WorldWideScience

Sample records for resource setting rural

  1. Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review.

    Science.gov (United States)

    Hoeft, Theresa J; Fortney, John C; Patel, Vikram; Unützer, Jürgen

    2018-12-01

    Rural areas persistently face a shortage of mental health specialists. Task shifting, or task sharing, is an approach in global mental health that may help address unmet mental health needs in rural and other low-resource areas. This review focuses on task-shifting approaches and highlights future directions for research in this area. Systematic review on task sharing of mental health care in rural areas of high-income countries included: (1) PubMed, (2) gray literature for innovations not yet published in peer-reviewed journals, and (3) outreach to experts for additional articles. We included English language articles published before August 31, 2013, on interventions sharing mental health care tasks across a team in rural settings. We excluded literature: (1) from low- and middle-income countries, (2) involving direct transfer of care to another provider, and (3) describing clinical guidelines and shared decision-making tools. The review identified approaches to task sharing focused mainly on community health workers and primary care providers. Technology was identified as a way to leverage mental health specialists to support care across settings both within primary care and out in the community. The review also highlighted how provider education, supervision, and partnerships with local communities can support task sharing. Challenges, such as confidentiality, are often not addressed in the literature. Approaches to task sharing may improve reach and effectiveness of mental health care in rural and other low-resource settings, though important questions remain. We recommend promising research directions to address these questions. © 2017 National Rural Health Association.

  2. Ultrasound-guided Breast Biopsy in the Resource-limited Setting: An Initial Experience in Rural Uganda

    Directory of Open Access Journals (Sweden)

    Christopher R. Stark

    2017-06-01

    Full Text Available Purpose: To describe the methodology and initial experience behind creation of an ultrasoundguided percutaneous breast core biopsy program in rural Uganda. Methods and Materials: Imaging the World Africa (ITWA is the registered non-governmental organization division of Imaging the World (ITW, a not-for-profit organization whose primary aim is the integration of affordable high-quality ultrasound into rural health centers. In 2013, ITWA began the pilot phase of an IRB-approved breast care protocol at a rural health center in Uganda. As part of the protocol’s diagnostic arm, an ultrasound-guided percutaneous breast core biopsy training curriculum was implemented in tandem with creation of regionally supplied biopsy kits. Results: A surgeon at a rural regional referral hospital was successfully trained and certified to perform ultrasound-guided percutaneous breast core biopsies. Affordable and safe biopsy kits were created using locally available medical supplies with the cost of each kit totaling $10.62 USD. Conclusion: Successful implementation of an ultrasound-guided percutaneous breast core biopsy program in the resource-limited setting is possible and can be made sustainable through incorporation of local health care personnel and regionally supplied biopsy materials. Our hope is that ITWA’s initial experience in rural Uganda can serve as a model for similar programs in the future.

  3. Understanding low uptake of contraceptives in resource-limited settings: a mixed-methods study in rural Burundi.

    Science.gov (United States)

    Ndayizigiye, M; Fawzi, M C Smith; Lively, C Thompson; Ware, N C

    2017-03-15

    Family planning can reduce deaths, improve health, and facilitate economic development in resource-limited settings. Yet, modern contraceptive methods are often underused. This mixed-methods study, conducted in rural Burundi, sought to explain low uptake of contraceptives by identifying utilization barriers. Results may inform development of family planning interventions in Burundi and elsewhere. We investigated uptake of contraceptives among women of reproductive age in two rural districts of Burundi, using an explanatory sequential, mixed-methods research design. We first assessed availability and utilization rates of modern contraceptives through a facility-based survey in 39 health clinics. Barriers to uptake of contraceptives were then explored through qualitative interviews (N = 10) and focus groups (N = 7). Contraceptives were generally available in the 39 clinics studied, yet uptake of family planning averaged only 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision, and with the number of different types of contraceptives available. Four uptake barriers were identified: (1) lack of providers to administer contraception, (2) lack of fit between available and preferred contraceptive methods, (3) a climate of fear surrounding contraceptive use, and (4) provider refusal to offer family planning services. Where resources are scarce, availability of modern contraceptives alone will likely not ensure uptake. Interventions addressing multiple uptake barriers simultaneously have the greatest chance of success. In rural Burundi, examples are community distribution of contraceptive methods, public information campaigns, improved training for health professionals and community health workers, and strengthening of the health infrastructure.

  4. Mapping knowledge management resources of maternal, newborn and child health (MNCH) among people living in rural and urban settings of Ilorin, Nigeria.

    Science.gov (United States)

    Bolarinwa, Oladimeji Akeem; Ameen, Hafsat Abolore; Durowade, Kabir Adekunle; Akande, Tanimola Makanjuola

    2014-01-01

    Lack of access to information and knowledge about mother and child health was identified as a major contributor to poor maternal and child health in Nigeria. The Partnership for Maternal, Newborn and Child Health (PMNCH) has recognized mapping the knowledge management of Maternal Newborn and Child Health (MNCH) as one of the major strategies to be deployed in improving the health of these vulnerable groups. The main aim of this study is to map the knowledge management resources of Maternal, Newborn and Child Health (MNCH) in rural and urban settings of Ilorin West LGA of Kwara state Nigeria. It is a descriptive cross-sectional study with a comparative analysis of findings from urban and rural settings. Epi-mapping was used to carve out the LGA and map responses. The p-value of less than 0.05 was considered significant at 95% confidence level. The study showed that traditional leader was responsible for more than half of the traditional way of obtaining information by rural (66.7%) and urban (56.2%) respondents while documentation accounts for the main MNCH knowledge preservation for the rural (40.6%) and the urban (50%) dwellers. Traditional leaders (32.2%) and elders (46.7%) were the main people responsible for dissemination of knowledge in rural areas whereas elders (35.9%) and Parents (19.9%) were the main people responsible in urban areas. It was concluded that traditional and family institutions are important in the knowledge management of MNCH in both rural and urban settings of Nigeria.

  5. Assessment of rural energy resources

    International Nuclear Information System (INIS)

    Rijal, K.; Bansal, N.K.; Grover, P.D.

    1990-01-01

    This article presents the methodological guidelines used to assess rural energy resources with an example of its application in three villages each from different physiographic zones of Nepal. Existing energy demand patterns of villages are compared with estimated resource availability, and rural energy planning issues are discussed. Economics and financial supply price of primary energy resources are compared, which provides insight into defective energy planning and policy formulation and implication in the context of rural areas of Nepal. Though aware of the formidable consequences, the rural populace continues to exhaust the forest as they are unable to find financially cheaper alternatives. Appropriate policy measures need to be devised by the government to promote the use of economically cost-effective renewable energy resources so as to change the present energy usage pattern to diminish the environmental impact caused by over exploitation of forest resources beyond their regenerative capacity

  6. Fasting capillary blood glucose: an appropriate measurement in screening for diabetes and pre-diabetes in low-resource rural settings.

    Science.gov (United States)

    Zhao, X; Zhao, W; Zhang, H; Li, J; Shu, Y; Li, S; Cai, L; Zhou, J; Li, Y; Hu, R

    2013-01-01

    To evaluate the efficiency of fasting capillary blood glucose (FCG) measurement as compared with fasting venous plasma glucose (FPG) measurement in screening diabetes and pre-diabetes in low-resource rural settings. In 2010, 993 participants were randomly selected from 9 villages in Yunnan province using cluster sampling method. Samples for FCG and FPG test were obtained after demographics and physical examination. The oral glucose tolerance test was performed in parallel as gold standard for diagnosis. Diagnostic capacities of the FCG measurement in predicting undiagnosed diabetes and pre-diabetes were assessed. The performance of FCG and FPG tests was compared. Fifty-seven individuals with undiagnosed diabetes and 145 subjects with pre-diabetes were detected. The concordance between FCG and FPG levels was high (r = 0.75, p curve (AUC) for FCG test in predicting diabetes was 0.88 [95% confidence interval (CI) 0.82-0.93] with the optimal cutoff value of 5.65 mmol/l, sensitivity of 84.2%, and specificity of 79.3%. The corresponding values in FPG tests were 0.92 (95% CI 0.88-0.97) (AUC), 6.51 mmol/l (optimal cutoff point), 82.5% (sensitivity) and 98.3% (specificity), respectively. No significant difference was found in the AUC for the two screening strategies. FCG measurement is considered to be a convenient, practicable screening method in low-resource rural communities with acceptable test properties.

  7. Health coping strategies of the people vulnerable to climate change in a resource-poor rural setting in Bangladesh

    OpenAIRE

    Haque, Md Aminul; Budi, Aji; Azam Malik, Ahmad; Suzanne Yamamoto, Shelby; Louis, Val?rie R; Sauerborn, Rainer

    2013-01-01

    Background Among the many challenges faced by the people of Bangladesh, the effects of climate change are discernibly threatening, impacting on human settlement, agricultural production, economic development, and human health. Bangladesh is a low-income country with limited resources; its vulnerability to climate change has influenced individuals to seek out health coping strategies. The objectives of the study were to explore the different strategies/measures people employ to cope with clima...

  8. Estimation of community-level influenza-associated illness in a low resource rural setting in India.

    Science.gov (United States)

    Saha, Siddhartha; Gupta, Vivek; Dawood, Fatimah S; Broor, Shobha; Lafond, Kathryn E; Chadha, Mandeep S; Rai, Sanjay K; Krishnan, Anand

    2018-01-01

    To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4-6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32-44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8-11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children value of influenza vaccination among target groups.

  9. Rural finance and natural resources

    OpenAIRE

    Gordon, Ann

    2000-01-01

    The Department for International Development (DFID), through its Renewable Natural Resources Knowledge Strategy (RNRKS), emphasizes demand-led research and a clear identification of uptake pathways in research design and implementation. These guidelines aim to provide RNRKS programme managers and project managers with sufficient information on rural finance to judge the extent to which project design may have to take it into account. This includes in particular the possibility that the charac...

  10. Estimation of community-level influenza-associated illness in a low resource rural setting in India.

    Directory of Open Access Journals (Sweden)

    Siddhartha Saha

    Full Text Available To estimate rates of community-level influenza-like-illness (ILI and influenza-associated ILI in rural north India.During 2011, we conducted household-based healthcare utilization surveys (HUS for any acute medical illness (AMI in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates.The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y and identified 150 (5%, 95%CI: 4-6 ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32-44. Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8-11 had laboratory-confirmed influenza (A (H3N2 = 72; B = 54. After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4-29 and persons≥60 years (11; 95%CI: 2-30.We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups.

  11. Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

    Directory of Open Access Journals (Sweden)

    Christine Mugasha

    Full Text Available INTRODUCTION: Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID to inform strategic scale up of PMTCT programs. METHODS: A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI. HIV-infected pregnant mothers, identified through routine antenatal care (ANC and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. RESULTS: Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26% in rural and 743/1,025 (74% in urban facilities. Of these 375/1,025 (37% were linked to HIV clinics [67/267(25% rural and 308/758(41% urban]. Of 636 HIV-exposed babies, 193 (30% were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636; 8/179 (4.5%] in rural and 93/457(20.3% in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1, p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. CONCLUSION: Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to

  12. Migration, Rural Poverty and Community Natural Resource ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Migration, Rural Poverty and Community Natural Resource Management in Cambodia. Cambodia has a ... Cambodia, Far East Asia, Central Asia, South Asia ... Call for new OWSD Fellowships for Early Career Women Scientists now open.

  13. Environmental resources and poverty in rural communities

    DEFF Research Database (Denmark)

    Charlery, Lindy Callen

    , is to be sustainably realized. However, most datasets on rural livelihoods do not accurately account for environmental income and therefore cannot answer this question. The Poverty Environment Network (PEN) project was initiated specifically to address this issue in the assessment of rural livelihoods in developing......D study focuses on answering two main research questions: 1) What is the importance of environmental income in assessments of poverty and poverty dynamics in rural forest reliant communities? and 2) What are the impacts of infrastructural development, in the form of rural roads, on rural household income......Over the last two decades, the burgeoning empirical evidence on the importance of forests and environmental resources to rural livelihoods in developing countries has attracted the attention of policy makers aiming to develop and implement strategies for reducing poverty and improving livelihoods...

  14. Cambodia Rural Livelihoods and Natural Resources Research ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Cambodia is one of the least developed countries in Southeast Asia, with a large poor rural population dependent on natural resources for food and income. Over the past several years, the country has introduced extensive legislation related to the management of natural resources. On paper, the role of local communities ...

  15. A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

    Science.gov (United States)

    Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

    2012-01-01

    BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

  16. Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania

    Directory of Open Access Journals (Sweden)

    Maliti Deodatus V

    2011-08-01

    Full Text Available Abstract Background Verbal autopsy (VA is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden. Objective The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania. Methods A database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1 death identified; 2 VA interviews conducted; 3 VA forms submitted to physicians; 4 coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined." Results The completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67, p = 0.016. Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96, p = 0.023. Being a child of the deceased compared to a partner (husband or wife was more likely to be associated with undetermined cause of death classification

  17. Bioenergy: a sustainable resource for rural population

    International Nuclear Information System (INIS)

    Gehlawat, J.K.

    2000-01-01

    Bio energy is a renewable resource. It is a product of the abundant solar energy. The plant kingdom collects solar energy by photosynthesis and stores it as biomass. This is a big source of energy that sustains the mankind in many ways-food, fuel, fibre and several others. The non-food biomass like agro-waste and forest residues already constitute a large component of the traditional energy sources of most rural population the world over. A scientific study and proper planning are required for an optimum use of this abundant renewable bio energy (biomass). This paper discusses various options to evolve workable technologies for an efficient use of biomass as a sustainable energy resource for rural areas where it is mostly produced. An integrated strategy is proposed. (author)

  18. Access to Productive Resources: The Catalyst to Rural Women's ...

    African Journals Online (AJOL)

    However, rural women in post-apartheid South Africa are experiencing hardships in laying hold of such resources. The pertinent questions the article seeks to interrogate are: who should determine the resource needs of rural women? Are the one size fit all programmes ideal for alleviating rural women's poverty. This article ...

  19. Creative practicum leadership experiences in rural settings.

    Science.gov (United States)

    Schoenfelder, Deborah Perry; Valde, Jill Gaffney

    2009-01-01

    Rural healthcare systems provide rich learning environments for nursing students, where strong nursing leaders manage care for people with diverse health problems across the lifespan. The authors describe the development, implementation, and evaluation of rural clinical leadership practicum, a prelicensure course that specifically focuses on the application of leadership concepts in small rural healthcare systems.

  20. Leveraging community health worker system to map a mountainous rural district in low resource setting: a low-cost approach to expand use of geographic information systems for public health.

    Science.gov (United States)

    Munyaneza, Fabien; Hirschhorn, Lisa R; Amoroso, Cheryl L; Nyirazinyoye, Laetitia; Birru, Ermyas; Mugunga, Jean Claude; Murekatete, Rachel M; Ntaganira, Joseph

    2014-12-06

    Geographic Information Systems (GIS) have become an important tool in monitoring and improving health services, particularly at local levels. However, GIS data are often unavailable in rural settings and village-level mapping is resource-intensive. This study describes the use of community health workers' (CHW) supervisors to map villages in a mountainous rural district of Northern Rwanda and subsequent use of these data to map village-level variability in safe water availability. We developed a low literacy and skills-focused training in the local language (Kinyarwanda) to train 86 CHW Supervisors and 25 nurses in charge of community health at the health center (HC) and health post (HP) levels to collect the geographic coordinates of the villages using Global Positioning Systems (GPS). Data were validated through meetings with key stakeholders at the sub-district and district levels and joined using ArcMap 10 Geo-processing tools. Costs were calculated using program budgets and activities' records, and compared with the estimated costs of mapping using a separate, trained GIS team. To demonstrate the usefulness of this work, we mapped drinking water sources (DWS) from data collected by CHW supervisors from the chief of the village. DWSs were categorized as safe versus unsafe using World Health Organization definitions. Following training, each CHW Supervisor spent five days collecting data on the villages in their coverage area. Over 12 months, the CHW supervisors mapped the district's 573 villages using 12 shared GPS devices. Sector maps were produced and distributed to local officials. The cost of mapping using CHW supervisors was $29,692, about two times less than the estimated cost of mapping using a trained and dedicated GIS team ($60,112). The availability of local mapping was able to rapidly identify village-level disparities in DWS, with lower access in populations living near to lakes and wetlands (p villages even in mountainous rural areas. These data

  1. Wind and solar resource data sets

    DEFF Research Database (Denmark)

    Clifton, Andrew; Hodge, Bri-Mathias; Draxl, Caroline

    2017-01-01

    The range of resource data sets spans from static cartography showing the mean annual wind speed or solar irradiance across a region to high temporal and high spatial resolution products that provide detailed information at a potential wind or solar energy facility. These data sets are used...... to support continental-scale, national, or regional renewable energy development; facilitate prospecting by developers; and enable grid integration studies. This review first provides an introduction to the wind and solar resource data sets, then provides an overview of the common methods used...... for their creation and validation. A brief history of wind and solar resource data sets is then presented, followed by areas for future research. For further resources related to this article, please visit the WIREs website....

  2. Sustainable natural resource use in rural China: Trends and policies

    NARCIS (Netherlands)

    Qu, F.; Kuyvenhoven, A.; Shi, X.; Heerink, N.

    2010-01-01

    In this paper we provide an overview of recent trends in the availability and quality of land and water resources in rural China, and examine the common presumption that rural resources are rapidly degrading in China. Data based on consistent definitions and measurement methods that have recently

  3. Childhood psychological problems in school settings in rural Southern Africa.

    Directory of Open Access Journals (Sweden)

    Melissa A Cortina

    Full Text Available BACKGROUND: Many children can be exposed to multiple adversities in low and middle-income countries (LMICs placing them at potential risk of psychological problems. However, there is a paucity of research using large representative cohorts examining the psychological adjustment of children in school settings in these countries. Children's psychological adjustment has been shown to affect educational progress which is critical for their future. This study, based in a rural, socio-economically disadvantaged area of South Africa, aimed to examine the prevalence of children's psychological problems as well as possible risk and protective factors. METHODS: Rates of psychological problems in 10-12 year olds were examined using teacher- and child-report questionnaires. Data on children from 10 rural primary schools, selected by stratified random sampling, were linked to individual and household data from the Agincourt health and socio-demographic surveillance system collected from households over 15 years. RESULTS: A total of 1,025 children were assessed. Teachers identified high levels of behavioural and emotional problems (41%. Children reported lower, but substantial rates of anxiety/depression (14%, and significant post-traumatic stress symptoms (24%; almost a quarter felt unsafe in school. Risk factors included being a second-generation former refugee and being from a large household. Protective factors highlight the importance of maternal factors, such as being more educated and in a stable partnership. CONCLUSION: The high levels of psychological problems identified by teachers are a serious public health concern, as they are likely to impact negatively on children's education, particularly given the large class sizes and limited resources in rural LMIC settings. Despite the high levels of risk, a proportion of children were managing well and research to understand resilience could inform interventions.

  4. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh

    Science.gov (United States)

    Iqbal, Afrin; Hoque, D. M. Emdadul; Moinuddin, Md.; Zaman, Sojib Bin; Rahman, Qazi Sadeq-ur; Begum, Tahmina; Chowdhury, Atique Iqbal; Haider, Rafiqul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.

    2017-01-01

    Introduction Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled ‘Interrupting Pathways to Sepsis Initiative’ (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Materials and Method Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite ‘Program Coaches’, facilitating triage and rapid transfer of patients through ‘Welcoming Persons’ and enabling rapid treatment through ‘Task Shifting’ from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. Results From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of

  5. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh.

    Directory of Open Access Journals (Sweden)

    Ahmed Ehsanur Rahman

    Full Text Available Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled 'Interrupting Pathways to Sepsis Initiative' (IPSI introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics.Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite 'Program Coaches', facilitating triage and rapid transfer of patients through 'Welcoming Persons' and enabling rapid treatment through 'Task Shifting' from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department.From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30

  6. Community attachment and resource harvesting in rural Denmark

    Science.gov (United States)

    Rodney R. Zwick; David Solan

    2002-01-01

    Community attachment has been related to "sense of place," and by extension to factors such as the natural resource base of a local geographic area and the utilitarian uses of those resources-a functional attachment that helps root people to a place. The purpose of this study was to examine the resource harvest activities of residents of three modern rural...

  7. Duration and setting of rural immersion during the medical degree relates to rural work outcomes.

    Science.gov (United States)

    O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah; Walker, Judi; Chambers, Helen; Major, Laura; Langham, Robyn

    2018-04-19

    Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  8. The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

    Science.gov (United States)

    Allott, Kelly; Lloyd, Susan

    2009-07-01

    Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

  9. Rural School as a Resource for the Intellectual and Labour Potential Formation of the Rural Society

    Science.gov (United States)

    Nasibullov, Ramis R.; Korshunova, Olga V.; Arshabekov, Nurgali R.

    2016-01-01

    The relevance of the research problem is reasoned by the need to create conceptual grounds of life organization variants in the rural school as a resource of intellectual and labor potential formation of rural society taking into account the socio-economic realities of Russia's development in the beginning of the twenty-first century, as well as…

  10. Establishing Medical Schools in Limited Resource Settings.

    Science.gov (United States)

    Tsinuel, Girma; Tsedeke, Asaminew; Matthias, Siebeck; Fischer, Martin R; Jacobs, Fabian; Sebsibe, Desalegn; Yoseph, Mamo; Abraham, Haileamlak

    2016-05-01

    One urgent goal of countries in sub-Saharan Africa is to dynamically scale up the education and work force of medical doctors in the training institutions and health facilities, respectively. These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical education done in the context of limited resources is thus compromising the quality of graduates. In the future, a collaborative and need-based approach involving major stakeholders such as medical educators concerned, ministries, planners and policy makers is needed. This article identifies the challenges of establishing medical schools and sustaining the quality of education through rapid scale-up in Sub-Saharan Africa in the settings of limited resources. It also outlines the minimum requirements for establishing medical schools. A consensus building workshop was conducted in Bishoftu, Ethiopia, from Nov 8-12, 2013. Participants were professionals from 13 Ethiopian medical schools, and representatives of medical schools from South Sudan, Somaliland, Somalia, and Mozambique. Participants are listed in Appendix 1. The governments and stakeholders should jointly develop strategic plans and a roadmaps for opening or expanding medical schools to scale up educational resources. It is advisable that medical schools have autonomy regarding the number of student-intake, student selection, curriculum ownership, resource allocation including for infrastructure and staff development. Health science and medical curricula should be integrated within and harmonized nationally. An educational evaluation framework needs to be embedded in the curricula, and all medical schools should have Health Science Education Development Centers.

  11. Wind and solar resource data sets: Wind and solar resource data sets

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew [National Renewable Energy Laboratory, Golden CO USA; Hodge, Bri-Mathias [National Renewable Energy Laboratory, Golden CO USA; Power Systems Engineering Center, National Renewable Energy Laboratory, Golden CO USA; Draxl, Caroline [National Renewable Energy Laboratory, Golden CO USA; National Wind Technology Center, National Renewable Energy Laboratory, Golden CO USA; Badger, Jake [Department of Wind Energy, Danish Technical University, Copenhagen Denmark; Habte, Aron [National Renewable Energy Laboratory, Golden CO USA; Power Systems Engineering Center, National Renewable Energy Laboratory, Golden CO USA

    2017-12-05

    The range of resource data sets spans from static cartography showing the mean annual wind speed or solar irradiance across a region to high temporal and high spatial resolution products that provide detailed information at a potential wind or solar energy facility. These data sets are used to support continental-scale, national, or regional renewable energy development; facilitate prospecting by developers; and enable grid integration studies. This review first provides an introduction to the wind and solar resource data sets, then provides an overview of the common methods used for their creation and validation. A brief history of wind and solar resource data sets is then presented, followed by areas for future research.

  12. Systematic Review of Palliative Care in the Rural Setting.

    Science.gov (United States)

    Bakitas, Marie A; Elk, Ronit; Astin, Meka; Ceronsky, Lyn; Clifford, Kathleen N; Dionne-Odom, J Nicholas; Emanuel, Linda L; Fink, Regina M; Kvale, Elizabeth; Levkoff, Sue; Ritchie, Christine; Smith, Thomas

    2015-10-01

    Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in rural areas have been limited. We searched 2 large databases of the medical literature and found 248 relevant articles; we also identified another 59 articles through networking and a hand search of reference lists. Of those 307 articles, 39 met the inclusion criteria and were grouped into the following subcategories: intervention (n = 4), needs assessment (n = 2), program planning (n = 3), program evaluation (n = 4), education (n = 7), financial (n = 8), and comprehensive/systematic literature reviews (n = 11). We synthesized the current state of rural palliative care research and practice to identify important gaps for future research. Studies were conducted in the United States, Australia, Canada, Africa, Sweden, and India. Two randomized control trials were identified, both of which used telehealth approaches and had positive survival outcomes. One study demonstrated positive patient quality of life and depression outcomes. Research to guide rural palliative care practice is sparse. Approaches to telehealth, community- academic partnerships, and training rural health care professionals show promise, but more research is needed to determine best practices for providing palliative care to patients living in rural settings.

  13. Integrated Water Resources Simulation Model for Rural Community

    Science.gov (United States)

    Li, Y.-H.; Liao, W.-T.; Tung, C.-P.

    2012-04-01

    The purpose of this study is to develop several water resources simulation models for residence houses, constructed wetlands and farms and then integrate these models for a rural community. Domestic and irrigation water uses are the major water demand in rural community. To build up a model estimating domestic water demand for residence houses, the average water use per person per day should be accounted first, including water uses of kitchen, bathroom, toilet and laundry. On the other hand, rice is the major crop in the study region, and its productive efficiency sometimes depends on the quantity of irrigation water. The water demand can be estimated by crop water use, field leakage and water distribution loss. Irrigation water comes from rainfall, water supply system and reclaimed water which treated by constructed wetland. In recent years, constructed wetlands play an important role in water resources recycle. They can purify domestic wastewater for water recycling and reuse. After treating from constructed wetlands, the reclaimed water can be reused in washing toilets, watering gardens and irrigating farms. Constructed wetland is one of highly economic benefits for treating wastewater through imitating the processing mechanism of natural wetlands. In general, the treatment efficiency of constructed wetlands is determined by evapotranspiration, inflow, and water temperature. This study uses system dynamics modeling to develop models for different water resource components in a rural community. Furthermore, these models are integrated into a whole system. The model not only is utilized to simulate how water moves through different components, including residence houses, constructed wetlands and farms, but also evaluates the efficiency of water use. By analyzing the flow of water, the water resource simulation model can optimizes water resource distribution under different scenarios, and the result can provide suggestions for designing water resource system of a

  14. Molecular diagnostics for low resource settings

    Science.gov (United States)

    Weigl, Bernhard H.

    2010-03-01

    As traditional high quality diagnostic laboratories are not widely available or affordable in developing country health care settings, microfluidics-based point-of-care diagnostics may be able to address the need to perform complex assays in under-resourced areas. Many instrument-based as well as non-instrumented microfluidic prototype diagnostics are currently being developed. In addition to various engineering challenges, the greatest remaining issue is the search for truly low-cost disposable manufacturing methods. Diagnostics for global health, and specifically microfluidics and molecular-based low resource diagnostics, have become a very active research area over the last five years, thanks in part to new funding that became available from the Bill and Melinda Gates Foundation, the National Institutes of Health, and other sources. This has led to a number of interesting prototype devices that are now in advanced development or clinical validation. These devices include disposables and instruments that perform multiplexed PCR-based lab-on-a-chips for enteric, febrile, and vaginal diseases, as well as immunoassays for diseases such as malaria, HIV, and various sexually transmitted diseases. More recently, instrument-free diagnostic disposables based on isothermal nucleic acid amplification have been developed as well. Regardless of platform, however, the search for truly low-cost manufacturing methods that would result in cost of goods per disposable of around US1/unit at volume remains a big challenge. This talk will give an overview over existing platform development efforts as well as present some original research in this area at PATH.

  15. Microfluidic diagnostics for low-resource settings

    Science.gov (United States)

    Hawkins, Kenneth R.; Weigl, Bernhard H.

    2010-02-01

    Diagnostics for low-resource settings need to be foremost inexpensive, but also accurate, reliable, rugged and suited to the contexts of the developing world. Diagnostics for global health, based on minimally-instrumented, microfluidicsbased platforms employing low-cost disposables, has become a very active research area recently-thanks, in part, to new funding from the Bill & Melinda Gates Foundation, the National Institutes of Health, and other sources. This has led to a number of interesting prototype devices that are now in advanced development or clinical validation. These devices include disposables and instruments that perform multiplexed PCR-based assays for enteric, febrile, and vaginal diseases, as well as immunoassays for diseases such as malaria, HIV, and various sexually transmitted diseases. More recently, instrument-free diagnostic disposables based on isothermal nucleic-acid amplification have been developed. Regardless of platform, however, the search for truly low-cost manufacturing methods that would enable affordable systems (at volume, in the appropriate context) remains a significant challenge. Here we give an overview of existing platform development efforts, present some original research in this area at PATH, and reiterate a call to action for more.

  16. Challenges for Older Drivers in Urban, Suburban, and Rural Settings

    Directory of Open Access Journals (Sweden)

    Rashmi P. Payyanadan

    2018-03-01

    Full Text Available Along with age-related factors, geographical settings—urban, suburban, and rural areas—also contribute to the differences in fatal crashes among older drivers. These differences in crash outcomes might be attributed to the various driving challenges faced by older drivers residing in different locations. To understand these challenges from the perspective of the older driver, a focus group study was conducted with drivers 65 and older from urban, suburban, and rural settings. Guided-group interviews were used to assess driving challenges, mobility options, opportunities for driver support systems (DSS, and alternate transportation needs. Content analysis of the interview responses resulted in four categories representing common challenges faced by older drivers across the settings: behavior of other drivers on the road, placement of road signs, reduced visibility of road signs due to age-related decline, and difficulties using in-vehicle technologies. Six categories involved location-specific challenges such as heavy traffic situations for urban and suburban drivers, and multi-destination trips for rural drivers. Countermeasures implemented by older drivers to address these challenges primarily involved route selection and avoidance. Technological advances of DSS systems provide a unique opportunity to support the information needs for route selection and avoidance preferences of drivers. Using the content analysis results, a framework was built to determine additional and modified DSS features to meet the specific challenges of older drivers in urban, suburban, and rural settings. These findings suggest that there is heterogeneity in the driving challenges and preferences of older drivers based on their location. Consequently, DSS technologies and vehicle automation need to be tailored to not only meet the driving safety and mobility needs of older drivers as a population, but also to their driving environment.

  17. Training resources and e-Government services for rural SMEs: the rural inclusion platform

    OpenAIRE

    Axel Maroudas; Pantelis Karamolegkos; Nikos Manouselis

    2010-01-01

    Rural Inclusion, a project supported by the Information and Communication Technologies Policy Support Programme of the European Commission, aims to adopt, adapt, and deploy a Web infrastructure, in rural settings, combining semantics with a collaborativetraining and networking approach, offering e-Government services that will be supported by a rigorous and reusable service process analysis and modeling, and facilitating the disambiguation of the small businesses needs and requirements when t...

  18. Multidisciplinary chronic pain management in a rural Canadian setting.

    Science.gov (United States)

    Burnham, Robert; Day, Jeremiah; Dudley, Wallace

    2010-01-01

    Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.

  19. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

  20. Urban-Rural Differences in School Nurses' Asthma Training Needs and Access to Asthma Resources.

    Science.gov (United States)

    Carpenter, Delesha M; Estrada, Robin Dawson; Roberts, Courtney A; Elio, Alice; Prendergast, Melissa; Durbin, Kathy; Jones, Graceann Clyburn; North, Steve

    Few studies have examined school nurses preferences' for asthma training. Our purpose was to: 1) assess school nurses' perceived asthma training needs, 2) describe nurses' access to asthma educational resources, and 3) identify urban-rural differences in training needs and access to resources in southern states. A convenience sample of school nurses (n=162) from seven counties (two urban and five rural) in North Carolina and South Carolina completed an online, anonymous survey. Chi-square tests were used to examine urban-rural differences. Although most nurses (64%) had received asthma training within the last five years, urban nurses were more likely to have had asthma training than rural nurses (χ 2 =10.84, p=0.001). A majority of nurses (87%) indicated they would like to receive additional asthma training. Approximately half (45%) of nurses reported access to age-appropriate asthma education materials, but only 16% reported that their schools implemented asthma education programs. Urban nurses were more likely than rural nurses to have access to asthma education programs (χ 2 =4.10, p=0.04) and age-appropriate asthma education materials (χ 2 =8.86, p=0.003). Few schools are implementing asthma education programs. Rural nurses may be disadvantaged in terms of receiving asthma training and having access to asthma education programs and materials. Schools are an ideal setting for delivering age-appropriate asthma education. By providing school nurses with access to age-appropriate asthma education resources and additional asthma training, we can help them overcome several of the barriers that impede their ability to deliver asthma care to their students. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Characteristics of human resources in Serbian rural tourism

    Directory of Open Access Journals (Sweden)

    Premović Jelena

    2016-01-01

    Full Text Available Modern consumer society affects the changes in behavior and wishes of modern tourists who require high-quality tourist service which can be provided only by highly qualified and well-trained tourism personnel. However, the education system, in almost all tourist countries doesn't follow the trends of modern tourism. This paper analyzes demographic conditions and the basic characteristics of human resources in rural areas of Serbia. In this analysis were applied the method of induction and deduction, analysis and synthesis method, deductive and comparative methods as well as techniques of structured questionnaire. The obtained data were processed in SPSS program. Based on the results of the original research, it was concluded that there is a positive correlation between level of education and the number of days spent on professional training of human resources and the competitive position of tourism enterprises in which human resources are working.

  2. Helping mothers survive bleeding after birth: an educational of simulation-based training in a low resource setting

    NARCIS (Netherlands)

    Nelissen, E.J.T.; Ersdal, H.; Ostergaard, D.; Mduma, E.; Broerse, J.E.W.; Evjen-Olsen, B.; van Roosmalen, J.; Stekelenburg, J.

    2014-01-01

    Objective To evaluate "Helping Mothers Survive Bleeding After Birth" (HMS BAB) simulation-based training in a low-resource setting. Design Educational intervention study. Setting Rural referral hospital in Northern Tanzania. Population Clinicians, nurse-midwives, medical attendants, and ambulance

  3. Experiences of nurses working in a rural primary health-care setting in Mopani district, Limpopo Province

    Directory of Open Access Journals (Sweden)

    MP Mohale

    2008-09-01

    Full Text Available Professional nurses working in rural, primary health-care settings are experiencing burnout due to serious shortages of personnel. This is exacerbated by the brain drain of nurses leaving the country. Rural settings are resource constrained in terms of personnel and equipment. This results in dissatisfaction among nurses due to the unbearable working conditions which result in stress and frustration. A qualitative, explorative, descriptive study was conducted to explore and describe the experiences of nurses working in a rural primary health-care setting in the greater Letaba sub district in Limpopo Province. Purposive sampling was used to identify the participants. Data was collected in the form of in-depth interviews. The study revealed that nurses working in primary health-care settings were experiencing emotional and physical strain as a result of the shortage of human resources. It was recommended that policies that meet the health-care needs of rural communities be developed, and that strategies to retain professional nurses in primary health-care settings be formulated.

  4. Rural providers’ access to online resources: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jonathan D. Eldredge

    2016-01-01

    Full Text Available Objective: The research determined the usage and satisfaction levels with one of two point-of-care (PoC resources among health care providers in a rural state. Methods: In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants’ attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA, paired t tests, and Cohen’s d statistic to compare pre- and post-study effects sizes. Results: Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to ‘‘about right amounts of information’’ at the completion of the study. DynaMed users reported a Cohen’s d increase of þ1.50 compared to AccessMedicine users’ reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen’s d. Conclusion: Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.

  5. Rural providers' access to online resources: a randomized controlled trial

    Science.gov (United States)

    Hall, Laura J.; McElfresh, Karen R.; Warner, Teddy D.; Stromberg, Tiffany L.; Trost, Jaren; Jelinek, Devin A.

    2016-01-01

    Objective The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. Methods In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. Results Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to “about right amounts of information” at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. Conclusion Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine. PMID:26807050

  6. Establishing Medical Schools in Limited Resource Settings | Girma ...

    African Journals Online (AJOL)

    Establishing Medical Schools in Limited Resource Settings. ... These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical ...

  7. Free Access to Point of Care Resource Results in Increased Use and Satisfaction by Rural Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Lindsay Alcock

    2016-12-01

    Full Text Available A Review of: Eldredge, J. D., Hall, L. J., McElfresh, K. R., Warner, T. D., Stromberg, T. L., Trost, J. T., & Jelinek, D. A. (2016. Rural providers’ access to online resources: A randomized controlled trial. Journal of the Medical Library Association, 104(1, 33-41. http://dx.doi.org/10.3163/1536-5050.104.1.005 Objective – To determine whether free access to the point of care (PoC resource Dynamed or the electronic book collection AccessMedicine was more useful to rural health care providers in answering clinical questions in terms of usage and satisfaction. Design – Randomized controlled trial. SettingRural New Mexico. Subjects – Twenty-eight health care providers (physicians, nurses, physician assistants, and pharmacists with no reported access to PoC resources, (specifically Dynamed and AccessMedicine or electronic textbook collections prior to enrollment.

  8. Depression screening optimization in an academic rural setting.

    Science.gov (United States)

    Aleem, Sohaib; Torrey, William C; Duncan, Mathew S; Hort, Shoshana J; Mecchella, John N

    2015-01-01

    Primary care plays a critical role in screening and management of depression. The purpose of this paper is to focus on leveraging the electronic health record (EHR) as well as work flow redesign to improve the efficiency and reliability of the process of depression screening in two adult primary care clinics of a rural academic institution in USA. The authors utilized various process improvement tools from lean six sigma methodology including project charter, swim lane process maps, critical to quality tree, process control charts, fishbone diagrams, frequency impact matrix, mistake proofing and monitoring plan in Define-Measure-Analyze-Improve-Control format. Interventions included change in depression screening tool, optimization of data entry in EHR. EHR data entry optimization; follow up of positive screen, staff training and EHR redesign. Depression screening rate for office-based primary care visits improved from 17.0 percent at baseline to 75.9 percent in the post-intervention control phase (p<0.001). Follow up of positive depression screen with Patient History Questionnaire-9 data collection remained above 90 percent. Duplication of depression screening increased from 0.6 percent initially to 11.7 percent and then decreased to 4.7 percent after optimization of data entry by patients and flow staff. Impact of interventions on clinical outcomes could not be evaluated. Successful implementation, sustainability and revision of a process improvement initiative to facilitate screening, follow up and management of depression in primary care requires accounting for voice of the process (performance metrics), system limitations and voice of the customer (staff and patients) to overcome various system, customer and human resource constraints.

  9. Beyond the biomedical: community resources for mental health care in rural Ethiopia.

    Science.gov (United States)

    Selamu, Medhin; Asher, Laura; Hanlon, Charlotte; Medhin, Girmay; Hailemariam, Maji; Patel, Vikram; Thornicroft, Graham; Fekadu, Abebaw

    2015-01-01

    The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources. We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered. The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities. The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support

  10. Beyond the biomedical: community resources for mental health care in rural Ethiopia.

    Directory of Open Access Journals (Sweden)

    Medhin Selamu

    Full Text Available The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources.We employed resource mapping within the Programme for Improving Mental Health Care (PRIME, to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered.The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs represented all the biomedical health services in the district. In addition the Health Development Army (HDA are community volunteers who support health promotion and prevention activities.The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be

  11. Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

    Science.gov (United States)

    Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

    2010-01-01

    Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

  12. Clinical bacteriology in low-resource settings: today's solutions.

    Science.gov (United States)

    Ombelet, Sien; Ronat, Jean-Baptiste; Walsh, Timothy; Yansouni, Cedric P; Cox, Janneke; Vlieghe, Erika; Martiny, Delphine; Semret, Makeda; Vandenberg, Olivier; Jacobs, Jan

    2018-03-05

    Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Perceived barriers, resources, and training needs of rural primary care providers relevant to the management of childhood obesity.

    Science.gov (United States)

    Findholt, Nancy E; Davis, Melinda M; Michael, Yvonne L

    2013-08-01

    To explore the perceived barriers, resources, and training needs of rural primary care providers in relation to implementing the American Medical Association Expert Committee recommendations for assessment, treatment, and prevention of childhood obesity. In-depth interviews were conducted with 13 rural primary care providers in Oregon. Transcribed interviews were thematically coded. Barriers to addressing childhood obesity fell into 5 categories: barriers related to the practice (time constraints, lack of reimbursement, few opportunities to detect obesity), the clinician (limited knowledge), the family/patient (family lifestyle and lack of parent motivation to change, low family income and lack of health insurance, sensitivity of the issue), the community (lack of pediatric subspecialists and multidisciplinary/tertiary care services, few community resources), and the broader sociocultural environment (sociocultural influences, high prevalence of childhood obesity). There were very few clinic and community resources to assist clinicians in addressing weight issues. Clinicians had received little previous training relevant to childhood obesity, and they expressed an interest in several topics. Rural primary care providers face extensive barriers in relation to implementing recommended practices for assessment, treatment, and prevention of childhood obesity. Particularly problematic is the lack of local and regional resources. Employing nurses to provide case management and behavior counseling, group visits, and telehealth and other technological communications are strategies that could improve the management of childhood obesity in rural primary care settings. © 2013 National Rural Health Association.

  14. Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

    Science.gov (United States)

    Reese, Sara M; Gilmartin, Heather; Rich, Karen L; Price, Connie S

    2014-06-01

    The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability

    Science.gov (United States)

    Holloway, Kristi; Riley, Geoffrey; Auret, Kirsten

    2013-01-01

    Background Online mental health resources have been proposed as an innovative means of overcoming barriers to accessing rural mental health services. However, clinicians tend to express lower satisfaction with online mental health resources than do clients. Objective To understand rural clinicians’ attitudes towards the acceptability of online mental health resources as a treatment option in the rural context. Methods In-depth interviews were conducted with 21 rural clinicians (general practitioners, psychologists, psychiatrists, and clinical social workers). Interviews were supplemented with rural-specific vignettes, which described clinical scenarios in which referral to online mental health resources might be considered. Symbolic interactionism was used as the theoretical framework for the study, and interview transcripts were thematically analyzed using a constant comparative method. Results Clinicians were optimistic about the use of online mental health resources into the future, showing a preference for integration alongside existing services, and use as an adjunct rather than an alternative to traditional approaches. Key themes identified included perceptions of resources, clinician factors, client factors, and the rural and remote context. Clinicians favored resources that were user-friendly and could be integrated into their clinical practice. Barriers to use included a lack of time to explore resources, difficulty accessing training in the rural environment, and concerns about the lack of feedback from clients. Social pressure exerted within professional clinical networks contributed to a cautious approach to referring clients to online resources. Conclusions Successful implementation of online mental health resources in the rural context requires attention to clinician perceptions of acceptability. Promotion of online mental health resources to rural clinicians should include information about resource effectiveness, enable integration with existing

  16. The leisure style of Canadian rural recreation participants: An analysis based on three different rural leisure settings

    Science.gov (United States)

    Paul Heintzman; Don. Dawson

    2012-01-01

    This study was a secondary analysis of data from a previous study of 248 Canadians on four dimensions of leisure style: time use, leisure setting, leisure activity participation, and leisure motivation. Correlation analyses were conducted to determine if frequency of participation in three rural leisure settings were related to other leisure style dimensions.

  17. A Curriculum Infusion Approach to Preservice Rural Teacher Preparation: Strategies and Resources.

    Science.gov (United States)

    Sarachan-Deily, Ann Beth; And Others

    Collaborative strategies were used by The College of Saint Rose (CSR) and 15 rural school districts in upstate New York to implement preservice teacher training and programming to better meet the needs of handicapped learners in rural settings. Through meetings and questionnaires, rural administrative teams identified relevant skills and issues…

  18. Trend differences in men and women in rural and urban U.S. settings.

    Science.gov (United States)

    Cepeda-Benito, A; Doogan, N J; Redner, R; Roberts, M E; Kurti, A N; Villanti, A C; Lopez, A A; Quisenberry, A J; Stanton, C A; Gaalema, D E; Keith, D R; Parker, M A; Higgins, S T

    2018-04-05

    Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Ergonomics work assessment in rural industrial settings: a student occupational therapy project.

    Science.gov (United States)

    Bowman, Peter J

    2012-01-01

    This case study describes a student occupational therapy (OT) program, the creation of a worksite assessment project as a part of a Community Connections: Partners for Learning and Service grant funded by Health Resources and Services Administration. The primary goals were to design occupation-based community learning experiences in a variety of rural community settings, so that students might benefit from participating in the community based learning and: based on the results, embed occupation-based learning into existing occupational therapy curriculum. The components of the project and the ergonomics content of the OT education program are described; details of the work assessment are presented with analysis of data from the student evaluation of this project.

  20. Managing Ebola from rural to urban slum settings: experiences from ...

    African Journals Online (AJOL)

    The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. Methods: Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak ...

  1. Training MA Psychologists for Work in Rural Settings: Issues and Models.

    Science.gov (United States)

    Keller, Peter A.

    Despite the assumptions some have naively made about various stresses and the quality of life associated with rural settings, most who have studied people residing in rural areas would acknowledge the strong need for mental health services. However psychologists, like most other health care professionals prefer the amenities of more metropolitan…

  2. Compounding medications in a rural setting: an interprofessional perspective

    Directory of Open Access Journals (Sweden)

    Taylor S

    2018-04-01

    Full Text Available Selina Taylor,1 Catherine Hays,1 Beverley Glass2 1Mount Isa Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia; 2College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Background: Interprofessional learning (IPL which focuses on the pharmacist’s role in specialty practices as part of a multidisciplinary health care team has not been explored. This study aimed to determine health care students’ understanding of the role of the pharmacist in compounding medications to optimize health outcomes for patients in rural and remote health care services.Methods: Four workshops followed by focus group interviews were conducted with undergraduate pharmacy, medical, nursing, physiotherapy, dentistry, Aboriginal public health, and speech pathology students (n=15. After an introductory lecture, students working in multidisciplinary teams undertook to compound three products. Focus groups were held at the end of the compounding workshops to explore students’ understanding and perceptions of these compounding activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups.Results: Student participants responded positively both to the opportunity to undertake a compounding exercise and being part of an interprofessional team, perceiving benefit for their future rural and remote health practice. Four major themes emerged from the qualitative analysis: improved knowledge and understanding; application to practice; interprofessional collaboration; and rural, remote, and Indigenous context. Students acknowledged that the workshops improved their understanding of the role of the pharmacist in compounding and how they, as part of a multidisciplinary team, could deliver better health outcomes for patients with special needs, especially in a rural and remote context.Conclusion: This study highlights that workshops of this nature have a role to play in developing

  3. Therapeutic drug monitoring of nevirapine in resource-limited settings.

    NARCIS (Netherlands)

    L'homme, R.F.A.; Muro, E.P.; Droste, J.A.H.; Wolters, L.R.; Ewijk-Beneken Kolmer, E.W.J. van; Schimana, W.; Burger, D.M.

    2008-01-01

    BACKGROUND: We developed a simple and inexpensive thin-layer chromatography (TLC) assay for semiquantitative detection of saliva concentrations of nevirapine in resource-limited settings. The method was validated in an African target population. METHODS: Paired plasma and saliva nevirapine

  4. Tuberculosis diagnosis in resource-limited settings: Clinical use of ...

    African Journals Online (AJOL)

    EB

    GeneXpert in the diagnosis of smear-negative PTB: a case report ... Background: The Xpert MTB/RIF test (GeneXpert) has recently been endorsed for use in resource-limited settings for the ... normochromic anemia (9.2g/dl), hypoalbuminemia.

  5. Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

    Science.gov (United States)

    Kakyo, Tracy Alexis; Xiao, Lily Dongxia

    2017-06-01

    Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

  6. Crossing the quality chasm in resource-limited settings.

    Science.gov (United States)

    Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

    2012-11-30

    Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

  7. Utilization characteristics and importance of woody biomass resources on the rural-urban fringe in botswana.

    Science.gov (United States)

    Nkambwe, Musisi; Sekhwela, Mogodisheng B M

    2006-02-01

    This article examines the utilization characteristics and importance of woody biomass resources in the rural-urban fringe zones of Botswana. In the literature for Africa, attention has been given to the availability and utilization of biomass in either urban or rural environments, but the rural-urban fringe has been neglected. Within southern Africa, this neglect is not justified; the rural-urban fringe, not getting the full benefits available in urban environments in Botswana, has developed problems in woody biomass availability and utilization that require close attention. In this article, socioeconomic data on the importance of woody biomass in the Batlokwa Tribal Territory, on the rural-urban fringe of Gaborone, Botswana, were collected together with ecologic data that reveal the utilization characteristics and potential for regrowth of woody biomass. The analysis of these results show that local woody biomass is very important in the daily lives of communities in the rural-urban fringe zones and that there is a high level of harvesting. However, there is no effort in planning land use in the tribal territory to either conserve this resource or provide alternatives to its utilization. The future of woody biomass resources in Botswana's rural-urban fringe is uncertain. The investigators recommend that a comprehensive policy for the development of the rural-urban fringe consider the importance of this resource. The neglect of this resource will have far-reaching implications on the livelihoods of residents as well as the environment in this zone.

  8. Prevention in old age psychiatry in low-resource settings

    Directory of Open Access Journals (Sweden)

    Bichitra Nanda Patra

    2017-01-01

    Full Text Available Recently, the global population is aging as a result of demographic transition. The elderly are at a higher risk of developing mental illness. This could be due to many reasons including biological factors such as multiple physical illnesses and their treatments and psychosocial factors such as migration, social isolation, and changing family structure. At times, the psychiatric illnesses in the elderly present with atypical features and often go unnoticed. There is a huge treatment gap in addressing the mental health issues of older adults in low-resource countries like India. So far, the preventive aspects in psychiatry are less developed and the mental health care mainly focuses on sickness and treatment. As the number of trained mental health professionals and resources allocated to the field of mental health is meager in low-resource settings, prevention of psychiatric disorders in older adults seems to be a cost-effective option for these settings. In this article, various measures for prevention of psychiatric disorders in elderly low-resource settings have been discussed.

  9. 76 FR 54196 - Public Meeting, Cherokee National Forest Secure Rural Schools Resource Advisory Committee

    Science.gov (United States)

    2011-08-31

    ... DEPARTMENT OF AGRICULTURE Forest Service Public Meeting, Cherokee National Forest Secure Rural Schools Resource Advisory Committee AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: In accordance with the Secure Rural Schools and Community Self Determination Act of 2000 (Pub. L. 106-393), [as...

  10. Rural communities’ vulnerability to farmland poverty in varied ecological settings of northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Menberu Teshome

    2018-01-01

    Full Text Available Environmental and climate changes are among the serious threats to the world’s land resources in the 21st Century. Particularly, in the developing countries the impact inevitably goes as the continuing toll on agricultural production, human lives, and properties. It is also a driving force of poverty and impediment of overall economic development in many less developed nations, like Ethiopia. Therefore, this paper assesses the rural communities’ vulnerability to farmland poverty in different ecological settings of northwest Ethiopia. Data were collected from 525 randomly selected farming households using questionnaire. Meteorological data were collected from Global Weather Data for soil and water assessment tool (SWAT from 1979 to 2010. Rainfall and temperature trends were characterized using simple linear regression model. Rural communities’ vulnerability to farmland poverty was determined using livelihood vulnerability index (LVI. Indices were constructed using simple and weighted average approaches to measure farmlands’ exposure, sensitivity and adaptive capacity. Overall communities’ levels of vulnerability to farmlands poverty were found to be 0.76 in the lowland, 0.57 in the flat highland and 0.51 in the midland areas. In almost all indicators the lowland (Abay Valley is more vulnerable to farmland-related troubles as the biophysical and socio-economic contexts were found to be the worst there. Communities and government and non-government officials have observed significant negative impacts of drought and extreme weather events on farmlands, pasturelands with declining availability, productivity and quality of farmlands. This study suggests education and research interventions for enhancing community-based participatory integrated watershed management approach supported with best indigenous knowledge and farmers’ practices. Adaptation interventions should also consider local communities’ resource capacity (low

  11. Strengthening laboratory systems in resource-limited settings.

    Science.gov (United States)

    Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

    2010-09-01

    Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

  12. Using evaluation theory in priority setting and resource allocation.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Cornelissen, Evelyn; Gibson, Jennifer; Peacock, Stuart

    2012-01-01

    Public sector interest in methods for priority setting and program or policy evaluation has grown considerably over the last several decades, given increased expectations for accountable and efficient use of resources and emphasis on evidence-based decision making as a component of good management practice. While there has been some occasional effort to conduct evaluation of priority setting projects, the literatures around priority setting and evaluation have largely evolved separately. In this paper, the aim is to bring them together. The contention is that evaluation theory is a means by which evaluators reflect upon what it is they are doing when they do evaluation work. Theories help to organize thinking, sort out relevant from irrelevant information, provide transparent grounds for particular implementation choices, and can help resolve problematic issues which may arise in the conduct of an evaluation project. A detailed review of three major branches of evaluation theory--methods, utilization, and valuing--identifies how such theories can guide the development of efforts to evaluate priority setting and resource allocation initiatives. Evaluation theories differ in terms of their guiding question, anticipated setting or context, evaluation foci, perspective from which benefits are calculated, and typical methods endorsed. Choosing a particular theoretical approach will structure the way in which any priority setting process is evaluated. The paper suggests that explicitly considering evaluation theory makes key aspects of the evaluation process more visible to all stakeholders, and can assist in the design of effective evaluation of priority setting processes; this should iteratively serve to improve the understanding of priority setting practices themselves.

  13. Low prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in urban and rural community settings in Bolivia and Peru.

    Science.gov (United States)

    Bartoloni, Alessandro; Pallecchi, Lucia; Fernandez, Connie; Mantella, Antonia; Riccobono, Eleonora; Magnelli, Donata; Mannini, Dario; Strohmeyer, Marianne; Bartalesi, Filippo; Segundo, Higinio; Monasterio, Joaquin; Rodriguez, Hugo; Cabezas, César; Gotuzzo, Eduardo; Rossolini, Gian Maria

    2013-05-01

    To investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in rural and urban community settings of Bolivia and Peru. MRSA nasal carriage was investigated in 585 individuals living in rural and urban areas of Bolivia and Peru (one urban area, one small rural village, and two native communities, one of which was highly isolated). MRSA isolates were subjected to molecular analysis for the detection of virulence genes, characterization of the staphylococcal cassette chromosome mec (SCCmec), and genotyping (multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)). An overall very low prevalence of MRSA nasal carriage was observed (0.5%), with MRSA carriers being detected only in a small rural village of the Bolivian Chaco. The three MRSA isolates showed the characteristics of community-associated MRSA (being susceptible to all non-beta-lactam antibiotics and harboring the SCCmec type IV), were clonally related, and belonged to ST1649. This study provides an insight into the epidemiology of MRSA in community settings of Bolivia and Peru. Reliable, time-saving, and low-cost methods should be implemented to encourage continued surveillance of MRSA dissemination in resource-limited countries. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  14. Incentive Mechanism Model Design for Sharing of Information Resources in Rural Areas

    OpenAIRE

    Gao, Xirong; Shan, Lingling

    2013-01-01

    In order to solve the issues concerning the cross-unit sharing of information resources in rural areas, we analyze the incentive problem of the sharing of information resources in rural areas using the incentive theory method; establish corresponding incentive mechanism model (It is divided into positive incentive model and negative incentive model, and only when the two models guarantee each other and are used at the same time can they be effective). Based on this, we put forward the institu...

  15. Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples.

    Science.gov (United States)

    Smith, Tina Anderson; Adimu, Tanisa Foxworth; Martinez, Amanda Phillips; Minyard, Karen

    2016-01-01

    This paper explores how communities translate evidence-based and promising health practices to rural contexts. A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation. Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.

  16. Diffusion of novel healthcare technologies to resource poor settings.

    Science.gov (United States)

    Malkin, Robert; von Oldenburg Beer, Kim

    2013-09-01

    A new product has completed clinical trials in a distant, resource poor hospital using a few dozen prototypes. The data looks great. The novel medical device solves a widely felt problem. The next goal is to integrate the device into the country's healthcare system and spread the device to other countries. But how? In order to be widely used, the device must be manufactured and distributed. One option is to license the intellectual property (IP) to an interested third party, if one can be found. However, it is possible to manage the manufacturing and distribution without licensing. There are at least two common means for manufacturing a novel medical device targeted to resource poor settings: (a) formal (contract) manufacturing and (b) informal (local) manufacturing. There are three primary routes to diffusion of novel medical devices in the developing world: (1) local distributors (2) direct international sales and (3) international donations. Perhaps surprisingly, the least effective mechanism is direct importation through donation. The most successful mechanism, the method used by nearly all working medical devices in resource-poor settings, is the use of contract manufacturing and a local distributor. This article is written for the biomedical innovator and entrepreneur who wishes to make a novel healthcare technology or product available and accessible to healthcare providers and patients in the developing world. There are very few documented cases and little formal research in this area. To this end, this article describes and explores the manufacturing and distribution options in order to provide insights into when and how each can be applied to scale up a novel technology to make a difference in a resource poor setting.

  17. Saving maternal lives in resource-poor settings: facing reality.

    Science.gov (United States)

    Prata, Ndola; Sreenivas, Amita; Vahidnia, Farnaz; Potts, Malcolm

    2009-02-01

    Evaluate safe-motherhood interventions suitable for resource-poor settings that can be implemented with current resources. Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions. Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to misoprostol to control postpartum hemorrhage (including for home births). The combined effect of postpartum hemorrhage and unsafe abortion prevention would result in the greatest gains in maternal deaths averted. Bold new initiatives are needed to achieve the Millennium Development Goal of reducing maternal mortality by three-quarters. Ninety-nine percent of maternal deaths occur in developing countries and the majority of these women deliver alone, or with a traditional birth attendant. It is time for maternal health program planners to reprioritize interventions in the face of human and financial resource constraints. The three proposed interventions address the largest part of the maternal health burden.

  18. Telemedicine for Epilepsy Support in Resource-poor Settings

    Directory of Open Access Journals (Sweden)

    Victor ePatterson

    2014-08-01

    Full Text Available The ProblemEpilepsy is a common disease worldwide causing significant physical and social. disability. It is one of the most treatable neurological diseases. Yet in rural, poorer countries like much of India and Nepal most people with epilepsy are not on any treatment often because they cannot access doctors. Conventional ApproachesIt is being appreciated that perhaps doctors are not the solution and that enabling health workers to treat epilepsy may be better. Few details however have been put forward about how that might be achieved.Thinking differentlyUntreated epilepsy should be considered a public health problem like HIV/AIDS, the various steps needed for treatment identified and solutions found. Telemedicine ApproachesTelemedicine might contribute to two steps - diagnosis and review. A tool which enables non-doctors to diagnose episodes as epileptic has been developed as a mobile phone app and has good applicability, sensitivity and specificity for the diagnosis. There are a number of ways in which the use of phone review or SMS can improve management.ConclusionsTelemedicine, as part of a public health program, can potentially help the millions of people in the resource-poor world with untreated epilepsy.

  19. Perinatal pathology: practice suggestions for limited-resource settings.

    Science.gov (United States)

    Roberts, Drucilla J

    2013-06-01

    The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

  20. Impacts of HIV/AIDS mortality on food security and natural resource utilisation in rural South Africa

    CSIR Research Space (South Africa)

    Mambo, J

    2012-03-01

    Full Text Available AIDS mortality, its linkages as a determinant and consequence of food security and its impact on natural resource utilisation by mainly rural populations, has not been well researched, especially their effects on rural livelihoods. Determining...

  1. Rebuilding common property management : a case study of community-based natural resource management in rural Guizhou, China

    NARCIS (Netherlands)

    Sun, Qiu

    2007-01-01

    Environmental degradation and rural poverty are inter-related problems of great concern to developing countries. The poor mostly live in environmentally fragile regions and rely heavily on natural resources for their livelihood subsistence. Unfortunately, environmental degradation and rural poverty

  2. Optimising Mycobacterium tuberculosis detection in resource limited settings.

    Science.gov (United States)

    Alfred, Nwofor; Lovette, Lawson; Aliyu, Gambo; Olusegun, Obasanya; Meshak, Panwal; Jilang, Tunkat; Iwakun, Mosunmola; Nnamdi, Emenyonu; Olubunmi, Onuoha; Dakum, Patrick; Abimiku, Alash'le

    2014-03-03

    The light-emitting diode (LED) fluorescence microscopy has made acid-fast bacilli (AFB) detection faster and efficient although its optimal performance in resource-limited settings is still being studied. We assessed the optimal performances of light and fluorescence microscopy in routine conditions of a resource-limited setting and evaluated the digestion time for sputum samples for maximum yield of positive cultures. Cross-sectional study. Facility-based involving samples of routine patients receiving tuberculosis treatment and care from the main tuberculosis case referral centre in northern Nigeria. The study included 450 sputum samples from 150 new patients with clinical diagnosis of pulmonary tuberculosis. The 450 samples were pooled into 150 specimens, examined independently with mercury vapour lamp (FM), LED CysCope (CY) and Primo Star iLED (PiLED) fluorescence microscopies, and with the Ziehl-Neelsen (ZN) microscopy to assess the performance of each technique compared with liquid culture. The cultured specimens were decontaminated with BD Mycoprep (4% NaOH-1% NLAC and 2.9% sodium citrate) for 10, 15 and 20 min before incubation in Mycobacterium growth incubator tube (MGIT) system and growth examined for acid-fast bacilli (AFB). Of the 150 specimens examined by direct microscopy: 44 (29%), 60 (40%), 49 (33%) and 64 (43%) were AFB positive by ZN, FM, CY and iLED microscopy, respectively. Digestion of sputum samples for 10, 15 and 20 min yielded mycobacterial growth in 72 (48%), 81 (54%) and 68 (45%) of the digested samples, respectively, after incubation in the MGIT system. In routine laboratory conditions of a resource-limited setting, our study has demonstrated the superiority of fluorescence microscopy over the conventional ZN technique. Digestion of sputum samples for 15 min yielded more positive cultures.

  3. Improving decision making for massive transfusions in a resource poor setting: a preliminary study in Kenya.

    Directory of Open Access Journals (Sweden)

    Elisabeth D Riviello

    Full Text Available The reality of finite resources has a real-world impact on a patient's ability to receive life-saving care in resource-poor settings. Blood for transfusion is an example of a scarce resource. Very few studies have looked at predictors of survival in patients requiring massive transfusion. We used data from a rural hospital in Kenya to develop a prediction model of survival among patients receiving massive transfusion.Patients who received five or more units of whole blood within 48 hours between 2004 and 2010 were identified from a blood registry in a rural hospital in Kenya. Presenting characteristics and in-hospital survival were collected from charts. Using stepwise selection, a logistic model was developed to predict who would survive with massive transfusion versus those who would die despite transfusion. An ROC curve was created from this model to quantify its predictive power.Ninety-five patients with data available met inclusion criteria, and 74% survived to discharge. The number of units transfused was not a predictor of mortality, and no threshold for futility could be identified. Preliminary results suggest that initial blood pressure, lack of comorbidities, and indication for transfusion are the most important predictors of survival. The ROC curve derived from our model demonstrates an area under the curve (AUC equal to 0.757, with optimism of 0.023 based on a bootstrap validation.This study provides a framework for making prioritization decisions for the use of whole blood in the setting of massive bleeding. Our analysis demonstrated an overall survival rate for patients receiving massive transfusion that was higher than clinical perception. Our analysis also produced a preliminary model to predict survival in patients with massive bleeding. Prediction analyses can contribute to more efficient prioritization decisions; these decisions must also include other considerations such as equity, acceptability, affordability and

  4. Identification, characterisation and composition of scavengeable feed resources for rural poultry production in Central Tanzania

    NARCIS (Netherlands)

    Goromela, E.H.; Kwakkel, R.P.; Verstegen, M.W.A.; Katule, A.M.

    2007-01-01

    A participatory study was carried out in four villages of central Tanzania to appraise existing and potential scavengeable feed resources available for rural poultry. In addition, proximate analysis of selected scavengeable feed resources including chicken crop and gizzards contents was carried out

  5. CONSIDERATIONS ON THE RURAL POPULATION AS A RESOURCE OF LABOR FORCE IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Agatha POPESCU

    2013-10-01

    Full Text Available The paper aimed to analyze the dynamics of Romania’s population and mainly of the rural population in the period 2005-2010. The following indicators were used: total population, rural population, the share of rural population in the total population, active population at national level, in the rural areas and the share of the rural active population in the total population, employment, unemployment, activity rate, employment rate, unemployment rate, employment rate by educational level, employment in agriculture by population’s age, active persons by age group. As a conclusion, Romania’s rural population accounts for 45 % of total population. A series of restraining factors such as: ageing, low training level, low capital and financial resources, lack of investments and other job alternatives affect the development of the rural areas where most of the population is dealing with agriculture. Rural space requires a multifunctional development meaning to achieve a balanced combination between agriculture, connected industries and services which could create jobs and raise the population income and living standard. This means investments both in agricultural and non-agricultural activities, a new national and local policy concerning the development of rural communities.

  6. Evaluation of groundwater resource potential in rural part of ...

    African Journals Online (AJOL)

    This study was carried out to determine groundwater potential in the rural area of Northcentral Nigeria using Vertical Electrical Sounding (VES). The VES data was generated from twenty (20) locations in the study area and was later processed and analyzed using IPI2 WIN software. The underlying geo-electric sections ...

  7. Natural resources and rural livelihoods: Differences between migrants and non-migrants in Madagascar

    Directory of Open Access Journals (Sweden)

    Raphael Nawrotzki

    2012-06-01

    Full Text Available BACKGROUND Although natural resources play a central role in rural livelihoods across the globe, little research has explored the relationship between migration and natural capital use, particularly in combination with other livelihood capitals (i.e., human, social, financial and physical. OBJECTIVE Grounded in the rural livelihood framework, this paper explores the association between the livelihood capital availability, especially natural capital, for migrants and non-migrants in rural Madagascar. METHODS Data from the 2008/2009 Demographic and Health Survey are used in combination with satellite imagery of vegetation coverage (Normalized Difference Vegetation Index, NDVI to proxy natural resources. Hierarchical multilevel models allow for inclusion of cross-level interactions between migrant status and proximate natural resources as determinants of the status of livelihood assets. RESULTS Three key findings emerge. First, higher levels of proximate natural resources are associated with greater financial, human, and social capital for both migrants and non-migrants. Second, migrants have, on average, greater financial, physical, human, and social capital than non-migrants, and urban-to-rural migrants do exceptionally well on all capital asset categories. Third, migrants residing in areas with higher levels of natural capital tend to have significantly higher levels of human capital (education. CONCLUSIONS Although we cannot examine livelihood strategies per se, the results suggest variation in livelihood potential among migrants and non-migrants in rural Madagascar, with migrants tending to have greater capital assets. In addition, access to natural resources is a central livelihood strategy.

  8. A casemix study of patients seen by a dermatology trainee in rural and urban outpatient settings.

    Science.gov (United States)

    Tilakaratne, Dev; Warren, Lachlan; Menz, Jennifer

    2016-02-01

    For 8 years South Australian dermatologists have provided an outreach service to the Northern Territory (NT), including rural and remote areas. In 2012 and 2013, a trainee accompanied a dermatologist on these outreach visits. This is the first prospective study that documents the spectrum of dermatological diseases requiring outpatient specialist input in various settings in the NT, and also the first study to compare the clinical experience of one Australian dermatology trainee in urban and rural settings. Characteristics of patients managed primarily by the outreach dermatology registrar were recorded prospectively from February 2013 to July 2013. The data from the trainee's urban encounters were compared to that of the rural centres. The spectrum of conditions seen in these two settings was placed in the disease categories specified in the Australasian College of Dermatologists (ACD) curriculum. The Royal Adelaide Hospital outpatient experience provided greater exposure to skin neoplasms, lymphoproliferative and myeloproliferative disorders and non-infectious neutrophilic/eosinophilic disorders. The outreach sites provided greater exposure to infections, adnexal diseases and genodermatoses. Both urban and rural experiences provided a broad exposure to the disease categories outlined in the ACD curriculum. The spectrum of disease requiring specialist dermatology input varies between urban South Australia and rural NT. The inclusion of dermatology trainees in outreach visits broadens their clinical exposure. It is recommended that other dermatology service providers in Australia consider documenting clinical casemix comparisons to assess dermatology demand, outcomes and trainee exposure. © 2014 The Australasian College of Dermatologists.

  9. Global Health: Preparation for Working in Resource-Limited Settings.

    Science.gov (United States)

    St Clair, Nicole E; Pitt, Michael B; Bakeera-Kitaka, Sabrina; McCall, Natalie; Lukolyo, Heather; Arnold, Linda D; Audcent, Tobey; Batra, Maneesh; Chan, Kevin; Jacquet, Gabrielle A; Schutze, Gordon E; Butteris, Sabrina

    2017-11-01

    Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships. Copyright © 2017 by the American Academy of Pediatrics.

  10. HIV and Pregnancy in Resource-Poor Settings

    Science.gov (United States)

    Tang, Jennifer; Nour, Nawal M

    2010-01-01

    There are 33.4 million people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome. Globally, HIV/AIDS is the leading cause of death among women of reproductive age. In the United States and other developed countries, aggressive efforts to treat HIV-positive pregnant women with highly active antiretroviral therapy have decreased the maternal-to-child transmission (MTCT) from over 20% to less than 2%. However, in resource-poor settings, access to antiretroviral therapy (ART) is not readily available, and perinatal transmission rates remain as high as 45%. Women are at greater risk of heterosexual transmission of HIV, which is compounded by lack of condom use, imbalance of social power, and the high fertility rate. Prevention programs are needed to empower and educate women and engender community awareness for condom use. Prenatal screening and treatment, intrapartum ART, and postpartum prophylaxis must be made available to all women and children to prevent MTCT. PMID:20842284

  11. Caring for the injured child in settings of limited resource.

    Science.gov (United States)

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. Published by Elsevier Inc.

  12. Frugal innovation in medicine for low resource settings.

    Science.gov (United States)

    Tran, Viet-Thi; Ravaud, Philippe

    2016-07-07

    Whilst it is clear that technology is crucial to advance healthcare: innovation in medicine is not just about high-tech tools, new procedures or genome discoveries. In constrained environments, healthcare providers often create unexpected solutions to provide adequate healthcare to patients. These inexpensive but effective frugal innovations may be imperfect, but they have the power to ensure that health is within reach of everyone. Frugal innovations are not limited to low-resource settings: ingenuous ideas can be adapted to offer simpler and disruptive alternatives to usual care all around the world, representing the concept of "reverse innovation". In this article, we discuss the different types of frugal innovations, illustrated with examples from the literature, and argue for the need to give voice to this neglected type of innovation in medicine.

  13. Characteristics of Pesticide Poisoning in Rural and Urban Settings in Uganda

    DEFF Research Database (Denmark)

    Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria

    2017-01-01

    , pesticides were the most prevalent single poison responsible for intoxications (N = 212 [28.8%]). Self-harm constituted a significantly higher proportion of the total number of poisonings in urban (63.3%) compared with rural areas (25.6%) where unintentional poisonings prevailed. Men were older than women...... and represented a majority of around 60% of the cases in both the urban and rural settings. Unintentional cases were almost the only ones seen below the age of 10, whereas self-harm dominated among adolescents and young persons from 10 to 29 years of age. Organophosphorus insecticides accounted for 73.......0% of the poisonings. Urban hospitals provided a more intensive treatment and had registered fever complications than rural health care settings. To minimize self-harm with pesticides, a restriction of pesticide availability as shown to be effective in other low-income countries is recommended. Training of health care...

  14. Energy use in the rural areas of India: setting up a rural energy data base

    International Nuclear Information System (INIS)

    Sinha, Chandra Shekhar; Sinha, Shirish; Joshi, Veena

    1998-01-01

    Aggregating and forecasting demand are crucial parts of energy planning. While a large number of energy consumption surveys have been conducted in the past in the rural energy sector of India, the lack of sufficient data and its compilation, coupled with doubt about the quality of data, has made the task extremely difficult. This paper summarizes recent efforts to compile, computerize and analyze data from 638 village energy consumption surveys covering over 39,000 households, carried out by different organisations between 1985 and 1989. The details of the level of information provided in the survey reports, area of survey, land use pattern, asset ownership, etc., of the collated studies are presented. Results based on the analysis of the energy consumption data compiled are then discussed. The paper also compares the estimates with those based on other surveys in India. (author)

  15. Action Learning Sets and Social Capital: Ameliorating the Burden of Clergy Isolation in One Rural Diocese

    Science.gov (United States)

    Muskett, Judith A.; Village, Andrew

    2016-01-01

    Rural clergy often lack colleagues and may struggle with isolation, especially if over-extended in multi-parish benefices. Theory suggests that this sense of isolation could be addressed by launching clergy action learning sets, which have the potential to establish a peer support network through the formation of social capital as a by-product of…

  16. User and provider perspectives on emergency obstetric care in a tanzanian rural setting

    DEFF Research Database (Denmark)

    Sørensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke

    2011-01-01

    The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems...

  17. Conceptualization and Measurement of the Neighborhood in Rural Settings: A Systematic Review of the Literature

    Science.gov (United States)

    De Marco, Allison; De Marco, Molly

    2010-01-01

    Interest in the effects of neighborhood context on individual wellbeing has increased in recent years. We now know that neighborhood conditions, such as poverty and deprivation, negatively impact residents. However, most of the extant work has taken an urban focus. Less is known about these processes in rural settings. Neighborhood…

  18. The Potential of Computer-Based Expert Systems for Special Educators in Rural Settings.

    Science.gov (United States)

    Parry, James D.; Ferrara, Joseph M.

    Knowledge-based expert computer systems are addressing issues relevant to all special educators, but are particularly relevant in rural settings where human experts are less available because of distance and cost. An expert system is an application of artificial intelligence (AI) that typically engages the user in a dialogue resembling the…

  19. Exploring Rural High School Learners' Experience of Mathematics Anxiety in Academic Settings

    Science.gov (United States)

    Hlalele, Dipane

    2012-01-01

    The purpose of the study was to explore rural high school learners' experience of mathematics anxiety in academic settings. Mathematics anxiety has been found to have an adverse effect on confidence, motivation and achievement. This quantitative study is exploratory and descriptive in nature. The participants were 403 learners doing mathematics in…

  20. Stressors, Coping Resources, and Depressive Symptoms among Rural American Indian Older Adults.

    Science.gov (United States)

    Roh, Soonhee; Brown-Rice, Kathleen A; Lee, Kyoung Hag; Lee, Yeon-Shim; Lawler, Michael J; Martin, James I

    2015-01-01

    The purpose of this study was to examine the associations of physical health stressors and coping resources with depressive symptoms among American Indian older adults age 50 years or older. The study used a convenience sample of 227 rural American Indian older adults. A hierarchical multiple regression tested three sets of predictors on depressive symptoms: (a) sociodemographics, (b) physical health stressors (functional disability and chronic medical conditions), and (c) coping resources (social support and spirituality). Most participants reported little difficulty in performing daily activities (e.g., eating, dressing, traveling, and managing money), while presenting over two types of chronic medical conditions. Depressive symptoms were predicted by higher scores on perceived social support and lower scores on functional disability; women and those having no health insurance also had higher levels of depressive symptoms. Findings suggest that social work practitioners should engage family and community support, advocate for access to adequate health care, and attend to women's unique circumstances and needs when working with American Indian older adults.

  1. Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

    Directory of Open Access Journals (Sweden)

    Yong-Feng Jing

    2018-01-01

    Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

  2. Behavioral management in children with intellectual disabilities in a resource-poor setting in Barwani, India

    Science.gov (United States)

    Lakhan, Ram

    2014-01-01

    Background: Management of behavioral problems in children with intellectual disabilities (ID) is a great concern in resource-poor areas in India. This study attempted to analyze the efficacy of behavioral intervention provided in resource-poor settings. Objective: This study was aimed to examine the outcome of behavioral management provided to children with ID in a poor rural region in India. Materials and Methods: We analyzed data from 104 children between 3 and 18 years old who received interventions for behavioral problems in a clinical or a community setting. The behavioral assessment scale for Indian children with mental retardation (BASIC-MR) was used to quantify the study subjects’ behavioral problems before and after we applied behavioral management techniques (baseline and post-intervention, respectively). The baseline and post-intervention scores were analyzed using the following statistical techniques: Wilcoxon matched-pairs signed-rank test for the efficacy of intervention; χ2 for group differences. Results: The study demonstrated behavioral improvements across all behavior domains (P < 0.05). Levels of improvement varied for children with different severities of ID (P = 0.001), between children who did and did not have multiple disabilities (P = 0.011). Conclusion: The outcome of this behavioral management study suggests that behavioral intervention can be effectively provided to children with ID in poor areas. PMID:24574557

  3. Biomass, energy and economic and natural resource differentiation in rural southern India

    International Nuclear Information System (INIS)

    Bhagavan, M.R.; Giriappa, S.

    1995-01-01

    The rural economy in India is as yet only partially monetized and continues to retain its semi-subsistence character, while at the same time undergoing the process of becoming more monetized and market-orientated. A large field study was conducted in rural Karnataka, a state in southern India, which uncovers the relations between the energy situations of the rural social classes and their access to labour, land, cash and physical assets. Of equal significance are regional variations in ecology, rainfall and irrigation. The study's principal focus is the rural household, but it also includes some analysis of the energy dimensions in agricultural activities and small-scale rural services. Eight villages were covered by the survey, one in each district, carefully selected to reflect the geographic, climatic, biomass-resource and socio-economic features of Karnataka. In each village an average of 55 households were studied in depth, making up a total of 450 households. Clear and marked differentiations are uncovered between the rural social classes in various aspects of energy production, purchase, sale and consumption, as well as in labour and cash inputs into the energy flows. It is found that traditional forms of biomass are still the dominant type of energy for all rural strata, and that only the rural middle class can be said to have begun the transition towards modern fuels, although its consumption of modern fuels is still negligibly small in absolute terms. The study reveals that the rural middle class faces no energy crisis, while the 'intermediate' class of the small peasantry is just about managing to make ends meet in energy terms. In contrast to this, the rural wage labour class continues to remain in a state of energy crisis. (author)

  4. Tool development to understand rural resource users' land use and ...

    African Journals Online (AJOL)

    -) ..... is a proxy for soil fertility and water availability. The resource users .... in Montpellier (France), two sessions with conservationists in Ant- ananarivo and .... hood activities within the wetlands of the Alaotra, (ii) living close to Lake Alaotra ...

  5. Opportunities for AIDS prevention in a rural state in criminal justice and drug treatment settings.

    Science.gov (United States)

    Farabee, D; Leukefeld, C G

    1999-01-01

    This study examined the likelihood that drug users would receive HIV/ AIDS prevention information and supplies (e.g., condoms and bleach) in the rural state of Kentucky. Despite evidence of high HIV risk among criminal justice and substance-using populations, incarceration and substance-user treatment were only minimally associated with prior HIV prevention exposure or HIV testing. These data strongly support the use of criminal justice and treatment settings to provide AIDS prevention interventions for the high-risk drug-using populations they serve, and to target HIV prevention services in rural as well as urban areas.

  6. System for portable nucleic acid testing in low resource settings

    Science.gov (United States)

    Lu, Hsiang-Wei; Roskos, Kristina; Hickerson, Anna I.; Carey, Thomas; Niemz, Angelika

    2013-03-01

    Our overall goal is to enable timely diagnosis of infectious diseases through nucleic acid testing at the point-of-care and in low resource settings, via a compact system that integrates nucleic acid sample preparation, isothermal DNA amplification, and nucleic acid lateral flow (NALF) detection. We herein present an interim milestone, the design of the amplification and detection subsystem, and the characterization of thermal and fluidic control and assay execution within this system. Using an earlier prototype of the amplification and detection unit, comprised of a disposable cartridge containing flexible pouches, passive valves, and electrolysis-driven pumps, in conjunction with a small heater, we have demonstrated successful execution of an established and clinically validated isothermal loop-mediated amplification (LAMP) reaction targeting Mycobacterium tuberculosis (M.tb) DNA, coupled to NALF detection. The refined design presented herein incorporates miniaturized and integrated electrolytic pumps, novel passive valves, overall design changes to facilitate integration with an upstream sample preparation unit, and a refined instrument design that automates pumping, heating, and timing. Nucleic acid amplification occurs in a two-layer pouch that facilitates fluid handling and appropriate thermal control. The disposable cartridge is manufactured using low-cost and scalable techniques and forms a closed system to prevent workplace contamination by amplicons. In a parallel effort, we are developing a sample preparation unit based on similar design principles, which performs mechanical lysis of mycobacteria and DNA extraction from liquefied and disinfected sputum. Our next step is to combine sample preparation, amplification, and detection in a final integrated cartridge and device, to enable fully automated sample-in to answer-out diagnosis of active tuberculosis in primary care facilities of low-resource and high-burden countries.

  7. Bush animal attacks: management of complex injuries in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Mitchell Katrina B

    2011-12-01

    Full Text Available Abstract Introduction Though animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting. Materials and methods Four patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC, in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home. Discussion Though human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is

  8. Relationships among sense of coherence, resources, and mental health in urban and rural residents in Japan

    Directory of Open Access Journals (Sweden)

    Tsuno Yoko Sumikawa

    2012-12-01

    Full Text Available Abstract Background The salutogenic model states that coping resources are defined within sociocultural and historical contexts and that various social and historical factors influence the availability of such resources. Though previous studies have suggested the need for an interregional comparison of psychological and social resources, few studies have undertaken such an investigation. The aim of this study is to investigate the associations among coping resources, sense of coherence (SOC, and health status in a comparison of urban and rural residents. Methods General residents (aged 30–69 years in two areas were targeted for the current study. Through a random sampling selection, 1,000 residents from each area were picked, and an anonymous questionnaire was mailed to each resident. Ultimately, 269 and 363 valid responses from the urban and rural areas, respectively, were analyzed. SOC, both social and psychological resources, and mental health were assessed. To examine relationships between SOC and resources associated with mental health, mental health was defined as a dependent variable. Hierarchical multiple regression was conducted with variables entered from sociodemographic characteristics, social and psychological resources, and SOC. Results Regarding regional characteristics, social capital and participation in community activities were significantly greater in the rural area than in the urban area. Urban residents reported significantly higher self-esteem and optimism than rural residents. SOC showed the most significant association with mental health in both areas. Mental health was significantly associated with physical activity limitations and life stressors in both areas. However, the associations were weakened when social and psychological resources and SOC were added, which demonstrated their buffering effect on the negative influence of life stressors on health. When SOC was added, the association of self-esteem with mental

  9. Strategies to advance vaccine technologies for resource-poor settings.

    Science.gov (United States)

    Kristensen, Debra; Chen, Dexiang

    2013-04-18

    New vaccine platform and delivery technologies that can have significant positive impacts on the effectiveness, acceptability, and safety of immunizations in developing countries are increasingly available. Although donor support for vaccine technology development is strong, the uptake of proven technologies by the vaccine industry and demand for them by purchasers continues to lag. This article explains the challenges and opportunities associated with accelerating the availability of innovative and beneficial vaccine technologies to meet critical needs in resource-poor settings over the next decade. Progress will require increased dialog between the public and private sectors around vaccine product attributes; establishment of specifications for vaccines that mirror programmatic needs; stronger encouragement of vaccine developers to consider novel technologies early in the product development process; broader facilitation of research and access to technologies through the formation of centers of excellence; the basing of vaccine purchase decisions on immunization systems costs rather than price per dose alone; possible subsidization of early technology adoption costs for vaccine producers that take on the risks of new technologies of importance to the public sector; and the provision of data to purchasers, better enabling them to make informed decisions that take into account the value of specific product attributes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Work setting, community attachment, and satisfaction among rural and remote nurses.

    Science.gov (United States)

    Kulig, Judith C; Stewart, Norma; Penz, Kelly; Forbes, Dorothy; Morgan, Debra; Emerson, Paige

    2009-01-01

    To describe community satisfaction and attachment among rural and remote registered nurses (RNs) in Canada. Cross-sectional survey of rural and remote RNs in Canada as part of a multimethod study.The sample consisted of a stratified random sample of RNs living in rural areas of the western country and the total population of RNs who worked in three northern regional areas and those in outpost settings. A subset of 3,331 rural and remote RNs who mainly worked in acute care, long-term care, community health, home care, and primary care comprised the sample. The home community satisfaction scale measured community satisfaction, whereas single-item questions measured work community satisfaction and overall job satisfaction. Community variables were compared across practice areas using analysis of variance, whereas a thematic analysis was conducted of the open-ended questions. Home care and community health RNs were significantly more satisfied with their work community than RNs from other practice areas. RNs who grew up in rural communities were more satisfied with their current home community. Four themes emerged from the open-ended responses that describe community satisfaction and community attachment. Recruitment and retention strategies need to include mechanisms that focus on community satisfaction, which will enhance job satisfaction.

  11. The small and rural academic library leveraging resources and overcoming limitations

    CERN Document Server

    Davis Kendrick, Kaetrena

    2016-01-01

    Through the use of case studies, research, and practical interviews, The Small or Rural Academic Library: Leveraging Resources and Overcoming Limitations explores how academic librarians in such environments can keep pace with, create, and improve modern library practices and services, network with colleagues, and access continuing education and professional development opportunities.

  12. Maternal Resources, Parenting Practices, and Child Competence in Rural, Single-Parent African American Families.

    Science.gov (United States)

    Brody, Gene H.; Flor, Douglas L.

    1998-01-01

    Tested a model linking maternal/family characteristics to child cognitive and psychosocial competence in African-American 6- to 9-year olds in rural single-mother-headed households. Found that maternal education, religiosity, and financial resources were linked with parenting style, mother-child relationship, and maternal school involvement.…

  13. Wheelbarrows full of frogs: social learning in rural resource management : international research and reflections

    NARCIS (Netherlands)

    Leeuwis, C.; Pyburn, R.; Röling, N.G.

    2002-01-01

    Standing in contrast to technological interventions and economics, ‘social learning’ reflects the idea that the shared learning of interdependent stakeholders is a key mechanism for arriving at more desirable solutions to complex problems in rural environments. Degradation of natural resources,

  14. The experience of intimate partner violence in the context of the rural setting

    Science.gov (United States)

    Roush, karen

    Intimate partner violence (IPV) against women is a pervasive health and social problem in the United States; one in three women report being abused by an intimate partner at least once in their lifetime. IPV presents unique challenges to women living in rural areas that increase their vulnerability, limit their options for safety, and hamper efforts to leave an abusive relationship. Yet there is little research examining the lived experience of WV in a general population of women in the rural setting. Also, though there is a large body of research on TV screening and health care providers' attitudes and beliefs, little is known about rural providers specifically. A mixed methods study exploring the lived experience of IPV in women in the context of the rural setting was conducted. Along with qualitative interviews with women with experience of IPV, I conducted a survey to examine the TV-related knowledge, attitudes, beliefs and behaviors of the health care providers who interact with the women. The results from this study form a picture of the lives of women who experience IPV in the rural setting as one of isolation, fear, and uncertainty tempered by determination to understand and overcome the violence. Six major themes were identified, 1) living with violence, 2) protect self, 3) isolation, 4) search for understanding, 5) system level abuse, and 6) creating a new life. In contrast to earlier studies, health care providers demonstrated good overall knowledge and judicious attitudes about IPV and beliefs congruent with available evidence related to IPV. When looked at together the knowledge, attitudes, beliefs, and behaviors of the health care providers were aligned with the experiences voiced by the women participating in the interviews. The results of this study highlight the need for an interprofessional, public health approach that addresses the complex web of individual, social, cultural, economic, and political factors that create and feed the problem.

  15. Accessing diabetes care in rural Uganda: Economic and social resources.

    Science.gov (United States)

    Nielsen, Jannie; Bahendeka, Silver K; Bygbjerg, Ib C; Meyrowitsch, Dan W; Whyte, Susan R

    2017-07-01

    Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients' journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.

  16. Late-life depression in Rural China: do village infrastructure and availability of community resources matter?

    Science.gov (United States)

    Li, Lydia W; Liu, Jinyu; Zhang, Zhenmei; Xu, Hongwei

    2015-07-01

    This study aimed to examine whether physical infrastructure and availability of three types of community resources (old-age income support, healthcare facilities, and elder activity centers) in rural villages are associated with depressive symptoms among older adults in rural China. Data were from the 2011 baseline survey of the Chinese Health and Retirement Longitudinal Study (CHARLS). The sample included 3824 older adults aged 60 years or older residing in 301 rural villages across China. A score of 12 on the 10-item Center for Epidemiologic Studies Depression Scale was used as the cutoff for depressed versus not depressed. Village infrastructure was indicated by an index summing deficiency in six areas: drinking water, fuel, road, sewage, waste management, and toilet facilities. Three dichotomous variables indicated whether income support, healthcare facility, and elder activity center were available in the village. Respondents' demographic characteristics (age, gender, marital status, and living arrangements), health status (chronic conditions and physical disability), and socioeconomic status (education, support from children, health insurance, household luxury items, and housing quality) were covariates. Multilevel logistic regression was conducted. Controlling for individuals' socioeconomic status, health status, and demographic characteristics, village infrastructure deficiency was positively associated with the odds of being depressed among rural older Chinese, whereas the provision of income support and healthcare facilities in rural villages was associated with lower odds. Village infrastructure and availability of community resources matter for depressive symptoms in rural older adults. Improving infrastructure, providing old-age income support, and establishing healthcare facilities in villages could be effective strategies to prevent late-life depression in rural China. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses.

    Science.gov (United States)

    Stratton, T D; Dunkin, J W; Juhl, N; Geller, J M

    1995-05-01

    Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

  18. Service user involvement in mental health system strengthening in a rural African setting: qualitative study

    OpenAIRE

    Abayneh, Sisay; Lempp, Heidi; Alem, Atalay; Alemayehu, Daniel; Eshetu, Tigist; Lund, Crick; Semrau, Maya; Thornicroft, Graham; Hanlon, Charlotte

    2017-01-01

    Background It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods Thirty nine semi-structured interviews were carried out with pur...

  19. Serving an Indigenous community: Exploring the cultural competence of medical students in a rural setting

    OpenAIRE

    Wong, Chin Hoong; Chen, Lee Ping; Koh, Kwee Choy; Chua, Siew Houy; Jong, Darren Chee Hiung; Mohd Fauzi, Nurliyana Mardhiah; Lim, Sue Yin

    2017-01-01

    Since 2013, medical students from the International Medical University (IMU) in Malaysia have been providing primary healthcare services, under the supervision of faculty members, to the indigenous people living in Kampung Sebir. The project has allowed the students to learn experientially within a rural setting. This study aims to examine the cultural competence of IMU medical students through an examination of their perspective of the indigenous people who they serve and the role of this co...

  20. SATISFACTION OF HUMAN RESOURCES IN SECONDARY SCHOOLS FROM ROMANIAN RURAL AREAS

    Directory of Open Access Journals (Sweden)

    Cristian Stefanescu

    2017-06-01

    Full Text Available Organization’s human resource is often called the "most valuable asset", although it does not appear in the organization’s accounts. Organization's success depends on the way in which its members implement its objectives; therefore the satisfaction of human resources is crucial for achieving good results in the organization. In this work, we conducted an analysis of the particularities of human resource management in secondary education area and an empirical study on the satisfaction of human resources in a typical rural Romanian schools. It is imperative for Romania to adopt a strategy to improve the education system in order to include new approaches of organizational governance and human resources management so that human resources within the education system have a high degree of satisfaction from the work performed.

  1. Anaesthesia in Congenital Facial Anomalies in a Rural Set up of a Developing Country

    Directory of Open Access Journals (Sweden)

    Debasish Saha

    2015-01-01

    Full Text Available Background: India has an estimated backlog of 1000000 cleft patients. A total of 35000 new cleft patients are born each year. With the capacity to operate on approximately 50000 patients each year only 15000 patients from the national backlog can be operated upon each year if capability is not augmented. Objectives: To reach the population at large we meticulously planned an out-reach programme and operated on patients even in rural set ups with lack of modern facilities. We operated on patients at sub divisional centres, where apparatus for providing sevoflurane was not available. Institutional Ethical clearance was taken before conduction of the study. Patients who required prolonged surgery were taken to the tertiary centre. Working ventilators were also not available at peripheral centres. Materials and Methods: This interventional study was carried in a time span of four years on nineteen hundred and nine patients, after taking approval from the Institutional Ethical Committee. Patients were screened and some were operated at rural centers and others at a tertiary care centre. Patients who could not afford to come to the tertiary care centre were operated at different rural centers. Informed consent was taken. Results: There were 1909 patients with Congenital Facial Anomalies (CFA over four years period out of which 918 patients were of either unilateral or bilateral cleft lip. They were successfully operated at rural health centers with limited facilities. This could reduce the total load of surgeries for CFA at tertiary care hospital ensuring safe surgeries for all with CFA for all age groups and both genders.No mortality was recorded and post operative complications consisted of nausea and vomiting, three had delayed recovery and one had laryngospasm. Conclusion: Outreach programmes can increase the efficacy of Smile Train Project and effective screening of patients before surgery can result in fruitful outcomes even in a rural set up

  2. Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

    Directory of Open Access Journals (Sweden)

    Ilona Sips

    Full Text Available Although home-based care (HBC programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs, in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs. An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data - CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25% of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.

  3. Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

    Science.gov (United States)

    Sips, Ilona; Haeri Mazanderani, Ahmad; Schneider, Helen; Greeff, Minrie; Barten, Francoise; Moshabela, Mosa

    2014-01-01

    Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data - CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.

  4. Local governance responses to social inclusion for older rural Victorians: building resources, opportunities and capabilities.

    Science.gov (United States)

    Winterton, Rachel; Clune, Samantha; Warburton, Jeni; Martin, John

    2014-09-01

    To explore how local governance enables access to resources, creates opportunities and increases capability for older people in rural communities to experience social inclusion. Twenty-six semi-structured interviews were undertaken with community stakeholders across two rural communities in north-east Victoria. Stakeholders were drawn from local government, and a range of community groups and organisations, as identified in a scoping study. Through the provision of community resources (e.g. physical and human infrastructure, organisational partnerships), local services and supports offer social and productive environments for participation. They also build individual resources (e.g. health, skills, finances, networks) to enable older people to participate within these environments, and provide assistance to allow older people to use individual and community resources. Community resources are integral in facilitating the development of older people's individual resources, and opportunities and capabilities for participation. These enable greater choice in participation, and contribute to the sustainability of community resources serving ageing populations. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.

  5. HERITAGE AS A STRATEGIC RESOURCE: EXPERIENCE OF ROMANIAN RURAL TOURISTIC FIRMS

    Directory of Open Access Journals (Sweden)

    Botezat Elena-Aurelia

    2014-12-01

    Full Text Available To achieve sustainable performance, touristic rural firms must offer more than food, accommodation and transport services. In this context, heritage plays a key role in rural tourism, directly linked with a competitive offer based on innovation and a responsible and sustainable tourism. The promotion of original elements from the life and culture of an area represents a strong touristic attraction for a significant segment of tourists. These tourists look for authenticity and they want to observe the daily life of people interspersed with local cultural elements. In our paper, firstly, we will present the Romanian rural heritage, with his particular and unique elements. Then, it will be explained how heritage can be valorised like strategic resource in order to attain competitive advantage and economic development. Finally, some examples will be presented based on study-parts of two European project implemented in the Western region of Romania.

  6. Ageing in rural China: impacts of increasing diversity in family and community resources.

    Science.gov (United States)

    Joseph, A E; Phillips, D R

    1999-06-01

    The majority of China's population lives in rural areas and a pattern is emerging of very uneven provision of support for rural elderly people. Local economic conditions and broad demographic trends are creating diversity in the ability both of rural families to care for their elderly kin and in the capacity of communities to support their elderly residents and family carers. In part as a consequence of China's population policy and the 'one-child policy', future Chinese families will have fewer members and be 'older', but they will continue to be regarded emotionally and in policy as the main source of economic and social support for the elderly. The increasing involvement of women in the paid workforce and the changing geographical distribution of family members resulting from work-related migration, are reducing the ability of families to care for their elderly relatives. The availability of resources other than the family for the care of older persons therefore becomes a key issue. Communities in more prosperous, modernising rural areas are often able to provide their elderly residents with welfare and social benefits previously found almost exclusively in urban areas. However, in poorly developed rural areas, provision is either very patchy or non-existent and the local economy cannot support expansion or improvement. A case study in Zhejiang Province illustrates the favourable provision for ageing in a prosperous modernising rural community, in which entitled elderly residents are provided with an impressive array of financial and social benefits. The paper concludes with a consideration of the policy implications of the growing differentiation of the social and economic capacity of rural communities to support their elderly members.

  7. Actors and networks in resource conflict resolution under climate change in rural Kenya

    Science.gov (United States)

    Ngaruiya, Grace W.; Scheffran, Jürgen

    2016-05-01

    The change from consensual decision-making arrangements into centralized hierarchical chieftaincy schemes through colonization disrupted many rural conflict resolution mechanisms in Africa. In addition, climate change impacts on land use have introduced additional socio-ecological factors that complicate rural conflict dynamics. Despite the current urgent need for conflict-sensitive adaptation, resolution efficiency of these fused rural institutions has hardly been documented. In this context, we analyse the Loitoktok network for implemented resource conflict resolution structures and identify potential actors to guide conflict-sensitive adaptation. This is based on social network data and processes that are collected using the saturation sampling technique to analyse mechanisms of brokerage. We find that there are three different forms of fused conflict resolution arrangements that integrate traditional institutions and private investors in the community. To effectively implement conflict-sensitive adaptation, we recommend the extension officers, the council of elders, local chiefs and private investors as potential conduits of knowledge in rural areas. In conclusion, efficiency of these fused conflict resolution institutions is aided by the presence of holistic resource management policies and diversification in conflict resolution actors and networks.

  8. Free and simple GIS as appropriate for health mapping in a low resource setting: a case study in eastern Indonesia.

    Science.gov (United States)

    Fisher, Rohan P; Myers, Bronwyn A

    2011-02-25

    Despite the demonstrated utility of GIS for health applications, there are perceived problems in low resource settings: GIS software can be expensive and complex; input data are often of low quality. This study aimed to test the appropriateness of new, inexpensive and simple GIS tools in poorly resourced areas of a developing country. GIS applications were trialled in pilot studies based on mapping of health resources and health indicators at the clinic and district level in the predominantly rural province of Nusa Tenggara Timur in eastern Indonesia. The pilot applications were (i) rapid field collection of health infrastructure data using a GPS enabled PDA, (ii) mapping health indicator data using open source GIS software, and (iii) service availability mapping using a free modelling tool. Through contextualised training, district and clinic staff acquired skills in spatial analysis and visualisation and, six months after the pilot studies, they were using these skills for advocacy in the planning process, to inform the allocation of some health resources, and to evaluate some public health initiatives. We demonstrated that GIS can be a useful and inexpensive tool for the decentralisation of health data analysis to low resource settings through the use of free and simple software, locally relevant training materials and by providing data collection tools to ensure data reliability.

  9. Vibrio Pathogens: A Public Health Concern in Rural Water Resources in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Charles A. Osunla

    2017-10-01

    Full Text Available Members of the Vibrio genus are autochthonous inhabitants of aquatic environments and play vital roles in sustaining the aquatic milieu. The genus comprises about 100 species, which are mostly of marine or freshwater origin, and their classification is frequently updated due to the continuous discovery of novel species. The main route of transmission of Vibrio pathogens to man is through drinking of contaminated water and consumption inadequately cooked aquatic food products. In sub-Saharan Africa and much of the developing world, some rural dwellers use freshwater resources such as rivers for domestic activities, bathing, and cultural and religious purposes. This review describes the impact of inadequately treated sewage effluents on the receiving freshwater resources and the associated risk to the rural dwellers that depends on the water. Vibrio infections remain a threat to public health. In the last decade, Vibrio disease outbreaks have created alertness on the personal, economic, and public health uncertainties associated with the impact of contaminated water in the aquatic environment of sub-Saharan Africa. In this review, we carried out an overview of Vibrio pathogens in rural water resources in Sub-Saharan Africa and the implication of Vibrio pathogens on public health. Continuous monitoring of Vibrio pathogens among environmental freshwater and treated effluents is expected to help reduce the risk associated with the early detection of sources of infection, and also aid our understanding of the natural ecology and evolution of Vibrio pathogens.

  10. Integrated water resources management for sustainable development of in western rural China

    Institute of Scientific and Technical Information of China (English)

    CHEN Gui-bao; HUANG Gao-bao

    2010-01-01

    Management in water resources development of Jinghe watershed of western rural China is examined with Participatory Rural Appraisal method--a rare applied method in China and questionnaire survey of stakeholders.Combination of these two survey methods derives good results as it could avoid personal bias in identifying and ranking the issues on a concrete basis in following up households'survey.Statistic Package for Social Sciences(SPSS)was used for data analysis.Results indicate that since the early 1980s.issues of water scarcity,river pollution,soil erosion,insufficient participation of stakeholders in water resources use and management,as well as centrahzed water planning and management system have created difficulties for sustainable development of the watershed.The stakeholders and local governments are fully aware of the challenges and are committed to achieving a solution through integrated water resource management(IWRD).The concept and the application of IWRD for rural China are reviewed and analyzed,and a framework for implementation of IWRD in China is developed.It is conchided that the keys to successful implementation of the approach will depend on optimal arrangement of institutions,policy reforms,community involvement and capacity building in water sector,which need to fully integrate various management functions within the watershed.

  11. Vibrio Pathogens: A Public Health Concern in Rural Water Resources in Sub-Saharan Africa.

    Science.gov (United States)

    Osunla, Charles A; Okoh, Anthony I

    2017-10-07

    Members of the Vibrio genus are autochthonous inhabitants of aquatic environments and play vital roles in sustaining the aquatic milieu. The genus comprises about 100 species, which are mostly of marine or freshwater origin, and their classification is frequently updated due to the continuous discovery of novel species. The main route of transmission of Vibrio pathogens to man is through drinking of contaminated water and consumption inadequately cooked aquatic food products. In sub-Saharan Africa and much of the developing world, some rural dwellers use freshwater resources such as rivers for domestic activities, bathing, and cultural and religious purposes. This review describes the impact of inadequately treated sewage effluents on the receiving freshwater resources and the associated risk to the rural dwellers that depends on the water. Vibrio infections remain a threat to public health. In the last decade, Vibrio disease outbreaks have created alertness on the personal, economic, and public health uncertainties associated with the impact of contaminated water in the aquatic environment of sub-Saharan Africa. In this review, we carried out an overview of Vibrio pathogens in rural water resources in Sub-Saharan Africa and the implication of Vibrio pathogens on public health. Continuous monitoring of Vibrio pathogens among environmental freshwater and treated effluents is expected to help reduce the risk associated with the early detection of sources of infection, and also aid our understanding of the natural ecology and evolution of Vibrio pathogens.

  12. Vibrio Pathogens: A Public Health Concern in Rural Water Resources in Sub-Saharan Africa

    Science.gov (United States)

    Osunla, Charles A.

    2017-01-01

    Members of the Vibrio genus are autochthonous inhabitants of aquatic environments and play vital roles in sustaining the aquatic milieu. The genus comprises about 100 species, which are mostly of marine or freshwater origin, and their classification is frequently updated due to the continuous discovery of novel species. The main route of transmission of Vibrio pathogens to man is through drinking of contaminated water and consumption inadequately cooked aquatic food products. In sub-Saharan Africa and much of the developing world, some rural dwellers use freshwater resources such as rivers for domestic activities, bathing, and cultural and religious purposes. This review describes the impact of inadequately treated sewage effluents on the receiving freshwater resources and the associated risk to the rural dwellers that depends on the water. Vibrio infections remain a threat to public health. In the last decade, Vibrio disease outbreaks have created alertness on the personal, economic, and public health uncertainties associated with the impact of contaminated water in the aquatic environment of sub-Saharan Africa. In this review, we carried out an overview of Vibrio pathogens in rural water resources in Sub-Saharan Africa and the implication of Vibrio pathogens on public health. Continuous monitoring of Vibrio pathogens among environmental freshwater and treated effluents is expected to help reduce the risk associated with the early detection of sources of infection, and also aid our understanding of the natural ecology and evolution of Vibrio pathogens. PMID:28991153

  13. Management of water resources in the Cantareira Water Producer System area: a look at the rural context

    Directory of Open Access Journals (Sweden)

    Rafael Eduardo Chiodi

    2013-12-01

    Full Text Available The National Water Resources Policy established the principles of participation, integration and decentralization, as well as new instruments for the management of water resources in Brazil. The implementation of this policy created several challenges, such as establishing effective management within the framework of rural territorial structure. The example of the Cantareira’s System in Piracicaba river watershed is conducive to the understanding of this challenge. In this scenario, we analyzed the effective implementation of principles, and of two instruments of water resource management from the perspective of farmers’ participation: the integration of water management and rural land use, and public policies for rural areas. To accomplish this, we reviewed documents and literature, and considered conclusions drawn from meetings at the Technical Chamber of Use and Water Conservation in Rural Areas (CT-Rural. We identified a lack of participation by farmers’ representatives in the CT-Rural Chamber and little concern to increase their participation in the management practices. However, the support payments for environmental services projects (PES are stimulating farmers and calling attention to the Cantareira area, in addition to promoting the integration of water resource management and rural land use. However, even though this support acknowledges the importance of the farmers, we emphasize the low priority given by the Piracicaba, Capivari and Jundiaí Watershed Committee to the rural context of the area studied.

  14. Manual cleaning of hospital mattresses: an observational study comparing high- and low-resource settings.

    Science.gov (United States)

    Hopman, J; Hakizimana, B; Meintjes, W A J; Nillessen, M; de Both, E; Voss, A; Mehtar, S

    2016-01-01

    Hospital-associated infections (HAIs) are more frequently encountered in low- than in high-resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low-resource settings. To evaluate the biological contamination of routinely cleaned mattresses in both high- and low-resource settings. In this two-stage observational study, routine manual bed cleaning was evaluated at two university hospitals using adenosine triphosphate (ATP). Standardized training of cleaning personnel was achieved in both high- and low-resource settings. Qualitative analysis of the cleaning process was performed to identify predictors of cleaning outcome in low-resource settings. Mattresses in low-resource settings were highly contaminated prior to cleaning. Cleaning significantly reduced biological contamination of mattresses in low-resource settings (P cleaning in both the high- and low-resource settings seemed comparable. Cleaning with appropriate type of cleaning materials reduced the contamination of mattresses adequately. Predictors for mattresses that remained contaminated in a low-resource setting included: type of product used, type of ward, training, and the level of contamination prior to cleaning. In low-resource settings mattresses were highly contaminated as noted by ATP levels. Routine manual cleaning by trained staff can be as effective in a low-resource setting as in a high-resource setting. We recommend a multi-modal cleaning strategy that consists of training of domestic services staff, availability of adequate time to clean beds between patients, and application of the correct type of cleaning products. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  15. Building quality mHealth for low resource settings.

    Science.gov (United States)

    Ettinger, Kate Michi; Pharaoh, Hamilton; Buckman, Reymound Yaw; Conradie, Hoffie; Karlen, Walter

    In low- and middle-income countries (LMIC), community health care workers (CHCW) are the primary point of care for millions of people. Mobile phone health applications (mHealth app) are the preferred technology platform to deliver clinical support to CHCW. In LMIC, limited regulatory oversight exists to guide quality and safety for medical devices, including mHealth. During the development of a mHealth app to assist CHCW with patient assessment and clinical diagnosis in rural South Africa, we applied human-centred design (HCD) and a bioethics consultation. The HCD approach enabled us to develop a mHealth app that responded to the needs and capacities of CHCW. The bioethics consultation prompted early consideration of safety concerns, social implications of our mHealth app and our technology's impact on the CHCW-patient relationship. In this study, we found that combining a HCD approach with bioethics consultation improved the design quality and reduced safety concerns for our mHealth app.

  16. Managing Human Resource based Intellectual Capital in a Global setting

    DEFF Research Database (Denmark)

    Gretzinger, Susanne; Lemke, Sarah; Matiaske, Wenzel

    2014-01-01

    From a strategic management perspective human capital and the embedded knowledge can be viewed as intellectual capital and became inevitably important for companies in general as well as for multinationals. While national companies just have to (re-)combine resources within a homogeneous...... if culturally differentiated incentive systems are necessary for optimised retention management? In the empirical part of this study it was made us of data from 32 countries. The research results reveal a moderating impact of cultural dimensions and therefore a cultural dependency for the effectiveness...... of incentives on retention management and therewith implicates that retention management is significant for the process of developing and fostering a MNCs intellectual capital. To improve their human-resource based intellectual capital MNCs have to adapt their initiatives to the cultural background...

  17. NICU OUTCOME IN A LOW RESOURCE TEACHING HOSPITAL SETTING

    OpenAIRE

    Sunil; Adarsh; Sahana; Prema; Tamil; Purushotham; Rajanish; Sebastain

    2013-01-01

    OBJECTIVE : To study the mortality pattern in a level III neonatal intensive care unit (NICU)in a low resource teaching hospital. METHODS : A retrospective study was conducted over a period of three years from January 2011 to December 2013. The medical records of all babies who died after being admitte d to the NICU were reviewed. Survival was defined as the discharge of a live infant from the hospital. Data regarding...

  18. Managing resources and reducing waste in healthcare settings.

    Science.gov (United States)

    Minogue, Virginia; Wells, Bill

    2016-05-18

    The NHS is under pressure to increase its effectiveness and productivity. Nurses are tasked with delivering effective and efficient care, as well as improving patient safety, experiences and results. The reduction of waste in service delivery, care and treatment can release time and resources for nurses to engage in direct patient care. Nurses have an important role in reducing waste and influencing other professionals in the healthcare environment to increase their efficiency and productivity.

  19. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings

    Science.gov (United States)

    Meyer, Ana-Claire L.; Dua, Tarun; Boscardin, John; Escarce, José J.; Saxena, Shekhar; Birbeck, Gretchen L.

    2013-01-01

    Purpose Epilepsy is one of the most common serious neurological disorders worldwide. Our objective was to determine which economic, healthcare, neurology and epilepsy specific resources were associated with untreated epilepsy in resource-constrained settings. Methods A systematic review of the literature identified community-based studies in resource-constrained settings that calculated the epilepsy treatment gap, the proportion with untreated epilepsy, from prevalent active epilepsy cases. Economic, healthcare, neurology and epilepsy specific resources were taken from existing datasets. Poisson regression models with jackknifed standard errors were used to create bivariate and multivariate models comparing the association between treatment status and economic and health resource indicators. Relative risks were reported. Key Findings Forty-seven studies of 8285 individuals from 24 countries met inclusion criteria. Bivariate analysis demonstrated that individuals residing in rural locations had significantly higher risks of untreated epilepsy [Relative Risk(RR)=1.63; 95% confidence interval(CI):1.26,2.11]. Significantly lower risks of untreated epilepsy were observed for higher physician density [RR=0.65, 95% CI:0.55,0.78], presence of a lay [RR=0.74, 95%CI:0.60,0.91] or professional association for epilepsy [RR=0.73, 95%CI:0.59,0.91], or post-graduate neurology training program [RR=0.67, 95%CI:0.55, 0.82]. In multivariate models, higher physician density maintained significant effects [RR=0.67; 95%CI:0.52,0.88]. Significance Even among resource-limited regions, people with epilepsy in countries with fewer economic, healthcare, neurology and epilepsy specific resources are more likely to have untreated epilepsy. Community-based epilepsy care programs have improved access to treatment but in order to decrease the epilepsy treatment gap, poverty and inequalities of healthcare, neurological and epilepsy resources must be dealt with at the local, national, and global

  20. Barriers to accessing termination of pregnancy in a remote and rural setting: a qualitative study.

    Science.gov (United States)

    Heller, R; Purcell, C; Mackay, L; Caird, L; Cameron, S T

    2016-09-01

    To explore the experiences of women from a remote and rural setting who had a termination of pregnancy (TOP), in relation to any barriers they may have experienced trying to access TOP. Qualitative interview study. Scottish Highlands and Western Isles. Women who had undergone TOP in the Scottish Highlands National Health Service between October 2014 and May 2015. Sixteen semi-structured, audio-recorded telephone interviews were conducted by a researcher with women who had consented to be interviewed at their initial assessment. Six stages of thematic analysis were followed to explore themes in and across participant accounts. Themes derived from interview transcripts. Four themes emerged relating to barriers to access and experience: (1) the impact of travel for TOP, (2) temporal factors unique to this population and how they affected women, (3) the attitude of health professionals, notably general practitioners, as a result of local culture, and (4) stigma surrounding TOP and the expectation that abortion will be traumatising. Women in remote and rural areas experience barriers to accessing TOP. Prompt referrals, more providers of TOP and tackling stigma associated with TOP could make delivery of this service more equitable and improve women's journey through TOP. Women in remote and rural areas of Scotland face multiple barriers to accessing termination of pregnancy. © 2016 Royal College of Obstetricians and Gynaecologists.

  1. Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

    Directory of Open Access Journals (Sweden)

    Lionis Christos

    2012-04-01

    Full Text Available Abstract Background Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece and to offer an estimate of iron deficiency anaemia (IDA frequency in this study group. Methods All patients attending the rural primary health care units of twelve general practitioners (GPs on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion. Results One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5% of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI from 10.9 to 11.4 and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7 (P = 0.01. Sixteen out of those 45 patients with anaemia (35.6% had IDA, with ferritin levels lower than 30 ng/ml. Conclusion Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.

  2. Dysmenorrhoea in different settings: Are the rural and urban adolescent girls perceiving and managing the dysmenorrhoea problem differently?

    Directory of Open Access Journals (Sweden)

    Avasarala Atchuta

    2008-01-01

    Full Text Available Context: It is well-known that every health problem, not only presents itself with different epidemiological profiles in different population settings, but is also perceived and managed differently. Having knowledge of these variations in its presentations and perceptions in different population settings, for example, in urban and rural settings, will be useful for its successful management. Aim: To study differences in epidemiological profiles, perceptions, socio economic losses, and quality-of-life losses and management of dysmenorrhoea in different settings for effective management. Design and Setting: A comparative cross-sectional study among adolescent school girls (101 girls in urban areas and 79 girls in rural areas in the district of Karimnagar. Materials and Methods: A cross-sectional survey using a pretested questionnaire was conducted among 180 adolescent girls in urban and rural settings. Statistical Analyses Used: Proportions and X 2 test. Results: The prevalence of dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas (X 2 df = 0.1, P = 0.05. Sickness absenteeism (28-48%, socio economic losses, and perceived quality of life losses are more prevalent among girls in urban areas than in girls in rural areas. Girls in rural areas resort to physical labor and other natural methods to obtain relief while the girls in urban areas are mainly depending on medications. Conclusions: Dysmenorrhoea can also be managed effectively by natural methods without resorting to medicines, provided one is psychologically prepared to face it without anxiety.

  3. Resources, not capital: A case study of the gendered distribution and productivity of social network ties in rural Ethiopia

    OpenAIRE

    Torkelsson, A.

    2007-01-01

    Metadata only record A rigid division of labor between men and women in the rural areas of developing countries oblige women to pursue household responsibilities while men work in the field for economic purposes. They use different resources for their livelihood strategies; therefore, men and women experience different opportunities and limitations to access the resources. With a case study of a rural village in Ethiopia, the author examines the gendered role in the distribution and produc...

  4. Pediatric Adenotonsillectomy in a Low Resource Setting: Lessons ...

    African Journals Online (AJOL)

    suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting. KEYWORDS: Adenoidectomy, analgesia, pediatric, tonsillectomy, transfusion. How to cite this article: Ameye SA, Owojuyigbe AM, Adeyemo A,. Adenekan AT, Ouche S. Pediatric adenotonsillectomy ...

  5. Women in natural resource collection: Experience from rural Jharkhand in India

    Science.gov (United States)

    Ghosh, Bhola Nath; De, Utpal Kumar

    2015-02-01

    Women living in rural areas are closely associated with the natural environment. Poor families are mostly dependent on natural resources for their survival activities viz. grazing of cattle, collection of water for drinking and cooking purposes and collection of fuel wood. In the poor families due to the compulsion of earning, adult males mostly go for outside activities and sometimes female members of the family also join them. The aforementioned natural resource collection activities are considered to be inferior, less remunerative and hence suitable for the women or young kids to perform. Thus, they are found to be more close to the nature than men and this very close relationship makes them perfect managers of the eco-system in their vicinity. The life of rural women is so much intertwined with the environment that they can't even think of her survival without it. However, there might be significant inter-household differences in the distribution of such activities between male and female members of the families, depending upon their socio-economic characteristics, cultural and religious beliefs and attitude towards women and children. The involvement of women in such activities is also found to be more in the tribal dominated societies. This paper tried to examine the extent to which women in rural Jharkhand are involved in such natural resource collection and management activities. Also, we tried to unearth various economic and cultural reasons and their impact on the involvement of women in such activities across various social and economic groups. The analysis of primary data collected from the rural areas of tribal dominated Jharkhand reveals that income, occupation and status of the families have significant inverse link with the involvement of women and also of girl children at the cost of their educational prospects. Religious and cultural beliefs also enter in the determination of extent of involvement of women and children in the rural society. It is

  6. Impacts of Rural Labor Resource Change on the Technical Efficiency of Crop Production in China

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    Ning Yin

    2017-03-01

    Full Text Available This paper probes effects of the evolvement of labor resources on technical efficiency in crop production in rural China. Based on twelve years of data on crop production of 30 provinces in China, a stochastic frontier production function model is used to measure crop production efficiency in three crop-functional areas—the production area, the consumption area, and the balanced area. Then effects of both quantity and quality change in labor force on technical efficiency in different regions of China are analyzed. Results show that rural China generally has an increasing number of employees shifted to non-agricultural sectors and a decreasing trend of the stock of human capital. However, both these two changes in rural labor force have significantly positive effects on improving crop production efficiency. In addition, China’s technical inefficiency is at an average of 22.2%. Dynamically, the technical efficiencies show a tendency to rise steadily throughout China and in three areas, while the consumption area possesses the highest technical efficiency. Those results may lend some experience for other countries that are currently experiencing rural labor force and economic transition.

  7. Emerging issues on the sustainability of the community based rural water resources management approach in Zimbabwe: A case study of Gwanda District

    Directory of Open Access Journals (Sweden)

    Thulani Dube

    2012-12-01

    Full Text Available Although there is considerable on-going debate about the suitability and sustainability of community based water resources management (CBWRM in Africa as a water provision strategy, evidence shows that this approach has gone a long way in promoting access to clean water amongst rural African communities. CBWRM provides an alternative approach to water provision for rural communities. This paper examines how the strategy has been operationalised in Gwanda District in Zimbabwe. The paper examines the experiences of rural communities in using CBWRM. Data was collected using focus group discussions, key informant in-depth interviews and a survey of 685 households in Gwanda district across five wards. The findings of this study are that 67% of the surveyed rural communities in Gwanda depended on community managed water resources mostly in the form of boreholes and protected wells. High rates of nun-functional sources were reported at 60-70% in most wards. Several system weaknesses were noted in the current CBWRM set-up including a depletion of committee memberships, inadequate community resources, limited agency and government support. This paper makes several recommendations on strengthening the capacity of CBWRM in Zimbabwe and Africa.

  8. Effect of wheelchair design on wheeled mobility and propulsion efficiency in less-resourced settings

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    Christopher J. Stanfill

    2017-09-01

    Conclusion: Use of wheel-mounted accelerometers as a means to test user mobility proved to be a feasible methodology in rural settings. Variability in wheeled mobility data could be decreased with longer acclimatisation periods. The data suggest that push rim users experience an easier transition to a dual-lever propulsion system.

  9. Mapping of Florida's Coastal and Marine Resources: Setting Priorities Workshop

    Science.gov (United States)

    Robbins, Lisa; Wolfe, Steven; Raabe, Ellen

    2008-01-01

    The importance of mapping habitats and bioregions as a means to improve resource management has become increasingly clear. Large areas of the waters surrounding Florida are unmapped or incompletely mapped, possibly hindering proper management and good decisionmaking. Mapping of these ecosystems is among the top priorities identified by the Florida Oceans and Coastal Council in their Annual Science Research Plan. However, lack of prioritization among the coastal and marine areas and lack of coordination of agency efforts impede efficient, cost-effective mapping. A workshop on Mapping of Florida's Coastal and Marine Resources was sponsored by the U.S. Geological Survey (USGS), Florida Department of Environmental Protection (FDEP), and Southeastern Regional Partnership for Planning and Sustainability (SERPPAS). The workshop was held at the USGS Florida Integrated Science Center (FISC) in St. Petersburg, FL, on February 7-8, 2007. The workshop was designed to provide State, Federal, university, and non-governmental organizations (NGOs) the opportunity to discuss their existing data coverage and create a prioritization of areas for new mapping data in Florida. Specific goals of the workshop were multifold, including to: * provide information to agencies on state-of-the-art technology for collecting data; * inform participants of the ongoing mapping programs in waters off Florida; * present the mapping needs and priorities of the State and Federal agencies and entities operating in Florida; * work with State of Florida agencies to establish an overall priority for areas needing mapping; * initiate discussion of a unified classification of habitat and bioregions; * discuss and examine the need to standardize terminology and data collection/storage so that data, in particular habitat data, can be shared; 9 identify opportunities for partnering and leveraging mapping efforts among agencies and entities; * identify impediments and organizational gaps that hinder collection

  10. Perspectives on healthcare, chronic non-communicable disease, and healthworlds in an urban and rural setting.

    Science.gov (United States)

    Lopes Ibanez-Gonzalez, Daniel

    2014-01-01

    Amidst diverging discourses describing chronic non-communicable disease (NCD) and healthcare access, the hermeneutical tradition within sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. In this study, we aimed to understand how women living with NCDs experience their illness and access healthcare in an urban and rural context. This study was a mixed-methods comparative case study of the healthcare access experiences of women with NCDs in an urban and rural area in South Africa. The core of the study methodology was a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The cross-sectional survey describes a low resource population with a high prevalence of NCDs. Slightly over half the respondents in urban Soweto (50.7%) reported having at least one NCD. Only around a third (33.3%) of these participants reported accessing formal healthcare services in the past 6 months. Similar trends were found in the review of research carried out in rural Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how medicine from the clinic interacts with the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. A consideration of the findings suggests five broad themes for further research: 1) processes of constructing body narratives; 2) encounters with purposive-rational systems; 3) encounters with traditional medicine; 4) encounters with contemporary informal medicine; and 5) religion and healthcare. These five themes constitute the beginning of a comprehensive schema of the lifeworld/healthworld.

  11. Exploring the impact of wheelchair design on user function in a rural South African setting.

    Science.gov (United States)

    Visagie, Surona; Duffield, Svenje; Unger, Mariaan

    2015-01-01

    Wheelchairs provide mobility that can enhance function and community integration. Function in a wheelchair is influenced by wheelchair design. To explore the impact of wheelchair design on user function and the variables that guided wheelchair prescription in the study setting. A mixed-method, descriptive design using convenience sampling was implemented. Quantitative data were collected from 30 wheelchair users using the functioning every day with a Wheelchair Scale and a Wheelchair Specification Checklist. Qualitative data were collected from ten therapists who prescribed wheelchairs to these users, through interviews. The Kruskal-Wallis test was used to identify relationships, and content analysis was undertaken to identify emerging themes in qualitative data. Wheelchairs with urban designs were issued to 25 (83%) participants. Wheelchair size, fit, support and functional features created challenges concerning transport, operating the wheelchair, performing personal tasks, and indoor and outdoor mobility. Users using wheelchairs designed for use in semi-rural environments achieved significantly better scores regarding the appropriateness of the prescribed wheelchair than those using wheelchairs designed for urban use ( p = <0.01). Therapists prescribed the basic, four-wheel folding frame design most often because of a lack of funding, lack of assessment, lack of skills and user choice. Issuing urban type wheelchairs to users living in rural settings might have a negative effect on users' functional outcomes. Comprehensive assessments, further training and research, on long term cost and quality of life implications, regarding provision of a suitable wheelchair versus a cheaper less suitable option is recommended.

  12. Exploring rural high school learners' experience of mathematics anxiety in academic settings

    Directory of Open Access Journals (Sweden)

    Dipane Hlalele

    2012-01-01

    Full Text Available The purpose of the study was to explore rural high school learners' experience of mathematics anxiety in academic settings. Mathematics anxiety has been found to have an adverse effect on confidence, motivation and achievement. This quantitative study is exploratory and descriptive in nature. The participants were 403 learners doing mathematics in 18 rural schools in the Free State province of South Africa. Participants completed a 20-item questionnaire and 373 (92.5% questionnaires were found to contain valid responses and were analysed by a professional statistician at the University of the Free State using the Statistical Package for the Social Sciences (SPSS, Version 17.0. The questionnaire was testedfor reliability using the Cronbach alpha coefficient and was found to have a reliability score of .841, indicating an acceptable reliability coefficient. Findings reveal that all learners sometimes, often, or always experience mathematics anxiety in academic settings. It is therefore important for teachers and authorities in education to observe its prevalence and to implement strategies toward the alleviation of the effects ofmathematics anxiety.

  13. Setting up an index for the appropriatness of energy sources for rural India

    Energy Technology Data Exchange (ETDEWEB)

    Tewari, S K

    1979-07-01

    In India, widespread poverty is noticed specially in the rural section, the poverty being attributed to a variety of reasons. Rural development comprises the development of basic necessities like water, power, etc. Availability of energy is therefore a major pre-requisite for rural development. The author discusses a model with which various alternate sources can be evaluated with the rural context in picture.

  14. Manual cleaning of hospital mattresses: an observational study comparing high- and low-resource settings

    NARCIS (Netherlands)

    Hopman, J.; Hakizimana, B.; Meintjes, W.A.; Nillessen, M.; Both, E. de; Voss, A.; Mehtar, S.

    2016-01-01

    BACKGROUND: Hospital-associated infections (HAIs) are more frequently encountered in low- than in high-resource settings. There is a need to identify and implement feasible and sustainable approaches to strengthen HAI prevention in low-resource settings. AIM: To evaluate the biological contamination

  15. Psychological wellbeing, physical impairments and rural aging in a developing country setting.

    Science.gov (United States)

    Abas, Melanie A; Punpuing, Sureeporn; Jirapramupitak, Tawanchai; Tangchonlatip, Kanchana; Leese, Morven

    2009-07-16

    There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability

  16. Care interrupted: Poverty, in-migration, and primary care in rural resource towns.

    Science.gov (United States)

    Rice, Kathleen; Webster, Fiona

    2017-10-01

    Internationally, rural people have poorer health outcomes relative to their urban counterparts, and primary care providers face particular challenges in rural and remote regions. Drawing on ethnographic fieldnotes and 14 open-ended qualitative interviews with care providers and chronic pain patients in two remote resource communities in Northern Ontario, Canada, this article examines the challenges involved in providing and receiving primary care for complex chronic conditions in these communities. Both towns struggle with high unemployment in the aftermath of industry closure, and are characterized by an abundance of affordable housing. Many of the challenges that care providers face and that patients experience are well-documented in Canadian and international literature on rural and remote health, and health care in resource towns (e.g. lack of specialized care, difficulty with recruitment and retention of care providers, heavy workload for existing care providers). However, our study also documents the recent in-migration of low-income, largely working-age people with complex chronic conditions who are drawn to the region by the low cost of housing. We discuss the ways in which the needs of these in-migrants compound existing challenges to rural primary care provision. To our knowledge, our study is the first to document both this migration trend, and the implications of this for primary care. In the interest of patient health and care provider well-being, existing health and social services will likely need to be expanded to meet the needs of these in-migrants. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  17. The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings.

    Science.gov (United States)

    Campbell, Jeffrey I; Aturinda, Isaac; Mwesigwa, Evans; Burns, Bridget; Santorino, Data; Haberer, Jessica E; Bangsberg, David R; Holden, Richard J; Ware, Norma C; Siedner, Mark J

    2017-11-01

    Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention's acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system's ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system's target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM

  18. Shea (Vitellaria paradoxa Butter Production and Resource Use by Urban and Rural Processors in Northern Ghana

    Directory of Open Access Journals (Sweden)

    Godfred Seidu Jasaw

    2015-03-01

    Full Text Available This article explores the use of field experimentation in presenting an account of input inventory, material quantities, and the process flow for shea butter production in Ghana. The shea fruit is a non-timber forest product (NTFP that is indigenous to ecosystems in semi-arid regions of Africa. Current methods and equipment for processing shea kernel into butter impose a dilemma of excessive harvesting of fuel wood for heating and the use of large quantities of water. Thus, the nature of input requirement and production process presents implications for conflict over natural resource use and for sustainability as more processing takes place. Material flow analysis was applied to the data generated from the processing experiments. The outcome was discussed in focus group discussion sessions and individual interviews as a way of data triangulation to validate study parameters. Results from this experiment showed that the quantity of water used in urban processing sites was higher than that used in rural sites. On the other hand, fuel wood use and labor expended were found to be higher in rural sites per unit processing cycle. The nature of the processing equipment, accessibility to input resources, and target market for shea butter were key determinants of the varying resource quantities used in the production process.

  19. Reporting diarrhoea through a vernacular term in Quechua-speaking settings of rural Bolivia.

    Science.gov (United States)

    Pacheco, Gonzalo Durán; Christen, Andri; Arnold, Ben; Hattendorf, Jan; Colford, John M; Smith, Thomas A; Mäusezahl, Daniel

    2011-12-01

    Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term k'echalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of k'echalera were collected for children aged less than five years. Reported k'echalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported k'echalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to k'echalera. Mucus in the stool was also associated with k'echalera; however, its presence in k'echalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term k'echalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of k'echalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of k'echalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia.

  20. Self-Assessed Competence of Experienced Expatriate Nurses in a Rural and Remote Setting

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    Salah Aqtash

    2017-04-01

    Full Text Available We aimed to measure the self-assessed level of competence among nurses working in the public hospitals of Al-Gharbia Region, a remote rural region of United Arab Emirates, and to explore the factors associated with the nurses’ self-perceived competency. The Nurse Competency Scale, which measures the self-assessed level of competency of nurses, has been validated in a variety of clinical settings, in facilities of various sizes, and in small and large cohorts. However, its application among an expatriate nursing workforce working in small hospitals and health facilities in remote and rural areas has not been examined. We used the Nurse Competency Scale to survey the nursing workforce in Al-Gharbia’s public hospitals in United Arab Emirates. All 435 practicing registered nurses with more than 3 months clinical experience in the network were invited to participate. Data were collected electronically and analyzed by international collaborators. Statistical analysis included analysis of variance, Kruskal–Wallis, multiple linear regression, χ 2 test of independence, and Cronbach’s α. Totally, 189 responses were analyzed (43.4% response rate. Overall self-assessed levels of competence were uniformly “very good” across all competence categories. The overall score (84.3 was higher than those found in most other studies. Frequency of use was the most outstanding variable influencing self-assessed competence. Total years of experience were the next significant variable. Some items of the scale were not yet applicable to activities in the region, particularly those relating to supervision of students. The high scores achieved by expatriate nurses in the small hospitals of Al-Gharbia reflect well on the rigor of the recruitment process, ongoing cross-training and functional competency assessment. Policies and practices aimed at recruiting experienced expatriate nurses and providing opportunities to use competencies continue to be critical in

  1. Psychological wellbeing, physical impairments and rural aging in a developing country setting

    Directory of Open Access Journals (Sweden)

    Tangchonlatip Kanchana

    2009-07-01

    Full Text Available Abstract Background There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. Methods A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Results Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p Conclusion In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

  2. Standardized network order sets in rural Ontario: a follow-up report on successes and sustainability.

    Science.gov (United States)

    Rawn, Andrea; Wilson, Katrina

    2011-01-01

    Unifying, implementing and sustaining a large order set project requires strategic placement of key organizational professionals to provide ongoing user education, communication and support. This article will outline the successful strategies implemented by the Grey Bruce Health Network, Evidence-Based Care Program to reduce length of stay, increase patient satisfaction and increase the use of best practices resulting in quality outcomes, safer practice and better allocation of resources by using standardized Order Sets within a network of 11 hospital sites. Audits conducted in 2007 and again in 2008 revealed a reduced length of stay of 0.96 in-patient days when order sets were used on admission and readmission for the same or a related diagnosis within one month decreased from 5.5% without order sets to 3.5% with order sets.

  3. Childhood epilepsy: Management in resource-limited setting

    Directory of Open Access Journals (Sweden)

    Valvi Chhaya

    2008-01-01

    Full Text Available Objective: To optimize the use of phenobarbital and/or phenytoin as frontline drugs for treatment of childhood epilepsy. Design: Before-and -after study. Setting: Epilepsy clinic at paediatric OPD, Sassoon General Hospital, Pune. Materials and Methods: Epilepsy is a condition in which seizures are triggered recurrently from within the brain. For epidemiological classification purpose epilepsy is considered to be present when two or more unprovoked seizures occur at an interval greater than twenty four hours apart. Seizures were classified as generalized and partial seizures, with underlying etiology investigated with EEG, CT scan in majority of the patients. Follow - up rate, seizure - control and antiepileptic drugs used among 151 children enrolled as on 31 March 2005 were compared with 106 children with new onset epilepsy enrolled as on February 2006. Eight children with breakthrough convulsion after a seizure free period of five to eighteen months were followed up after injection vitamin D. Nineteen children with poor control of seizures receiving polytherapy with newer antiepileptic drugs were assessed with frontline antiepileptic medication of phenobarbital and/or phenytoin. Serum calcium, phosphorus, alkaline phosphatase were done in seventy two consecutive children with seizure disorder. Results: During post protocol period good seizure control was achieved in 84.8% as against 80.7% and use of phenobarbital and/or phenytoin increased to 65.11% from 22.87%. Of the 8 cases with breakthrough seizures seven remained seizure free after vitamin D administration and with no dose enhancement of AED medications of the nineteen. Children receiving polytherapy thirteen children could be successfully switched to phenobarbital and/or phenytoin. Forty four (61% children had hypocalcemia (less than 9 mg%, fifty seven (79% children had raised alkaline phosphatase levels (more than 270 IU. Comments: Phenobarbital and/or phenytoin have been found to be

  4. Supervisors' experiences of workplace supervision of nursing and paramedic students in rural settings: a scoping review.

    Science.gov (United States)

    Trede, Franziska; McEwen, Celina; Kenny, Amanda; O'Meara, Peter

    2014-05-01

    We present our findings from a scoping review that sought to identify what is known about nursing and paramedic clinical supervisors' experiences of their supervision practices in rural settings. Our interest in these two groups is based on the central role that nurses and paramedics play in rural health care. Scoping reviews support identification of a broad range of literature, including all types of study designs. We adopted Arksey and O'Malley's five-stage approach: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarising and reporting results. Databases searched included Academic Search Complete, Springer, Factiva, ProQuest, Ebsco, Informit, VOCEDplus and Scopus. Based on our research question and inclusion and exclusion criteria we selected relevant literature and summarised and reported it using Arksey and O'Malley's framework. The review yielded five articles from four countries: Sweden, Belgium, Malaysia and Australia. From this scoping review, we identified key themes related to supervisors' experiences, including clarification of expectations, support from managers and colleagues, the need for shared understanding between university, students and supervisors and required skills and competence in supervising students. © 2013.

  5. Psychometric assessment of the patient activation measure short form (PAM-13) in rural settings.

    Science.gov (United States)

    Hung, Man; Carter, Marjorie; Hayden, Candace; Dzierzon, Rhonda; Morales, Jose; Snow, Laverne; Butler, Jorie; Bateman, Kim; Samore, Matthew

    2013-04-01

    The patient activation measure short form (PAM-13) assesses patients' self-reported health management skills, knowledge, confidence, and motivation. We used item response theory to evaluate the psychometric properties of the PAM-13 utilized in rural settings. A Rasch partial credit model analysis was conducted on the PAM-13 instrument using a sample of 812 rural patients recruited by providers and our research staff. Specially, we examined dimensionality, item fit, and quality of measures, category response curves, and item differential functioning. Convergent and divergent validities were also examined. The PAM-13 instrument has excellent convergent and divergent validities. It is fairly unidimensional, and all items fit the Rasch model well. It has relatively high person and item reliability indices. Majority of the items were free of item differential functioning. There were, however, some issues with ceiling effects. Additionally, there was a lack of responses for category one across all items. Patient activation measure short form (PAM-13) performs well in some areas, but not all. In general, more items need to be added to cover the upper end of the trait. The four response categories of PAM-13 should be collapsed into three.

  6. County-level poverty is equally associated with unmet health care needs in rural and urban settings.

    Science.gov (United States)

    Peterson, Lars E; Litaker, David G

    2010-01-01

    Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Compare the association between regional poverty with self-reported unmet need, a marker of health care access, by rural/urban setting. Multilevel, cross-sectional analysis of a state-representative sample of 39,953 adults stratified by rural/urban status, linked at the county level to data describing contextual characteristics. Weighted random intercept models examined the independent association of regional poverty with unmet needs, controlling for a range of contextual and individual-level characteristics. The unadjusted association between regional poverty levels and unmet needs was similar in both rural (OR = 1.06 [95% CI, 1.04-1.08]) and urban (OR = 1.03 [1.02-1.05]) settings. Adjusting for other contextual characteristics increased the size of the association in both rural (OR = 1.11 [1.04-1.19]) and urban (OR = 1.11 [1.05-1.18]) settings. Further adjustment for individual characteristics had little additional effect in rural (OR = 1.10 [1.00-1.20]) or urban (OR = 1.11 [1.01-1.22]) settings. To better meet the health care needs of all Americans, health care systems in areas with high regional poverty should acknowledge the relationship between poverty and unmet health care needs. Investments, or other interventions, that reduce regional poverty may be useful strategies for improving health through better access to health care. © 2010 National Rural Health Association.

  7. A comparison of work stressors in higher and lower resourced emergency medicine health settings.

    Science.gov (United States)

    de Haan, Sebastian; Lamprecht, Hein; Howlett, Michael K; Fraser, Jacqueline; Sohi, Dylan; Adisesh, Anil; Atkinson, Paul R

    2018-04-06

    CLINICIAN'S CAPSULE What is known about the topic? Emergency physicians and trainees have high rates of stress and burnout. What did this study ask? How do reported stressors for emergency physicians and trainees differ between high and low resource settings? What did this study find? Trainees in the low resource setting reported higher stressors. Trainees reported higher levels of stressors than specialists in general. Why does this study matter to clinicians? High levels of reported stressors among trainees, and in low resource settings should be acknowledged and mitigated where possible.

  8. PROJECT-ORIENTED RESOURCE MANAGEMENT SYSTEM FOR RESPONDING TO EMERGENCIES IN RURAL AREAS

    Directory of Open Access Journals (Sweden)

    Андрій Іванович ІВАНУСА

    2016-02-01

    Full Text Available Substantiated way to determine the feasibility of the location of rescue units in the conditions of rural areas. Proposed improving the existing methods of using of forces and means to extinguish fires, emergencies, etc., by involving specially trained volunteer rescue brigades, carrying out daily duty at their place of residence. To improve the interaction of rescue units involved in the reaction to emergency situations improved the system of information and communication management of forces and means. Developed the model diagram of the project environment optimal allocation of resources when creating center responding to emergencies in conditions of encirclement turbulent environment of a sphere of civil protection. Developed 3D-model and WBS-structure of the project creation of center responding to emergencies using modern energy saving technologies that will minimize the use of financial resources on the stages of the realization and exploitation of the project.

  9. Comparing Costs of Telephone versus Face-to-Face Extended Care Programs for the Management of Obesity in Rural Settings

    Science.gov (United States)

    Radcliff, Tiffany A.; Bobroff, Linda B.; Lutes, Lesley D.; Durning, Patricia E.; Daniels, Michael J.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Perri, Michael G.

    2012-01-01

    Background A major challenge following successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge may be exacerbated in rural areas with limited local support resources. Objective This study describes and compares program costs and cost-effectiveness for 12-month extended care lifestyle maintenance programs following an initial 6-month weight loss program. Design A 1-year prospective controlled randomized clinical trial. Participants/Setting The study included 215 female participants age 50 or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003, to May 31, 2007. Intervention The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly-assigned to a 12-month extended care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main Outcome Measures Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical Analyses Performed Non-parametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared to individual telephone counseling ($268 per participant) and

  10. Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013

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    Chodziwadziwa W. Kabudula

    2017-05-01

    Full Text Available Abstract Background Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population. Methods We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013. Results From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males. Conclusions This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact

  11. Motivation of human resources for health: a case study at rural district level in Tanzania.

    Science.gov (United States)

    Zinnen, Véronique; Paul, Elisabeth; Mwisongo, Aziza; Nyato, Daniel; Robert, Annie

    2012-01-01

    An increasing number of studies explore the association between financial and non-financial incentives and the retention of health workers in developing countries. This study aims to contribute to empirical evidence on human resource for health motivation factors to assist policy makers in promoting effective and realistic interventions. A cross-sectional survey was conducted in four rural Tanzanian districts to explore staff stability and health workers' motivation. Data were collected using qualitative and quantitative techniques, covering all levels and types of health facilities. Stability of staff was found to be quite high. Public institutions remained very attractive with better job security, salary and retirement benefits. Satisfaction over working conditions was very low owing to inadequate working equipment, work overload, lack of services, difficult environment, favouritism and 'empty promotions'. Positive incentives mentioned were support for career development and supportive supervision. Attracting new staff in rural areas appeared to be more difficult than retaining staff in place. The study concluded that strategies to better motivate health personnel should focus on adequate remuneration, positive working and living environment and supportive management. However, by multiplying health facilities, the latest Tanzanian human resource for health plan could jeopardize current positive results. Copyright © 2012 John Wiley & Sons, Ltd.

  12. Nurses' experiences providing palliative care to individuals living in rural communities: aspects of the physical residential setting.

    Science.gov (United States)

    Kaasalainen, S; Brazil, K; Williams, A; Wilson, D; Willison, K; Marshall, D; Taniguchi, A; Phillips, C

    2014-01-01

    Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting. This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis. Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather. These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve

  13. Sanitation challenges of the poor in urban and rural settings: Case studies of Bengaluru City and rural North Karnataka

    NARCIS (Netherlands)

    Seshaiah, Manasi; Nagesh, Latha; Ramesh, Hemalatha

    2017-01-01

    Bengaluru city faces severe challenges in providing sanitation infrastructure for the urban poor. Similarly, we have villages in North Karnataka that encounter problems of toilet access and related challenges. This paper addresses concerns both in city and rural contexts. We surveyed 400 respondents

  14. Sustainable use of endogenous touristic resources of rural areas: two portuguese case studies

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    Cruz Vareiro, Laurentina

    2007-01-01

    Full Text Available Empirical evidence shows that tourism can give a real contribution to regional development and, in the case of certain remote and economic lagged territories, it is one of the best sectors to achieve this goal. This role of tourism as to do, namely, with the possibility of taking profit from the endogenous resources endowment of these territories. Meanwhile, the opportunities are not the same for each region and it is easy to understand that, considering the resources available, not every one has the choice to base its development strategy in the tourism sector. On the other hand, sustainable development depends, both, on conservation and valorisation of the resources potential and on diversification of tourism activities and products, no matter the agents or policy options are. Based on empirical research carried out in Caminha and Paredes de Coura portuguese municipalities, and in what Tourism in Rural Areas (TRA is concerned, we present in this paper a preliminary evaluation of the social and economic impacts of the tourism strategies followed. We also aim to extract some policy implications in order to better design future approaches to this issue of taking profit from resources endowment of territories. The starting point is the one of tourism based on quality, which serves the interests of local populations

  15. Motivators of couple HIV counseling and testing (CHCT uptake in a rural setting in Uganda

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    Victoria Nannozi

    2017-01-01

    Full Text Available Abstract Background Couple HIV Counseling and Testing (CHCT is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. Methods The study was conducted in two sub-counties in a rural district (Mukono district about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. Results The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53 and 49% (26/53 of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC attendance and preparation for marriage. Conclusion The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater

  16. Motivators of couple HIV counseling and testing (CHCT) uptake in a rural setting in Uganda.

    Science.gov (United States)

    Nannozi, Victoria; Wobudeya, Eric; Matsiko, Nicholas; Gahagan, Jacqueline

    2017-01-23

    Couple HIV Counseling and Testing (CHCT) is one of the key preventive strategies used to reduce the spread of HIV. In Uganda, HIV prevalence among married/living together is 7.2% among women and 7.6% among men. CHCT can help ease disclosure of HIV-positive status, which in turn may help increase opportunities to get social support and reduce new infections. The uptake of CHCT among attendees of health facilities in rural Uganda is as high as 34%. The purpose of this study was to explore the motivators of CHCT uptake in Mukono district, a rural setting in Uganda. The study was conducted in two sub-counties in a rural district (Mukono district) about 28 km east of the capital Kampala, using a descriptive and explorative qualitative research design. Specifically, we conducted focus group discussions and key informant interviews with HIV focal persons, village health team (VHT) members, religious leaders and political leaders. We also interviewed persons in couple relationships. Data was analysed using NVivo 8 software. Ethical clearance was received from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology. The study was conducted from June 2013 to July 2013 We conducted 4 focus group discussions, 10 key informant interviews and interviewed 53 persons in couple relationships. None of the participants were a couple. The women were 68% (36/53) and 49% (26/53) of them were above 29 years old. The motivators of CHCT uptake were; perceived benefit of HIV testing, sickness of a partner or child in the family and suspicion of infidelity. Other important motivators were men involvement in antenatal care (ANC) attendance and preparation for marriage. The motivators for CHCT uptake included the perceived benefit of HIV testing, sickness of a partner or child, preparation for marriage, lack of trust among couples and men involvement in antenatal care. Greater attention to enhancers of CHCT programming is needed in trying to

  17. The use of an integrated variable fuzzy sets in water resources management

    Science.gov (United States)

    Qiu, Qingtai; Liu, Jia; Li, Chuanzhe; Yu, Xinzhe; Wang, Yang

    2018-06-01

    Based on the evaluation of the present situation of water resources and the development of water conservancy projects and social economy, optimal allocation of regional water resources presents an increasing need in the water resources management. Meanwhile it is also the most effective way to promote the harmonic relationship between human and water. In view of the own limitations of the traditional evaluations of which always choose a single index model using in optimal allocation of regional water resources, on the basis of the theory of variable fuzzy sets (VFS) and system dynamics (SD), an integrated variable fuzzy sets model (IVFS) is proposed to address dynamically complex problems in regional water resources management in this paper. The model is applied to evaluate the level of the optimal allocation of regional water resources of Zoucheng in China. Results show that the level of allocation schemes of water resources ranging from 2.5 to 3.5, generally showing a trend of lower level. To achieve optimal regional management of water resources, this model conveys a certain degree of accessing water resources management, which prominently improve the authentic assessment of water resources management by using the eigenvector of level H.

  18. Setting priorities for safe motherhood interventions in resource-scarce settings.

    Science.gov (United States)

    Prata, Ndola; Sreenivas, Amita; Greig, Fiona; Walsh, Julia; Potts, Malcolm

    2010-01-01

    Guide policy-makers in prioritizing safe motherhood interventions. Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per capital maternal health expenditures respectively for LOW, MED, and HIGH models. The most cost-effective interventions were family planning and safe abortion (fpsa), antenatal care including misoprostol distribution for postpartum hemorrhage prevention at home deliveries (anc-miso), followed by sepsis treatment (sepsis) and facility-based postpartum hemorrhage management (pph). The combination of interventions that avert the greatest number of maternal deaths should be prioritized and expanded to cover the greatest number of women at risk. Those which save the most number of lives in each model are 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for LOW; 'fpsa, anc-miso' and 'fpsa, sepsis, safe delivery' for MED; and 'fpsa, anc-miso, sepsis, eclampsia treatment, safe delivery' for HIGH settings. Safe motherhood interventions save a significant number of newborn lives.

  19. Implementing antiretroviral therapy programs in resource-constrained settings: lessons from Monze, Zambia.

    Science.gov (United States)

    Adedimeji, Adebola; Malokota, Oliver; Manafa, Ogenna

    2011-05-01

    We describe the impact of an antiretroviral therapy program on human resource utilization and service delivery in a rural hospital in Monze, Zambia, using qualitative data. We assess project impact on staff capacity utilization, service delivery, and community perception of care. Increased workload resulted in fatigue, low staff morale, and exacerbated critical manpower shortages, but also an increase in users of antiretroviral therapy, improvement in hospital infrastructure and funding, and an overall community satisfaction with service delivery. Integrating HAART programs within existing hospital units and services may be a good alternative to increase overall efficiency.

  20. Community-Engaged Attribute Mapping: Exploring Resources and Readiness to Change the Rural Context for Obesity Prevention.

    Science.gov (United States)

    John, Deborah; Winfield, Tammy; Etuk, Lena; Hystad, Perry; Langellotto, Gail; Manore, Melinda; Gunter, Kathy

    2017-01-01

    Individual risk factors for obesity are well-known, but environmental characteristics that influence individual risk, especially in rural communities, are not confirmed. Rural communities face unique challenges to implementing environmental strategies, such as walkability, aimed at supporting weight healthy lifestyles. Cooperative Extension, a community-embedded weight health partner, convened and engaged community members in self-exploration of local resources and readiness to change environmental characteristics perceived to promote unhealthy eating and inactivity. This approach leveraged Extension's mission, which includes connecting rural communities with land-grant university resources. HEAL MAPPS™ (Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys) was developed as a participatory action research methodology. Adopted by Extension community partners, HEAL MAPPS™ involved residents in photomapping, characterizing, and communicating lived experiences of their rural community, and prioritizing interventions to change the obesogenic context. Extension educators serving rural communities in six Western U.S. states were trained to implement HEAL MAPPS™. Extension engaged community members who mapped and evaluated their encounters with environmental attributes that shape their dietary and activity patterns. The method partnered residents with decision makers in identifying issues, assessing resources and readiness, and prioritizing locally relevant environmental strategies to reduce access disparities for rural populations with high obesity risk. HEAL MAPPS™ revealed differences in resource availability, accessibility, and affordability within and among rural communities, as well as in readiness to address the obesogenic context. Extension functioned successfully as the backbone organization, and local community health partner, cooperatively implementing HEAL MAPPS™ and engaging constituents in shaping weight healthy

  1. Service Quality: A Main Determinant Factor for Health Information System Success in Low-resource Settings.

    Science.gov (United States)

    Tilahun, Binyam; Fritz, Fleur

    2015-01-01

    With the increasing implementation of different health information systems in developing countries, there is a growing need to measure the main determinants of their success. The results of this evaluation study on the determinants of HIS success in five low resource setting hospitals show that service quality is the main determinant factor for information system success in those kind of settings.

  2. Learning with Nature and Learning from Others: Nature as Setting and Resource for Early Childhood Education

    Science.gov (United States)

    MacQuarrie, Sarah; Nugent, Clare; Warden, Claire

    2015-01-01

    Nature-based learning is an increasingly popular type of early childhood education. Despite this, children's experiences--in particular, their form and function within different settings and how they are viewed by practitioners--are relatively unknown. Accordingly, the use of nature as a setting and a resource for learning was researched. A…

  3. Response to antiretroviral therapy of HIV type 1-infected children in urban and rural settings of Uganda.

    Science.gov (United States)

    Musiime, Victor; Kayiwa, Joshua; Kiconco, Mary; Tamale, William; Alima, Hillary; Mugerwa, Henry; Abwola, Mary; Apilli, Eunice; Ahimbisibwe, Fred; Kizito, Hilda; Abongomera, George; Namusoke, Asia; Makabayi, Agnes; Kiweewa, Francis; Ssali, Francis; Kityo, Cissy; Colebunders, Robert; Mugyenyi, Peter

    2012-12-01

    From 2006 to 2011, a cohort study was conducted among 1000 children resident in urban and rural settings of Uganda to ascertain and compare the response to antiretroviral therapy (ART) among urban versus rural children and the factors associated with this response. Clinical, immunological, and virological parameters were ascertained at baseline and weeks 24, 48, 96, and 144 after ART initiation. Adherence to ART was assessed at enrollment by self-report (SR) and pill counts (PC). Overall, 499/948 (52.6%) children were resident in rural areas, 504/948 (53.1%) were male, and their mean age was 11.9±4.4 years (urban children) and 11.4±4.1 years (rural children). The urban children were more likely to switch to second-line ART at a rate of 39.9 per 1000 person-years (95% CI: 28.2-56.4) versus 14.9 per 1000 person-years (95% CI: 8.7-25.7), p=0.0038, develop any new WHO 3/4 events at 127/414 (30.7%) versus 108/466 (23.2%), p=0.012, and have a higher cumulative incidence of hospitalization of 54/449 (12.0%) versus 32/499 (6.4%), p=0.003, when compared to rural children. No differences were observed in mean changes in weight, height, CD4 count and percentage, and hemoglobin and viral load between urban and rural children. Adherence of ≥95% was observed in 88.2% of urban versus 91.3% of rural children by SR (p=0.130), and in 78.8% of urban versus 88.8% of rural children by PC (pART than urban children.

  4. Barriers to access to antiretroviral treatment in Mozambique, as perceived by patients and health workers in urban and rural settings.

    NARCIS (Netherlands)

    Posse, M.E.; Baltussen, R.M.P.M.

    2009-01-01

    This study identifies, ranks, and compares factors perceived as barriers to accessing antiretroviral treatment (ART) in urban and rural settings in Mozambique. Data were collected between March and July 2008. It consisted of 13 focus group discussions and a structured questionnaire administered to

  5. County-Level Poverty Is Equally Associated with Unmet Health Care Needs in Rural and Urban Settings

    Science.gov (United States)

    Peterson, Lars E.; Litaker, David G.

    2010-01-01

    Context: Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Purpose: Compare the association between regional poverty with self-reported unmet…

  6. Goal Setting Theory: What It Implies for Strategic Human Resource Development

    OpenAIRE

    AVCI, Ömer

    2016-01-01

    Among numerous motivational theories, goal setting theory particularly can serve strategic human resource development practices. The goal-setting theory suggests that organizational goals have to be communicated clearly and the goals need to be specific enough. Another feature of goal-setting is that they need not be too easy or perceived to be impossible to fulfill. SHRD personnel should keep in mind that some employees prefer to work individually toward fulfilling a goal, while others prefe...

  7. Developing a mental health care plan in a low resource setting: the theory of change approach.

    Science.gov (United States)

    Hailemariam, Maji; Fekadu, Abebaw; Selamu, Medhin; Alem, Atalay; Medhin, Girmay; Giorgis, Tedla Wolde; DeSilva, Mary; Breuer, Erica

    2015-09-28

    . The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

  8. Social Work Practice in a Rural Health Care Setting: Farm Families.

    Science.gov (United States)

    Durham, Judith A.; Miah, M. Mizanur Rahman

    1993-01-01

    Literature review addresses the status of farm families; farm stresses and their effects; dysfunctional family relationships; and the unique attitudes, behaviors, and perceptions of rural culture toward social service intervention. By implementing coordinated service programs and initiating new legislation that addresses rural health care issues,…

  9. Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia.

    Science.gov (United States)

    Devi, B C R; Tang, T S; Corbex, M

    2008-12-01

    The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access. The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC. The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from 1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect. The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

  10. Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.

    Science.gov (United States)

    Papo, Jacqueline K; Bauni, Evasius K; Sanders, Eduard J; Brocklehurst, Peter; Jaffe, Harold W

    2011-01-14

    to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use. GPS mapping of condom outlets, and population-based survey. an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15-49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use. the median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low. there is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  11. Defining the anesthesia gap for reproductive health procedures in resource-limited settings.

    Science.gov (United States)

    Anderson, R Eleanor; Ahn, Roy; Nelson, Brett D; Chavez, Jean; de Redon, Emily; Burke, Thomas

    2014-12-01

    In resource-limited settings, severe shortages of anesthetists and anesthesiologists lead to surgical delays that increase maternal and neonatal mortality and morbidity. To more clearly understand the individual components of the anesthesia gap pertaining to reproductive health surgeries and procedures in resource-limited settings. Medline, the Cochrane Library, CINAHL, Embase, and POPLINE were systematically searched for reports published before December 31, 2013. Search terms were related to obstetric surgery, resource-limited settings, and anesthesia. Studies that addressed the use of anesthesia in reproductive procedures in resource-limited settings were included. Reviewers independently evaluated the full text of identified studies, extracted information related to study objectives and conclusions, and identified the anesthesia gap. Overall, 14 publications met the inclusion criteria. A significant lack of infrastructure, equipment and supplies, and trained personnel were identified as key factors responsible for a lack of anesthesia services. A shortage of trained anesthesia providers, equipment, supplies, medications, and infrastructure, along with limitations in transportation in resource-limited settings have produced a wide gap between available anesthesia services and the demand for them for reproductive health surgeries and procedures. Safe, affordable, and scalable solutions to address the anesthesia gap are urgently needed. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Innovative accountability of tracking test kit as locked resources: a lesson in a restricted resource setting.

    Science.gov (United States)

    Makuwani, Ahmad M; Msuya, Sia; Haule, Dunstan; Mogella, Deus; Nkya, Efesper

    2013-09-01

    To implement quality screening in a blood service requires the presence of screening strategy with a clear algorithm and supporting standard operating procedures (SOPs), skilled and motivated human resource to perform testing, infrastructure, regular available test kits, and other supplies. In developing countries, smooth supply chain management of critical transfusion transmissible infections (TTIs) screening reagents is a challenge. Therefore, managing the little available kits by knowing the rate of consumption, good forecasting, and monitoring expiry date may be a key in ensuring regular supply. Test kit monitoring tool (TKMT) for Vironostika HIV Uni-Form kit/192 1&2 Ag/Ab, Genedia kits for HBsAg and HCV, and RPR for syphilis was developed to track these reagents. This excel tool was developed to assess received reagents, quantity used, quantity remaining, and date of expiration. The tool was evaluated by assessing rerun for each test kits, match tests conducted with blood units tested, adherence to the principle of first in-first out (FIFO), and quantity remaining in the center against the need. The mean rerun for HIV ELISA Vironistika uniform II Ag/Ab observed over expected was 6.9% (n = 3.8) than 2.4% (n = 1.3), HBsAg was 9.9% (n = 5.7) than 6.7% (3.5) (expected), Genedia for HCV was 1.3% (n = 0.7) than 0.5% (n = 0.3), and RPR test for syphilis 3.3% (n = 1.5) than 0.5%. During implementation, TKMT managed to detect expiring kits in the zonal blood transfusion centers. A tool-like TKMT may capture other supplies within blood when expanded. Monitoring of supplies may enable blood service actual accounting and in forecasting supplies and reagents. © 2013 Wiley Periodicals, Inc.

  13. Electronic data capture in a rural African setting: evaluating experiences with different systems in Malawi.

    Science.gov (United States)

    King, Carina; Hall, Jenny; Banda, Masford; Beard, James; Bird, Jon; Kazembe, Peter; Fottrell, Ed

    2014-01-01

    As hardware for electronic data capture (EDC), such as smartphones or tablets, becomes cheaper and more widely available, the potential for using such hardware as data capture tools in routine healthcare and research is increasing. We aim to highlight the advantages and disadvantages of four EDC systems being used simultaneously in rural Malawi: two for Android devices (CommCare and ODK Collect), one for PALM and Windows OS (Pendragon), and a custom-built application for Android (Mobile InterVA--MIVA). We report on the personal field and development experience of fieldworkers, project managers, and EDC system developers. Fieldworkers preferred using EDC to paper-based systems, although some struggled with the technology at first. Highlighted features include in-built skip patterns for all systems, and specifically the 'case' function that CommCare offers. MIVA as a standalone app required considerably more time and expertise than the other systems to create and could not be customised for our specific research needs; however, it facilitates standardised routine data collection. CommCare and ODK Collect both have user-friendly web-interfaces for form development and good technical support. CommCare requires Internet to build an application and download it to a device, whereas all steps can be done offline with ODK Collect, a desirable feature in low connectivity settings. Pendragon required more complex programming of logic, using a Microsoft Access application, and generally had less technical support. Start-up costs varied between systems, and all were considered more expensive than setting up a paper-based system; however running costs were generally low and therefore thought to be cost-effective over the course of our projects. EDC offers many opportunities for efficient data collection, but brings some issues requiring consideration when designing a study; the decision of which hardware and software to use should be informed by the aim of data collection

  14. WASTE OF LOCAL RESOURCES IN RURAL AREAS IN THE SUSTAINABLE DEVELOPMENT CONTEXT – AN ATTEMPT OF THE PROBLEM IDENTIFICATION

    Directory of Open Access Journals (Sweden)

    Anna Bruska

    2014-06-01

    Full Text Available The purpose of this article was to explore the real problem of wasting local resources, which is in opposition to the principles of sustainable development, understood as avoiding waste of any resources. The article highlights the key manifestations of this problem and its implication for rural development. Some actions realised in the world are also mentioned – their implementation contributes to the prevention of this phenomenon.

  15. Resources, Not Capital: A Case Study of the Gendered Distribution and Productivity of Social Network Ties in Rural Ethiopia

    Science.gov (United States)

    Torkelsson, Asa

    2007-01-01

    Poor people make use of a variety of contextually relevant resources to pursue their livelihood strategies, and there is wide empirical evidence that opportunities and constraints for accessing these may vary considerably for women and men, particularly in the rural areas of developing countries. In this article, micro-evidence from a case study…

  16. Czech Rural Development Policies for Human Resources, post-2004: A Story of Muddled Definitions Preventing Strategic Visions?"

    Czech Academy of Sciences Publication Activity Database

    Vobecká, Jana

    2009-01-01

    Roč. 3, č. 1 (2009), s. 44-65 ISSN 1802-4866 R&D Projects: GA MŠk 2D06006 Institutional research plan: CEZ:AV0Z70280505 Keywords : rural development * human resources * policy formulation Subject RIV: AD - Politology ; Political Sciences

  17. Rural women caregivers in Canada.

    Science.gov (United States)

    Crosato, Kay E; Leipert, Beverly

    2006-01-01

    Informal caregiving within rural contexts in Canada is increasing. This is due in part to a number of factors related to the restructuring of the Canadian health care system, the regionalization of services to urban locations, the increased population of people 65 years and older, and the desire of this population to age within their rural homes. Most often, the informal caregiving role is assumed by rural women. Women tend to fall into the role of informal caregiver to elders because of the many societal and gender expectations and values that are present within the rural culture. The purpose of this literature review is to identify the context in which women provide care for an elder in rural Canada. Illustrating these issues will help to uncover challenges and barriers rural women face when providing care and highlight recommendations and implications for rural women caregivers and nurses employed within rural settings. Many rural women share similar caregiving experiences as urban informal caregivers, but rural women are faced with additional challenges in providing quality care for an elder. Rural women caregivers are faced with such issues as limited access to adequate and appropriate healthcare services, culturally incongruent health care, geographical distance from regionalized centers and health services, transportation challenges, and social/geographical isolation. In addition to these issues, many rural women are faced with the multiple role demands that attend being a wife, mother, caregiver and employee. The pile up of these factors leaves rural women caregivers susceptible to additional stresses and burn out, with limited resources on which to depend. Through reviewing pertinent literature, appropriate implications and recommendations can be made that may assist rural women caregivers and rural nurses. Nurses working within rural communities are in ideal settings to work collaboratively in building supportive relationships with rural women in order to

  18. Task set induces dynamic reallocation of resources in visual short-term memory.

    Science.gov (United States)

    Sheremata, Summer L; Shomstein, Sarah

    2017-08-01

    Successful interaction with the environment requires the ability to flexibly allocate resources to different locations in the visual field. Recent evidence suggests that visual short-term memory (VSTM) resources are distributed asymmetrically across the visual field based upon task demands. Here, we propose that context, rather than the stimulus itself, determines asymmetrical distribution of VSTM resources. To test whether context modulates the reallocation of resources to the right visual field, task set, defined by memory-load, was manipulated to influence visual short-term memory performance. Performance was measured for single-feature objects embedded within predominantly single- or two-feature memory blocks. Therefore, context was varied to determine whether task set directly predicts changes in visual field biases. In accord with the dynamic reallocation of resources hypothesis, task set, rather than aspects of the physical stimulus, drove improvements in performance in the right- visual field. Our results show, for the first time, that preparation for upcoming memory demands directly determines how resources are allocated across the visual field.

  19. Helping behavior in a rural and an urban setting: professional and casual attire.

    Science.gov (United States)

    Wilson, Shauna B; Kennedy, Janice H

    2006-02-01

    This study assessed differences in helping behavior in a rural versus an urban location when directed toward either a professionally or a casually dressed woman. Convenience samples included 40 men and 40 women (10 people of each sex assigned to each condition: rural and professional, rural and casual, urban and professional, and urban and casual). A 21-yr.-old female confederate dropped an envelope near each target helper individually and recorded number of seconds for the target helper to retrieve or point out the dropped item. Analysis indicated significantly faster helping occurred in the rural than in the urban location and that men helped the confederate more often than women. No difference in frequencey of help was related to kind of attire.

  20. Serving an Indigenous community: Exploring the cultural competence of medical students in a rural setting

    Directory of Open Access Journals (Sweden)

    Chin Hoong Wong

    2017-06-01

    Full Text Available Since 2013, medical students from the International Medical University (IMU in Malaysia have been providing primary healthcare services, under the supervision of faculty members, to the indigenous people living in Kampung Sebir. The project has allowed the students to learn experientially within a rural setting. This study aims to examine the cultural competence of IMU medical students through an examination of their perspective of the indigenous people who they serve and the role of this community service in their personal and professional development. Students who participated in the project were required to complete a questionnaire after each community engagement activity to help them reflect on the above areas. We analysed the responses of students from January to December 2015 using a thematic analysis approach to identify overarching themes in the students’ responses. Students had differing perceptions of culture and worldviews when compared to the indigenous people. However, they lacked the self-reflection skills necessary to understand how such differences can affect their relationship with the indigenous people. Because of this, the basis of their engagement with the indigenous community (as demonstrated by their views of community service is focused on their agenda of promoting health from a student’s perspective rather than connecting and building relationships first. Students also lacked the appreciation that building cultural competency is a continuous process. The results show that the medical students have a developing cultural competence. The project in Kampung Sebir is an experiential learning platform of great value to provide insights into and develop the cultural competency of participating students. This study also reflects on the project itself, and how the relationship with stakeholders, the competence and diversity of academic staff, and the support of the university can contribute toward training in cultural

  1. Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

    Science.gov (United States)

    Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

    2013-06-10

    Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching

  2. Area-level risk factors for adverse birth outcomes: trends in urban and rural settings

    OpenAIRE

    Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

    2013-01-01

    Background Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban?rural status. Methods Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends b...

  3. Learning with nature and learning from others: nature as setting and resource for early childhood education

    OpenAIRE

    MacQuarrie, Sarah; Nugent, Clare; Warden, Claire

    2015-01-01

    Nature-based learning is an increasingly popular type of early childhood education. Despite this, children's experiences-in particular, their form and function within different settings and how they are viewed by practitioners-are relatively unknown. Accordingly, the use of nature as a setting and a resource for learning was researched. A description and an emerging understanding of nature-based learning were obtained through the use of a group discussion and case studies. Practitioners' view...

  4. Micro-Study of the Evolution of Rural Settlement Patterns and Their Spatial Association with Water and Land Resources: A Case Study of Shandan County, China

    Directory of Open Access Journals (Sweden)

    Libang Ma

    2017-12-01

    Full Text Available The balance between population and water and land resources is an important part of regional sustainable development. It is also significant for the ecological civilization in China and can help solve the Three Rural Issues (agriculture, countryside and farmers in China. The Silk Road Economic Belt and Maritime Silk Road in twenty-first Century Strategy have brought new opportunities for the Hexi Corridor, which is facing challenges in the sustainable development of rural settlements. In this paper, we analyzed the temporal-spatial differentiation of rural settlement patterns in Shandan County of Hexi Corridor and studied the spatial association between rural settlements and water-land resources. Results show that the total area of rural settlement patches (CA, the number of rural settlement patches (NP, the mean patch area (MPS, the maximum patch areas (MAXP, the minimum patch areas (MINP and the density of rural settlement patches (PD changed more rapidly from 1998 to 2008 than from 2008 to 2015. In the second period, the indices mentioned before did not change significantly. The kernel density of rural settlements is basically consistent in three periods. Rural settlements mainly distribute along major roads and the hydrographic network and the kernel density of rural settlements decreases in the direction away from these roads and the hydrographic network. In addition, rural settlements in Shandan County are densely distributed in some regions and sparsely distributed in other regions. The dispersion degree of rural settlements increased from 1998 to 2008 and tended to be stable after 2008. These lead to the dispersion, hollowing and chaos of rural settlements in Shandan County. The spatial distribution of rural settlements in Shandan County is closely related to that of cultivated land and the hydrographic network. Our results might provide a theoretical basis for the reasonable utilization of water and land resources in Shandan County

  5. A Life-cycle Approach to Improve the Sustainability of Rural Water Systems in Resource-Limited Countries

    Directory of Open Access Journals (Sweden)

    Nicholas Stacey

    2012-11-01

    Full Text Available A WHO and UNICEF joint report states that in 2008, 884 million people lacked access to potable drinking water. A life-cycle approach to develop potable water systems may improve the sustainability for such systems, however, a review of the literature shows that such an approach has primarily been used for urban systems located in resourced countries. Although urbanization is increasing globally, over 40 percent of the world’s population is currently rural with many considered poor. In this paper, we present a first step towards using life-cycle assessment to develop sustainable rural water systems in resource-limited countries while pointing out the needs. For example, while there are few differences in costs and environmental impacts for many improved rural water system options, a system that uses groundwater with community standpipes is substantially lower in cost that other alternatives with a somewhat lower environmental inventory. However, a LCA approach shows that from institutional as well as community and managerial perspectives, sustainability includes many other factors besides cost and environment that are a function of the interdependent decision process used across the life cycle of a water system by aid organizations, water user committees, and household users. These factors often present the biggest challenge to designing sustainable rural water systems for resource-limited countries.

  6. Implementation of quality management for clinical bacteriology in low-resource settings.

    Science.gov (United States)

    Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J

    2017-07-01

    The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by

  7. Corporate sustainability: the environmental design and human resource management interface in healthcare settings.

    Science.gov (United States)

    Sadatsafavi, Hessam; Walewski, John

    2013-01-01

    Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions. This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework. The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs. Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms. Staff, evidence-based design, interdisciplinary, modeling, perceived organizational supportPreferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sustainability: The environmental design and human resource management interface in

  8. Electronic data capture in a rural African setting: evaluating experiences with different systems in Malawi

    Directory of Open Access Journals (Sweden)

    Carina King

    2014-10-01

    Full Text Available Background: As hardware for electronic data capture (EDC, such as smartphones or tablets, becomes cheaper and more widely available, the potential for using such hardware as data capture tools in routine healthcare and research is increasing. Objective: We aim to highlight the advantages and disadvantages of four EDC systems being used simultaneously in rural Malawi: two for Android devices (CommCare and ODK Collect, one for PALM and Windows OS (Pendragon, and a custom-built application for Android (Mobile InterVA – MIVA. Design: We report on the personal field and development experience of fieldworkers, project managers, and EDC system developers. Results: Fieldworkers preferred using EDC to paper-based systems, although some struggled with the technology at first. Highlighted features include in-built skip patterns for all systems, and specifically the ‘case’ function that CommCare offers. MIVA as a standalone app required considerably more time and expertise than the other systems to create and could not be customised for our specific research needs; however, it facilitates standardised routine data collection. CommCare and ODK Collect both have user-friendly web-interfaces for form development and good technical support. CommCare requires Internet to build an application and download it to a device, whereas all steps can be done offline with ODK Collect, a desirable feature in low connectivity settings. Pendragon required more complex programming of logic, using a Microsoft Access application, and generally had less technical support. Start-up costs varied between systems, and all were considered more expensive than setting up a paper-based system; however running costs were generally low and therefore thought to be cost-effective over the course of our projects. Conclusions: EDC offers many opportunities for efficient data collection, but brings some issues requiring consideration when designing a study; the decision of which hardware

  9. Effects of Crew Resource Management Training on Medical Errors in a Simulated Prehospital Setting

    Science.gov (United States)

    Carhart, Elliot D.

    2012-01-01

    This applied dissertation investigated the effect of crew resource management (CRM) training on medical errors in a simulated prehospital setting. Specific areas addressed by this program included situational awareness, decision making, task management, teamwork, and communication. This study is believed to be the first investigation of CRM…

  10. Assisting differential clinical diagnosis of cattle diseases using smartphone-based technology in low resource settings

    NARCIS (Netherlands)

    Beyene, Tariku Jibat; Eshetu, Amanuel; Abdu, Amina; Wondimu, Etenesh; Beyi, Ashenafi Feyisa; Tufa, Takele Beyene; Ibrahim, Sami

    2017-01-01

    Background: The recent rise in mobile phone use and increased signal coverage has created opportunities for growth of the mobile Health sector in many low resource settings. This pilot study explores the use of a smartphone-based application, VetAfrica-Ethiopia, in assisting diagnosis of cattle

  11. Recommendations for blood pressure measuring devices for office/clinic use in low resource settings

    NARCIS (Netherlands)

    Parati, G.; Mendis, S.; Abegunde, D.; Asmar, R.; Mieke, S.; Murray, A.; Shengelia, B.; Steenvoorden, G.; Montfrans, G. van; O'Brien, E.

    2005-01-01

    This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/ clinic use in low resource settings. Blood pressure measuring devices to be used in

  12. How do small rural food-processing firms compete?A resource-based approach to competitive strategies

    Directory of Open Access Journals (Sweden)

    S. FORSMAN

    2008-12-01

    Full Text Available The study was concerned with the competitive strategies of small food-processing firms in rural Finland and their ability to achieve and maintain a competitively advantaged position in relation to larger food companies in the dynamic and mature food market. Competitive strategies were approached from the resource-based view (RBV that emphasises internal firm factors as sources of competitive advantage and long-term success. As strategic choices, differentiation was specifically considered. The main objective was to explain the relationships between resources, competitive advantage and firm success. To understand the ambiguous nature of the resources in the small-scale food production context, the study introduced a distinction between strategic resources and basic resources and the strategic relationship between them. The empirical part of the study was based on quantitative analyses of the survey data collected from 238 small (less than 20 persons, food-processing firms in rural Finland. The sample firms represented different branches of the food industry and 39% of them operated in connection with a farm. The linkage between resources, competitive advantage and firm success was investigated by means of cluster analysis, mean comparisons and LISREL modelling. The results demonstrated that there are some typical features relating to small-scale food production in Finland. The results also revealed that small-scale, rural food processing firms do not constitute a homogenous group of their own, but that different strategies among small firms can be identified as well. The analyses proved that a linkage between resources, competitive advantage and firm success can be identified, which is consistent with resource-based logic. However, according to the findings, following a particular strategy does not automatically ensure that a firm will achieve success. The analysis also showed that strategic resources and basic resources are strongly interlinked

  13. Validating the WHO maternal near miss tool: comparing high- and low-resource settings.

    Science.gov (United States)

    Witteveen, Tom; Bezstarosti, Hans; de Koning, Ilona; Nelissen, Ellen; Bloemenkamp, Kitty W; van Roosmalen, Jos; van den Akker, Thomas

    2017-06-19

    WHO proposed the WHO Maternal Near Miss (MNM) tool, classifying women according to several (potentially) life-threatening conditions, to monitor and improve quality of obstetric care. The objective of this study is to analyse merged data of one high- and two low-resource settings where this tool was applied and test whether the tool may be suitable for comparing severe maternal outcome (SMO) between these settings. Using three cohort studies that included SMO cases, during two-year time frames in the Netherlands, Tanzania and Malawi we reassessed all SMO cases (as defined by the original studies) with the WHO MNM tool (five disease-, four intervention- and seven organ dysfunction-based criteria). Main outcome measures were prevalence of MNM criteria and case fatality rates (CFR). A total of 3172 women were studied; 2538 (80.0%) from the Netherlands, 248 (7.8%) from Tanzania and 386 (12.2%) from Malawi. Total SMO detection was 2767 (87.2%) for disease-based criteria, 2504 (78.9%) for intervention-based criteria and 1211 (38.2%) for organ dysfunction-based criteria. Including every woman who received ≥1 unit of blood in low-resource settings as life-threatening, as defined by organ dysfunction criteria, led to more equally distributed populations. In one third of all Dutch and Malawian maternal death cases, organ dysfunction criteria could not be identified from medical records. Applying solely organ dysfunction-based criteria may lead to underreporting of SMO. Therefore, a tool based on defining MNM only upon establishing organ failure is of limited use for comparing settings with varying resources. In low-resource settings, lowering the threshold of transfused units of blood leads to a higher detection rate of MNM. We recommend refined disease-based criteria, accompanied by a limited set of intervention- and organ dysfunction-based criteria to set a measure of severity.

  14. Breastfeeding Patterns in the Rural Community of Hilo, Hawai‘i: An Exploration of Existing Data Sets

    OpenAIRE

    Flood, Jeanie L

    2013-01-01

    Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai‘i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai‘i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in...

  15. Engineering a mobile health tool for resource-poor settings to assess and manage cardiovascular disease risk: SMARThealth study.

    Science.gov (United States)

    Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

    2015-04-29

    The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings. Through pilot testing, the preliminary acceptability, utility, and efficiency of the CDS tool was obtained. The CDS tool was part of an mHealth system comprising a mobile application that consisted of an evidence-based risk prediction and management algorithm, and a server-side electronic medical record system. Through an agile development process and user-centred design approach, key features of the mobile application that fitted the requirements of the end users and environment were obtained. A comprehensive analytics framework facilitated a data-driven approach to investigate four areas, namely, system efficiency, end-user variability, manual data entry errors, and usefulness of point-of-care management recommendations to the healthcare worker. A four-point Likert scale was used at the end of every risk assessment to gauge ease-of-use of the system. The system was field-tested with eleven village healthcare workers and three Primary Health Centre doctors, who screened a total of 292 adults aged 40 years and above. 34% of participants screened by health workers were identified by the CDS tool to be high CVD risk and referred to a doctor. In-depth analysis of user interactions found the CDS tool feasible for use and easily integrable into the workflow of healthcare workers. Following completion of the pilot, further technical enhancements were implemented to improve uptake of the mHealth platform. It will then be evaluated for effectiveness and cost-effectiveness in a cluster randomized

  16. Vaginal Birth After Caesarean Section in Low Resource Settings: The Clinical and Ethical Dilemma.

    Science.gov (United States)

    Wanyonyi, Sikolia; Muriithi, Francis G

    2015-10-01

    Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.

  17. Allocating the Fixed Resources and Setting Targets in Integer Data Envelopment Analysis

    Directory of Open Access Journals (Sweden)

    Kobra Gholami

    2013-11-01

    Full Text Available Data envelopment analysis (DEA is a non-parametric approach to evaluate a set of decision making units (DMUs consuming multiple inputs to produce multiple outputs. Formally, DEA use to estimate the efficiency score into the empirical efficient frontier. Also, DEA can be used to allocate resources and set targets for future forecast. The data are continuous in the standard DEA model whereas there are many problems in the real life that data must be integer such as number of employee, machinery, expert and so on. Thus in this paper we propose an approach to allocate fixed resources and set fixed targets with selective integer assumption that is based on an integer data envelopment analysis (IDEA approach for the first time. The major aim in this approach is preserving the efficiency score of DMUs. We use the concept of benchmarking to reach this aim. The numerical example gets to illustrate the applicability of the proposed method.

  18. Medicaid managed care for mental health services: the survival of safety net institutions in rural settings.

    Science.gov (United States)

    Willging, Cathleen E; Waitzkin, Howard; Nicdao, Ethel

    2008-09-01

    Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.

  19. Water resources development and management: an experience in rural hilly area.

    Science.gov (United States)

    Khadse, G K; Talkhande, A V; Andey, S P; Kelkar, P S

    2010-01-01

    The Himalayan region of Tehri Garhwal in India has scattered habitations in the villages with scanty, non-perennial and unsafe water resources like springs and streams. Poor environmental conditions arising from unsafe drinking water, inadequate sanitary measures, unhygienic disposal of excreta, sullage and accumulation of solid wastes have resulted in poor public health. The experiences gained through water supply and sanitation studies carried out especially in this rural area have been shared in this paper so as to enable adoption of relevant practices and technologies developed by the National Environmental Engineering Research Institute (NEERI, India) in the affected areas. Environmental protection of the streams and springs for sustained water availability and safe drinking water supply was ensured with active public participation, training, and awareness programs. Various surface rainwater harvesting structures were constructed at suitable sites along with ferro-cement roofwater harvesting tanks in selected villages. The activities related to designing and commissioning of a small slow sand filtration unit were carried out at Chhati (Nakot) village for safe drinking water supply. Chlorination pots were demonstrated and installed in rainwater harvesting tanks for disinfection of water for drinking purpose. Water quality assessment and health survey (parasitic and hemoglobin investigation) in the affected villages were carried out before and after technological intervention. The training and awareness programs were organised for people of 23 villages in the study area covering water and sanitation related topics. The beneficiary's opinions, perceptions, apprehensions, as well as expectations reflected positive approach towards the achievement of anticipated benefits and impacts.

  20. Subcutaneous Fentanyl Administration: A Novel Approach for Pain Management in a Rural and Suburban Prehospital Setting.

    Science.gov (United States)

    Lebon, Johann; Fournier, Francis; Bégin, François; Hebert, Denise; Fleet, Richard; Foldes-Busque, Guilaume; Tanguay, Alain

    2016-01-01

    To determine the feasibility, safety, and effectiveness of the subcutaneous route of fentanyl administration by Basic Life Support-Emergency Medical Technicians (BLS-EMT) in a rural and suburban region, with the support of an online pain management medical control center. Retrospective study of patients who received subcutaneous fentanyl and were transported by BLS-EMT to the emergency department (ED) of an academic hospital between July 1, 2013 and January 1, 2014, inclusively. Fentanyl orders were obtained from emergency physicians via an online medical control (OLMC) center. Effectiveness was defined by changes in pain scores 15 minutes, 30 minutes, and 45+ minutes after initial fentanyl administration. Safety was evaluated by measuring vital signs, Ramsay sedation scores, and adverse events subsequent to fentanyl administration. Feasibility was defined as successful fentanyl administration by BLS-EMT. SPSS-20 was used for descriptive statistics, and independent t-tests and Mann-Whitney U tests were used to determine inter- and intra-group differences based on transport time. Two hundred and eighty-eight patients (288; 14 to 93 years old) with pain scores ≥7 were eligible for the study. Of the 284 (98.6%) who successfully received subcutaneous fentanyl, 35 had missing records or data, and 249 (86.5%) were included in analyses. Average pain score pre-fentanyl was 8.9 ± 1.1. Patients fentanyl than those ≥70 years old (1.4 ± 0.3 vs, 0.8 ± 0.2 mcg/kg, p fentanyl administration and the proportion of patients achieving pain relief increased significantly (p 3 (n = 1; 0.4%). Prehospital subcutaneous fentanyl administration by BLS-EMT with the support of an OLMC center is a safe and feasible approach to pain relief in prehospital settings, and is not associated with major adverse events. Effectiveness, subsequent to subcutaneous fentanyl administration is characterized by a decrease in pain over the course of transport to ED. Further studies are needed to

  1. Expanding HIV testing efforts in concentrated epidemic settings: a population-based survey from rural Vietnam.

    Directory of Open Access Journals (Sweden)

    Anastasia Pharris

    Full Text Available BACKGROUND: To improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services. METHODS: A population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS. Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV. RESULTS: The age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14-3.01, higher economic status (aOR 3.4, 95% CI 2.21-5.22, and semi-urban residence (aOR 2.37, 95% CI 1.53-3.66 were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not. CONCLUSIONS: We found low testing uptake (6% among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider

  2. Expanding HIV testing efforts in concentrated epidemic settings: a population-based survey from rural Vietnam.

    Science.gov (United States)

    Pharris, Anastasia; Nguyen, Thi Kim Chuc; Tishelman, Carol; Brugha, Ruairí; Nguyen, Phuong Hoa; Thorson, Anna

    2011-01-11

    To improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services. A population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS). Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV. The age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14-3.01), higher economic status (aOR 3.4, 95% CI 2.21-5.22), and semi-urban residence (aOR 2.37, 95% CI 1.53-3.66) were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not. We found low testing uptake (6%) among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider-initiated testing of those who believe that they are at-risk of

  3. Service user involvement in mental health system strengthening in a rural African setting: qualitative study.

    Science.gov (United States)

    Abayneh, Sisay; Lempp, Heidi; Alem, Atalay; Alemayehu, Daniel; Eshetu, Tigist; Lund, Crick; Semrau, Maya; Thornicroft, Graham; Hanlon, Charlotte

    2017-05-18

    It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered

  4. Global patient safety and antiretroviral drug-drug interactions in the resource-limited setting.

    Science.gov (United States)

    Seden, Kay; Khoo, Saye H; Back, David; Byakika-Kibwika, Pauline; Lamorde, Mohammed; Ryan, Mairin; Merry, Concepta

    2013-01-01

    Scale-up of HIV treatment services may have contributed to an increase in functional health facilities available in resource-limited settings and an increase in patient use of facilities and retention in care. As more patients are reached with medicines, monitoring patient safety is increasingly important. Limited data from resource-limited settings suggest that medication error and antiretroviral drug-drug interactions may pose a significant risk to patient safety. Commonly cited causes of medication error in the developed world include the speed and complexity of the medication use cycle combined with inadequate systems and processes. In resource-limited settings, specific factors may contribute, such as inadequate human resources and high disease burden. Management of drug-drug interactions may be complicated by limited access to alternative medicines or laboratory monitoring. Improving patient safety by addressing the issue of antiretroviral drug-drug interactions has the potential not just to improve healthcare for individuals, but also to strengthen health systems and improve vital communication among healthcare providers and with regulatory agencies.

  5. Introducing priority setting and resource allocation in home and community care programs.

    Science.gov (United States)

    Urquhart, Bonnie; Mitton, Craig; Peacock, Stuart

    2008-01-01

    To use evidence from research to identify and implement priority setting and resource allocation that incorporates both ethical practices and economic principles. Program budgeting and marginal analysis (PBMA) is based on two key economic principles: opportunity cost (i.e. doing one thing instead of another) and the margin (i.e. resource allocation should result in maximum benefit for available resources). An ethical framework for priority setting and resource allocation known as Accountability for Reasonableness (A4R) focuses on making sure that resource allocations are based on a fair decision-making process. It includes the following four conditions: publicity; relevance; appeals; and enforcement. More recent literature on the topic suggests that a fifth condition, that of empowerment, should be added to the Framework. The 2007-08 operating budget for Home and Community Care, excluding the residential sector, was developed using PBMA and incorporating the A4R conditions. Recommendations developed using PBMA were forwarded to the Executive Committee, approved and implemented for the 2007-08 fiscal year operating budget. In addition there were two projects approved for approximately $200,000. PBMA is an improvement over previous practice. Managers of Home and Community Care are committed to using the process for the 2008-09 fiscal year operating budget and expanding its use to include mental health and addictions services. In addition, managers of public health prevention and promotion services are considering using the process.

  6. Hope Matters: Developing and Validating a Measure of Future Expectations Among Young Women in a High HIV Prevalence Setting in Rural South Africa (HPTN 068).

    Science.gov (United States)

    Abler, Laurie; Hill, Lauren; Maman, Suzanne; DeVellis, Robert; Twine, Rhian; Kahn, Kathleen; MacPhail, Catherine; Pettifor, Audrey

    2017-07-01

    Hope is a future expectancy characterized by an individual's perception that a desirable future outcome can be achieved. Though scales exist to measure hope, they may have limited relevance in low resource, high HIV prevalence settings. We developed and validated a hope scale among young women living in rural South Africa. We conducted formative interviews to identify the key elements of hope. Using items developed from these interviews, we administered the hope scale to 2533 young women enrolled in an HIV-prevention trial. Women endorsed scale items highly and the scale proved to be unidimensional in the sample. Hope scores were significantly correlated with hypothesized psycholosocial correlates with the exception of life stressors. Overall, our hope measure was found to have excellent reliability and to show encouraging preliminary indications of validity in this population. This study presents a promising measure to assess hope among young women in South Africa.

  7. Injury surveillance in low-resource settings using Geospatial and Social Web technologies

    Directory of Open Access Journals (Sweden)

    Schuurman Nadine

    2010-05-01

    Full Text Available Abstract Background Extensive public health gains have benefited high-income countries in recent decades, however, citizens of low and middle-income countries (LMIC have largely not enjoyed the same advancements. This is in part due to the fact that public health data - the foundation for public health advances - are rarely collected in many LMIC. Injury data are particularly scarce in many low-resource settings, despite the huge associated burden of morbidity and mortality. Advances in freely-accessible and easy-to-use information and communication (ICT technology may provide the impetus for increased public health data collection in settings with limited financial and personnel resources. Methods and Results A pilot study was conducted at a hospital in Cape Town, South Africa to assess the utility and feasibility of using free (non-licensed, and easy-to-use Social Web and GeoWeb tools for injury surveillance in low-resource settings. Data entry, geocoding, data exploration, and data visualization were successfully conducted using these technologies, including Google Spreadsheet, Mapalist, BatchGeocode, and Google Earth. Conclusion This study examined the potential for Social Web and GeoWeb technologies to contribute to public health data collection and analysis in low-resource settings through an injury surveillance pilot study conducted in Cape Town, South Africa. The success of this study illustrates the great potential for these technologies to be leveraged for public health surveillance in resource-constrained environments, given their ease-of-use and low-cost, and the sharing and collaboration capabilities they afford. The possibilities and potential limitations of these technologies are discussed in relation to the study, and to the field of public health in general.

  8. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru.

    Science.gov (United States)

    Jaganath, Devan; Miranda, J Jaime; Gilman, Robert H; Wise, Robert A; Diette, Gregory B; Miele, Catherine H; Bernabe-Ortiz, Antonio; Checkley, William

    2015-03-18

    It is unclear how geographic and social diversity affects the prevalence of chronic obstructive pulmonary disease (COPD). We sought to characterize the prevalence of COPD and identify risk factors across four settings in Peru with varying degrees of urbanization, altitude, and biomass fuel use. We collected sociodemographics, clinical history, and post-bronchodilator spirometry in a randomly selected, age-, sex- and site-stratified, population-based sample of 2,957 adults aged ≥35 years (median age was 54.8 years and 49.3% were men) from four resource-poor settings: Lima, Tumbes, urban and rural Puno. We defined COPD as a post-bronchodilator FEV1/FVC Peru was not uniform and, unlike other settings, was not predominantly explained by tobacco smoking. This study emphasizes the role of biomass fuel use, and highlights pulmonary tuberculosis as an often neglected risk factor in endemic areas.

  9. Critical care in resource-poor settings: lessons learned and future directions.

    Science.gov (United States)

    Riviello, Elisabeth D; Letchford, Stephen; Achieng, Loice; Newton, Mark W

    2011-04-01

    Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable

  10. Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings

    Directory of Open Access Journals (Sweden)

    Melissa S. Lopez

    2017-10-01

    Full Text Available Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

  11. Providing high-quality HIV care in a deeply rural setting – the ...

    African Journals Online (AJOL)

    challenges are not unique, rural health facilities are often fragile entities. ... problems with procurement, an isolated work environment and lack of on-site ... The government has focused on expanding programmes across the country, with ... us over the years to design and implement this programme, including. Drs Karl and ...

  12. Universal Prevention Program Outcomes: Safe Schools Healthy Students in a Rural, Multicultural Setting

    Science.gov (United States)

    Harris, Elizabeth; McFarland, Joyce; Siebold, Wendi; Aguilar, Rafael; Sarmiento, Ana

    2007-01-01

    The Idaho Consortium for Safe Schools Healthy Students consists of three school districts in rural North Central Idaho and the Nez Perce Tribe's Students for Success Program. Universal prevention programs implemented in the elementary schools include Second Step and the middle schools implemented the Life Skills program. Each of the three…

  13. Effects of a Metacognitive Social Skill Intervention in a Rural Setting with At-Risk Adolescents

    Science.gov (United States)

    Whetstone, Patti J.; Gillmor, Susan C.; Schuster, Jonathan G.

    2015-01-01

    Ten at-risk students in a rural high school completed a social skills program based on metacognitive strategies and aligned with social and emotional learning principles. The intervention's primary goal was to stimulate the development of metacognitive strategies for internal locus of control in the students, rather than attempting to change their…

  14. Women Managing/Managing Women: The Marginalization of Female Leadership in Rural School Settings.

    Science.gov (United States)

    Sherman, Ann

    2000-01-01

    Examines 21 female administrators' accounts of their experience in a rural Nova Scotia school district. Presents preliminary findings of these women's own responses, resistances, and initiatives while attempting to legitimize and implement their preferred leadership styles, which stressed relationships, instructional leadership, communication, and…

  15. Programa de Fortalecimiento de Capacidades: Reflections on a Case Study of Community-Based Teacher Education Set in Rural Northern Peru

    Science.gov (United States)

    Alsop, Steve; Ames, Patricia; Arroyo, Graciela Cordero; Dippo, Don

    2010-01-01

    This article explores distinctive features of a 5-year international education development project set in rural northern Peru (PROMEB, the "Proyecto de Mejoramiento de la Educacion Basica"). Grounded within a partnership between teacher educators from Peru, Mexico and Canada, and rural Peruvian teachers, students and their communities,…

  16. The prevalence and correlates of lifetime psychiatric disorders and trauma exposures in urban and rural settings: results from the national comorbidity survey replication (NCS-R.

    Directory of Open Access Journals (Sweden)

    Jennifer S McCall-Hosenfeld

    Full Text Available Distinctions between rural and urban environments produce different frequencies of traumatic exposures and psychiatric disorders. We examine the prevalence of psychiatric disorders and frequency of trauma exposures by position on the rural-urban continuum.The National Comorbidity Survey Replication (NCS-R was used to evaluate psychiatric disorders among a nationally-representative sample of the U.S. population. Rurality was designated using the Department of Agriculture's 2003 rural-urban continuum codes (RUCC, which differentiate counties into levels of rurality by population density and adjacency to metropolitan areas. Lifetime psychiatric disorders included post-traumatic stress disorder (PTSD, anxiety disorders, major depressive disorder, mood disorders, impulse-control disorders, and substance abuse. Trauma exposures were classified as war-related, accident-related, disaster-related, interpersonal or other. Weighted logistic regression models examined the odds of psychiatric disorders and trauma exposures by position on the rural-urban continuum, adjusted for relevant covariates.75% of participants were metropolitan, 12.2% were suburban, and 12.8% were from rural counties. The most common disorder reported was any anxiety disorder (38.5%. Drug abuse was more common among metropolitan (8.7%, p = 0.018, compared to nonmetropolitan (5.1% suburban, 6.1% rural participants. A one-category increase in rurality was associated with decreased odds for war-related trauma (aOR = 0.86, 95%CI 0.78-0.95. Rurality was not associated with risk for any other lifetime psychiatric disorders or trauma exposure.Contrary to the expectation of some rural primary care providers, the frequencies of most psychiatric disorders and trauma exposures are similar across the rural-urban continuum, reinforcing calls to improve mental healthcare access in resource-poor rural communities.

  17. Weight gain prevention among black women in the rural community health center setting: The Shape Program

    Directory of Open Access Journals (Sweden)

    Foley Perry

    2012-06-01

    for depression. Discussion The Shape Program utilizes an innovative intervention approach to lower the risk of obesity and obesity-associated chronic disease among black women in the primary care setting. The intervention was informed by behavior change theory and aims to prevent weight gain using inexpensive mobile technologies and existing health center resources. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk population sample in need of evidence-based treatment strategies. Trial registration The trial is registered with clinicaltrials.gov NCT00938535.

  18. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

    Science.gov (United States)

    Flood, David; Douglas, Kate; Goldberg, Vera; Martinez, Boris; Garcia, Pablo; Arbour, MaryCatherine; Rohloff, Peter

    2017-08-01

    Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. This project utilized the Model for Improvement and Agile Global Health, our organization's complementary healthcare implementation framework. A bundle of improvement activities were implemented at the home, clinic and institutional level. Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review.

    Science.gov (United States)

    Syzdykova, Assel; Malta, André; Zolfo, Maria; Diro, Ermias; Oliveira, José Luis

    2017-11-13

    Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code

  20. Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study.

    Science.gov (United States)

    Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta A; Davis, William Austin; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

    2018-03-01

    Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.

  1. Success criteria for electronic medical record implementations in low-resource settings: a systematic review.

    Science.gov (United States)

    Fritz, Fleur; Tilahun, Binyam; Dugas, Martin

    2015-03-01

    Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

    Science.gov (United States)

    Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

    2015-01-01

    We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

  3. Variations in fresh fruit and vegetable quality by store type, urban-rural setting and neighbourhood deprivation in Scotland.

    Science.gov (United States)

    Cummins, Steven; Smith, Dianna M; Taylor, Mathew; Dawson, John; Marshall, David; Sparks, Leigh; Anderson, Annie S

    2009-11-01

    Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural-urban location and neighbourhood deprivation in a selection of communities across Scotland. Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban-rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban-rural classification. Scotland. Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items. The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

  4. Prevention for child and adolescent psychiatry in low-resource settings

    OpenAIRE

    Rachna Bhargava; Anamika Sahu; Debabani Bhattacharya

    2017-01-01

    Preventive measures for mental health issues among children have received meager attention. Although the prevalence rates of mental disorders are significant, systematic focused efforts toward management specifically in this special population in low-resources settings have been markedly inconsequential. Certainly, unlike other medical conditions, policies, and services related to mental health of children and adolescent are not adequate and efficient to deal with the burden of mental disorde...

  5. Mentoring for junior medical faculty: Existing models and suggestions for low-resource settings.

    Science.gov (United States)

    Menon, Vikas; Muraleedharan, Aparna; Bhat, Ballambhattu Vishnu

    2016-02-01

    Globally, there is increasing recognition about the positive benefits and impact of mentoring on faculty retention rates, career satisfaction and scholarly output. However, emphasis on research and practice of mentoring is comparatively meagre in low and middle income countries. In this commentary, we critically examine two existing models of mentorship for medical faculty and offer few suggestions for an integrated hybrid model that can be adapted for use in low resource settings. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Creating Highly Qualified Teachers: Maximizing University Resources to Provide Professional Development in Rural Areas

    Science.gov (United States)

    Mollenkopf, Dawn L.

    2009-01-01

    The "highly qualified teacher" requirement of No Child Left Behind has put pressure on rural school districts to recruit and retain highly qualified regular and special education teachers. If necessary, they may utilize uncertified, rural teachers with provisional certification; however, these teachers may find completing the necessary…

  7. Rural Livelihoods: Interplay Between Farm Activities, Non-Farm Activities and the Resource Base

    NARCIS (Netherlands)

    Kuiper, M.H.; Meijerink, G.W.; Eaton, D.J.F.

    2007-01-01

    Despite ongoing urbanization, over 70% of the world's poor are located in rural areas (IFAD 2001). Agriculture plays an important part in their livelihoods. Rural households play a central role in realizing policy objectives. Production decisions at farm household level determine the current

  8. Urban Forest and Rural Cities: Multi-sited Households, Consumption Patterns, and Forest Resources in Amazonia

    Directory of Open Access Journals (Sweden)

    Christine Padoch

    2008-12-01

    Full Text Available In much of the Amazon Basin, approximately 70% of the population lives in urban areas and urbanward migration continues. Based on data collected over more than a decade in two long-settled regions of Amazonia, we find that rural-urban migration in the region is an extended and complex process. Like recent rural-urban migrants worldwide, Amazonian migrants, although they may be counted as urban residents, are often not absent from rural areas but remain members of multi-sited households and continue to participate in rural-urban networks and in rural land-use decisions. Our research indicates that, despite their general poverty, these migrants have affected urban markets for both food and construction materials. We present two cases: that of açaí palm fruit in the estuary of the Amazon and of cheap construction timbers in the Peruvian Amazon. We find that many new Amazonian rural-urban migrants have maintained some important rural patterns of both consumption and knowledge. Through their consumer behavior, they are affecting the areal extent of forests; in the two floodplain regions discussed, tree cover is increasing. We also find changes in forest composition, reflecting the persistence of rural consumption patterns in cities resulting in increased demand for and production of açaí and cheap timber species.

  9. Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal

    Directory of Open Access Journals (Sweden)

    Sokhna Thiam

    2017-09-01

    Full Text Available We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011–2014. Climatic data (i.e., daily temperature, night temperature and rainfall for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health–climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.

  10. Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal.

    Science.gov (United States)

    Thiam, Sokhna; Diène, Aminata N; Sy, Ibrahima; Winkler, Mirko S; Schindler, Christian; Ndione, Jacques A; Faye, Ousmane; Vounatsou, Penelope; Utzinger, Jürg; Cissé, Guéladio

    2017-09-12

    We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011-2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health-climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.

  11. Barriers in implementing evidence-informed health decisions in rural rehabilitation settings: a mixed methods pilot study.

    Science.gov (United States)

    Prakash, V; Hariohm, K; Balaganapathy, M

    2014-08-01

    Literature on the barriers to implementing research findings into physiotherapy practice are often urban centric, using self report based on the hypothetical patient scenario. The objective of this study was to investigate the occurrence of barriers, encountered by evidence informed practice-trained physiotherapists in the management of "real world" patients in rural rehabilitation settings. A mixed-methods research design was used. Physiotherapists working in rural outpatient rehabilitation settings participated in the study. In the first phase, we asked all participants (N = 5) to maintain a log book for a 4-week period to record questions that arose during their routine clinical encounters and asked them also to follow first four of the five steps of evidence-informed practice (ask, access, appraise and apply). In the second phase (after 4 weeks), we conducted a semistructured, direct interviews with the participants exploring their experiences involved in the process of implementing evidence-informed clinical decisions made during the study period. At the end of 4 weeks, 30 questions were recorded. For 17 questions, the participants found evidence but applied that evidence into their practice only in 9 instances. Being generalist practitioners, lack of outcomes specific to the patients were reported as barriers more so than time constraints in implementing evidence-informed practice. Practice setting, lack of patient-centered research and evidence-informed practice competency of physiotherapists can be significant barriers to implementing evidence-informed health decisions in rural rehabilitation setting. © 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  12. Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

    Science.gov (United States)

    Nishtar, Sania

    2003-01-01

    This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

  13. Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review.

    Science.gov (United States)

    Deardorff, Katrina V; McCollum, Eric D; Ginsburg, Amy Sarah

    2017-12-22

    Pneumonia is the leading infectious cause of death among children less than five years of age. Predictive tools, commonly referred to as risk scores, can be employed to identify high-risk children early for targeted management to prevent adverse outcomes. This systematic review was conducted to identify pediatric pneumonia risk scores developed, validated, and implemented in low-resource settings. We searched CAB Direct, Cochrane Reviews, Embase, PubMed, Scopus, and Web of Science for studies that developed formal risk scores to predict treatment failure or mortality among children less than five years of age diagnosed with a respiratory infection or pneumonia in low-resource settings. Data abstracted from articles included location and study design, sample size, age, diagnosis, score features and model discrimination. Three pediatric pneumonia risk scores predicted mortality specifically, and two treatment failure. Scores developed using World Health Organization recommended variables for pneumonia assessment demonstrated better predictive fit than scores developed using alternative features. Scores developed using routinely collected healthcare data performed similarly well as those developed using clinical trial data. No score has been implemented in low-resource settings. While pediatric pneumonia-specific risk scores have been developed and validated, it is yet unclear if implementation is feasible, what impact, if any, implemented scores may have on child outcomes, or how broadly scores may be generalized. To increase the feasibility of implementation, future research should focus on developing scores based on routinely collected data.

  14. Poor health and loneliness in later life: the role of depressive symptoms, social resources, and rural environments.

    Science.gov (United States)

    Burholt, Vanessa; Scharf, Thomas

    2014-03-01

    We draw on cognitive discrepancy theory to hypothesize and test a pathway from poor health to loneliness in later life. We hypothesize that poor health will have a negative influence on social participation and social resources, and these factors will mediate between health and loneliness. We hypothesize that rural environments will amplify any difficulties associated with social participation or accessing social resources and that depression will moderate how intensely people react to levels of social contact and support. We conceptualize a mediation model and a moderated-mediation model. Nationally representative data on older people living in the Republic of Ireland are used to validate the hypothesized pathways. In the mediation model, health has a significant indirect effect on loneliness through the mediating variables social resources and social participation. In the moderated-mediation model, rurality moderates the pathway between health and social resources but not social participation. Depressive symptoms moderate the effect of social resources on loneliness but not social participation. The results provide further credence to cognitive discrepancy theory, suggesting that depressive symptoms influence cognitive processes, interfering with judgments about the adequacy of social interaction. The theory is extended by demonstrating the impact of the environment on loneliness.

  15. Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women.

    Science.gov (United States)

    Ries, A V; Blackman, L T; Page, R A; Gizlice, Z; Benedict, S; Barnes, K; Kelsey, K; Carter-Edwards, L

    2014-01-01

    Rural, minority populations are disproportionately affected by overweight and obesity and may benefit from lifestyle modification programs that are tailored to meet their unique needs. Obesity interventions commonly use goal setting as a behavior change strategy; however, few have investigated the specific contribution of goal setting to behavior change and/or identified the mechanisms by which goal setting may have an impact on behavior change. Furthermore, studies have not examined goal setting processes among racial/ethnic minorities. Using data from an obesity intervention for predominately minority women in rural North Carolina, this study sought to examine whether intervention participation resulted in working on goals and using goal setting strategies which in turn affected health behavior outcomes. It also examined racial/ethnic group differences in working on goals and use of goal setting strategies. Data came from a community-based participatory research project to address obesity among low-income, predominately minority women in rural North Carolina. A quasi-experimental intervention design was used. Participants included 485 women aged 18 years and over. Intervention participants (n=208) received health information and goal setting support through group meetings and tailored newsletters. Comparison participants (n = 277) received newsletters on topics unrelated to obesity. Surveys assessed physical activity, fruit and vegetable intake, goal-related stage of change, and use of goal setting strategies. Chi squared statistics were used to assess intervention group differences in changes in goal-related stage of change and use of goal setting strategies as well as racial/ethnic group differences in stage of change and use of goal setting strategies at baseline. The causal steps approach of Baron and Kenny was used to assess mediation. Intervention compared to comparison participants were more likely to move from contemplation to action/maintenance for the

  16. Maternal perceptions of factors contributing to severe under-nutrition among children in a rural African setting.

    Science.gov (United States)

    Abubakar, A; Holding, P; Mwangome, M; Maitland, K

    2011-01-01

    In developing countries, severe undernutrition in early childhood is associated with increased mortality and morbidity, and 10-40% of hospital admissions. The current study aimed to elicit maternal perceptions of factors that contribute to severe undernutrition among children in a rural Kenyan community in order to identify appropriate and acceptable targeted interventions. The study consisted of 10 focus group discussions (FGDs) of between eight and ten mothers each, in a rural coastal community in Kenya. A grounded theory approach was used to analyse the FGD data. In all FGDs 'financial constraints' was the main reason given for severe undernutrition of children. The mothers reported the additional factors of inadequate food intake, ill health, inadequate care of children, heavy workload for mothers, inadequate control of family resources by women and a lack of resources for generating income for the family. The mothers also reported their local cultural belief that severe malnutrition was due to witchcraft and the violation of sexual taboos. The mothers in the study community recognised multiple aetiologies for severe undernutrition. A multidisciplinary approach is needed address the range of issues raised and so combat severe undernutrition. Suggested interventions include poverty alleviation, medical education and psychosocial strategies. The content and approach of any program must address the need for variability, determined by individual and local needs, concerns, attitudes and beliefs.

  17. The efficacy of staff training on improving internal customer satisfaction in a rural health setting.

    Science.gov (United States)

    Hartley, R; Turner, R

    1995-09-01

    The NSW Health Department is 3 years into its customer satisfaction initiative. North West Health Service, one of the largest rural health districts, was among the first centres to embrace the customer satisfaction philosophy starting with compulsory training of all staff. This paper reports on changes in staff morale (internal satisfaction) as a result of that training. The data suggest that training per se has had minimal effect and argues for management development, particularly regarding leadership, rather than fiscal skills.

  18. Linking poverty levels to water resource use and conflicts in rural Tanzania

    Science.gov (United States)

    Madulu, Ndalahwa F.

    Water scarcity is an important environmental constraint to development. Water availability is closely linked to human welfare and health by affecting nutrition status and quantity of drinking water especially for the poor. It has impacts on household labour because of the time and energy spent in obtaining it. These problems are more keenly felt among the poor households and in the agricultural subsistence economy. In many areas, the demand for water has been increasing due to rapid population growth, economic development, and climatic change. Water scarcity also stimulates social conflicts between various water users: individuals, communities, industries, livestock, wildlife, agriculture etc. Consequently, local communities have evolved strategies for coping with water stress and drought. These strategies include use of various sources of water, inaction to strict bye-laws regarding the use of water, crop diversification, wage labour, and possibly seasonal migration. The available strategies are likely to vary from one area to another. Some of these actions have measurable longterm demographic consequences, particularly if water stress is severe or repetitive. Although most governments and donor organizations often put much emphasis on the provision of water for drinking purposes, there is clear evidence that the supply of water for other uses has equal importance especially among rural communities. This observation suggests that putting too much emphasis on drinking water needs, addresses a rather insignificant part of the problem of water resources and biases the range of solutions which are likely to be proposed for perceived shortages. The presence of other water uses necessitates the provision of multi-purpose water sources that can serve a number of contrasting functions. This demand-responsive approach can enable the local communities and the poor households to choose the type of services they require on the basis of perceived needs and their ability to

  19. Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

    Science.gov (United States)

    Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian

    2017-02-07

    NGO) and the local government respectively. The current study identified challenges that adoptive families as well as the AIDS-orphaned children themselves faced in Mbeya Rural District, Tanzania. Recognition of these issues highlights the need for targeted interventions to address the underlying social determinants of human immunodeficiency virus or HIV and AIDS in affected populations in order to prevent further imposition of social, cultural and economic disadvantages on families that provide care for AIDS-orphaned children and the children themselves. These findings may prove useful in provoking discussions that may lead to HIV/AIDS prevention and the development of broader mitigation strategies to alleviate the impact of this scourge on families and communities in rural Tanzania, and in similar settings across the world.

  20. Sustainable fuelwood use in rural Mexico. Volume 1: Current patterns of resource use

    Energy Technology Data Exchange (ETDEWEB)

    Masera, O.

    1993-04-01

    The present report summarizes the results of the first phase of a project of cooperation between the Mexican National Commission for Energy Conservation (CONAE) and the United States Environmental Protection Agency (U.S. EPA) on sustainable biofuel use in rural Mexico. This first phase has been devoted to (i) conducting an in-depth review of the status of fuelwood use in rural and peri-urban areas of Mexico, (ii) providing improved estimates of biomass energy use, (iii) assessing the socioeconomic and environmental impacts of fuelwood use, and (iv) identifying preliminary potential lines of action to improve the patterns of biomass energy use in Mexico; in particular, identifying those interventions that, by improving living conditions for rural inhabitants, can result in global benefits (such as the reduction in greenhouse gas emissions). A comprehensive review of the existing documentation of biofuel use in rural and peri-urban Mexico was conducted. Reports from official, academic, and non-governmental organizations were gathered and analyzed. A computerized rural energy database was created by re-processing a national rural energy survey. Because of the paucity of information about biofuel use in small rural industries, most of the analysis is devoted to the household sector.

  1. The impact of ACE gene polymorphism on the incidence and phenotype of sarcoidosis in rural and urban settings.

    Science.gov (United States)

    Kieszko, Robert; Krawczyk, Paweł; Powrózek, Tomasz; Szudy-Szczyrek, Aneta; Szczyrek, Michał; Homa, Iwona; Daniluk, Jadwiga; Milanowski, Janusz

    2016-12-01

    Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Current theory on the etiology of this disease involves participation of genetic factors and unknown antigens present in the patients' environment. The aim of the study was to evaluate the prevalence of different polymorphic forms of the ACE gene in healthy individuals and sarcoidosis patients, and to estimate the risk of sarcoidosis in carriers of different ACE genotypes living in rural and urban settings. The study group included 180 patients with pulmonary sarcoidosis. Assessment of the disease was based on clinical features, laboratory and imaging examinations, as well as bronchoscopy with bronchoalveolar lavage (BAL). ACE gene polymorphism was examined in DNA isolated from peripheral blood or BAL fluid (BALF) leukocytes. Incidence of sarcoidosis was not influenced by gender, age or place of residence of the patients. There were no differences in the frequency of particular genotypes in patients with sarcoidosis and in healthy individuals. The risk of disease did not depend on the ACE gene polymorphism. There were no differences in the frequencies of the different genotypes and alleles of the ACE gene in patients with sarcoidosis divided by gender, age and place of residence or by clinical manifestation of sarcoidosis. Our results do not support the previous concept which suggested a higher incidence of sarcoidosis in individuals living in rural areas and in carriers of selected ACE genotypes. It is possible that this is related to the changing environment of rural areas, increasing urbanization and pollution.

  2. Urban Rural Comparisons of Polycystic Ovary Syndrome Burden among Adolescent Girls in a Hospital Setting in India

    Directory of Open Access Journals (Sweden)

    Swetha Balaji

    2015-01-01

    Full Text Available Background. Polycystic ovarian syndrome (PCOS is a multifaceted disorder characterized by varying clinical presentations. Objective. The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. Methods. A pilot cross-sectional study was conducted for a period of one month (August-September 2013 at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, n=63 and rural (50%, n=63 settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. Results. Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements. Majority of the individuals with PCOS had an average age of 16 (SD = 2 (P=.02 years with an average age of menarche 12 years (SD = 1. Conclusion. The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants.

  3. Rural wood consumption patterns of local and immigrant households with differentiated access to resources in Xishuangbanna, Yunnan, China

    International Nuclear Information System (INIS)

    Mertens, Charlotte Filt; Bruun, Thilde Bech; Schmidt-Vogt, Dietrich; He, Jun; Neergaard, Andreas de

    2015-01-01

    In Xishuangbanna, China, rubber production has spread rapidly, resulting in extensive land use changes and an increasing influx of migrant workers who have come to find work on the plantations. These migrant workers have limited access to subsidies and the local collective forest due to the household registration system in China called hukou. To assess how these policy-based restrictions on access affect wood consumption and local communities, a case study was conducted in Manlin village, Xishuangbanna, undertaking a household and weight survey with local and immigrant households. The results show no significant difference in firewood consumption between the subpopulations, despite predominantly more local than immigrant households have access to subsidised alternative energy sources. On the other hand, limited access to the collective forest is found to influence the choice of housing materials and living standards in immigrant households as they cannot access timber or afford brick houses. This paper highlights rural issues connected to the hukou system and suggests that rural energy and resource policies should take the growing population of immigrant workers into consideration in future to expand the reach of the polices to the de facto and not only de jure rural population and thus optimise policy efficiency. - Highlights: • The hukou system directly affects rural wood access and consumption. • Immigrant households have little or no access to timber. • Registration status does not have a significant effect on firewood consumption. • Excluding immigrant households will limit policy outreach and efficiency

  4. Managing Ebola from rural to urban slum settings: experiences from Uganda.

    Science.gov (United States)

    Okware, Sam I; Omaswa, Francis; Talisuna, Ambrose; Amandua, Jacinto; Amone, Jackson; Onek, Paul; Opio, Alex; Wamala, Joseph; Lubwama, Julius; Luswa, Lukwago; Kagwa, Paul; Tylleskar, Thorkild

    2015-03-01

    Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.

  5. Environmental resources reduce income inequality and the prevalence, depth and severity of poverty in rural Nepal

    DEFF Research Database (Denmark)

    Chhetri, Bir Bahadur Khanal; Larsen, Helle Overgaard; Smith-Hall, Carsten

    2015-01-01

    This paper investigates the economic importance of environmental income to rural households in Nepal and how environmental income influences poverty and inequality measures. Qualitative contextual information was collected from two village development committees in middle Gorkha District followed...

  6. Household fuel consumption and resource use in rural-urban Ethiopia

    NARCIS (Netherlands)

    Gebreegziabher, Z.

    2007-01-01

    Keywords: biofuels; land degradation; technology adoption; fuel-savings efficiency; stove R&D; household and community tree investments; fuelwood availability; animal dung; biogas; urban fuel demand; rural hinterlands; northern Ethiopia. Fuel scarcity and land degradation are intertwined

  7. Shuffled Frog Leaping Algorithm for Preemptive Project Scheduling Problems with Resource Vacations Based on Patterson Set

    Directory of Open Access Journals (Sweden)

    Yi Han

    2013-01-01

    Full Text Available This paper presents a shuffled frog leaping algorithm (SFLA for the single-mode resource-constrained project scheduling problem where activities can be divided into equant units and interrupted during processing. Each activity consumes 0–3 types of resources which are renewable and temporarily not available due to resource vacations in each period. The presence of scarce resources and precedence relations between activities makes project scheduling a difficult and important task in project management. A recent popular metaheuristic shuffled frog leaping algorithm, which is enlightened by the predatory habit of frog group in a small pond, is adopted to investigate the project makespan improvement on Patterson benchmark sets which is composed of different small and medium size projects. Computational results demonstrate the effectiveness and efficiency of SFLA in reducing project makespan and minimizing activity splitting number within an average CPU runtime, 0.521 second. This paper exposes all the scheduling sequences for each project and shows that of the 23 best known solutions have been improved.

  8. Review of two years of experiences with SPECT among psychiatric patients in a rural hospital setting.

    Science.gov (United States)

    Sheehan, William; Thurber, Steven

    2008-09-01

    We summarize single proton emission computed tomography (SPECT) findings from 63 psychiatric patients in a small rural hospital in western Minnesota. SPECT scans were ordered only for patients in whom documentation of hypoperfusion and functional deficits might be helpful in clarifying diagnoses and treatment planning. The patients referred for SPECT scans had histories of traumatic brain injuries, atypical psychiatric symptom presentations, or conditions that were refractory to standard treatments. In the context of strict referral guidelines and close psychiatrist-radiologist collaboration, a much higher yield of significant findings was obtained compared with those noted in other reports in the literature.

  9. Electronic data capture in a rural African setting: evaluating experiences with different systems in Malawi

    OpenAIRE

    King, Carina; Hall, Jenny; Banda, Masford; Beard, James; Bird, Jon; Kazembe, Peter; Fottrell, Ed

    2014-01-01

    Background\\ud \\ud As hardware for electronic data capture (EDC), such as smartphones or tablets, becomes cheaper and more widely available, the potential for using such hardware as data capture tools in routine healthcare and research is increasing.\\ud \\ud Objective\\ud \\ud We aim to highlight the advantages and disadvantages of four EDC systems being used simultaneously in rural Malawi: two for Android devices (CommCare and ODK Collect), one for PALM and Windows OS (Pendragon), and a custom-b...

  10. Analysis of rural entrepreneurship under the theorethical approach of resources and capabilities: the case of a rural microbusiness

    International Nuclear Information System (INIS)

    Vargas-Hernandez-Jose, G.

    2012-01-01

    The aim of this paper is to analyze the case of a joint venture stage to determine the successes and failures to undertake this business, based on the theory of resources and skills of entrepreneurship and business. It is intended to answer the question, what were the successes and failures committed by entrepreneurs to run the business plan in this particular case?. The answers were found relating the situations described in the case with the theories of resources and skills and entrepreneurship. The analysis concludes that the empirical knowledge of entrepreneurs, in this case were not sufficient to direct the business to success, and that the lack of structured knowledge and adequate scientific support for this project strongly directed towards the non-permanence on the market

  11. Vaccination program in a resource-limited setting: A case study in the Philippines.

    Science.gov (United States)

    Chootipongchaivat, Sarocha; Chantarastapornchit, Varit; Kulpeng, Wantanee; Ceria, Joyce Anne; Tolentino, Niña Isabelle; Teerawattananon, Yot

    2016-09-14

    Implementing national-level vaccination programs involves long-term investment, which can be a significant financial burden, particularly in resource-limited settings. Although many studies have assessed the economic impacts of providing vaccinations, evidence on the positive and negative implications of human resources for health (HRH) is still lacking. Therefore, this study aims to estimate the HRH impact of introducing pneumococcal conjugate vaccine (PCV) using a model-based economic evaluation. This study adapted a Markov model from a prior study that was conducted in the Philippines for assessing the cost-effectiveness of 10-valent and 13-valent PCV compared to no vaccination. The Markov model was used for estimating the number of cases of pneumococcal-related diseases, categorized by policy options. HRH-related parameters were obtained from document reviews and interviews using the quantity, task, and productivity model (QTP model). The number of full-time equivalent (FTE) of general practitioners, nurses, and midwives increases significantly if the universal vaccine coverage policy is implemented. A universal coverage of PCV13 - which is considered to be the best value for money compared to other vaccination strategies - requires an additional 380 FTEs for general practitioners, 602 FTEs for nurses, and 205 FTEs for midwives; it can reduce the number of FTEs for medical social workers, paediatricians, infectious disease specialists, neurologists, anaesthesiologists, radiologists, ultrasonologists, medical technologists, radiologic technologists, and pharmacists by 7, 17.9, 9.7, 0.4, 0.1, 0.7, 0.1, 12.3, 2, and 9.7, respectively, when compared to the no vaccination policy. This is the first attempt to estimate the impact of HRH alongside a model-based economic evaluation study, which can be eventually applied to other vaccine studies, especially those which inform resource allocation in developing settings where not only financial resources but also HRH are

  12. Magnitude of indoor NO{sub 2} from biomass fuels in rural settings of Ethiopia

    Energy Technology Data Exchange (ETDEWEB)

    Kumie, A.; Ali, A.; Mekonnen, E. (Addis Ababa Univ., Medical Faculty (Ethiopia)); Emmelin, A.; Wahlberg, S.; Brandstrom, D. (Umeaa Univ., Umeaa Int. School of Public Health (Sweden)); Berhane, Y. (Addis Continental Inst. of Public Health, Addis Ababa (Ethiopia))

    2009-02-15

    Half of the world's population and about 80% of households in Sub-Saharan Africa depend on biomass fuels. Indoor air pollution due to biomass fuel combustion may constitute a major public health threat affecting children and women. The purpose of this study was to measure levels of indoor NO{sub 2} concentration in homes with under-five children in rural Ethiopia. The study was undertaken in the Butajira area in Ethiopia from March 2000 to April 2002. 24-h samples were taken regularly at about three month intervals in approximately 3300 homes. Indoor air sampling was done using a modified Willems badge. For each sample taken, an interview with the mother of the child was performed. A Saltzman colorimetric method using a spectrometer calibrated at 540 nm was employed to analyze the mass of NO{sub 2} in field samples. Wood, crop residues and animal dung were the main household fuels. The mean (s.d.) 24-h concentration of NO{sub 2} was 97 mug/m3 (91.4). This is more than double the currently proposed annual mean of WHO air quality guideline. Highland households had significantly higher indoor NO{sub 2} concentration. This study demonstrates high levels of indoor NO{sub 2} in rural homes of Ethiopia. (au)

  13. Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

    Science.gov (United States)

    Milano, Giulia; Saenz, Elizabeth; Clark, Nicolas; Busse, Anja; Gale, John; Campello, Giovanna; Mattfeld, Elizabeth; Maalouf, Wadih; Heikkila, Hanna; Martelli, Antonietta; Morales, Brian; Gerra, Gilberto

    2017-11-10

    Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.

  14. Growth and development in school-age children from Rostov region, Russia: Comparison between urban and rural settings.

    Science.gov (United States)

    Voynov, V B; Kulba, S N; Arapova, Yu Yu

    2017-12-01

    The purposes of the current study were: (1) to describe growth and physical development and establish norms for schoolchildren from Rostov region in Russia; (2) to compare major characteristics of development between urban and rural children by sex and age. Nearly 200,000 children (198,712) aged between 7 and 17 years from 232 urban and rural schools of Rostov region (Southern Federal District of Russia) participated in the study. School age is a period of intensive growth and physiological and psychological development. Irregularities of personal development are caused by a multitude of factors, such as sex differences, heredity, socio-economic status of a family, standard of living, particular environmental conditions, and lifestyle. It has been established that children from the Southern Federal District of Russia had body mass index values higher than age-appropriate norms for all Russians (Total Russian, Rudnev et al., 2014) and World Health Organization charts. Children from urban settings were taller and heavier than children from rural settings. Sex is one of the most influential factors which play key role in determining specific characteristics of growth and personal development. According to our results, boys and girls both had similar age-related changes in weight and height, but their respective dynamics differed. Girls' height and weight values accelerated at the age 10 to 12 years and plateaued after the age fourteen, whereas in boys height and weight steadily increased with age, showing slight acceleration at the age 12 to 13 years, and reached a plateau by the age of seventeen. Copyright © 2017 Elsevier GmbH. All rights reserved.

  15. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

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    Scanlon ML

    2013-01-01

    Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

  16. Rapid molecular assays for the detection of yellow fever virus in low-resource settings.

    Science.gov (United States)

    Escadafal, Camille; Faye, Oumar; Sall, Amadou Alpha; Faye, Ousmane; Weidmann, Manfred; Strohmeier, Oliver; von Stetten, Felix; Drexler, Josef; Eberhard, Michael; Niedrig, Matthias; Patel, Pranav

    2014-03-01

    Yellow fever (YF) is an acute viral hemorrhagic disease transmitted by Aedes mosquitoes. The causative agent, the yellow fever virus (YFV), is found in tropical and subtropical areas of South America and Africa. Although a vaccine is available since the 1930s, YF still causes thousands of deaths and several outbreaks have recently occurred in Africa. Therefore, rapid and reliable diagnostic methods easy to perform in low-resources settings could have a major impact on early detection of outbreaks and implementation of appropriate response strategies such as vaccination and/or vector control. The aim of this study was to develop a YFV nucleic acid detection method applicable in outbreak investigations and surveillance studies in low-resource and field settings. The method should be simple, robust, rapid and reliable. Therefore, we adopted an isothermal approach and developed a recombinase polymerase amplification (RPA) assay which can be performed with a small portable instrument and easy-to-use lyophilized reagents. The assay was developed in three different formats (real-time with or without microfluidic semi-automated system and lateral-flow assay) to evaluate their application for different purposes. Analytical specificity and sensitivity were evaluated with a wide panel of viruses and serial dilutions of YFV RNA. Mosquito pools and spiked human plasma samples were also tested for assay validation. Finally, real-time RPA in portable format was tested under field conditions in Senegal. The assay was able to detect 20 different YFV strains and demonstrated no cross-reactions with closely related viruses. The RPA assay proved to be a robust, portable method with a low detection limit (<21 genome equivalent copies per reaction) and rapid processing time (<20 min). Results from real-time RPA field testing were comparable to results obtained in the laboratory, thus confirming our method is suitable for YFV detection in low-resource settings.

  17. Rapid molecular assays for the detection of yellow fever virus in low-resource settings.

    Directory of Open Access Journals (Sweden)

    Camille Escadafal

    2014-03-01

    Full Text Available BACKGROUND: Yellow fever (YF is an acute viral hemorrhagic disease transmitted by Aedes mosquitoes. The causative agent, the yellow fever virus (YFV, is found in tropical and subtropical areas of South America and Africa. Although a vaccine is available since the 1930s, YF still causes thousands of deaths and several outbreaks have recently occurred in Africa. Therefore, rapid and reliable diagnostic methods easy to perform in low-resources settings could have a major impact on early detection of outbreaks and implementation of appropriate response strategies such as vaccination and/or vector control. METHODOLOGY: The aim of this study was to develop a YFV nucleic acid detection method applicable in outbreak investigations and surveillance studies in low-resource and field settings. The method should be simple, robust, rapid and reliable. Therefore, we adopted an isothermal approach and developed a recombinase polymerase amplification (RPA assay which can be performed with a small portable instrument and easy-to-use lyophilized reagents. The assay was developed in three different formats (real-time with or without microfluidic semi-automated system and lateral-flow assay to evaluate their application for different purposes. Analytical specificity and sensitivity were evaluated with a wide panel of viruses and serial dilutions of YFV RNA. Mosquito pools and spiked human plasma samples were also tested for assay validation. Finally, real-time RPA in portable format was tested under field conditions in Senegal. CONCLUSION/SIGNIFICANCE: The assay was able to detect 20 different YFV strains and demonstrated no cross-reactions with closely related viruses. The RPA assay proved to be a robust, portable method with a low detection limit (<21 genome equivalent copies per reaction and rapid processing time (<20 min. Results from real-time RPA field testing were comparable to results obtained in the laboratory, thus confirming our method is suitable for

  18. A systematic review of portable electronic technology for health education in resource-limited settings.

    Science.gov (United States)

    McHenry, Megan S; Fischer, Lydia J; Chun, Yeona; Vreeman, Rachel C

    2017-08-01

    The objective of this study is to conduct a systematic review of the literature of how portable electronic technologies with offline functionality are perceived and used to provide health education in resource-limited settings. Three reviewers evaluated articles and performed a bibliography search to identify studies describing health education delivered by portable electronic device with offline functionality in low- or middle-income countries. Data extracted included: study population; study design and type of analysis; type of technology used; method of use; setting of technology use; impact on caregivers, patients, or overall health outcomes; and reported limitations. Searches yielded 5514 unique titles. Out of 75 critically reviewed full-text articles, 10 met inclusion criteria. Study locations included Botswana, Peru, Kenya, Thailand, Nigeria, India, Ghana, and Tanzania. Topics addressed included: development of healthcare worker training modules, clinical decision support tools, patient education tools, perceptions and usability of portable electronic technology, and comparisons of technologies and/or mobile applications. Studies primarily looked at the assessment of developed educational modules on trainee health knowledge, perceptions and usability of technology, and comparisons of technologies. Overall, studies reported positive results for portable electronic device-based health education, frequently reporting increased provider/patient knowledge, improved patient outcomes in both quality of care and management, increased provider comfort level with technology, and an environment characterized by increased levels of technology-based, informal learning situations. Negative assessments included high investment costs, lack of technical support, and fear of device theft. While the research is limited, portable electronic educational resources present promising avenues to increase access to effective health education in resource-limited settings, contingent

  19. Breastfeeding Patterns in the Rural Community of Hilo, Hawai‘i: An Exploration of Existing Data Sets

    Science.gov (United States)

    2013-01-01

    Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai‘i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai‘i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai‘i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai‘i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data. PMID:23520565

  20. Breastfeeding patterns in the rural community of Hilo, Hawai'i: an exploration of existing data sets.

    Science.gov (United States)

    Flood, Jeanie L

    2013-03-01

    Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai'i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai'i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai'i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai'i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data.

  1. Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013.

    Science.gov (United States)

    Ncogo, Policarpo; Romay-Barja, Maria; Benito, Agustin; Aparicio, Pilar; Nseng, Gloria; Berzosa, Pedro; Santana-Morales, Maria A; Riloha, Matilde; Valladares, Basilio; Herrador, Zaida

    2017-01-01

    Anemia in children under 5 years of age is a global public health problem. According to the World Health Organization the current rate of anemia among preschool aged children in Equatorial Guinea is 66%. No information is available above this age. The cross-sectional Prevamal Survey was conducted in 2013 aimed at providing baseline data on malaria prevalence in children aged 2 months-15 years old. Sampling was carried out with the use of a multistage, stratified cluster strategy in the district of Bata, Equatorial Guinea. The χ2 test and adjusted Poisson regression models were applied to assess the association between social-demographic and economic factors, malaria and anemia. A total of 1436 children were tested, out of which 1,421 children (99%) were tested for anemia. Over 85% were anemic; out of them, 284 (24%), 815 (67%) and 111 (9%) children had mild, moderate and severe anemia, respectively. Severe anemia was more frequent among children aged 2-12 months old and those living in rural sites. About 47% tested positive for malaria via a rapid diagnostic test (RDT). This rate was significantly higher in rural villages (66%; panemia and malaria was higher in rural settings (panemia in urban areas displayed a heterogeneity and complexity that differed from the rural environment: in urban neighbourhoods, children with concomitant malaria infection were more likely to be anemic (adjusted prevalence rate (aPR):1.19; CI 95%: 1.12-1.28). Moreover, the prevalence of anemia was higher in children aged above 13 months compared to younger children (pchildren' parents being employees (aPR: 0.86, 95% CI: 0.76-0.96) or self-employed (aPR: 0.86, 95% CI: 0.76-0.97) vs. working in agriculture and/or fishing negatively associated with anemia among urban children. This marked urban-rural variation indicates the importance of targeting specific areas or districts. Strategies aimed at reducing malaria are clearly paramount in this country. Prevention and treatment of other factors

  2. Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013.

    Directory of Open Access Journals (Sweden)

    Policarpo Ncogo

    Full Text Available Anemia in children under 5 years of age is a global public health problem. According to the World Health Organization the current rate of anemia among preschool aged children in Equatorial Guinea is 66%. No information is available above this age. The cross-sectional Prevamal Survey was conducted in 2013 aimed at providing baseline data on malaria prevalence in children aged 2 months-15 years old. Sampling was carried out with the use of a multistage, stratified cluster strategy in the district of Bata, Equatorial Guinea. The χ2 test and adjusted Poisson regression models were applied to assess the association between social-demographic and economic factors, malaria and anemia. A total of 1436 children were tested, out of which 1,421 children (99% were tested for anemia. Over 85% were anemic; out of them, 284 (24%, 815 (67% and 111 (9% children had mild, moderate and severe anemia, respectively. Severe anemia was more frequent among children aged 2-12 months old and those living in rural sites. About 47% tested positive for malaria via a rapid diagnostic test (RDT. This rate was significantly higher in rural villages (66%; p<0.001. The prevalence of anemia and malaria was higher in rural settings (p<0.001. On the other hand, anemia in urban areas displayed a heterogeneity and complexity that differed from the rural environment: in urban neighbourhoods, children with concomitant malaria infection were more likely to be anemic (adjusted prevalence rate (aPR:1.19; CI 95%: 1.12-1.28. Moreover, the prevalence of anemia was higher in children aged above 13 months compared to younger children (p<0.005. Belonging to the poorest wealth tertile were positively (aPR: 1.14, 95% CI: 1.05-1.24 and children' parents being employees (aPR: 0.86, 95% CI: 0.76-0.96 or self-employed (aPR: 0.86, 95% CI: 0.76-0.97 vs. working in agriculture and/or fishing negatively associated with anemia among urban children. This marked urban-rural variation indicates the

  3. Peer mentoring supports the learning needs of nurses providing palliative care in a rural acute care setting.

    Science.gov (United States)

    Rabbetts, Lyn

    2017-06-02

    A specific set of assessment scales can underpin the management of distressing symptoms of patients requiring palliative care. A research assistant supported nurses working in a rural hospital setting during the introduction of these scales. A secondary analysis was conducted to further explore the qualitative data of a previously reported mixed-method study. In particular, the experiences of nurses working alongside a research assistant in the facilitation of using a new assessment form. Purposeful sampling was employed: participating nurses were invited to attend one of three focus group meetings. Data analysis revealed three main themes: a contact person, coach/mentor and extra help initiatives. Three to four subthemes corresponded with each main theme. Findings suggest nurses benefit from having someone to assist in learning about new documentation. Nurses respond positively to mentorship and practical guidance when integrating a new assessment form into routine evidence-based practice.

  4. Understanding Healthcare Workers Self-Reported Practices, Knowledge and Attitude about Hand Hygiene in a Medical Setting in Rural India.

    Science.gov (United States)

    Diwan, Vishal; Gustafsson, Charlotte; Rosales Klintz, Senia; Joshi, Sudhir Chandra; Joshi, Rita; Sharma, Megha; Shah, Harshada; Pathak, Ashish; Tamhankar, Ashok J; Stålsby Lundborg, Cecilia

    2016-01-01

    To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to 'always' practice hand hygiene in the selected situations varied from 40-96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers' knowledge and understanding regarding the importance of persistent practice in all situations.

  5. Exploring training needs of nursing staff in rural Cretan primary care settings.

    Science.gov (United States)

    Markaki, Adelais; Alegakis, Athanasios; Antonakis, Nikos; Kalokerinou-Anagnostopoulou, Athena; Lionis, Christos

    2009-05-01

    The purpose of this exploratory study was to assess occupational profile, level of performance, and on-the-job training needs of nursing staff employed in all government primary health care centers in rural Crete, Greece. The translated, culturally adapted, and validated Greek version of the Training Needs Assessment questionnaire was used. There were no significant differences between 2-year degree graduates (LPNs) and 3- or 4-year degree graduates (RNs, midwives, and health visitors) in terms of importance for 28 of 30 assigned tasks, whereas level of performance did not differ in any tasks. Significant training needs were reported by all staff, mainly in research/audit and clinical skills. Systematic overview of skill deficits in relation to skill requirements should be implemented by regional health authorities to enhance delivery of on-the-job training targeting group-specific, local needs.

  6. A 10-year cohort analysis of routine paediatric ART data in a rural South African setting.

    Science.gov (United States)

    Lilian, R R; Mutasa, B; Railton, J; Mongwe, W; McINTYRE, J A; Struthers, H E; Peters, R P H

    2017-01-01

    South Africa's paediatric antiretroviral therapy (ART) programme is managed using a monitoring and evaluation tool known as TIER.Net. This electronic system has several advantages over paper-based systems, allowing profiling of the paediatric ART programme over time. We analysed anonymized TIER.Net data for HIV-infected children aged ART in a rural district of South Africa between 2005 and 2014. We performed Kaplan-Meier survival analysis to assess outcomes over time. Records of 5461 children were available for analysis; 3593 (66%) children were retained in care. Losses from the programme were higher in children initiated on treatment in more recent years (P ART programme and highlights interventions to improve programme performance.

  7. Prevalence of pregnancy-relevant infections in a rural setting of Ghana.

    Science.gov (United States)

    Völker, Fabian; Cooper, Paul; Bader, Oliver; Uy, Angela; Zimmermann, Ortrud; Lugert, Raimond; Groß, Uwe

    2017-06-06

    Although infectious diseases still account for a high burden of morbidity and mortality in sub-Saharan Africa, simultaneous investigations on multiple infections affecting maternal and child health are missing. We conducted a cross-sectional, single-centre pilot study in a rural area of Ghana to assess the infectiological profile during pregnancy. Screening of 180 expectant mothers was done by vaginal swabs and serology to detect the most common pregnancy-relevant infections. They were also interviewed for potential risk factors, outcome of previous pregnancies, and socio-economic aspects. We found a high prevalence of infections caused by hepatitis B virus (16.7% HBs antigen positive). In contrast, infections caused by hepatitis C virus (1.1% anti-HCV) and HIV (0.6%) were rare. Maternal malaria was frequent (10.6%), despite increasing acceptance of intermittent preventive treatment during pregnancy (IPTp). Group B streptococci were present in 10.6% of all pregnant women. Absence of antibodies against varicella zoster virus in 43.2%, Toxoplasma gondii in 26.8%, parvovirus B19 in 20.0%, and rubella virus in 15.7% makes a significant proportion of pregnant women susceptible for acquiring primary infections. Whereas all study participants had specific IgG antibodies against human cytomegalovirus, infections with Listeria, Brucella, or Neisseria gonorrhoeae as well as active syphilis were absent. Our pilot study in a rural community in Ghana indicates an urgent need for action in dealing at least with high-prevalent pregnancy-relevant infections, such as hepatitis B, malaria and those caused by group B streptococci. In addition, the resulting prevalence rates of various other infections may offer guidance for health officials to prioritize possible future intervention schemes.

  8. Teaching and sustainably implementing awake craniotomy in resource-poor settings.

    Science.gov (United States)

    Howe, Kathryn L; Zhou, Guosheng; July, Julius; Totimeh, Teddy; Dakurah, Thomas; Malomo, Adefolarin O; Mahmud, Muhammad R; Ismail, Nasiru J; Bernstein, Mark A

    2013-12-01

    Awake craniotomy for brain tumor resection has the benefit of avoiding a general anesthetic and decreasing associated costs (e.g., intensive care unit beds and intravenous line insertion). In low- and middle-income countries, significant resource limitations for the system and individual make awake craniotomy an ideal tool, yet it is infrequently used. We sought to determine if awake craniotomy could be effectively taught and implemented safely and sustainably in low- and middle-income countries. A neurosurgeon experienced in the procedure taught awake craniotomy to colleagues in China, Indonesia, Ghana, and Nigeria during the period 2007-2012. Patients were selected on the basis of suspected intraaxial tumor, absence of major dysphasia or confusion, and ability to tolerate the positioning. Data were recorded by the local surgeons and included preoperative imaging, length of hospital admission, final pathology, postoperative morbidity, and mortality. Awake craniotomy was performed for 38 cases of suspected brain tumor; most procedures were completed independently. All patients underwent preoperative computed tomography or magnetic resonance imaging. In 64% of cases, patients remained in the hospital Awake craniotomy was successfully taught and implemented in 6 neurosurgical centers in China, Indonesia, Ghana, and Nigeria. Awake craniotomy is safe, resource-sparing, and sustainable. The data suggest awake craniotomy has the potential to significantly improve access to neurosurgical care in resource-challenged settings. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Dressing-related trauma: clinical sequelae and resource utilization in a UK setting

    Directory of Open Access Journals (Sweden)

    Charlesworth B

    2014-04-01

    Full Text Available Bruce Charlesworth,1 Claire Pilling,1 Paul Chadwick,2 Martyn Butcher31Adelphi Values, Macclesfield, 2Salford Royal Foundation Trust, Salford, 3Northern Devon Healthcare Trust, Devon, UKBackground: Dressings are the mainstay of wound care management; however, adherence of the dressing to the wound or periwound skin is common and can lead to dressing-related pain and trauma. Dressing-related trauma is recognized as a clinical and economic burden to patients and health care providers. This study was conducted to garner expert opinion on clinical sequelae and resource use associated with dressing-related trauma in a UK setting.Methods: This was an exploratory study with two phases: qualitative pilot interviews with six wound care specialists to explore dressing-related trauma concepts, sequelae, and resource utilization; and online quantitative research with 30 wound care specialists to validate and quantify the concepts, sequelae, and resource utilization explored in the first phase of the study. Data were collected on mean health care professional time, material costs, pharmaceutical costs, and inpatient management per sequela occurrence until resolution. Data were analyzed to give total costs per sequela and concept occurrence.Results: The results demonstrate that dressing-related trauma is a clinically relevant concept. The main types of dressing-related trauma concepts included skin reactions, adherence to the wound, skin stripping, maceration, drying, and plugging of the wound. These were the foundation for a number of clinical sequelae, including wound enlargement, increased exudate, bleeding, infection, pain, itching/excoriation, edema, dermatitis, inflammation, and anxiety. Mean total costs range from £56 to £175 for the complete onward management of each occurrence of the six main concepts.Conclusion: These results provide insight into the hidden costs of dressing-related trauma in a UK setting. This research successfully conceptualized

  10. Engineering bacteriophage for a pragmatic low-resource setting bacterial diagnostic platform.

    Science.gov (United States)

    Talbert, Joey N; Alcaine, Samuel D; Nugen, Sam R

    2016-04-01

    Bacteriophages represent multifaceted building blocks that can be incorporated as substitutes for, or in unison with other detection methods, to create powerful new diagnostics for the detection of bacteria. The ease of phage manipulation, production, and detection speed clearly highlights that there remains unrealized opportunities to leverage these phage-based components in diagnostics amenable to resource-limited settings. The passage of regulations like the Food Safety Modernization act, and the ever increasing extent of global trade and travel, will create further demand for these types of diagnostics. While phage-based diagnostics have begun to entering the market place, further research is needed to ensure the potential benefits of phage-based technologies for public health are fully realized. We are just beginning to explore the possibilities that phage-based detection can offer us in the future. The combination of engineered phages as well as engineered enzymes could result in ultrasensitive detection systems for low-resource settings. Because the reporter enzyme is synthesized in vivo, we need to consider the options outside of normal enzyme reporters. In this case, common enzyme issues such as purification and long-term stability are less important. Phage-based diagnostics were conceptualized from out-of-the box thinking and the evolution of these systems should be as well.

  11. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    Science.gov (United States)

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  12. Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

    Science.gov (United States)

    Kandil, Mohamed; Sanad, Zakaria; Gaber, Wael

    2014-04-01

    To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

  13. Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition.

    Science.gov (United States)

    Riviello, Elisabeth D; Buregeya, Egide; Twagirumugabe, Theogene

    2017-02-01

    The acute respiratory distress syndrome (ARDS) was re-defined by a panel of experts in Berlin in 2012. Although the Berlin criteria improved upon the validity and reliability of the definition, it did not make diagnosis of ARDS in resource limited settings possible. Mechanical ventilation, arterial blood gas measurements, and chest radiographs are not feasible in many regions of the world. In 2014, we proposed and applied the Kigali modification of the Berlin definition in a hospital in Rwanda. This review synthesizes literature from the last 18 months relevant to the Kigali modification. In the last 18 months, the need for a universally applicable ARDS definition was reinforced by advances in supportive care that can be implemented in resource poor settings. Research demonstrating the variable impact of positive end expiratory pressure on hypoxemia, the validity of using pulse oximetry rather than arterial blood gas to categorize hypoxemia, and the accuracy of lung ultrasound support the use of the Kigali modification of the Berlin definition. Studies directly comparing the Berlin definition to the Kigali modification are needed. Ongoing clinical research on ARDS needs to include low-income countries.

  14. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

    Science.gov (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

    2018-01-01

    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  15. Autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Jama, Ngcwalisa Amanda; Wilford, Aurene; Haskins, Lyn; Coutsoudis, Anna; Spies, Lenore; Horwood, Christiane

    2018-02-17

    The nutritional status of infants born to teenage mothers can be sub-optimal compared to those born to older mothers. One contributing factor is inappropriate feeding practices adopted by teenage mothers. Little is known about how infant feeding decisions are made among teenage mothers, particularly in under resourced settings. In this study we prospectively explored autonomy and infant feeding decision-making among teenage mothers in a rural and urban setting in KwaZulu-Natal, South Africa. This study adopted a qualitative longitudinal design. Thirty pregnant participants were recruited to the study cohort, from the catchment area of two hospitals (one urban and one rural). Participants were purposively selected to include teenagers, HIV positive, and working pregnant women. We report findings from ten teenage mothers, aged between 15 and 19 years, who participated in the larger cohort (n = 5 rural; n = 5 urban). Monthly in-depth interviews were conducted with participating mothers for 6 months starting 2 weeks after delivery. All interviews were conducted in the local language, transcribed verbatim and translated into English. Data was coded using NVivo v10 and framework analysis was used. Findings from this study showed that teenage mothers had knowledge about recommended feeding practices. However, our findings suggest that these mothers were not involved in infant feeding decisions once they were at home, because infant feeding decision-making was a role largely assumed by older mothers in the family. Further, the age of the mother and financial dependency diminished her autonomy and ability to influence feeding practices or challenge incorrect advice given at home. Most feeding advice shared by family members was inappropriate, leading to poor infant feeding practices among teenage mothers. Returning to school and fear of breastfeeding in public were also barriers to exclusive breastfeeding. Teenage mothers had a limited role in the infant feeding

  16. Tele-cytology: An innovative approach for cervical cancer screening in resource-poor settings.

    Science.gov (United States)

    Singh, Sandeep; Badaya, Sorabh

    2016-01-01

    Carcinoma cervix remains a leading cause of cancer mortality among women in countries lacking any screening program. The existing screening policy and approach via conventional cytology centered mainly in Tertiary Care Center, is totally unaffordable to Indian women, especially in the remote areas. This suggests the need of depolarizing the resources via generating the near real time modalities which could be used at the door step of the needy ones. For any screening modality to be effective it should be adequately sensitive, specific, reproducible, cheap, simple, affordable, and the most important is should be real time to ensure wide coverage and curtail loss to follow-up. Incorporating telecytology as a screening tool could make the dream come true. Telecytology is the interpretation of cytology material at a distance using digital images. Use of mobile telecytology unit housed in a van carrying satellite equipment and the automated image capturing systems is the central theme behind this idea. The imaging equipment would be carrying out the imaging of Papanicolaou smears prepared at the screening site and sending the images to the central laboratories situated at some tertiary care level. This concept could overcome the hindrance of trained cytology infrastructure in the resource poor settings and could provide an efficient and economical way of screening patients. There is possibility that the designed approach may not detect the entire women positive for the disease but if the desired objective was to diagnose as many cases as possible in resource poor setting, then this process offers an advantage over no screening at all.

  17. Randomized trial of plastic bags to prevent term neonatal hypothermia in a resource-poor setting.

    Science.gov (United States)

    Belsches, Theodore C; Tilly, Alyssa E; Miller, Tonya R; Kambeyanda, Rohan H; Leadford, Alicia; Manasyan, Albert; Chomba, Elwyn; Ramani, Manimaran; Ambalavanan, Namasivayam; Carlo, Waldemar A

    2013-09-01

    Term infants in resource-poor settings frequently develop hypothermia during the first hours after birth. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in preterm and low birth weight infants that may also be effective in term infants. Our objective was to test the hypothesis that placement of term neonates in plastic bags at birth reduces hypothermia at 1 hour after birth in a resource-poor hospital. This parallel-group randomized controlled trial was conducted at University Teaching Hospital, the tertiary referral center in Zambia. Inborn neonates with both a gestational age ≥37 weeks and a birth weight ≥2500 g were randomized 1:1 to either a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a plastic bag within 10 minutes after birth. The primary outcome was hypothermia (plastic bag (n = 135) or to standard thermoregulation care (n = 136) had similar baseline characteristics (birth weight, gestational age, gender, and baseline temperature). Neonates in the plastic bag group had a lower rate of hypothermia (60% vs 73%, risk ratio 0.76, confidence interval 0.60-0.96, P = .026) and a higher axillary temperature (36.4 ± 0.5°C vs 36.2 ± 0.7°C, P plastic bag at birth reduced the incidence of hypothermia at 1 hour after birth in term neonates born in a resource-poor setting, but most neonates remained hypothermic.

  18. A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa.

    Science.gov (United States)

    Murphy, Gail Tomblin; Goma, Fastone; MacKenzie, Adrian; Bradish, Stephanie; Price, Sheri; Nzala, Selestine; Rose, Annette Elliott; Rigby, Janet; Muzongwe, Chilweza; Chizuni, Nellisiwe; Carey, Amanda; Hamavhwa, Derrick

    2014-12-16

    Most African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries' abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa. Fourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria. There was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents. The lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for

  19. African Swine Fever in Uganda: Qualitative Evaluation of Three Surveillance Methods with Implications for Other Resource-Poor Settings.

    Science.gov (United States)

    Chenais, Erika; Sternberg-Lewerin, Susanna; Boqvist, Sofia; Emanuelson, Ulf; Aliro, Tonny; Tejler, Emma; Cocca, Giampaolo; Masembe, Charles; Ståhl, Karl

    2015-01-01

    Animal diseases impact negatively on households and on national economies. In low-income countries, this pertains especially to socio-economic effects on household level. To control animal diseases and mitigate their impact, it is necessary to understand the epidemiology of the disease in its local context. Such understanding, gained through disease surveillance, is often lacking in resource-poor settings. Alternative surveillance methods have been developed to overcome some of the hurdles obstructing surveillance. The objective of this study was to evaluate and qualitatively compare three methods for surveillance of acute infectious diseases using African swine fever in northern Uganda as an example. Report-driven outbreak investigations, participatory rural appraisals (PRAs), and a household survey using a smartphone application were evaluated. All three methods had good disease-detecting capacity, and each of them detected many more outbreaks compared to those reported to the World Organization for Animal Health during the same time period. Apparent mortality rates were similar for the three methods although highest for the report-driven outbreak investigations, followed by the PRAs, and then the household survey. The three methods have different characteristics and the method of choice will depend on the surveillance objective. The optimal situation might be achieved by a combination of the methods: outbreak detection via smartphone-based real-time surveillance, outbreak investigation for collection of biological samples, and a PRA for a better understanding of the epidemiology of the specific outbreak. All three methods require initial investments and continuous efforts. The sustainability of the surveillance system should, therefore, be carefully evaluated before making such investments.

  20. African swine fever in Uganda: qualitative evaluation of three surveillance methods with implications for other resource-poor settings

    Directory of Open Access Journals (Sweden)

    Erika eChenais

    2015-10-01

    Full Text Available Animal diseases impact negatively on households and on national economies. In low-income countries this pertains especially to socio-economic effects on household level. To control animal diseases and mitigate their impact, it is necessary to understand the epidemiology of the disease in its local context. Such understanding, gained through disease surveillance, is often lacking in resource-poor settings. Alternative surveillance methods have been developed to overcome some of the hurdles obstructing surveillance. The objective of this study was to evaluate and qualitatively compare three methods for surveillance of acute infectious diseases using African swine fever (ASF in northern Uganda as an example. Report-driven outbreak investigations, participatory rural appraisals (PRA, and a household survey using a smartphone application were evaluated. All three methods had good disease-detecting capacity, each of them detected many more outbreaks compared to those reported to the World Organization for Animal Health (OIE during the same time period. Apparent mortality rates were similar for the three methods although highest for the report-driven outbreak investigations, followed by the PRAs, and then the household survey. The three methods have different characteristics and the method of choice will depend on the surveillance objective. The optimal situation might be achieved by a combination of the methods: outbreak detection via smartphone-based real-time surveillance, outbreak investigation for collection of biological samples, and a PRA for a better understanding of the epidemiology of the specific outbreak. All three methods require initial investments and continuous efforts. The sustainability of the surveillance system should therefore be carefully evaluated before making such investments.

  1. Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings.

    Science.gov (United States)

    Lang, Danielle L; Zhao, Fei-Li; Robertson, Jane

    2015-11-23

    While inferior to oxytocin injection in both efficacy and safety, orally administered misoprostol has been included in the World Health Organization Model List of Essential Medicines for use in the prevention of postpartum haemorrhage (PPH) in low-resource settings. This study evaluates the costs and health outcomes of use of oral misoprostol to prevent PPH in settings where injectable uterotonics are not available. A cost-consequences analysis was conducted from the international health system perspective, using data from a recent Cochrane systematic review and WHO's Mother-Baby Package Costing Spreadsheet in a hypothetical cohort of 1000 births in a mixed hospital (40% births)/community setting (60% births). Costs were estimated based on 2012 US dollars. Using oxytocin in the hospital setting and misoprostol in the community setting in a cohort of 1000 births, instead of oxytocin (hospital setting) and no treatment (community setting), 22 cases of PPH could be prevented. Six fewer women would require additional uterotonics and four fewer women a blood transfusion. An additional 130 women would experience shivering and an extra 42 women fever. Oxytocin/misoprostol was found to be cost saving (US$320) compared to oxytocin/no treatment. If misoprostol is used in both the hospital and community setting compared with no treatment (i.e. oxytocin not available in the hospital setting), 37 cases of PPH could be prevented; ten fewer women would require additional uterotonics; and six fewer women a blood transfusion. An additional 217 women would experience shivering and 70 fever. The cost savings would be US$533. Sensitivity analyses indicate that the results are sensitive to the incidence of PPH-related outcomes, drug costs and the proportion of hospital births. Our findings confirm that, even though misoprostol is not the optimum choice in the prevention of PPH, misoprostol could be an effective and cost-saving choice where oxytocin is not or cannot be used due to a

  2. Seasonal household income dependency on forest and environmental resources in rural Mozambique

    DEFF Research Database (Denmark)

    Walelign, Solomon Zena; Nielsen, Øystein Juul

    2013-01-01

    Households in agrarian societies engage in variety of income generating activities. These activities are often seasonal and the associated income generated is volatile. Based on an income survey from 2006 in rural Mozambique, this study assesses the seasonal contribution of different income sources....... The volatility did vary across income sources; crop income seems the most volatile income component. Volatility in crop income is likely to have severe negative implications for rural households as poverty is widespread and other income opportunities are few. Therefore, the government and other developments...

  3. Estimating health workforce needs for antiretroviral therapy in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Fullem Andrew

    2006-01-01

    Full Text Available Abstract Background Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART, for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. Methods We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. Results We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, Discussion These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

  4. Building sustainable organizational capacity to deliver HIV programs in resource-constrained settings: stakeholder perspectives.

    Science.gov (United States)

    Sharma, Anjali; Chiliade, Philippe; Michael Reyes, E; Thomas, Kate K; Collens, Stephen R; Rafael Morales, José

    2013-12-13

    In 2008, the US government mandated that HIV/AIDS care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) should shift from US-based international partners (IPs) to registered locally owned organizations (local partners, or LPs). The US Health Resources and Services Administration (HRSA) developed the Clinical Assessment for Systems Strengthening (ClASS) framework for technical assistance in resource-constrained settings. The ClASS framework involves all stakeholders in the identification of LPs' strengths and needs for technical assistance. This article examines the role of ClASS in building capacity of LPs that can endure and adapt to changing financial and policy environments. All stakeholders (n=68) in Kenya, Zambia, and Nigeria who had participated in the ClASS from LPs and IPs, the US Centers for Disease Control and Prevention (CDC), and, in Nigeria, HIV/AIDS treatment facilities (TFs) were interviewed individually or in groups (n=42) using an open-ended interview guide. Thematic analysis revealed stakeholder perspectives on ClASS-initiated changes and their sustainability. Local organizations were motivated to make changes in internal operations with the ClASS approach, PEPFAR's competitive funding climate, organizational goals, and desired patient health outcomes. Local organizations drew on internal resources and, if needed, technical assistance from IPs. Reportedly, ClASS-initiated changes and remedial action plans made LPs more competitive for PEPFAR funding. LPs also attributed their successful funding applications to their preexisting systems and reputation. Bureaucracy, complex and competing tasks, and staff attrition impeded progress toward the desired changes. Although CDC continues to provide technical assistance through IPs, declining PEPFAR funds threaten the consolidation of gains, smooth program transition, and continuity of treatment services. The well-timed adaptation and implementation of Cl

  5. Stress Testing Water Resource Systems at Regional and National Scales with Synthetic Drought Event Sets

    Science.gov (United States)

    Hall, J. W.; Mortazavi-Naeini, M.; Coxon, G.; Guillod, B. P.; Allen, M. R.

    2017-12-01

    Water resources systems can fail to deliver the services required by water users (and deprive the environment of flow requirements) in many different ways. In an attempt to make systems more resilient, they have also been made more complex, for example through a growing number of large-scale transfers, optimized storages and reuse plants. These systems may be vulnerable to complex variants of hydrological variability in space and time, and behavioural adaptations by water users. In previous research we have used non-parametric stochastic streamflow generators to test the vulnerability of water resource systems. Here we use a very large ensemble of regional climate model outputs from the weather@home crowd-sourced citizen science project, which has generated more than 30,000 years of synthetic weather for present and future climates in the UK and western Europe, using the HadAM3P regional climate model. These simulations have been constructed in order to preserve prolonged drought characteristics, through treatment of long-memory processes in ocean circulations and soil moisture. The weather simulations have been propagated through the newly developed DynaTOP national hydrological for Britain, in order to provide low flow simulations at points of water withdrawal for public water supply, energy and agricultural abstractors. We have used the WATHNET water resource simulation model, set up for the Thames Basin and for all of the large water resource zones in England, to simulate the frequency, severity and duration of water shortages in all of these synthetic weather conditions. In particular, we have sought to explore systemic vulnerabilities associated with inter-basin transfers and the trade-offs between different water users. This analytical capability is providing the basis for (i) implementation of the Duty of Resilience, which has been placed upon the water industry in the 2014 Water Act and (ii) testing reformed abstraction arrangements which the UK government

  6. Assessing patterns and determinants of latrine use in rural settings: A longitudinal study in Odisha, India.

    Science.gov (United States)

    Sinha, Antara; Nagel, Corey L; Schmidt, Wolf P; Torondel, Belen; Boisson, Sophie; Routray, Parimita; Clasen, Thomas F

    2017-07-01

    Monitoring of sanitation programs is often limited to sanitation access and coverage, with little emphasis on use of the facilities despite increasing evidence of widespread non-use. We assessed patterns and determinants of individual latrine use over 12 months in a low- income rural study population that had recently received latrines as part of the Government of India's Total Sanitation Campaign (TSC) in coastal Puri district in Odisha, India. We surveyed 1938 individuals (>3years) in 310 rural households with latrines from 25 villages over 12 months. Data collection rounds were timed to correspond with the seasons. The primary outcome was reported use by each member of the household over the prior 48h. We classified use into three categories-"never", "sometimes" and "always/usually". We also assessed consistency of use over six days across the three seasons (dry cold, dry hot, rainy). We explored the association between individual and household-level variables and latrine use in any given season and longitudinally using multinomial logistic regression. We also inquired about reasons for non-use. Overall, latrine use was poor and inconsistent. The average response probability at any given round of never use was 43.5% (95% CI=37.9, 49.1), sometimes use was 4.6% (95% CI=3.8, 5.5), and always/usual use was 51.9% (95% CI=46.2, 57.5). Only two-thirds of those who reported always/usually using a latrine in round one reported the same for all three rounds. Across all three rounds, the study population was about equally divided among those who reported never using the latrine (30.1%, 95% CI=23.0, 37.2), sometimes using the latrine (33.2%, 95% CI=28.3, 38.1) and always/usually using the latrine (36.8%, 95% CI=31.8, 41.8). The reported likelihood of always/usually versus never using the latrine was significantly greater in the dry cold season (OR=1.50, 95% CI=1.18, 1.89, p=0.001) and in the rainy season (OR=1.34, 95% CI=1.07, 1.69, p=0.012), than in the dry hot season

  7. Community-based interventions to optimize early childhood development in low resource settings.

    Science.gov (United States)

    Maulik, P K; Darmstadt, G L

    2009-08-01

    Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments. PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling. Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions. Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.

  8. Business incomes in rural Nicaragua: the role of household resources, location, experience and trust

    NARCIS (Netherlands)

    Haese, D' M.F.C.; Ruijter de Wildt, de M.J.M.; Ruben, R.

    2008-01-01

    This paper analyses the determinants of business income for rural households in Nicaragua. A sample of 1030 households was studied in order to assess the importance of material and behavioural factors that influence income from business activity. The households are involved in manufacturing, trade,

  9. An Intelligent Approach to Strengthening of the Rural Electrical Power Supply Using Renewable Energy Resources

    Science.gov (United States)

    Robert, F. C.; Sisodia, G. S.; Gopalan, S.

    2017-08-01

    The healthy growth of economy lies in the balance between rural and urban development. Several developing countries have achieved a successful growth of urban areas, yet rural infrastructure has been neglected until recently. The rural electrical grids are weak with heavy losses and low capacity. Renewable energy represents an efficient way to generate electricity locally. However, the renewable energy generation may be limited by the low grid capacity. The current solutions focus on grid reinforcement only. This article presents a model for improving renewable energy integration in rural grids with the intelligent combination of three strategies: 1) grid reinforcement, 2) use of storage and 3) renewable energy curtailments. Such approach provides a solution to integrate a maximum of renewable energy generation on low capacity grids while minimising project cost and increasing the percentage of utilisation of assets. The test cases show that a grid connection agreement and a main inverter sized at 60 kW (resp. 80 kW) can accommodate a 100 kWp solar park (resp. 100 kW wind turbine) with minimal storage.

  10. Galvanizing Local Resources: A Strategy for Sustainable Development in Rural China

    Science.gov (United States)

    Cho, Eun Ji

    2014-01-01

    China has been undergoing a rapid development over the past decades, and rural areas are facing a number of challenges in the process of the change. The "New Channel" project, initiated to promote sustainable development and protect natural and cultural heritage in Tongdao county in China from a rapid urbanization and economic…

  11. The Learning Projects of Rural Third Age Women: Enriching a Valuable Community Resource

    Science.gov (United States)

    Lear, Glenna

    2011-01-01

    As a third age PhD candidate with a passion for learning, I wanted to explore the learning of other rural third age women who live on the Lower Eyre Peninsula (LEP) of South Australia. This reflects the methodological stance of heuristic inquiry, which requires the researcher to have a passionate interest in the phenomena under investigation, and…

  12. Concussion Law Compliance: The Allocation of Time, Resources, and Money in a Rural Western State

    Science.gov (United States)

    Faure, Caroline; Moffit, Dani M.; Schiess, Kurt

    2015-01-01

    Secondary schools across the United States that sponsor extracurricular athletic programs are challenged to comply with recent laws that require concussion education and appropriate concussion management. This study examined one rural state's efforts by illustrating both the successes and challenges that secondary schools faced. The findings…

  13. Essays on Women’s Bargaining Power and Intra-household Resource in Rural Ethiopia

    NARCIS (Netherlands)

    B.B. Dito

    2011-01-01

    textabstractxv Abstract This thesis investigates the effect of a woman’s bargaining power on her welfare and that of her children in rural Ethiopia. The issue is of particular concern because, as empirical evidence shows, intra-household inequalities in welfare are frequently the direct

  14. Seeking surprise : rethinking monitoring for collective learning in rural resource management

    NARCIS (Netherlands)

    Guijt, I.M.

    2008-01-01

    Commonsense says that monitoring systems should be able to provide feedback that can help correct ineffective actions. But practice shows that when dealing with complex rural development issues that involve collaborative action by a changing configuration of stakeholders, monitoring practice often

  15. Institutional Innovation for Sustainable Agriculture and Rural Resources Management: Changing the rules of the game

    NARCIS (Netherlands)

    Santamaria Guerra, J.

    2003-01-01

    This study was carried out to critically examine the state of the art of institutional innovation and to identify the theories of action informing it in rural research and development (R&D) organisations.The study was carried out in three cases. The selected case studies are different in their

  16. Improving food security? Setting indicators and observing change of rural household in Central Sulawesi

    Directory of Open Access Journals (Sweden)

    Stephan Klasen

    2017-11-01

    Full Text Available Household food security is a critical issue for Indonesia, which is investigated in this study. Many of rural household in Indonesia depends on agricultural sectors and facing challenges of global warming that threatening food security and poverty alleviation in the country. We use panel data at the household level for a sample of households living in Central Sulawesi at the rainforest margin in Indonesia. For the purpose of this study, we apply principal component analysis to develop an indicator of food security and used the index in determining the household’s condition to be persistent food secure or insecure. The findings present the fact that over the period the household’s food security in the study area has changed to better food condition. The number of people who are food insecure has declined by 23.73 % over the year. However, the results suggest that public services on health, education and infrastructure need to be strengthened, investments in access to credit and off-farm employment policies, as well as insurance programs on social protection and disaster management, need to be developed.

  17. Field Testing of Alternative Cookstove Performance in a Rural Setting of Western India

    Directory of Open Access Journals (Sweden)

    Veena Muralidharan

    2015-02-01

    Full Text Available Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs that are aimed at reducing emissions and fuel consumption. Here, we tested a traditional clay chulha cookstove (TCS and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1 and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL, in a test kitchen in a rural village of western India. Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5 and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%, which persisted after normalization for fuel consumption or useful energy. PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization (ACSs: 277–714 μg/m3 or 11–28 fold higher than the WHO recommendation of 25 μg/m3.

  18. How to Set Up a Research Framework to Analyze Social-Ecological Interactive Processes in a Rural Landscape

    Directory of Open Access Journals (Sweden)

    Marc Deconchat

    2007-06-01

    Full Text Available Interdisciplinary research frameworks can be useful in providing answers to the environmental challenges facing rural environments, but concrete implementation of them remains empirical and requires better control. We present our practical experience of an interdisciplinary research project dealing with non-industrial private forestry in rural landscapes. The theoretical background, management, and methodological aspects, as well as results of the project, are presented in order to identify practical key factors that may influence its outcomes. Landscape ecology plays a central role in organizing the project. The efforts allocated for communication between scientists from different disciplines must be clearly stated in order to earn reciprocal trust. Sharing the same nested sampling areas, common approaches, and analytical tools (GIS is important, but has to be balanced by autonomy for actual implementation of field work and data analysis in a modular and evolving framework. Data sets are at the heart of the collaboration and GIS is necessary to ensure their long-term management and sharing. The experience acquired from practical development of such projects should be shared more often in networks of teams to compare their behavior and identify common rules of functioning.

  19. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

    Science.gov (United States)

    Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

    2008-05-01

    Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

  20. ICTs as Placed Resources in a Rural Kenyan Secondary School Journalism Club

    Science.gov (United States)

    Kendrick, Maureen; Chemjor, Walter; Early, Margaret

    2012-01-01

    In this study, we draw on three interrelated concepts, i.e. placed resources, multiliteracies and the carnivalesque, to understand how information and communication technology (ICT) resources are taken up within the context of a print-based journalism club. Our research participants attend an under-resourced girls' residential secondary school in…

  1. Panic disorder in rural Tanzania: an explorative study | Nordgreen ...

    African Journals Online (AJOL)

    ... patients as especially useful. Conclusion: A manual for brief interventions for PD may be adapted to a rural Tanzanian setting, also taking into consideration the limited financial and human resources in a rural low-income country setting. Keywords: Panic disorder; Culture; Cognitive behaviour therapy; Low-income country ...

  2. Chinese Gini Coefficient from 2005 to 2012, Based on 20 Grouped Income Data Sets of Urban and Rural Residents

    Directory of Open Access Journals (Sweden)

    Jiandong Chen

    2015-01-01

    Full Text Available Data insufficiency has become the primary factor affecting research on income disparity in China. To resolve this issue, this paper explores Chinese income distribution and income inequality using distribution functions. First, it examines 20 sets of grouped data on family income between 2005 and 2012 by the China Yearbook of Household Surveys, 2013, and compares the fitting effects of eight distribution functions. The results show that the generalized beta distribution of the second kind has a high fitting to the income distribution of urban and rural residents in China. Next, these results are used to calculate the Chinese Gini ratio, which is then compared with the findings of relevant studies. Finally, this paper discusses the influence of urbanization on income inequality in China and suggests that accelerating urbanization can play an important role in narrowing the income gap of Chinese residents.

  3. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

    Science.gov (United States)

    Kwast, B E

    1996-10-01

    The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality.

  4. Evaluation of Community Care Network (CCN) system in a rural health care setting.

    Science.gov (United States)

    Galfalvy, H C; Reddy, S M; Niewiadomska-Bugaj, M; Friedman, S; Merkin, B

    1995-01-01

    Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.

  5. saltPAD: A New Analytical Tool for Monitoring Salt Iodization in Low Resource Settings

    Directory of Open Access Journals (Sweden)

    Nicholas M. Myers

    2016-03-01

    Full Text Available We created a paper test card that measures a common iodizing agent, iodate, in salt. To test the analytical metrics, usability, and robustness of the paper test card when it is used in low resource settings, the South African Medical Research Council and GroundWork performed independ‐ ent validation studies of the device. The accuracy and precision metrics from both studies were comparable. In the SAMRC study, more than 90% of the test results (n=1704 were correctly classified as corresponding to adequately or inadequately iodized salt. The cards are suitable for market and household surveys to determine whether salt is adequately iodized. Further development of the cards will improve their utility for monitoring salt iodization during production.

  6. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; McNerney, Ruth

    2014-06-01

    Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

  7. Evaluation of a Low-Cost Bubble CPAP System Designed for Resource-Limited Settings.

    Science.gov (United States)

    Bennett, Desmond J; Carroll, Ryan W; Kacmarek, Robert M

    2018-04-01

    Respiratory compromise is a leading contributor to global neonatal death. CPAP is a method of treatment that helps maintain lung volume during expiration, promotes comfortable breathing, and improves oxygenation. Bubble CPAP is an effective alternative to standard CPAP. We sought to determine the reliability and functionality of a low-cost bubble CPAP device designed for low-resource settings. The low-cost bubble CPAP device was compared to a commercially available bubble CPAP system. The devices were connected to a lung simulator that simulated neonates of 4 different weights with compromised respiratory mechanics (∼1, ∼3, ∼5, and ∼10 kg). The devices' abilities to establish and maintain pressure and flow under normal conditions as well as under conditions of leak were compared. Multiple combinations of pressure levels (5, 8, and 10 cm H 2 O) and flow levels (3, 6, and 10 L/min) were tested. The endurance of both devices was also tested by running the systems continuously for 8 h and measuring the changes in pressure and flow. Both devices performed equivalently during the no-leak and leak trials. While our testing revealed individual differences that were statistically significant and clinically important (>10% difference) within specific CPAP and flow-level settings, no overall comparisons of CPAP or flow were both statistically significant and clinically important. Each device delivered pressures similar to the desired pressures, although the flows delivered by both machines were lower than the set flows in most trials. During the endurance trials, the low-cost device was marginally better at maintaining pressure, while the commercially available device was better at maintaining flow. The low-cost bubble CPAP device evaluated in this study is comparable to a bubble CPAP system used in developed settings. Extensive clinical trials, however, are necessary to confirm its effectiveness. Copyright © 2018 by Daedalus Enterprises.

  8. Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals.

    Science.gov (United States)

    Tilahun, Binyam; Fritz, Fleur

    2015-08-01

    With the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings. A quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects. The findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P quality has significant influence on EMR use (β = 0.44, P service quality has strong significant influence on EMR use (β = 0.36, P effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P mediating factor in the relationship between service quality and EMR use (P effect on perceived net-benefit of health professionals. EMR implementers and managers in developing countries are in urgent need of implementation models to design proper implementation strategies. In this study, the constructs and relationships depicted in the updated D&M model were found to be applicable to assess the success of EMR in low resource settings. Additionally, computer literacy was found to be a mediating factor in EMR use and user satisfaction of

  9. Guidelines for a palliative approach for aged care in the community setting: a suite of resources

    Directory of Open Access Journals (Sweden)

    David C. Currow

    2012-11-01

    Full Text Available AbstractIn Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations

  10. Guidelines for a palliative approach for aged care in the community setting: A suite of resources.

    Science.gov (United States)

    Toye, Christine; Blackwell, Scott; Maher, Sean; Currow, David C; Holloway, Kristi; Tieman, Jennifer; Hegarty, Meg

    2012-01-01

    In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two 'plain English' booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client's deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and

  11. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting.

    Science.gov (United States)

    Scheepers, Renée A; Lases, Lenny S S; Arah, Onyebuchi A; Heineman, Maas Jan; Lombarts, Kiki M J M H

    2017-10-01

    Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.

  12. Access and management of HIV-related diseases in resource-constrained settings: a workshop report.

    Science.gov (United States)

    Dimba, Eao; Yengopal, V; Joshua, E; Thavarajah, R; Balasundaram, S

    2016-04-01

    With advancement of medical interventions, the lifespan of people living with HIV has increased globally. However, low- and middle-income countries (LMICs) which bear the greatest burden of the HIV pandemic face a constant challenge in addressing the treatment needs of immune-suppressed patients. An analysis of the current management protocols and access to medication in resource-poor settings was conducted at this workshop, with emphasis on the situation in resource-poor settings. The participants developed a consensus document based on the need to respond to the constantly changing HIV pandemic. Provision of oral health care must be guided by interconnecting principles based on population based strategies that address upstream determinants of health. Basic oral health coverage in developing countries can only be realized with a strong foundation at the primary health level. Early diagnosis of HIV-related comorbidities including the adverse effects of ARVs is essential for the improvement of treatment outcomes. Standardization of oral health care delivery mechanisms will facilitate evaluation at national and regional levels. Oral health care workers have a moral obligation to participate in sustained campaigns to reduce the social stigma associated with HIV/AIDS in their work places at every stage of the referral chain. Future research also needs to realign itself towards prevention using the common risk factor approach, which has a broader impact on non-communicable diseases, which are increasingly affecting patients with HIV/AIDS as their life expectancies increase. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Leski Tomasz A

    2012-07-01

    Full Text Available Abstract Background Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. Methods A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. Results The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. Conclusions This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting.

  14. Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-06-01

    Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

  15. Prediction of Severe Disease in Children with Diarrhea in a Resource-Limited Setting

    Science.gov (United States)

    Levine, Adam C.; Munyaneza, Richard M.; Glavis-Bloom, Justin; Redditt, Vanessa; Cockrell, Hannah C.; Kalimba, Bantu; Kabemba, Valentin; Musavuli, Juvenal; Gakwerere, Mathias; Umurungi, Jean Paul de Charles; Shah, Sachita P.; Drobac, Peter C.

    2013-01-01

    Objective To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. PMID:24349271

  16. Ethical considerations in HIV prevention and vaccine research in resource-limited settings.

    Science.gov (United States)

    Garner, Samual A; Anude, Chuka J; Adams, Elizabeth; Dawson, Liza

    2014-09-01

    HIV prevention research has been facing increasing ethical and operational challenges. Factors influencing the design and conduct of HIV prevention trials include a rapidly changing evidence base, new biomedical prevention methods and modalities being tested, a large diversity of countries, sites and populations affected by HIV and participating in trials, and challenges of developing and making available products that will be feasible and affordable for at-risk populations. To discuss these challenges, a meeting, Ethical considerations around novel combination prevention modalities in HIV prevention and vaccine trials in resource-limited settings, was convened by NIH/NIAID/Division of AIDS on April 22-23, 2013. Several themes emerged from the meeting: (1) because of both trial design and ethical complexities, choosing prevention packages and designing combination prevention research trials will need to be evaluated on a case by case basis in different clinical trials, countries, and health systems; (2) multilevel stakeholder engagement from the beginning is vital to a fair and transparent process and also to designing ethical and relevant trials; (3) research should generally be responsive to a host country's needs, and sponsors and stakeholders should work together to address potential barriers to future access; and finally, (4) another meeting including a broader group of stakeholders is needed to address many of the outstanding ethical issues raised by this meeting. We offer an overview of the meeting and the key discussion points and recommendations to help guide the design and conduct of future HIV prevention and vaccine research in resource-limited settings.

  17. Model for Estimating Power and Downtime Effects on Teletherapy Units in Low-Resource Settings

    Directory of Open Access Journals (Sweden)

    Rachel McCarroll

    2017-10-01

    Full Text Available Purpose: More than 6,500 megavoltage teletherapy units are needed worldwide, many in low-resource settings. Cobalt-60 units or linear accelerators (linacs can fill this need. We have evaluated machine performance on the basis of patient throughput to provide insight into machine viability under various conditions in such a way that conclusions can be generalized to a vast array of clinical scenarios. Materials and Methods: Data from patient treatment plans, peer-reviewed studies, and international organizations were combined to assess the relative patient throughput of linacs and cobalt-60 units that deliver radiotherapy with standard techniques under various power and maintenance support conditions. Data concerning the frequency and duration of power outages and downtime characteristics of the machines were used to model teletherapy operation in low-resource settings. Results: Modeled average daily throughput was decreased for linacs because of lack of power infrastructure and for cobalt-60 units because of limited and decaying source strength. For conformal radiotherapy delivered with multileaf collimators, average daily patient throughput over 8 years of operation was equal for cobalt-60 units and linacs when an average of 1.83 hours of power outage occurred per 10-hour working day. Relative to conformal treatments delivered with multileaf collimators on the respective machines, the use of advanced techniques on linacs decreased throughput between 20% and 32% and, for cobalt machines, the need to manually place blocks reduced throughput up to 37%. Conclusion: Our patient throughput data indicate that cobalt-60 units are generally best suited for implementation when machine operation might be 70% or less of total operable time because of power outages or mechanical repair. However, each implementation scenario is unique and requires consideration of all variables affecting implementation.

  18. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study.

    Science.gov (United States)

    Kululanga, Lucy I; Sundby, Johanne; Malata, Address; Chirwa, Ellen

    2011-12-02

    Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at

  19. Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings.

    Science.gov (United States)

    Schmidt, Lisa M; Reidmohr, Alison A; Helgerson, Steven D; Harwell, Todd S

    2016-12-01

    Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41 % response rate) living in PHA multiunit buildings in Montana in 2013. Our primary outcome was tenant support of smoke-free policies; our secondary outcome was exacerbation of child asthma symptoms due to SHS exposure. In 2014, we used multiple logistic regression models to test associations between independent variables and outcomes of interest. The majority (80.6 %) of respondents supported having a smoke-free policy in their building, with support being significantly higher among nonsmokers [adjusted odds ratio (aOR) 4.2, 95 % confidence interval (CI) 1.5-11.6] and among residents living with children (aOR 2.9, 95 % CI 1.3-6.2). Tribal residents were as likely to support smoke-free policies as non-tribal residents (aOR 1.4; 95 % CI 0.5-4.0). Over half (56.5 %) of respondents reported SHS exposure in their home; residents in a building with no smoke-free policy in place were significantly more likely to report exposure (aOR 3.5, 95 % CI 2.2-5.5). SHS exposure was not significantly associated with asthma symptoms. There is a significant reduction in exposure to SHS in facilities with smoke-free policies and there is strong support for such policies by both tribal and non-tribal MUH residents. Opportunities exist for smoke-free policy initiatives in rural and tribal settings.

  20. Applicability of direct agglutination test (DAT) at a rural health setting in Bangladesh and feasibility of local antigen production.

    Science.gov (United States)

    Chowdhury, M S; al Masum, A; al Karim, E; Semiáo-Santos, S; Rahman, K M; Ar-Rashid, H; el Harith, A

    1993-01-01

    As part of a large-scale sero-epidemiological survey on visceral leishmaniasis (VL) carried out in Mymensingh district of Bangladesh, applicability of DAT was assessed at the level of a rural health setting in Trishal (upazila) subdistrict. Despite the relatively less optimal conditions encountered, 5854 inhabitants from 7 villages appendant to Trishal were assessed for VL. The demographic distribution for sero-positivity obtained at the rural setting was comparable to that found by DAT as executed at the central laboratory (IEDC&R, Dhaka) on 9619 inhabitants from the same upazila. The overall sero-prevalence rate was 4.4% compared to 3.7% obtained in the population assessed at the central laboratory. In either study, similar VL prevalence rates of 2.1% were obtained in the male populations. Irrespective of sex, younger population ( or = 90 years (1.4% and 1.8%). Local production of DAT antigen employing an authochtonus L. donovani isolate was attempted at the central laboratory (IEDC&R) in Dhaka. By comparison with the reference antigen, titres obtained in all 33 VL sera tested were equally higher (1:6400- > or =: 51200) than in 35 out of 38 negative controls (< or = 1:400-1:1600). A comparable level of reactivity was also obtained in 53 VL and 52 negative control sera using a well characterized L. donovani strain (MHOM/IN/80/D88) from India. However, unlike the reference strain, titres obtained in 7 endemic controls were significantly higher with the authochtonous and homologous antigen (1:3200 - 1:6400) than with the reference (1:100 - 1:1600). The results signify the advantage of employing indigenous L. donovani isolates to further improve DAT sensitivity for detection of early and sub-clinical VL.

  1. Assessment of differences in psychosocial resources and state of health of rural and urban residents – based on studies carried out on students during examination stress

    Directory of Open Access Journals (Sweden)

    Danuta Zarzycka

    2014-11-01

    Full Text Available [b]introduction[/b]. Civilization changes of the environment shaping the psychosocial resources from rural to urban influence human health. [b]aim.[/b] The study aimed to identify the differences due to the place of residence (rural, urban as far as health resources are concerned (social support, sense of coherence, dehydroepiandrosterone sulfate concentration in plasma and health in examination stress situations. The study also determined the concentration of dehydroepiandrosterone sulfate (health resource and cortisol (stress indicator. [b]material and methods.[/b] The psychosocial variables were assessed using the scales: ISEL-48v. Coll., SOC-29, SF-36v.2™ o and analogue scale (perception of examination stress. The study included, based on a stratified sampling (year of study and purposive sampling (written examination, major, 731 students representing the six universities in Lublin, south-east Poland. Among the respondents, 130 students were rural residents. [b]results.[/b] Health resources of students living in rural and urban areas generally differ statistically significantly in social support and the subscales of availability of tangible support, availability of appreciative support, the availability of cognitive-evaluative support and a sense of resourcefulness. The study recorded a sstatistically significantly larger network of family ties among students living in rural areas. The demonstrated diversity of resources did not substantially affect the perceived health, with the exception of pain sensation. Examination stress assessed by subjective opinion of the respondents and plasma cortisol levels vary relative to the place of residence. Students residing in rural areas showed significantly lower cortisol levels values, but subjectively perceived the situation of examation as more stressful. [b]conclusions[/b]. Differences in health resources and their mechanism of impact on health, to a limited extent, were conditioned by the place

  2. Effective Practices in Providing Online, In-Service Training to Health Professionals in Low-Resource Settings

    Science.gov (United States)

    Chio, Karen Sherk

    2012-01-01

    As doctors, nurses and public health professionals are promoted into management and leadership positions in resource-poor countries around the world, they are tasked with leading teams and managing drugs and financial and material resources. These responsibilities require a set of skills and knowledge different from that needed for their clinical…

  3. Factors Associated With Community Health Worker Performance Differ by Task in a Multi-Tasked Setting in Rural Zimbabwe.

    Science.gov (United States)

    Kambarami, Rukundo A; Mbuya, Mduduzi Nn; Pelletier, David; Fundira, Dadirai; Tavengwa, Naume V; Stoltzfus, Rebecca J

    2016-06-20

    Zimbabwe, like most low-income countries, faces health worker shortages. Community health workers (CHWs) bridge this gap by delivering essential health services and nutrition interventions to communities. However, as workloads increase, CHWs' ability to provide quality services may be compromised. We studied influences upon CHWs' performance related to pregnancy surveillance and nutrition and hygiene education in rural Zimbabwe. In the context of a cluster-randomized trial conducted in 2 rural districts between November 2012 and March 2015, 342 government-employed CHWs identified and referred pregnant women for early antenatal care and delivered household-level behavior change lessons about infant feeding and hygiene to more than 5,000 women. In 2013, we conducted a survey among 322 of the CHWs to assess the association between demographic and work characteristics and task performance. Exploratory factor analyses of the Likert-type survey questions produced 8 distinct and reliable constructs of job satisfaction and motivation, supervision, peer support, and feedback (Cronbach α range, 0.68 to 0.92). Pregnancy surveillance performance was assessed from pregnancy referrals, and nutrition and hygiene education performance was assessed by taking the average summative score (range, 5 to 30) of lesson delivery observations completed by a nurse supervisor using a 6-item Likert-type checklist. Poisson and multiple linear regressions were used to test associations between CHW demographic and work characteristics and performance. CHWs who referred more pregnant women were female, unmarried, under 40 years old, from larger households, and of longer tenure. They also perceived work resources to be adequate and received positive feedback from supervisors and the community, but they were less satisfied with remuneration. CHWs with high scores on behavior change lesson delivery were from smaller households, and they received more supportive supervision but less operational

  4. Seeking surprise : rethinking monitoring for collective learning in rural resource management

    OpenAIRE

    Guijt, I.M.

    2008-01-01

    Commonsense says that monitoring systems should be able to provide feedback that can help correct ineffective actions. But practice shows that when dealing with complex rural development issues that involve collaborative action by a changing configuration of stakeholders, monitoring practice often falls short of its potential. In this thesis, I describe my search to understand why practice is so limited and what might be needed to design monitoring processes that foster learning in concerted ...

  5. Wild mushroom--an underutilized healthy food resource and income generator: experience from Tanzania rural areas.

    Science.gov (United States)

    Tibuhwa, Donatha D

    2013-07-10

    This study documents the use of a wild edible mushroom (WEM) in Tanzania rural areas and assesses its significance as a source of healthy food and income for the disadvantaged rural dwellers. The data was gathered through local market surveys in order to conventionally identify different common WEM taxa using a semi-structured interview and it involved 160 people comprised of WEM hunters, traders and consumers. The collected data covered the information on where, how, when and who was the principal transmitter of the mycological knowledge learned and the general information on their market and values. Results show that mushroom gathering is gender oriented, dominated by women (76.25%) whereas men account for 23.75%. Women possess vast knowledge of mushroom folk taxonomy, biology and ecology and are therefore the principal knowledge transmitters. It was also found that learning about WEM began at an early age and is family tradition based. The knowledge is acquired and imparted by practices and is mostly transmitted vertically through family dissemination. The results also revealed that 75 WEM species belong to 14 families sold in fresh or dry form. The common sold species belonged to the family Cantharellaceae (19) followed by Rusullaceae (16) and Lyophyllaceae (13), respectively. Collectors residing near miombo woodland may harvest 20-30 buckets (capacity 20 liters) and the business may earn a person about $400-900 annually. This finding envisages the purposeful strengthening of WEM exploitation, which would contribute significantly in boosting the rural income/economy and reduce conflicts between community and forest conservers. The activity would also provide alternative employment, improve food security to rural disadvantaged groups especially women and old people hence improve their livelihood.

  6. Agricultural law and development of rural areas: food challenges, natural resources and climate change

    OpenAIRE

    Hernández, Ángel Sánchez

    2017-01-01

    In order to eradicate hunger in the world agricultural decisions must be made that will design a new model of agricultural production that will be more productive and will fit better in the fight against global warming. These decisions will help to regulate agricultural activities so that they help in the above mentioned fight as well. This new model of agricultural production will come together with the adoption of rural development decisions which will then be suitable for every ecosystem, ...

  7. Social Context of First Birth Timing in a Rapidly Changing Rural Setting

    Science.gov (United States)

    Ghimire, Dirgha J.

    2016-01-01

    This article examines the influence of social context on the rate of first birth. Drawing on socialization models, I develop a theoretical framework to explain how different aspects of social context (i.e., neighbors), may affect the rate of first birth. Neighbors, who in the study setting comprise individuals’ immediate social context, have an important influence on the rate of first birth. To test my hypotheses, I leverage a setting, measures and analytical techniques designed to study the impact of macro-level social contexts on micro-level individual behavior. The results show that neighbors’ age at first birth, travel to the capital city and media exposure tend to reduce the first birth rate, while neighbors’ non-family work experience increases first birth rate. These effects are independent of neighborhood characteristics and are robust against several key variations in model specifications. PMID:27886737

  8. Building sustainable organizational capacity to deliver HIV programs in resource-constrained settings: stakeholder perspectives

    Directory of Open Access Journals (Sweden)

    Anjali Sharma

    2013-12-01

    Full Text Available Background: In 2008, the US government mandated that HIV/AIDS care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR should shift from US-based international partners (IPs to registered locally owned organizations (local partners, or LPs. The US Health Resources and Services Administration (HRSA developed the Clinical Assessment for Systems Strengthening (ClASS framework for technical assistance in resource-constrained settings. The ClASS framework involves all stakeholders in the identification of LPs’ strengths and needs for technical assistance. Objective: This article examines the role of ClASS in building capacity of LPs that can endure and adapt to changing financial and policy environments. Design: All stakeholders (n=68 in Kenya, Zambia, and Nigeria who had participated in the ClASS from LPs and IPs, the US Centers for Disease Control and Prevention (CDC, and, in Nigeria, HIV/AIDS treatment facilities (TFs were interviewed individually or in groups (n=42 using an open-ended interview guide. Thematic analysis revealed stakeholder perspectives on ClASS-initiated changes and their sustainability. Results: Local organizations were motivated to make changes in internal operations with the ClASS approach, PEPFAR's competitive funding climate, organizational goals, and desired patient health outcomes. Local organizations drew on internal resources and, if needed, technical assistance from IPs. Reportedly, ClASS-initiated changes and remedial action plans made LPs more competitive for PEPFAR funding. LPs also attributed their successful funding applications to their preexisting systems and reputation. Bureaucracy, complex and competing tasks, and staff attrition impeded progress toward the desired changes. Although CDC continues to provide technical assistance through IPs, declining PEPFAR funds threaten the consolidation of gains, smooth program transition, and continuity of treatment services

  9. Quantifying social contacts in a household setting of rural Kenya using wearable proximity sensors

    OpenAIRE

    Kiti, Moses C.; Tizzoni, Michele; Kinyanjui, Timothy M.; Koech, Dorothy C.; Munywoki, Patrick K.; Meriac, Milosch; Cappa, Luca; Panisson, André; Barrat, Alain; Cattuto, Ciro; Nokes, D. James

    2016-01-01

    Close proximity interactions between individuals influence how infections spread. Quantifying close contacts in developing world settings, where such data is sparse yet disease burden is high, can provide insights into the design of intervention strategies such as vaccination. Recent technological advances have enabled collection of time-resolved face-to-face human contact data using radio frequency proximity sensors. The acceptability and practicalities of using proximity devices within the ...

  10. Diagnosis and outcome of birth asphyxia in resource constrained health care set up

    International Nuclear Information System (INIS)

    Zaman, S.; Shah, S.A.; Mehmood, S.; Shahzad, S.; Munir, M.; Mushtaq, A.

    2017-01-01

    Objective: To determine morbidity and mortality of neonates with low APGAR score in a resource constrained health care set up. Study Design: Prospective descriptive study. Place and Duration of Study: The study was carried out in combined military hospital Attock, from Jan 2013 to Jan 2015. Material and Methods: All term neonates with 37 completed weeks of gestation and APGAR score less than 7 were included in the study. APGAR score was calculated by an attending pediatrician, gynecologist or trained female nurse at 0 and 5 minutes. In Neonatal Intensive Care Unit [NICU] the babies were daily examined by pediatrician. Outcome was documented in term of morbidity i.e. fits and mortality i.e. death of babies. Results: Total number of neonates included in the study were 85 of which 55 (65%) were males and 30 (35%) were females. Of the total neonates 65 (76%) were discharged in satisfactory conditions and 20 (24%) expired during stay in the hospital. The mean APGAR score of newborns was 4.98 +- 0.98 at 5 minutes. During stay in hospital 46 (54%) were diagnosed to have hypoxic ischemic encephalopathy 2 (HIE2), those diagnosed with HIE3 were 5 (6%) and the rest 14 (16%) with HIE1. Conclusion: Low APGAR score is an important cause of admission to NICU. Low APGAR score was found associated with increased risk of fits in neonates and one of the most important cause of mortality in our set up. (author)

  11. Associations of income with self-reported ill-health and health resources in a rural community sample of Austria.

    Science.gov (United States)

    Freidl, W; Stronegger, W J; Rásky, E; Neuhold, C

    2001-01-01

    Three levels of health indicators (1) self-reported ill-health, (2) internal health resources, and (3) external health resources were analysed in relation to a four-category house-hold income distribution in order to describe possible social gradients. The particular aim of this study was to obtain information on the association of income data with self-reported ill-health. This cross-sectional study was based on a health survey. The sample represents around 10% of the rural population of some communities in Styria, randomly selected from the population registry. Interview data was collected from 3781 participants aged 15 years and older, 1559 males and 2222 females. The results show that individuals from lower house-hold income classes are disadvantaged with regard to indicators of ill-health, internal and external health resources. Overall, the link between low income and poor health is highly consistent within our data. Considering our results we conclude that internal and external health resources are as unequally distributed over income levels as health outcome indicators.

  12. Human Resources for Health in Rural China : an Assessment of the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Recent official documents pertaining to healthcare delivery system reform in China have focused mainly on infrastructure, equipment, management, insurance and drug policies. There has been little if any attention paid to human resources for health. Given the time and resources required to train qualified primary care ...

  13. Focus of the ECEL systems in rural environment: rational advantage of resources

    International Nuclear Information System (INIS)

    Vinas, R.

    1994-01-01

    Although the eolic resource is distributed in our country, its effective use goes by a serious technical and economic evaluation that takes to the correct design and operation of the generating system. Different use alternatives are explored in this work relating them to the analysis of the resource carried out in the Uruguay

  14. Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia

    Directory of Open Access Journals (Sweden)

    Richard Alynn Henker

    2017-07-01

    Full Text Available IntroductionA crisis team management (CTM simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2, crisis team training (3, and TeamSTEPPs© models (4. The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance.MethodsEach of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5. CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course.ResultsOf the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve (p < 0.05 for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information.ConclusionTeaching of non-technical skills can be effective in a setting with scarce

  15. Protecting the health of medical students on international electives in low-resource settings.

    Science.gov (United States)

    Johnston, Niall; Sandys, Nichola; Geoghegan, Rosemary; O'Donovan, Diarmuid; Flaherty, Gerard

    2018-01-01

    Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit

  16. Crisis Team Management in a Scarce Resource Setting: Angkor Hospital for Children in Siem Reap, Cambodia.

    Science.gov (United States)

    Henker, Richard Alynn; Henker, Hiroko; Eng, Hor; O'Donnell, John; Jirativanont, Tachawan

    2017-01-01

    A crisis team management (CTM) simulation course was developed by volunteers from Health Volunteers Overseas for physicians and nurses at Angkor Hospital for Children (AHC) in Siem Reap, Cambodia. The framework for the course was adapted from crisis resource management (1, 2), crisis team training (3), and TeamSTEPPs© models (4). The CTM course focused on teaching physicians and nurses on the development of team performance knowledge, skills, and attitudes. Challenges to providing this course at AHC included availability of simulation equipment, cultural differences in learning, and language barriers. The purpose of this project was to evaluate the impact of a CTM simulation course at AHC on attitudes and perceptions of participants on concepts related to team performance. Each of the CTM courses consisted of three lectures, including team performance concepts, communication, and debriefing followed by rotation through four simulation scenarios. The evaluation instrument used to evaluate the AHC CTM course was developed for Cambodian staff at AHC based on TeamSTEPPs© instruments evaluating attitude and perceptions of team performance (5). CTM team performance concepts included in lectures, debriefing sessions, and the evaluation instrument were: team structure, leadership, situation monitoring, mutual support, and communication. The Wilcoxon signed-rank test was used to analyze pre- and post-test paired data from participants in the course. Of the 54 participants completing the three CTM courses at AHC, 27 were nurses, 6 were anesthetists, and 21 were physicians. Attitude and perception scores were found to significantly improve ( p  < 0.05) for team structure, leadership, situation monitoring, and communication. Team performance areas that improved the most were: discussion of team performance, communication, and exchange of information. Teaching of non-technical skills can be effective in a setting with scarce resources in a Southeastern Asian country.

  17. Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.

    Science.gov (United States)

    Houston, Kirsty Anne; George, Elizabeth C; Maitland, Kathryn

    2018-05-04

    Although the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty. We re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings. We established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%). The updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group

  18. Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study.

    Science.gov (United States)

    Tirfessa, K; Lund, C; Medhin, G; Hailemichael, Y; Fekadu, A; Hanlon, C

    2017-11-16

    In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity. Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0. Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability. Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated.

  19. Can traditional birth attendants be trained to accurately identify septic infants, initiate antibiotics, and refer in a rural African setting?

    Science.gov (United States)

    Gill, Christopher John; MacLeod, William B; Phiri-Mazala, Grace; Guerina, Nicholas G; Mirochnick, Mark; Knapp, Anna B; Hamer, Davidson H

    2014-08-01

    Neonatal sepsis is a major cause of neonatal mortality. In populations with limited access to health care, early identification of bacterial infections and initiation of antibiotics by community health workers (CHWs) could be lifesaving. It is unknown whether this strategy would be feasible using traditional birth attendants (TBAs), a cadre of CHWs who typically have limited training and educational backgrounds. We analyzed data from the intervention arm of a cluster-randomized trial involving TBAs in Lufwanyama District, Zambia, from June 2006 to November 2008. TBAs followed neonates for signs of potential infection through 28 days of life. If any of 16 criteria were met, TBAs administered oral amoxicillin and facilitated referral to a rural health center. Our analysis included 1,889 neonates with final vital status by day 28. TBAs conducted a median of 2 (interquartile range 2-6) home visits (51.4% in week 1 and 48.2% in weeks 2-4) and referred 208 neonates (11%) for suspected sepsis. Of referred neonates, 176/208 (84.6%) completed their referral. Among neonates given amoxicillin, 171/183 (93.4%) were referred; among referred neonates, 171/208 (82.2%) received amoxicillin. Referral and/or initiation of antibiotics were strongly associated with neonatal death (for referral, relative risk [RR] = 7.93, 95% confidence interval [CI] = 4.4-14.3; for amoxicillin administration, RR = 4.7, 95% CI = 2.4-8.7). Neonates clinically judged to be "extremely sick" by the referring TBA were at greatest risk of death (RR = 8.61, 95% CI = 4.0-18.5). The strategy of administering a first dose of antibiotics and referring based solely on the clinical evaluation of a TBA is feasible and could be effective in reducing neonatal mortality in remote rural settings.

  20. Appropriate technology for rural India - solar decontamination of water for emergency settings and small communities.

    Science.gov (United States)

    Kang, Gagandeep; Roy, Sheela; Balraj, Vinohar

    2006-09-01

    A commercial solar water heating system was evaluated for its effectiveness in decontaminating drinking water with a view to use in emergency situations. A total of 18 seeding experiments carried out over 6 months with 10(5) to 10(7)Escherichia coli/ml showed that the solar heater produced 125 l of bacteriologically safe water in 4 h when the ambient temperature was above 30 degrees C, with a holding time of at least 2 h. The solar water heating system is inexpensive, easy to transport and set up and could provide safer drinking water for 50 people a day. It would be effective in the decrease and prevention of waterborne disease in emergency situations, and is appropriate for use in small communities.

  1. Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting.

    Science.gov (United States)

    Nkrumah, Bernard; Nguah, Samuel Blay; Sarpong, Nimako; Dekker, Denise; Idriss, Ali; May, Juergen; Adu-Sarkodie, Yaw

    2011-04-21

    In resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used. This method though cheaper, takes more time. In blood donations, the semi-quantitative gravimetric copper sulfate method which is very easy and inexpensive may be used but does not provide an acceptable degree of accuracy. The HemoCue® hemoglobin photometer has been used for these purposes. This study was conducted to generate data to support or refute its use as a point-of-care device for hemoglobin estimation in mobile blood donations and critical care areas in health facilities. EDTA blood was collected from study participants drawn from five groups: pre-school children, school children, pregnant women, non-pregnant women and men. Blood collected was immediately processed to estimate the hemoglobin concentration using three different methods (HemoCue®, Sysmex KX21N and Cyanmethemoglobin). Agreement between the test methods was assessed by the method of Bland and Altman. The Intraclass correlation coefficient (ICC) was used to determine the within subject variability of measured hemoglobin. Of 398 subjects, 42% were males with the overall mean age being 19.4 years. The overall mean hemoglobin as estimated by each method was 10.4 g/dl for HemoCue, 10.3 g/dl for Sysmex KX21N and 10.3 g/dl for Cyanmethemoglobin. Pairwise analysis revealed that the hemoglobin determined by the HemoCue method was higher than that measured by the KX21N and Cyanmethemoglobin. Comparing the hemoglobin determined by the HemoCue to Cyanmethemoglobin, the concordance correlation coefficient was 0.995 (95% CI: 0.994-0.996, p < 0.001). The Bland and Altman's limit of agreement was -0.389 - 0.644 g/dl with the mean difference being 0.127 (95% CI: 0.102-0.153) and a non-significant difference in variability between the two measurements (p = 0.843). After adjusting to assess the effect of other possible confounders such as sex, age and category of person, there was no

  2. Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

    Directory of Open Access Journals (Sweden)

    Zoë M. McLaren

    Full Text Available Background: Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17% of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs. Methods: Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results: Because the disability-adjusted life years (DALYs averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions: Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and

  3. Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting

    Directory of Open Access Journals (Sweden)

    Idriss Ali

    2011-04-01

    Full Text Available Abstract Background In resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used. This method though cheaper, takes more time. In blood donations, the semi-quantitative gravimetric copper sulfate method which is very easy and inexpensive may be used but does not provide an acceptable degree of accuracy. The HemoCue® hemoglobin photometer has been used for these purposes. This study was conducted to generate data to support or refute its use as a point-of-care device for hemoglobin estimation in mobile blood donations and critical care areas in health facilities. Method EDTA blood was collected from study participants drawn from five groups: pre-school children, school children, pregnant women, non-pregnant women and men. Blood collected was immediately processed to estimate the hemoglobin concentration using three different methods (HemoCue®, Sysmex KX21N and Cyanmethemoglobin. Agreement between the test methods was assessed by the method of Bland and Altman. The Intraclass correlation coefficient (ICC was used to determine the within subject variability of measured hemoglobin. Results Of 398 subjects, 42% were males with the overall mean age being 19.4 years. The overall mean hemoglobin as estimated by each method was 10.4 g/dl for HemoCue, 10.3 g/dl for Sysmex KX21N and 10.3 g/dl for Cyanmethemoglobin. Pairwise analysis revealed that the hemoglobin determined by the HemoCue method was higher than that measured by the KX21N and Cyanmethemoglobin. Comparing the hemoglobin determined by the HemoCue to Cyanmethemoglobin, the concordance correlation coefficient was 0.995 (95% CI: 0.994-0.996, p Conclusion Hemoglobin determined by the HemoCue method is comparable to that determined by the other methods. The HemoCue photometer is therefore recommended for use as on-the-spot device for determining hemoglobin in resource poor setting.

  4. A Rapid and Low-Cost PCR Thermal Cycler for Low Resource Settings.

    Directory of Open Access Journals (Sweden)

    Grace Wong

    Full Text Available Many modern molecular diagnostic assays targeting nucleic acids are typically confined to developed countries or to the national reference laboratories of developing-world countries. The ability to make technologies for the rapid diagnosis of infectious diseases broadly available in a portable, low-cost format would mark a revolutionary step forward in global health. Many molecular assays are also developed based on polymerase chain reactions (PCR, which require thermal cyclers that are relatively heavy (>20 pounds and need continuous electrical power. The temperature ramping speed of most economical thermal cyclers are relatively slow (2 to 3 °C/s so a polymerase chain reaction can take 1 to 2 hours. Most of all, these thermal cyclers are still too expensive ($2k to $4k for low-resource setting uses.In this article, we demonstrate the development of a low-cost and rapid water bath based thermal cycler that does not require active temperature control or continuous power supply during PCR. This unit costs $130 to build using commercial off-the-shelf items. The use of two or three vacuum-insulated stainless-steel Thermos food jars containing heated water (for denaturation and annealing/extension steps and a layer of oil on top of the water allow for significantly stabilized temperatures for PCR to take place. Using an Arduino-based microcontroller, we automate the "archaic" method of hand-transferring PCR tubes between water baths.We demonstrate that this innovative unit can deliver high speed PCR (17 s per PCR cycle with the potential to go beyond the 1,522 bp long amplicons tested in this study and can amplify from templates down to at least 20 copies per reaction. The unit also accepts regular PCR tubes and glass capillary tubes. The PCR efficiency of our thermal cycler is not different from other commercial thermal cyclers. When combined with a rapid nucleic acid detection approach, the thermos thermal cycler (TTC can enable on-site molecular

  5. Archeologia delle risorse: tra archeologia ambientale, ecologia storica e archeologia rurale / Archaeology of resources: between environmental archaeology, historical ecology and rural archaeology

    Directory of Open Access Journals (Sweden)

    Carlo Alessandro Montanari

    2015-12-01

    Full Text Available Il contributo, attraverso la discussione di alcuni casi di studio, prova ad esemplificare gli approcci del Laboratorio di Archeologia e Storia Ambientale (Dafist-Distav dell’Università di Genova allo studio delle aree rurali, insediate e non insediate. Oggetto principale delle ricerche è il tentativo di ricostruire, con un approccio analitico fortemente contestuale, le pratiche storiche di gestione e attivazione delle risorse ambientali (e le pratiche e i saperi naturalistici locali legati a tali pratiche a partire dal riconoscimento delle loro tracce archeologico-ambientali e attraverso gli apporti dell’archeologia, dell’archeobotanica, dell’ecologia storica e della ricerca documentaria. Gli esempi si concentrano su alcune tracce, riferibili per lo più a pratiche multiple di gestione delle risorse agro-silvo-pastorali (praterie alberate e boschi pascolati, agricoltura temporanea e uso del fuoco, colture permanenti e attività di pascolo, studiate in diverse aree dell’Appennino Ligure e riferibili a cronologie per lo più medievali e postmedievali. This contribution, through the discussion of case studies, tries to illustrate the study approach of the Laboratory of Environmental Archaeology and History (Dafist-Distav,University of Genoa to rural areas settled and not settled. The main object of the research is an attempt to reconstruct, with a strongly contextual analytical approach, historical practices of management and activation of environmental resources (and the practices and naturalistic knowledge related to such practices, starting from the analysis of their archaeological environmental evidence and through the contributions of archaeology, archaeobotany, historical ecology and documentary research. The examples focus on traces, related mostly to multiple practices of management of agro-forestry-pastoral resources (grazed wooded grassland and grazed woodland, temporary agriculture and use of fire, permanent crops and

  6. Are schools a good setting for adolescent sexual health promotion in rural Africa? A qualitative assessment from Tanzania.

    Science.gov (United States)

    Plummer, Mary L; Wight, D; Wamoyi, J; Nyalali, K; Ingall, T; Mshana, G; Shigongo, Z S; Obasi, A I N; Ross, D A

    2007-08-01

    African adolescents are at high risk of poor sexual health. School-based interventions could reach many adolescents in a sustainable and replicable way, if enrolment, funding and infrastructure are adequate. This study examined pupils', recent school leavers', parents' and teachers' views and experiences of rural Tanzanian primary schools, focusing on the implications for potential sexual health programmes. From 1999 to 2002, participant observation was conducted in nine villages for 158 person-weeks. Half of Year 7 pupils were 15-17 years old, and few went on to secondary school, suggesting that primary schools may be a good venue for such programmes. However, serious challenges include low enrolment and attendance rates, limited teacher training, little access to teaching resources and official and unofficial practices that may alienate pupils and their parents, e.g. corporal punishment, pupils being made to do unpaid work, forced pregnancy examinations, and some teachers' alcohol or sexual abuse. At a national level, improved teacher training and supervision are critical, as well as policies that better prevent, identify and correct undesired practices. At a programme level, intervention developers need to simplify the subject matter, introduce alternative teaching methods, help improve teacher-pupil and teacher-community relationships, and closely supervise and appropriately respond to undesired practices.

  7. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Zolfo Maria

    2010-09-01

    Full Text Available Abstract Background We present an innovative approach to healthcare worker (HCW training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone, each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module. Methods In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning. Results With a response rate of 90% (18/20 questionnaires returned, the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone. Conclusions Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs. Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

  8. Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: observation from India.

    Directory of Open Access Journals (Sweden)

    Suman Kanungo

    Full Text Available To control the double burden of communicable and non-communicable diseases (NCDs, in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting.Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2.Recent illnesses were reported by 55.91% (n=24,600 participants. Among diagnosed ailments (n=23,626, 50.92% (n=12,031 were NCDs. Respiratory (17.28%, n=7605, gastrointestinal (13.48%, n=5929 and musculoskeletal (6.25%, n=2749 problems were predominant. Non-qualified practitioners treated 53.16% (n=13,074 episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers (AORPri=0.76, 95% confidence interval=0.71-0.83 and for Govt. healthcare provider (AORGovt=0.80(0.68-0.95], females [AORGovt=0.80(0.73-0.88], Muslims [AORPri=0.85(0.69-0.76 and AORGovt=0.92(0.87-0.96], backward castes [AORGovt=0.93(0.91-0.96] and rural residents [AORPri=0.82(0.75-0.89 and AORGovt=0.72(0.64-0.81] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AORPri=0.41(0.37-0.46 & AORGovt=0.41(0.37-0.46, osteoarthritis: AORPri=0.72(0.59-0.68 & AORGovt=0.58(0.43-0.78], gastrointestinal [AORPri=0.28(0.24-0.33 & AORGovt=0.69(0.58-0.81], respiratory [AORPri=0.35(0.32-0.39 & AORGovt=0.46(0.41-0.52] and skin infections [AORPri=0.65(0.55-0.77] were also less often treated by qualified practitioners. Better education [AORPri=1.91(1.65-2.22 for ≥graduation], sanitation [AORPri=1

  9. Epidemiologic profile of patients seen in primary care clinics in an urban and a rural setting in Haiti, 2010-11.

    Science.gov (United States)

    Dickstein, Yaakov; Neuberger, Ami; Golus, Miri; Schwartz, Eli

    2014-09-01

    This study examined the demographic and epidemiological differences between patient populations presenting to a rural and an urban clinic in Haiti. A primary health clinic was established in urban Leogane, and a once-weekly clinic was established in Magandou, a rural village. Patient data were recorded for all individuals presenting to each clinic. Over 7 months, 6632 patients (median age 25) were seen in the urban clinic, and 567 (median age 47) in the rural clinic. There was a female majority at both sites. Hypertension was diagnosed in 41.9% (238/567) of the rural population over 40 years of age, while 29.5% (1956/6632) of patients in the urban setting had the same diagnosis (pHaiti must address the wide rural prevalence. STDs are a major urban health issue requiring treatment for both patients and their partners. Vector-borne disease was unseen in the rural clinic, despite an altitude insufficient to prevent mosquito-borne illness. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Project of setting to contribution of renewable energies for an pre-electrification to support rural development

    International Nuclear Information System (INIS)

    1999-01-01

    The document is a project of the Government of Burkina Faso. The project aim is to increase the energy utilization renewable by the populations living in the rural areas. It aims moreover the improvement of the standard living in the rural areas, the access of rural population to basic elements to fight against poverty and rural depopulation. It is a question of popularizing in rural area, the use of the renewable energy equipment consumers, in particular the photovoltaic one. This equipment will make it possible to satisfy the requirements in lighting with the Community systems, in leisure by providing a minimum of equipment in the community centres of leisure, in drugs conservation installation in the health centres and in using energy to pump drinking water. The use of this energy source will make it possible to mitigate the non access of the rural areas to the energy produced by the National Company of Electricity of Burkina [fr

  11. Improving health-care delivery in low-resource settings with nanotechnology

    Directory of Open Access Journals (Sweden)

    James J Abbas

    2017-03-01

    Full Text Available In the two decades after 1990, the rates of child and maternal mortality dropped by over 40% and 47%, respectively. Despite these improvements, which are in part due to increased access to medical technologies, profound health disparities exist. In 2015, a child born in a developing region is nearly eight times as likely to die before the age of 5 than one born in a developed region and developing regions accounted for nearly 99% of the maternal deaths. Recent developments in nanotechnology, however, have great potential to ameliorate these and other health disparities by providing new cost-effective solutions for diagnosis or treatment of a variety of medical conditions. Affordability is only one of the several challenges that will need to be met to translate new ideas into a medical product that addresses a global health need. This article aims to describe some of the other challenges that will be faced by nanotechnologists who seek to make an impact in low-resource settings across the globe.

  12. Egg beater as centrifuge: isolating human blood plasma from whole blood in resource-poor settings.

    Science.gov (United States)

    Wong, Amy P; Gupta, Malancha; Shevkoplyas, Sergey S; Whitesides, George M

    2008-12-01

    This paper demonstrates that a hand-powered egg beater can be modified to serve as a centrifuge for separating plasma from human whole blood. Immunoassays used to diagnose infectious diseases often require plasma from whole blood, and obtaining plasma typically requires electrically-powered centrifuges, which are not widely available in resource-limited settings. Human whole blood was loaded into polyethylene (PE) tubing, and the tubing was attached to the paddle of an egg beater. Spinning the paddle pelleted the blood cells to the distal end of the PE tubing; the plasma remained as the supernatant. A cholesterol assay (run on patterned paper) demonstrated the suitability of this plasma for use in diagnostic assays. The physics of the system was also analyzed as a guide for the selection of other rotating systems for use in centrifugation. Egg beaters, polyethylene tubing, and paper are readily available devices and supplies that can facilitate the use of point-of-care diagnostics at sites far from centralized laboratory facilities.

  13. Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

    Science.gov (United States)

    Drummond, Jennifer L; Were, Martin C; Arrossi, Silvina; Wools-Kaloustian, Kara

    2017-07-01

    Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  14. A theory for aftercare of human trafficking survivors for nursing practice in low resource settings.

    Science.gov (United States)

    Curran, R L; Naidoo, J R; Mchunu, G

    2017-06-01

    Research on aftercare for human trafficking survivors highlights the limited knowledge of the needs of survivors; the evaluation of current aftercare; and the process of recovery navigated by the survivor in aftercare (Oram et al., 2012; Locke, 2010; Hacker & Cohen, 2012). Furthermore there has been a transition in aftercare where the victim or survivor, who before was seen as a passive victim of circumstance of their life and in need of therapeutic intervention, is now seen as having an active role in their recovery, thus facilitating recovery (Hacker & Cohen, 2012). The need for a theory grounded in survivor's voices therefore motivated this grounded theory study underpinned by Freire's (1970) Pedagogy of the oppressed. The aim of the theory is to inform nursing care of human trafficking survivors in low resource settings. The findings elicit a theoretical model of the renewed self, and the conditions that facilitate this process in care of human trafficking survivors. The recommendations of this paper may improve the nursing care provided to human trafficking survivors and equip nurses and other health professionals with the knowledge and skills to promote the renewing of human trafficking survivors. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Infection prevention and control in outpatient settings in China-structure, resources, and basic practices.

    Science.gov (United States)

    Qiao, Fu; Huang, Wenzhi; Zong, Zhiyong; Yin, Weijia

    2018-01-25

    More than 7 billion visits are made by patients to ambulatory services every year in mainland China. Healthcare-associated infections are becoming a new source of illness for outpatients. Little is known about infection prevention, control structure, resources available, and basic practices in outpatient settings. In 2014, we conducted a multisite survey. Five provinces were invited to participate based on geographic dispersion. Self-assessment questionnaires regarding the structure, infrastructure, apparatus and materials, and basic activities of infection prevention and control were issued to 25 hospitals and 5 community health centers in each province. A weight was assigned to each question according to its importance. Overall, 146 of 150 facilities (97.3%) participated in this study. The average survey score was 77.6 (95% confidence interval 75.7-79.5) and varied significantly between the different gross domestic product areas (P infection prevention and control was practiced consistently, although there were lapses in some areas. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Comprehensive Diabetes and Non-Communicable Disease Educator in the Low-Resource Settings.

    Science.gov (United States)

    Bhattarai, M D

    2016-01-01

    The role of self-management education in diabetes and other major non-communicable diseases is clearly evident. To take care of and educate people with diabetes and other major NCD under the supervision of medical professionals and for education of other health care professionals, Comprehensive Diabetes and NCD Educators are needed in the routine service in peripheral health clinics and hospitals. The areas of training of CDNCD educator should match with the cost-effective interventions for diabetes and other major NCD that are feasible and planned for implementation in primary care in the low resource settings. Most of such interventions are part of diabetes education as required for Diabetes Self-Management Education programmes and traditional Diabetes Educator. The addition of use of inhaled steroids and bronchodilator in chronic respiratory disease and identification of presenting features of cancer, also required for many people with diabetes with various such common co-morbidities, will complete the areas of training of traditional Diabetes Educator as that of CDNCD Educator. Staff nurse and health assistants, who are as such already providing routine clinical service to all patients including with diabetes and major NCD in peripheral health clinics and hospitals, are most appropriate for CDNCD Educator training. The training of CDNCD Educator, like that of traditional Diabetes Educator, requires fulfilment of sufficient hours of practical work experience under supervision and achievement of the essential competencies entailing at least 6 month or more of intensive training schedules to be eligible to appear in its final certifying examination.

  17. Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

    Science.gov (United States)

    Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

    2017-09-01

    The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

  18. The introduction of syphilis point of care tests in resource limited settings.

    Science.gov (United States)

    Marks, Michael; Mabey, David Cw

    2017-04-01

    Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

  19. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

    Directory of Open Access Journals (Sweden)

    Kululanga Lucy I

    2011-12-01

    Full Text Available Abstract Background Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city

  20. Economic Costs of Patients Attending the Prevention of Mother-to- Child Transmission of HIV/AIDS (PMTCT Services in Ethiopia: Urban-Rural Settings

    Directory of Open Access Journals (Sweden)

    Elias Asfaw Zegeye

    2016-08-01

    Full Text Available Economic analyses of patients’ costs are pertinent to improve effective healthcare services including the prevention of mother-to-child HIV/AIDS transmission (PMTCT. This study assessed the direct and non-direct medical costs borne by pregnant women attending PMTCT services in urban (high-HIV prevalence and rural (low-HIV prevalence settings, in Ethiopia. Patient-level direct medical costs and direct non-medical data were collected from HIV-positive pregnant women in six regions. The cost estimation was classified as direct medical (service fee, drugs and laboratory and direct non-medical (food, transportation and accommodation. The mean direct medical expense per patient per year was Ethiopian birr (ETB 746 (US$ 38 in the urban settings, as compared to ETB 368 (US$ 19 in the rural settings. On average, a pregnant woman from urban and rural catchments incurred direct non-medical costs of ETB 6,435 (US$ 327 and ETB 2,154 (US$ 110 per year, respectively. On average, non-medical costs of friend/relative/guardian were ETB 2,595 (US$ 132 and ETB 2,919 (US$ 148.39 in the urban and rural settings, respectively. Although the PMTCT service is provided free of charge, HIV-positive pregnant women and infant pairs still face a substantial amount of out-of-pocket spending due to direct medical and non-medical costs.

  1. The Impact of Family Setting and Local Opportunities on Leaving Home and Migration Destinations of Rural Youths, The Netherlands 1860-1940

    NARCIS (Netherlands)

    Mönkediek, Bastian; Kok, Jan; Mandemakers, Kees

    2016-01-01

    In this article we aim to study how Dutch children’s individual destinies result from the complex interplay of family setting and local conditions in a rural environment. We focus on their final move from the parental home, and we will analyse not only timing and incidence of leaving, but also the

  2. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana.

    Science.gov (United States)

    Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

    2016-09-21

    Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

  3. Rural food insecurity and poverty mappings and their linkage with water resources in the Limpopo River Basin

    Science.gov (United States)

    Magombeyi, M. S.; Taigbenu, A. E.; Barron, J.

    2016-04-01

    The mappings of poverty and food insecurity were carried out for the rural districts of the four riparian countries (Botswana, Mozambique, South Africa and Zimbabwe) of the Limpopo river basin using the results of national surveys that were conducted between 2003 and 2013. The analysis shows lower range of food insecure persons (0-40%) than poverty stricken persons (0-95%) that is attributable to enhanced government and non-government food safety networks in the basin countries, the dynamic and transitory nature of food insecurity which depends on the timings of the surveys in relation to harvests, markets and food prices, and the limited dimension of food insecurity in relation to poverty which tends to be a more structural and pervasive socio-economic condition. The usefulness of this study in influencing policies and strategies targeted at alleviating poverty and improving rural livelihoods lies with using food insecurity mappings to address short-term socio-economic conditions and poverty mappings to address more structural and long-term deprivations. Using the poverty line of 1.25/day per person (2008-2013) in the basin, Zimbabwe had the highest percentage of 68.7% of its rural population classified as poor, followed by Mozambique with 68.2%, South Africa with 56.1% and Botswana with 20%. While average poverty reduction of 6.4% was observed between 2003 and 2009 in Botswana, its population growth of 20.1% indicated no real poverty reduction. Similar observations are made about Mozambique and Zimbabwe where population growth outstripped poverty reductions. In contrast, both average poverty levels and population increased by 4.3% and 11%, respectively, in South Africa from 2007 to 2010. While areas of high food insecurity and poverty consistently coincide with low water availability, it does not indicate a simple cause-effect relationship between water, poverty and food insecurity. With limited water resources, rural folks in the basin require stronger

  4. Parkia biglobosa as an economic resource for rural women in south-western Burkina Faso

    DEFF Research Database (Denmark)

    Andersen, Mette-Helene Kronborg; Lykke, Anne Mette; Ilboudo, Jean-Baptiste

    2013-01-01

    An approach for commercialising a product from Parkia biglobosa in order to improve the economic situation of rural women in south-western Burkina Faso was explored. Income is generated from sales of a derivative from the fermented seeds called soumbala. About one fifth of the women (18%) were...... involved in the sale of soumbala, and 34% of those not participating in soumbala sales were interested in getting involved, suggesting that there is a basis for expanding the soumbala trade. Possible factors that could motivate more women to participate in soumbala sales were sustainability, sowing...... of seeds and amount of seeds harvested per year. In addition, 90% of the informants managed Parkia sustainably, suggesting that enhanced exploitation of Parkia for commercial purposes can be ecologically sustainable if present management techniques are maintained. The results suggest that Parkia have...

  5. Rethinking the cost of healthcare in low-resource settings: the value of time-driven activity-based costing.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Warsh, Jonathan; Browning, Micaela; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Rhatigan, Joseph; Leandre, Fernet; Kaplan, Robert

    2016-01-01

    Low-income and middle-income countries account for over 80% of the world's infectious disease burden, but measuring the human, equipment and facility resources used to treat the patients. The benefits of this approach are numerous: fewer assumptions need to be made, heterogeneity in expenditures can be studied, service delivery can be modelled and streamlined and stronger linkages can be established between resource allocation and health outcomes. TDABC has demonstrated significant benefits for improving health service delivery in high-income countries but has yet to be adopted in resource-limited settings. We provide an illustrative case study of its application throughout a network of hospitals in Haiti, as well as a simplified framework for policymakers to apply this approach in low-resource settings around the world.

  6. Treating 4,000 diabetic patients in Cambodia, a high-prevalence but resource-limited setting: a 5-year study

    Directory of Open Access Journals (Sweden)

    Keuky Lim

    2009-07-01

    Full Text Available Abstract Background Despite the worldwide increasing burden of diabetes, there has been no corresponding scale-up of treatment in developing countries and limited evidence of program effectiveness. In 2002, in collaboration with the Ministry of Health of Cambodia, Médecins Sans Frontières initiated an outpatient program of subsidized diabetic care in two hospital-based chronic disease clinics in rural settings. We aimed to describe the outcomes of newly and previously diagnosed diabetic patients enrolled from 2002 to 2008. Methods We calculated the mean and proportion of patients who met the recommended treatment targets, and the drop from baseline values for random blood glucose (RBG, hemoglobin A1c (HbA1c, blood pressure (BP, and body mass index (BMI at regular intervals. Analysis was restricted to patients not lost to follow-up. We used the t test to compare baseline and subsequent paired values. Results Of 4404 patients enrolled, 2,872 (65% were still in care at the time of the study, 24 (0.5% had died, and 1,508 (34% were lost tofollow-up. Median age was 53 years, 2,905 (66% were female and 4,350 (99% had type 2 diabetes. Median (interquartile range (IQR follow-up was 20 months (5 to 39.5 months. A total of 24% (51/210 of patients had a HbA1c concentration of P P P P 2 after 1 year. Factors associated with loss to follow-up were male sex, age >60 years, living outside the province, normal BMI on admission, high RBG on last visit, and coming late for the last consultation. Conclusion Significant and clinically important improvements in glycemia and BP were observed, but a relatively low proportion of diabetic patients reached treatment targets. These results and the high loss to follow-up rate highlight the challenges of delivering diabetic care in rural, resource-limited settings.

  7. Climate governance, rural livelihoods and social networks : Using the ecosystem service governance approach to analyse climate adaptation and resource conflict resolution in Kenya

    OpenAIRE

    Wambui Ngaruiya, G.

    2014-01-01

    No doubt impacts from climate change on natural resources threaten achievement of the Millennium Development Goals. But of more concern is the controversial “climate-conflicts nexus” theory which paints a grim future as resources become scarcer in Africa. Though some scientists believe that this popular theory is biased, there is an evident knowledge gap on successful adaptation strategies currently sustaining rural livelihoods across the Sub-Sahara. Moreover, poorly coordinated “adaptation e...

  8. Global women's health is more than maternal health: a review of gynecology care needs in low-resource settings.

    Science.gov (United States)

    Robinson, Nuriya; Stoffel, Cynthia; Haider, Sadia

    2015-03-01

    Women's health care efforts in low-resource settings are often focused primarily on prenatal and obstetric care. However, women all over the world experience significant morbidity and mortality related to cervical cancer, sexually transmitted infections, and urogynecologic conditions as well as gynecologic care provision including insufficient and ineffective family planning services. Health care providers with an interest in clinical care in low-resource settings should be aware of the scope of the burden of gynecologic issues and strategies in place to combat the problems. This review article discusses the important concerns both in the developing world as well as highlights similar disparities that exist in the United States by women's age, race and ethnicity, and socioeconomic status. Ultimately, this review article aims to inform and update health care providers on critical gynecologic issues in low-resource settings.

  9. Creating Online Training for Procedures in Global Health with PEARLS (Procedural Education for Adaptation to Resource-Limited Settings).

    Science.gov (United States)

    Bensman, Rachel S; Slusher, Tina M; Butteris, Sabrina M; Pitt, Michael B; On Behalf Of The Sugar Pearls Investigators; Becker, Amanda; Desai, Brinda; George, Alisha; Hagen, Scott; Kiragu, Andrew; Johannsen, Ron; Miller, Kathleen; Rule, Amy; Webber, Sarah

    2017-11-01

    The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

  10. Scaling-up Sustainable Land Management Practices through the Concept of the Rural Resource Centre: Reconciling Farmers' Interests with Research Agendas

    Science.gov (United States)

    Takoutsing, Bertin; Tchoundjeu, Zacharie; Degrande, Ann; Asaah, Ebenezar; Tsobeng, Alain

    2014-01-01

    Purpose: Formal agricultural research has generated vast amount of knowledge and fundamental insights on land management, but their low adoption has been attributed to the use of public extension approach. This research aims to address whether and how full participation of farmers through the concept of Rural Resource Centre (RRC) provides new…

  11. 'Rich man poor man' - inter-household and community factors influencing the use of wild plant resources amongst rural households in South Africa

    NARCIS (Netherlands)

    Cocks, M.L.; Bangay, L.; Shackleton, C.M.; Wiersum, K.F.

    2008-01-01

    Biodiversity is recognised as an integral part of people's daily livelihoods. This study therefore aims to understand the use of NTFPs at an intricate level by determining what role these resources fulfil in six rural villages and 1011 households' livelihoods. It examines how the use of NTFPs are

  12. A Comparison Study of Single-Parent Families Living on Remote, Rural Islands and in Urban Settings in Japan.

    Science.gov (United States)

    Hiratani, Yuko; Hohashi, Naohiro

    2016-06-01

    Nursing interventions that aim to enhance the family environment are necessary to help single-parent families with children to improve family functioning. The cultural and social factors that are unique to Japan's remote islands should be considered to assess the influence of this unique setting on family functioning. The objectives of this study were to evaluate the family functioning of child-rearing single-parent families living in different environments and to investigate the association between family demographics and family functioning. A self-administered questionnaire, the Japanese version of the Survey of Family Environment, was used to evaluate the sufficiency of family functioning. The participants were families with children enrolled in nurseries and kindergartens who were either living in remote, rural islands or in an urban city on the mainland in Japan. Family functioning was significantly higher for single-parent families living on the islands than for those living in the city in terms of media use, participation in community activities, and the collaboration of family members in child-rearing. Family functioning of single-parent families correlated significantly with household income, the parent's gender, family members' health, and family life cycle. Single-parent families living on Japanese offshore islands maintained family functioning through mutual support and the effective use of information technology. Nevertheless, single-parent families require additional support to improve their healthcare and financial situations.

  13. An evaluation of the impact of a restrictive retail food environment intervention in a rural community pharmacy setting

    Directory of Open Access Journals (Sweden)

    Leia M. Minaker

    2016-07-01

    Full Text Available Abstract Background Sugar-sweetened beverage consumption is associated with morbidity and mortality. The retail food environment influences food and beverage purchasing and consumption. This study assesses the impact of a community pharmacy’s removal of sweet beverages on overall community sales of carbonated soft drinks (CSD in a rural setting. We also examined whether the pharmacy intervention affected CSD sales in the town’s other food stores. Methods Weekly CSD sales data were acquired from the three food retailers in the town of Baddeck, Nova Scotia (January 1, 2013 to May 8, 2015, n = 123 weeks. Autoregressive integrated moving average (ARIMA analysis was used to analyse the interrupted time series data and estimate the impact of the pharmacy intervention (September 11, 2014 on overall CSD sales at the community level. Data were analysed in 2015. Results Before the intervention, the pharmacy accounted for approximately 6 % of CSD sales in the community. After the intervention, declines in total weekly average community CSD sales were not statistically significantly. CSD sales at the other food stores did not increase after the pharmacy intervention. Conclusions This study was among the first to examine the impact of a restrictive retail food environment intervention, and found a non-significant decline in CSD sales at the community level. It is the first study to examine a retail food environment intervention in a community pharmacy. Pharmacies may have an important role to play in creating healthy retail food environments.

  14. Role of Papanicolaou Smear in the Diagnosis of Pathologic Flora in Asymptomatic Patients in Rural Health Care Set-Up

    Directory of Open Access Journals (Sweden)

    Siona Sabu

    2017-10-01

    Full Text Available Introduction: The infections of female genital tract, especially the cervix are asymptomatic in presentation and pose a diagnostic challenge. Vaginal infections can lead to cytoplasmic and nuclear abnormalities in the epithelial cells. Additionally, these infections could augur an inflammatory response of varying nature. The most common flora include Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, Human Papilloma Virus (HPV, Human Herpes Virus (HHV and Actinomyces sp. Aim: This study seeks to measure the role of Papanicolaou smear in detection of pathologic flora: Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, HPV, HHV and Actinomyces; in a rural health care set up amongst women in the reproductive and menopausal age group. Materials and Methods: A retrospective study of cervical smears by Papanicolaou method, over a 14 month period was carried out in a tertiary care centre including a total number of 150 patients. Results: Of the total of 150 samples examined, Candida species was the most frequently detected (8.7% followed by Trichomonas vaginalis (5.3% and Gardnerella vaginalis species (4.7%. HPV-induced changes were noted in a mere 2% of cases. Actinomyces species was noted in less than 1% of cases. Conclusion: The Papanicolaou test for examining cervical smear has definite uses in detecting vaginal microorganisms. Apart from detection of the usual pathogenic flora, the test has utility in defining the degree of inflammation and additional reparative changes.

  15. Extensive diversity in the allelic frequency of Plasmodium falciparum merozoite surface proteins and glutamate-rich protein in rural and urban settings of southwestern Nigeria.

    Science.gov (United States)

    Funwei, Roland I; Thomas, Bolaji N; Falade, Catherine O; Ojurongbe, Olusola

    2018-01-02

    Nigeria carries a high burden of malaria which makes continuous surveillance for current information on genetic diversity imperative. In this study, the merozoite surface proteins (msp-1, msp-2) and glutamate-rich protein (glurp) of Plasmodium falciparum collected from two communities representing rural and urban settings in Ibadan, southwestern Nigeria were analysed. A total of 511 febrile children, aged 3-59 months, whose parents/guardians provided informed consent, were recruited into the study. Capillary blood was obtained for malaria rapid diagnostic test, thick blood smears for parasite count and blood spots on filter paper for molecular analysis. Three-hundred and nine samples were successfully genotyped for msp-1, msp-2 and glurp genes. The allelic distribution of the three genes was not significantly different in the rural and urban communities. R033 and 3D7 were the most prevalent alleles in both rural and urban communities for msp-1 and msp-2, respectively. Eleven of glurp RII region genotypes, coded I-XII, with sizes ranging from 500 to 1100 base pairs were detected in the rural setting. Genotype XI (1000-1050 bp) had the highest prevalence of 41.5 and 38.5% in rural and urban settings, respectively. Overall, 82.1 and 70.0% of samples had multiclonal infection with msp-1 gene resulting in a mean multiplicity of infection (MOI) of 2.8 and 2.6 for rural and urban samples, respectively. Msp-1 and msp-2 genes displayed higher levels of diversity and higher MOI rates than the glurp gene. Significant genetic diversity was observed between rural and urban parasite populations in Ibadan, southwestern Nigeria. The results of this study show that malaria transmission intensity in these regions is still high. No significant difference was observed between rural and urban settings, except for a completely different msp-1 allele, compared to previous reports, thereby confirming the changing face of malaria transmission in these communities. This study provides

  16. Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings.

    Science.gov (United States)

    Ralston, Mark E; Myatt, Mark A

    2016-01-01

    A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers. To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries. This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design. Locations with high prevalence of acute and chronic malnutrition. A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values). Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined. Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision. Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and

  17. A Low-Pressure Oxygen Storage System for Oxygen Supply in Low-Resource Settings.

    Science.gov (United States)

    Rassool, Roger P; Sobott, Bryn A; Peake, David J; Mutetire, Bagayana S; Moschovis, Peter P; Black, Jim Fp

    2017-12-01

    Widespread access to medical oxygen would reduce global pneumonia mortality. Oxygen concentrators are one proposed solution, but they have limitations, in particular vulnerability to electricity fluctuations and failure during blackouts. The low-pressure oxygen storage system addresses these limitations in low-resource settings. This study reports testing of the system in Melbourne, Australia, and nonclinical field testing in Mbarara, Uganda. The system included a power-conditioning unit, a standard oxygen concentrator, and an oxygen store. In Melbourne, pressure and flows were monitored during cycles of filling/emptying, with forced voltage fluctuations. The bladders were tested by increasing pressure until they ruptured. In Mbarara, the system was tested by accelerated cycles of filling/emptying and then run on grid power for 30 d. The low-pressure oxygen storage system performed well, including sustaining a pressure approximately twice the standard working pressure before rupture of the outer bag. Flow of 1.2 L/min was continuously maintained to a simulated patient during 30 d on grid power, despite power failures totaling 2.9% of the total time, with durations of 1-176 min (mean 36.2, median 18.5). The low-pressure oxygen storage system was robust and durable, with accelerated testing equivalent to at least 2 y of operation revealing no visible signs of imminent failure. Despite power cuts, the system continuously provided oxygen, equivalent to the treatment of one child, for 30 d under typical power conditions for sub-Saharan Africa. The low-pressure oxygen storage system is ready for clinical field trials. Copyright © 2017 by Daedalus Enterprises.

  18. Feasibility of Using Mobile ECG Recording Technology to Detect Atrial Fibrillation in Low-Resource Settings.

    Science.gov (United States)

    Evans, Grahame F; Shirk, Arianna; Muturi, Peter; Soliman, Elsayed Z

    2017-12-01

    Screening for atrial fibrillation (AF), a major risk factor for stroke that is on the rise in Africa, is becoming increasingly critical. This study sought to examine the feasibility of using mobile electrocardiogram (ECG) recording technology to detect AF. In this prospective observational study, we used a mobile ECG recorder to screen 50 African adults (66% women; mean age 54.3 ± 20.5 years) attending Kijabe Hospital (Kijabe, Kenya). Five hospital health providers involved in this study's data collection process also completed a self-administered survey to obtain information on their access to the Internet and mobile devices, both factors necessary to implement ECG mobile technology. Outcome measures included feasibility (completion of the study and recruitment of the patients on the planned study time frame) and the yield of the screening by the mobile ECG technology (ability to detect previously undiagnosed AF). Patients were recruited in a 2-week period as planned; only 1 of the 51 patients approached refused to participate (98% acceptance rate). All of the 50 patients who agreed to participate completed the test and produced readable ECGs (100% study completion rate). ECG tracings of 4 of the 50 patients who completed the study showed AF (8% AF yield), and none had been previously diagnosed with AF. When asked about continuous access to Internet and personal mobile devices, almost all of the health care providers surveyed answered affirmatively. Using mobile ECG technology in screening for AF in low-resource settings is feasible, and can detect a significant proportion of AF cases that will otherwise go undiagnosed. Further study is needed to examine the cost-effectiveness of this approach for detection of AF and its effect on reducing the risk of stroke in developing countries. Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  19. Strategic establishment of an International Pharmacology Specialty Laboratory in a resource-limited setting.

    Science.gov (United States)

    Mtisi, Takudzwa J; Maponga, Charles; Monera-Penduka, Tsitsi G; Mudzviti, Tinashe; Chagwena, Dexter; Makita-Chingombe, Faithful; DiFranchesco, Robin; Morse, Gene D

    2018-01-01

    A growing number of drug development studies that include pharmacokinetic evaluations are conducted in regions lacking a specialised pharmacology laboratory. This necessitated the development of an International Pharmacology Specialty Laboratory (IPSL) in Zimbabwe. The aim of this article is to describe the development of an IPSL in Zimbabwe. The IPSL was developed collaboratively by the University of Zimbabwe and the University at Buffalo Center for Integrated Global Biomedical Sciences. Key stages included infrastructure development, establishment of quality management systems and collaborative mentorship in clinical pharmacology study design and chromatographic assay development and validation. Two high performance liquid chromatography instruments were donated by an instrument manufacturer and a contract research organisation. Laboratory space was acquired through association with the Zimbabwe national drug regulatory authority. Operational policies, standard operating procedures and a document control system were established. Scientists and technicians were trained in aspects relevant to IPSL operations. A high-performance liquid chromatography method for nevirapine was developed with the guidance of the Clinical Pharmacology Quality Assurance programme and approved by the assay method review programme. The University of Zimbabwe IPSL is engaged with the United States National Institute of Allergy and Infectious Diseases Division of AIDS research networks and is poised to begin drug assays and pharmacokinetic analyses. An IPSL has been successfully established in a resource-limited setting through the efforts of an external partnership providing technical guidance and motivated internal faculty and staff. Strategic partnerships were beneficial in navigating challenges leading to laboratory development and training new investigators. The IPSL is now engaged in clinical pharmacology research.

  20. Risk factors and perinatal outcome of uterine rupture in a low-resource setting.

    Science.gov (United States)

    Igwegbe, Anthony Osita; Eleje, George Uchenna; Udegbunam, Onyebuchi Izuchukwu

    2013-11-01

    Uterine rupture has continued to be a catastrophic feature of obstetric practice especially in the low-resource settings. This study determined the incidence, predisposing factors, treatment options and feto-maternal outcome of ruptured uterus. A 10-year retrolective study of all cases of uterine ruptures that were managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria between 1st January, 2001 and 31st December, 2010 was undertaken. The proforma was initially used for data collection, which was transferred to a data sheet before entering them into the Epi-info software. Analysis was done using Epi info 2008 (version 3.5.1). Out of 5,585 deliveries over the study period, 47 had uterine rupture, giving an incidence of 0.84% or 1 in 119 deliveries. All the patients were multiparous and majority (63.8%) was unbooked. Traumatic (iatrogenic) rupture predominated (72.1%). Uterine repair with (55.8%) or without (34.9%) bilateral tubal ligation was the commonest surgery performed. Case fatality rate was 16.3%, while the perinatal mortality rate was 88.4%. Average duration of hospitalization following uterine rupture was 10.3 days. Uterine rupture constituted a major obstetric emergency in the study hospital and its environs. The incidence, maternal and perinatal mortalities were high. The traumatic/iatrogenic ruptures constituted the majority of cases, hence, majority of the cases are preventable. There is therefore a dire need for education of our women on health-related issues, utilization of available health facilities, adequate supervision of labour and provision of facilities for emergency obstetric care.

  1. Natural resource managers: their role in international tourism and rural development

    Science.gov (United States)

    Arthur W. Magill

    1995-01-01

    Though our wildlands are important destinations for international visitors, little is known about their activities or influence on local economies. This paper encourages resource managers to assume leadership for developing an international tourism strategy for our wildlands by packaging lesser known wildland attractions as regional complexes to attract tourists.

  2. Food First Resource Guide: Documentation on the Roots of World Hunger and Rural Poverty.

    Science.gov (United States)

    Institute for Food and Development Policy, San Francisco, CA.

    This guide reviews resources used to develop the analysis of world hunger in "Food First: Beyond the Myth of Scarcity," Houghton Mifflin, 1977. The objectives are to help people understand the economic and political factors that contribute to food deprivation, document this analysis with credible sources, and inform high school, college, and…

  3. Geographical Information System, to support the management of water resource in rural basins

    International Nuclear Information System (INIS)

    Correa V, Paula Lizet; Velez U, Jaime Ignacio

    2002-01-01

    The implementation of a GIS support system for the management of water resources at a catchment scale is presented. This system is based upon the hidroSIG java software, which was developed within the Atlas Hidrologico de Colombia project. In the GIS database was included all the information required by the environmental authorities in charge of the water resources management, offering the possibility of displaying, consulting and evaluating different scenarios that could help to make decisions upon the assignation and use of the resource. As a first application of the GIS, a 35 km 2 river basin located in Rionegro Plateau was used. The applied methodology was developed in the following stages: gathering of the available information, processing of the digital topography, study of the dynamics of the climate in the zone, evaluation of the water availability, and evaluation of the demand and water balance. The results obtained show the importance of having continuous and articulated spatial information in a GIS, so permanent update of the information is allowed. It is concluded that the implemented GIS constitutes a valuable tool for planning and management of the hydric resource within a hydrographic basin

  4. Improving maternal and neonatal departments in high and low resource settings: the opinion of local health providers.

    Science.gov (United States)

    Trevisanuto, Daniele; Bavuusuren, Bayasgalantai; Wickramasinghe, Chandani S; Dharmaratne, Saminda M; Doglioni, Nicoletta; Giordan, Alessia; Zanardo, Vincenzo; Carlo, Waldemar A

    2011-10-01

    We compared local health caregivers' opinions regarding the priority areas for improving the maternal and neonatal departments in low and high resource countries. Personnel involved in maternal and neonatal care operating in level III, teaching hospitals in four countries (Sri Lanka, Mongolia, USA, and Italy) were asked to fill out an anonymous, written questionnaire. The questionnaire was completed by 1112 out of 1265 (87.9%) participants. "Personnel's education" was classified as the first most important intervention by health providers working in high (49.0%) as well as in low (29.9%) resource countries, respectively. Improvement in salary, equipment, internet access, and organizational protocols were considered as the most important interventions by a significantly larger percentage of personnel from low resource countries in comparison with those from high resource countries. Health providers from high resource countries considered organizational aspects (to define specific roles and responsibilities) as a priority more frequently than their colleagues from low resource countries. Although education of personnel was valued as the highest priority for improving maternal and neonatal departments there are substantial differences in priorities associated with the working setting. Local caregivers' opinion may contribute to better design interventions in settings with high or limited resources.

  5. Seasonality, water use and community management of water systems in rural settings: Qualitative evidence from Ghana, Kenya, and Zambia.

    Science.gov (United States)

    Kelly, Emma; Shields, Katherine F; Cronk, Ryan; Lee, Kristen; Behnke, Nikki; Klug, Tori; Bartram, Jamie

    2018-07-01

    The sustainability of rural, community-managed water systems in sub-Saharan Africa depends in part on the ability of local water committees to repair breakdowns and carry out the operation and maintenance (O&M) of the system. Much of sub-Saharan Africa has two distinct seasons that affect the availability of water sources and how people use water. Little is known about how seasonality affects water system management. This qualitative study is based on 320 interviews and focus group discussions and examines the effects of season on community water use and management in Ghana, Kenya and Zambia. Participants revealed that seasonality affects water availability, water system breakdowns, resource mobilization, committee activity, and external support availability. In the rainy season, participants typically reported spending less time and money on water collection because rainwater harvesting and seasonal streams, ponds, wells and reservoirs are available. In the dry season, people used improved groundwater sources more often and spent more money and time collecting water. Although seasonal changes in household water demand and use have been examined previously, our data suggest that seasonality also influences community management through differential water system use, system breakdowns and management characteristics. We found that water committees generally have less money, time and access to external support during the rainy season, making them less able to carry out O&M. Our results suggest that community engagement should take place over a long period of time so that seasonal patterns in management can be understood and incorporated into water committee training. External support actors should make a more targeted effort to understand the cultural and economic patterns in a community in order to train committees with appropriate management strategies. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

    Science.gov (United States)

    Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

    2017-05-01

    Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

  7. A global health delivery framework approach to epilepsy care in resource-limited settings.

    Science.gov (United States)

    Cochran, Maggie F; Berkowitz, Aaron L

    2015-11-15

    The Global Health Delivery (GHD) framework (Farmer, Kim, and Porter, Lancet 2013;382:1060-69) allows for the analysis of health care delivery systems along four axes: a care delivery value chain that incorporates prevention, diagnosis, and treatment of a medical condition; shared delivery infrastructure that integrates care within existing healthcare delivery systems; alignment of care delivery with local context; and generation of economic growth and social development through the health care delivery system. Here, we apply the GHD framework to epilepsy care in rural regions of low- and middle-income countries (LMIC) where there are few or no neurologists. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Distribution, utilization structure and potential of biomass resources in rural China: With special references of crop residues

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H [Laboratory of Quantitative Vegetation Ecology, Institute of Botany, Chinese Academy of Sciences, 20 Nanxincun, Xiangshan, Beijing 100093 (China); Graduate University of Chinese Academy of Sciences, Beijing 100049 (China); Jiang, G M [Laboratory of Quantitative Vegetation Ecology, Institute of Botany, Chinese Academy of Sciences, 20 Nanxincun, Xiangshan, Beijing 100093 (China); Agronomy Department, Shandong Agricultural University, Tai' an 271018, Shandong Province (China); Zhuang, H Y [National Bio-Energy CO., LTD, No. 26B, Financial Street, Xicheng District, Beijing 100032 (China); Shandong Academy of Sciences, No. 19, Keyuan Road, Ji' nan 250014, Shandong Province (China); Wang, K J [Agronomy Department, Shandong Agricultural University, Tai' an 271018, Shandong Province (China)

    2008-06-15

    As the largest developing country in the world, China is urgently in short of energy and natural resources. However, biological resources such as crop residues are burnt in the field, which cause serious environmental pollution. Still it is not clear how much storage and potential of these huge crop residues are in China. This paper firstly reported the distribution, utilization structure and potential of crop biomass and provided the tangible information of crop residues in rural China through careful collecting and recalculating data. From 1995 to 2005, China produces some 630 million tons of crop residues per year, 50% of which comes from east and central south of China. The amount of crop residues is 1.3 times of the total yield of crops, 2 times of the total fodder of grassland, which covers 41% of China's territory. Crop residues of corn, wheat and rice amounted to 239, 137 and 116 million tons, respectively, accounting for nearly 80% of the total crop residues. Unfortunately, the utilizing structure is seriously improper for such abundant biomass resources. Although 23% of the crop residues are used for forage, 4% for industry materials and 0.5% for biogas, the large parts are used with lower efficiency or wasted, with 37% being directly combusted by farmers, 15% lost during collection and the rest 20.5% discarded or directly burnt in the field. Reasonable adjustment of the utilizing pattern and popularization of the recycling agriculture are essential out-ways for residues, with the development of the forage industry being the breakthrough point. We suggested that utilizing the abandoned 20.5% of the total residues for forage and combining agriculture and stock raising can greatly improve the farm system and cut down fertilizer pollution. Through the development of forage industries, the use efficiency of crop residues could be largely enhanced. Commercializing and popularizing technologies of biomass gasification and liquefaction might be substitute

  9. Modelling the impact of antiretroviral use in resource-poor settings.

    Directory of Open Access Journals (Sweden)

    Rebecca F Baggaley

    2006-04-01

    Full Text Available BACKGROUND: The anticipated scale-up of antiretroviral therapy (ART in high-prevalence, resource-constrained settings requires operational research to guide policy on the design of treatment programmes. Mathematical models can explore the potential impacts of various treatment strategies, including timing of treatment initiation and provision of laboratory monitoring facilities, to complement evidence from pilot programmes. METHODS AND FINDINGS: A deterministic model of HIV transmission incorporating ART and stratifying infection progression into stages was constructed. The impact of ART was evaluated for various scenarios and treatment strategies, with different levels of coverage, patient eligibility, and other parameter values. These strategies included the provision of laboratory facilities that perform CD4 counts and viral load testing, and the timing of the stage of infection at which treatment is initiated. In our analysis, unlimited ART provision initiated at late-stage infection (AIDS increased prevalence of HIV infection. The effect of additionally treating pre-AIDS patients depended on the behaviour change of treated patients. Different coverage levels for ART do not affect benefits such as life-years gained per person-year of treatment and have minimal effect on infections averted when treating AIDS patients only. Scaling up treatment of pre-AIDS patients resulted in more infections being averted per person-year of treatment, but the absolute number of infections averted remained small. As coverage increased in the models, the emergence and risk of spread of drug resistance increased. Withdrawal of failing treatment (clinical resurgence of symptoms, immunologic (CD4 count decline, or virologic failure (viral rebound increased the number of infected individuals who could benefit from ART, but effectiveness per person is compromised. Only withdrawal at a very early stage of treatment failure, soon after viral rebound, would have a

  10. Improving patient safety in the radiation oncology setting through crew resource management.

    Science.gov (United States)

    Sundararaman, Srinath; Babbo, Angela E; Brown, John A; Doss, Richard

    2014-01-01

    This paper demonstrates how the communication patterns and protocol rigors of a methodology called crew resource management (CRM) can be adapted to a radiation oncology environment to create a culture of patient safety. CRM training was introduced to our comprehensive radiation oncology department in the autumn of 2009. With 34 full-time equivalent staff, we see 100-125 patients daily on 2 hospital campuses. We were assisted by a consulting group with considerable experience in helping hospitals incorporate CRM principles and practices. Implementation steps included developing change initiative skills for key leaders, providing training in teamwork and communications, creating site-specific tools for safety and efficiency, and collecting data to document results. Our goals were to improve patient safety, teamwork, communication, and efficiency through the use of tools we developed that emphasized teamwork and communication, cross-checking, and routinizing specific protocols. Our CRM plan relies on the following 4 pillars: patient identification methods; "pause for the cause"; enabling all staff to halt treatment and question decisions; and daily morning meetings. We discuss some of the hurdles to change we encountered. Our safety record has improved. Our near-miss rate before CRM implementation averaged 11 per month; our near-miss rate currently averages 1.2 per month. In the 5 years prior to CRM implementation, we experienced 1 treatment deviation per year, although none rose to the level of "mis-administration." Since implementing CRM, our current patient treatment setup and delivery process has eliminated all treatment deviations. Our practices have identified situations where ambiguity or conflicting documentation could have resulted in inappropriate treatment or treatment inefficiencies. Our staff members have developed an extraordinary sense of teamwork combined with a high degree of personal responsibility to assure patient safety and have spoken up when

  11. Determinants and management outcomes of pelvic organ prolapse in a low resource setting.

    Science.gov (United States)

    Eleje, Gu; Udegbunam, Oi; Ofojebe, Cj; Adichie, Cv

    2014-09-01

    The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary. The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse. A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software. There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up. The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative

  12. Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting

    NARCIS (Netherlands)

    van Zyl, Gert Uves; van Mens, Thijs E.; McIlleron, Helen; Zeier, Michele; Nachega, Jean B.; Decloedt, Eric; Malavazzi, Carolina; Smith, Peter; Huang, Yong; van der Merwe, Lize; Gandhi, Monica; Maartens, Gary

    2011-01-01

    In resource-limited settings, many patients, with no prior protease inhibitor (PI) treatment on a second-line, high genetic barrier, ritonavir-boosted PI-containing regimen have virologic failure. We conducted a cross-sectional survey to investigate the aetiology of virologic failure in 2 public

  13. Work-Family Conflict, Resources, and Role Set Density: Assessing Their Effects on Distress among Working Mothers

    Science.gov (United States)

    Kulik, Liat; Liberman, Gabriel

    2013-01-01

    We explored the relationships between the experience of work-family conflict and levels of distress in the family and at work among a sample of 227 Israeli working mothers. We also examined how role set density (RSD, the number of roles they perform) and personal and environmental resources are related to the women's experience of distress.…

  14. Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision

    Directory of Open Access Journals (Sweden)

    Gisore Peter

    2012-03-01

    Full Text Available Abstract Background Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities. Methods To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement. The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth and the percent of women enrolled before delivery. Results The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found. Conclusions Pregnancy

  15. Increasing natural resource rents from Farmland: A curse or a blessing for the rural poor?

    DEFF Research Database (Denmark)

    Hvid, Anna

    2015-01-01

    as a diffuse resource with low economic value, this categorization may no longer be appropriate, because demand for land is currently on the rise, and may continue to increase in the future. This study presents and discusses recent theoretical and empirical approaches to analyzing the effects of high......-value agricultural land on rent seeking and rent distribution. Results suggest that the potential for small scale farmers to organize and obtain political power determines the extent of rent seeking and rent distribution, and that while more democratic institutions may increase the share of rents going...

  16. Aged-care nurses in rural Tasmanian clinical settings more likely to think hypothetical medication error would be reported and disclosed compared to hospital and community nurses.

    Science.gov (United States)

    Carnes, Debra; Kilpatrick, Sue; Iedema, Rick

    2015-12-01

    This study aims to determine the likelihood that rural nurses perceive a hypothetical medication error would be reported in their workplace. This employs cross-sectional survey using hypothetical error scenario with varying levels of harm. Clinical settings in rural Tasmania. Participants were 116 eligible surveys received from registered and enrolled nurses. Frequency of responses indicating the likelihood that severe, moderate and near miss (no harm) scenario would 'always' be reported or disclosed. Eighty per cent of nurses viewed a severe error would 'always' be reported, 64.8% a moderate error and 45.7% a near-miss error. In regards to disclosure, 54.7% felt this was 'always' likely to occur for a severe error, 44.8% for a moderate error and 26.4% for a near miss. Across all levels of severity, aged-care nurses were more likely than nurses in other settings to view error to 'always' be reported (ranging from 72-96%, P = 0.010 to 0.042,) and disclosed (68-88%, P = 0.000). Those in a management role were more likely to view error to 'always' be disclosed compared to those in a clinical role (50-77.3%, P = 0.008-0.024). Further research in rural clinical settings is needed to improve the understanding of error management and disclosure. © 2015 The Authors. Australian Journal of Rural Health published by Wiley Publishing Asia Pty Ltd on behalf of National Rural Health Alliance.

  17. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting

    NARCIS (Netherlands)

    Scheepers, Renée A.; Lases, Lenny S. S.; Arah, Onyebuchi A.; Heineman, Maas Jan; Lombarts, Kiki M. J. M. H.

    2017-01-01

    Purpose Physician work engagement is associated with better work performance and fewer medical errors; however, whether workengaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision

  18. Birth asphyxia and perinatal outcome in a low resourced setting in ...

    African Journals Online (AJOL)

    The main administrative problem was a delay in caesarean section due to an inadequate ... Conclusion: This audit identifies resource deficiencies. ... The hospital management must be involved in delays in CS due to staff shortages and ...

  19. Coroners' records of rural and non-rural cases of youth suicide in New South Wales.

    Science.gov (United States)

    Dudley, M; Kelk, N; Florio, T; Waters, B; Howard, J; Taylor, D

    1998-04-01

    The aim of this study is to compare the frequency of certain putative risk factors for youth suicide in New South Wales (especially use of alcohol, social class, unemployment, and internal migration) in metropolitan and rural settings. A review of 137 files for 10-19-year-old subjects judged by the Coroner to have committed suicide in 1988-1990 was carried out. One hundred and fifteen males and 21 females were identified (one subjects sex was unavailable). The male-female ratio was higher in rural (13.0) areas than non-rural (4.9 chi 2 = 12.14, p Australia, most migrated in a rural direction, and most to rural shires. Unemployment was somewhat more common among rural (38.5%) than non-rural (28.9%) subjects (chi 2 = 0.75, p = 0.39). Eleven of 50 non-rural parents of the deceased, but none of the 11 rural parents, were ranked as being in social classes 2 or 3. Alcohol consumption appeared more common in rural shires (44%) than metropolitan areas (32.9%), but this was not statistically significant. Medical services were less utilised prior to death in rural (15%) than non-rural (25%) areas (chi 2 = 1.69, p = 0.19), and a psychiatric diagnosis was recorded more commonly in non-rural areas. Incomplete coronial file data and relatively small numbers limit this study's conclusions. Male suicides, principally by firearms, predominated in rural areas. Youth firearm access remains highly relevant to rural communities. Possible trends among rural subjects toward rural migration, higher unemployment, lower social class and lower medical attendance may point to resource deprivation among this group; these matters require further investigation.

  20. Dietary Diversity is a Predictor of Acute Malnutrition in Rural but Not in Urban Settings: Evidence from Ghana

    OpenAIRE

    Amugsi, Dickson Abanimi; Mittelmark, Maurice B.; Lartey, Anna

    2014-01-01

    Aims: To document the relationships between child dietary diversity and acute malnutrition (wasting) in urban and rural Ghana, controlling for maternal, child and household socio-demographic characteristics. Study Design: Cross sectional survey Place and Duration of Study: Urban and rural Ghana, between September and November 2008. Methodology: The analysis uses data from the 2008 Ghana Demographic and Health Survey. Data on children aged 6-36 months (n = 1,187) and their...

  1. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Sheri L Lewis

    Full Text Available Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

  2. Hydrocephalic newborn in a missed advanced abdominal pregnancy - diagnostic challenges in a rural setting: A case report

    Directory of Open Access Journals (Sweden)

    Ibrahim Aliyu

    2016-01-01

    Full Text Available Advanced abdominal pregnancy (AAP is a rare event associated with high maternal and perinatal morbidity and mortality. It is commonly seen among patients in the low socioeconomic class, those with previous history of infertility, and women with pelvic infection that seems to be more in the developing countries like Nigeria. It could, however, pose a diagnostic challenge, especially in resource-limited settings where there is lack or restriction of healthcare professionals and medical diagnostic facilities; hence diagnosis is often clinical that is fraught with errors. This may result in misdiagnosis as was observed in our case. Abdominal pregnancy is often associated with congenital deformation anomalies such as talipes and spinal dysraphism. However, the case of a live newborn delivered at term with combination of talipes and hydrocephalus, which are deformation and malformation anomalies respectively is reported.

  3. The Consortium for Evidence Based Research in Rural Educational Settings (CEBRRES): Applying Collaborative Action Research as a Means of Enhancing the Development of Rural Middle School Science Teachers

    Science.gov (United States)

    Wulff, A. H.

    2006-05-01

    Kentucky ranks third in the U.S. in need of rural education attention. Rural schools in Kentucky serve nearly 40% of the total student population, and graduation rates and NAEP scores are low. A two-year pilot study is being completed addressing psychological, social, and content knowledge based constructs, as they apply to science and mathematics achievement in rural environments. The goals are to identify the key aspects of rural teachers knowledge and skills, use a framework to describe how knowledge and skills develop in the rural classroom, apply a useful model of intervention to promote teacher development and increased student learning. If proven successful the knowledge can be incorporated into the practice of current teaching and preservice pedagogical methods. The problem that was identified and addressed by CEBRRES is the high level of student disengagement and the shortage of rigorous stimulating curriculum models. The action taken was the development and implementation of model eliciting activities. Teachers at the target school were expected to utilize action research methodology to execute model-eliciting activities in the classroom, and then communicate results in forms that are useful for other teachers. Benefits to teachers included stipends, increased science content depth and breadth, support to achieve "highly qualified teacher status", extensive professional development, and technology, equipment, and supplies for their school. Survey instruments were devised to address school perceptions (61% worry that they are not doing well enough in school), future plans (80% expect to attend college vs. the current 47.5%), various self concepts, academic self concepts (23% feel that learning is difficult for them), and family self concepts. Science was identified by the students as the subject that interests them the most, followed by math, yet Kentucky ranks near the bottom of the U.S. in math and science training in the workplace. Geology

  4. Cross-sectional study of malnutrition and associated factors among school aged children in rural and urban settings of Fogera and Libo Kemkem districts, Ethiopia.

    Science.gov (United States)

    Herrador, Zaida; Sordo, Luis; Gadisa, Endalamaw; Moreno, Javier; Nieto, Javier; Benito, Agustín; Aseffa, Abraham; Cañavate, Carmen; Custodio, Estefania

    2014-01-01

    Little information is available on malnutrition-related factors among school-aged children ≥5 years in Ethiopia. This study describes the prevalence of stunting and thinness and their related factors in Libo Kemkem and Fogera, Amhara Regional State and assesses differences between urban and rural areas. In this cross-sectional study, anthropometrics and individual and household characteristics data were collected from 886 children. Height-for-age z-score for stunting and body-mass-index-for-age z-score for thinness were computed. Dietary data were collected through a 24-hour recall. Bivariate and backward stepwise multivariable statistical methods were employed to assess malnutrition-associated factors in rural and urban communities. The prevalence of stunting among school-aged children was 42.7% in rural areas and 29.2% in urban areas, while the corresponding figures for thinness were 21.6% and 20.8%. Age differences were significant in both strata. In the rural setting, fever in the previous 2 weeks (OR: 1.62; 95% CI: 1.23-2.32), consumption of food from animal sources (OR: 0.51; 95% CI: 0.29-0.91) and consumption of the family's own cattle products (OR: 0.50; 95% CI: 0.27-0.93), among others factors were significantly associated with stunting, while in the urban setting, only age (OR: 4.62; 95% CI: 2.09-10.21) and years of schooling of the person in charge of food preparation were significant (OR: 0.88; 95% CI: 0.79-0.97). Thinness was statistically associated with number of children living in the house (OR: 1.28; 95% CI: 1.03-1.60) and family rice cultivation (OR: 0.64; 95% CI: 0.41-0.99) in the rural setting, and with consumption of food from animal sources (OR: 0.26; 95% CI: 0.10-0.67) and literacy of head of household (OR: 0.24; 95% CI: 0.09-0.65) in the urban setting. The prevalence of stunting was significantly higher in rural areas, whereas no significant differences were observed for thinness. Various factors were associated with one or both types of

  5. Impact of Rotavirus Vaccine Introduction and Postintroduction Etiology of Diarrhea Requiring Hospital Admission in Haydom, Tanzania, a Rural African Setting

    Science.gov (United States)

    Platts-Mills, James A.; Amour, Caroline; Gratz, Jean; Nshama, Rosemary; Walongo, Thomas; Mujaga, Buliga; Maro, Athanasia; McMurry, Timothy L; Liu, Jie; Mduma, Estomih; Houpt, Eric R

    2017-01-01

    Abstract Background No data are available on the etiology of diarrhea requiring hospitalization after rotavirus vaccine introduction in Africa. The monovalent rotavirus vaccine was introduced in Tanzania on 1 January 2013. We performed a vaccine impact and effectiveness study as well as a quantitative polymerase chain reaction (qPCR)–based etiology study at a rural Tanzanian hospital. Methods We obtained data on admissions among children <5 years to Haydom Lutheran Hospital between 1 January 2010 and 31 December 2015 and estimated the impact of vaccine introduction on all-cause diarrhea admissions. We then performed a vaccine effectiveness study using the test-negative design. Finally, we tested diarrheal specimens during 2015 by qPCR for a broad range of enteropathogens and calculated pathogen-specific attributable fractions (AFs). Results Vaccine introduction was associated with a 44.9% (95% confidence interval [CI], 17.6%–97.4%) reduction in diarrhea admissions in 2015, as well as delay of the rotavirus season. The effectiveness of 2 doses of vaccine was 74.8% (95% CI, –8.2% to 94.1%) using an enzyme immunoassay–based case definition and 85.1% (95% CI, 26.5%–97.0%) using a qPCR-based case definition. Among 146 children enrolled in 2015, rotavirus remained the leading etiology of diarrhea requiring hospitalization (AF, 25.8% [95% CI, 24.4%–26.7%]), followed by heat-stable enterotoxin-producing Escherichia coli (AF, 18.4% [95% CI, 12.9%–21.9%]), Shigella/enteroinvasive E. coli (AF, 14.5% [95% CI, 10.2%–22.8%]), and Cryptosporidium (AF, 7.9% [95% CI, 6.2%–9.3%]). Conclusions Despite the clear impact of vaccine introduction in this setting, rotavirus remained the leading etiology of diarrhea requiring hospitalization. Further efforts to maximize vaccine coverage and improve vaccine performance in these settings are warranted. PMID:28575304

  6. The accountability for reasonableness approach to guide priority setting in health systems within limited resources

    DEFF Research Database (Denmark)

    Byskov, Jens; Marchal, Bruno; Maluka, Stephen

    2014-01-01

    : relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). METHODS...... of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications....

  7. Plasmodium falciparum genotypes diversity in symptomatic malaria of children living in an urban and a rural setting in Burkina Faso

    Directory of Open Access Journals (Sweden)

    Konaté Amadou T

    2009-06-01

    Full Text Available Abstract Background The clinical presentation of malaria, considered as the result of a complex interaction between parasite and human genetics, is described to be different between rural and urban areas. The analysis of the Plasmodium falciparum genetic diversity in children with uncomplicated malaria, living in these two different areas, may help to understand the effect of urbanization on the distribution of P. falciparum genotypes. Methods Isolates collected from 75 and 89 children with uncomplicated malaria infection living in a rural and an urban area of Burkina Faso, respectively, were analysed by a nested PCR amplification of msp1 and msp2 genes to compare P. falciparum diversity. Results The K1 allelic family was widespread in children living in the two sites, compared to other msp1 allelic families (frequency >90%. The MAD 20 allelic family of msp1 was more prevalent (p = 0.0001 in the urban (85.3% than the rural area (63.2%. In the urban area, the 3D7 alleles of msp2 were more prevalent compared to FC27 alleles, with a high frequency for the 3D7 300bp allele (>30%. The multiplicity of infection was in the range of one to six in the urban area and of one to seven in the rural area. There was no difference in the frequency of multiple infections (p = 0.6: 96.0% (95% C.I: 91.6–100 in urban versus 93.1% (95%C.I: 87.6–98.6 in rural areas. The complexity of infection increased with age [p = 0.04 (rural area, p = 0.06 (urban area]. Conclusion Urban-rural area differences were observed in some allelic families (MAD20, FC27, 3D7, suggesting a probable impact of urbanization on genetic variability of P. falciparum. This should be taken into account in the implementation of malaria control measures.

  8. Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Campbell Timothy C

    2012-09-01

    Full Text Available Abstract Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

  9. The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

    Science.gov (United States)

    Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till; Velasco-Mondragón, Héctor Eduardo; Darney, Blair Grant

    2017-08-03

    The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P human resources in primary health facilities.

  10. New indices for home nursing care resource disparities in rural and urban areas, based on geocoding and geographic distance barriers: a cross-sectional study.

    Science.gov (United States)

    Lin, Shyang-Woei; Yen, Chia-Feng; Chiu, Tzu-Ying; Chi, Wen-Chou; Liou, Tsan-Hon

    2015-10-08

    Aging in place is the crucial object of long-term care policy worldwide. Approximately 15.6-19.4% of people aged 15 or above live with a disability, and 15.3% of them have moderate or severe disabilities. The allocation of home nursing care services is therefore an important issue. Service providers in Taiwan vary substantially across regions, and between rural and urban areas. There are no appropriate indices for describing the capacity of providers that it is due to the distances from care recipients. This study therefore aimed to describe and compare distance barriers for home nursing care providers using indices of the "profit willing distance" and the "tolerance limited distance". This cross-sectional study was conducted during 2012 and 2013 using geocoding and a geographic information system to identify the distance from the providers' locations to participants' homes in urban (Taipei City) and rural (Hualien County) areas in Taiwan. Data were collected in-person by professionals in Taiwanese hospitals using the World Health Organization Disability Assessment Schedule 2.0. The indices were calculated using regression curves, and the first inflection points were determined as the points on the curves where the first and second derivatives equaled 0. There were 5627 participants from urban areas and 956 from rural areas. In urban areas, the profit willing distance was 550-600 m, and we were unable to identify them in rural areas. This demonstrates that providers may need to supply services even when there is little profit. The tolerance limited distance were 1600-1650 m in urban areas and 1950-2000 m in rural areas. In rural areas, 33.3% of those living inside the tolerance limited distance and there was no provider within this distance, but this figure fell to just 13.9% in urban areas. There were strong disparities between urban and rural areas in home nursing care resource allocation. Our new "profit willing distance" and the "tolerance limited distance" are

  11. Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

    Science.gov (United States)

    Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

    2016-10-19

    Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

  12. Sustainability in health care by allocating resources effectively (SHARE) 4: exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting.

    Science.gov (United States)

    Harris, Claire; Ko, Henry; Waller, Cara; Sloss, Pamela; Williams, Pamela

    2017-05-05

    This is the fourth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Healthcare decision-makers have sought to improve the effectiveness and efficiency of services through removal or restriction of practices that are unsafe or of little benefit, often referred to as 'disinvestment'. A systematic, integrated, evidence-based program for disinvestment was being established within a large Australian health service network. Consumer engagement was acknowledged as integral to this process. This paper reports the process of developing a model to integrate consumer views and preferences into an organisation-wide approach to resource allocation. A literature search was conducted and interviews and workshops were undertaken with health service consumers and staff. Findings were drafted into a model for consumer engagement in resource allocation which was workshopped and refined. Although consumer engagement is increasingly becoming a requirement of publicly-funded health services and documented in standards and policies, participation in organisational decision-making is not widespread. Several consistent messages for consumer engagement in this context emerged from the literature and consumer responses. Opportunities, settings and activities for consumer engagement through communication, consultation and participation were identified within the resource allocation process. Sources of information regarding consumer values and perspectives in publications and locally-collected data, and methods to use them in health service decision-making, were identified. A model bringing these elements together was developed. The proposed model presents potential opportunities and activities for consumer engagement in the context of resource allocation.

  13. Epidemiological study of clinical characteristics of patients with PCOS attending infertility clinic and awareness of PCOS in a rural set up

    OpenAIRE

    Shubhada Jajoo; Riju Angik

    2013-01-01

    Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age group. It is a common diagnosis in women presenting with infertility. All the dimensions of PCOS have not been completely explored. In this study we studied the clinical features of PCOS and comparing with non-PCOS infertility patients and simultaneously studied the prevalence of PCOS in infertility patients and its awareness in a rural set up. Methods: It is a prospect...

  14. Screening, management, and treatment of intimate partner violence among women in low-resource settings.

    Science.gov (United States)

    Schwab-Reese, Laura M; Renner, Lynette M

    2018-01-01

    The prevention of intimate partner violence continues to be a high priority for health practitioners and researchers around the world. Screening practices and intervention efforts utilized within high- and/or middle-income areas may not translate effectively to low-resource areas due to differences in financial, social, and physical context. However, little is known about the evidence-base of intervention efforts in such areas. Using the Arksey and O'Malley framework for scoping reviews, the purpose of this review was to synthesize what is known about intimate partner violence screening, management, and treatment in low-resource areas. A total of 31 programs reported across 34 articles were included in this scoping review. The programs incorporated a range of intervention activities, including group-based education and skill-development combined with microfinance to screening and referral to community resources. Slightly less than half of the studies (n = 14) were randomized controlled trials or clustered randomized controlled trials. Many barriers were common across the programs, including limited financial support, lack of community support, and lack of coordination across programs. Despite considerable barriers related to the limited available resources, the literature base had many strengths, such as strong evaluation methodologies, inclusion of a theoretical or conceptual framework to guide the intervention, and community engagement before and during the intervention implementation. However, insufficient statistical power and barriers related to cultural differences or inadequate cultural sensitivity were also common. With a variety of barriers to program implementation noted within the articles, it is important for researchers and practitioners to consider the geographic, social, cultural, and economic contexts when implementing intimate partner violence programs in low-resource areas. Given the significant differences in context across low-resource areas

  15. Information resource preferences by general pediatricians in office settings: a qualitative study

    Directory of Open Access Journals (Sweden)

    Lehmann Harold P

    2005-10-01

    Full Text Available Abstract Background Information needs and resource preferences of office-based general pediatricians have not been well characterized. Methods Data collected from a sample of twenty office-based urban/suburban general pediatricians consisted of: (a a demographic survey about participants' practice and computer use, (b semi-structured interviews on their use of different types of information resources and (c semi-structured interviews on perceptions of information needs and resource preferences in response to clinical vignettes representing cases in Genetics and Infectious Diseases. Content analysis of interviews provided participants' perceived use of resources and their perceived questions and preferred resources in response to vignettes. Results Participants' average time in practice was 15.4 years (2–28 years. All had in-office online access. Participants identified specialist/generalist colleagues, general/specialty pediatric texts, drug formularies, federal government/professional organization Websites and medical portals (when available as preferred information sources. They did not identify decision-making texts, evidence-based reviews, journal abstracts, medical librarians or consumer health information for routine office use. In response to clinical vignettes in Genetics and Infectious Diseases, participants identified Question Types about patient-specific (diagnosis, history and findings and general medical (diagnostic, therapeutic and referral guidelines information. They identified specialists and specialty textbooks, history and physical examination, colleagues and general pediatric textbooks, and federal and professional organizational Websites as information sources. Participants with access to portals identified them as information resources in lieu of texts. For Genetics vignettes, participants identified questions about prenatal history, disease etiology and treatment guidelines. For Genetics vignettes, they identified

  16. Large scale mapping of groundwater resources using a highly integrated set of tools

    DEFF Research Database (Denmark)

    Søndergaard, Verner; Auken, Esben; Christiansen, Anders Vest

    large areas with information from an optimum number of new investigation boreholes, existing boreholes, logs and water samples to get an integrated and detailed description of the groundwater resources and their vulnerability.Development of more time efficient and airborne geophysical data acquisition...... platforms (e.g. SkyTEM) have made large-scale mapping attractive and affordable in the planning and administration of groundwater resources. The handling and optimized use of huge amounts of geophysical data covering large areas has also required a comprehensive database, where data can easily be stored...

  17. Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population.

    Science.gov (United States)

    Afulani, Patience A; Diamond-Smith, Nadia; Golub, Ginger; Sudhinaraset, May

    2017-09-22

    Person-centered reproductive health care is recognized as critical to improving reproductive health outcomes. Yet, little research exists on how to operationalize it. We extend the literature in this area by developing and validating a tool to measure person-centered maternity care. We describe the process of developing the tool and present the results of psychometric analyses to assess its validity and reliability in a rural and urban setting in Kenya. We followed standard procedures for scale development. First, we reviewed the literature to define our construct and identify domains, and developed items to measure each domain. Next, we conducted expert reviews to assess content validity; and cognitive interviews with potential respondents to assess clarity, appropriateness, and relevance of the questions. The questions were then refined and administered in surveys; and survey results used to assess construct and criterion validity and reliability. The exploratory factor analysis yielded one dominant factor in both the rural and urban settings. Three factors with eigenvalues greater than one were identified for the rural sample and four factors identified for the urban sample. Thirty of the 38 items administered in the survey were retained based on the factors loadings and correlation between the items. Twenty-five items load very well onto a single factor in both the rural and urban sample, with five items loading well in either the rural or urban sample, but not in both samples. These 30 items also load on three sub-scales that we created to measure dignified and respectful care, communication and autonomy, and supportive care. The Chronbach alpha for the main scale is greater than 0.8 in both samples, and that for the sub-scales are between 0.6 and 0.8. The main scale and sub-scales are correlated with global measures of satisfaction with maternity services, suggesting criterion validity. We present a 30-item scale with three sub-scales to measure person

  18. Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.

    Science.gov (United States)

    West, Susan P; Lagua, Carina; Trief, Paula M; Izquierdo, Roberto; Weinstock, Ruth S

    2010-05-01

    To describe the use of telemedicine for setting goals for behavior change and examine the success in achieving these goals in rural underserved older adults with diabetes. Medicare beneficiaries with diabetes living in rural upstate New York who were enrolled in the telemedicine intervention of the Informatics for Diabetes Education and Telemedicine (IDEATel) project (n = 610) participated in home televisits with nurse and dietitian educators every 4-6 weeks for 2-6 years. Behavior change goals related to nutrition, physical activity, monitoring, diabetes health maintenance, and/or use of the home telemedicine unit were established at the conclusion of each televisit and assessed at the next visit. Collaborative goal setting was employed during 18,355 televisits (mean of 33 goal-setting televisits/participant). The most common goals were related to monitoring, followed by diabetes health maintenance, nutrition, exercise, and use of the telemedicine equipment. Overall, 68% of behavioral goals were rated as "improved" or "met." The greatest success was achieved for goals related to proper insulin injection technique and daily foot care. These elderly participants had the most difficulty achieving goals related to use of the computer. No gender differences in goal achievement were observed. Televisits can be successfully used to collaboratively establish behavior change goals to help improve diabetes self-management in underserved elderly rural adults.

  19. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

    Directory of Open Access Journals (Sweden)

    Silva Diego S

    2012-03-01

    Full Text Available Abstract Background Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. Methods To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Results Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Conclusions Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

  20. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives.

    Science.gov (United States)

    Silva, Diego S; Gibson, Jennifer L; Robertson, Ann; Bensimon, Cécile M; Sahni, Sachin; Maunula, Laena; Smith, Maxwell J

    2012-03-26

    Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

  1. An Assessment of Resource Availability for Problem Based Learning in a Ghanaian University Setting

    Science.gov (United States)

    Okyere, Gabriel Asare; Tawiah, Richard; Lamptey, Richard Bruce; Oduro, William; Thompson, Michael

    2017-01-01

    Purpose: The purpose of this paper is to assess the differences pertaining to the resources presently accessible for problem-based learning (PBL) among six colleges of Kwame Nkrumah University of Science and Technology (KNUST) in Ghana. Design/methodology/approach: Data for the study are the cross-sectional type drawn from 1,020 students. Poisson…

  2. Digital Resource Developments for Mathematics Education Involving Homework across Formal, Non-Formal and Informal Settings

    Science.gov (United States)

    Radovic, Slaviša; Passey, Don

    2016-01-01

    The aim of this paper is to explore further an under-developed area--how drivers of curriculum, pedagogy and assessment conceptions and practices shape the creation and uses of technologically based resources to support mathematics learning across informal, non-formal and formal learning environments. The paper considers: the importance of…

  3. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    Science.gov (United States)

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  4. Resource Loss Moderates the Association Between Child Abuse and Current PTSD Symptoms Among Women in Primary-Care Settings.

    Science.gov (United States)

    Costa, Eleonora C V; Guimarães, Sara; Ferreira, Domingos; Pereira, M Graça

    2016-09-01

    This study examined if abuse during childhood, rape in adulthood, and loss of resources predict a woman's probability of reporting symptoms of posttraumatic stress disorder (PTSD), and whether resource loss moderates the association between reporting childhood abuse and PTSD symptoms. The sample included 767 women and was collected in publicly funded primary-care settings. Women who reported having been abused during childhood also reported more resource loss, more acute PTSD symptoms, and having suffered more adult rape than those who reported no childhood abuse. Hierarchical logistic regression yielded a two-variable additive model in which child abuse and adult rape predict the probability of reporting or not any PTSD symptoms, explaining 59.7% of the variance. Women abused as children were 1 to 2 times more likely to report PTSD symptoms, with sexual abuse during childhood contributing most strongly to this result. Similarly, women reporting adult rape were almost twice as likely to report symptoms of PTSD as those not reporting it. Resource loss was unexpectedly not among the predictors but a moderation analysis showed that such loss moderated the association between child abuse and current PTSD symptoms, with resource loss increasing the number and severity of PTSD symptoms in women who also reported childhood abuse. The findings highlight the importance of early assessment and intervention in providing mental health care to abused, neglected, and impoverished women to help them prevent and reverse resource loss and revictimization.

  5. RSW-MCFP: A Resource-Oriented Solid Waste Management System for a Mixed Rural-Urban Area through Monte Carlo Simulation-Based Fuzzy Programming

    Directory of Open Access Journals (Sweden)

    P. Li

    2013-01-01

    Full Text Available The growth of global population and economy continually increases the waste volumes and consequently creates challenges to handle and dispose solid wastes. It becomes more challenging in mixed rural-urban areas (i.e., areas of mixed land use for rural and urban purposes where both agricultural waste (e.g., manure and municipal solid waste are generated. The efficiency and confidence of decisions in current management practices significantly rely on the accurate information and subjective judgments, which are usually compromised by uncertainties. This study proposed a resource-oriented solid waste management system for mixed rural-urban areas. The system is featured by a novel Monte Carlo simulation-based fuzzy programming approach. The developed system was tested by a real-world case with consideration of various resource-oriented treatment technologies and the associated uncertainties. The modeling results indicated that the community-based bio-coal and household-based CH4 facilities were necessary and would become predominant in the waste management system. The 95% confidence intervals of waste loadings to the CH4 and bio-coal facilities were 387, 450 and 178, 215 tonne/day (mixed flow, respectively. In general, the developed system has high capability in supporting solid waste management for mixed rural-urban areas in a cost-efficient and sustainable manner under uncertainty.

  6. The Impact of Family Setting and Local Opportunities on Leaving Home and Migration Destinations of Rural Youths, The Netherlands 1860-1940

    Directory of Open Access Journals (Sweden)

    Bastian Mönkediek

    2015-11-01

    Full Text Available In this article we aim to study how Dutch children’s individual destinies result from the complex interplay of family setting and local conditions in a rural environment. We focus on their final move from the parental home, and we will analyse not only timing and incidence of leaving, but also the destinations. To do this, we propose a multi-level competing risk analysis of migration destinations. We focus on two groups: the children of farmers and those of rural workers. Dutch farmers and workers differ in the type of family economy in which children were integrated, and contrasting them will allow us to explain the speed, the directions, and the individual and family backgrounds of the process of leaving agriculture. We make use of the Historical Sample of the Netherlands to analyse last migrations of 8,338 children of farmers and rural workers. As we cover the entire country, we can study the full impact of regional differences on type of agriculture and inheritance, in combination with the family composition. Our results indicate significant effects of specialised versus traditional, mixed farming on the migration behaviour of farmers’ and rural workers’ children, as well as the importance of the number of siblings of the same sex and birth order. The variations in the effects of the sibship among regions with different agricultural systems demonstrate the importance of gender-specific divisions of labour on leaving home.

  7. Assessing and Improving Performance: A Longitudinal Evaluation of Priority Setting and Resource Allocation in a Canadian Health Region.

    Science.gov (United States)

    Hall, William; Smith, Neale; Mitton, Craig; Urquhart, Bonnie; Bryan, Stirling

    2017-08-22

    In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources. The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization's priority setting and resource allocation (PSRA) process 2 years post the original evaluation. Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization's PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to reallocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization. While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization's journey, the authors' intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  8. Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated.

    Science.gov (United States)

    Sutherland, Rebecca; Trembath, David; Hodge, Antoinette; Drevensek, Suzi; Lee, Sabrena; Silove, Natalie; Roberts, Jacqueline

    2017-01-01

    Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children's needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children's reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8-12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child's point of view. Parent feedback about their child's experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96-1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The

  9. Application of Resource Utilization in Dementia (RUD) instrument in a global setting.

    Science.gov (United States)

    Wimo, Anders; Gustavsson, Anders; Jönsson, Linus; Winblad, Bengt; Hsu, Ming-Ann; Gannon, Brenda

    2013-07-01

    The Resource Utilization in Dementia (RUD) questionnaire is the most widely used instrument for resource use data collection in dementia, enabling comparison of costs of care across countries with differing health care provisions. Recent feedback from payers questioned its face validity given that health care provisions have changed since the initial development of the RUD in 1998. The aim of this study was to update the RUD to improve its face validity in Alzheimer's disease (AD) clinical research and its utility for health care resource allocation. An extensive PubMed review was conducted of current relevant resource items in AD in 15 countries. The findings were complemented by interviews with local care providers and experts in dementia care and health economics. Their proposed revisions were discussed with five leading dementia experts in North and South America, northern and southern Europe, and Asia. A new version of the RUD was developed based on their recommendations. RUD users identified a need for more information relevant to coverage decisions. Proposed revisions included changes to existing questions (e.g., to capture more accurately the number and type of health care visits) and the addition of new questions (e.g., on informal caregiver hours and the primary caregiver's hours of sleep). Several minor changes were made to the RUD instrument to improve the accuracy and precision of the data while maintaining comparability with the original version and reflecting current medical practice. The RUD Complete Version 4.0 is now available for use in future AD clinical trials. Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  10. Using mobile technologies to give health students access to learning resources in the UK community setting.

    Science.gov (United States)

    Walton, Graham; Childs, Susan; Blenkinsopp, Elizabeth

    2005-12-01

    This article describes a project which explored the potential for mobile technologies to give health students in the community access to learning resources. The purpose included the need to identify possible barriers students could face in using mobile technologies. Another focus was to assess the students perceptions of the importance of being able to access learning resources in the community. This 1-year project used two main approaches for data collection. A review of the literature on mobile technologies in the health context was conducted. This was used in a systematic way to identify key issues and trends. The literature review was used to inform the design and production of a questionnaire. This was distributed to and completed by a group of community health students at Northumbria University, UK. The questionnaire was piloted and there was a 100% completion rate with 49 returned forms. The literature review indicated that most mobile technology applications were occurring in the US. At the time of the review the most prevalent mobile technologies were PDAs, laptops, WAP phones and portable radios with use being concentrated around doctors in the acute sector. A range of advantages and disadvantages to the technology were discovered. Mobile technologies were mainly being used for clinical rather than learning applications. The students showed a low level of awareness of the technology but placed great importance to accessing learning resources from the community. Significant development and changes are taking place in mobile technologies. Since the data collection for this work was completed in 2004 podcasting and videocasting have become significant in mobile learning for health professionals. Librarians will need to address the relevance and implications of m-learning for their practice. Care and consideration needs to be given on the time and resources librarians allocate for the necessary development work around mobile technologies. Collaboration and

  11. Local resource based approach to maintaining and preserving rural local access roads assets: Siyatentela institutional framework and governance case study discourses

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-10-01

    Full Text Available and other development agencies focusing on the use of appropriate technologies for civil construction be it in the road, transport, water, agriculture or environmental sectors (World Bank 2001; ILO, 2002; Clegg, 2003). The seminal study conducted... and contribution of local resource based approach to rural and community access roads requires a review of the labour based initiatives in the road, transport and infrastructure sub-sector. An apt statement that captures the essence of building local community...

  12. WE-FG-201-02: Automated Treatment Planning for Low-Resource Settings

    Energy Technology Data Exchange (ETDEWEB)

    Court, L. [UT MD Anderson Cancer Center (United States)

    2016-06-15

    Many low- and middle-income countries lack the resources and services to manage cancer, from screening and diagnosis to radiation therapy planning, treatment and quality assurance. The challenges in upgrading or introducing the needed services are enormous, and include severe shortages in equipment and trained staff. In this symposium, we will describe examples of technology and scientific research that have the potential to impact all these areas. These include: (1) the development of high-quality/low-cost colposcopes for cervical cancer screening, (2) the application of automated radiotherapy treatment planning to reduce staffing shortages, (3) the development of a novel radiotherapy treatment unit, and (4) utilizing a cloud-based infrastructure to facilitate collaboration and QA. Learning Objectives: Understand some of the issues in cancer care in low- resource environments, including shortages in staff and equipment, and inadequate physical infrastructure for advanced radiotherapy. Understand the challenges in developing and deploying diagnostic and treatment devices and services for low-resource environments. Understand some of the emerging technological solutions for cancer management in LMICs. NCI; L. Court, NIH, Varian, Elekta; I. Feain, Ilana Feain is founder and CTO of Nano-X Pty Ltd.

  13. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

    Directory of Open Access Journals (Sweden)

    Andrew W. Kiragu

    2018-06-01

    Full Text Available Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs 3–6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

  14. WE-FG-201-02: Automated Treatment Planning for Low-Resource Settings

    International Nuclear Information System (INIS)

    Court, L.

    2016-01-01

    Many low- and middle-income countries lack the resources and services to manage cancer, from screening and diagnosis to radiation therapy planning, treatment and quality assurance. The challenges in upgrading or introducing the needed services are enormous, and include severe shortages in equipment and trained staff. In this symposium, we will describe examples of technology and scientific research that have the potential to impact all these areas. These include: (1) the development of high-quality/low-cost colposcopes for cervical cancer screening, (2) the application of automated radiotherapy treatment planning to reduce staffing shortages, (3) the development of a novel radiotherapy treatment unit, and (4) utilizing a cloud-based infrastructure to facilitate collaboration and QA. Learning Objectives: Understand some of the issues in cancer care in low- resource environments, including shortages in staff and equipment, and inadequate physical infrastructure for advanced radiotherapy. Understand the challenges in developing and deploying diagnostic and treatment devices and services for low-resource environments. Understand some of the emerging technological solutions for cancer management in LMICs. NCI; L. Court, NIH, Varian, Elekta; I. Feain, Ilana Feain is founder and CTO of Nano-X Pty Ltd

  15. African swine fever in Uganda: qualitative evaluation of three surveillance methods with implications for other resource-poor settings

    OpenAIRE

    Chenais, Erika; Sternberg Lewerin, Susanna; Boqvist, Sofia; Emanuelson, Ulf; Aliro, Tonny; Tejler, Emma; Cocca, Giampaolo; Masembe, Charles; Ståhl, Karl

    2015-01-01

    Animal diseases impact negatively on households and on national economies. In low-income countries, this pertains especially to socio-economic effects on household level. To control animal diseases and mitigate their impact, it is necessary to understand the epidemiology of the disease in its local context. Such understanding, gained through disease surveillance, is often lacking in resource-poor settings. Alternative surveillance methods have been developed to overcome some of the hurdles ob...

  16. African swine fever in Uganda: qualitative evaluation of three surveillance methods with implications for other resource-poor settings

    OpenAIRE

    Erika eChenais; Erika eChenais; Susanna eSternberg-Lewerin; Sofia eBoqvist; Ulf eEmanuelson; Tonny eAliro; Emma eTejler; Giampaolo eCocca; Charles eMasembe; Karl eStåhl; Karl eStåhl

    2015-01-01

    Animal diseases impact negatively on households and on national economies. In low-income countries this pertains especially to socio-economic effects on household level. To control animal diseases and mitigate their impact, it is necessary to understand the epidemiology of the disease in its local context. Such understanding, gained through disease surveillance, is often lacking in resource-poor settings. Alternative surveillance methods have been developed to overcome some of the hurdles obs...

  17. Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review.

    Science.gov (United States)

    Verhey, Ruth; Chibanda, Dixon; Brakarsh, Jonathan; Seedat, Soraya

    2016-10-01

    Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries. © 2016 John Wiley & Sons Ltd.

  18. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru

    Directory of Open Access Journals (Sweden)

    Soto Giselle

    2008-11-01

    Full Text Available Abstract Background Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD. Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. Methods This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. Results After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1 issues with personnel and stakeholders; (2 issues with resources in a developing setting; (3 issues with processes involved in the collection of data and operation of the system; and (4 issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. Conclusion There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.

  19. Heritage tourism development in rural Russia: A case study in collaborative tourism planning in an international setting

    Science.gov (United States)

    Roy Ramthun; Susan Williams; Vladimir Shalaev; Svetlana Guseva; Irina Polinkova; Sofia Chervakova; Svetlana Ivanova; Anna Pahkmutova; Anastasia Shalaev

    2010-01-01

    In the United States, advisers from such organizations as universities and extension services often assist rural communities with community planning and development efforts. These outside groups typically facilitate communication and discussion among stakeholders and help to lay out a process by which the community may proceed towards its shared goals. Faculty members...

  20. ICT4RED 12 - Component implementation framework: A conceptual framework for integrating mobile technology into resource-constrained rural schools

    CSIR Research Space (South Africa)

    Ford, M

    2014-05-01

    Full Text Available ICT for Rural Education Development (ICT4RED) is a large-scale pilot that is testing the use of tablets in 26 deep rural schools in the Eastern Cape Province of South Africa. The aim is to develop a replicable framework that will enable evidence...

  1. Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

    Directory of Open Access Journals (Sweden)

    Norheim Ole

    2004-01-01

    Full Text Available Abstract Introduction Several studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context. Objective This study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda. Design 610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity. Results Actual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention. Conclusions In a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than

  2. Malaria and Anemia among Children in a Low Resource Setting In Nigeria

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    AA Onifade

    2012-09-01

    Full Text Available Background: This study aimed at determining the prevalence of malaria and anemia among child­ren in rural community of Okada, Edo State Nigeria, as well as to assess the level of use of Insecti­cide treated bed nets and its impact on prevalence of malaria and anemia among study population. Methods: Thick blood films from 226 children with signs and symptoms of malaria in Okada commu­nity were stained and examined for presence of malaria parasites. Hemoglobin concentra­tion of all children was also determined using standard method. Result: A total of 185 (81.9% children were infected with malaria parasite. Malaria parasitaemia was significantly affected by age (P =0.003. A significantly higher number of positive cases of malaria and anemia was observed in rainy season as compared to dry season (P<0.05. The prevalence of anemia in children was 47.3%. Malaria was a risk factor for development of anemia in children (OR=2.551; 95% CI=1.227, 5.305; P=0.015. Use of insecticide treated bed nets was recorded in 11(4.9% of children studied, and did not significantly reduce the prevalence of malaria and anemia. However among malaria parasite infected children, its use significantly reduced the prevalence of anemia (OR=0.126; 95%CI = 0.015, 1.047; P= 0.031. Conclusion: Malaria and anemia among children was high malaria intervention progammes by rele­vant agencies is strongly advocated.

  3. Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting.

    Science.gov (United States)

    Alobu, Isaac; Oshi, Sarah N; Oshi, Daniel C; Ukwaja, Kingsley N

    2014-12-01

    To evaluate the rates, timing and determinants of default and death among adult tuberculosis patients in Nigeria. Routine surveillance data were used. A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State, Nigeria was conducted. Multivariable logistic regression analyses were used to identify independent predictors for treatment default and death. Of 1 668 treated patients, the default rate was 157 (9.4%), whilst 165 (9.9%) died. Also, 35.7% (56) of the treatment defaults and 151 (91.5%) of deaths occurred during the intensive phase of treatment. Risk of default increased with increasing age (adjusted odds ratio (aOR) 1.2; 95% confidence interval (CI) 1.1-1.9), smear-negative TB case (aOR 2.3; CI 1.5-3.6), extrapulmonary TB case (aOR 2.7; CI 1.3-5.2), and patients who received the longer treatment regimen (aOR 1.6; 1.1-2.2). Risk of death was highest in extrapulmonary TB (aOR 3.0; CI 1.4-6.1) and smear-negative TB cases (aOR 2.4; CI 1.7-3.5), rural residents (aOR 1.7; CI 1.2-2.6), HIV co-infected (aOR 2.5; CI 1.7-3.6), not receiving antiretroviral therapy (aOR 1.6; CI 1.1-2.9), and not receiving cotrimoxazole prophylaxis (aOR 1.7; CI 1.2-2.6). Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed. This needs to be urgently addressed by the National Tuberculosis Programme. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  4. Rural transformations in the context of changing rural-urban connections

    DEFF Research Database (Denmark)

    Birch-Thomsen, Torben; Ørtenblad, Sinne Borby; Msese, Lukelo

    , the infrastructure, including road systems and means of communication, has in general increased and improved. This development has among a number of other things caused changing patterns of mobility. These changes are highly interrelated and connected to changing rural-urban linkages, which include flows of people......, capital, resources, agricultural commodities, goods, services, technology and information, between rural and urban locations. We emphasize that the rural-urban connections go beyond the spatial dichotomy and that the linkages often occur in a dynamic rural-urban continuum. Influenced by these changes......, this paper sets out to elucidate patterns and dynamics of rural transformation in Tanzania in the context of changing rural-urban linkages by presenting data from a particularly dynamic region; namely Njombe Region in the Southern Highlands of Tanzania. Based on fieldwork conducted during 2014 and 2015...

  5. Prehospital care practices for venomous snakebites in resource-limited settings: A narrative review

    Directory of Open Access Journals (Sweden)

    Godpower Chinedu Michael

    2017-01-01

    Full Text Available Venomous snakebite is a medical emergency encountered worldwide, especially in resource-limited communities. It usually leaves victims at the mercy of traditional care, whose effectiveness have come under scrutiny over time. Several of these traditional/ first aid practices have also been reported over time. Controversies over their efficacy often result in confusion among snakebite victims, their caregivers, and sometimes, among health-care providers. This narrative review describes reported prehospital interventions for venomous snakebites highlighting their usefulness, dangers, and/or limitations associated with their use and the currently widely recommended prehospital activities for venomous snakebite.

  6. Visitors' relationship to the resource: comparing place attachment in wildland and developed settings

    Science.gov (United States)

    Cynthia A. Warzecha; David W. Lime; Jerrilyn L. Thompson

    2000-01-01

    Emotional/symbolic and functional place attachments were measured on the Green and Colorado Rivers in Canyonlands National Park and at Mount Rushmore National Memorial. Although Canyonlands and Mount Rushmore represent very different recreational settings, it was possible to measure both types of attachment by using 12 place attachment statements. In Canyonlands, river...

  7. Review of crisis resource management (CRM) principles in the setting of intraoperative malignant hyperthermia.

    Science.gov (United States)

    Isaak, Robert Scott; Stiegler, Marjorie Podraza

    2016-04-01

    The practice of medicine is characterized by routine and typical cases whose management usually goes according to plan. However, the occasional case does arise which involves rare catastrophic emergencies, such as intraoperative malignant hyperthermia (MH), which require a comprehensive, coordinated, and resource-intensive treatment plan. Physicians are expected to provide expert quality care for routine, typical cases, but is it reasonable to expect the same standard of expertise and comprehensive management when the emergency involves a rare entity? Although physicians would like to say yes to this question, the reality is that no physician will ever amass the amount of experience in patient care needed to truly qualify as an expert in the management of a rare emergency entity, such as MH. However, physicians can become expert in the global process of managing emergencies by using the principles of crisis resource management (CRM). In this article, we review the key concepts of CRM, using a real life example of a team who utilized CRM principles to successfully manage an intraoperative MH crisis, despite there being no one on the team who had ever previously encountered a true MH crisis.

  8. Ancillary care in public health intervention research in low-resource settings: researchers' practices and decision-making.

    Science.gov (United States)

    Taylor, Holly A; Merritt, Maria W; Mullany, Luke C

    2011-09-01

    Little is known about researchers' practices regarding the provision of ancillary care (AC) in public health intervention studies they have conducted and the factors that influence their decisions about whether to provide ancillary care in low-resource settings. We conducted 52 in-person in-depth interviews with public health researchers. Data analysis was iterative and led to the identification of themes and patterns among themes. We found that researchers who conduct their research in the community setting are more likely to identify and plan for the AC needs of potential research subjects before a study begins, whereas those affiliated with a permanent facility are more likely to deliver AC to research subjects on an ad hoc basis. Our findings suggest that on the whole, at least for public health intervention research in low-resource settings, researchers conducting research in the community setting confront more complex ethical and operational challenges in their decision-making about AC than do researchers conducting facility-based studies.

  9. Sustaining the rural workforce: nursing perspectives on worklife challenges.

    Science.gov (United States)

    Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

    2009-01-01

    Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

  10. Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting.

    Science.gov (United States)

    Martinez, Boris; Hall-Clifford, Rachel; Coyote, Enma; Stroux, Lisa; Valderrama, Camilo E; Aaron, Christopher; Francis, Aaron; Hendren, Cate; Rohloff, Peter; Clifford, Gari D

    2017-01-01

    Technology provides the potential to empower frontline healthcare workers with low levels of training and literacy, particularly in low- and middle-income countries. An obvious platform for achieving this aim is the smartphone, a low cost, almost ubiquitous device with good supply chain infrastructure and a general cultural acceptance for its use. In particular, the smartphone offers the opportunity to provide augmented or procedural information through active audiovisual aids to illiterate or untrained users, as described in this article. In this article, the process of refinement and iterative design of a smartphone application prototype to support perinatal surveillance in rural Guatemala for indigenous Maya lay midwives with low levels of literacy and technology exposure is described. Following on from a pilot to investigate the feasibility of this system, a two-year project to develop a robust in-field system was initiated, culminating in a randomized controlled trial of the system, which is ongoing. The development required an agile approach, with the development team working both remotely and in country to identify and solve key technical and cultural issues in close collaboration with the midwife end-users. This article describes this process and intermediate results. The application prototype was refined in two phases, with expanding numbers of end-users. Some of the key weaknesses identified in the system during the development cycles were user error when inserting and assembling cables and interacting with the 1-D ultrasound-recording interface, as well as unexpectedly poor bandwidth for data uploads in the central healthcare facility. Safety nets for these issues were developed and the resultant system was well accepted and highly utilized by the end-users. To evaluate the effectiveness of the system after full field deployment, data quality, and corruption over time, as well as general usage of the system and the volume of application support for end

  11. Comparison of two approaches for measuring household wealth via an asset-based index in rural and peri-urban settings of Hunan province, China

    Directory of Open Access Journals (Sweden)

    Balen Julie

    2010-09-01

    Full Text Available Abstract Background There are growing concerns regarding inequities in health, with poverty being an important determinant of health as well as a product of health status. Within the People's Republic of China (P.R. China, disparities in socio-economic position are apparent, with the rural-urban gap of particular concern. Our aim was to compare direct and proxy methods of estimating household wealth in a rural and a peri-urban setting of Hunan province, P.R. China. Methods We collected data on ownership of household durable assets, housing characteristics, and utility and sanitation variables in two village-wide surveys in Hunan province. We employed principal components analysis (PCA and principal axis factoring (PAF to generate household asset-based proxy wealth indices. Households were grouped into quartiles, from 'most wealthy' to 'most poor'. We compared the estimated household wealth for each approach. Asset-based proxy wealth indices were compared to those based on self-reported average annual income and savings at the household level. Results Spearman's rank correlation analysis revealed that PCA and PAF yielded similar results, indicating that either approach may be used for estimating household wealth. In both settings investigated, the two indices were significantly associated with self-reported average annual income and combined income and savings, but not with savings alone. However, low correlation coefficients between the proxy and direct measures of wealth indicated that they are not complementary. We found wide disparities in ownership of household durable assets, and utility and sanitation variables, within and between settings. Conclusion PCA and PAF yielded almost identical results and generated robust proxy wealth indices and categories. Pooled data from the rural and peri-urban settings highlighted structural differences in wealth, most likely a result of localized urbanization and modernization. Further research is needed

  12. Wind resource and plant output data sets for wind integration studies

    Energy Technology Data Exchange (ETDEWEB)

    Frank, Jaclyn D.; Manobianco, John; Alonge, Charles J.; Brower, Michael C. [AWS Truepower, Albany, NY (United States)

    2010-07-01

    One of the first step towards understanding the impact of increasing penetrations of wind is developing data sets of wind power output over large regions. To facilitate the development of these data sets, AWS Truepower (AWST) generated wind speeds over multiple years (2-3) using the Mesoscale Atmospheric Simulation System (MASS). These simulations were performed with high spatial resolution (1-2 km) to capture the wind flows over each area of interest. Output was saved in 10-minute interval to capture variations in wind speed so that plant output could be analyzed against utility load and system operations. This paper will describe the methodology of mesoscale modeling, site selection, conversion to power, and downscaling to high frequency output. Additionally, the generation of synthetic forecasts will be discussed. The validation results from recent studies in the eastern United States and Hawaii will be highlighted. (orig.)

  13. Use of 90% ethanol to decontaminate stethoscopes in resource limited settings

    OpenAIRE