Rural Southern Research Articles

Prevalence of Airflow Obstruction as Measured by Spirometry, in Rural Southern Indian Adults

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu.A cross sectional survey was done in nine villages, among adults aged ≥30 years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1 s/Forced Vital Capacity (FEV1/FVC) < Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria.Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%–9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC < LLN) was 4.6% (95% CI: 3.1%–6.1%, 36), and 4.1% (95% CI: 2.7%–5.5%, 32) using post bronchodilator FEV1/FVC < 70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year.This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms.

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador.

IntroductionControl of triatomine infestation is a key strategy for the prevention of Chagas disease (CD). To promote this strategy, it is important to know which antecedents to behavioral change are the best to emphasize when promoting prevention.ObjectiveThe aim of this study was to determine predictors for intention to prevent home infestation based on the Health Belief Model (HBM), a commonly used health intervention planning theory.Materials & methodsA cross-sectional study was conducted with 112 heads of household in six communities with endemic and high rates of triatomine infestation in Loja province, Ecuador. The data was collected by a questionnaire including perceived severity, susceptibility, benefits to action, barriers to action, and self-efficacy. These data were also used to predict actual infestation of homes.ResultsCommunity members reported strong intentions to prevent home infestation. HBM constructs predicted about 14% of the observed variance in intentions. Perceived susceptibility and severity did not predict behavioral intention well; perceived barriers to small-scale action that reduce likelihood of infestation and self-efficacy in participating in surveillance systems did. Self-efficacy and perception of barriers were equally powerful predictors. The HBM constructs, however, did not predict well actual infestation.ConclusionThe findings supported the HBM as a way to predict intentions to prevent infestation of the home by triatomine bugs. The findings highlight that messages emphasizing self-efficacy in participating in surveillance systems and overcoming barriers to small-scale action that reduce likelihood of infestation, rather than a focus on risk, should be central messages when designing and implementing educational interventions for CD. The gap between behavioral intention and actual infestation reveals the need to assess home practices and their actual efficacy to fully enact and apply the HBM.

Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana

BackgroundPregnancy is an important period to promote healthy behaviors, prevent and identify diseases early and treat them to maximize the health and development of both the woman and her unborn child. A new World Health Organization antenatal care model recommends the initiation of antenatal care visit within the first trimester of gestation.This study sought to examine the timing of initiation of antenatal care among first-time mothers and associated factors in rural Southern Ghana.MethodsInformation on gestational age, timing of antenatal care, demographic and socioeconomic status of 1076 first-time mothers who gave birth in 2011 to 2013 in the Dodowa Health and Demographic Surveillance System were included in the study. The time of initiation of antenatal clinic attendance was calculated. The associations between dependent and independent variables were explored using logistic regression at 95% confidence interval in STATA version 14.2.ResultsThe mean gestational age at which the first-time mothers initiated antenatal care attendance was 3 month. Maternal age, level of education and household socioeconomic status were statistically significantly associated with timing of initiation of antenatal care attendance.ConclusionAlthough more than half of the study participants initiated ANC visit in the first trimester of pregnancy, a high proportion also started ANC attendance after the World Health Organization recommended period. Maternal age is significantly associated with timing of initiation of antenatal care visit among first-time mothers; older women were more likely to initiate antenatal care visit in the first trimester of gestation compared to the younger women.

Decentralising NCD management in rural southern Africa: evaluation of a pilot implementation study

BackgroundThe prevalence of non-communicable diseases, and associated morbidity and mortality, is increasing rapidly in low and middle-income countries where health systems often have limited access and lower quality of care. The intervention was to decentralise uncomplicated non-communicable disease (NCD) care from a hospital to nurse practitioners in health centres in a poor rural district in Eswatini, southern Africa. The objective of this study was to assess the feasibility and impact of decentralised care for NCDs within nurse-led clinics in order improve access and inform healthcare planning in Eswatini and similar settings.MethodsIn collaboration with the Eswatini Ministry of Health, we developed and implemented a package of interventions to support nurse-led delivery of care, including: clinical desk-guide for hypertension and diabetes, training modules, treatment cards and registries and patient leaflets. Ten community clinics in the Lubombo Region of Eswatini were randomly selected to be trained to deliver NCD care for a period of 18 months. Observational data on follow-up rates, blood pressure (BP), glucose etc. were recorded and evaluated. We compared blood pressure and blood glucose measurements between the first and fourth visits and fitted a linear mixed effects model.ResultsOne thousand one hundred twenty-five patients were recruited to the study. Of these patients, 573 attended for at least 4 appointments. There was a significant reduction in mean BP among hypertensive patients after four visits of 9.9 mmHg systolic and 4.7 mmHg diastolic (p = 0.01), and a non-significant reduction in fasting blood glucose among diabetic patients of 1.2 mmol/l (p = 0.2). Key components of NCD care were completed consistently by nurses throughout the intervention period, including a trend towards patients progressing from monotherapy to dual therapy in accordance with prescribing guidelines.ConclusionsThe findings suggest that management of diabetes and hypertension care in a rural district setting can be safely delivered by nurses in community clinics according to a shared care protocol. Improved access is likely to lead to improved patient compliance with treatment.

Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey

BackgroundAccording to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania.MethodsA community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization.ResultsThe vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = − 1.965 at 95% CI = -0.985 to − 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = − 0.091; p = 0.453); male partners (B = − 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = − 0.138; p = 0.244); male partners (B = − 0.155; p = 0.205)] scores increase among both pregnant women and their male partners.ConclusionDespite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.

Septic systems contribute artificial sweeteners to streams through groundwater

Artificial sweeteners are ubiquitous constituents of sanitary wastewater and are not completely attenuated by wastewater treatment processes. Consequently, artificial sweeteners are increasingly employed as a tool to detect wastewater and help evaluate its impact on aquatic environments. In rural areas, septic systems are known point sources of artificial sweeteners to groundwater, however the potential contribution of artificial sweeteners to streams via this pathway is unknown. We analyzed 294 samples from 173 stream sites in Southern Ontario, Canada, for acesulfame, saccharin, cyclamate, and sucralose, and found that 91% had one or more of these compounds present. The stream sites sampled did not have municipal wastewater treatment plants upstream and therefore septic system effluent was the most likely source of the artificial sweeteners. Acesulfame, which is the most recalcitrant of the four artificial sweeteners, was by far the most ubiquitous in streams, with a 91% detection frequency, compared to 27, 8, and 3% for saccharin, cyclamate, and sucralose, respectively. Stream concentrations ranged from non-detectable to maximum values of 225, 380, 204, and 291 ng/L for acesulfame, saccharin, cyclamate, and sucralose, respectively. We calculated that water from septic effluent contributed from <0.005% to 0.5% of streamflow, with a median value of 0.052%. This is the first study to use artificial sweetener concentrations to quantify the fraction of septic effluent reaching streams via groundwater flow. Using acesulfame concentrations, we calculated that approximately 13% of the septic effluent water generated in rural Southern Ontario eventually ends up in local streams, however this is likely a conservative estimate. Although much of the septic effluent water that reaches streams may be free of all but the most persistent anthropogenic compounds, our study demonstrates that domestic wastewater must be considered as a possible source of stream contaminants, even if municipal wastewater is not a factor in the watershed.

Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

BackgroundIncreased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care.MethodsUsing an audit tool and interviews, respectively, facility readiness and health providers’ knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training.ResultsInfection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators.ConclusionsFacility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.

Homes On-the-Road, Terrorized Cabins, and Prophetic Nightmare-scapes: Emma J. Ray's Unsettling Western Fantasies

Homes On-the-Road, Terrorized Cabins, and Prophetic Nightmare-scapesEmma J. Ray's Unsettling Western Fantasies Shelly Jarenski (bio) Despite almost thirty years of scholarship on women's experience in the mythic West of the United States, scholarship that began in many ways with Annette Kolodny's The Land Before Her, the frontier myth continues to conjure gendered notions of pioneerism, nonconformity, and adventure. Even when the gendered aspects of this myth are challenged, the American West that most people imagine is still inherently white. In many ways the story of African American women's experience as agents in one of the most palpable fantasies of American belonging has been obscured or erased.1 This erasure has given us an inaccurate sense of both the United States' and African American history. As Eric Gardner's recent work has powerfully documented, this erasure has also given us a truncated definition of African American literary history, one that is limited to the long-form stories of enslaved and ex-enslaved people in rural southern and urban northeastern geographies. And, as Kolodny argues, it has caused the prevailing fantasy of the United States' frontier to be one of "privatized erotic mastery" rather than one of a "home and familial human community within a cultivated garden" (xiii); and, to extend Kolodny, the dominance of one fantasy over the other has fueled realities of genocide and environmental exploitation. Finally, this erasure has limited our perceptions of who belongs in the nation's narratives, defining who gets to be a "real American" and who does not. However, placing African American women's narratives at the center of our study of American western literature presents a counternarrative to the mythic West by re-centering feminized ideologies of community, care, and cooperation into the pioneer fantasy, [End Page 381] including reimagining these feminized ideologies into environmental relationships. Re-centering African American women's narratives of the West also shifts African American literary history, extending it beyond rural southern and urban northeastern geographies. And, of course, re-centering African American women's narratives in our study of American western literature allows us to reimagine national belonging. This essay aims to unsettle some of our conceptions of belonging, and of the West, by studying the 1926 memoir of Seattle-based, formerly enslaved evangelical reformer and itinerant preacher Emma J. Ray, titled Twice Sold, Twice Ransomed: Autobiography of Mr. and Mrs. L. P. Ray.2 Although Ray's narrative conforms to masculine aspects of the frontier fantasy at times, more often it breaks with those norms by positing decidedly feminized ideals of resistance and coming of age. For example, Ray and her husband, L. P., find their second freedom—that is, salvation—by conforming to the norms of temperance, service, and grace. Also, Ray transitions from a meek, passive, and placating woman at the beginning of the narrative to an outspoken leader by the end, and she does so through her reliance on Black, often female, communities of piety, such as the Colored Women's Christian Temperance Union and Methodist tent revivals, rather than through any kind of isolationist self-reliance or trials with the landscape. Ray's coming of age in the midst of communities is a reversal of the "solitary Black westerner" stereotype defined by Quintard Taylor as "a solitary figure loosened from moorings of family, home, and community" (qtd. in Johnson 11). Ray's reversal and resituation of this stereotype is crucial for the way we imagine race as well as gender, as Michael Johnson argues that this figure functions imaginatively to "transcen[d] race in part by separating himself from the black (eastern) community to become a member of white (western) society" (11). Ray's coming of age is instead embedded in western, Black, religious communities led by women. In addition to these racialized and feminized modes of resistance, Ray deploys three connected, deeply unsettling themes in her autobiography: mobility, domesticity, and the environmental imaginary. These themes were of crucial importance to those people who were held in bondage's post-emancipation realities, and they have [End Page 382] special resonance for women in the context of the mythic West. These themes are unsettling in Ray...

In Word or Deed: Practices of Print and Citizenship in the Early U.S.

In Word or Deed:Practices of Print and Citizenship in the Early U.S. Nathan Jérémie Brink (bio) THE PRACTICE OF CITIZENSHIP: BLACK POLITICS AND PRINT CULTURE IN THE EARLY UNITED STATES. By Derrick R. Spires. Philadelphia: University of Pennsylvania Press, 2019. A LITERATE SOUTH: READING BEFORE EMANCIPATION. By Beth Barton Schweiger. New Haven: Yale University Press, 2019. The third chapter and seventeenth verse of the book of Colossians encourages its readers that their word and deed must be unified practices of faith. The scripture mentions shared songs and teachings, but also suggests the ethical model of Jesus demands peace and mutual concern overriding the marks of religion, people groups, and states of freedom or bondage. This scripture would be familiar to many of the antebellum urban Black activists and rural White female southern readers explored in new monographs by Derrick R. Spires and Beth Barton Schweiger. Both Spires' The Practice of Citizenship: Black Politics and Print Culture in the Early United States and Schweiger's A Literate South: [End Page 7] Reading Before Emancipation consider not only the words their subjects' read or wrote, but rather examine their literary activities as culturally and politically significant practices. For their subjects, word and deed were not distinct categories but enmeshed practices demonstrating what they thought, how they encountered ideas, and the ways they enacted them in the world. However, these books reveal that readers of the nineteenth century did not uniformly interpret what this text's proposition that in Christ there is neither slave nor free meant in their own context. They show the divergence between communities of interpreters, with some who celebrated Black humanity and fostered revolutionary social restructure, and others whose tacit or overt support upheld ideas of white superiority and the institution of slavery in the early United States. In the early nineteenth-century United States, to read, talk about, recite, or share printed material sometimes took on significant civic meaning. Spires and Schweiger each contribute to an expanding field of studies on the practices of literacy and print culture during this period that push the field beyond the literary and print culture of White cosmopolitan elites. The Practice of Citizenship and A Literate South both problematize the view that literary culture was a normative, uniform, or straightforward building block for citizenship and public virtue in the early American republic. Neither relies upon discussion of the public sphere initiated by Michael Warner that serves as a dominant paradigm for understanding the broader subject of literacy and print culture in this period.1 Spires examines the practices and agency of African American thinkers and activists and Schweiger explores the access and agency of rural, mostly White women in Southern states. Each show how their subjects' reading, writing, and participation in print culture represented important cultural and political practices. The Practice of Citizenship was awarded the St. Louis Mercantile Library Prize from the Bibliographical Society of America. It offers an exceptional balance between recovery of under-examined sources and a powerful framework for understanding the significance of Black ideas and practices of citizenship in the early-nineteenth century United States. Spires, an associate professor of English at Cornell University, takes care to recognize literary historians such as Frances Smith Foster, Jocelyn Moody, Carla Peterson, and others, on whose work he builds. In contrast to asking where Black print culture of the nineteenth century fits within theorization of the early American public sphere so commonly considered since Warner's application of Jürgen Habermas' theory, or as creating a what Joanna Brooks has theorized as a Black counterpublic in print, Spires method of "black theorizing" takes Black writers of the nineteenth century at their word.2 Instead of considering how Black ideas of the period fit scholarly paradigms "in a largely white-defined discourse," Spires pays close attention to primary sources, textual details, and social practices of Black writers, preachers, authors, and their communities whose thought and action developed "a practice of citizenship." Spires offers a refreshing suggestion to "base our working definitions of citizenship on black writers' proactive attempts to describe their own political work."3 This method of "black theorizing" in Spires draws upon the [End Page...

Alarming: high prevalence of Leishmania infantum infection in cats from southern Iran based on molecular and serological methods.

Recently, Leishmania infantum has increasingly been detected in stray cats in endemic regions of the world. Cats have been considered playing a role in the epidemiology of visceral leishmaniosis, an endemic zoonosis in Iran. The studies concerning feline leishmaniosis (FeL) allow the hypothesis that cats can be considered as potential reservoirs. The investigations on Leishmania infection in cats are very few in Iran and therefore we aimed to assess the L. infantum infection in stray cats and its possible role in transmission of the disease to human by direct agglutination test (DAT), ELISA, nested-PCR and confirmation via sequencing and phylogenetic analysis in Fars province, Iran. Whole blood samples were obtained from 174 stray cats. Anti-Leishmania antibodies were detected in the sera using DAT and ELISA. DNA was extracted from the buffy coat of each subject and PCR amplified, targeting Leishmania kDNA gene. PCR results were confirmed by sequence analysis. Prevalence of clinical signs in positive cats was 19.0%. Anti-Leishmania antibodies with different titers were detected in 48 (27.59%) and leishmanial DNA in 36 (20.69%) of the cats. The sequencing of PCR-positive cats revealed the parasite as L. infantum. A high seroprevalence of L. infantum was revealed, with higher levels in males, adult cats, and those living in rural districts and southern zones. Despite the reservoir task of cats in nature is still ambiguous, the high serological and molecular detection of L. infantum in stray cats indicates that cats are regularly bitten by infected sand flies in Fars province, southern Iran, and may have a potential reservoir role in the maintenance of L. infantum in the endemic areas of zoonotic visceral leishmaniosis in Iran. Anyway, Leishmania infection must be appraised in the differential diagnosis of cutaneous or systemic clinical signs in cats.

Delivered by Midwives: African American Midwifery in the Twentieth-Century South by Jenny M. Luke

Reviewed by: Delivered by Midwives: African American Midwifery in the Twentieth-Century South by Jenny M. Luke Sandra L. Barney Delivered by Midwives: African American Midwifery in the Twentieth-Century South. By Jenny M. Luke. (Jackson: University Press of Mississippi, 2018. Pp. x, 193. Paper, $30.00, ISBN 978-1-4968-2113-3; cloth, $90.00, ISBN 978-1-4968-1891-1.) Jenny M. Luke has written a concise book that raises a myriad of complex themes: sexism, professional identity and authority, classism, state and federal struggles over the definitions and funding of health care, and, most significant, racism in all its persistent forms. The book details the ways these mammoth struggles defined the experiences of African American midwives. Luke begins her narrative by introducing a construction, borrowed from biobehavioral health specialist Collins Airhihenbuwa, that “takes into consideration micro and macro factors of care” (p. 6). “[M]icro elements of health,” according to this model, are “those found at the grassroots level,” while “[m]acro-level health care brings with it state and federal structures and the associated hierarchy, the potential for racism, and the presumed superiority of Western modern medicine” (p. 6). Luke refers to these distinctions between micro- and macro-level institutions and experiences frequently, essentially establishing a narrative in which lay midwives were brought under the control of practitioners of scientific medicine and regulated until they were no longer economically useful; they were then outlawed by state legislators guided by medical practitioners. Her story, then, is of the triumph of the macro over the micro. [End Page 213] The great challenge is that neither the micro nor the macro was ever static or monolithic. As has been well documented, enslaved peoples shaped, to their fullest ability, the experience of captivity and forced labor. Nowhere was that truer than in the area of reproduction, as Luke acknowledges in her early chapters. The agency that lay midwives asserted on the plantations and during Reconstruction was profoundly challenged, however, when they encountered scientifically educated physicians and their allies in state governments. Luke reminds readers that the forces arrayed in support of introducing scientific advances into childbirth were diverse and varied. African American physicians, usually men, struggled to secure adequate education, residencies, and hospital privileges before the 1960s. Nurses of all races faced resistance in achieving formal education and professional status. State governments were hampered by inadequate budgets and little political will to commit to their African American citizens. When federal dollars arrived in the 1920s through programs like the Sheppard-Towner Maternity and Infancy Act (1921), physicians and reactive politicians screamed “socialized medicine” and undermined programs as often as they implemented them. Racism ran through all of these efforts, as the author acknowledges. Midwives were victimized by this mind-set while their continued practice contributed to its perpetuation. So long as racism limited efforts to secure medical education for African American physicians and nurses, and the chronic poverty of rural southern African Americans made them an undesirable patient pool for white doctors, then there was tolerance for state-sanctioned lay midwives. By the 1970s, that all changed. Physicians found new economic opportunity in obstetrics, especially if their patients possessed private health insurance. At the same time, nurse-midwives, who have always been predominantly white, sought a monopoly as the only legitimate nonphysician childbirth attendants. Luke documents the creation of a two-tiered system in many parts of the South in which less affluent women were attended by nurse-midwives and privately insured women saw physicians. Luke asserts “that the juggernaut of scientific hegemony forced into obsolescence a brand of care that held intrinsic value” (p. 145). This author helps readers see how scientific medicine was integrated into lay midwifery but demonstrates that this sharing of knowledge and skills was opportunistic. Scientifically educated doctors and their government and professional allies did not recognize the “intrinsic value” of lay midwifery, sacrificing traditional practice on the altar of science. Sandra L. Barney Lock Haven University Copyright © 2020 The Southern Historical Association

Prevalence and determinants of sleep disorders in a community in rural southern India.

. We assessed the prevalence of sleep disorders among people above 15 years of age from a rural area of Puducherry, south India. . We did a community-based cross-sectional study among people residing in four service area villages of a rural primary health centre in Puducherry, India. Probability sampling techniques were used to select participants. The Pittsburgh Sleep Quality Index was administered to detect sleep disorders among the participants. The data were entered and analysed using EpiData entry 3.1 and Stata 12 software, respectively. Association between various individual factors and sleep disorders was assessed using generalized linear models adjusting for clustering at the household level and expressed as prevalence ratio with 95% confidence interval (CI). . The mean (SD) age of the 501 participants was 38.3 (15.4) years. Poor quality of sleep was present in 36.3% (95% CI 32.2%-40.6%). In multivariate generalized linear model, age >60 years (adjusted prevalence rate ratio [aPRR] 1.68; 95% CI 1.11-2.53), female sex (aPRR 1.57; 95% CI 1.18-2.08), living in a broken family (aPRR 1.47; 95% CI 1.06-2.02) and having a television in their sleeping room (aPRR 1.40; 95% CI 1.40-1.79) were independently associated with poor quality of sleep. . A high prevalence suggests that sleep disorders are a problem in the rural community too. Capacity building among the existing health workforce to identify and treat sleep disorders and health education activities focusing on sleep hygiene among the general public are needed to tackle sleep disorders in the community.

When an Object Speaks to, for, or against Blacks: Raymond Andrews's Imaginary Construction of Radio

. From the perspective of Material Culture Studies, this article examines Raymond Andrews' observations on the material culture of the American South and explores how radio, literally and metaphorically, is constructed in his literary works as an object of often contesting, and even clashing, codes and voices. Instead of being passive and inert, the medium of radio shapes the lives of his characters by speaking to, or for, or against them. Radio provides a new media outlet for the representation of Black culture and acts as an agent in creating new social relationships in discussions of Andrews' rural Southern areas. However, radio can also be used to misrepresent Blacks, to the point where the Black audience's choice of programs is more a moral judgment than an aesthetic one. Through an analysis of Andrews' biographical and fictional stories for radio, I will argue in this article that Andrews is racially conscious of the imaginary construction of radio, which is not just a vehicle to communicate information or provide entertainment, but also shapes perception itself. Access to radio dramatically influences and changes the ways people interpret race.

Building &lt;em&gt;Benkadi&lt;/em&gt;: The Role of Trust in Malian Women's Community Savings Groups

The affective bonds between women that lead to trust and cooperation are recognized as the foundation of microfinance programs for women based on the village savings and loan association (VSLA) model. Nevertheless, there has been little anthropological consideration of how trust operates in such groups: how it is established, under what contexts it is sustained, and the importance of culturally-specific values and norms around mutual support. Through studying the concept of benkadi (cooperation or mutual aid) among Malian women who participate in community savings groups, Deubel and Boyer examine how systems of trust constitute the driving force for Saving for Change (SfC), a large-scale savings group program throughout rural southern Mali, and consider the larger implications for the sustainability of international aid programs focused on gender and development.

An Openness to Experiment: Ruy Duarte de Carvalho's Anthropological Field Photography in Rural Southern Angola and its Archival Reusages

This article explores the afterlives of the photographic production by Ruy Duarte de Carvalho (1941-2010), a Portuguese-born Angolan anthropologist who amidst the country's long-lasting civil war (1975-2002) engaged with the Ovakuvale trans-humant shepherds dwelling in the semi-arid region of southern Angola. Through the 1990s, Carvalho used analogue photographic cameras to document his field-work among the Ovakuvale, and afterwards engaged in various experiments with the medium for ethnographic purposes. Departing from the current assemblage of Carvalho's personal archive that remains after he passed away, I explore distinct photographic relations connected to public usages of his Ovakuvale images during his lifetime, to discuss the ways in which he articulated them through diverse expressive modes and ventures - such as watercolours, illustrated publications, temporary exhibitions and a theatre play. Offering the opportunity to surrender to a broad experimental practice that makes his overall Ovakuvale ethnography particularly revealing, I project through the current archival assemblage a comparative approach to the rationales guiding the presentation of his Ovakuvale field images, to discuss salient temporal relationships between his method to produce and later reuse these images in postcolonial times.

“We do not want to be served. We want to serve Chile”. The Role of Mothers’ Centers in rural areas of Southern Chile between 1973 and 1983

This article analyzes historically the relationship of rural mothers in Southern Chile with Mothers’ Centers during the first decade of the Civil-Military Dictatorship. How did the Mothers’ Centers impact on the social organization of rural women in Southern Chile between the seventies and the eighties? How was the economy of peasant women transformed through the guidelines of the Mothers’ Centers? What specific discourses were addressed to rural southern mothers during the period of study? This article claims that despite the existence of Mothers’ Centers “refounded” after the dictatorship, their impact was hindered by the historicity of women from Llanquihue and Chiloe, most of whom did not participate in these instances as they prioritized family-subsistence-related labor in remote geographical areas, or because of the political rejection of these women for their experiences of organization before the military coup.

The Devil's Music: How Christians Inspired, Condemned, and Embraced Rock 'n' Roll by Randall J. Stephens

Reviewed by: The Devil's Music: How Christians Inspired, Condemned, and Embraced Rock 'n' Roll by Randall J. Stephens Amanda Martinez (bio) The Devil's Music: How Christians Inspired, Condemned, and Embraced Rock 'n' Roll. By Randall J. Stephens. (Cambridge: Harvard University Press, 2018. Pp. 344. $29.95 cloth) Throughout the course of the twentieth-century United States, few cultural outlets proved more influential than Christianity and rock 'n' roll. And yet, rarely are the two linked in the popular imagination. Randall J. Stephens corrects this omission in historical memory with The Devil's Music: How Christians Inspired, Condemned, and Embraced Rock 'n' Roll by revealing the often complicated but nevertheless inherent relationship between Christianity and rock 'n' roll. From the early influences of the music found in Pentecostal churches, to the ensuing push and pull relationship between the two, to Christian rock's dominance by the end of the century, Stephens shows how Christianity and rock evolved with and adapted to one another. The Devil's Music begins its analysis with the early days of rock 'n' roll's national popularity, when "The rebellious, loud anthems of Black and white teenagers threatened the good order of the white Christian South and stirred the leadership and laity in Black churches as well" (p. 47). Though the music and religion appeared antithetical, Stephens shows how many early rock 'n' rollers were in fact directly influenced by the energetic, music-filled Pentecostalism they had grown up with. Throughout the 1960s, the Beatles and the growth of the counterculture continued to represent a perceived threat to [End Page 382] Christianity, stemming from fears the music distracted from or even replaced religious devotion, and beliefs rock encouraged gender deviance. By the early 1970s, however, many Christian leaders began to recognize how popular culture and its music held an unavoidable influence in the lives of young, baby boomer Americans. As growing numbers of churches began to adopt rock music and stylistic elements of the counterculture, even Billy Graham, a fierce opponent in the 1950s and 1960s, grew to embrace the music under the proper circumstances. Not all Christians, however, welcomed rock. From the 1970s onward, fundamentalists in particular continued to attack the music and its influence. Despite such criticism, Stephens shows how Christian rock grew into a powerhouse industry by the end of the century. Impressively researched, Stephens draws from a broad range of both religious and secular, mainstream sources to round out his study. Particularly refreshing were the chapters on the 1960s and 1970s, when growing numbers of younger Americans grew to embrace Christianity. Though this period is often correctly remembered for its cultural divisiveness, historical memory often oversimplifies these divisions into a youthful counterculture on the one hand, and the aging silent majority, on the other. Stephens complicates this over-simplification of generational tensions, showing how the younger and older generation compromised to create a version of conservative Christianity that was palatable to both. At times, however, this work could have benefited from more historical context and interpretation. For instance, Stephens does not provide an interpretation to the question the mainstream media posed by the early 1970s: "Why had not America become less, not more, religious?" (p. 195). What was it about the 1960s and 1970s that made Christianity increasingly attractive? Stephens does not go beyond superficial explanations of Christians simply adopting the sonic and stylistic markers of the counterculture to explain what about this period made religion grow. Though he adequately shows how Christians adopted and rejected rock, at times he could have been more forthcoming about why, and [End Page 383] under what broader historical circumstances Christianity grew. Still, this shortcoming does not distract from the overall merits of The Devil's Music, and this work should be of interest to not only those interested in popular music and religion, but conservatism and rise of the New Right, Southern history, and race. Amanda Martinez AMANDA MARTINEZ is a PhD candidate in history at the University of California, Los Angeles. Her dissertation, "Gone Country: White, Urban, and Affluent America's Appropriation of Southern Rural Identity, 1964-1996," looks at the growth of the country music audience and analyzes the social, economic, and...

Rehabilitation Intervention for Individuals With Heart Failure and Fatigue to Reduce Fatigue Impact: A Feasibility Study.

ObjectiveTo investigate feasibility of recruitment, tablet use in intervention delivery, and use of self-report outcome measures and to analyze the effect of Energy Conservation plus Problem-Solving Therapy versus Health Education interventions for individuals with heart failure-associated fatigue.MethodsThis feasibility study was a block-randomized controlled trial involving 23 adults, blinded to their group assignment, in a rural southern area in the United States. Individuals with heart failure and fatigue received the interventions for 6 weeks through videoconferencing or telephone. Participants were taught to solve their fatigue-related problems using energy conservation strategies and the process of Problem-Solving Therapy or educated about health-related topics.ResultsThe recruitment rate was 23%. All participants completed the study participation according to their group assignment, except for one participant in the Energy Conservation plus Problem-Solving Therapy group. Participants primarily used the tablet (n=21) rather than the phone (n=2). Self-report errors were noted on Activity Card Sort (n=23). Reported fatigue was significantly lower for both the Energy Conservation plus Problem-Solving Therapy (p=0.03, r=0.49) and Health Education (p=0.004, r=0.64) groups. The Health Education group reported significantly lower fatigue impact (p=0.019, r=0.48). Participation was significantly different in low-physical demand leisure activities (p=0.008; r=0.55) favoring the Energy Conservation plus Problem-Solving Therapy group.ConclusionThe recruitment and delivery of the interventions were feasible. Activity Card Sort may not be appropriate for this study population due to recall bias. The interventions warrant future research to reduce fatigue and decrease participation in sedentary activities (Clinical Trial Registration number: NCT03820674).

Geospatial analysis of dengue emergence in rural areas in the Southern Province of Sri Lanka.

Dengue is a major cause of acute febrile illness in Sri Lanka. Dengue has historically been considered an urban disease. In 2012-2013, we documented that acute dengue was surprisingly associated with self-reported rural residence in the Southern Province of Sri Lanka. Patients admitted with an acute febrile illness were enrolled from June 2012-May 2013 in a cross-sectional surveillance study at the largest tertiary care hospital in the Southern Province. Acute dengue was diagnosed by serology and virology testing. Site visits were performed to collect residential geographical coordinates. Spatial variation in odds of acute dengue was modeled using a spatial generalized additive model predicted onto a grid of coordinate pairs covering the Southern Province. Of 800 patients, 333 (41.6%) had laboratory-confirmed acute dengue. Dengue was spatially heterogeneous (local probability of acute dengue 0.26 to 0.42). There were higher than average odds of acute dengue in the rural northeast of the Southern Province and lower than average odds in the urbanized southwest of the Southern Province, including the city Galle. Our study further affirms the emergence of dengue in rural southern Sri Lanka and highlights both the need for real-time geospatial analyses to optimize public health activities as well as the importance of strengthening dengue surveillance in non-urban areas.

Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: A prospective cohort study.

Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.