Treatment In Rural Areas Research Articles

Regional Collaboration in Healthcare: A view from a health care initiative for people with epilepsy in rural areas of China

Regional Collaboration in Healthcare: A view from a health care initiative for people with epilepsy in rural areas of China

Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

BackgroundThe Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV) under the acquired immunodeficiency syndrome (AIDS) care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART) under the national Free Care Program (China CARES).MethodsA retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV) treatment year.ResultsFive ARV regimens are commonly used in China CARES: zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP), stavudine (D4T) + 3TC + efavirenz (EFV), D4T + 3TC + NVP, didanosine (DDI) + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY)) among 276 participants. The total costs for treating all adverse drug events (ADEs) and opportunistic infections (OIs) were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV) infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus <100 cells/μL, P = 0.02; and ≥200 cells/μL versus <100 cells/μL, P < 0.004), residence in Mangshi County (P < 0.0001), ADEs (P = 0.04) and OIs (P = 0.02) were significantly associated with total expenditures in the first ARV treatment year.ConclusionsThis is the first study to determine the actual costs of HIV treatment in rural areas of China. Costs for ARV drugs represented the major portion of HIV medical expenditures. Initiating HAART in patients with higher CD4 cell count levels is likely to reduce treatment expenses for ADEs and OIs in patients with AIDS.

Analysis on Affected Factors of Treatment Efficiency of Rural Sewage Removal with Constructed Wetland

Sewage treatment in rural areas is relatively lower. Most of the sewage discharged into the environment directly without any treatment. More and more severe environmental problems are threatening the rural situation. As an effective rural sewage treatment method, constructed wetland wastewater treatment technique had played an important role in the rural sewage treatment. In this paper, the constructed wetlands of Luqiao Village of Xiake Town in Jiangyin were taken as a case to explore the mechanism and effects of decontamination of constructed wetland. By using PCA method, the relationships between the removal efficiency of constructed wetlands and water temperature, water quantity, water loads, influent concentration and pH are analyzed quantitative The results showed that constructed wetland has a high rural sewage removal rate; and the water temperature, water loads, influent concentration have a greater impact on the rural sewage removal rate than water quantity and PH. The results are helpful in providing a technical reference for further improving the treatment efficiency of rural sewage removal with constructed wetland ecological system

Injections that kill: nosocomial bacteraemia and degedege in Tanzania

In Tanzania and some other African rural settings, a traditional proscription of injections for the treatment of cerebral malaria (degedege) stems from parents' fear that injections will kill a child with fever and convulsions. The re-use of injection equipment in rural clinics is associated with bacterial contamination even where sterilization is practiced to prevent HIV transmission. A secondary infection with bacterial sepsis is indistinguishable from non-responsive malaria on clinical examination, and may be a significantly under-reported adverse event in rural Tanzania. In a prospective survey of patients whose venous catheter was culture positive on removal, 61% developed bloodstream infections. Parents report having witnessed a child's death following an injection for the treatment of fever and convulsions in rural Tanzania, and some traditional healers who would refer a child with uncomplicated malaria for Western biomedical treatment are convinced that injections are fatal for a child with convulsions. Injection drug users learn aseptic technique to avoid what is called a 'dirty hit', a systemic infection that is felt immediately after injecting, indicating sudden deterioration is likely in a sick child if an IV injection is unsafe. Community mistrust of injection providers has been too casually attributed to superstition; to address parents' concerns, injection safety should be a priority in rural health services. Intravenous injections carry a 0.2% risk of acute bacteremia when given with unsterile equipment, while unsafe infusions carry a 3.7% risk of infection, much greater than the risk from intramuscular injections of vaccine. Sepsis should be considered an important adverse event in the management of severe malaria, but the diagnosis of nosocomial bloodstream infections is a challenge in hospitals that cannot culture for bacteria. When the auto-disable syringe was introduced, patient safety improved at a Tanzanian district hospital; a reduction in the burden of serious secondary infections large enough to reduce the average inpatient length of stay was observed. Nosocomial bloodstream infections are a common cause of fever in Tanzanian hospitals. In Tanzania, bacteremia is sometimes associated with more deaths in hospitals than malaria. Although other obstacles to appropriate treatment for malaria may be more important in rural Tanzania, the belief that injections will kill a child is suggestive of avoidable adverse events. The intensity of malaria treatment in rural areas and frequent recourse to informal sector health care presented a significant challenge for the prevention of adverse events including sepsis and HIV transmission. A household survey in rural Tanzania found that 27% of malaria treatment occurs at drug stores, and 30% of patients seek treatment at a general shop. A majority of rural patients evaluated for malaria in the formal sector have taken chloroquine before coming to the clinic. A new national injection safety policy banning the import of non-auto-disable syringes prevents injection equipment re-use in the informal sector. Improving injection safety in rural Tanzania through the introduction of auto-disable syringes will ensure that parents have nothing to fear from quinine injections and infusions that are usually life saving.

Japanese and Chinese firms aim to improve wastewater treatment in rural areas

Teijin Ltd has signed a business collaboration agreement with Yixing City Water Works & Construction Investment Co Ltd, which manages water supply and sewage systems for the city of Yixing, Jiangsu Province, China, to co-develop wastewater treatment systems for rural communities.

An epidemiological investigation of the rabies between 1999 - 2008 in Yancheng city, Jiangsu province.

To better understand the epidemiology of rabies during the past ten years in Yancheng city, Jiangsu province. Data was collected and analyzed on rabies cases in Yancheng. Density and vaccination rate on Canine, Rate of injured people bit by dogs, and the information of post-exposure prophylaxis were studied. Rabies virus in the dog brains, collected around the epidemic areas of Yancheng, were detected and analyzed. A total of 135 human rabies cases occurred from 1999 through 2008, and formed the second epidemic peak since 1958. Of these victims, 84% (114) were farmers. In general, the rate of people having dogs were 3% - 6% per 100 people, and the injured person-times of 100 dogs were 6.37 per year. Notably, the vaccination rate of dogs was only 20%. Of those people injured by dogs and other animals, 77% had received post-exposure treatment, and only 5% - 10% had been administered anti-rabies serum. Rabies virus antigen was found in 4 (3.6%) of 111 brain specimens among dogs collected from epidemic areas. Genetic analysis of N and G genes, which were amplified from brain specimens, indicated that these viruses belong to genotype I rabies and expressing a close relationship with the Chinese vaccine strain CTN. The large number of dogs with low vaccination rate among them, together with the incorrect and low post-exposure treatment in rural areas seemed to be responsible for the outbreak of rabies in Yancheng city.

A novel integrated step-feed biofilm process for the treatment of decentralized domestic wastewater in rural areas of China

For wastewater treatment in rural areas, a novel three-stage step-feed wastewater treatment system, combined with a drop-aeration biofilm process, was tested in the laboratory to investigate its performance in removing suspended solids (SS), chemical oxygen demand (COD), NH 4 +-N, total nitrogen (TN), and total phosphorus (TP). The removal rates of SS, COD and NH 4 +-N were 90%, 80%, and 90% in effluent concentrations less than 10 mg/L, 50 mg/Land8mg/L, respectively. The TP removal rate was less satisfactory. The C/N ratio in the raw wastewater was often less than 3.5, and the removal efficiency of TN was therefore limited. A carbon-release batch experiment was carried out to measure the feasibility of enhancing denitrification at low influent C/N ratios. The result showed that the C/N could be over 9.0 in the supernatant. Polymerase chain reaction denaturing gradient gel electrophoresis technology was used to reveal the changes in the bacterial community during different stages of the integrated step-feed biofilm process. The results showed that banding patterns and the distribution of dominant bands for the same experimental period in different aerobic zones were similar. Phylogenetic analysis indicated that lanes 10, 11 and 12, which presented three aerobic zones at the same operation period, had the closest phylogenetic relationship among the lanes.

Arsenic removal from aqueous solution using ferrous based red mud sludge

Ferrous based red mud sludge (FRS) which combined the iron–arsenic co-precipitation and the high arsenic adsorption features was developed aimed at low arsenic water treatment in rural areas. Arsenic removal studies shown that FRS in dosage of 0.2 or 0.3 g/l can be used effectively to remove arsenic from aqueous solutions when initial As(V) concentration was 0.2 or 0.3 mg/l. Meanwhile, turbidity of supernatant in disturbing water was lower than 2 NTU after 24 h. The pH range (4.5–8.0) for FRS in effective arsenic removal was applicable in natural circumstance. Phosphate can greatly reduce the arsenic removal efficiency while the presence of carbonate had no significant effect on arsenic removal. Arsenic fractionation experiments showed that amorphous hydrous oxide-bound arsenic was the major components. When aqueous pH was decreased from 8.0 to 4.5, arsenic in FRS was not obviously released. The high arsenic uptake capability, good settlement performance and cost-effective characteristic of FRS make it potentially attractive material for the arsenic removal in rural areas.

An introduction of a multi‐soil‐layering system: a novel green technology for wastewater treatment in rural areas

AbstractMulti‐soil‐layering (MSL) systems are designed for municipal wastewater, livestock wastewater and polluted river water treatments. They are mainly composed of soil mixture block layers and water‐permeable layers (PL). The MSL system overcomes many of the shortcomings of conventional soil treatment systems such as easy clogging, large land requirement and low hydraulic loading rate. This paper summarizes the structure, purification mechanism and practical application of the systems for different kinds of wastewater treatment. The paper also compares MSL systems with other decentralized systems such as wetland and compact filter systems in their respective structures and treatment efficiencies. Finally, the paper gives a rough evaluation of the lifespan and cost of an MSL system based on its material composition.

Forecast on the Application of Japanese Universal Service Fund to Remote Diagnosis for Frozen Section

Due to the socioeconomic reason in Japan, some cancer patient is sometimes operated at a rural hospital where only several surgeons perform and no pathologist checks its malignancy. Therefore, the system of the remote diagnosis for frozen section has been standing up in this country for 7 years. In Japan, the USF has started from February 2007 to support only telecommunications operator's hardware (NTT's equipment such as digital switch board) in high cost areas, not for the reimbursement of the tariff of the public users, such as telepathology. To solve such social cormorant equality, when the USF and PAs were supported in the present quick frozen intraoperative telepathology diagnosis, the quality of the cancer treatment in rural area will be improved. Based on the past data of the Japanese telepathology with beta distribution function, it can be estimated that user terminals becomes five times more than present users with support of USF and PAs. Moreover, using VPN on the B'FLETS, the effect of other teleconsultations will spread to the nationwide.

Concentration and drug prices in the retail market for malaria treatment in rural Tanzania

The impact of market concentration has been little studied in markets for ambulatory care in the developing world, where the retail sector often accounts for a high proportion of treatments. This study begins to address this gap through an analysis of the consumer market for malaria treatment in rural areas of three districts in Tanzania. We developed methods for investigating market definition, sales volumes and concentration, and used these to explore the relationship between antimalarial retail prices and competition.The market was strongly geographically segmented and highly concentrated in terms of antimalarial sales. Antimalarial prices were positively associated with market concentration. High antimalarial prices were likely to be an important factor in the low proportion of care-seekers obtaining appropriate treatment.Retail sector distribution of subsidised antimalarials has been proposed to increase the coverage of effective treatment, but this analysis indicates that local market power may prevent such subsidies from being passed on to rural customers. Policymakers should consider the potential to maintain lower retail prices by decreasing concentration among antimalarial providers and recommending retail price levels.

A Novel Combined System for Onsite Domestic Wastewater Treatment in Rural Areas

A combined system, which consisted of an innovative septic tank (IST) and compound media filter bed (CMFB), was used for onsite domestic wastewater treatment in a rural area. Performance of this system was evaluated by both bench-scale and pilot-scale experiments. The system showed relatively good removal efficiency of chemical oxygen demand (COD) and suspended solids, but removal efficiencies of total phosphorus (TP) and total nitrogen (TN) were not so impressive. Correlated regression models provided good estimates of the nutrient removal performance in this system. Hydraulic retention time (HRT) had a positive effect on nutrient removal. Ambient temperature had no obvious relationship with the suspended solids (SS) and TP removal in the system. By contrast, ambient temperature had a significant effect on COD removal (p < 0.05). Furthermore, the nutrients were hard to remove in cold seasons. During the operation period, this system showed high treatment capacity for rural domestic wastewater treatment with good landscape integration. Results demonstrated that this IST + CMFB system could be a practical technology for onsite domestic wastewater treatment in rural areas.

Enhancing the Performance of Anaerobic Digestion of Dairy Manure through Phase‐Separation

AbstractAnaerobic digestion (AD) is an effective way to convert animal manures into profitable by‐products while simultaneously reducing the pollution of water, air, and soil caused by these wastes. Conventional high‐rate anaerobic reactors cannot effectively process animal manures with high solids‐containing wastes. The two‐phase configuration for AD has several advantages over conventional one‐phase processes, e. g., increased stability of the process, smaller size and cost efficient process configurations. In the present study, the experiments were carried out in a two‐phase system composed of an acidogenic reactor and a methanogenic reactor, and in a one‐phase system composed of only a methanogenic reactor. The reactors were operated as unmixed (without an external mixing aid), unsophisticated, and daily‐fed mode. It was found that the two‐phase configuration was more efficient than the one‐phase system. The biogas production in the two‐phase system at a hydraulic retention time (HRT) of 8.6 days (only methanogenic phase) was calculated to be 42% higher at an organic loading rate (OLR) of 3.5 g VS/L·day than that of the one‐phase with a HRT of 20 days. This translates into significant performance improvement and reduced volume requirement. This finding represents a further step in the achievement of wider use of simple anaerobic reactor configurations for waste treatment in rural areas.

Decentralized approaches to wastewater treatment and management: Applicability in developing countries

Providing reliable and affordable wastewater treatment in rural areas is a challenge in many parts of the world, particularly in developing countries. The problems and limitations of the centralized approaches for wastewater treatment are progressively surfacing. Centralized wastewater collection and treatment systems are costly to build and operate, especially in areas with low population densities and dispersed households. Developing countries lack both the funding to construct centralized facilities and the technical expertise to manage and operate them. Alternatively, the decentralized approach for wastewater treatment which employs a combination of onsite and/or cluster systems is gaining more attention. Such an approach allows for flexibility in management, and simple as well as complex technologies are available. The decentralized system is not only a long-term solution for small communities but is more reliable and cost effective. This paper presents a review of the various decentralized approaches to wastewater treatment and management. A discussion as to their applicability in developing countries, primarily in rural areas, and challenges faced is emphasized all through the paper. While there are many impediments and challenges towards wastewater management in developing countries, these can be overcome by suitable planning and policy implementation. Understanding the receiving environment is crucial for technology selection and should be accomplished by conducting a comprehensive site evaluation process. Centralized management of the decentralized wastewater treatment systems is essential to ensure they are inspected and maintained regularly. Management strategies should be site specific accounting for social, cultural, environmental and economic conditions in the target area.

Project ADAPT: A Program to Assess Depression and Provide Proactive Treatment in Rural Areas

We describe and evaluate a project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT-Assuring Depression Assessment and Proactive Treatment-utilized existing primary care resources to overcome barriers to sustainability experienced by similar projects. This multifaceted intervention, which was structured after the successful IMPACT (Improving Mood/Promoting Access to Collaborative Treatment) research intervention, used on-site geriatric depression specialists, clinic staff training, team collaboration, and depression practice guidelines to improve depression care for rural elders. IMPACT screening and assessment instruments and treatment protocols were modified for use by less highly trained staff already employed by the rural primary care clinics. Patient and provider depression educational materials and depression screening and monitoring protocols were provided by means of regional training sessions and phone contact. Evaluation data were collected by mail and phone surveys. Although Project ADAPT materials and training were initially developed for providers in rural primary care clinics, most participants came from long-term-care facilities, hospitals, home care, and public health and social service agencies. Forty-four sites sent 56 staff to Project ADAPT regional trainings, but many did not participate after the initial training. Participants who did continue reported that training improved geriatric depression screening and communication with the primary provider. Outcomes suggest that provider, patient, and system issues have to be addressed differently in rural areas to improve geriatric depression treatment in primary care settings.

Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study

To estimate the prevalence of HIV and associated sociodemographic factors including mobility and migration in a rural population in KwaZulu-Natal, South Africa. A household-based HIV serosurvey of a population that has been under longitudinal demographic surveillance since 2000. All residents (women aged 15-49 years; men aged 15-54 years) and a sample of non-residents ('migrants') who return periodically to their households in the area were identified and approached for finger-prick HIV testing. A total of 8325/11 505 male and 11 542/14 396 female residents were traced. Of these, 4692 men and 6859 women consented to HIV testing. Overall, 27% of female and 13.5% of male residents were HIV infected. HIV prevalence peaked at 51% among resident women aged 25-29 years and 44% among resident men aged 30-34 years, with the highest infection rates of 57.5% among 26-year-old women. The female: male infection ratio for residents aged 15-19 years was 13.0. Many factors, including increased mobility, associated with an increased risk of HIV infection among residents, were also associated with non-participation. Among non-residents, 34% of men aged 15-54 years and 41% of women aged 15-49 years were HIV infected. The extremely high prevalence of HIV suggests an urgent need to allocate adequate resources for HIV prevention and treatment in rural areas. Effective monitoring of the epidemic in Africa needs to include efforts to strengthen sentinel surveillance in rural areas and strategies for the surveillance of migrants and mobile individuals.

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

HCV‐related morbidity in a rural community of Egypt

The origin of the hepatitis C virus (HCV) epidemic in Egypt has been attributed to intravenous schistosomiasis treatment in rural areas in the 1960s to 70s. The objective of this study was to estimate the HCV-related morbidity in a rural area where mass schistosomiasis treatment campaigns took place 20-40 years before. The study sample included 2,425 village residents aged 18-65 years recruited through home-based visits. Overall, HCV antibody prevalence was 448/2,425 = 18.5% (95% CI = 16.9-20.1%), reaching 45% in males over 40 years, and 30% in females over 50 years. Of those with HCV antibodies, 284/448 (63.4%, 95% CI = 58.7-67.9%) had chronic HCV infection, among which 107/266 (40.2%, 95% CI = 34.3-46.4%) had elevated alanine aminotransferase (ALT). As part of pre-treatment screening, 26 consenting patients had a liver biopsy: 13 (50.0%) had a treatment indication. Thus, of all patients with HCV antibodies, 13 (2.9%) were eligible for treatment and willing to be treated. The relatively low level of morbidity observed in this study is discussed in view of co-factors of HCV infection progression, such as young age at infection, absence of alcohol intake, the prevalence of Schistosoma mansoni infection, and the prevalence of chronic hepatitis B.

Problem drinking: Rural and urban trends in America, 1995/1997 to 2003

Objective. Studies examining trends in problem alcohol use for U.S. adults residing in rural locations are lacking. This study examines recent trends in heavy and binge drinking in urban counties and three types of rural counties. Methods. Random-digit telephone survey of adults aged 18 years or older residing in states participating in the Behavioral Risk Factor Surveillance System, in the years 1995/1997 ( n = 247,255), 1999/2001 ( n = 362,077) and 2003 ( n = 257,659). Analyses were performed in 2006. Results. Metropolitan counties experienced higher prevalence of heavy and binge drinking than rural counties in all years, and all geographic areas showed upward trends in both drinking behaviors. Trends in heavy drinking were sharper in rural counties (3.8% to 5.4% compared with 4.9% to 6.0% in metro counties). Metropolitan and rural counties overall saw similar increases in binge drinking, however, the greatest increase occurred in remote micropolitan counties (12.7% to 15.7%). Conclusion. Heavy and binge drinking are problems that continue to increase in rural areas nationwide. Because of the difficulties inherent in accessing and administering substance abuse treatment in rural areas, special attention should be given to tailoring alcohol abuse interventions to the needs of rural residents.

Home water treatment by direct filtration with natural coagulant

Seeds of the plant species Strychnos potatorum and Moringa oleifera contain natural polyelectrolytes which can be used as coagulants to clarify turbid waters. In laboratory tests, direct filtration of a turbid surface water (turbidity 15-25 NTU, heterotrophic bacteria 280-500 cfu ml(-1), and fecal coliforms 280-500 MPN 100 ml(-1)), with seeds of S. potatorum or M. oleifera as coagulant, produced a substantial improvement in its aesthetic and microbiological quality (turbidity 0.3-1.5 NTU, heterotrophic bacteria 5-20 cfu ml(-1) and fecal coliforms 5-10 MPN 100 ml(-1)). The method appears suitable for home water treatment in rural areas of developing countries. These natural coagulants produce a 'low risk' water; however, additional disinfection or boiling should be practised during localised outbreaks/epidemics of enteric infections.