Rural Province Research Articles

Current status of the Food Security system in Mongolia new policies, and expected outcomes

The national food security system in our country is not established well and continues to remain weak. Failures within the system have caused malfunctions and distortions in government policy implementation, leading to unexpected policy shifts. These faults are the main causes of time loss, inter-agency misunderstandings, lack of coordination, information flow deficiencies, and a shortage of skilled human resources. These issues can have a negative impact on food security in Mongolia, resulting in the shortfall of government policy implementation. Coordination of food security activities among government organizations in Mongolia has been unsatisfactory due to the weak system. Government services have not adequately reached organizations at the middle and primary levels in the Mongolian rural provinces. This research paper aims to evaluate the national food security situation based on policies in Mongolia's food sector over the past decade, their implementation, encountered problems, and involved stakeholders. The research findings show that our country's food security system is not well-established, leading to compromised food security, highlighting the urgent need for developing necessary legal and policy documents to effectively implement state food security policy.

Pilot Study to Evaluate Patients’ Understanding of Key Terms and Aspects of Antimicrobial Use in a Rural Province in South Africa Findings and Implications

Abstract Introduction: Antimicrobial resistance (AMR) is a global concern, necessitating the understanding of utilisation patterns and their rationale. Pilot studies have been conducted in a rural province in South Africa to determine the extent of self-purchasing of antibiotics by patients from independent and chain pharmacies. It is imperative to understand the extent of knowledge and concerns of patients regarding the key aspects of antibiotic use and AMR, and potential language barriers, when pharmacists and their assistants are discussing the key aspects with patients. Consequently, the aim was to pre-test a patient questionnaire translated in three native languages building on the findings from the English language pilot. Materials and Methods: The English patient questionnaire (Parts 1 and 2) was translated to Sepedi, Tshivenda and Xitsonga. In total 30 patients were interviewed (5/language for Part 1 and Part 2 respectively) when leaving 10 chain and independent pharmacies. This was followed by interviews with patients to evaluate their understanding of questions and key concepts. Results: Eleven of 15 patients interviewed for Part 1 received antibiotics, including 8 without a prescription. Only independent pharmacies (8/10) dispensed antibiotics without prescriptions. Interviews revealed concerns about antibiotic knowledge and AMR and that certain terms including ‘antibiotic’ and ‘AMR’ posed challenges with patient understanding of the purpose of antibiotics. For instance, one patient self-purchased antibiotics for ‘cleansing’ of sexually transmitted infections. The questionnaires in the native languages were subsequently revised so that explanations for terms, including ‘antibiotic’ and ‘AMR’ will be provided in the main study. Conclusion: Similar to the previous pilot studies, self-purchasing of antibiotics was observed among independent pharmacies, although at varying rates, with similar indications. Continued health literacy education for pharmacists and patients, especially with native language communication, are needed to address current challenges and will be explored in the main study.

7604 Examining Disparities in Diabetes Control and Complications: A Comparative Study of Type 2 Diabetes Mellitus Patients in Rural and Urban Saudi Arabia

Abstract Disclosure: S.F. Alqifari: None. O. Alkomi: None. P. Amirthalingam: None. T. Alrasheed: None. M. Muqresh: None. H. Hamad: None. A. Khojah: None. N. Alshehri: None. B. Alhunayhani: None. B. AbuAlhasan: None. N. Alajlan: None. S. Alatawi: None. N. Alsabeelah: None. A. Wasel: None. A. Alqifari: None. Background: The escalating global prevalence of diabetes is also mirrored in Saudi Arabia. Approximately one in four individuals in the country is diagnosed with diabetes, as reported by the World Health Organization (WHO). The Ministry of Health has taken steps to address the needs of patients with diabetes by creating more than 20 specialized diabetes care centers in various regions throughout Saudi Arabia. However, disparities in access and utilization of primary healthcare facilities persist between rural and urban provinces within the country. Highlighting these disparities would bridge healthcare gaps between rural and urban areas to enhance diabetes management, ensure better access to specialized care, and improve the overall well-being of individuals living with Type 2 Diabetes Mellitus (T2DM) in Saudi Arabia. Objectives: This study aims to examine disparities in diabetes control and complications in patients with T2DM in rural and urban Saudi Arabia. Methods: This is an observational retrospective study conducted from November 2022 until May 2023, we collected data from 13 diabetes care centers across Saudi Arabia to assess diabetes control and complications of T2DM among patients who received their care in rural and urban Saudi Arabia. Results: Among 709 patients residing in rural and urban areas, rural area patients' recent HbA1c readings were generally within the range of 7-8%. Among these patients, around 2.6% had a history of heart disease, and 6.08% had experienced cerebrovascular events. Limb numbness was reported by 44.34% of subjects, 47.82% experienced vision complications, and renal impairment was observed in 10.43% of the participants. Additionally, among male patients, 26.41% suffered from erectile dysfunction. Remarkably, 21% of the rural patients reported having been hospitalized due to diabetes complications at least once in the past 12 months. Conclusion: The study findings emphasize the importance of considering regional disparities and socio-environmental factors when managing diabetes and its complications. Additional research is needed to understand the underlying causes and develop targeted interventions for improved diabetes care in rural and urban populations in Saudi Arabia. Presentation: 6/2/2024

Interregional watershed services: Valuation of the benefits of controlled embankment breaches to manage urban flood risk

The Lower Mekong delta of Vietnam, particularly Can Tho city, is highly susceptible to flooding which urgently calls for significant efforts to mitigate urban flood risks. A possible measure to reduce flood risk is the application of controlled embankment breaches (CEB) in a rural province upstream. Utilising a Protection Motivation Theory approach, this paper uses a contingent valuation to assess the welfare effects of a reduction of flood risks in the city resulting from CEB in the upstream region of the delta. The findings revealed that households residing in the downstream areas of Vietnamese Mekong Delta were willing to financially support the implementation of the CEB upstream in An Giang city, as a measure to alleviate urban flood threats in Can Tho city. These results suggest that interregional cooperation, involving the concept of payments for watershed services between regional jurisdictions, may help to effectively mitigate flood risk in a low-lying population centre in a major river delta. As such, these findings can inform policies for urban flood risk mitigation regarding the development of a more comprehensive flood risk reduction strategy in similar geographical contexts.

Faecal microbiota and cytokine profiles of rural Cambodian infants linked to diet and diarrhoeal episodes

The gut microbiota of infants in low- to middle-income countries is underrepresented in microbiome research. This study explored the faecal microbiota composition and faecal cytokine profiles in a cohort of infants in a rural province of Cambodia and investigated the impact of sample storage conditions and infant environment on microbiota composition. Faecal samples collected at three time points from 32 infants were analysed for microbiota composition using 16S rRNA amplicon sequencing and concentrations of faecal cytokines. Faecal bacterial isolates were subjected to whole genome sequencing and genomic analysis. We compared the effects of two sample collection methods due to the challenges of faecal sample collection in a rural location. Storage of faecal samples in a DNA preservation solution preserved Bacteroides abundance. Microbiota analysis of preserved samples showed that Bifidobacterium was the most abundant genus with Bifidobacterium longum the most abundant species, with higher abundance in breast-fed infants. Most infants had detectable pathogenic taxa, with Shigella and Klebsiella more abundant in infants with recent diarrhoeal illness. Neither antibiotics nor infant growth were associated with gut microbiota composition. Genomic analysis of isolates showed gene clusters encoding the ability to digest human milk oligosaccharides in B. longum and B. breve isolates. Antibiotic-resistant genes were present in both potentially pathogenic species and in Bifidobacterium. Faecal concentrations of Interlukin-1alpha and vascular endothelial growth factor were higher in breast-fed infants. This study provides insights into an underrepresented population of rural Cambodian infants, showing pathogen exposure and breastfeeding impact gut microbiota composition and faecal immune profiles.

Assessing the quality of life in a rural Thai province: A case study

This study investigates the impact of personal characteristics (PER), personal environment (PEV), individual factors (INF), and urban development (DEV) on the quality of life (QoL) in the northeastern (Isan) region of Thailand, specifically focusing on Roi Et Province. The research employs a quantitative approach using stratified random sampling to select a sample of 400 individuals from a population of just over 1 million residents. Data analysis was conducted using LISREL 9.1 for confirmatory factor analysis (CFA) and structural equation modeling (SEM) to explore the relationships between the variables. The results reveal significant positive relationships between the studied variables and their influence on public services. Personal characteristics showed a moderate positive effect on QoL, highlighting the importance of gender and community relationships. The personal environment significantly impacted QoL, emphasizing the role of supportive living conditions. Individual factors were crucial for QoL, indicating the significance of societal roles and personal well-being. Urban development directly influenced QoL, suggesting that well-planned infrastructure enhances residents' QoL. These findings align with the Social Determinants of Health framework and New Urbanism theory. This research underscores the multifaceted nature of QoL determinants in rural settings, demonstrating that both individual and environmental factors contribute to residents' well-being. The study provides valuable insights for policymakers and urban planners, suggesting that enhancing personal and environmental factors, alongside strategic urban development, can significantly improve the quality of life in rural areas.

A real-world study of BBIBP-CorV vaccine effectiveness in a Sri Lanka rural province

ObjectiveReal-world studies assessing the effectiveness of the BBIBP-CorV vaccine in low and middle-income countries are limited. We evaluated the BBIBP-CorV vaccine's effectiveness in reducing COVID-19 symptomatic disease, hospitalisation, severe disease, and mortality during the third wave of the pandemic in Sri Lanka. MethodsWe conducted a test-negative case-control study in North Central Province from May 2021 to February 2022. Evidence of vaccination was obtained from the national registry. The PCR-positive patients were cases, while negative individuals were controls. Adjusted vaccine effectiveness (aVE) was computed for fully, partially, and non-vaccinated groups in reducing symptomatic disease, hospitalisation, severe disease, and mortality. ResultsOur study involved 3305 cases and 3418 controls. The overall aVE for preventing PCR-positive infection in fully vaccinated was 30·8 % (95 % CI:17·9–41·6). In fully vaccinated over 60 years, the overall aVE was 72·3 % (95 % CI: 49·7–84·8). Full vaccination with BBIBP-CorV is effective in reducing hospitalisation, severe COVID-19 disease, and death, with aVE rates of 70·3 % (95 % CI: 57·9–79·0), 88·9 % (95 % CI: 81·8–93·2), and 92·3 % (95 % CI: 84·8–96·1) respectively. ConclusionIndividuals who have received two doses of the BBIBP-CorV vaccine are protected against hospitalisation, severe COVID-19 disease, and death. Duration of protection against hospitalisation, severe COVID-19, and fatal COVID-19 sustained at least 121 days, with no sign of waning during that time.

Making family medicine work: Rural community-based and interprofessional medical education.

At the University of the Free State, the 5-year MBChB curriculum had to be complemented with community-based education exposure to meet the requirements of the Health Professions Council of South Africa. Following the faculty leadership's vision, an interprofessional training experience was conceptualised and implemented by a project team from the three schools in the Faculty of Health Sciences (Medicine, Nursing, and Health and Rehabilitation Sciences). For the past decade, 4th-year medical students participated in the 2-week rotation in the rural southern Free State province, of which 1 week is spent with students from other health professions programmes in a structured interprofessional learning experience. The other week focuses on the realities of nurse-driven primary healthcare services in a resource-deprived area, including exposure to the programme-guided care for patients with tuberculosis (TB) or chronic diseases, care for pregnant women and for babies, including vaccinations.

Birth defects in a rural province in Papua New Guinea

BackgroundGlobally, birth defects are the fourth most common cause of neonatal mortality. They cause substantial morbidity, and often long-term disability. Despite this, the impact of birth defects on public health...

Communication of health messages using theatre: Appreciative inquiry from Ubuntu theatre group.

Theatre involves expressing meaning in a collaborative art using words, movements, and visual elements. However, theatre remains poorly used as a viable teaching strategy or a method for communicating health messages. Instead, it is relegated to solemnly transmitting indigenous knowledge. To explore and describe communication of educational health messages through theatre using an appreciative inquiry approach. The study was conducted among the Ubuntu theatre group from a rural province in South Africa. The group is famous for using theatre to communicate educational health messages through the lens of Ubuntu philosophy. A qualitative exploratory descriptive design was followed. A non-probability purposive sampling was used to select thirteen members of the Ubuntu theatre group. Data were collected by two moderators from the two focus group discussions through conference calls. Deductive thematic content data analysis was used to describe the 4-Ds of appreciative inquiry. Theatre is a playful pedagogy that can cut through language and cultural barriers when used to communicate educational health messages. There is a need to formalise it as an alternative pedagogy within the health care sciences curriculum. Furthermore, the sustainability of theatre as an educational tool is dependent on expanding educational practices, documenting its success stories and periodical in-service training. Using Ubuntu innovation to communicate complex educational health messages through theatre can maximise learning. This study recommends that Ubuntu-infused health messages be conveyed using theatre. The study adds to the body of knowledge by presenting Ubuntu innovation in communicating health messages through theatre.

Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa.

The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.

Double malnutrition and associated factors in a middle-aged and older, rural South African population

IntroductionDouble malnutrition (co-existing overnutrition and undernutrition) is increasingly prevalent in sub-Saharan Africa due to rapid epidemiological and nutritional transitions. In this region, studies of double malnutrition have largely been conducted at country and household level, with individual-level studies primarily limited to children and women of reproductive age. We investigated the prevalence and determinants of individual-level double malnutrition in middle-aged and older adults who constitute an increasing proportion of the sub-Saharan African population.Methods250 individuals aged 40–70 years (50% women) and resident in the Agincourt Health and socio-Demographic Surveillance System in rural Mpumalanga province, South Africa, were randomly selected. Double malnutrition was defined as overweight/obesity and anaemia only, overweight/obesity and iodine insufficiency, or overweight/obesity and any micronutrient deficiency (anaemia and/or iodine insufficiency). The Chi-squared goodness of fit test was used to compare the expected and observed numbers of individuals with the type of double malnutrition. Logistic regression was used to investigate determinants of each type of double malnutrition.ResultsDouble malnutrition was present in 22–36% of participants, depending on the definition used. All types of double malnutrition were more common in women than in men (overweight/obesity and anaemia: 34% vs. 10.2%, p < 0.01; overweight/obesity and iodine insufficiency: 32% vs. 12.2%, p < 0.01 and overweight/obesity and any micronutrient deficiency: 50.5% vs. 20.4%, p < 0.01). There were no differences between the overall expected and observed numbers of individuals with combinations of overweight and micronutrient deficiencies [overweight/obesity and anaemia (p = 0.28), overweight/obesity and iodine insufficiency (p = 0.27) or overweight/obesity and any micronutrient deficiency (p = 0.99)]. In models adjusted for socio-demographic factors, HIV and antiretroviral drug status, and food security or dietary diversity, men were 84–85% less likely than women to have overweight/obesity and anaemia, 65% less likely to have overweight/obesity and iodine insufficiency and 74% less likely to have overweight/obesity and any micronutrient deficiency.ConclusionsIndividual-level double malnutrition is prevalent in middle-aged and older adults in a rural sub-Saharan African community. Interventions to improve nutrition in similar settings should target individuals throughout the life course and a focus on women may be warranted.

Collaborative international partnership: Enabling the development of a state-of-the-art minimally invasive surgical center in rural Uganda through telementoring.

Access to minimally invasive surgery (MIS) is limited in Sub-Saharan African countries. In 2019, the Mount Sinai Department of Surgery in New York collaborated with local Ugandans to construct the Kyabirwa Surgical Center (KSC), an independent, replicable, self-sustaining ambulatory surgical center in Uganda. We developed a focused MIS training program using a combination of in-person training and supervised telementoring. We present the results of our initial MIS telementoring experience. We worked jointly with Ugandan staff to construct the KSC in the rural province of Jinja. A solar-powered backup battery system ensured continuous power availability. Underground fiber optic cables were installed to provide stable high-speed Internet. The local Ugandan general surgeon (JOD) underwent a mini-fellowship in MIS and then trained extensively using the Fundamentals of Laparoscopic Surgery program. After a weeklong in-person session to train the Ugandan OR team, JOD performed laparoscopic cases with telementoring, which was conducted remotely by surgeons in New York via audiovisual feeds from the KSC OR. From October 2021 to February 2024, JOD performed 61 telementored laparoscopic operations at KSC including 37 appendectomies and 24 cholecystectomies. Feedback was provided regarding patient positioning, port placement, surgical technique, instrument use, and critical steps of the operation. There were no intra-operative complications. Postoperatively, field medical workers visited patients at home to collect follow-up information. Two superficial wound infections (3.3%) were reported in the short-term follow-up. Telementoring can be safely implemented to assist surgeons in previously underserved areas to provide advanced laparoscopic surgical care to the local patient population.

Combination treatment of WHO standard drugs and Artemisia Afra for pulmonary tuberculosis - a Pilot study of 25 multi resistant patients

Introduction: Tuberculosis is one of the leading infectious causes of death worldwide. The WHO estimates that 1.7 billion people close to one quarter of the humanity are infected with Mycobacterium Tuberculosis the bacteria that causes TB. Last year, 10.6 million fell ill from TB and 1.6 million died.1 Moreover, multi resistance to the current anti-tuberculosis drugs is growing thus causing a serious challenge in controlling the spread of the disease worldwide. Fortunately, as we demonstrated on previous studies that Artemisia Afra infusions given with the WHO approved drugs can shorten treatment duration and resistance from 9 months to 52 days maximum2 and out of the 102 patients 95 were cured in 30 days and 7 in 52 days. Most recently we also demonstrated that 25 patients of regular tuberculosis completely recovered after 30 days or less by combining Artemisia Afra infusions whereby the other 25 patients who took the WHO treatment ALONE either abandoned their treatment and if they continued it, they were still sick on day 30.3 The objective of this pilot study is to demonstrate that 25 patients with multi resistant tuberculosis when given Artemisia Afra infusions combined with second line anti tb drugs were able to recover in 35 days maximum instead of 90 days or more. Methods: This case study involved 25 patients who were all multi resistant or recidivist to the tuberculosis and have failed the first line treatment. Moreover, they were confirmed by a GeneXpert test to be resistant to Rifampicin and or Isoniazid. All patients were hospitalized at Ijenda Hospital in Bujumbura rural Province, Burundi between February, and April 2024. They were given the second line treatment at the regular dose + Artemisia Afra infusion at 330 ml three times a day. The patients were also fed with a protein rich meal and nurses made sure that medications were taken regularly according to DOT [Directly Observed Technique]. Results: All the 25 patients recovered in 35 days maximum (see details in the Tables below). Conclusion: The combination therapy [Artemisia Afra infusions+ WHO protocol] has a lot of potential in curing tuberculosis but more studies on a larger cohort [300 patients] will be carried out and there will also be a third leg with multi resistant cases that failed first line treatment with many months of sickness.

Confidence in providing methadone maintenance treatment of primary care providers in Vietnam.

Delivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in rural mountainous areas. This study aims to investigate factors related to confidence in providing methadone treatment among primary care providers in Vietnam to inform good practice development. We conducted a cross-sectional survey with 276 primary care providers who were physicians, physician assistants, nurses, pharmacists or dispensing staff from 67 communes in a mountainous province in Northern Vietnam. Using self-report scales, we measured providers' confidence in providing methadone treatment, beliefs in harm reduction, perceived work-related support, perceived stigma and risk in working with drug-using patients, and empathy towards this population. We used multiple linear regression analyses to explore factors associated with providers' confidence in providing methadone treatment in the whole sample and to compare two groups of providers who did and did not have experience providing methadone. Potential associated factors were measured at facility and provider levels. 114 (41.3%) participants had previously experience in providing methadone treatment. Providers with methadone treatment experiences had higher confidence in and more accurate knowledge of methadone treatment, perceived less stigma of working with drug-using patients, and reported more work-related support than those without experiences. Higher medical education is associated with lower confidence in providing methadone treatment among providers without methadone experiences, but higher confidence among providers with methadone experiences. Better methadone knowledge was associated with greater confidence in providing methadone treatment among inexperienced providers but not among those with experiences. Receiving work-related support was associated with greater confidence in providing treatment in both groups, regardless of their past methadone experiences. In rural provinces where methadone treatment has been expanded to primary care clinics, interventions to improve primary care providers' confidence should benefit professionals with diverse experiences in providing methadone treatment. Continued training and support at work for providers is essential to ensuring quality in decentralized methadone treatment.

Emergency medical services in Armenia: national call trends and future directions.

Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods. For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%). Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.

Unveiling school community perceptions of nutrition-friendly school initiatives in preschool settings in rural Sindh province, Pakistan: an exploratory study.

In 1995, the World Health Organization launched its Global School Health Initiative to expand the Health Promoting School (HPS). The objective of this study was to explore the perception of the school community in implementing nutrition-friendly school initiatives in preschool settings. This paper delineates the exploratory phase of a mixed-method study, which broadly aims to assess the adoption of the Nutrition Friendly School Initiative (NFSI) through a preschool preparedness intervention package in rural Sindh province, Pakistan. The study sites include three campuses of the Aga Khan School (Mirpur Sakro, Junior Campus Vur, and a community-based school in Sujawal). Participants were selected purposively from these campuses and constituted a committee named 'school community,' which was responsible for implementing all activities outlined in the intervention package. Data was gathered through in-depth interviews and consultative meeting with the school community. Thematic analysis was employed for data analysis. The analysis established five major themes that represent the participants' perception of school-based nutrition interventions in preschool settings. These five themes include (i) Challenges in health and nutrition for pre-school age children, (ii) Clarity in roles and responsibilities for school-based nutrition intervention, (iii) Advancing school-based nutrition activities and interventions, (iv) Recognizing resources requirements, (v) Opportunities and challenges for the way forward in school-based nutrition. Findings also suggest sustainability and scalability measures that include the aligning School Nutrition Policy with the school handbook, ways to engage with parents, a nutrition theme corner, the inclusion of a parenting component in the nutrition manual, and capacity building of the school community. Qualitative findings have guided the refinement of the intervention package, proposing additional measures for sustainability and scalability across AKES, P. The school community is hopeful that the implementation of the refined intervention package will enhance preschool preparedness toward achieving nutrition-friendly school checklist items. This study holds strong potential for replication in a public school setting and presents an opportunity to launch a school accreditation program to certify schools as Nutrition-friendly.

Metabolic Resistance and Not Voltage-Gated Sodium Channel Gene Mutation Is Associated with Pyrethroid Resistance of Aedes albopictus (Skuse, 1894) from Cambodia.

(1) Background: In Cambodia, Aedes albopictus is an important vector of the dengue virus. Vector control using insecticides is a major strategy implemented in managing mosquito-borne diseases. Resistance, however, threatens to undermine the use of insecticides. In this study, we present the levels of insecticide resistance of Ae. albopictus in Cambodia and the mechanisms involved. (2) Methods: Two Ae. albopictus populations were collected from the capital, Phnom Penh city, and from rural Pailin province. Adults were tested with diagnostic doses of malathion (0.8%), deltamethrin (0.03%), permethrin (0.25%), and DDT (4%) using WHO tube assays. Synergist assays using piperonyl butoxide (PBO) were implemented before the pyrethroid assays to detect the potential involvement of metabolic resistance mechanisms. Adult female mosquitoes collected from Phnom Penh and Pailin were tested for voltage-gated sodium channel (VGSC) kdr (knockdown resistance) mutations commonly found in Aedes sp.-resistant populations throughout Asia (S989P, V1016G, and F1534C), as well as for other mutations (V410L, L982W, A1007G, I1011M, T1520I, and D1763Y). (3) Results: The two populations showed resistance against all the insecticides tested (<90% mortality). The use of PBO (an inhibitor of P450s) strongly restored the efficacy of deltamethrin and permethrin against the two resistant populations. Sequences of regions of the vgsc gene showed a lack of kdr mutations known to be associated with pyrethroid resistance. However, four novel non-synonymous mutations (L412P/S, C983S, Q1554STOP, and R1718L) and twenty-nine synonymous mutations were detected. It remains to be determined whether these mutations contribute to pyrethroid resistance. (4) Conclusions: Pyrethroid resistance is occurring in two Ae. albopictus populations originating from urban and rural areas of Cambodia. The resistance is likely due to metabolic resistance specifically involving P450s monooxygenases. The levels of resistance against different insecticide classes are a cause for concern in Cambodia. Alternative tools and insecticides for controlling dengue vectors should be used to minimize disease prevalence in the country.

‘Land for my children’: Gendered moral economies, social reproduction and resistance against land grabs in rural Cambodia

AbstractThis article elaborates the connections between women's roles in household and community social reproduction and their leadership in resistance against land dispossession. Drawing on interviews with women land activists in two rural provinces, situated in south and central Cambodia, it examines the beliefs and processes of meaning‐making underpinning women's activism against state‐sanctioned land acquisitions through an examination of the symbols, discourses and imaginaries of land, home and social reproductive labour that embed their struggles. It argues that rural women's resistance makes visible gendered moral economies—moored to agrarian social relations and shaped by the modalities of social reproduction—that legitimate contestation against state‐sanctioned land dispossession.

Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa.

The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.