy and affordable cooling options are needed to protect vulnerable rural populations. InterpretationOur findings underline the need to improve heat literacy and adaptation as only half of the population assessed perceived heat as a potential health hazard and practised limited heat protective measures. Addressing climate change and health necessitates fundamental behavioural changes on the part of individuals and communities, to protect them against the adverse effects of heat. FundingMonash University Malaysia and Heidelberg Institute of Global Health, Heidelberg University.

Credit Cultivation: A deep dive into the harmonies and dissonances of Macroeconomics impact on agricultural financing practices in Djibouti

In this study, we investigate the impact of selected macroeconomic factors on agricultural financing practices in Djibouti. Therefore, the objective of this study is to understand how these factors influence the accessibility, distribution, and effectiveness of financial resources within the agricultural sector. To achieve this objective, we employed Autoregressive Distributed Lag (ARDL) and Wavelet Coherence Analysis on an annual dataset covering a span of 25 years, ranging from 1998 to 2022. The findings reveal that factors such as inflation, diminishing rural population, economic growth, and the institutional framework of the country exert negative pressures on the availability of funding for agriculture. However, amidst these challenges, we find that official development assistance serves as a positive mitigating factor, offering crucial support to the agricultural sector. These findings hold significant implications for policymakers in Djibouti by providing valuable insights into how to develop targeted interventions to support farmers, increase access to credit, and improve agricultural productivity, as it lays the foundation for investments in food security, technology adoption, and climate-resilient practices.

Combining Frequent Alcohol Testing with Swift-Certain-Fair Sanctions

24/7 Sobriety programs largely focus on reducing alcohol consumption among justice-involved individuals whose alcohol use has led them to repeatedly threaten public safety. Participants are ordered to abstain from alcohol use and subject to frequent alcohol testing (e.g., twice daily breathalyzers, remote alcohol monitoring); those testing positive face an immediate sanction, typically a night or two in jail. Unlike drug courts and other forms of coerced substance use disorder treatment, 24/7 does not require participants to enter a treatment program or attend self-help group meetings; however, these approaches are not necessarily mutually exclusive. The empirical evidence suggests that participants largely abstain from heavy drinking while in the program and that 24/7 participation is associated with lower probability of criminal legal involvement and mortality. This evidence is largely based on research in the Great Plains states with large rural populations. Several questions remain about these programs (e.g., optimal program length, possible benefits of incorporating positive incentives, efficacy of different alcohol testing technologies), many of which can best be answered in an experimental setting. In addition to reviewing the existing research on 24/7, this paper highlights additional research questions and ideas for conducting randomized controlled trials with the program, especially in more urban areas.

Exploring Cognitive Fluidity: A Comparative Study of Male and Female Adults in Nuclear and Joint Family Structures

This study explores the assessment of cognitive fluidity among male and female adults residing in nuclear and joint family setups in India. With the country's diverse societal fabric marked by varied traditions, languages, and belief systems, understanding cognitive fluidity's role becomes imperative in navigating this complex landscape. Through the meticulously developed Cognitive Fluidity Scale, validated for this study, 120 young adults aged 25 to 30 were evaluated within the Udaipur district, Rajasthan. The district's mix of urban and rural populations provided a rich environment for studying the influence of familial structures on cognitive fluidity. Participants were selected through purposive sampling, ensuring demographic diversity and representation across family types. Findings indicate a predominant display of moderate cognitive fluidity levels across both family structures. However, noteworthy variations emerged between genders and family types, with joint family environments correlating with higher cognitive fluidity levels compared to nuclear families. Specifically, individuals within joint family setups exhibited greater adaptability, learning capacity, and flexible thinking skills. This suggests that shared experiences and cognitive stimuli within familial environments contribute significantly to shaping cognitive processes. The study underscores the importance of considering family dynamics when assessing cognitive abilities among adults, providing valuable insights for interventions aimed at promoting cognitive development and well-being within diverse family systems in India.