Cardiovascular risk screening: a 10-year prediction cross-sectional study in a Nigerian agrarian community

Introduction

cardiovascular disease (CVD) is a major public health issue with a high global death rate and a significant death contribution from low-and middle-income countries. Modifiable and non-modifiable risk factors assessment and screening are important in their effective prevention and control. This study was designed to screen and assess cardiovascular risk factors in an agrarian community in Nigeria and to predict their 10-year CVD risk.

Methods

this was a cross-sectional study carried out in the Umueri community in Anambra State, Nigeria. Each participant responded to an epidemiologic survey using the World Health Organization (WHO) cardiovascular risk factors assessment tool with point-of-care screening procedures. The risk assessment for 10-year CV risk was conducted using region-specific WHO/ISH charts. Patients´ characteristics were analyzed and presented in frequencies and percentages.

Results

the mean age, systolic blood pressure, fasting plasma glucose, and total cholesterol of the study population were 54 years ± 1.27, 132 mmHg ± 2.088, 130 mg/dl ± 4.608, and 215 mg/dl ± 10.355 respectively. However, 98 (48.8%) have never had their blood pressure checked. About a quarter of the population had a high predicted risk of developing CVD within 10 years.

Conclusion

most of the assessed cardiovascular risk factors in the community are on average above the normal ranges and their probability risk of developing CVD within the next 10 years is high.

Rural community perceptions and practices toward the novel coronavirus (COVID-19) prevention in Konso Zone, Southern Ethiopia: a lesson for the next pandemic

Background

Corona Virus Disease (COVID-19) has provided a lesson on preparedness and coping mechanisms for similar pandemics to different community segments. To control and prevent the spreading of COVID-19, people need to possess the correct attitude and perception to follow the appropriate practices against the causative agent. Therefore, this study aimed to assess the rural community's perceptions and practices toward COVID-19 prevention among southern Ethiopia's Konso zone rural communities.

Methods

A community-based cross-sectional study conducted from April to May 2022 on 605 study participants in the Kena district of the Konso zone of Ethiopia. Participants were recruited using simple random sampling techniques. Face-to-face interviews were conducted to collect data using structured questionnaires developed from the World Health Organization guide and related literature. A logistic regression model was used to identify determinants of perception and practice.

Results

Among the 564 participants, 296 (52.5%) believed they would go to the healthcare facility if they contracted COVID-19. About 276 (48.9%) perceived that COVID-19 is not a stigma and should not be concealed. About 233 (41.3%) perceived COVID-19 would be controlled. However, the majority, 451 (80%), 440 (78%), 384 (68.1%), 381 (67.6%), 337 (59.8%), and 317 (56.2%) perceived that the cause of COVID-19 is sin, eating some food items were effective against the virus, no cases in their locality, living far away from COVID-19 area, the virus does not exist, respectively. Overall, only 22.5% of the study participants have good perceptions. About 58.5% practiced handwashing to prevent COVID-19, and 45.2% covered their mouth and nose while coughing/sneezing. Among the participants, 39.8% were vaccinated, and about a quarter (24.8%) of the respondents had good prevention practices. Participants with better educational status, use of social media as a source of information, and those with better income levels are found to be protective factors while being married is a risk factor.

Conclusion

The status of the participant's perception and preventive practices toward COVID-19 was meager. There was a substantial magnitude of wrong perceptions about controlling such pandemics. High inaccurate perceptions and low preventive practice need an urgent and sustained improvement strategy to tackle similar pandemics or epidemics.

Sense of community affects community satisfaction: Mediating role of community participation

Community satisfaction is a central component of community development because it indicates the overall contentment of residents with their community. As such, it can indicate the directions for community development. This study is aimed at examining a sense of community and community participation as factors influencing community satisfaction in the Yirgachefe district of Ethiopia. We collected data from 360 randomly selected household heads (male = 80.2%, female = 19.2%) residing in 12 rural communities. We used structural equation modeling to analyze the data. Results revealed that residents with a higher sense of community were more likely to have participated in their community and to be satisfied with their community. However, sense of community only indirectly influenced community satisfaction and had an insignificant direct effect on community satisfaction. There is a fully mediating effect of community participation between sense of community and community satisfaction. We propose policy implications based on the study.

Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias

OBJECTIVES

We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults.

METHODS

We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up.

RESULTS

A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups.

CONCLUSIONS

Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies.

CLINICAL IMPLICATIONS

This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.

"CoviSainik Program" - A Novel Public Private Partnership Initiative in the Control of COVID-19 in Rural India

Background

"CoviSainik Program" was implemented in collaboration with the Ambuja Cement Foundation and Community Medicine Department in rural districts of eight states of India from May to December 2021 to create a cadre of volunteers. The aim of the present paper is to describe the program and evaluate it so that the findings can be the guiding tool for policymakers to replicate a similar program.

Material and Method

A cross-sectional, mixed-method - concurrent study design was adopted to evaluate the program for its short-term outcomes such as gain in the basic knowledge of COVID-19 amongst master trainers and their feedback and program output viz - the proportion of volunteers trained and their profile by census sampling. Motivational factors, experiences of volunteers, and outcomes of COVID-19 work in their villages were explored by purposive with maximum diversity sampling with 62 online in-depth interviews and 8 online focus group discussions (FGDs).

Results

There was a statistically significant difference in the pre-test (12.8 ± 5.6) and post-test (25.9 ± 9.3) scores of the Master Training Program evaluation test. Out of 6534 trained volunteers, 5901 worked as volunteers, and amongst those, 47.1%, 35.1%, and 17.8% worked for ≤3 months, 3 to 6 months, and ≥6 months, respectively, in their villages. The major themes generated for motivational factors to join the program were altruism, savior nature, generating awareness, and concern for others. The major outcomes generated by trained volunteers COVID-19 vaccination were in raising awareness on COVID-19 appropriate behavior and early identification of COVID-19 cases in their villages.

Conclusion

The "CoviSainik Program" was successful in creating cadres of trained volunteers.

Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report

BACKGROUND

People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs.

OBJECTIVE

This study aimed to analyze the process of a multidisciplinary team-encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs-that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges.

METHODS

Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges.

RESULTS

Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes.

CONCLUSIONS

While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.

Demand of and Access to Health Messages Through Mass Media in the Rural Community of Eastern Ethiopia: A Mixed Method Study

Background

The demand for health-related information has increased dramatically in recent years. Media is crucial in reaching health messages to audiences, especially those who are distant and rural. Therefore, the study aimed to assess demands, access, and factors associated with access to health messages through mass media in the rural community of Kersa District of East Hararghe, Eastern Ethiopia.

Methods

A mixed-methods study was conducted from October 15 to November 20, 2020. A quantitative cross-sectional and a qualitative phenomenological study design were applied. A total of 578 participants were included by using a systematic sampling technique. Collected data were entered into Epidata version 3.1 and analyzed using SPSS version 22.0. A multivariate logistic regression analysis model was used and reported using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Statistical significance was set at p <0.05. For qualitative, six-focused group discussions (FGDs) were used and then analyzed thematically.

Results

Overall, the demand of and access to health messages through mass media was 32.5% (95% CI=28.5-34.2%) and 26.6% (95% CI=24.6-28.7%), respectively. Factors such as having electric services (AOR=2.36, 95% CI=2.13-5.41), having a mobile phone (AOR=4.56, 95% CI=4.32-8.73), exposure to TV (AOR=4.73, 95% CI=1.03-11.62), and exposure to social media and printed media (AOR=5.24, 95% CI=1.07-15.63), a preference for programs such as news, current affairs, entertainment, health and educational were 2.37, 9.47, 4.75 and 7.55 times more likely to access health messages (AOR=2.37, 95% CI=1.00-5.61; AOR=9.47, 95% CI=3.54-25.34; AOR=4.75, 95% CI=1.23-18.38; and AOR=7.55, 95% CI=3.12-8.66, respectively). Qualitative findings, participants demand for health messages from health workers, radio, and the main source for accessing the message was the radio.

Conclusion

Approximately one in every three and one in every four rural communities in the study area had demand, and access to health messages through mass media, respectively. As a result, all stakeholders should emphasize and strengthen expanding methods of reaching health messages using mass media.

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

PURPOSE

The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings.

METHODS

The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records.

FINDINGS

All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period.

CONCLUSIONS

To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.

An agricultural community's perspectives on COVID-19 testing to support safe school reopening

Introduction

School-based COVID-19 testing may be an effective strategy for reducing transmission in schools and keeping schools open. The study objective was to examine community perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening.

Methods

We conducted a qualitative study in Yakima County, an agricultural region of Washington state, where over half of residents are Hispanic/Latino. From June to July 2021, we interviewed 18 students (13 years old, on average) and 19 school employees, and conducted four focus groups (2 in Spanish, 2 in English) with 26 parents. We audio-recorded the semi-structured interviews and focus group discussions which were then transcribed. We used an inductive, constant comparison approach to code the transcripts and conducted a thematic analysis to generate themes.

Results

We identified four main themes. Students, parents, and school employees desired a return to in-person learning (Theme 1). Schools implemented numerous COVID-19 mitigation strategies (e.g., masking) to facilitate a safe return to school but felt that adding testing would not be feasible due to a lack of resources and overworked staff (Theme 2). Parents and school employees' familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4).

Discussion

Schools require adequate resources and medical personnel to implement COVID-19 testing. Individuals also need resources after testing positive, including physical space to isolate, financial resources for those without paid time off, and delivery of food and other necessities to households in rural communities.

Online art therapy pilot in the Western Isles of Scotland: a feasibility and acceptability study of a novel service in a rural community

Introduction

Art therapy, despite being an evidence-based, safe and acceptable intervention, is not widely available to clients in Scotland. Online delivery has the potential to expand the reach and accessibility, but special considerations need to be given to designing successful online art therapy services, due to the unique emphasis on the role of an image and artmaking alongside the therapeutic relationship.

Methods

A pilot online art therapy service was developed and delivered in the Western Isles of Scotland to individual adult clients wishing to increase their psychological wellbeing. This research aimed to assess feasibility and acceptability of the novel service, identify enablers and challenges in setting up and delivering the service, explore participants' expectations and experiences of art therapy and identify any impacts of the service. Mixed-method evaluation incorporated questionnaires, focus groups, interviews and Audio Image Recordings (AIRs). Findings were grouped into themes across several key areas: service setup, research procedures, intervention design and impacts and insights. Recommendations were developed for the first three areas and the last section presents indications of change and gives voice to client experience primarily.

Results

Online art therapy was described by clients as a judgement-free zone which allowed freedom to experiment, express, feel and immerse themselves in the creative flow. Other benefits included readiness to accept emotions, increased understanding of self and others and being able to see things from a new perspective. Clients recognised the unique nature of art therapy in relation to other psychological treatments and valued the freedom of expression it offered, including the non-verbal.

Discussion

This project demonstrated that online art therapy is not only a feasible an acceptable intervention, but potentially also a powerfully impactful one, capable of instilling a positive change in a surprisingly short period of time. Exploring ways to expand current and introduce new art therapy services is highly recommended. Refinement of an intervention design, tools and research procedures is recommended through further feasibility studies of a larger scale.

Examining the Relationship Between Existing Community Resources and Community Leaders' Perceptions of Resilience and Rural Health During COVID-19

This study explored the relationship between existing community resources and community leaders' perceptions of resilience and rural health during COVID-19. Observational data of material capitals (e.g., grocery stores and physical activity resources) present in five rural communities involved in a health promotion project were collected and compared with key informant interviews of perceived community health and resilience during the COVID-19 pandemic. The analysis compares the differences in community leaders' perceptions of resilience during the pandemic to the actual material capitals of the community. While these rural counties were average in terms of available physical activity and nutritional resources, the onset of the pandemic led to varying degrees of disruption in access due to structural closures of mainstay resources, as well as residents perceiving that they cannot or should not access available resources. In addition, county coalition progress was stalled as individuals and groups could not gather together to complete projects, such as building playground equipment. This study demonstrates that existing quantitative instruments, such as NEMS and PARA, fail to take into account perceived access and utility of resources. Therefore, practitioners should consider multiple ways to evaluate resources, capacity, and progress on a health intervention or program and consider community voice to ensure feasibility, relevance, and sustainability-especially when faced with a public health emergency like COVID-19.

Bone Mineral Density and Serum Bone Turnover Markers among Post-Menarchal Girls from Rural South India

Background

The data on the bone mineral density (BMD) and bone turnover markers (BTMs) in Indian adolescents are limited.

Objectives

To assess BMD at lumbar spine (LS, L1-L4) and femoral neck (FN) in South Indian post-menarchal girls and correlate it with dietary calcium intake (mg/day), physical activity score and post-menarchal years. The study also assessed serum BTMs and their correlation with chronological age in the study population.

Methods

This cross-sectional study included apparently healthy post-menarchal adolescent girls aged 12-16 years randomly selected from the community. Participants with vitamin D deficiency were excluded. The data on calcium intake and physical activity were obtained using validated questionnaires. All participants were evaluated with serum calcium, 25-hydroxy vitamin D, parathyroid hormone, N-terminal propeptide of type 1 collagen (P1NP) and Beta-CrossLaps (CTx) and BMD at LS and FN using dual X-ray absorptiometry (DXA).

Statistical Analysis

EpiData version 3.1 was used for the data entry. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21. Continuous variables were expressed as mean ± SD. Pearson's correlation coefficient (r) was calculated, and two-tailed Kendall's tau-b test was used for assessing correlation of all nonparametric measures.

Results

A total of 103 participants were screened, and data from 77 were analysed. There was a significant positive correlation of BMD at LS with chronological age (r: +0.235, P = 0.036), but not at FN. Positive correlation of BMD with increase in post-menarchal years was also noted at LS (r: +0.276, P = 0.015). There was no significant association of BMD with calcium intake and physical activity scores at both sites. There was a significant negative correlation of serum BTMs with age CTx (r: -0.596, P = 0.0001) and P1NP (r: -0.505, P = 0.0001).

Conclusion

This study provides insight into the reference BMD range at LS spine and FN in South Indian rural post-menarchal adolescent girls. BMD positively correlated, whereas BTMs negatively correlated with age. The study also provides the first Indian reference range for serum BTMs in this age group.

Breast Cancer and Screening Prevention Programmes: Perceptions of Women in a Multicultural Community in Southern Thailand

BACKGROUND

Breast cancer is a leading cause of morbidity and mortality among women worldwide and in Thailand.

OBJECTIVE

To explore perceptions of breast cancer and screening prevention programmes among a group of at-risk women in a multicultural setting in southern Thailand.

METHODS

Semi-structured in-depth interviews were used for data collection with 30 at-risk group women. Women from Muslim and Buddhist backgrounds were purposively included in this study. The thematic analysis method was used to analyse the data.

RESULTS

Four themes were identified from our data: perceptions of breast cancer, being diagnosed with breast cancer and anxiety, stigma: effects of breast cancer, and breast self-screening and prevention of breast cancer. The participants had some knowledge about the risk factors for breast cancer. However, participants perceived that breast cancer could occur to individual women at any time and that it was not possible to entirely prevent the disease, even when following a breast self-examination programme. However, most participants perceived that whether one would be afflicted by breast cancer depended also on Allah and their own karma. All participants were encouraged to attend breast self-screening training by healthcare providers of local health centres, but they had no confidence to perform self-screening soon after finishing the training programme. This became the reason for a lack of regular self-screening with responsibility left to health practitioners. Although participants were aware that breast self-screening should be their routine practice, there were multiple barriers to this, including accurate knowledge about breast cancer, belief, self-awareness, screening skills and healthcare facilities. Breast self-screening was recognised as an important means of early detection. However, most women did not perform this regularly, which could increase their risk of developing breast cancer.

CONCLUSIONS

Public health providers need to be more concerned about the perceptions, beliefs and practices regarding breast cancer and develop prevention practices that work better for women living in more diverse cultural locations so that they may be able to follow preventive practices and reduce their vulnerability to breast cancer.

Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.

Feasibility, acceptance and factors related to the implementation of telemedicine in rural areas: A scoping review protocol

Background

Telemedicine is a quickly developing service that offers more people the access to effective and high-quality healthcare. Societies residing in rural places tend to travel long distances to receive health care, usually have limited access to health care and/or postpone getting health care until a health emergency occurs. However, for telemedicine services to be accessible, a number of prerequisites including the availability of cutting-edge technology and equipment in rural areas must be present.

Objective

This scoping review aims to collect all available data on the viability, acceptability, challenges and facilitators of telemedicine in rural areas.

Methods

PubMed, Scopus and Medical collection of ProQuest are the databases chosen for an electronic search of the literature. Identification of the title and abstract will be followed by an evaluation of the paper's accuracy and eligibility in a two-fold mode; whereas the identification of papers will be openly and completely described using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart.

Conclusion

This scoping review would be among the first to offer a thorough evaluation of issues related to the viability, acceptance and implementation of telemedicine in rural areas. In order to improve the conditions of supply, demand and other circumstances relevant to the implementation of telemedicine, the results would be helpful in providing direction and recommendations for future developments in the usage of telemedicine, particularly in rural areas.

Community Perceptions of Arsenic Contaminated Drinking Water and Preferences for Risk Communication in California's San Joaquin Valley

Due to chronic exposure to elevated levels of arsenic in drinking water, thousands of Californians have increased risk for internal cancers and other adverse health effects. The mortality risk of cancer is 1 in 400 people exposed to above 10 μg/L of arsenic in their drinking water. The purpose of this community assessment was to understand the perceptions and awareness of the residents and public water representatives in rural, unincorporated farming communities of color in San Joaquin Valley, California. In our research, we asked 27 community informants about their (1) available water sources, (2) knowledge about the health impacts of arsenic, and (3) preferences for risk communication and education regarding the health impacts of arsenic-contaminated drinking water. Through our qualitative coding and analysis, we found that most community informants indicated that there was limited community awareness about the health effects of drinking water with elevated arsenic levels. Preferences for risk communication included using in-language, culturally relevant, and health literate health promotion strategies and teaching these topics through the local K-8 schools' science curriculum with a language brokerage approach to transfer student knowledge to family members. Key recommendations include implementing these communication preferences to increase community-wide knowledge about safe drinking water.

A Community-Based Cross-Sectional Study on Latrine Utilization and Associated Factors Among Rural Community of East Meskan District, Gurage Zone, Southern Ethiopia

Background

Using sanitary facilities is proven to enhance health and halt the spread of fecal-to-oral disease. Despite efforts to improve the availability of latrine facilities in developing countries like Ethiopia, finding a village that is entirely free of open defecation remains difficult. To determine the need for intervention programs and promote regular latrine usage, local data is essential.

Objectives

This study aimed to assess latrine utilization and associated factors among households in East Meskan District, Southern Ethiopia.

Methods

A community-based cross-sectional study was conducted among 630 households from April 15 to May 30, 2022. A simple random sampling technique was used to select the study households. Data were collected using an interviewer-administered structured questionnaire and an observational checklist. The collected data were then entered into Epi-Info version 7.1 and analyzed using SPSS version 21. In binary logistic regression analysis, independent variables with a P-value < .25 were considered candidates for multiple logistic regression analysis. The association was expressed in odds ratio with a 95% confidence interval (CI), and significance was declared at P-value < .05 in the final model.

Results

The magnitude of latrine utilization was 73.3% (95% CI: 69.7, 76.8) in the study district. Husband being family head (adjusted odds ratio [AOR] = 12.9; 95% CI: 5.78 ,28.90), being female (AOR = 16.4; 95% CI: 6.52, 41.27), family size less than 5 (AOR = 24.2; 95% CI: 11.49, 51.09), absence of school children (AOR = 0.3; 95% CI: 0.13, 0.51), and greater than 2 years since latrine was constructed (AOR = 14; 95% CI: 7.18, 27.41) had a significant association with latrine utilization.

Conclusion

In this study, utilization of latrines was low compared to the national target plan. Family head, sex, family size, presence of school children, and length of years in which the latrine was constructed were factors associated with latrine utilization. Thus, regular supervision of early latrine construction and utilization in communities is essential.

Value of social activities and prerequisites for continued participation of rural older adults: A qualitative study

AIMS

To explore the value of social activities and the prerequisites for continuous participation among rural older adults based on their experiences.

DESIGN

Qualitative, descriptive design.

METHODS

Individual semi-structured interviews were conducted with 14 older adults from voluntary community salons in a rural area in Japan. Participants were selected through purposeful sampling. Data were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist were used.

RESULTS

Four values of social activities were identified: "Mutual benefit connectedness," "Preventing and coping with aging," "Making life brilliant 'now'," and "Building a safety net." Three prerequisites for activities were identified: "Do not overreach," "Do not infringe on personal territory," and "Do not go against community norms." Social activities provide rural older adults with reciprocity ties, coping with aging, enhanced daily lives, and a social safety net. Continued participation in rural social activities requires adherence to cultural norms and moderation of relationship distances. Community and public health nurses are expected to promote social activities that incorporate these values and adhere to these prerequisites.

Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study

Background

Despite indications of a rapid increase in the number of hysterectomies performed in India, very few studies have methodically investigated the rate and determinants of the incidence of hysterectomy. The present study aims to estimate the rate of incidence of hysterectomy and identify predictors/determinants of incident hysterectomy in a cohort of North Indian women.

Methods

In the present study, a cohort of 1,009 ever-married North Indian women (aged 30-75 years) was followed up after a median of 8.11 years. Those hysterectomized at the baseline (63) were excluded; and of the rest 946 participants, 702 (74.2%) could be successfully followed-up. During the baseline assessment, data about sociodemographic variables, reproductive history, menopausal status, physiological health, and selected blood biochemicals were collected. During the end-line assessment, data about sociodemographic variables, current menopausal status, and incident hysterectomy were recorded.

Results

The overall rate of incidence of hysterectomy was found to be 11.59 per 1,000 women-years, in the study population. Interestingly, the incidence rates were found to be similar among pre- and post-menopausal women. Further, while late age at menarche was found to be negatively associated with incident hysterectomy, folate repletion and high triglyceride (TG) at the baseline were found to be positively associated.

Conclusions

High rate of incident hysterectomy in the studied population points toward the huge burden of gynecological morbidity and the unavailability of non-invasive protocols. Such a situation warrants immediate policy intervention. Further, maintaining TG and folate within normal physiological ranges may be beneficial in gynecological ailments necessitating hysterectomy.

To stay or not to stay: the role of sense of belonging in the retention of physicians in rural areas

Rural communities across the circumpolar region and worldwide perennially suffer from physician shortages despite decades of attempting targeted strategies for recruitment. Particularly in rural Canada, financial incentives have attracted but not retained a medical workforce. Although the importance of social connection or belonging is a long-established source of well-being, such information has not infiltrated the dialogue or action on physician retention in rural areas. A physician's sense of belonging, arising from that emotional need for social connectedness, is built via bilateral active efforts at community engagement, reciprocity, social integration of family and workplace collegiality. Links between rural upbringing, rural training opportunities and subsequent rural practice likely rest upon fostering this sense of belonging. Policymakers and recruiters might consider how to help physicians adapt, "fit in", and consider they have "come home" when they venture off to rural settings. Empowering the community to be involved in the recruitment and retention of rural physicians may also be effective. Perhaps this approach would better address the age-old battle to retain physicians in rural Canada and around the world.

Factors influencing COVID-19 vaccine acceptance and hesitancy among rural community in Bangladesh: A cross-sectional survey based study

Although more than one hundred million beneficiaries were administered COVID-19 vaccine until 20th February, 2022 in Bangladesh; however, proportionally a low turnout has been recorded in rural places and a substantial gap exist among the people living in rural and urban areas concerning the ratio of receiving vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to identify the potential factors influencing vaccine acceptance and hesitancy among the rural community in Bangladesh. A bilingual, self-administered anonymous questionnaire was developed, and data were collected between 10th June 2021 and 14th August 2021 through face-to-face interview. 655 rural people participated in this cross-sectional study, and sampling was done randomly. Descriptive statistics and binary logistic regressions were used to explore and rationalize study objectives. Out of 655 rural participants, 552 (84.3%, 95% CI 81.2─86.8) responded to accept COVID-19 vaccine; however, minor fractions (n = 5, n% = 0.8, 95% CI 0.12-1.4) of rural community had willingness to pay (WTP) for a COVID-19 vaccine. The result of binary regression showed that "safety," "side effects," "effectiveness," and "trust" had highly significant (p <.01) and positive correlation with vaccine acceptance intention. "Rumor" had moderately significant (p <.05) and negative association while "gender" had insignificant correlation with vaccine acceptance intention. Easy and constant access to evidence-based and trustworthy information on vaccination consequences is imperative for resource-less remote people. Health communication regarding safety, side effect, and effectiveness of vaccines were identified as the most important predictor to convert vaccines to vaccinations and for ensuring mass immunization against COVID-19 in Bangladesh.

Prevalence of Pseudoexfoliation Among Adults and Its Related Ophthalmic Variables in Southern Ethiopia: A Cross-Sectional Study

PURPOSE

A community-based study was conducted to determine the prevalence and sociodemographic factors of pseudoexfoliation syndrome among adults in Southern Ethiopia.

PATIENTS AND METHODS

A community-based cross-sectional study was conducted among subjects aged 40 years or older. Subjects underwent standardized examination, including portable slit-lamp biomicroscopy before and after pupillary dilatation, and intraocular pressure measurement using Tono-Pen. Pseudoexfoliation was diagnosed on slit-lamp examination by the presence of white dandruff-like material on the pupillary margin and/or on the anterior lens capsule of one or both eyes.

RESULTS

Among 760 participants, the prevalence of pseudoexfoliation was 12.0% (95% confidence interval: 9.7-14.3%). The mean age of pseudoexfoliation cases was 63.9 years (SD 9.96, age range 40-90 years). The prevalence increased with increasing age, with 26.9% of those 60 or older affected. Slightly higher proportion of males (12.4%) were found to have pseudoexfoliation in either of the eyes than females (11.6%) which was not statistically significant (p = 0.738). Mean IOP in subjects with pseudoexfoliation was found to be 20.65 ± 5.15 mmHg, while it was 15.0 ± 2.3 mmHg for those without pseudoexfoliation. The difference between the two populations was found to be statistically significant (P < 0.05).

CONCLUSION

The prevalence of pseudoexfoliation in eyes of people in Southern Ethiopia appears greater than that reported in other places of Africa and Asia. Pseudoexfoliation occurs at a relatively younger age in our population. Increasing age is associated with the presence of pseudoexfoliation, and pseudoexfoliation in turn is associated with higher intraocular pressure.

A conservation organisation's approach to COVID-19: Lessons learned from Madagascar

Blue Ventures (BV) works holistically with communities in Madagascar, developing transformative approaches to catalyse and sustain locally led marine conservation. In response to the coronavirus disease 2019 (COVID-19) pandemic, BV's priority was to safeguard the immediate wellbeing and livelihoods of as many communities as possible, recognising that livelihoods are integral to broader well-being. This article describes in detail BV's health response and the perceptions of BV's Madagascar team regarding the successes and challenges of this effort. As a result of the combined efforts of BV teams across Madagascar and in the United Kingdom, the existing healthcare services at BV's sites were maintained, and messages about recognising and dealing with COVID-19 and the importance of vaccination were conveyed to communities that might otherwise not have received comprehensive information. Data were also collected on suspected cases in areas where testing was not available, and outbreaks of suspected COVID-19 cases were managed. Because BV's teams are embedded within the communities where they work, they maintain strong relationships with communities and conveyed important messages around reducing the spread of COVID-19, not only via activities in response to the pandemic but also through activities for other programmes such as fisheries and livelihoods. Blue Ventures' holistic approach ensured that the organisation had a multidimensional understanding of the impacts of the pandemic on communities, facilitating the development of more relevant messaging that considered both safety and the need for continued income-generating activities. Staff felt that an effective public health response was facilitated by strong in-country partnerships and BV's long-standing presence in communities.

CONTRIBUTION

The challenges in responding to the pandemic and in implementing and maintaining effective behaviour change are discussed. Although not an objective study of the effectiveness of the response or a comparison with other approaches, the lessons learned from this process are shared in the hope that they may inform responses to future shocks in low-income countries.

Screening of Endocrine Disrupting Potential of Surface Waters via an Affinity-Based Biosensor in a Rural Community in the Yellow River Basin, China

Overcoming the limitations of traditional analytical methods and developing technologies to continuously monitor environments and produce a comprehensive picture of potential endocrine-disrupting chemicals (EDCs) has been an ongoing challenge. Herein, we developed a portable nuclear receptor (NR)-based biosensor within 90 min to perform highly sensitive analyses of a broad range of EDCs in environmental water samples. Based on the specific binding of the fluorescence-labeled NRs with their ligands, the receptors were attached to the EDC-functionalized fiber surface by competing with EDCs in the samples. The biosensor emitted fluorescence due to the evanescent wave excitation, thereby resulting in a turn-off sensing mode. The biosensor showed a detection limit of 5 ng/L E₂-binding activity equivalent (E₂-BAE) and 93 ng/L T₃-BAE. As a case study, the biosensor was used to map the estrogenic binding activities of surface waters obtained from a rural community in the Yellow River basin in China. When the results obtained were compared with those from the traditional yeast two-hybrid bioassay, a high correlation was observed. It is anticipated that the good universality and versatility exhibited by this biosensor for various EDCs, which is achieved by using different NRs, will significantly promote the continuous assessment of global EDCs.

Associations between Perception of Help-Seeking Behaviors and Quality of Life among Older People in Rural Communities: A Cross-Sectional Study

Older people's help-seeking behaviors (HSBs) may be limited because of various factors and are essential in improving healthcare in aging societies. This cross-sectional study investigated the association between perception of HSBs, concrete HSBs, quality of life (QOL), and other variables among people over 65 in rural Japan using standardized questionnaires. Participants were divided into high or low health status index score groups based on a median split. Logistic regression was used to assess the association between perception of HSBs and high QOL while controlling for age, sex, living conditions, annual health checks, having chronic diseases, regular clinic visits, smoking, habitual alcohol consumption, education, living conditions, social support, social capital, socioeconomic status (SES), and health literacy. Participants in the high QOL group were younger (p < 0.001), and had fewer chronic diseases and regular clinic visits than those in the low QOL group (p < 0.001). The multivariate logistic regression model revealed that age, chronic diseases, tobacco usage, family consultation, and consulting primary care physicians negatively predicted QOL. High SES, social capital and support, and HSB intention positively predicted QOL. Self-efficacy and intention regarding HSBs should be investigated to improve health among older rural people.

Promoting Health and Behavior Change through Evidence-Based Landscape Interventions in Rural Communities: A Pilot Protocol

Rural communities in the United States have many public health issues, including a high prevalence of physical inactivity, obesity, and higher risks for major non-communicable diseases. A lack of safe and convenient places to exercise could intensify healthy lifestyle disparities. Individually adapted physical activity prescriptions at the primary level of healthcare could play a role in behavior change for rural residents. Healthcare professionals and designers created the rural wellness hub concept, which integrates walking trails and therapeutic landscape features on the clinic site, to support patient physician-prescribed activities and treatments. This research protocol reports the design and implementation of the rural wellness hub at a clinic in Clay County, West Virginia. Following a participatory, evidence-based landscape intervention (EBLI) protocol, 58 user representatives (patient = 49; clinic employee = 9) participated in the four-phase protocol: (1) pre-design survey, (2) design and development, (3) post-design interview, and (4) post-occupancy evaluation. Survey and interview data from all phases were collected and analyzed. The preliminary results indicate that the redesigned clinic campus could promote several health programs among local communities, with the benefits of walking trails, in particular, highlighted. The rigorous EBLI protocol could serve as a template for rural communities that seek to develop similar healthcare intervention programs.

Risk Factors for Delayed Diagnosis of Acute Cholecystitis among Rural Older Patients: A Retrospective Cohort Study

Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous drainage, depending on the patient’s condition. The symptoms of acute cholecystitis in older patients may be atypical and difficult to diagnose, causing delayed treatment. Clarifying the risk factors for delayed diagnosis among older patients could lead to early diagnosis and treatment of acute cholecystitis. This study aimed to explore the risk factors for delayed diagnosis of acute cholecystitis among rural older patients. Material and Methods: This retrospective cohort study included patients aged over 65 years diagnosed with acute cholecystitis at a rural community hospital. The primary outcome was the time from symptom onset to acute cholecystitis diagnosis. We reviewed the electronic medical records of patients with acute cholecystitis and investigated whether they were diagnosed and treated for the condition at the time of symptom onset. Results: The average ages of the control and exposure groups were 77.71 years (standard deviation [SD] = 14.62) and 80.13 years (SD = 13.95), respectively. Additionally, 41.7% and 64.1% of the participants in the control and exposure groups, respectively, were men. The logistic regression model revealed that the serum albumin level was significantly related to a time to diagnosis > 3 days (odds ratio = 0.51; 95% confidence interval, 0.28−0.94). Conclusion: Low serum albumin levels are related to delayed diagnosis of cholecystitis and male sex. The presence of abdominal pain and a high body mass index (BMI) may be related to early cholecystitis diagnosis. Clinicians should be concerned about the delay in cholecystitis diagnosis in older female patients with poor nutritional conditions, including low serum albumin levels, a low BMI, vague symptoms, and no abdominal pain.

Cohort profile of the largest health & demographic surveillance system (Dibrugarh-HDSS) from North-East India

Dibrugarh Health and Demographic Surveillance System (Dibrugarh-HDSS), was started in the year 2019 with the objective to create the health and demographic database of a population from a defined geographical area and a surveillance system for providing technical assistance for the implementation of programmes and formulating intervention strategies for reducing disease morbidities and mortalities in the population. Dibrugarh-HDSS adopted a panel design and covered 60 contiguous villages and 20 tea gardens. Line listing of all the households was conducted and a unique identification number detailing State, district, village/tea garden and serial number was provided along with geotagging. Detailed sociodemographic variables, anthropometric measurements (subjects ≥five years) and blood pressure data (subjects ≥18 yr), disease morbidity and mortality were collected. All data were collected in pre-designed and pre-tested questionnaires using a mobile application package developed for this purpose. Dibrugarh-HDSS included a total of 106,769 individuals (rural: 46,762, tea garden: 60,007) with 52,934 males (49.6%) and 53,835 females (50.4%). The number of females per thousand males were significantly higher (1042 in tea garden vs. 985 in rural populations) in the tea-garden community as compared to the village population. More than one-third (35.1%) of tea populations were illiterate compared to the rural population (17.1%). Villagers had significantly higher body mass index than the tea-garden community. The overall prevalence of hypertension (adjusted for age) was 29.4 vs. 28.2 per cent, respectively, for the village and tea-garden population. For both these communities, males (village=30.8%, tea garden=31.1%) showed a higher prevalence of hypertension (adjusted for age) than females (village=28.2%, tea garden=25.8%). The findings of the present study give an insight into the profile of the native rural and tea-garden populations that will help to identify risk factors of different health problems, review the effectiveness of different ongoing programmes, implement intervention strategies for reducing morbidity and mortality and assist the State health authorities in prioritizing their resource allocation and implementation strategies.

Effects of connection to nature on residents' perceptions of conservation policy justice of Natura 2000

We examined the effects of human connection to nature on residents' concerns about justice in conservation policies of Natura 2000. Expansion of Natura 2000 conservation network has resulted in local communities having to consider Natura 2000 in their development plans, and justice concerns have been strong in some communities near Natura 2000 sites. We conceptualized Natura 2000 justice within a framework composed of 3 domains of conservation justice: distribution, recognition, and representation. To examine the effect of nature connection on perceived justice of Natura 2000, we conducted a door-to-door survey of rural resident (80.09% response rate) in 3 municipalities of Pomerania in Poland. The effect of connection to nature on perceived distribution of Natura 2000 benefits was positive (b = 0.187, t = 7.057, p < 0.001); perceived communication about Natura 2000 was positive (b = 0.089, t = 2.940 p < 0.01); perception of limitations was positive (b = 0.078, t = 2.416, p < 0.01); perceived recognition was positive (b = 0.117, t = 3.367, p < 0.001); and perceived representation was positive (b = 0.123, t = 5.015, p < 0.001). Our results suggest local residents' bonds with nature matter and they should be considered when new conservation approaches, such as Natura 2000, are introduced.

Underreported Human Exposure to Mycotoxins: The Case of South Africa

South Africa (SA) is a leading exporter of maize in Africa. The commercial maize farming sector contributes to about 85% of the overall maize produced. More than 33% of South Africa’s population live in rural settlements, and their livelihoods depend entirely on subsistence farming. The subsistence farming system promotes fungal growth and mycotoxin production. This review aims to investigate the exposure levels of the rural population of South Africa to dietary mycotoxins contrary to several reports issued concerning the safety of South African maize. A systematic search was conducted using Google Scholar. Maize is a staple food in South Africa and consumption rates in rural and urban communities are different, for instance, intake may be 1–2 kg/person/day and 400 g/person/day, respectively. Commercial and subsistence maize farming techniques are different. There exist differences influencing the composition of mycotoxins in food commodities from both sectors. Depending on the levels of contamination, dietary exposure of South Africans to mycotoxins is evident in the high levels of fumonisins (FBs) that have been detected in SA home-grown maize. Other potential sources of exposure to mycotoxins, such as carryover effects from animal products and processed foods, were reviewed. The combined effects between FBs and aflatoxins (AFs) have been reported in humans/animals and should not be ignored, as sporadic breakouts of aflatoxicosis have been reported in South Africa. These reports are not a true representation of the entire country as reports from the subsistence-farming rural communities show high incidence of maize contaminated with both AFs and FBs. While commercial farmers and exporters have all the resources needed to perform laboratory analyses of maize products, the greater challenge in combatting mycotoxin exposure is encountered in rural communities with predominantly subsistence farming systems, where conventional food surveillance is lacking.

Improvement in Quality of Life through Self-Management of Mild Symptoms during the COVID-19 Pandemic: A Prospective Cohort Study

The COVID-19 pandemic has inhibited people's help-seeking behaviors (HSBs). In particular, older people in rural communities experienced limited access to medical care, which negatively affected their quality of life (QOL). Within HSB, self-management of mild symptoms may mitigate the difficulties experienced by older people in rural communities. However, few studies have examined the relationship between self-management and QOL. Therefore, we conducted a prospective cohort study to clarify this relationship. Our participants were over 65 years of age and lived in rural communities. QOL was measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L). Demographic data and QOL were collected from participants via questionnaires in 2021 and 2022. The exposure group showed a significantly greater change in EQ-5D-5L health status index scores than the control group (p = 0.002). In addition, the exposure group scored significantly lower than the control group on the EQ-5D-5L dimension "usual activities" in 2021 and on all dimensions in 2022. Thus, self-management of mild symptoms may improve QOL among older people in rural communities during the COVID-19 pandemic. Educational interventions for this population regarding self-management could improve QOL for entire communities.

Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas

Research examining homelessness in rural areas has been sparse. The current study aims to expand conceptions of rural homelessness by mapping community-level risk factors related to housing insecurity. Geographic information systems (GIS) techniques were used to map the distribution of select community-level risk indicators in the State of Maine. Three methodological choices related to this process are demonstrated: (1) selection and distribution of housing insecurity risk indicators; (2) use of location quotients; and (3) use of spatial lags. After examining and mapping selected risk factors against the location of homeless service supports, four areas in Maine were identified as communities of concern for housing insecurity. Better understanding the extent and location of areas of high need that are resource poor can help service and funding agencies to plan for the more efficient and effective distribution of homeless prevention and mitigation services. Implications for research in rural areas are discussed.

Physical Inactivity and Possible Sarcopenia in Rural Community Daycare Stations of Taiwan: A Cross-Sectional Study

Physical inactivity and possible sarcopenia pose a challenge for long-term care, especially in rural areas. We aimed to examine the prevalence of and associated factors for physical inactivity and possible sarcopenia in rural community daycare stations. A total of 275 adults aged 55–98 years (75% women) were recruited from all 11 rural community daycare stations in Northern Hualien, Taiwan. Physical inactivity was defined as less than 150 min/week of moderate-intensity aerobic physical activity. Possible sarcopenia was defined according to the Asian-specific criteria from 2019. Multiple linear and logistic regression analyses were used to determine associated factors for physical inactivity and possible sarcopenia. The prevalence of physical inactivity and possible sarcopenia was 29.1% and 68.7%, respectively. About 86.8% of possible sarcopenia were ascribed to poor five-times-sit-to-stand performance. After adjusting for covariates, poor lower-limb muscle function, e.g., slow gait speed, was associated with possible sarcopenia and physical inactivity. However, physical inactivity was not independently associated with possible sarcopenia (adjusted odds ratio 1.95, 95% confidence interval 0.88–4.30, p = 0.100). Our results indicated that individuals with poor lower-limb muscle function were more likely to have possible sarcopenia and physical inactivity. Improving lower-limb muscle function would be a priority task in rural community daycare stations.

The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study

BACKGROUND

The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China.

OBJECTIVE

In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet.

METHODS

Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants' behavior during the web-based operational tasks.

RESULTS

A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet.

CONCLUSIONS

Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information.

Blastocystis One Health Approach in a Rural Community of Northern Thailand: Prevalence, Subtypes and Novel Transmission Routes

Blastocystis is the most commonly found eukaryote in the gut of humans and other animals. This protist is extremely heterogeneous genetically and is classified into 28 subtypes (STs) based on the small subunit ribosomal RNA (SSU rRNA) gene. Numerous studies exist on prevalence of the organism, which usually focus on either humans or animals or the environment, while only a handful investigates all three sources simultaneously. Consequently, understanding of Blastocystis transmission dynamics remains inadequate. Our aim was to explore Blastocystis under the One Health perspective using a rural community in northern Thailand as our study area. We surveyed human, other animal and environmental samples using both morphological and molecular approaches. Prevalence rates of Blastocystis were 73% in human hosts (n = 45), 100% in non-human hosts (n = 44) and 91% in environmental samples (n = 35). Overall, ten subtypes were identified (ST1, ST2, ST3, ST4 ST5, ST6, ST7, ST10, ST23, and ST26), eight of which were detected in humans (ST1, ST2, ST3, ST4, ST5, ST7, ST10, and ST23), three in other animals (ST6, ST7, and ST23), while seven (ST1, ST3, ST6, ST7, ST10, ST23, and ST26) were found in the environment. In our investigation of transmission dynamics, we assessed various groupings both at the household and community level. Given the overall high prevalence rate, transmission amongst humans and between animals and humans are not as frequent as expected with only two subtypes being shared. This raises questions on the role of the environment on transmission of Blastocystis. Water and soil comprise the main reservoirs of the various subtypes in this community. Five subtypes are shared between humans and the environment, while three overlap between the latter and animal hosts. We propose soil as a novel route of transmission, which should be considered in future investigations. This study provides a thorough One Health perspective on Blastocystis. Using this type of approach advances our understanding on occurrence, diversity, ecology and transmission dynamics of this poorly understood, yet frequent gut resident.

Psychometric Evidence of the Attitudes Toward Food Scale for Native Hawaiians

Many efforts are being made to promote healthy eating habits and nutrition among Native Hawaiian communities by cultivating positive attitudes toward healthy foods. However, there are limited quantitative scales that have been psychometrically validated with Native Hawaiian communities. This paper examines evidence on the reliability and validity of the Attitudes Toward Food (ATF) scale used with 68 Native Hawaiian adults from Waimānalo who are participating in a backyard aquaponics intervention called Mini Ahupua'a for Lifestyle and Mea'ai through Aquaponics (MALAMA). Exploratory factor analysis (EFA) and internal consistency reliability analysis were conducted to examine the underlying constructs of the ATF scale. Cognitive interviews with 3 MALAMA participants were also conducted to analyze how participants understood, processed, and responded to the scale. Findings from the cognitive interviews provided response-process evidence of validity and acceptability. Findings from the EFA revealed 2 factors. Factor 1 contained items that discussed confidence in preparing and using healthy foods. Factor 2 contained items that involved the consumption of healthy foods. The reliability analysis suggested that the 2 factors of the ATF scale are internally consistent (Cronbach's alpha = 0.79 and 0.71, respectively). Taken together, the evidence provides provisional support for the validity and reliability of the instrument for measuring attitudes among Native Hawaiians from Waimānalo. The ATF scale may be useful for similar health and nutritional programs for Native Hawaiians in Hawai'i. Future studies with larger samples and diverse sources of validity evidence may provide additional support of the scale's validity.

Metal exposure and oxidative stress biomarkers in a Brazilian agricultural community

We examined the association between exposure to metals, metalloids, and oxidative stress biomarkers among rural community residents in Brazil. Multiple linear regression was used to evaluate associations between serum metal and metalloid concentrations and blood oxidative stress biomarkers, adjusting for sex, age, education, smoking, and alcohol use. After adjustment for covariates, glutathione peroxidase activity (GPx) was inversely and significantly associated with an increase in serum arsenic (As) levels. Positive and significant associations were seen between elevated glutathione reductase (GR) activity and serum cadmium (Cd), barium (Ba), and lead (Pb) concentrations. In addition, we observed a significant increase in malondialdehyde (MDA) levels in association with an increase in Ba levels. These findings suggest that toxic metals and metalloids such as As, Ba, Cd, and Pb alter antioxidant enzyme activities. In addition, Ba seems to promote lipid peroxidation.

Virological investigation of fatal rabies in a minor bitten by a mongrel in Nigeria

Rabies is a deadly viral disease transmitted through bites of infected animals. Outbreaks continue to escalate in Africa, with fatalities in humans, especially in rural areas, but are rarely reported. About 40% casualties occur among children of < 15 years. A 5-year-old boy on referral from a Primary Health Care Centre to a tertiary hospital presented with anxiety, confusion, agitation, hydrophobia, photo-phobia and aero-phobia, seven weeks after he was bitten by a stray dog in a rural community in Nigeria. The patient did not receive post-exposure prophylaxis and died 48 hours post admission. Confirmatory diagnosis was rabies and the phylogenetic analysis of the partial N-gene sequence of the virus localized it to Africa 2 (genotype 1) Lyssaviruses. There was 95.7-100% and 94.9-99.5% identity between the isolate and other genotype 1 Lyssaviruses and 100% homology with rabies viruses from Mali, Burkina Faso, Senegal and Central African Republic.

The Association between the Self-Management of Mild Symptoms and Quality of Life of Elderly Populations in Rural Communities: A Cross-Sectional Study

Maintaining people’s health based on their help-seeking behavior (HSB) regarding mild symptoms is essential. An effective HSB, especially self-management, can facilitate the attainment of appropriate healthcare resources and affect health outcomes such as quality of life (QOL). However, clear evidence regarding the relationship between self-management, mild symptoms, and QOL is unavailable. Therefore, this cross-sectional study investigated this association in a rural elderly population. The participants, aged over 65 years, were living in rural communities. The primary outcome of QOL was examined using the EuroQol 5-Dimension 5-Level (EQ-5D-5L). After adjusting for propensity score matching, 298 participants in the self-management usage group were matched with 298 in the group not using self-management. The most frequent HSB trend was consulting with primary care physicians, followed by self-care, consulting with families, utilizing home medicines, and buying medicines. The EQ-5D-5L scores were statistically higher in the self-management usage group than in the other group. The HSBs with a trend of using self-management were related to a high QOL. Self-management of symptoms along with other HSBs can improve elderly HSBs in rural contexts. Educational interventions and system development for HSBs in rural contexts could be effective in enhancing the QOL of rural elderly populations.

Socio-economic determinants of prenatal anaemia in rural communities of South-West Nigeria: a preliminary report

BACKGROUND

Anaemia is common worldwide and pregnant women are one of the most vulnerable group. Although, anaemia in the general population including pregnant women is multi-factorial in aetiology, the most frequent cause in pregnancy worldwide is iron deficiency. In Nigeria, an estimated prevalence of anaemia among pregnant women ranges from 35-75%. Anaemia in pregnancy (AIP) is associated with significant perinatal and maternal morbidity and mortality including premature birth and low birth weight.

AIM

The aim of this study was to determine the prevalence, demographic and socio-economic determinants of anaemia in pregnancy in a rural community of South-West Nigeria.

MATERIALS AND METHODS

One-hundred and fifty consenting pregnant women aged 18-42 years in the three trimesters were recruited from four primary health centres of Ikene Local Government of Ogun State of Nigeria after ethical approval was obtained from the Ethics Unit of the Medical officer of Health of the Local Government. Pre-tested interviewer-administered questionnaire was used to collect data on socio-demographic information and 24-hour dietary recall. Using a finger prick, the haemoglobin concentration of each respondent was determined with a haemoglobinometer (DG-300HB manufactured by DouBle, China). Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20.

RESULTS

All the respondents belonged to low socio-economic class. The mean haemoglobin (Hb) concentration obtained in this study was 10.22±1.60 g/dL with a range of 6-14.8 g/dL. Using WHO cut-off Hb concentration of 11 g/dL, the prevalence of anaemia in this study was 67.3%. The frequency of anaemia increased with increase in age group. P=0.010. About 21.4% of those with adequate dietary iron intake were anaemic when compared with 72.1% (98 of 136) of those with inadequate dietary iron intake who were anaemic. AOR-0.090; 95% CI- 0.018-0.457; P=0.004.

CONCLUSION

Increasing age, low socio-economic status, poor health education and low dietary iron intake were the predominant socio-economic determinants of prenatal anaemia in the population studied. Efforts must be intensified to alleviate poverty in rural areas and give health education on iron-rich foods to girls and women of children-bearing age in the rural communities.

Do Age-Friendly Rural Communities Affect Quality of Life? A Comparison of Perceptions from Middle-Aged and Older Adults in China

The aging population in rural areas of China faces serious challenges due to urban–rural disparities. In order to improve the active aging of rural older adults, the establishment of age-friendly communities is encouraged. However, globally, the focus is on age-friendly communities in urban areas, not reflecting rural communities. Hence, we addressed the importance of age-friendly rural communities (AFRCs) and aimed to investigate their impact on the quality of life (QoL) of older adults. We examined different perceptions of AFRCs among older adults (aged over 60) and middle-aged people (45–60) in rural communities with questionnaire surveys (n = 470 and 393, respectively). Several statistical methods, such as Chi-squared test, t-test, reliability test, and multiple regression, were adopted to investigate and compare the perceptions of these two. The results indicated that (1) middle-aged people were more satisfied with AFRC components and had a higher QoL than older adults; (2) the QoL of middle-aged people was predicted by housing, accessibility, and outdoor spaces; (3) the QoL of older adults was affected by housing, outdoor spaces, social participation, and public transportation. These findings aid in our understanding of rural communities and the QoL of rural residents. They are helpful for urban planners and policymakers to improve the planning of AFRCs and supplement research on age-friendly communities in rural areas. Practical implementations are proposed for the planning of AFRCs, such as the passive design of residential housing, grouping of community facilities together, and improvement in the hygiene of outdoor spaces in rural areas.

Prevalence and biosocial determinants of hypertension in a rural population in Edo State, Southern Nigeria

Background

Hypertension is a public health threat of global concern with increasing prevalence in many countries, including Nigeria.

Aim

The aim of the study was to determine the prevalence and determinants of hypertension in a rural agrarian community in Edo North, Nigeria.

Setting

The study was carried out in Ayua, a community in Edo North, southern Nigeria.

Methods

This cross-sectional descriptive study involved the use of a structured interviewer-administered questionnaire to obtain relevant data. Body mass index (BMI), blood pressure and glucose were recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0.

Results

Two hundred and nineteen participants aged > 15 years completed the study with a mean age of 54.03 ± 16.61 years and females comprising 159 (72.6%) of the total. The prevalence of hypertension was 27.9% (in 61 participants). Twenty-one (9.8%) respondents gave a family history of hypertension. The mean BMI amongst respondents was 27.10 ± 6.61 kg/m². Obesity and pre-obesity were found in 58 (26.5%) and 71(32.4%) respondents, respectively. The determinants of hypertension were age and BMI. Compared with those who were less than 40 years old, those aged 40–65 years and > 65 years had 1.9 and 4.2 times increased odds of developing hypertension, respectively. Similarly, compared with the non-obese, obese participants had 2.3 times increased odd of having hypertension.

Conclusion

Hypertension was highly prevalent in this rural community. Health sensitisation and intervention programmes are recommended in rural communities for early detection and management of hypertension, especially amongst older and obese adults.

Effects of the Older Family Network Program on Improving Quality of Life Among Older Adults in Thailand

BACKGROUND

The evidence of promoting family members' health care for older adults by applying family networks and theory of planned behavior will lead to mental health and lower the quality of life among older adults in rural community in Thailand is unclear.

OBJECTIVE

The study aimed to assess the effects of health promotion among older adults using an aging family network program to reduce depression and improve quality of life (QOL) among older adults.

PATIENTS AND METHODS

This quasi-experimental study was enrolled on one hundred and ten older adults and their family members. Fifty-five older adult participants joined the health promoting program using family member involvement. This program trained them to change health behaviors such as eating healthy food, exercising, emotion management and disability preventive activities to reduce dementia, stroke and falls. The program was conducted in a rural community for 12 months. A comparison group program conducted usual health promoting activities by health personnel. They evaluated quality of life (QOL) using WHOQOL-OLD measurement, and 30-item geriatric depression scale before implementing interventions and after interventions at 9th and 12th months. Data were analyzed using general linear mixed model analysis.

RESULTS

After the intervention, social support and perception of health care from family members were significantly improved at the 9th month. At the 12th month, overall QOL, sensory ability, social participation, intimacy, social support, and perception of health care from family members significantly improved. Depression was also reduced at the 12th month.

CONCLUSION

These findings demonstrated that health promotion using family members improved QOL and reduced depression long term. Policymakers should implement programs to improve QOL among older adults. They need to improve the involvement of family members when conducting health promotion among older adults and support funding due to conduct on weekends or in the evening.

Prevalence of Orthohantavirus-Reactive Antibodies in Humans and Peri-Domestic Rodents in Northern Ethiopia

In 2012, Tigray orthohantavirus was discovered in Ethiopia, but its seasonal infection in small mammals, and whether it poses a risk to humans was unknown. The occurrence of small mammals, rodents and shrews, in human inhabitations in northern Ethiopia is affected by season and presence of stone bunds. We sampled small mammals in two seasons from low- and high-density stone bund fields adjacent to houses and community-protected semi-natural habitats in Atsbi and Hagere Selam, where Tigray orthohantavirus was first discovered. We collected blood samples from both small mammals and residents using filter paper. The presence of orthohantavirus-reactive antibodies in blood was then analyzed using immunofluorescence assay (human samples) and enzyme linked immunosorbent assays (small mammal samples) with Puumala orthohantavirus as antigen. Viral RNA was detected by RT-PCR using small mammal blood samples. Total orthohantavirus prevalence (antibodies or virus RNA) in the small mammals was 3.37%. The positive animals were three Stenocephalemys albipes rats (prevalence in this species = 13.04%). The low prevalence made it impossible to determine whether season and stone bunds were associated with orthohantavirus prevalence in the small mammals. In humans, we report the first detection of orthohantavirus-reactive IgG antibodies in Ethiopia (seroprevalence = 5.26%). S. albipes lives in close proximity to humans, likely increasing the risk of zoonotic transmission.

The pattern and socio-cultural determinants of intimate partner violence in a Nigerian rural community

Background

Intimate partner violence (IPV) refers to a violation of women’s reproductive rights as it impacts on their sexual and reproductive health autonomy.

Aim

In this study, we aimed at assessing the pattern of IPV and the socio-cultural determinants and predictors of partner violence in a rural community setting where the bulk of the abuse prevails.

Setting

This study was conducted in a rural community in Southern Nigeria.

Methods

This study employed a mixed method comprising seven focus group discussions (FGDs) and quantitative components. The cross-sectional survey was conducted amongst 209 ever married or cohabited females in 2018 using the World Health Organization (WHO) multi-country survey questionnaire adapted to the study objectives. Data analysis was conducted by using IBM SPSS v21.0. The level of significance was set at p < 0.05.

Results

The overall IPV prevalence was 79.4%. The prevalence of partner’s controlling behaviour, emotional IPV, physical IPV and sexual IPV was 62.6%, 55.98%, 49.3% and 2.6%, respectively. Membership of an interest group was protective against IPV (OR = 0.430, 95% CI = 0.193–0.957) whilst the belief that a good wife obeys her partner even if she disagrees (OR = 9.201, 95% CI = 1.299–65.194) and the belief that it is the wife’s obligation to have sex with the husband even if she doesn’t feel like (OR = 2.356, 95% CI = 1.049–5.288) were risk factors.

Conclusion

The burden of IPV in the studied rural community is enormous. There should be public enlightenment to desensitise people regarding the erroneous views that encourage partner violence. We encourage women to become a part of social groups that can enhance their education and empowerment.

Evaluation of Community Resilience in Rural China-Taking Licheng Subdistrict, Guangzhou as an Example

Resilience of rural communities is becoming increasingly important to contemporary society. In this study we used a quantitative method to measure the resilience regulating ability of rural communities close to urban areas-in Licheng Subdistrict, Guangzhou City, China. The main results are as follows: (1) Rural systems close to urban areas display superior adapting and learning abilities and have a stronger overall resilience strength, the spatial distribution of which is characterized by dispersion in whole and aggregation in part; (2) the resilience of most rural economic subsystems can reach moderate or higher levels with apparent spatial agglomeration, whilst the ecological subsystem resilience and social resilience are generally weaker; the spatial distribution of the former shows a greater regional difference while the latter is in a layered layout; (3) some strategies such as rebuilding a stable ecological pattern, making use of urban resources and cultivating rural subjectivity are proposed on this basis, in order to promote the sustainable development of rural areas and realize rural revitalization. This work also gives suggestion for the creation of appropriate and effective resilience standards specifically targeted for rural community-aiming to achieve the delivery of local sustainability goals.

Vulnerability of rural households to climate-induced shocks in Lokka Abaya district, Sidama zone, southern Ethiopia

This study was conducted in rural communities of Lokka Abaya district, Sidama zone, southern Ethiopia to assess vulnerability status of men and women households to climate-induced shocks and stress. This article is based on household survey, focus group discussion and key informant interviews. A total of 258 smallholder farmers were selected from three villages using stratified random sampling. A combination of social, economic and environmental indicators was employed to develop the vulnerability index of each household head and estimate quantitatively that is vulnerability is estimated as a function of adaptive capacity, exposure and sensitivity of households. The results indicated that farmers had poor access to public services including access to affordable credit, market, health services and climate information. The survey revealed that droughts, floods, soil erosion, pests and diseases were climate-related challenges in the study area. Regarding vulnerability of households to climate variability, results indicated that around 8.5% and 18.2% of male- and female-headed households, respectively, were highly vulnerable whilst 41% and 45.5% of male- and female-headed households, respectively, were moderately vulnerable. The results confirmed that 37.7% and 27.3% of male- and female-headed households, respectively, were less vulnerable. The rest 12.8% men and 9% women were not vulnerable. Therefore, there is a need to enhance access to affordable credit, market, climate information, health, income diversification of farmers, soil and water conservation and afforestation of hilly areas if farmers need to be climate resilient.

Factors influencing physical activity: A cross-sectional study of the community-dwelling older adults in a Portuguese rural area

BACKGROUND

There are a variety of intrinsic determinants which are key to understand the reasons for older people to stay (or not) active.

OBJECTIVES

To identify and analyse the factors underlying the physical activity engagement in older Portuguese living in a rural area.

METHODS

A total of 504 community-dwelling older adults (aged ≥65 years) were enrolled in this cross-sectional study. Sociodemographic data, physical activity levels, physical fitness and body composition were analysed.

RESULTS

Gender, age, income level, lower body strength, overweight, muscle mass and sedentarism (sitting time) were significantly associated with different physical activity levels. The multinomial logistic regression pointed out that dynamic balance, BMI and sitting time for moderate levels, as well as muscle mass for high levels, were the main independent factors that seem to influence the engagement in these levels compared to low physical activity levels. Additionally, classification tree analysis confirmed sitting time, dynamic balance and gender as discriminating factors for physical activity levels.

CONCLUSION

Physical fitness-related variables seem to mainly determine the levels of physical activity in the studied population. Thus, nursing care must promote the integration of physical activity into daily life routines of community-dwelling older adults, especially in rural areas.

IMPLICATIONS FOR PRACTICE

The diverse nature of factors influencing physical activity must be taken into account in primary health care, particularly in rural areas. Nursing care for older people must promote the integration of physical activity into daily life routines of community-dwelling older adults.

Social Work Responses and Household-level Determinants of Coronavirus Preparedness in Rural Ethiopia

The novel coronavirus caused the death of many people globally, and in Ethiopia. The death of people due to COVID surpasses 1,466,289with more than 63,135,973 cases in the world. This study aimed to identify the barriers toward the understanding of COVID-19, the rural (agrarians) public commitment to respond coronavirus, and the factors that affect their preparedness in rural Ethiopia. Probit regression and descriptive statistics were used to analyze data from a sample of 190 respondents. The result revealed that the public infrastructural problems (roads, health centers, telecommunication and broadcasting service) were the main barriers identified in this study. In response, the agricultural and health extension providers, college and university students, local administrators and government official, religious leaders, and community elders were contributing to enhance the public understanding and preparedness. The model result confirmed that gender, age group, family education level, membership to communal association, family mobile usage, health extension service, non-farm income, and economic situation were significant factors for preparedness. Intervention aimed at easing identified key limit factors to rural and agrarian community preparedness as well as the way to enhance public understanding through reasonable support to local stakeholders against COVID-19.

"He Never Wants to Leave. I Would Leave in a Second." Examining Perceptions of Rural Life and its Impact on Families who Migrate for Employment and Those who Stay Behind in Atlantic Canadian Communities

In Canada, interprovincial labor migration is a common form of mobile work that is significant for rural communities especially in Atlantic Canada. Unique to this form of labor migration is the gendered nature of the phenomenon resulting in men often leaving their wives, families and rural communities behind for employment opportunities in the oil and gas sectors thousands of kilometers away. As men leave their families and communities for employment, women who are left behind become primary caregivers to children in addition to also being the primary caretakers of the family home. The Tale of Two Islands project was a multi-year, cross regional mixed methods research study that examined labor mobility and its impact on families and communities. This paper examines how labor migration has impacted families and rural communities. Drawing upon focus group, conversational and key informant interviews with families impacted by mobile labor and practitioners who serve them, societal perceptions of gendered norms and perceptions of rural life became illuminated. This has contributed to multiple contradictions and role confusion as families adapt and adjust to periods of reunification and separation while striving to remain connected to their rural communities. Men yearn for opportunities to be an active member of their home communities but cannot a result of living away for extended periods of time. In contrast, women who stay behind in rural communities often chose to isolate from community activities as a result of perceived judgments that are attributed to traditional views of rural life and family roles.