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  1. 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.

  2. Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal.

    Science.gov (United States)

    Acharya, Bibhav; Maru, Duncan; Schwarz, Ryan; Citrin, David; Tenpa, Jasmine; Hirachan, Soniya; Basnet, Madhur; Thapa, Poshan; Swar, Sikhar; Halliday, Scott; Kohrt, Brandon; Luitel, Nagendra P; Hung, Erick; Gauchan, Bikash; Pokharel, Rajeev; Ekstrand, Maria

    2017-01-13

    Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal.

  3. China Sets Resources Strategy

    Institute of Scientific and Technical Information of China (English)

    LiMin

    2003-01-01

    All mineral mining in China now has a set road to follow, and straying off its path will attract severe penalties. The country's first-round programs for provincial mineral resources exploitation took effect in mid-January, setting output goals and designating mining regions.

  4. Solutions to Integration Model of Rural Information Resources

    Institute of Scientific and Technical Information of China (English)

    Xirong; GAO; Bo; TAO

    2014-01-01

    The integration of rural information resources is a key factor restricting rural informationization and effective operation of rural information services. To solve problems of separate rural information resources and departments acting willfully regardless of overall interest,this paper analyzed characteristics and distribution of rural information resources,built a basic framework for integration of rural information resources and a mathematic model of integration,and finally came up with specific solutions to integration of rural information resources.

  5. 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.

  6. An Empirical Study of the Allocation Efficiency of Rural Financial Resources in Hubei Province from the Perspective of Agricultural Loans

    Institute of Scientific and Technical Information of China (English)

    Xiaofang; ZOU; Xueqin; JIANG

    2014-01-01

    The incompatibility of China’s economy and finance has to some extent inhibited the development of rural economy. Taking Hubei Province for example,we measure the allocation efficiency of rural financial resources from the perspective of agricultural input and output,and use the modern rural financial development theory to set forth some policy recommendations on how to build a new rural financial resource allocation system. Studies have shown that the allocation efficiency of rural financial resources is low in China,and improving the allocation efficiency of rural financial resources is the key to perfecting rural financial environment while increasing financial support for agriculture.

  7. Environmental resources and poverty in rural communities

    DEFF Research Database (Denmark)

    Charlery, Lindy Callen

    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....... This has led to the following question being asked: Are forests and environmental resources able to help poor households escape poverty? Empirically, answering this question is important if the role of forests in poverty prevention and reduction, contributing to the first Millennium Development Goal......, 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...

  8. Environmental resources and poverty in rural communities

    DEFF Research Database (Denmark)

    Charlery, Lindy Callen

    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....... This has led to the following question being asked: Are forests and environmental resources able to help poor households escape poverty? Empirically, answering this question is important if the role of forests in poverty prevention and reduction, contributing to the first Millennium Development Goal......, 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...

  9. 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

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

    Science.gov (United States)

    Mwanyangala, Mathew A; Urassa, Honorathy M; Rutashobya, Jensen C; Mahutanga, Chrisostom C; Lutambi, Angelina M; Maliti, Deodatus V; Masanja, Honorati M; Abdulla, Salim K; Lema, Rose N

    2011-08-05

    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. The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania. 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." 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 (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023). Every year

  11. Poverty and resource dependence in rural India

    Energy Technology Data Exchange (ETDEWEB)

    Narain, Urvashi [Resources for the Future,1616 P St. NW, 20036 Washington, DC (United States); Gupta, Shreekant [Department of Economics, Delhi School of Economics, University of Delhi, 110007 Delhi (India); Van ' t Veld, Klaas [University of Wyoming, Department of Economics and Finance, Dept 3985, 1000 E. University Ave, 82071 Laramie, Wyoming (United States)

    2008-05-15

    Previous studies of rural households in developing countries have tended to find that the dependence of these households on common-pool resources declines with income. Our study of households in Jhabua, India, finds a more complex relationship. Using the share of resource income in total long-run or 'permanent' income as our dependence measure - which we argue is more appropriate than the short-run income-based measure commonly used in the literature - we find that for households that collect any resources at all, dependence exhibits a U-shaped relationship with income. That is, the poorest and richest households depend more on resources than households with intermediate incomes. The poorest and richest households are also found to be least likely to collect, however, indicating that resource use at the income extremes is bimodal - either zero or above average. Moreover, the observed trends for resources as a whole are not mirrored in those for individual resources. Dependence on fuelwood and dung declines with income, for example, while dependence on fodder and construction wood increases. These findings suggest that common-pool resources are a productive source of income not just for the poor but also for the rich, and that improvements in the stocks of these resources can potentially form the basis of poverty reduction efforts in these economies. (author)

  12. 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.

  13. 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)

    Rahman, Ahmed Ehsanur; 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

    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%) were referred

  14. 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 be

  15. 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.

  16. Cost valuation in resource-poor settings.

    NARCIS (Netherlands)

    Hutton, G.; Baltussen, R.M.P.M.

    2005-01-01

    Methods of cost-effectiveness analysis (CEA) have largely been developed for application in Western country settings. Little attention has been paid to the methodological issues in cost valuation in resource-poor settings, where failing exchange rates and severe market distortions require further

  17. Strengthening resources for midlife and older rural women who experience intimate partner violence.

    Science.gov (United States)

    Weeks, Lori E; Macquarrie, Colleen; Begley, Lorraine; Gill, Carmen; Leblanc, Kristal D

    2016-01-01

    Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.

  18. Pneumonia severity scores in resource poor settings

    Directory of Open Access Journals (Sweden)

    Jamie Rylance

    2014-06-01

    Full Text Available Clinical prognostic scores are increasingly used to streamline care in well-resourced settings. The potential benefits of identifying patients at risk of clinical deterioration and poor outcome, delivering appropriate higher level clinical care, and increasing efficiency are clear. In this focused review, we examine the use and applicability of severity scores applied to patients with community acquired pneumonia in resource poor settings. We challenge clinical researchers working in such systems to consider the generalisability of existing severity scores in their populations, and where performance of scores is suboptimal, to promote efforts to develop and validate new tools for the benefit of patients and healthcare systems.

  19. Non conventional fuel resources in rural India

    Energy Technology Data Exchange (ETDEWEB)

    Dixit, G.; Dixit, S.; Tiwari, S.

    2006-03-15

    In India there is a shortage of energy resources. The conventional sources are incapable to mitigate this problem by providing sufficient amount of energy. The crisis is gradually becoming more acute particularly in the countryside thus hampering the economic growth. To deal with this problem some new strategies have been envisaged. Generation of energy to meet daily requirement from non-conventional sources is one of the steps in this regard. With the increasing popularity of biogas plants in rural as well as in urban areas of India, it has become essential to find various location specific organic substances that can be used as feed material in biogas plant. In this study we have concentrated on use of cow dung and water hyacinth as feed material in biogas plants. The objective of the study is to assess the suitability of using mixture of cow dung and water hyacinth as feed material in biogas plants. Attempt has been made to find out the optimum proportion of cow dung and water hyacinth. The 1:1 mixture of cow dung and water hyacinth is the optimum proportion as per the study conducted. (author)

  20. 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

  1. Water Resource Uses and Recreational Activities in Rural Nigeria.

    Science.gov (United States)

    Adekoya, Adebola

    1991-01-01

    This study surveys rural Nigerian residents concerning local water resource uses and tourists' recreational activities with respect to scales of awareness, understanding, and incentive. Results indicate a public willingness to encourage and finance the rural development of water bodies for agricultural purposes exclusive of investment for tourism…

  2. 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.

  3. Subject,Object and Target Systems of Rural Human Resource Development

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    From subject,object and target subsystems,we analyze the rural human resource development system.The subject system includes government,education and training organizations,society,and rural human resource itself.Different development subject bears different responsibility.Object system includes farmers engaged in farming,farmer workers,rural unemployed people,rural students,rural left-behind people,and other people in rural areas.Different development object has different features.Development target system includes raising quality of rural human resource,keeping reasonable population size,optimizing structure of rural human resource,and improving vitality of rural human resource,etc.

  4. A Shipping Container-Based Sterile Processing Unit for Low Resources Settings

    OpenAIRE

    Jean Boubour; Katherine Jenson; Hannah Richter; Josiah Yarbrough; Maria Oden, Z.; Schuler, Douglas A.

    2016-01-01

    Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor ...

  5. 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

  6. An Analysis of Spatial Distribution Differences in Rural Leisure Tourist Destination Resources in Liaoning Province

    Institute of Scientific and Technical Information of China (English)

    Liang ZHAO; Xiaoxiao QI

    2016-01-01

    From the perspective of tourism resources elements,we use abundance and geographic concentration methods to analyze the spatial distribution differences in the resources of 149 rural leisure tourist destinations in Liaoning Province. The results show that most of Liaoning’s rural leisure tourist destination resources are mainly concentrated in the central,southern and eastern regions of Liaoning Province; in the main category of rural leisure tourism resources,water scenery,geological landform and mountain ecosystem concentrate,while agricultural resources and rural scenic view present balanced distribution; rural leisure tourism resources are highly concentrated in Shenyang,Dalian,Anshan,Benxi,Liaoyang and Dandong.

  7. Social factors affecting ART adherence in rural settings in Zambia

    Science.gov (United States)

    Nozaki, Ikuma; Dube, Christopher; Kakimoto, Kazuhiro; Yamada, Norio; Simpungwe, James B.

    2011-01-01

    The purpose of this study was to assess the factors that influence ART adherence arising in rural settings in Zambia. A survey was conducted with face-to-face interviews using a semi-structured questionnaire and written informed consent was obtained at ART sites in Mumbwa District in rural Zambia. The questionnaire included items such as the socio-demographic characteristics of respondents, support for adherence, ways to remember when to take ARVs at scheduled times, and the current status of adherence. Valid responses were obtained from 518 research participants. The mean age of the respondents was 38.3 years and the average treatment period was 12.5 months. More than half of the respondents (51%) were farmers, about half (49%) did not own a watch, and 10% of them used the position of the sun to remember when to take ARVs. Sixteen percent of respondents experienced fear of stigma resulting from taking ARVs at work or home, and 10% felt pressured to share ARVs with someone. Eighty-eight percent of the participants reported that they had never missed ARVs in the past four days. Multivariable logistic regression analysis identified age (38 years old or less, odds ratio (OR) = 2.5, 95% confidence interval (CI): 1.3–4.8, p = 0.005), “remembering when to take ARVs based on the position of the sun” (OR = 3.3, 95% CI: 1.3–8.8, p = 0.016), and “feeling pressured to share ARVs with someone” (OR = 4.4, 95% CI: 1.6–12.0, p = 0.004) as independent factors for low adherence. As ART services expand to rural areas, program implementers should pay more attention to more specific factors arising in rural settings since they may differ from those in urban settings. PMID:21400314

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

    Directory of Open Access Journals (Sweden)

    Axel Maroudas

    2010-11-01

    Full Text Available 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 trying to carry outthe particular transactions. This paper, presents an overview of the architecture of RuralObservatory2.0 which will play the critical role of training content and eGovernment services repository of the overall Rural Inclusion platform.

  9. Practical resources for critical science education in rural Appalachia

    Science.gov (United States)

    Kingsolver, Ann

    2017-03-01

    This article argues that there is no typical Appalachian experience or community. There is more cultural diversity and global interchange in this region of the U.S. than appears in popular representations of "isolated" Appalachians, which are ironic because of the region's having been so central to the global extractive economy for centuries. Some pedagogical resources are provided to encourage or contribute to a broader perspective on the possibilities and knowledge centered in rural communities, with Appalachian examples.

  10. Practical resources for critical science education in rural Appalachia

    Science.gov (United States)

    Kingsolver, Ann

    2016-08-01

    This article argues that there is no typical Appalachian experience or community. There is more cultural diversity and global interchange in this region of the U.S. than appears in popular representations of "isolated" Appalachians, which are ironic because of the region's having been so central to the global extractive economy for centuries. Some pedagogical resources are provided to encourage or contribute to a broader perspective on the possibilities and knowledge centered in rural communities, with Appalachian examples.

  11. Nurse Practitioner Autonomy and Satisfaction in Rural Settings.

    Science.gov (United States)

    Spetz, Joanne; Skillman, Susan M; Andrilla, C Holly A

    2016-01-29

    Rural primary care shortages may be alleviated if more nurse practitioners (NPs) practiced there. This study compares urban and rural primary care NPs (classified by practice location in urban, large rural, small rural, or isolated small rural areas) using descriptive analysis of the 2012 National Sample Survey of NPs. A higher share of rural NPs worked in states without physician oversight requirements, had a DEA (drug enforcement administration) number, hospital admitting privileges, and billed using their own provider identifier. Rural NPs more often reported they were fully using their NP skills, practicing to the fullest extent of the legal scope of practice, satisfied with their work, and planning to stay in their jobs. We found lower per capita NP supply in rural areas, but the proportion in primary care increased with rurality. To meet rural primary care needs, states should support rural NP practice, in concert with support for rural physician practice.

  12. Human Resources in the South: Rural Sociology in the 1990s.

    Science.gov (United States)

    Ross, Peggy J.

    1990-01-01

    Examines the condition of human resources in the rural South, particularly educational attainment, outmigration, illiteracy, and quality of rural schools. Discusses strategies for the development of human resources in the 1990s involving local, state, and federal governments and the role of rural sociologists. Contains 40 references. (Author/SV)

  13. Initial management of traumatic brain injury in the rural setting

    Directory of Open Access Journals (Sweden)

    Stephen Honeybul

    2013-01-01

    Full Text Available Healthcare workers in the rural setting face unique problems when dealing with head injured patients however the basic principle of medical management are the same in any situation. The key initial elements remain aggressive early resuscitation followed by a comprehensive assessment of conscious level and either early consultation or transfer to a neurosurgical facility. What has improved considerably over recent years is the understanding of the pathophysiology of traumatic brain injury and as such some of the medical management strategies have changed. A basic understanding of some of these concepts is useful in the clinical setting and serves to emphasis the importance of effective early medical management. Thereafter consideration must be given to which patients require radiological investigations and possible discussion with or transfer to a neurosurgical facility.

  14. 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.

  15. OA27 Rural palliative care for low resource settings among marginalised communities in the south indian state of tamilnadu - a new venture with two and a half years of outcome.

    Science.gov (United States)

    Thiagarajan, Mohanasundaram

    2015-04-01

    India with a total of 1.27 Billion (2014) population and over 73% of them are living in rural areas. Cancer remaining as the second cause of death in rural community and at any given time over 4 million cancer cases are living in our country and most of them are diagnosed at their advanced stages and suffering with intractable pain and 'total sufferings'. At present, time available for palliative care services is less than 1% for the needy, it is mostly spread out around the urban areas leaving the remaining 73% of rural sufferers in lack of availability, accessibility, acceptability and affordability. To identify the need for palliative care, in a particular Block of the district, and provide home based total care. Selection of 'Andanallur' village block with a population of nearly 100,000. Sensitisation of the health care staff, village members, self help groups and schools and through the Information, educative and communication methods. Conduction of a primary survey to identify the needy Examination and short listing cases for home based Palliative care Home based palliative care The project was started in 2011 January and 156 cases short listed; 121 cases started with home care and 52 cases had passed away, 8 cases were given end of life care. Palliative care reaching the sufferers directly Reaching the unreachable and under-privileged Need based 'total care' at their door steps Empowering and training the family members. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Human resource development in rural health care facilities.

    Science.gov (United States)

    Johnson, L

    1991-01-01

    In this paper, human resource development problems facing rural health care facilities are identified and it is recognised that, particularly in the face of escalating demands for training arising from environmental pressures such as implementation of the structural efficiency principle, a coordinated approach to meet these problems is desirable. Such coordination is often sought via a regional staff development service. Accordingly, using the organisational life cycle as a conceptual framework, staff development services in five NSW health regions are examined. Ranging from a cafeteria style to a results-orientation, a diversity of strategic approaches to staff development is reflected.

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

    Institute of Scientific and Technical Information of China (English)

    Xirong; GAO; Lingling; SHAN

    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 institutional design for sharing of information resources in rural areas as follows: firstly, establishing an administrative agency of rural information resources sharing, above the authority of all units, responsible for related work on sharing of information resources in rural areas; secondly, establishing and improving the positive and negative incentive mechanisms, to ensure the realization of sharing of information resources in rural areas.

  18. 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.

  19. Resource Matchmaking Algorithm using Dynamic Rough Set in Grid Environment

    CERN Document Server

    Ataollahi, Iraj

    2009-01-01

    Grid environment is a service oriented infrastructure in which many heterogeneous resources participate to provide the high performance computation. One of the bug issues in the grid environment is the vagueness and uncertainty between advertised resources and requested resources. Furthermore, in an environment such as grid dynamicity is considered as a crucial issue which must be dealt with. Classical rough set have been used to deal with the uncertainty and vagueness. But it can just be used on the static systems and can not support dynamicity in a system. In this work we propose a solution, called Dynamic Rough Set Resource Discovery (DRSRD), for dealing with cases of vagueness and uncertainty problems based on Dynamic rough set theory which considers dynamic features in this environment. In this way, requested resource properties have a weight as priority according to which resource matchmaking and ranking process is done. We also report the result of the solution obtained from the simulation in GridSim s...

  20. 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.

  1. Exercise Preference Patterns, Resources, and Environment among Rural Breast Cancer Survivors

    Science.gov (United States)

    Rogers, Laura Q.; Markwell, Stephen J.; Courneya, Kerry S.; McAuley, Edward; Verhulst, Steven

    2009-01-01

    Context: Rural breast cancer survivors may be at increased risk for inadequate exercise participation. Purpose: To determine for rural breast cancer survivors: (1) exercise preference "patterns," (2) exercise resources and associated factors, and (3) exercise environment. Methods: A mail survey was sent to rural breast cancer survivors identified…

  2. Reconstructive maxillofacial surgery in a resource poor setting ...

    African Journals Online (AJOL)

    Reconstructive maxillofacial surgery in a resource poor setting: Challenges encountered ... Background: Facial reconstruction in a paediatric patient requires peculiar ... age and gender considerations, depth of expertise and extent of surgery ...

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

    African Journals Online (AJOL)

    EB

    In resource-limited settings, GeneXpert has been used ... had several visits to various lower level health centres and two admissions in a tertiary care hospital; however, the diagnosis .... point of view, implementation of GeneXpert testing.

  4. Maximizing resource efficiency in rural prehospital emergency medical services through call frequency analysis

    OpenAIRE

    Flynn, Andrew

    2013-01-01

    Rural prehospital emergency medical services are often lacking when compared with their urban counterparts in terms of resources and coordinated resource use: can only employ important resources, such as paramedics, during limited shifts. This project demonstrates a method for determining the most effective use of these limited resources in a rural Red Cross ambulance service in Guápiles, Costa Rica. In this community, paramedic services are only available six days a week for twelve hours. Em...

  5. 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

  6. 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

  7. 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.…

  8. 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.…

  9. Sustainable natural resource use in rural China: Recent trends and policies

    NARCIS (Netherlands)

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

    2011-01-01

    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 be

  10. Epidemiology of preinvasive lesions of the cervix and accuracy of its screening modalities in low resource settings

    Directory of Open Access Journals (Sweden)

    Rashi Rashi

    2016-05-01

    Conclusions: VIA is a screening modality suitable for low resource setting like ours along with cytology. It also offers see and treat option for women in rural areas who are usually lost to follow up. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1582-1584

  11. 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.

  12. Assessing health literacy in rural settings: a pilot study in rural areas of Cluj County, Romania.

    Science.gov (United States)

    Pop, Oana M; Brînzaniuc, Alexandra; Sirlincan, Emanuela O; Baba, Catalin O; Chereches, Razvan M

    2013-12-01

    Health literacy improves knowledge and builds skills to help individuals make appropriate decisions regarding their health. Over the past 20 years, several studies have described associations between health literacy and health outcomes. With respect to Romania, evidence is scarce on the level of health literacy, as well as on its determinants. Thus, the objectives of this study were to briefly screen functional health literacy levels in a sample of rural inhabitants, to assess the relationship between health literacy and reported health status, as well as to explore health literacy determinants within this population. Data were collected between September-November 2010, in four villages in Cluj County, Romania, using a cross-sectional survey. The mean age of respondents in the sample was 56 years, with roughly half of respondents being retired. The brief screening of health literacy suggested inadequate to marginal levels within the sample. Significant associations were observed between health literacy score and education, and self-perceived health status, whereas the relationship between health literacy and gender, and the presence of a chronic disease was not statistically significant. Limited health literacy has been shown to be common in people who rated their health as poor, those who attended only middle school, and individuals lacking basic information about their body. In order to minimize the adverse effects of low health literacy on health and health outcomes, efforts should be invested in identifying and addressing the health needs of adults with low and marginal health literacy, especially in underserved areas such as rural and remote settings, where access to health-related information is limited.

  13. Diagnostics in Ebola Virus Disease in Resource-Rich and Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Robert J Shorten

    2016-10-01

    Full Text Available The Ebola virus disease (EVD outbreak in West Africa was unprecedented in scale and location. Limited access to both diagnostic and supportive pathology assays in both resource-rich and resource-limited settings had a detrimental effect on the identification and isolation of cases as well as individual patient management. Limited access to such assays in resource-rich settings resulted in delays in differentiating EVD from other illnesses in returning travellers, in turn utilising valuable resources until a diagnosis could be made. This had a much greater impact in West Africa, where it contributed to the initial failure to contain the outbreak. This review explores diagnostic assays of use in EVD in both resource-rich and resource-limited settings, including their respective limitations, and some novel assays and approaches that may be of use in future outbreaks.

  14. 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.

  15. 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.

  16. Molecular oncology testing in resource-limited settings.

    Science.gov (United States)

    Gulley, Margaret L; Morgan, Douglas R

    2014-11-01

    Cancer prevalence and mortality are high in developing nations, where resources for cancer control are inadequate. Nearly one-quarter of cancers in resource-limited nations are infection related, and molecular assays can capitalize on this relationship by detecting pertinent pathogen genomes and human gene variants to identify those at highest risk for progression to cancer, to classify lesions, to predict effective therapy, and to monitor tumor burden over time. Prime examples are human papillomavirus in cervical neoplasia, Helicobacter pylori and Epstein-Barr virus in gastric adenocarcinoma and lymphoma, and hepatitis B or C virus in hepatocellular cancer. Research is underway to engineer devices that overcome social, economic, and technical barriers limiting effective laboratory support. Additional challenges include an educated workforce, infrastructure for quality metrics and record keeping, and funds to sustain molecular test services. The combination of well-designed interfaces, novel and robust electrochemical technology, and telemedicine tools will promote adoption by frontline providers. Fast turnaround is crucial for surmounting loss to follow-up, although increased use of cell phones, even in rural areas, enhances options for patient education and engagement. Links to a broadband network facilitate consultation and centralized storage of medical data. Molecular technology shows promise to address gaps in health care through rapid, user-friendly, and cost-effective devices reflecting clinical priorities in resource-poor areas.

  17. 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.; Kolmer, NW van Ewijk-Benek; 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 concentra

  18. 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.; Kolmer, NW van Ewijk-Benek; 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 concentra

  19. 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.

  20. Crossing the quality chasm in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Maru Duncan

    2012-11-01

    Full Text Available Abstract 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.

  1. Factors Associated with American Indian Cigarette Smoking in Rural Settings

    OpenAIRE

    Karabi Nandy; Felicia Hodge

    2011-01-01

    Introduction: This paper reports on the prevalence, factors and patterns of cigarette smoking among rural California American Indian (AI) adults. Methods: Thirteen Indian health clinic registries formed the random household survey sampling frame (N = 457). Measures included socio-demographics, age at smoking initiation, intention to quit, smoking usage, smoking during pregnancy, health effects of smoking, suicide attempts or ideation, history of physical abuse, neglect and the role of the env...

  2. 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.

  3. 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.

  4. A Shipping Container-Based Sterile Processing Unit for Low Resources Settings.

    Science.gov (United States)

    Boubour, Jean; Jenson, Katherine; Richter, Hannah; Yarbrough, Josiah; Oden, Z Maria; Schuler, Douglas A

    2016-01-01

    Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor protocols, and inadequate quality control over inventory. Inspired by our sterile processing fieldwork at a district hospital in Sierra Leone in 2013, we built an autonomous, shipping-container-based sterile processing unit to address these deficiencies. The sterile processing unit, dubbed "the sterile box," is a full suite capable of handling instruments from the moment they leave the operating room to the point they are sterile and ready to be reused for the next surgery. The sterile processing unit is self-sufficient in power and water and features an intake for contaminated instruments, decontamination, sterilization via non-electric steam sterilizers, and secure inventory storage. To validate efficacy, we ran tests of decontamination and sterilization performance. Results of 61 trials validate convincingly that our sterile processing unit achieves satisfactory outcomes for decontamination and sterilization and as such holds promise to support healthcare facilities in low resources settings.

  5. A Shipping Container-Based Sterile Processing Unit for Low Resources Settings.

    Directory of Open Access Journals (Sweden)

    Jean Boubour

    Full Text Available Deficiencies in the sterile processing of medical instruments contribute to poor outcomes for patients, such as surgical site infections, longer hospital stays, and deaths. In low resources settings, such as some rural and semi-rural areas and secondary and tertiary cities of developing countries, deficiencies in sterile processing are accentuated due to the lack of access to sterilization equipment, improperly maintained and malfunctioning equipment, lack of power to operate equipment, poor protocols, and inadequate quality control over inventory. Inspired by our sterile processing fieldwork at a district hospital in Sierra Leone in 2013, we built an autonomous, shipping-container-based sterile processing unit to address these deficiencies. The sterile processing unit, dubbed "the sterile box," is a full suite capable of handling instruments from the moment they leave the operating room to the point they are sterile and ready to be reused for the next surgery. The sterile processing unit is self-sufficient in power and water and features an intake for contaminated instruments, decontamination, sterilization via non-electric steam sterilizers, and secure inventory storage. To validate efficacy, we ran tests of decontamination and sterilization performance. Results of 61 trials validate convincingly that our sterile processing unit achieves satisfactory outcomes for decontamination and sterilization and as such holds promise to support healthcare facilities in low resources settings.

  6. Population survey sampling methods in a rural African setting: measuring mortality

    Directory of Open Access Journals (Sweden)

    Byass Peter

    2008-05-01

    Full Text Available Abstract Background Population-based sample surveys and sentinel surveillance methods are commonly used as substitutes for more widespread health and demographic monitoring and intervention studies in resource-poor settings. Such methods have been criticised as only being worthwhile if the results can be extrapolated to the surrounding 100-fold population. With an emphasis on measuring mortality, this study explores the extent to which choice of sampling method affects the representativeness of 1% sample data in relation to various demographic and health parameters in a rural, developing-country setting. Methods Data from a large community based census and health survey conducted in rural Burkina Faso were used as a basis for modelling. Twenty 1% samples incorporating a range of health and demographic parameters were drawn at random from the overall dataset for each of seven different sampling procedures at two different levels of local administrative units. Each sample was compared with the overall 'gold standard' survey results, thus enabling comparisons between the different sampling procedures. Results All sampling methods and parameters tested performed reasonably well in representing the overall population. Nevertheless, a degree of variation could be observed both between sampling approaches and between different parameters, relating to their overall distribution in the total population. Conclusion Sample surveys are able to provide useful demographic and health profiles of local populations. However, various parameters being measured and their distribution within the sampling unit of interest may not all be best represented by a particular sampling method. It is likely therefore that compromises may have to be made in choosing a sampling strategy, with costs, logistics the intended use of the data being important considerations.

  7. Assessment of Population-Based HIV RNA Levels in a Rural East African Setting Using a Fingerprick-Based Blood Collection Method

    OpenAIRE

    Jain, Vivek; Liegler, Teri; Kabami, Jane; Chamie, Gabriel; Clark, Tamara D; Black, Douglas; Geng, Elvin H.; Kwarisiima, Dalsone; Wong, Joseph K.; Abdel-Mohsen, Mohamed; Sonawane, Nitin; Aweeka, Francesca T.; THIRUMURTHY, Harsha; Petersen, Maya L; Charlebois, Edwin D.

    2012-01-01

    Population-based human immunodeficiency virus (HIV) RNA metrics can help estimate antiretroviral therapy effectiveness within a community. We developed a fingerprick-based viral load technique and measured population HIV RNA levels in a rural Ugandan community, providing the first report from a resource limited setting.

  8. Infertility in resource-constrained settings: moving towards amelioration.

    Science.gov (United States)

    Hammarberg, Karin; Kirkman, Maggie

    2013-02-01

    It is often presumed that infertility is not a problem in resource-poor areas where fertility rates are high. This is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproductive technology in low-resource countries. This paper challenges the construct that infertility is not a serious problem in resource-constrained settings and argues that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. It is often presumed that infertility is not a problem in densely populated, resource-poor areas where fertility rates are high. This presumption is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Because many families in low-income countries depend on children for economic survival

  9. Research on Human Resources Development of Rural Public Service Departments in New Countryside Construction

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    On the basis of defining related concepts concerning human resources in rural public service departments,this paper analyses the overall status quo of human resources in China’s rural public service departments and points out the problems existing in human resources in China’s rural public service departments during new countryside construction as follows:first,the constitution structure is not rational;second,the cultural quality of staff is universally low,and the business capacity remains to be promoted;third,the improvement of human resources development environment lags behind,and the supporting reform is short.In the context of new countryside construction,the opportunities faced by the human resources in China’s rural public service departments are as follows:China has elevated strengthening new countryside construction and rural talents construction as important state development strategy;the ideas of service-oriented government and learning-oriented government are put forward;civil servant system is overhauled.Therefore,I advance the development strategy of human resources in China’s rural public service departments as follows:implement elastic personnel system reform in public service departments(including civil servant positions in department),to form the public service personnel system of "able one comes in,mediocre one moves over and shiftless one steps down";audaciously promote young and middle-aged grass-roots cadres with strong business ability,high political quality,acute judgement and decision-making ability;build learning-oriented grass-roots public service organization,to make the staff in rural pubic service departments study assiduously and progress;broaden horizon,and build the human resources development system geared to international standards;in developed regions,the human resources in grass-roots public service departments should introduce enterprise competition model.

  10. 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...

  11. 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

  12. 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

  13. 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.

  14. Paediatric emergency and acute care in resource poor settings.

    Science.gov (United States)

    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.

  15. 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.

  16. Policy implementation in wheelchair service delivery in a rural South African setting

    Directory of Open Access Journals (Sweden)

    Surona Visagie

    2013-01-01

    Full Text Available Background: Wheelchairs allow users to realise basic human rights and improved quality of life. South African and international documents guide rehabilitation service delivery and thus the provision of wheelchairs. Evidence indicates that rehabilitation policy implementation gaps exist in rural South Africa.Objectives: The aim of this article was to explore the extent to which wheelchair service delivery in a rural, remote area of South Africa was aligned with the South African National Guidelines on Provision of Assistive Devices, The United Nations Convention on the Rights of Persons with Disabilities and The World Health Organization Guidelines on Provision of Wheelchairs in Less-Resourced Settings.Method: Qualitative methods were used. Data were collected through semi-structured interviews with 22 participants who were identified through purposive sampling. Content analysis of data was preformed around the construct of wheelchair service delivery.Results: Study findings identified gaps between the guiding documents and wheelchair service delivery. Areas where gaps were identified included service aspects such as referral, assessment, prescription, user and provider training, follow up, maintenance and repair as well as management aspects such as staff support, budget and monitoring. Positive findings related to individual assessments, enthusiastic and caring staff and the provision of wheelchairs at no cost.Conclusion: The gaps in policy implementation can have a negative impact on users and the service provider. Inappropriate or no wheelchairs limit user function, participation and quality of life. In addition, an inappropriate wheelchair will have a shorter lifespan, requiring frequent repairs and replacements with cost implications for the service provider.

  17. DPT/CT: A Realistic Answer for Preventive Special Education Services in Rural School Setting.

    Science.gov (United States)

    Sapp, David N.

    The consulting teacher program involving the use of special classes and resource rooms, which serves mildly to moderately handicapped students in Griggs, Steele, and Traill Counties in North Dakota, a rural school district, is described. Outlined is the service design model consisting of 11 steps: referral, observation, initial parent contact,…

  18. 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

  19. Prevention for common mental disorders in low-resource settings

    Directory of Open Access Journals (Sweden)

    Raman Deep Pattanayak

    2017-01-01

    Full Text Available Only a limited research evidence is available from low- and middle-income countries for various preventive strategies for anxiety and mood disorders. In the context of these low-resource settings, the models of primary and secondary prevention have to be adapted to the available resources and sociocultural context. The thrust of preventive activities for common mental disorders, as per emerging evidence and expert consensus, may be placed on information and awareness campaigns, workplace prevention, task shifting to community health workers (CHWs, multi-sectoral collaborations with broad-based preventive approach, targeting multiple risk factors, identifying unique protective factors with cultural relevance, and use of modern technology and smart tools for cost-effective solutions with a wider reach. In the future research, the scalability aspects, cost-effectiveness evaluation, and methodological rigor as well as cultural acceptability should be important considerations.

  20. 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.

  1. Malariometric Indices among Nigerian Children in a Rural Setting

    Directory of Open Access Journals (Sweden)

    Ekong E. Udoh

    2013-01-01

    Full Text Available Malaria contributes to high childhood morbidity and mortality in Nigeria. To determine its endemicity in a rural farming community in the south-south of Nigeria, the following malariometric indices, namely, malaria parasitaemia, spleen rates, and anaemia were evaluated in children aged 2–10 years. This was a descriptive cross-sectional survey among school-age children residing in a rubber plantation settlement. The children were selected from six primary schools using a multistaged stratified cluster sampling technique. They were all examined for pallor, enlarged spleen, or liver among other clinical parameters and had blood films for malaria parasites. Of the 461 children recruited, 329 (71.4% had malaria parasites. The prevalence of malaria parasitaemia was slightly higher in the under fives than that of those ≥5 years, 76.2% and 70.3%, respectively. Splenic enlargement was present in 133 children (28.9%. The overall prevalence of anaemia was 35.7%. Anaemia was more common in the under-fives (48.8% than in those ≥5 years (32.8%. The odds of anaemia in the under fives were significantly higher than the odds of those ≥5 years (OR=1.95 [1.19–3.18]. Malaria is highly endemic in this farming community and calls for intensification of control interventions in the area with special attention to school-age children.

  2. Factors Associated with American Indian Cigarette Smoking in Rural Settings

    Directory of Open Access Journals (Sweden)

    Karabi Nandy

    2011-03-01

    Full Text Available Introduction: This paper reports on the prevalence, factors and patterns of cigarette smoking among rural California American Indian (AI adults. Methods: Thirteen Indian health clinic registries formed the random household survey sampling frame (N = 457. Measures included socio-demographics, age at smoking initiation, intention to quit, smoking usage, smoking during pregnancy, health effects of smoking, suicide attempts or ideation, history of physical abuse, neglect and the role of the environment (smoking at home and at work. Statistical tests included Chi Square and Fisher’s Exact test, as well as multiple logistic regression analysis among never, former, and current smokers. Results: Findings confirm high smoking prevalence among male and female participants (44% and 37% respectively. American Indians begin smoking in early adolescence (age 14.7. Also, 65% of current smokers are less than 50% Indian blood and 76% of current smokers have no intention to quit smoking. Current and former smokers are statistically more likely to report having suicidal ideation than those who never smoked. Current smokers also report being neglected and physically abused in childhood and adolescence, are statistically more likely to smoke ½ pack or less (39% vs. 10% who smoke 1+ pack, smoke during pregnancy, and have others who smoke in the house compared with former and never smokers. Conclusion: Understanding the factors associated with smoking will help to bring about policy changes and more effective programs to address the problem of high smoking rates among American Indians.

  3. Optimization of Training Program for Land Resource Management Major under the Background of Urban and Rural Integration

    Institute of Scientific and Technical Information of China (English)

    Qian; CHEN; Qigang; ZHOU; Dan; CHEN; Xiaoyuan; ZHANG; Fuhai; WANG

    2013-01-01

    With constant deepening of development outlook of urban and rural integration,education circle starts to attach great importance to reform of personnel training program.Since scarcity of land resource and key role of land management in urban and rural integration,it is urgent to optimize the personnel training program for land resource management major.From aspects of optimum objectives,principles,program and implementation effect,this paper discusses training program for land resource management major under the background of urban and rural integration.It is expected to provide reference for cultivating land resource management personnel suitable for development of urban and rural integration.

  4. An assessment of multidimensional wellbeing in rural Rwanda: impacts of and implications for rural development and natural resource conservation

    OpenAIRE

    2013-01-01

    This study applies a multidimensional definition of wellbeing, which includes material, social and subjective dimensions, to household level social research in rural Rwanda. Its contribution lies in applying the approach to three different fields: the study of cultural difference; natural resource management; and agrarian change, and in combining a wellbeing assessment with dominant theories or concepts in each. Rwanda has received acclaim for meeting development targets despite high level...

  5. Resilience in rural common-pool resource management systems: towards enhancing landscape amenities using a multi-agent approach

    NARCIS (Netherlands)

    Schouten, M.A.H.; Polman, N.B.P.; Westerhof, E.J.G.M.; Woltjer, G.B.

    2010-01-01

    Rural areas are continuously subject to changing circumstances, varying from changes in ecosystem conditions to socio-economic changes like food- and financial crises. Within Europe, the Common Agricultural Policy (CAP) reform is driver as well for change of rural common pool resources (CPR). Rural

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

    DEFF Research Database (Denmark)

    Pedersen, Bastian; Ssemugabo, Charles; Nabankema, Victoria

    2017-01-01

    Pesticide poisoning is a significant burden on health care systems in many low-income countries. This study evaluates cases of registered pesticide poisonings treated in selected rural (N = 101) and urban (N = 212) health facilities in Uganda from January 2010 to August 2016. In the urban setting......, 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.......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...

  7. Empirical Study on the Reform of Water Resources Management in Xinjiang Rural Communities

    Institute of Scientific and Technical Information of China (English)

    Pichang; YUE; Jian; DAI; Chaohui; LU; Jianguo; DING; Mubarek

    2013-01-01

    With the case study of two rural communities of Hetian County and Shawan County in Xinjiang, the foundation, operation and development of the water management organizations in the two communities and their reform achievements were studied and compared. It was concluded that the reform of water resources management should be in accordance with the practical conditions of rural communities. Only with the same objectives of community people and by benefiting the farmers could the reform of water resources management be effectively implemented and achieve good results.

  8. 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.

  9. 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.

  10. 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…

  11. 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…

  12. 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

  13. 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

  14. Cross-efficiency DEA model-based evaluation of allocative efficiency of rural information resources in Jiangsu Province, China

    Institute of Scientific and Technical Information of China (English)

    Jiannong; ZHOU; Aidong; PENG; Jing; CUI; Shuiqing; HUANG

    2012-01-01

    Purpose:This paper aims to compare and rank the allocative efficiency of information resources in rural areas by taking 13 rural areas in Jiangsu Province,China as the research sample.Design/methodology/approach:We designed input and output indicators for allocation of rural information resources and conducted the quantitative evaluation of allocative efficiency of rural information resources based on cross-efficiency model in combination with the classical CCR model in data envelopment analysis(DEA).Findings:Cross-efficiency DEA model can be used for our research with the objective to evaluate quantitatively and objectively whether the allocation of information resources in various rural areas is reasonable and whether the output is commensurate with the input.Research limitations:We have to give up using some indicators because of limited data availability.There is a need to further improve the cross-efficiency DEA model because it cannot identify the specific factors influencing the efficiency of decision-making units(DMUs).Practical implications:The evaluation results will help us understand the present allocative efficiency levels of information resources in various rural areas so as to provide a decisionmaking basis for formulation of the policies aimed at promoting the circulation of information resources in rural areas.Originality/value:Little or no research has been published about the allocative efficiency of rural information resources.The value of this research lies in its focus on studying rural informatization from the perspective of allocative efficiency of rural information resources and in the application of cross-efficiency DEA model to evaluate allocative efficiency of rural information resources as well.

  15. 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.

  16. 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.

  17. Eye-tracking-based assessment of cognitive function in low-resource settings.

    Science.gov (United States)

    Forssman, Linda; Ashorn, Per; Ashorn, Ulla; Maleta, Kenneth; Matchado, Andrew; Kortekangas, Emma; Leppänen, Jukka M

    2017-04-01

    Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings. The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40). Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks. High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  18. Assessing Rural Sustainable Development potentialities using a Dominance-based Rough Set Approach.

    Science.gov (United States)

    Boggia, Antonio; Rocchi, Lucia; Paolotti, Luisa; Musotti, Francesco; Greco, Salvatore

    2014-11-01

    Rural Development is a priority in Europe and it is supported by specific, financial programmes. At the same time, sustainability is the key word for the European Union to construct programmes and policies for all human activities. However, measuring sustainability of rural areas is not easy, due to their particular features. The improvement of knowledge on sustainability in rural areas is important to build long term policies and strategies for those territories. The objective of this study is the development of a decision support system based on the Dominance-based Rough Set Approach (DRSA), to assess the level of Rural Sustainable Development in specific areas. We used DRSA to analyze the level of sustainability of the 92 municipalities of the Region of Umbria, Italy. The results were synthesized in a final ranking, taking into account the equilibrium and the integration between development and sustainability of each municipality. DRSA showed a high potential in the context of management or planning, and for supporting Decision Makers. DRSA is able to give a ranking as well as an explanation of the main factors driving sustainable development in rural areas.

  19. Intergenerational Exchange of Resources and Elderly Support in Rural China.

    Science.gov (United States)

    Lin, Zhiyong; Pei, Xiaomei

    2016-07-01

    This study examines how parental investments on children affect elderly support, and how this effect is contingent on emotional closeness or parental authority. Data collected from 770 elderly parents residing in rural China were analyzed. We gathered dichotomous data for (a) whether parents invested on their children via financial or instrumental means (i.e., parental investments) and (b) whether parents reported closeness to their children (i.e., emotional closeness) and whether children respected them (i.e., parental authority). We examined the relation between these variables and children's elderly support (financial, instrumental, and emotional). We tested models in two ways, one examining the direct effect of investments, and another testing the interactions between investments and closeness or authority. We first found that investments were not directly associated with elderly support, although the closeness and authority were. Additionally, the association between investments and support was found within parents who reported authority or closeness with their children.

  20. Devolution and human resources in primary healthcare in rural Mali.

    Science.gov (United States)

    Lodenstein, Elsbet; Dao, Dramane

    2011-06-08

    Devolution, as other types of decentralization (e.g. deconcentration, delegation, privatization), profoundly changes governance relations in the health system. Devolution is meant to affect performance of the health system by transferring responsibilities and authority to locally elected governments. The key question of this article is: what does devolution mean for human resources for health in Mali?This article assesses the key advantages and dilemmas associated with devolution such as responsiveness to local needs, downward accountability and health worker retention. Challenges of politics and capacities are also addressed in relation to human resources for health at the local level. Examples are derived from experiences in Mali with a capacity development programme and from case studies of other countries. It is not research findings that are presented, but highlights of key issues at stake aimed at inspiring the debate in Mali and elsewhere.A first lesson from the discussion suggests that in the context of human resources for health, decentralization of authority and resources is not the main issue. The challenge is to develop or strengthen accountability of those who decide and act, whether they are local politicians, bureaucrats or community representatives. If decentralization policies do not address public accountability, they will not fundamentally change human resource management, quality and equity of staffing. A second lesson is that successful devolution requires innovations in capacity development of all actors involved and in designing effective incentive measures. A final key conclusion is that the topic of devolution policy and its effects on human resources for health, and vice versa, merit more attention. A better understanding may lead to more appropriate policy designs and better preparation for the actors involved in countries that are embarking on decentralization, as is the case in Mali.

  1. Devolution and human resources in primary healthcare in rural Mali

    Directory of Open Access Journals (Sweden)

    Dao Dramane

    2011-06-01

    Full Text Available Abstract Devolution, as other types of decentralization (e.g. deconcentration, delegation, privatization, profoundly changes governance relations in the health system. Devolution is meant to affect performance of the health system by transferring responsibilities and authority to locally elected governments. The key question of this article is: what does devolution mean for human resources for health in Mali? This article assesses the key advantages and dilemmas associated with devolution such as responsiveness to local needs, downward accountability and health worker retention. Challenges of politics and capacities are also addressed in relation to human resources for health at the local level. Examples are derived from experiences in Mali with a capacity development programme and from case studies of other countries. It is not research findings that are presented, but highlights of key issues at stake aimed at inspiring the debate in Mali and elsewhere. A first lesson from the discussion suggests that in the context of human resources for health, decentralization of authority and resources is not the main issue. The challenge is to develop or strengthen accountability of those who decide and act, whether they are local politicians, bureaucrats or community representatives. If decentralization policies do not address public accountability, they will not fundamentally change human resource management, quality and equity of staffing. A second lesson is that successful devolution requires innovations in capacity development of all actors involved and in designing effective incentive measures. A final key conclusion is that the topic of devolution policy and its effects on human resources for health, and vice versa, merit more attention. A better understanding may lead to more appropriate policy designs and better preparation for the actors involved in countries that are embarking on decentralization, as is the case in Mali.

  2. Helping Rural Communities Manage Growth and Protect Natural Resources

    Science.gov (United States)

    Tyson, C. Benjamin; Westa, Susan P.; Broderick, Stephen H.

    2007-01-01

    A learning needs assessment survey was conducted by the Green Valley Institute in the Quinebaug Shetucket National Heritage Corridor in Connecticut and Massachusetts. This survey was designed to assess educational interests, perceived knowledge, and importance relating to land use, community planning and design, and natural resources. Findings…

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. Trichomoniasis: How do we diagnose in a resource poor setting?

    Directory of Open Access Journals (Sweden)

    R Sivaranjini

    2013-01-01

    (culture, especially in resource poor settings.

  8. 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.

  9. Achievement of national cholesterol education program goals by patients with dyslipidemia in rural ambulatory care settings.

    Science.gov (United States)

    Qayyum, Rehan; Chattha, Ashraf A; Bhullar, Navneet; Katsetos, Manny; Schulman, Peter

    2006-01-01

    The Third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program provides guidelines for managing dyslipidemia; however, studies from large centers find that most dyslipidemic patients fail to achieve management goals. Few data exist on lipid management in rural settings. To determine the proportion of rural dyslipidemic patients achieving ATP III goals, records of 461 patients were reviewed from 4 practices. Only 54% of the patients with dyslipidemia achieved ATP III goals. Patients with diabetes or with a family history of premature coronary heart disease were less likely to achieve ATP III goals (odds ratio 0.56; 95% confidence interval, 0.38-0.84 and odds ratio 0.42; 95% confidence interval, 0.25-0.71, respectively). Patients taking statins were more likely to achieve goals (odds ratio 3.23; 95% confidence interval, 2.13-4.89). These results indicate that a significant proportion of patients with dyslipidemia in rural practices do not achieve management goals. Strategies to improve lipid management in rural practices are needed.

  10. Guidance on the diagnosis and management of asthma among adults in resource limited settings

    NARCIS (Netherlands)

    Kirenga, Bruce J.; Schwartz, Jeremy I.; de Jong, Corina; van der Molen, Thys; Okot-Nwang, Martin

    2015-01-01

    BACKGROUND: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. ME

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Myers Bronwyn A

    2011-02-01

    Full Text Available Abstract Background 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. Results 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. Conclusions 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.

  13. 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.

  14. Study on Urban and Rural Medical and Health Resources Allocation Balance in China%我国城乡医疗卫生资源配置均衡性研究

    Institute of Scientific and Technical Information of China (English)

    张映芹; 王青

    2016-01-01

    China continuously stresses on its urban and rural medical and health resources ( URMHR) particularly the balancing issues. China's urban and rural medical and health resources allocation uneven performance in urban and rural residents'consumption of health care invest-ment proportion is not equal, the government budget for urban and rural health expenditure is unequal, distribution of human resources between urban and rural areas is unequal, urban and rural resources allocation of resources is not equal.The causes of medical resource allocation imbal-ance are the low level of rural economy in our country, the health service's ability to pay is low, China's urban and rural medical and health care' s spending way of resource allocation is not reasonable, the influence of urban and rural duality system on our country, and the Chinese govern-ment for differences in urban and rural medical and health resources.This paper argues that we should develop the Midwest rural economy, im-prove the quality of medical and health service, perfect rural medical security system, expand the scope of the disease protection, strengthen the construction of community health service, change the ideas, perfect the financial system, set up the mechanism of the government -led health care subsidies, increase social support four aspects to alleviate our country' s status of the urban and rural medical and health resources allocation which is not balanced.%我国城乡医疗卫生资源配置不均衡,其原因是我国部分地区农村医疗卫生服务支付能力低,城乡医疗卫生资源配置方式不合理,政府对城乡医疗卫生资源投入不均. 应大力发展中西部农村经济,提高医疗卫生服务质量;健全农村医疗保障制度,扩大疾病保障范围;加强基层社区医疗服务建设,改变现有就医观念;完善政府财政体制,建全医疗卫生补助机制.

  15. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    Science.gov (United States)

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India.

  16. Harvesting of communal resources by 'outsiders' in rural South Africa: a case of xenophobia or a real threat to sustainability?

    CSIR Research Space (South Africa)

    Twine, W

    2003-09-01

    Full Text Available The harvesting of communal natural resources by 'outsiders' (i.e. harvesters from other villages or towns) was investigated in ten rural villages in South Africa. Participatory Rural Appraisal (PRA) techniques were used to collect data in focus...

  17. 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.

  18. The Local Beneath the National and Global - Institutional Education, Credentialed Natural Resource Management (NRM) and Rural Community (Un) Sustainability

    Science.gov (United States)

    Franklin, Janice

    2011-01-01

    The implementation of strategies for national and global outcomes has in some instances left rural community resources and practices devalued and disturbed and rural people demoralised with the result that local community sustainability has been compromised. Formal education in Australia is about many things, but is rarely sympathetic towards…

  19. 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.

  20. Acute rheumatic fever and rheumatic heart disease in resource-limited settings.

    Science.gov (United States)

    Watson, Gabriella; Jallow, Bintou; Le Doare, Kirsty; Pushparajah, Kuberan; Anderson, Suzanne T

    2015-04-01

    Poststreptococcal complications, such as acute rheumatic fever (ARF) and rheumatic heart disease (RHD), are common in resource-limited settings, with RHD recognised as the most common cause of paediatric heart disease worldwide. Managing these conditions in resource-limited settings can be challenging. We review the investigation and treatment options for ARF and RHD and, most importantly, prevention methods in an African setting.

  1. 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

  2. Community Perspectives on Access to and Availability of Healthy Food in Rural, Low-Resource, Latino Communities

    OpenAIRE

    Valdez, Zulema; Ramírez, A. Susana; Estrada, Erendira; Grassi, Kathleen; Nathan, Stephanie

    2016-01-01

    Introduction Attention has focused on the food environment as a result of the growing concern with obesity rates among Latinos in rural areas. Researchers have observed associations between a lack of physical access to affordable produce in areas where supermarkets and grocery stores are limited and poor dietary intake and obesity; these associations are high in rural, low-resource neighborhoods with a high population of Latino residents. We aimed to engage residents of low-resource, Latino-m...

  3. 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.

  4. Applicability of the WHO maternal near miss criteria in a low-resource setting.

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    Ellen Nelissen

    Full Text Available BACKGROUND: Maternal near misses are increasingly used to study quality of obstetric care. Inclusion criteria for the identification of near misses are diverse and studies not comparable. WHO developed universal near miss inclusion criteria in 2009 and these criteria have been validated in Brazil and Canada. OBJECTIVES: To validate and refine the WHO near miss criteria in a low-resource setting. METHODS: A prospective cross-sectional study was performed in a rural referral hospital in Tanzania. From November 2009 until November 2011, all cases of maternal death (MD and maternal near miss (MNM were included. For identification of MNM, a local modification of the WHO near miss criteria was used, because most laboratory-based and some management-based criteria could not be applied in this setting. Disease-based criteria were added as they reflect severe maternal morbidity. In the absence of a gold standard for identification of MNM, the clinical WHO criteria were validated for identification of MD. RESULTS: 32 MD and 216 MNM were identified using the locally adapted near miss criteria; case fatality rate (CFR was 12.9%. WHO near miss criteria identified only 60 MNM (CFR 35.6%. All clinical criteria, 25% of the laboratory-based criteria and 50% of the management-based criteria could be applied. The threshold of five units of blood for identification of MNM led to underreporting of MNM. Clinical criteria showed specificity of 99.5% (95%CI: 99.4%-99.7% and sensitivity of 100% (95%CI: 91.1%-100%. Some inclusion criteria did not contribute to the identification of cases and therefore may be eligible for removal. CONCLUSION: The applicability of the WHO near miss criteria depends on the local context, e.g. level of health care. The clinical criteria showed good validity. Lowering the threshold for blood transfusion from five to two units in settings without blood bank and addition of disease-based criteria in low-resource settings is recommended.

  5. Sources and prevalence of self-reported asthma diagnoses in adults in urban and rural settings of Bangladesh.

    Science.gov (United States)

    Bartlett, Emily; Parr, John; Lindeboom, Wietze; Khanam, Masuma Akter; Koehlmoos, Tracy Pérez

    2013-01-01

    This study provides data on the sources of asthma diagnoses in the adult Bangladeshi population in urban and rural settings. The paper also reports the prevalence of self-reported asthma diagnoses and associated socio-demographic factors. A cross-sectional study was conducted in three communities: two rural settings and one urban setting, with a total sample size of 32,665 subjects. Pre-existing surveillance data provided individual socio-demographic factors. Provider categories were based on previous research describing provider plurality in Bangladesh. Descriptive statistics, univariate regression and multivariate regression analyses were performed. Bachelor of Medicine, Bachelor of Surgery (MBBS) generalists provided the largest proportion of diagnoses in both urban (54.6%) and rural (42.4%) sites. The largest proportion of non-MBBS-trained healthcare workers providing diagnoses of asthma was spiritual healers (13.3%) in the urban settings and village doctors (42.4%) in rural settings. The overall prevalence of self-reported asthma diagnoses was 5.0% in the urban population and 3.5% in the rural population. The results highlight the importance of non-MBBS doctors in serving the healthcare needs of the Bangladeshi population. This study reveals a higher prevalence of self-reported asthma diagnoses in the urban setting than in rural ones, which is consistent with international literature on the topic.

  6. Road traffi c crashes in rural setting: an experience of a middle-income country

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    Davoudi-Kiakalayeh Ali

    2014-12-01

    Full Text Available 【Abstract】Objective: To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. Methods: Rural road accident deaths from 2009 to 2013 were extracted from Iran’s Forensic Medicine System, Death Registry System and Road Trauma Research center database. Results: During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011- 2012 to 15.8 per 1 000 persons during March 012-2013. Conclusion: Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffi c crash victims in rural settings and show us that more attention is needed in this area. Key words: Accidents, traffi c; Iran; Mortality

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

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    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.

  8. STUDY OF SETTING UP THE FOREST RESOURCES MANAGEMENT INFORMATION SYSTEM BASED ON WEBGIS

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Based on an analysis of the characteristics of the Forest Resources Management Information System of each development phase, and consideration of the technical trend in Geographic Information System (GIS) in the Internet Age, this paper explores the importance and the feasibility of setting up Forest Resources Management Information System based on the WEBGIS. At the same time, based on the experience of our study, the paper explores the function, structure and method of developing the Forest Resources Management Information System based on WEBGIS. With the technology of WEBGIS, the Forest Resources Management Information System with data from Huoditang Farm was set up, which makes a great impact on forest resources management. So setting up the Forest Resources Management Information System based on WEBGIS is a trend of forest resources management. In the course of setting up this system, we must pay attention to following questions: 1) unify data standard and information encoding; 2) change mind.

  9. 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

  10. User and provider perspectives on emergency obstetric care in a Tanzanian rural setting

    DEFF Research Database (Denmark)

    Sorensen, 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...... perspectives and to identify a feasible strategy of action to improve access to timely and effective emergency obstetric care. There seems to be a need for a supplementary analytic model that more clearly has the health system as the central agent responsible for improving maternal health. A modified...

  11. 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.

  12. Dietary characteristics of complementary foods offered to Guatemalan infants vary between urban and rural settings.

    Science.gov (United States)

    Enneman, Anke; Hernández, Liza; Campos, Raquel; Vossenaar, Marieke; Solomons, Noel W

    2009-07-01

    The objective of this study was to describe and compare the dietary variety, diversity, and origins of complementary foods given to urban and rural Guatemalan infants in the second semester of life. Dietary intake from a total of 128 infants of both sexes, aged 6.0 to 12.0 months on admission, from a low-income district of Guatemala City and a rural Mayan village was collected by means of 3 nonconsecutive 24-hour quantitative intake recalls and breast-feeding histories. We hypothesized that rural/urban, age, and sex differences would occur with respect to dietary variety and diversity scores and descriptive features at 7 levels, that is, animal or plant origin (animal, plant, both, or water); solids or semisolids vs soups and stews vs liquids; infant vs family foods; modern vs traditional foods; processed vs nonprocessed foods; commercial vs noncommercial foods; and fortified vs nonfortified foods. Overall dietary variety and diversity scores did not differ significantly between sampling areas or between sexes. Infants aged 9 to 12 months had a higher dietary variety and diversity than infants aged 6 to 9 months. Plant sources constituted a large part of the diet in both areas. Foods prepared specifically for infants, rather than for the household, were not common, although more common in the urban area than in the rural area. Commercial, processed, and fortified foods were commonly consumed in both settings. It can be concluded that although no geographical differences were seen in dietary variety or diversity, distinctions between types of selected and consumed foods were observed.

  13. 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...... 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...... 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...

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

    Science.gov (United States)

    Ibanez-Gonzalez, Daniel Lopes

    2014-12-01

    Background 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. Methods 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. Results 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. Discussion 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.

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

    Directory of Open Access Journals (Sweden)

    Daniel Lopes Ibanez-Gonzalez

    2014-09-01

    Full Text Available Background: 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. Methods: 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. Results: 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. Discussion: 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.

  16. Solar energy and the Third World: Photovoltaic applications and their implications in rural settings for Zaire

    Science.gov (United States)

    Badibanga, Maurice Kalombay

    Purpose. The purpose of this study was to explore and analyze the level of development attained by flat-plate photovoltaic systems operating around the world and to consider the possibility of using them as an energy solution for the rural areas of Zaire. Methodology. The study was conceived to answer research questions in the following areas: (1) Zaire's overall energy situation; (2) status of photovoltaic applications and their performance in other countries; (3) how the information from this study can be applied toward a possible solution of the energy problem in rural areas of Zaire. The Dual Case Study Method was the mainstay for data and information analysis, based principally on two plants: Tangaye Village PV in Burkina Faso and Kaw Village in French Guiana. Focused Synthesis was the main strategy used to gather the information and data. The analysis of information conveyed an idea of the level of technology readiness for flat-plate photovoltaics and the direction in which future research is headed. Findings and conclusions. The study found that (1) Zaire's rural areas (70 percent of the total population) are deficient in commercial energy provision, when compared to other countries; and (2) government policies, at the time the study took place, favored big projects which benefited mostly urban settings. The rural areas could benefit from photovoltaics, due to its modular and stand-alone characteristics, if it can be afforded by the government. Zaire's geographical position is conducive to successful implementation of the PV program, and is similar to the Tangaye and Kaw situations. Recommendations. (1) The government of Zaire should seriously assess its rural energy needs and consider photovoltaics as an energy solution. (2) Research and development work in the area of energy should be encouraged in the institutions of higher learning in Zaire, where efforts should be made to keep abreast of energy technology updates in developed countries. (3) Systems that

  17. Insecticide treated bednet strategy in rural settings: can we exploit women's decision making power?

    Science.gov (United States)

    Tilak, Rina; Tilak, V W; Bhalwar, R

    2007-01-01

    Use of insecticide treated bednets in prevention of malaria is a widely propagated global strategy, however, its use has been reported to be influenced and limited by many variables especially gender bias. A cross sectional field epidemiological study was conducted in a rural setting with two outcome variables, 'Bednet use'(primary outcome variable) and 'Women's Decision Making Power' which were studied in reference to various predictor variables. Analysis reveals a significant effect on the primary outcome variable 'Bednet use' of the predictor variables- age, occupation, bednet purchase decision, women's decision making power, husband's education and knowledge about malaria and its prevention. The study recommends IEC on treated bednets to be disseminated through TV targeting the elderly women who have better decision making power and mobilizing younger women who were found to prefer bednets for prevention of mosquito bites for optimizing the use of treated bednets in similar settings.

  18. 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

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

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    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.

  20. Rural Community Colleges Developing Perceptions of Self-Identity

    Science.gov (United States)

    Miller, Michael T.; Tuttle, Courtney C.

    2006-01-01

    Rural America, in direct competition with growing suburban and urban America, has struggled to maintain a high quality of life. Rural out-migration levels are high, as are poverty and illiteracy rates. Rural community colleges have worked to defend and expand opportunities in rural settings, yet face their own challenges tied to resources,…

  1. Students Setting out to Alleviate "Poverty of Spirit" in Rural China Found Themselves Transformed: Self-Organized Volunteerism among University Students for Rural Development

    Science.gov (United States)

    Geng, Diane

    2008-01-01

    Most university students in China have their sights firmly set on future job and study opportunities in urban cities and abroad. However, a network of student volunteers felt compelled to join the cause of rural development and villager empowerment, reminiscent of efforts promoted forty years ago by Chairman Mao who sent "educated youth"…

  2. Setting the research agenda in a resource-limited setting--viewpoint.

    Science.gov (United States)

    Borok, Margaret Z; Busakhala, Naftali; Makadzange, Tariro; Hakim, James

    2014-01-01

    The phenomenon of disproportionately large allocations of global health research resources to relatively limited components of the global health burden is widely acknowledged. Factors contributing to this are explored. The development of a national or regional research agenda is a critical step toward attempting to redress this imbalance. Key areas to be considered are a broad vision, dialogue, and commitment from those stakeholders comprising the "health research triangle": national policy makers and decision makers, key personnel in both health research and health care, and community representatives. The interdependent roles of human, material, and community resources are further examined.

  3. Protecting patient safety in resource-poor settings.

    Science.gov (United States)

    Galadanci, Hadiza Shehu

    2013-08-01

    A crucial element in the delivery of high-quality health care is patient safety. The rate of adverse events among hospital patients is an indication of patient safety. A systematic review of in-hospital adverse events revealed the median incidence of adverse events as 9.2%; 7.4% were lethal and 43.5% preventable. All the studies in the systemic review were from developed countries, as research is lacking from developing countries. In 2012, data from 10 developing countries reported adverse events ranging from 2.5 to 18.4% per country; 30% were lethal and 83% preventable. This study places patient safety as one of the major concerns of the health policy agenda in developing countries. Human resources for health deficits in developing countries constitute a major structural constraint for ensuring patient safety. The key to reducing adverse events in health care is system-based interventions rather than clinical interventions or technologies. Patient safety skills training, effective communication, and good team work are essential in improving patient safety in developing countries. Research on patient safety is needed to address the knowledge gap in developing countries.

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

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    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.

  5. Snakebite profile from a medical college in rural setting in the hills of Himachal Pradesh, India

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    Sujeet Raina

    2014-01-01

    Full Text Available Objective: The objective of the following study is to assess the clinical profiles and manifestations of snakebite patients in the rural hilly setting of Shivalik and the Lesser Himalayan region of Himachal Pradesh. Materials and Methods: A hospital record-based retrospective descriptive study was carried out that included details on demography, clinical profile, treatment and outcome among 200 patients over a period of 2 years. The data was analyzed using Chi-square test for comparison. Results: 142 (71% patients were young (age group of 16-45 years and the number of male patients was 118 (59% and female patients were 82 (41%. All the cases recorded presented in the months of April to November. Not a single case was recorded from December to March. The most frequently bitten sites were the lower limbs particularly the feet. 86 (43% of the patients presented without any features of envenomation. Neuroparalysis was the commonest presentation in 53 (46% patients followed by hemotoxicity in 36 (31% among symptomatic patients. Early morning neuroparalysis syndrome was the presentation in 26.4% patients. Allergic reactions in the form of early anaphylaxis were noted in 7% patients. Conclusion: Snake bite is a neglected tropical disease affecting poor villagers in rural areas. Future research focusing on understanding epidemiological determinants of snake bite is desired.

  6. Asymptomatic bacteriuria: predisposing factors and correlation with preterm labor in low resource settings

    Directory of Open Access Journals (Sweden)

    Meenakshi Lallar

    2014-04-01

    Full Text Available Background: Infection of urinary tract occurs frequently during pregnancy ranging from Asymptomatic Bacteriuria (ASB to potentially life threatening acute pyelonephritis. The incidence varies from 5% to 20% and it is an important risk factor for preterm labor and perinatal morbidity and mortality. The present study was performed to correlate preterm labor and to define other risk factors associated with ASB like gravida status, socioeconomic status, and anaemia in pregnant women with ASB in low resource settings. Methods: A total of 1000 pregnant mothers in second and third trimester of pregnancy were screened for ASB by using two rapid reagent strip tests, namely nitrate and leukocyte esterase reagent strip tests. Out of those screened positive hundred consecutive pregnant women were taken as cases, after positive urine culture and out of those screened negative, two hundred patients were followed as controls after matching and pairing with cases. A detailed history was taken from each patient to determine all risk factors for ASB. The cases and controls were followed prospectively till delivery. Results: Mean gestational age at the time of labor in 100 cases of ASB was 35.6 +/- 2.9 weeks and in 200 controls was 37.9 +/- 0.6 weeks. The difference between mean gestational age at the time of labor in cases and controls was statistically significant (P value 0.000. The likelihood of preterm labor in the cases was 14.5 times more than the control and the difference was significant (P <0.05. Conclusions: ASB leads to a higher rate of preterm labor and is more frequently seen in population with anemia, illiteracy, rural background and low socioeconomic status. [Int J Reprod Contracept Obstet Gynecol 2014; 3(2.000: 403-408

  7. Mobile Learning in a Rural Medical School: Feasibility and Educational Benefits in Campus and Clinical Settings

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    Debra Nestel

    2014-01-01

    Full Text Available Students in a new medical school were provided with laptops. This study explored the feasibility and educational benefits of mobile learning for two cohorts of students learning in two settings—university campus (first-year students and rural clinical placements (second-year students. Evaluation involved questionnaires, focus groups (faculty and students, and document analysis. Descriptive statistics were computed. Focus groups were audio-recorded, transcribed, and analysed thematically. Response rates for questionnaires exceeded 84%. Compared with second-year students, significantly more first-year students (60% took their laptops to campus daily (P=0.14 and used their laptops for more hours each day (P=0.031. All students used laptops most frequently to access the internet (85% and 97% and applications (Microsoft Word (80% and 61% and Microsoft PowerPoint (80% and 63%. Focus groups with students revealed appreciation for the laptops but frustration with the initial software image. Focus groups with faculty identified enthusiasm for mobile learning but acknowledged its limitations. Physical infrastructure and information technology support influenced mobile learning. Document analysis revealed significant costs and issues with maintenance. If adequately resourced, mobile learning through university-issued laptops would be feasible and have educational benefits, including equitable access to learning resources, when and where they are needed. However, barriers remain for full implementation.

  8. Descriptive analysis of the inequalities of health information resources between Alberta's rural and urban health regions.

    Science.gov (United States)

    Stieda, Vivian; Colvin, Barb

    2009-01-01

    In an effort to understand the extent of the inequalities in health information resources across Alberta, SEARCH Custom, HKN (Health Knowledge Network) and IRREN (Inter-Regional Research and Evaluation Network) conducted a survey in December 2007 to determine what library resources currently existed in Alberta's seven rural health regions and the two urban health regions. Although anecdotal evidence indicated that these gaps existed, the analysis was undertaken to provide empirical evidence of the exact nature of these gaps. The results, coupled with the published literature on the impact, effectiveness and value of information on clinical practice and administrative decisions in healthcare management, will be used to build momentum among relevant stakeholders to support a vision of equitably funded health information for all healthcare practitioners across the province of Alberta.

  9. 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

  10. Evaluating Vulnerability and Resilience between Urban and Rural Area in a Regional Water Resources System under Climate Change

    Science.gov (United States)

    Liu, T. M.; Tung, C. P.; Li, M. H.; Tsao, J. H.; Lin, C. Y.

    2014-12-01

    To the threat of climate change, the risk of water resources vary in different area but the same system because of the structure of water supply system and the different sensitivity and exposure to climate for different urbanization area. For example, the urban area with high population density is sensitive to any disturbance from drought and the rural area with unpopular tap water system is insensitive to disturbance of drought but highly risk to water shortage. The resilience of water supply relies on water storage from reservoirs or lakes and water management in urban area but relies on intake from groundwater in rural area. The strategies to water resources should be considered with the water mass flow between urban and rural area. To strengthen the whole water resources system, also, it is important to find where the vulnerability from, how to reduce it and how to build up the resilience for both urban and rural area. This study aims to evaluate the vulnerability and resilience of water resources in different township and city but in the same system. An integrated tool - TaiWAP (Taiwan Water Resources Assessment Program) for climate change vulnerability assessment on water resources is used for climate impact assessment. For the simulation of the complex water supply system, the system dynamics model- VENSIM which is connected with TaiWAP is adopted to simulate a water supply system and evaluate risk of each township and city in a water supply system. The cause of vulnerability will be identified and discussed in both urban and rural. The strategies to reduce vulnerability of water resources for urban and rural will be proposed and discussed in this study.

  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.

  12. Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness.

    Science.gov (United States)

    Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen

    2017-09-07

    Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

  13. Evaluating potential renewable energy resources in Poultney, Vermont: A GIS-based approach to supporting rural community energy planning

    Energy Technology Data Exchange (ETDEWEB)

    Van Hoesen, John; Letendre, Steven (Green Mountain College, One Brennan Circle, Poultney, VT 05764, US)

    2010-09-15

    The current electricity infrastructure in the United States relies on a centralized distribution network that carries a heavy carbon footprint and is susceptible to disruption and failure. Rural communities are more susceptible to longer term interruption and should strive towards a local distributed energy model. This transition will require municipalities to engage with and seek input from community stakeholders. This paper describes a possible model for supporting rural community energy projects using a Geographic Information System (GIS), which was used to develop an inventory of energy resource potential in a rural Vermont town for biomass, wind, and solar technologies. (author)

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

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    Surona Visagie

    2015-02-01

    Full Text Available Background: Wheelchairs provide mobility that can enhance function and community integration. Function in a wheelchair is influenced by wheelchair design.Objectives: To explore the impact of wheelchair design on user function and the variables that guided wheelchair prescription in the study setting.Method: 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.Results: 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.Conclusion: 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.

  15. A comparative study of cervical cancer screening methods in a rural community setting of North India

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    L Satyanarayana

    2014-01-01

    Full Text Available Context: Pap smear testing as a conventional cervical screening approach has limitations for implementation and aided visual cervical testing has varying results in different regions. Aims: The aim of this study is to demonstrate the performance of aided visual cervical screening tests as against conventional Pap smear testing in a rural community setting of North India. Settings and Design: This was a rural community based cross-sectional study. Materials and Methods: All 7603 ever married women of age 30-59 years surveyed in a pocket of Dadri Tehsil, Uttar Pradesh, India were targeted for screening by Pap, visual inspection of cervix using acetic acid (VIA and visual inspection of cervix using Lugol′s iodine (VILI methods. Screen positives were referred to colposcopy and confirmation by histology. Statistical Analysis Used: Detection of histological cervical intraepithelial neoplasia (CIN II + and CIN III + assessed separately by sensitivity, specificity and likelihood ratio′s and predictive values. Analysis of data was performed by using IBM SPSS statstics software version 16.0. Results: A total of 65.6%(4988/7604 eligible women of 30-59 years age group in the target population were screened. Out of 4988, further analysis was performed on 4148 after excluding those who did not complete all screenings, who lost to follow-up and had missing histology results. Screen positivity rates by Pap (ASCUS and above, VIA and VILI were 2.6%, 9.7% and 13.5% respectively. Sensitivity and specificity of detecting the CIN III+ lesions were 87.5 and 98.8% for Pap, 50.0% and 96.7% for VIA and 50.0% and 95.7% for VILI respectively. Conclusions: VIA screening demonstrated as a feasible primary screening test for detecting high grade CIN and as to perform better when the Pap test is not feasible.

  16. Dimensions and determinants of trust in health care in resource poor settings--a qualitative exploration.

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    Vijayaprasad Gopichandran

    Full Text Available BACKGROUND: Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. OBJECTIVES: This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. METHODOLOGY: The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. RESULTS: The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients' willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. CONCLUSIONS: The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants.

  17. Resources

    Science.gov (United States)

    ... resources Alzheimer's - resources Anorexia nervosa - resources Arthritis - resources Asthma and allergy - resources Autism - resources Blindness - resources BPH - resources Breastfeeding - resources Bulimia - resources Burns - resources Cancer - resources Cerebral ...

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

    Directory of Open Access Journals (Sweden)

    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

  19. Agricultural Resource Access and the Influence of Socioeconomic Characteristics Among Rural Women in Borno State, Nigeria

    Directory of Open Access Journals (Sweden)

    C. Ojo

    2012-06-01

    Full Text Available Agricultural resource access and the influence of socioeconomic characteristics among women in Borno State, Nigeria was the main objective of this study. The data for the study were generated by the use of structured questionnaire which was administered to 266 respondents obtained by the use of multistage random sampling technique. The techniques used to analyze the data generated for this study were descriptive statistics and the binary logistic regression analyses. The major findings of the study showed that respondent’s socioeconomic characteristics indicated high levels of illiteracy (59.4%, non-membership of cooperatives (89.8%, no extension contact (72% and low access to credit (89.4%. Access to production resources including fertilizers, agrochemicals, family and hired laours and land ownership were low. Some socio- economic factors influenced the likelihood of women’s access to production resources. These factors included cooperative membership, years of schooling, farm income, extension contact, off-farm income, family size, age, farming experience and farm size. It was recommended that agricultural development planners should work at enhancing rural women’s access to socioeconomic factors which enhance their access to production resources for more efficient agricultural productivity.

  20. Rethinking rural politics in postsocialist settings : Rural Communities, Land Grabbing and Agrarian Change in Russia and Ukraine

    NARCIS (Netherlands)

    N.V. Mamonova (Natalia)

    2016-01-01

    textabstractRural politics in the time of global land grabs and neoliberal agricultural development have received much international attention. However, the processes at work in the post-socialist countryside (such as in Russia and Ukraine) are rarely addressed in the critical agrarian studies

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

    OpenAIRE

    Lindsay Alcock

    2016-01-01

    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 p...

  2. Equalizing Access to Electronic Networked Resources: A Model for Rural Libraries in the United States.

    Science.gov (United States)

    Senkevitch, Judith J.; Wolfram, Dietmar

    1994-01-01

    Provides an overview of the current state of networking technology in rural libraries and describes a model for educating rural librarians in accessing electronic networks. Topics discussed include information needs in rural libraries; telecommunications technology access in rural areas; and examples of services to enhance information access.…

  3. Clinical and corneal microbial profile of infectious keratitis in a high HIV prevalence setting in rural South Africa

    NARCIS (Netherlands)

    W. Schaftenaar (Willem); R.P.H. Peters (Remco); G.S. Baarsma (Seerp); C. Meenken (Christina); N.S. Khosa; S. Getu (Sarah); J.A. McIntyre (James); A.D.M.E. Osterhaus (Albert); G.M.G.M. Verjans (George)

    2016-01-01

    textabstractThe purpose of this investigation was to determine the clinical and corneal microbial profile of infectious keratitis in a high human immunodeficiency virus (HIV) prevalence setting in rural South Africa. Data in this cross-sectional study were collected from patients presenting with sym

  4. 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…

  5. 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…

  6. 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…

  7. 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.

  8. High coverage of mass drug administration for lymphatic filariasis in rural and non-rural settings in the Western Area, Sierra Leone

    Directory of Open Access Journals (Sweden)

    Sonnie Mustapha

    2010-12-01

    Full Text Available Abstract Background Lymphatic filariasis elimination programs are based upon preventative chemotherapy annually in populations with prevalence more than or equal to 1%. The goal is to treat 80% of the eligible, at risk population yearly, for at least 5 years, in order to interrupt transmission and prevent children from becoming infected. This level of coverage has been a challenge in urban settings. Assessing the coverage in a rapidly growing urban/non-rural setting with inadequate population data is also problematic. In Sierra Leone, a 5-day preventative chemotherapy campaign was carried out in the Western Area including the capital: Freetown. An intensive, social mobilization strategy combined traditional and modern communication channels. To aid dissemination of appropriate information Frequently Asked Questions were developed and widely circulated. The population of the Western Area has grown faster than projected by the 2004 National Census due to the post-war settlement of internally displaced persons. As a reliable denominator was not available, independent monitoring was adapted and performed "in process" to aid program performance and "end process" to assess final coverage. Results In 5 days 1,104,407 eligible persons were treated. Using the projected population from the 2004 census this figure represented coverage of 116% in the Urban Western Area and 129% in the Rural Western Area. Independent monitors interviewed a total of 9,253 persons during the 2 End Process days representing 1% of the projected population. Of these, 85.8% recalled taking both ivermectin and albendazole (Urban: 85.2%, Rural: 87.1%. No serious adverse drug reactions were reported. Conclusion The paper presents the key elements of success of the social mobilization and implementation strategy and describes the independent monitoring used to estimate final coverage in this urban/non-rural setting where the current population size is uncertain. This implementation

  9. 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.

  10. The role of rapid diagnostic tests in managing adults with pneumonia in low-resource settings

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    Stephen J Aston

    2014-06-01

    Full Text Available In well-resourced settings the systematic use of rapid diagnostics tests (e.g. pneumococcal urinary antigen test that define the causal pathogen to direct therapy has not resulted in significantly improved outcomes in adults with pneumonia. The management of pneumonia in many low-resource settings is complicated by a substantial burden of tuberculosis and HIV-associated opportunistic infections, in addition to the usual spectrum of pathogens seen in well-resourced settings. Clinical features alone do not reliably distinguish between these different aetiologies and physicians often have to treat empirically. Given the limitations in diagnostic laboratory capability present in most low-resource settings, rapid and point-of-care diagnostic tests could become valuable tools to guide treatment decisions. Pneumococcal and Legionella urinary antigen tests are specific and moderately sensitive, but their utility in low-resource settings is uncertain. The Xpert MTB/RIF (Cepheid, USA platform and rapid assays for urinary lipoarabinomannan can substantially speed up tuberculosis diagnosis; the current challenge is to translate this into earlier treatment and hopefully improve patient outcome. In HIV-infected patients, 1-3-β-D-glucan is a serum marker of Pneumocystis jirovecii infection with excellent sensitivity. Further studies are needed to assess the clinical utility and cost-effectiveness of these rapid diagnostic assays when they are incorporated into treatment algorithms.

  11. 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

    2014-12-01

    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 and software to use should

  12. Maternal resources, parenting, and dietary patterns among rural African American children in single-parent families.

    Science.gov (United States)

    Lee, E Juanita; McBride Murry, Velma; Brody, Gene; Parker, Veronica

    2002-01-01

    A correlation study was designed to test the hypothesis that maternal education, perceived family resources, and the importance of family routines would be related to children's dietary patterns. Additionally, the study examined the hypothesis that dietary patterns would be associated with children's cognitive and physical abilities. The sample for this study included 159 African American single-mother families with a 6- to 9-year-old child living in rural areas, most of whom lived in poverty. Children's eating patterns were assessed using a self-report questionnaire administered to the mother in an interview format. Children's cognitive ability was measured by several subscales from the Woodcock Johnson Psycho-Educational Instrument and the Harter Perceived Competence Scale for children. For male children, the mother's higher education was related to more adequate eating patterns at home, and more perceived family resources were related to the likelihood of taking vitamin supplements. For female children, greater milk intake was positively related to cognitive outcomes, including applied problem, passage comprehension, calculation, synonym identification, antonym identification, and quantitative concept scores. Milk intake was clearly related to more optimal cognitive development. The results of this study support the literature related to the importance of nutrition for cognitive and physical abilities in children.

  13. 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.

  14. ASSASYING THE NEED OF COMMERCIAL PLASMA VIRAL LOAD TESTING IN RESOURCE LIMITED SETTINGS

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    Arnaw

    2015-09-01

    Full Text Available Around nine million Human Immunodeficiency Virus (HIV infected individuals are on antiretroviral therapy (ART. People living with HIV/AIDS in resource - limited settings where HIV burden is usually high, there is an urgent need of affordable, accessible and inexpensive tests to monitor response to treatment. Quite a few commercially available assay has been introduced to measure Plasma Viral Load (PVL as testing can increase adherence to ART and facilitate timely switching of failing regimens and thus minimizing the development of resistance. We analyzed Nucleic Acid Test (NAT based assay and Non Nucleic Acid Test based assay for PVL testing. Though both the assay has its own advantage and disadvantages, but the use of Non Nucleic Acid Test has an upper hand in resource limited settings. It is the duty of administration, clinicians, microbiologist and health care personnel to introduce appropriate laboratory monitoring assays in resource - limited settings.

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

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    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.

  16. Human Resource Management in Small Rural Districts: The Administrator's Role in Recruitment, Hiring and Staff Development

    Science.gov (United States)

    Townsell, Rhodena

    2007-01-01

    The purpose of this article is to review the rural area administrator's role in the areas of teacher recruitment, hiring and staff development. State and Regional Policies reveal that these areas are chief among the concerns of rural school leaders (Johnson, 2005). The rural school administrator's role often requires him/her to become involved in…

  17. 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

  18. 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

  19. 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

  20. Communicating vaccine safety in the context of immunization programs in low resource settings.

    Science.gov (United States)

    Arwanire, Edison M; Mbabazi, William; Mugyenyi, Possy

    2015-01-01

    Vaccines are effective in preventing infectious diseases and their complications, hence reducing morbidity and infectious disease mortaity. Successful immunization programs, however, depend on high vaccine acceptance and coverage rates. In recent years there has been an increased level of public concern towards real or perceived adverse events associated with immunizations, leading to many people in high- as well as low-resource settings to refuse vaccines. Health care workers therefore must be able to provide parents and guardians of children with the most current and accurate information about the benefits and risks of vaccination. Communicating vaccine safety using appropriate channels plays a crucial role in maintaining public trust and confidence in vaccination programs. Several factors render this endeavor especially challenging in low-resource settings where literacy rates are low and access to information is often limited. Many languages are spoken in most countries in low-resource settings, making the provision of appropriate information difficult. Poor infrastructure often results in inadequate logistics. Recently, some concerned consumer groups have been able to propagate misinformation and rumors. To successfully communicate vaccine safety in a resource limited setting it is crucial to use a mix of communication channels that are both culturally acceptable and effective. Social mobilization through cultural, administrative and political leaders, the media or text messages (SMS) as well as the adoption of the Village Health Team (VHT) strategy whereby trained community members (Community Health Workers (CHWs)) are providing primary healthcare, can all be effective in increasing the demand for immunization.

  1. Evaluation of an immunoassay for determination of plasma efavirenz concentrations in resource-limited settings

    DEFF Research Database (Denmark)

    Abdissa, Alemseged; Wiesner, Lubbe; McIlleron, Helen

    2014-01-01

    to be implemented in resource-limited settings. This study evaluated a commercially available immunoassay for measurement of plasma efavirenz. Methods: The immunoassay-based method was applied to measure efavirenz using a readily available Humastar 80 chemistry analyzer. We compared plasma efavirenz concentrations...

  2. 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…

  3. 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 R; Rodriguez, William; Bassett, Ingrid V

    2014-03-01

    The aim of diagnostic point-of-care testing is to minimise the time to obtain a test result, thereby allowing clinicians and patients to make a quick clinical decision. Because point-of-care tests are used in resource-limited settings, the benefits need to outweigh the costs. To optimise point-of-care testing in resource-limited settings, diagnostic tests need rigorous assessments focused on relevant clinical outcomes and operational costs, which differ from assessments of conventional diagnostic tests. We reviewed published studies on point-of-care testing in resource-limited settings, and found no clearly defined metric for the clinical usefulness of point-of-care testing. Therefore, we propose a framework for the assessment of point-of-care tests, and suggest and define the term test efficacy to describe the ability of a diagnostic test to support a clinical decision within its operational context. We also propose revised criteria for an ideal diagnostic point-of-care test in resource-limited settings. Through systematic assessments, comparisons between centralised testing and novel point-of-care technologies can be more formalised, and health officials can better establish which point-of-care technologies represent valuable additions to their clinical programmes. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Teaching and Learning about Managing People: Human Resource Management for Education Settings--A Queensland Case.

    Science.gov (United States)

    McCrea, Nadine L.; Ehrich, Lisa C.

    1996-01-01

    Describes the development of a human resource management (HRM) elective for educators aspiring to management positions in various educational settings. The unit is part of a graduate diploma offered within the Faculty of Education at one Australian university. The paper argues the necessity of HRM studies in postgraduate education courses. (SM)

  5. ATTENTION PROBLEMS IN PRIMARY SCHOOL CHILDREN, IN A RURAL SETTING, IN INDIA

    Directory of Open Access Journals (Sweden)

    Mubeen Taj

    2014-10-01

    Full Text Available Behavioral and emotional disorders include internalizing symptoms which affect the self and externalizing symptoms that impact others and the environment. Behavioral and emotional disorders occur frequently in the general population of children. It has been seen that female children had more of internalizing behavior problems whereas male children had more of externalizing symptoms. Psychiatric epidemiological studies from developed countries indicate that more than a quarter of children and adolescents meet lifetime criteria for a mental disorder. Among the behavioral disorders, the presence of attention problems is of importance as they have been shown to be associated with increasing academic difficulties. Among the various scales that have been used to study behavior problems, Achenbach Child Behavior Checklist has been the most widely used and has different versions for parents and teachers so that a complete assessment of a child’s behavior can made with several inputs. This study aimed at assessing attention problems among primary school children, and to study the association between academic performance and attention problems using the Achenbach Child Behavior Checklist, using class teachers as raters, as interventions to reduce attention problems at an early stage may go a long way in improving the academic performance of the children. In this cross- sectional study, 198 children, 114 boys and 84 girls between 6 and 12 years of age, were rated on Achenbach Child Behavior Checklist (CBCL 6-18years - Teacher Rating Form (TRF, revised 2001, by his/her class teacher. About 25 children had a score of more than 50% on the attention problems scale. No significant differences were found in the attention problem scores between boys and girls in the sample studied. There was no significant association between current academic performance as rated on the TRF and attention problem scores. School teachers, especially in the rural areas where

  6. A new approach to water resources system assessment——set pair analysis method

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Most traditional assessment methods, which have complicated mathematic formulas, are difficult for calculation and application in water resources system assessment. A new approach to water resources system assessment, the set pair analysis method (SPAM), has been proposed based on the principle of set pair analysis (SPA). The basic ideals and steps of SPAM are discussed. The proposed method can take fuzzy property of threshold values for grade standards into full account and avoid determining the discrepancy uncertainty coefficient i or i1, i2, i3, … in SPA. The presented method is simple in concept, convenient to calculate and feasible for application. Two case studies of water resources assessment have been made. The results show that the proposed method is satisfactory.

  7. Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Iyengar, Kirti; Klingberg-Allvin, Marie; Iyengar, Sharad D; Paul, Mandira; Essén, Birgitta; Gemzell-Danielsson, Kristina

    2016-02-01

    Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting. This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days. Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience. Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  8. 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 sourc...... practitioners shall give attention to the role of farm and non-farm income opportunities to help households cope with seasonal income short falls. Recognizing the importance of forest and environmental resources to meet subsistence needs is also important....... to total household income. The results indicate that forest and environmental income was the second largest contributor to households’ total income next to crop income, the relative share being 23.7 percent of total income. With regard to seasonal income contributions, wage income and other income sources...... (gold in particular) are important in filling the gap when income from crop production is low, although they do not completely offset the fall. All income sources, including forest and environmental income, were fluctuating significantly between seasons, except for livestock and business income...

  9. Developments in CD4 and viral load monitoring in resource-limited settings.

    Science.gov (United States)

    Rowley, Christopher F

    2014-02-01

    CD4 counts and human immunodeficiency virus (HIV) load testing are essential components of HIV care, and making these tests available in resource-limited settings is critical to the roll-out of HIV treatment globally. Until recently, the evidence supporting the importance of laboratory monitoring in resource-limited settings was lacking, but there is now a consensus emerging that testing should become routine to ensure the longevity of treatment programs. Low-cost, point-of-care testing offers the potential to fill this role as it potentially improves all aspects of HIV care, ranging from the diagnosis and staging of HIV infection in both infants and adults to monitoring for treatment failure once antiretroviral therapy has been initiated. It is imperative for low-cost solutions to become a reality, but it is equally imperative that close scrutiny be given to each new device that hits the market to ensure they perform optimally in all settings.

  10. 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.

  11. Emerging biomarkers for the diagnosis of severe neonatal infections applicable to low-resource settings

    Directory of Open Access Journals (Sweden)

    Thor A. Wagner

    2011-12-01

    Full Text Available More than 500 000 children die each year in low resource settings due to serious neonatal infections. Better diagnostics that can be utilized in these settings to identify infected infants has the potential to significantly reduce neonatal deaths and the associated morbidity. A systematic review was performed and identified more than 250 potential new biomarkers for the diagnosis of serious neonatal infections. Eight of these biomarkers were both high-performance and high-abundance (antithrombin, inter-a inhibitor proteins, interferon-g inducible protein-10, interleukin-1 receptor antagonist, LPS binding protein, mannose binding lectin, serum amyloid A, resistin, visfatin, and are promising for the diagnosis of serious neonatal infections in low resource settings. Future clinical trials comparing these biomarkers with more traditional biomarkers seem warranted.

  12. 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.

  13. 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.

  14. Comparison between performances of three types of manual wheelchairs often distributed in low-resource settings.

    Science.gov (United States)

    Rispin, Karen; Wee, Joy

    2015-07-01

    This study was conducted to compare the performance of three types of chairs in a low-resource setting. The larger goal was to provide information which will enable more effective use of limited funds by wheelchair manufacturers and suppliers in low-resource settings. The Motivation Rough Terrain and Whirlwind Rough Rider were compared in six skills tests which participants completed in one wheelchair type and then a day later in the other. A hospital-style folding transport wheelchair was also included in one test. For all skills, participants rated the ease or difficulty on a visual analogue scale. For all tracks, distance traveled and the physiological cost index were recorded. Data were analyzed using repeated measures analysis of variance. The Motivation wheelchair outperformed Whirlwind wheelchair on rough and smooth tracks, and in some metrics on the tight spaces track. Motivation and Whirlwind wheelchairs significantly outperformed the hospital transport wheelchair in all metrics on the rough track skills test. This comparative study provides data that are valuable for manufacturers and for those who provide wheelchairs to users. The comparison with the hospital-style transport chair confirms the cost to users of inappropriate wheelchair provision. Implications for Rehabilitation For those with compromised lower limb function, wheelchairs are essential to enable full participation and improved quality of life. Therefore, provision of wheelchairs which effectively enable mobility in the cultures and environments in which people with disabilities live is crucial. This includes low-resource settings where the need for appropriate seating is especially urgent. A repeated measures study to measure wheelchair performances in everyday skills in the setting where wheelchairs are used gives information on the quality of mobility provided by those wheelchairs. This study highlights differences in the performance of three types of wheelchairs often distributed in low-resource

  15. 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.

  16. Incentives could induce Ethiopian doctors and nurses to work in rural settings.

    Science.gov (United States)

    Hanson, Kara; Jack, William

    2010-08-01

    What would best motivate more doctors and nurses to work in rural areas of poor countries, where they are badly needed? We presented doctors and nurses in Ethiopia with a series of hypothetical job combinations of wages, working conditions, housing benefits, and training opportunities. For doctors, we found that higher wages and quality housing incentives had the biggest impact on their willingness to practice in towns in rural areas. For nurses, improvements in the availability of medical equipment and supplies were the factors most likely to bring about a move to a rural village. Choosing the right incentive package requires a consideration of both the effects of different packages on health workers' choices and the cost of those packages.

  17. The diagnosis and management of acute bacterial meningitis in resource-poor settings.

    Science.gov (United States)

    Scarborough, Matthew; Thwaites, Guy E

    2008-07-01

    Acute bacterial meningitis is more common in resource-poor than resource-rich settings. Survival is dependent on rapid diagnosis and early treatment, both of which are difficult to achieve when laboratory support and antibiotics are scarce. Diagnostic algorithms that use basic clinic and laboratory features to distinguish bacterial meningitis from other diseases can be useful. Analysis of the CSF is essential, and simple techniques can enhance the yield of diagnostic microbiology. Penicillin-resistant and chloramphenicol-resistant bacteria are a considerable threat in resource-poor settings that go undetected if CSF and blood can not be cultured. Generic formulations of ceftriaxone are becoming more affordable and available, and are effective against meningitis caused by penicillin-resistant or chloramphenicol-resistant bacteria. However, infection with Streptococcus pneumoniae with reduced susceptibility to ceftriaxone is reported increasingly, and alternatives are either too expensive (eg, vancomycin) or can not be widely recommended (eg, rifampicin, which is the key drug to treat tuberculosis) in resource-poor settings. Additionally, improved access to affordable antibiotics will not overcome the problems of poor access to hospitals and the fatal consequences of delayed treatment. The future rests with the provision of effective conjugate vaccines against S pneumoniae, Haemophilus influenzae, and Neisseria meningitides to children in the poorest regions of the world.

  18. 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.

  19. 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,…

  20. 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,…

  1. 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, we offer…

  2. 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

  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. 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.

  5. Do Schools in Rural and Nonrural Districts Allocate Resources Differently? An Analysis of Spending and Staffing Patterns in the West Region States. Issues & Answers. REL 2011-No. 099

    Science.gov (United States)

    Levin, Jesse; Manship, Karen; Chambers, Jay; Johnson, Jerry; Blankenship, Charles

    2011-01-01

    This report presents the first detailed comparison of resource allocation between rural and nonrural districts in the West Region. Three regional characteristics often associated with rural districts were chosen for the analysis: district enrollment, student population density within a district (students per square mile), and drive time from the…

  6. 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

  7. Can Technology Acceptance Model be Applied on the Rural Setting: The Case of Village Development and Security Committee in Malaysia

    Directory of Open Access Journals (Sweden)

    Bahaman A. Samah

    2011-01-01

    Full Text Available Problem statement: Malaysia has come out with a number of strategies such as National Information Technology Center, Universal Services Provider, Rural Internet Center and Rural Info Center to strengthen and encourage ICT usage among the rural community. Besides the efforts that are brought by the government, do the rural community especially their leaders which are the Village Development and Security Committee use ICT? Approach: The main objective of this study was to investigate any relationship that might occur between variables of Technology Acceptance Model and ICT usage among Village Development and Security Committee. A total of 240 Village Development and Security Committees were selected as the respondents for this study where a developed questionnaire was used to gain the data needed. For the purpose of analysis, SPSS was used where descriptive and inferential analyses were performed. Results: Based on the analyses run, it can be concluded that Village Development and Security Committee in Malaysia have a moderate level of ICT usage. Further analyses run showed that all of the three variables of Technology Acceptance Model namely attitude, perceive ease of use and perceive usefulness have a positive and significant relationship with ICT usage while attitude was detected as the main contributor towards ICT usage among Village Development and Security Committee. Conclusion/Recommendation: This study has revealed that Technology Acceptance Model that was used to explain ICT usage can be applied within the Malaysian rural setting. It also can be concluded that Village Development and Security Committee with a high level of attitude, perceive ease of use and perceive usefulness towards ICT will have higher level of ICT usage. To further develop and sustain this high level of attitude, perceive ease of use and perceive usefulness towards ICT usage, Village Development and Security Committee must be frequently exposed to ICT information and

  8. Making Culture and Language Real in a Rural Setting: The Technology Connection.

    Science.gov (United States)

    Smith, Elizabeth A.

    2000-01-01

    Asserts that with the growth of the Internet, e-mail, synchronous chat, and videoconferencing, students in rural (and urban) areas have virtually endless access to culture and language from their school or home. Describes the utilization of technology as a means of cultural exchange between Southwest Virginia Community College and the University…

  9. Building social capital with interprofessional student teams in rural settings: A service-learning model.

    Science.gov (United States)

    Craig, Pippa L; Phillips, Christine; Hall, Sally

    2016-08-01

    To describe outcomes of a model of service learning in interprofessional learning (IPL) aimed at developing a sustainable model of training that also contributed to service strengthening. A total of 57 semi-structured interviews with key informants and document review exploring the impacts of interprofessional student teams engaged in locally relevant IPL activities. Six rural towns in South East New South Wales. Local facilitators, staff of local health and other services, health professionals who supervised the 89 students in 37 IPL teams, and academic and administrative staff. Perceived benefits as a consequence of interprofessional, service-learning interventions in these rural towns. Reported outcomes included increased local awareness of a particular issue addressed by the team; improved communication between different health professions; continued use of the team's product or a changed procedure in response to the teams' work; and evidence of improved use of a particular local health service. Given the limited workforce available in rural areas to supervise clinical IPL placements, a service-learning IPL model that aims to build social capital may be a useful educational model. © 2015 National Rural Health Alliance Inc.

  10. Dietary characteristics of complementary foods offered to Guatemalan infants vary between urban and rural settings

    NARCIS (Netherlands)

    Enneman, A.; Hernandez, L.; Campos, R.; Vossenaar, M.; Solomons, N.W.

    2009-01-01

    The objective of this study was to describe and compare the dietary variety, diversity, and origins of complementary foods given to urban and rural Guatemalan infants in the second semester of life. Dietary intake from a total of 128 infants of both sexes, aged 6.0 to 12.0 months on admission, from

  11. A Self System Perspective on Young Adolescents' Motivation to Learn English in Urban and Rural Settings

    Science.gov (United States)

    Lamb, Martin

    2012-01-01

    This study examined the motivation to learn English of Indonesian junior high school pupils, 13-14 years of age, in three distinct contexts: a metropolitan city, a provincial town, and a rural district. Utilizing Dornyei's second language (L2) Motivational Self System as the theoretical framework, this study employed a 50-item questionnaire to…

  12. Results of a Test and Win Contest to Raise Radon Awareness in Urban and Rural Settings

    Science.gov (United States)

    Hahn, Ellen J.; Rayens, Mary Kay; Kercsmar, Sarah E.; Robertson, Heather; Adkins, Sarah M.

    2014-01-01

    Background: Radon is a leading cause of lung cancer, but few test their homes to determine radon levels. Purpose: The study assessed feasibility and success of a Test and Win Contest to promote radon testing in rural and urban communities. Methods: The prospective, quasi-experimental study tested a novel contest to raise radon awareness. Paid and…

  13. 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.

  14. Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa

    Directory of Open Access Journals (Sweden)

    Jean-Claude Mbanya

    2009-10-01

    Full Text Available BACKGROUND: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. METHODS: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's; circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. RESULTS: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. CONCLUSION: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care.

  15. Stress, Social Resources, and Depression among Never-Married and Divorced Rural Mothers

    Science.gov (United States)

    Turner, Heather A.

    2006-01-01

    While the impact of single parenting on women and children has long been a concern, very little research has focused on single parents living in rural areas. Based on a probability sample of 508 single mothers aged 18-39 living in rural Northern New England, the present study: (1) examines the impact of several domains of stress on mothers'…

  16. 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

  17. The challenge of treating conduct disorder in low-resourced settings: rap music to the rescue.

    Science.gov (United States)

    Evans, Dylan J

    2010-12-01

    Conduct disorder is one of the most frequent serious childhood problems that present for treatment in community clinic settings. Evidence-based treatments for conduct disorder are intensive and require considerable resources to implement. In low-resourced contexts it is often not feasible to implement evidence-based treatments in their current form, which poses significant challenges for clinicians attempting to treat children in these settings. This article explores these challenges using a case study of the treatment of a young adolescent boy with a short-term multisystem intervention where rap music was employed as a powerful tool to facilitate an empathic connection in therapy and as a projective technique to explore underlying emotional difficulties.

  18. 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.

  19. Novel techniques and future directions in molecular diagnosis of malaria in resource-limited settings.

    Science.gov (United States)

    Oriero, Eniyou Cheryll; Van Geertruyden, Jean-Pierre; Nwakanma, Davis C; D'Alessandro, Umberto; Jacobs, Jan

    2015-01-01

    Despite being preventable and treatable, malaria remains a global health concern with approximately 1.2 billion people at high risk of being infected, 90% of whom are in the resource-limited settings of sub-Saharan Africa. The continued decline in malaria cases globally has rekindled the possibility of elimination in certain regions. As humans constitute the main reservoir of malaria, prompt and accurate diagnosis by microscopy or rapid diagnostic tests is part not only of effective disease management but also of control measures. However, for malaria elimination, more sensitive diagnostic tools are needed to detect asymptomatic and sub-microscopic infections that contribute to transmission. Molecular techniques, which involve amplification of nucleic acids, are being developed and modified to suit this purpose. This report provides a summary of the nucleic acid amplification tests that are currently available for diagnosis of malaria, with current improvements and adaptations for use in resource-limited settings.

  20. Sero-prevalence of Taenia spp. cysticercosis in rural and urban smallholder pig production settings in Uganda.

    Science.gov (United States)

    Kungu, Joseph M; Dione, Michel M; Ejobi, Francis; Harrison, Leslie J S; Poole, E Jane; Pezo, Danilo; Grace, Delia

    2017-01-01

    The pork tapeworm, Taenia solium, is prevalent in Uganda although the prevalence has not been determined in all areas of the country. A cross-sectional study, to determine the sero-prevalence of the parasite in pigs kept under rural and urban production settings, was carried out in three Ugandan districts, Masaka, Mukono and Kamuli. Serum samples from 1185 pigs were tested for the presence of T. solium cysticercosis antigen using the HP10 antigen-ELISA (Ag-ELISA) and the ApDia Ag-ELISA assays. Using parallel interpretation of the two tests showed lower levels of observed prevalence of T. solium in rural production settings (10.8%) compared to urban (17.1%). Additionally, Maximum Likelihood Estimation for evaluating assays in the absence of a gold standard, using TAGS on the R platform, estimated the true sero-prevalence to be lower in rural production setting, 0.0% [0.0-3.2%; 95% confidence interval (CI)] than in urban production setting, 12.3% (4.2-77.5% CI). When the sensitivity/specificity (Se/Sp) of the assays were estimated, assuming conditional independence of the tests, HP10 Ag-ELISA was more sensitive and specific [(Se=53.9%; 10.1-100% CI), (Sp=97.0%; 95.9-100% CI)] than the ApDia assay [(Se=20.2%; 1.5-47.7% CI), (Sp=92.2%; 90.5-93.9% CI)]. Subject to parasitological verification, these results indicate there may be a need to implement appropriate control measures for T. solium in the study areas.

  1. NCBI Epigenomics: a new public resource for exploring epigenomic data sets.

    Science.gov (United States)

    Fingerman, Ian M; McDaniel, Lee; Zhang, Xuan; Ratzat, Walter; Hassan, Tarek; Jiang, Zhifang; Cohen, Robert F; Schuler, Gregory D

    2011-01-01

    The Epigenomics database at the National Center for Biotechnology Information (NCBI) is a new resource that has been created to serve as a comprehensive public resource for whole-genome epigenetic data sets (www.ncbi.nlm.nih.gov/epigenomics). Epigenetics is the study of stable and heritable changes in gene expression that occur independently of the primary DNA sequence. Epigenetic mechanisms include post-translational modifications of histones, DNA methylation, chromatin conformation and non-coding RNAs. It has been observed that misregulation of epigenetic processes has been associated with human disease. We have constructed the new resource by selecting the subset of epigenetics-specific data from general-purpose archives, such as the Gene Expression Omnibus, and Sequence Read Archives, and then subjecting them to further review, annotation and reorganization. Raw data is processed and mapped to genomic coordinates to generate 'tracks' that are a visual representation of the data. These data tracks can be viewed using popular genome browsers or downloaded for local analysis. The Epigenomics resource also provides the user with a unique interface that allows for intuitive browsing and searching of data sets based on biological attributes. Currently, there are 69 studies, 337 samples and over 1100 data tracks from five well-studied species that are viewable and downloadable in Epigenomics.

  2. Management of a posterior mediastinal Gardner fibroma causing critical airway stenosis in a resource limited setting

    Directory of Open Access Journals (Sweden)

    Katie Clouthier, DO

    2017-05-01

    Full Text Available In developed countries, surgeons and anesthesiologists approach the mediastinal mass causing airway compression with prudence and trepidation. Resource-limited settings provide unique challenges in the diagnosis and management of patients with critical airway compression. We report the successful treatment of a patient in Port-au-Prince, Haiti with a posterior mediastinal mass that filled the left chest cavity and caused critical airway stenosis. The pathology revealed a Gardner Fibroma, which is rarely associated with mediastinal airway obstruction.

  3. Disclosure of HIV status to children in resource-limited settings: a systematic review

    Directory of Open Access Journals (Sweden)

    Rachel C Vreeman

    2013-05-01

    Full Text Available Introduction: Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact. Methods: MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*. We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. Results: Thirty-two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one-time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART improved post-disclosure but the emotional and psychological effects of disclosure were variable. Conclusions: Most studies show that a minority of HIV-infected children in resource-limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age- and culture

  4. 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.

  5. [Management of bilateral hand amputations in low-resources setting: the Krukenberg procedure is still indicated].

    Science.gov (United States)

    Mathieu, L; Gaillard, C; Mottier, F; Bertani, A; Rongiéras, F; Chauvin, F

    2013-01-01

    Double hand amputation leads to complete loss of prehensive function and touch sense. Patients become totally dependent on others for survival. In developing countries, where sophisticated myoelectric prosthesis are not available, the Krukenberg procedure gives to these patients elementary self-sufficiency for daily-life. This procedure can be performed in low-resources setting and requires minimal rehabilitation. However, patient selection and preparation are critical because of an unattractive aesthetic aspect which limits this operation use in occidental countries.

  6. 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.

  7. 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

  8. Management of pre-invasive cervical cancer in low-resource setting.

    Science.gov (United States)

    Chichareon, Saibua B

    2004-10-01

    Cervical cancer is one of the health burdens in many developing countries. The advanced knowledge in the past decade reassured the important role of human papillomavirus as the necessary cause of cervical cancer and makes a clear understanding of its natural history. Cervical cancer has a long period of pre-invasive stage, and only a small proportion of cervical intraepithelial neoplasia (CIN) that can progress to be an invasive lesion. Appropriate management of CIN can prevent invasive cervical cancer. The contemporary treatment of CIN is more conservative and requires effective follow-up process. However inappropriate management of CIN is still be found at the international and national survey of less developed countries. Although no apparent superior surgical technique for treating CIN, loop electrosurgical excision procedure (LEEP) and cryotherapy are fascinated for the low-resource setting. Other alternative approach, which eliminates cytology and colposcopy may be considered in the ultrashort- resource setting with a high prevalence of cervical cancer. In this article, the contemporary knowledge about the natural history of cervical cancer, especially the implication of human papillomavirus (HPV) for pre-invasive cervical cancer, is summarized. The current approaches for treatment of CIN are reviewed from the perspective of low-resource settings. The various strategies for management approaches are demonstrated, and the cost-effectiveness is discussed. The pattern of pre-invasive cervical cancer management in developing countries, including in the south of Thailand is exhibited, and the single-visit service for cervical cancer prevention in the northeast is challenged.

  9. 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.

  10. 安徽农村地区创业型人力资源开发策略研究%Research on the Tactics of Entrepreneurial Human Resource Development in Rural Areas of Anhui Province

    Institute of Scientific and Technical Information of China (English)

    施培智; 韦文联; 程业炳

    2012-01-01

    创业型人力资源具有引领示范、带头带动等作用,在安徽农村地区人力资源开发中居于重要位置,具有转变农村人力资源思想观念、完善农村人力资源结构、解决当下农村人力资源问题、调整安徽农业经济结构等方面的意义。为此,可从加强农村人力资源现状筛查,加强农民基础性教育和培训,完善农民创业保障,面向打工回乡创业者开展创业教育,加强创业培训师的遴选和培训等方面,加强安徽农村创业型人力资源开发。%Entrepreneurial human resource plays an important role in Anhui rural areas' human resource development,for entrepreneurial human resource can set the example for the other kinds of human resources.The paper demonstrates the significance of cultivating the entrepreneurial human resource in Anhui rural areas,from the aspects of updating the ideological thoughts of human resources,improving human resources' structure,solving the current human resource problems,adjusting the agricultural economical structures.With the problems analysis,the paper offers six concrete measures,namely,select proper human resource,strengthen the fundamental education and training,improve the entrepreneurial guarantee,offer entrepreneurial education toward the labors back home from cities,strengthen the selection and training of entrepreneurship teacher that benefits the entrepreneurial human resource in rural areas of Anhui province.

  11. The patient experience of remote telemonitoring for heart failure in the rural setting: a literature review.

    Science.gov (United States)

    Jones, Lauren; Grech, Carol

    2016-01-01

    Remote telemonitoring is utilised to provide specialised care to people with heart failure living in rural locations. There is limited research into the patients' experience of telemonitoring. This literature review was completed to examine the available evidence and inform the development of a telemonitoring service. Cochrane Database of Systematic Reviews; Medline; CINAHL database, Joanna Briggs Institute, AMED, EMBASE were searched using the key words. A thematic analysis was applied. Forty-six studies reviewed, 11 met inclusion criteria. Individual health status, use of technology, and effect on lifestyle influenced the patient experience. Limited literature was available addressing the patient experience of telemonitoring and no studies were found that specifically investigated the experiences of patients with heart failure in rural locations. Further research is required to examine the patient/user perspective of this type of service, and explore the feasibility of including telemonitoring in usual care.

  12. 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.

  13. Data sets for author name disambiguation: an empirical analysis and a new resource.

    Science.gov (United States)

    Müller, Mark-Christoph; Reitz, Florian; Roy, Nicolas

    2017-01-01

    Data sets of publication meta data with manually disambiguated author names play an important role in current author name disambiguation (AND) research. We review the most important data sets used so far, and compare their respective advantages and shortcomings. From the results of this review, we derive a set of general requirements to future AND data sets. These include both trivial requirements, like absence of errors and preservation of author order, and more substantial ones, like full disambiguation and adequate representation of publications with a small number of authors and highly variable author names. On the basis of these requirements, we create and make publicly available a new AND data set, SCAD-zbMATH. Both the quantitative analysis of this data set and the results of our initial AND experiments with a naive baseline algorithm show the SCAD-zbMATH data set to be considerably different from existing ones. We consider it a useful new resource that will challenge the state of the art in AND and benefit the AND research community.

  14. PREVALENCE OF GLAUCOMA IN PATIENTS UNDERGOING CATARACT SURGERY IN RURAL SET UP IN SOUTHERN INDIA

    Directory of Open Access Journals (Sweden)

    Bharathi

    2015-05-01

    Full Text Available PURPOSE: To determine the prevalence and types of glaucoma in rural patients posted for cataract surgery under eye camps at a tertiary care hospital . BACKGROUND: Glaucoma is the second leading cause of blindness in the adult pop ulation in India. The global prevalence of glaucoma for population aged 40 to 80 years is estimated to be 3.54% and the projected number of people with glaucoma worldwide will increase to 111.8 million in 2040. This creates a need for early diagnosis and p rompt management of glaucomas especially in the underprivileged rural areas that lack awareness and facilities. METHODOLOGY: A cross - sectional study was conducted at a regional ophthalmic center for all the patients posted for cataract surgery under eye ca mps. Study was carried out for duration of one year and included 1400 patients. The patients underwent detailed workup to detect the presence of glaucomas and were treated accordingly if the disease was detected. RESULTS: The overall prevalence of glaucoma in our study population was 2.14%. Amongst them, 0.78% had primary open angle glaucoma, 0.14% had primary angle closure glaucoma and 1.21% of them had pseudoexfoliative glaucoma. The prevalence of glaucomas increased with increasing age. CONCLUSION: With increasing life expectancy the number of glaucoma patients is constantly growing large in our country. Early case detection rate is of utmost importance to reduce the disease burden in the rural population where awareness in terms of routine eye screening is very low

  15. 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.

  16. Retrospective analysis of patients with carcinoma cervix in a rural/semi-urban setting in Western India

    Directory of Open Access Journals (Sweden)

    Ranvijay Singh

    2016-01-01

    Full Text Available Objectives: To compare the presentation of cervical cancer and the treatment modalities received by the patients at a semi-urban/rural area of Western India with that of published literature from urban centers. Materials and Methods: We conducted a retrospective analysis of patients with cervical cancer who presented at a semi-urban/rural cancer center between 2010 and 2013. A total of 141 patients with the median age of 51 years (25-81 were studied. The demographic and clinical variables included age, annual family income, profession, comorbidities, baseline hemoglobin, prior screening, clinical stage, treatment administered, and complications. The pathological variables included tumor type and grade. Results: In our study, all patients presented with vaginal bleeding. Majority of the patients (51 patients, 37.7% had Stage 3B disease. Since majority presented at later stages (Stage 3B, chemotherapy-radiotherapy was the most common treatment modality used in our population. On histopathology, 127 patients (90% had squamous cell carcinoma while 14 patients (10% had adenocarcinoma. In 96 patients (68%, the tumor grade was not known while it was a high, intermediate, and low grade in 6 (4%, 18 (13%, and 21 (15% patients, respectively. The follow-up data of our study were not adequate; hence, the long-term survival results could not be presented. Conclusion: Patients in rural India setting present at later stages which could be improved by creating awareness, improving their personal hygiene, and adequate screening.

  17. 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.

  18. STUDY ON THE NATURAL AND ANTHROPIC TOURISM RESOURCES – FACTORS OF SUSTAINABLE RURAL DEVELOPMENT IN THE AREA HAŢEG-RETEZAT

    Directory of Open Access Journals (Sweden)

    GABRIELA BOTICI

    2012-05-01

    Full Text Available The rural area from Ţara Haţegului – Retezat is one of the richest area in Romania in natural and anthropic tourism supplies, determined by the natural, socio-cultural, economic and historical potential that can be used for tourism purposes. As the tourism potential comprises few economic resources that can be used only “in situ”, their inclusion in the economic circuit of values represents the premise of a superior economic process of rural development in the rural area Ţara Haţegului - Retezat.Starting from the great variety of the tourism supply, the specialists in economy and tourism management can find optimum solutions for the development of the rural and agro-tourism services as a sustainable rural development component, while the optimization of the rural tourism services activities can be based on mathematical models and adequate system analyses.

  19. A Summary Catalogue of Microbial Drinking Water Tests for Low and Medium Resource Settings

    Directory of Open Access Journals (Sweden)

    Stephen Gundry

    2012-05-01

    Full Text Available Microbial drinking-water quality testing plays an essential role in measures to protect public health. However, such testing remains a significant challenge where resources are limited. With a wide variety of tests available, researchers and practitioners have expressed difficulties in selecting the most appropriate test(s for a particular budget, application and setting. To assist the selection process we identified the characteristics associated with low and medium resource settings and we specified the basic information that is needed for different forms of water quality monitoring. We then searched for available faecal indicator bacteria tests and collated this information. In total 44 tests have been identified, 18 of which yield a presence/absence result and 26 of which provide enumeration of bacterial concentration. The suitability of each test is assessed for use in the three settings. The cost per test was found to vary from $0.60 to $5.00 for a presence/absence test and from $0.50 to $7.50 for a quantitative format, though it is likely to be only a small component of the overall costs of testing. This article presents the first comprehensive catalogue of the characteristics of available and emerging low-cost tests for faecal indicator bacteria. It will be of value to organizations responsible for monitoring national water quality, water service providers, researchers and policy makers in selecting water quality tests appropriate for a given setting and application.

  20. 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 intertwin

  1. 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 intertwin

  2. Satellite-Based Solar Resource Data Sets for India 2002-2012

    Energy Technology Data Exchange (ETDEWEB)

    Sengupta, M.; Perez, R.; Gueymard, C.; Anderberg, M.; Gotseff, P.

    2014-02-01

    A new 10-km hourly solar resource product was created for India. This product was created using satellite radiances from the Meteosat series of satellites. The product contains global horizontal irradiances (GHI) and direct normal irradiances (DNI) for the period from 2002 to 2011. An additional solar resource data set covering the period from January 2012 to June 2012 was created solely for validation because this period overlaps ground measurements that were made available from the Indian Ministry of New and Renewable Energy's (MNRE's) National Institute for Solar Energy for five stations that are part of MNRE's solar resource network. These measurements were quality checked using the SERI QC software and used to validate the satellite product. A comparison of the satellite product to the ground measurements for the five stations shows good agreement. This report also presents a comparison of the new version of solar resource data to the previous version, which covered the period from 2002 to 2008.

  3. Impacts of surface heterogeneity on dry planetary boundary layers in an urban-rural setting

    Science.gov (United States)

    Zhu, Xiaoliang; Ni, Guangheng; Cong, Zhentao; Sun, Ting; Li, Dan

    2016-10-01

    Understanding the impacts of land use and land-cover change such as urbanization is essential in many disciplines. This study investigates the impacts of urban-rural contrasts in terms of momentum roughness length (z0) and aerodynamic surface temperature (TSK) on dry planetary boundary layers (PBLs) using large-eddy simulations (LES) with the Weather Research and Forecasting (WRF) model. In addition, the impacts of small-scale heterogeneities within urban areas are also examined. The original WRF-LES is modified in order to use prescribed TSK as surface boundary conditions. Numerical simulations are then conducted to examine turbulence characteristics and mesoscale circulations resulting from large-scale urban-rural contrasts as well as small-scale heterogeneities in urban areas. The results indicate that (1) the urban-rural contrasts in z0 and TSK have significant but different impacts on surface heat fluxes, mesoscale circulations, and the wind and potential temperature profiles. Compared to the case where the whole domain is homogeneous, increases in z0 and/or TSK in urban areas in the center of domain induce stronger sensible heat fluxes, stronger urban circulations, and weaker inversions at the top of the PBL. (2) When the patch size that characterizes the urban heterogeneity scale is comparable to the size of the whole urban area, the simulated results are strongly dependent on both the heterogeneity scale and the specified surface temperature values. As the patch size decreases, the simulated results become more similar to those over a homogeneous urban surface.

  4. Seasonality of water quality and diarrheal disease counts in urban and rural settings in south India

    Science.gov (United States)

    Kulinkina, Alexandra V.; Mohan, Venkat R.; Francis, Mark R.; Kattula, Deepthi; Sarkar, Rajiv; Plummer, Jeanine D.; Ward, Honorine; Kang, Gagandeep; Balraj, Vinohar; Naumova, Elena N.

    2016-02-01

    The study examined relationships among meteorological parameters, water quality and diarrheal disease counts in two urban and three rural sites in Tamil Nadu, India. Disease surveillance was conducted between August 2010 and March 2012; concurrently water samples from street-level taps in piped distribution systems and from household storage containers were tested for pH, nitrate, total dissolved solids, and total and fecal coliforms. Methodological advances in data collection (concurrent prospective disease surveillance and environmental monitoring) and analysis (preserving temporality within the data through time series analysis) were used to quantify independent effects of meteorological conditions and water quality on diarrheal risk. The utility of a local calendar in communicating seasonality is also presented. Piped distribution systems in the study area showed high seasonal fluctuations in water quality. Higher ambient temperature decreased and higher rainfall increased diarrheal risk with temperature being the predominant factor in urban and rainfall in rural sites. Associations with microbial contamination were inconsistent; however, disease risk in the urban sites increased with higher median household total coliform concentrations. Understanding seasonal patterns in health outcomes and their temporal links to environmental exposures may lead to improvements in prospective environmental and disease surveillance tailored to addressing public health problems.

  5. Treatment counselor's attitudes about lesbian, gay, bisexual, and transgendered clients: urban vs. rural settings.

    Science.gov (United States)

    Eliason, Michele J; Hughes, Tonda

    2004-03-01

    Treatment counselors' attitudes about lesbian, gay, bisexual, and transgendered (LGBT) clients can have important effects on these client's recovery. There is a common, but unexamined, perception that LGBT people are more accepted in urban areas (and thus urban treatment programs) and that urban counselors have greater knowledge of the needs of the LGBT community. This study examined the attitudes and knowledge of treatment counselors from two geographic regions: urban Chicago (n = 109) and rural Iowa (n = 242) in 2000. The instrument assessed demographic characteristics, knowledge, and experiences working with LGBT clients, and attitudes about LGBT clients (an adaptation of Herek's Attititudes about Lesbians and Gays rating scale). Only a few demographic differences between the urban and rural counselors were identified. Chicago counselors were more racially diverse and more likely to have grown up in an urban area than the Iowa counselors. The Iowa counselors had slightly higher levels of formal education. Although the Chicago providers reported having considerably more contact with LGBT clients and more formal and continuing education about LGBT people, they did not have more positive attitudes or report more knowledge of specific LGBT issues that might influence alcohol and drug treatment. Overall, both Chicago and Iowa counselors had very little formal education regarding the needs of LGBT clients, and nearly half reported negative or ambivalent attitudes. Many of the counselors lacked knowledge about legal issues such as domestic partnership and power of attorney, the concepts of domestic partnership and internalized homophobia, and issues related to family of origin and current family.

  6. Technical and social challenges of laparoscopic appendectomy performed in a rural setting.

    Science.gov (United States)

    Kucuk, Gultekin Ozan

    2015-01-01

    Lo studio illustra i dettagli tecnici e sociali delle difficoltà da affrontare nell’adozione dell’appendicectomia laparoscopica in un ospedale periferico in ambiente rurale, e suggerisce le soluzioni, includendo la casistica nell’intervallo tra aprile 2009 e dicembre 2010, di cui sono analizzati le caratteristiche demografiche, i reperti operatori ed i risultati. La casistica si riferisce a 51 pazienti (28 uomini e 23 donne) sottoposti ad appendicectomia laparoscopica, di età media di 23 anni (tra 13 e 74 anni). In media l’intervento ha richiesto 45 minuti (tra 20 e 75 minuti). La base appendicolare è stata trattata con endoloop in 4 casi (7,8%) o per nodo intracorporeo in 46 casi (90,2%); in un caso la base è stata suturata. In 20 casi (39,2%) si sono dovute fronteggiare difficoltà tecniche, ed in un paziente (2%) si è fatto ricorso alla conversione al trattamento laparotomico. La degenza postoperatoria è stata di 2.4 ± 0.8 giorni, ed in un paziente (2%) si è sviluppato un ascesso intra-addominale. In conclusione la appendicectomia laparoscopica può essere adottata con sicurezza in ambiente rurale, anche se si tratta di casi complicati. Si discutono alcune difficoltà tecniche e sociali da affrontare, e le soluzioni adottate.

  7. Uveitis is predominantly of infectious origin in a high HIV and TB prevalence setting in rural South Africa.

    Science.gov (United States)

    Schaftenaar, Erik; Meenken, Christina; Baarsma, G Seerp; Khosa, N Sellina; Luijendijk, Ad; McIntyre, James A; Osterhaus, Albert D M E; Verjans, Georges M G M; Peters, Remco P H

    2016-10-01

    To determine the burden of disease in a unique sample of patients with uveitis from a rural South African setting. Data in this cross-sectional study were collected from patients presenting with uveitis (n=103) at the ophthalmology outpatient department of three hospitals in rural South Africa. Demographic and clinical data were collected, and laboratory analysis of aqueous humour, serological evaluation and routine diagnostics for tuberculosis (TB) were performed. Sixty-six (64%) participants were HIV infected. Uveitis was predominantly of infectious origin (72%) followed by idiopathic (16%) and autoimmune (12%). Infectious uveitis was attributed to herpes virus (51%), Mycobacterium tuberculosis (24%) and Treponema pallidum (7%) infection. HIV-infected individuals were more likely to have infectious aetiology of uveitis compared with HIV-uninfected individuals (83% vs 51%; p=0.001). Microbial aetiology of uveitis is common in areas where HIV and TB are endemic. In these settings, a high index of suspicion for infectious origin of uveitis is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting.

    Science.gov (United States)

    Shao, Elichilia R; Joseph, Pantaleo M; Slootweg, Piet; Mkwizu, Elifuraha W; Kilonzo, Kajiru G; Mwasamwaja, Amos O

    2015-08-01

    Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.

  14. 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.

  15. Doing more with less: Teacher professional learning communities in resource-constrained primary schools in rural China.

    Science.gov (United States)

    Sargent, Tanja C; Hannum, Emily C

    2009-01-01

    Teacher professional learning communities provide environments in which teachers engage in regular research and collaboration. They have been found effective as a means for connecting professional learning to the day-to-day realities faced by teachers in the classroom. In this paper, we draw on survey data collected in primary schools serving 71 villages in rural Gansu Province, as well as transcripts from in-depth interviews with 30 teachers. Our findings indicate that professional learning communities penetrate to some of China's most resource-constrained schools, but that their nature and development are shaped by institutional supports, principal leadership, and teachers' own initiative.

  16. 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

    researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. RESULTS: The values underlying the AFR approach were in all three districts well...... to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. CONCLUSIONS: District stakeholders were able to take greater charge of closing the gap between nationally set planning on one hand and the local realities and demands of the served...... communities on the other within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment...

  17. Diagnostic challenges of sexually transmitted infections in resource-limited settings.

    Science.gov (United States)

    Peeling, Rosanna W; Ronald, Allan

    2009-12-01

    The global burden of sexually transmitted infections (STIs) is highest in the developing world where access to laboratory services is limited. Sophisticated laboratory diagnostic tests using noninvasive specimens have enabled developed countries to screen and diagnose curable STIs in a variety of settings, but control programs in resource-limited settings continue to struggle to find simple rapid tests that can provide adequate performance in the absence of laboratory services. While recent technological advances and investments in research and development may soon yield improved STI tests that can make an impact, these tests will need to be deployed within a health system that includes: regulatory oversight, quality assurance, good supply-chain management, effective training, information systems and a sound surveillance system to monitor disease trends, inform policy decisions and assess the impact of interventions.

  18. HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Julia L Finkelstein

    2015-01-01

    Full Text Available Introduction: Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings. Methods: We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human, 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808, and studies that did not meet inclusion criteria (n=799, 90 studies were included in this review. Results and Discussion: Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART. In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden. Conclusions: Lipodystrophy is

  19. Fruit Plants Species along Corridor in Kopendukuh Village as a Resource for Rural Tourism Development

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    Widya Kristiyanti Putri

    2015-02-01

    Full Text Available This research aims to identify fruit plants species which is potential for tourism attraction, spatially describes fruit plants distribution and identify local people’s response for fruit plants as tourims attraction in Kopendukuh village, Banyuwangi. Survey was done along the villages corridors. The fruit plant species along corridors was identified and mapped using GPS. Furthermore, semi-structural interview was used to gain informations of local people response about fruit plants as tourism attraction. There were about 18 species and 162 individuals were found along corridor of Kopendukuh village. Fruit plants always found in local home gardens along rural corridor. Local peoples argue that fruit planst s important for numerous purposes. Local people support tourism development in rural area which based on the fruit plants richness (i.e. agrotourism. Keywords: fruit plants, mapping, corridor, rural tourism.

  20. A COMPARATIVE STUDY BETWEEN OPEN CHOLECYSTECTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY IN RURAL MEDICAL COLLEGE SET UP

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    Sinha

    2014-12-01

    Full Text Available laparoscopic cholecystectomy has established itself as the gold standard for cholecystectomy replacing decades old open cholecystectomy. This study compared open cholecystectomy and lap chole in a medical college in rural setup and consisted of 40 patients with a diagnosis of gall stone disease, that underwent Cholecystectomy at M V J Medical College and Research Hospital from Nov 2011 T0 Oct 2013 to compare the advantages and disadvantages of both the methods. Patients with cholelithiasis proven by USG with at least one attack of upper abdominal pain were included in the study. Patients with CBD stones and aged above 70 yrs were excluded from the study. The main advantages of LC were the reduced post-operative pain with less duration of analgesic intake, more rapid recovery and reduced hospital stay

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

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    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.

  2. The functioning of oxygen concentrators in resource-limited settings: a situation assessment in two countries.

    Science.gov (United States)

    La Vincente, S F; Peel, D; Carai, S; Weber, M W; Enarson, P; Maganga, E; Soyolgerel, G; Duke, T

    2011-05-01

    The paediatric wards of hospitals in Malawi and Mongolia. To describe oxygen concentrator functioning in two countries with widespread, long-term use of concentrators as a primary source of oxygen for treating children. A systematic assessment of concentrators in the paediatric wards of 15 hospitals in Malawi and nine hospitals in Mongolia. Oxygen concentrators had been installed for a median of 48 months (interquartile range [IQR] 6-60) and 36 months (IQR 12-96), respectively, prior to the evaluation in Malawi and Mongolia. Concentrators were the primary source of oxygen. Three quarters of the concentrators assessed in Malawi (28/36) and half those assessed in Mongolia (13/25) were functional. Concentrators were found to remain functional with up to 30 000 h of use. However, several concentrators were functioning very poorly despite limited use. Concentrators from a number of different manufacturers were evaluated, and there was marked variation in performance between brands. Inadequate resources for maintenance were reported in both countries. Years after installation of oxygen concentrators, many machines were still functioning, indicating that widespread use can be sustained in resource-limited settings. However, concentrator performance varied substantially. Procurement of high-quality and appropriate equipment is critical, and resources should be made available for ongoing maintenance.

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

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    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

  4. Carotid intima-media thickness and apolipoproteins in patients of ischemic stroke in a rural hospital setting in central India: A cross-sectional study

    OpenAIRE

    Jyoti Jain; Tejal Lathia; Om Prakash Gupta; Vishakha Jain

    2012-01-01

    Context: Carotid intima-media thickness (CIMT) and apolipoproteins have been found as a risk factor for ischemic stroke . Objective: The objective was to study the carotid intima-media thickness, apolipoproteins, and their relation in patients of ischemic stroke in central rural India. Settings and Design: A cross-sectional study was performed in a rural hospital in central India. Materials and Methods: In all patients of ischemic stroke proven by computerized tomography (CT), CIMT, apolipopr...

  5. Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings.

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    Lijun Sun

    Full Text Available Many HIV serodiscordant couples have a strong desire to have their own biological children. Natural conception may be the only choice in some resource limited settings but data about natural conception is limited. Here, we reported our findings of natural conception in HIV serodiscordant couples. Between January 2008 and June 2014, we retrospectively collected data on 91 HIV serodiscordant couples presenting to Beijing Youan Hospital with childbearing desires. HIV counseling, effective ART on HIV infected partners, pre-exposure prophylaxis (PrEP and post-exposure prophylaxis (PEP in negative female partners and timed intercourse were used to maximally reduce the risk of HIV transmission. Of the 91 HIV serodiscordant couples, 43 were positive in male partners and 48 were positive in female partners. There were 196 unprotected vaginal intercourses, 100 natural conception and 97 newborns. There were no cases of HIV seroconversion in uninfected sexual partners. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings if HIV-positive individuals have undetectable viremia on HAART, combined with HIV counseling, PrEP, PEP and timed intercourse.

  6. Assessment of Neurodevelopment, Nutrition, and Inflammation From Fetal Life to Adolescence in Low-Resource Settings.

    Science.gov (United States)

    Suchdev, Parminder S; Boivin, Michael J; Forsyth, Brian W; Georgieff, Michael K; Guerrant, Richard L; Nelson, Charles A

    2017-04-01

    Efforts to improve child neurodevelopment are critical to health, equity, and sustainable development, particularly in low-resource settings in the United States and globally. The colliding epidemics of food insecurity, infectious diseases, and noncommunicable diseases interact and impact neurodevelopment. Understanding the complex relationships between nutrition, inflammation, and neurodevelopment can inform clinical and public health interventions to improve outcomes. This article reviews key definitions, tools, and considerations for the assessment of nutrition, inflammation, and child neurodevelopment. The effectiveness of existing assessment tools to reflect status and biology, particularly in relation to each other, and to predict long-term changes in health is examined. The aim of this review is to present the extant evidence, identify critical research gaps, and suggest a research agenda for future longitudinal and intervention studies to address the assessment of nutrition, inflammation, and child neurodevelopment, particularly in low-resource settings. Despite research gaps, there is a strong relationship between nutrition, inflammation, environmental factors, and child neurodevelopment, which emphasizes the need to evaluate targeted, early interventions to improve long-term health and well-being. Copyright © 2017 by the American Academy of Pediatrics.

  7. Natural Conception May Be an Acceptable Option in HIV-Serodiscordant Couples in Resource Limited Settings.

    Science.gov (United States)

    Sun, Lijun; Wang, Fang; Liu, An; Xin, Ruolei; Zhu, Yunxia; Li, Jianwei; Shao, Ying; Ye, Jiangzhu; Chen, Danqing; Li, Zaicun

    2015-01-01

    Many HIV serodiscordant couples have a strong desire to have their own biological children. Natural conception may be the only choice in some resource limited settings but data about natural conception is limited. Here, we reported our findings of natural conception in HIV serodiscordant couples. Between January 2008 and June 2014, we retrospectively collected data on 91 HIV serodiscordant couples presenting to Beijing Youan Hospital with childbearing desires. HIV counseling, effective ART on HIV infected partners, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in negative female partners and timed intercourse were used to maximally reduce the risk of HIV transmission. Of the 91 HIV serodiscordant couples, 43 were positive in male partners and 48 were positive in female partners. There were 196 unprotected vaginal intercourses, 100 natural conception and 97 newborns. There were no cases of HIV seroconversion in uninfected sexual partners. Natural conception may be an acceptable option in HIV-serodiscordant couples in resource limited settings if HIV-positive individuals have undetectable viremia on HAART, combined with HIV counseling, PrEP, PEP and timed intercourse.

  8. 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

  9. 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.

  10. Special Needs of Young Women with Breast Cancer in Limited Resource Settings.

    Science.gov (United States)

    Gálvez-Hernández, Carmen Lizette; González-Robledo, María Cecilia; Barragán-Carrillo, Regina; Villarreal-Garza, Cynthia

    2017-01-01

    Young women with breast cancer (YWBC) comprise a group of patients with unique biopsychosocial characteristics with a special perception of needs throughout their disease and survivorship. Contexts marked by restricted allocations and economic constraints might further aggravate the struggle of these patients living within limited resource settings and can demand added requirements for them and their families. To analytically explore the existing knowledge regarding the needs of YWBC in low- and middle- income countries (LMICs). We conducted a thorough literature review of scientific journal databases available in Spanish and English containing information on YWBC in LMICs. We did not find any publications exclusively assessing this topic in resource-limited settings. We looked for data on the different types of YW need from studies in the region that assessed the needs of breast cancer (BC) patients in general and described in their findings the particularities of young patients. Young BC patients described within the literature present a variety of needs. Those reported most frequently as unmet were related to information needs and psychological counseling, practical and physical assistance, and social and spiritual support. Published literature on the subject - particularly in Latin America - is extremely scarce. This offers an area of opportunity for conducting further research in this topic that would help improve health professional training and establish health policies in favor of YWBC.

  11. A point-of-care PCR test for HIV-1 detection in resource-limited settings.

    Science.gov (United States)

    Jangam, Sujit R; Agarwal, Abhishek K; Sur, Kunal; Kelso, David M

    2013-04-15

    A low-cost, fully integrated sample-to-answer, quantitative PCR (qPCR) system that can be used for detection of HIV-1 proviral DNA in infants at the point-of-care in resource-limited settings has been developed and tested. The system is based on a novel DNA extraction method, which uses a glass fiber membrane, a disposable assay card that includes on-board reagent storage, provisions for thermal cycling and fluorescence detection, and a battery-operated portable analyzer. The system is capable of automated PCR mix assembly using a novel reagent delivery system and performing qPCR. HIV-1 and internal control targets are detected using two spectrally separated fluorophores, FAM and Quasar 670. In this report, a proof-of-concept of the platform is demonstrated. Initial results with whole blood demonstrate that the test is capable of detecting HIV-1 in blood samples containing greater than 5000 copies of HIV-1. In resource-limited settings, a point-of-care HIV-1 qPCR test would greatly increase the number of test results that reach the infants caregivers, allowing them to pursue anti-retroviral therapy.

  12. Diagnostic and Treatment Difficulties of Pyelonephritis in Pregnancy in Resource-Limited Settings

    Science.gov (United States)

    McGready, Rose; Wuthiekanun, Vanaporn; Ashley, Elizabeth A.; Tan, Saw Oo; Pimanpanarak, Mupawjay; Viladpai-nguen, Samuel Jacher; Jesadapanpong, Wilarat; Blacksell, Stuart D.; Proux, Stephane; Day, Nicholas P.; Singhasivanon, Pratap; White, Nicholas J.; Nosten, François; Peacock, Sharon J.

    2010-01-01

    Limited microbiology services impede adequate diagnosis and treatment of common infections such as pyelonephritis in resource-limited settings. Febrile pregnant women attending antenatal clinics at Shoklo Malaria Research Unit were offered urine dipstick, sediment microscopy, urine culture, and a 5-mL blood culture. The incidence of pyelonephritis was 11/1,000 deliveries (N = 53 in 4,819 pregnancies) between January 7, 2004 and May 17, 2006. Pyelonephritis accounted for 20.2% (41/203) of fever cases in pregnancy. Escherichia coli was the most commonly isolated pathogen: 87.5% (28/32) of organisms cultured. Susceptibility of E. coli to ampicillin (14%), cotrimoxazole (21%), and amoxicillin-clavulanic acid (48%) was very low. E. coli was susceptible to ceftriaxone and ciprofloxacin. The rate of extended spectrum β-lactamase (4.2%; 95% confidence interval = 0.7–19.5) was low. The rate and causes of pyelonephritis in pregnant refugee and migrant women were comparable with those described in developed countries. Diagnostic innovation in microbiology that permits affordable access is a high priority for resource-poor settings. PMID:21118943

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

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    Sandeep Singh

    2016-01-01

    Full Text Available 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.

  14. Open-source mobile digital platform for clinical trial data collection in low-resource settings

    Science.gov (United States)

    van Dam, Joris; Omondi Onyango, Kevin; Midamba, Brian; Groosman, Nele; Hooper, Norman; Spector, Jonathan; Pillai, Goonaseelan (Colin); Ogutu, Bernhards

    2017-01-01

    Background Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Objective Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. Methods The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. Results The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. Discussion and Conclusions This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and

  15. Study on the Exploitation and Utilization of Traditional Food Safety and Chinese Medicine Resources in Rural Areas-based on the Survey of Tongcheng Anhui

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    Zhen-Bo Xu

    2015-07-01

    Full Text Available In this study, we have a study on the exploitation and utilization of traditional food safety and Chinese medicine resources in rural areas based on the survey of Tongcheng Anhui. There are a large variety and effectiveness of Traditional Chinese Medicine (TCM resources in vast rural areas and they are the material basis for the development of TCM cause and research of TCM products. For a long time, however, because of various objective and subjective factors such as lacking of due attention to development and utilization of the resources of TCM, the cause of traditional Chinese medicine in rural areas are lack of development potential. By selecting a representative sample of rural Tongcheng in Anhui and on the basis of investigation on development and utilization of local traditional Chinese medicine resources, we should analyze current problems of development and utilization of existing rural medicine resource and propose suggestions from the aspects of government and farmers research. In this way, we can provide a reference to the motherland researchers and workers of the pharmaceutical industry.

  16. Nutritional status of breastfed infants in rural Zambia : comparison of the National Center for Health Statistics growth reference versus the WHO 12-month breastfed pooled data set

    NARCIS (Netherlands)

    Hautvast, J.L.A.; Pandor, A.; Burema, J.; Tolboom, J.J.M.; Chishimba, N.; Monnens, L.A.H.; Staveren, van W.A.

    2000-01-01

    Cross-sectional data for breastfed infants in rural Zambia were used to evaluate the effect of applying two different data sets as a reference, i.e. the WHO 12-month breastfed pooled data set and the National Center for Health Statistics (NCHS) growth reference in terms of prevalence of malnutrition

  17. 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

  18. 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.

  19. 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.

  20. 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 organ

  1. 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…

  2. 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 f

  3. Participatory rural appraisal to assess groundwater resources in Al-Mujaylis, Tihama Coastal Plain, Yemen

    NARCIS (Netherlands)

    Al-Qubatee, W.S.M.; Ritzema, H.P.; Al-Weshall, Adel; Steenbergen, van F.; Hellegers, P.J.G.J.

    2017-01-01

    A participatory rural appraisal (PRA) conducted in the Al-Mujaylis area, Tihama Coastal Plain, Yemen provided a contribution, as a bottom-up approach, to the assessment of the needs of communities and their views on how to avoid groundwater degradation. It was found that PRA tools could be applied

  4. 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

  5. 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…

  6. 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.

  7. 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 consequence

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

    Directory of Open Access Journals (Sweden)

    Robin R. Sears

    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. 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 f

  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. 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

  12. 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

  13. 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.

  14. Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting.

    Science.gov (United States)

    Haque, Farhana; Ball, Robyn L; Khatun, Selina; Ahmed, Mujaddeed; Kache, Saraswati; Chisti, Mohammod Jobayer; Sarker, Shafiqul Alam; Maples, Stace D; Pieri, Dane; Vardhan Korrapati, Teja; Sarnquist, Clea; Federspiel, Nancy; Rahman, Muhammad Waliur; Andrews, Jason R; Rahman, Mahmudur; Nelson, Eric Jorge

    2017-01-01

    The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings

  15. One-two-triage: validation and reliability of a novel triage system for low-resource settings

    Science.gov (United States)

    Khan, Ayesha; Mahadevan, S V; Dreyfuss, Andrea; Quinn, James; Woods, Joan; Somontha, Koy; Strehlow, Matthew

    2016-01-01

    Objectives To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings. Methods This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital. Results Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308). Conclusions OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience. PMID:27466347

  16. Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting

    Science.gov (United States)

    Khatun, Selina; Ahmed, Mujaddeed; Kache, Saraswati; Chisti, Mohammod Jobayer; Sarker, Shafiqul Alam; Maples, Stace D.; Pieri, Dane; Vardhan Korrapati, Teja; Sarnquist, Clea; Federspiel, Nancy; Rahman, Muhammad Waliur; Andrews, Jason R.; Rahman, Mahmudur; Nelson, Eric Jorge

    2017-01-01

    The emergence of mobile technology offers new opportunities to improve clinical guideline adherence in resource-limited settings. We conducted a clinical pilot study in rural Bangladesh to evaluate the impact of a smartphone adaptation of the World Health Organization (WHO) diarrheal disease management guidelines, including a modality for age-based weight estimation. Software development was guided by end-user input and evaluated in a resource-limited district and sub-district hospital during the fall 2015 cholera season; both hospitals lacked scales which necessitated weight estimation. The study consisted of a 6 week pre-intervention and 6 week intervention period with a 10-day post-discharge follow-up. Standard of care was maintained throughout the study with the exception that admitting clinicians used the tool during the intervention. Inclusion criteria were patients two months of age and older with uncomplicated diarrheal disease. The primary outcome was adherence to guidelines for prescriptions of intravenous (IV) fluids, antibiotics and zinc. A total of 841 patients were enrolled (325 pre-intervention; 516 intervention). During the intervention, the proportion of prescriptions for IV fluids decreased at the district and sub-district hospitals (both p < 0.001) with risk ratios (RRs) of 0.5 and 0.2, respectively. However, when IV fluids were prescribed, the volume better adhered to recommendations. The proportion of prescriptions for the recommended antibiotic azithromycin increased (p < 0.001 district; p = 0.035 sub-district) with RRs of 6.9 (district) and 1.6 (sub-district) while prescriptions for other antibiotics decreased; zinc adherence increased. Limitations included an absence of a concurrent control group and no independent dehydration assessment during the pre-intervention. Despite limitations, opportunities were identified to improve clinical care, including better assessment, weight estimation, and fluid/ antibiotic selection. These findings

  17. Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural Kenya.

    Science.gov (United States)

    Odero, Merab; Hatcher, Abigail M; Bryant, Chenoia; Onono, Maricianah; Romito, Patrizia; Bukusi, Elizabeth A; Turan, Janet M

    2014-03-01

    Intimate partner violence (IPV) is reported by one in three women globally, but the prevalence is much higher in East Africa. Though some formal and informal resources do exist for women experiencing IPV, data suggest that disclosure, help seeking, and subsequent utilization of these resources are often hindered by sociocultural, economic, and institutional factors. This article explores actions taken by victims, available support services, and barriers to the utilization of available IPV resources by pregnant women in rural Nyanza, Kenya. Qualitative data were collected through nine focus group discussions and 20 in-depth interviews with pregnant women, partners or male relatives of pregnant women, and service providers. Data were managed in NVivo 8 using a descriptive analytical approach that harnessed thematic content coding and in-depth grounded analysis. We found that while formal resources for IPV were scarce, women utilized many informal resources (family, pastors, local leaders) as well as the health facility. In rare occasions, women escalated their response to formal services (police, judiciary). The community was sometimes responsive to women experiencing IPV but often viewed it as a "normal" part of local culture. Further barriers to women accessing services included logistical challenges and providers who were undertrained or uncommitted to responding to IPV appropriately. Moreover, the very sanctions meant to address violence (such as fines or jail) were often inhibiting for women who depended on their partners for financial resources. The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources-including the health clinic-to address violence among women of childbearing age.

  18. Physical methods used by Sudanese mothers in rural settings to manage a child with fever.

    Science.gov (United States)

    Mukhtar, Hanadi M E; Elnimeiri, Mustafa K

    2014-01-01

    Although the mainstays of antipyretic treatments are drugs such as paracetamol and ibuprofen, physical methods are also used. These include tepid sponging, removing clothes, and cooling the environment with fans to improve ventilation. The objective of this study is to assess the physical methods used by Sudanese rural mothers to manage a child with fever. A cross-sectional descriptive study was designed and conducted within 6 months; it involved 332 mothers of children under five. The data were collected through using a standardized administered questionnaire and focus group discussion and analyzed by statistical package for social science version 15.0 (SPSS). Tepid sponging was used by 47% of the interviewed mothers. 15% of the mothers increased fluid intake, 7% bathed the child and 5% put the child in light clothes. 59% of mothers applied tepid sponging on head, 33.9% on all the body, 3.7% and 2.2% on groin area and axilla, respectively. The majority of mothers (86%) used water from refrigerator or zeir [water clay pot] for applying tepid sponging, 9% used tap water, and 3% used ice water. In conclusion, this study revealed that the common physical treatment method for fever used by mothers was tepid sponging with inappropriate application.

  19. Field testing of alternative cookstove performance in a rural setting of western India.

    Science.gov (United States)

    Muralidharan, Veena; Sussan, Thomas E; Limaye, Sneha; Koehler, Kirsten; Williams, D'Ann L; Rule, Ana M; Juvekar, Sanjay; Breysse, Patrick N; Salvi, Sundeep; Biswal, Shyam

    2015-02-03

    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).

  20. 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.

  1. A New Approach to Reach Latino Populations in Rural and Urban Settings

    Science.gov (United States)

    Morris, P.; Garcia, A.; Galindo, C.; Obot, V.; Allen, J.; Reiff, P.; Sumners, C.; Garcia, J.; Garza, O.

    2004-12-01

    Current statistics indicate that Latino populations have lower high school and college graduation rates than Anglos or African Americans. If Latinos do not pursue baccalaureate and higher degrees, then this group will be left behind as technological advances increasingly drive our society. The drop out rate affects not only the individuals, families, communities, and society from many different aspects, including financial independence, but also loss of potential contributing members of society in science, engineering, etc. Houston, an urban area, with a Latino population of 39% and Brownsville, a rural area represented by 84% Latinos, are two Texas areas where universities, schools, museums, and NASA are reaching out to increase science skills and graduation rates. Many Houston families have the opportunity to be introduced to different options, but Brownsville families do not have the same opportunities as the area lacks a strong industrial and technological base. We have developed programs to improve the space and Earth science knowledge base by providing summer science enrichment programs for K-12 students, family events, exposing high school students to college opportunities, and training high school and college students to serve as mentors to their peers. The peer mentors lead many of the outreach venues, interacting with the public with demonstrations and interactive science activities. In addition, we have developed a series of teacher workshops and modules on integrated science and mathematics. The teacher workshops are designed to provide the teachers with a wealth of integrated examples for classroom use.

  2. Risk factors for mortality during antiretroviral therapy in older populations in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Daniel O’Brien

    2016-01-01

    Full Text Available Introduction: An increasing proportion of adult patients initiating antiretroviral therapy (ART in resource-limited settings are aged >50 years. Older populations on ART appear to have heightened risk of death, but little is known about factors influencing mortality in this population. Methods: We performed a retrospective observational multisite cohort study including all adult patients (≥15 years initiating ART between 2003 and 2013 in programmes supported by Médecins Sans Frontières across 12 countries in Asia, Africa and Europe. Patients were stratified into two age groups, >50 years and 15 to 50 years. A Cox proportional hazards model was used to explore factors associated with mortality. Results: The study included 41,088 patients: 2591 (6.3% were aged >50 years and 38,497 (93.7% were aged 15 to 50 years. The mortality rate was significantly higher in the age group >50 years [367 (14.2% deaths; mortality rate 7.67 deaths per 100 person-years (95% confidence interval, CI: 6.93 to 8.50] compared to the age group 15 to 50 years [3788 (9.8% deaths; mortality rate 4.18 deaths per 100 person-years (95% CI: 4.05 to 4.31], p50 age group. WHO Stage 4 conditions were more strongly associated with increased mortality rates in the 15 to 50 age group compared to populations >50 years. WHO Stage 3 conditions were associated with an increased mortality rate in the 15 to 50 age group but not in the >50 age group. Programme region did not affect mortality rates in the >50 age group; however being in an Asian programme was associated with a 36% reduced mortality rate in populations aged 15 to 50 years compared to being in an African programme. There was a higher overall incidence of Stage 3 WHO conditions in people >50 years (12.8/100 person-years compared to those 15 to 50 years (8.1/100 person-years (p50 age groups. Conclusions: Older patients on ART in resource-limited settings have increased mortality rates, but compared to younger populations this

  3. Beijing Rural Commercial Bank to Be Established at the End of 2005

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ Recently, Beijing Rural Commercial Bank Preparatory Group(BRCBPG) was officially set up,which started the prelude of the Rural Credit Cooperatives changing to Rural Commercial Bank. It is reported that Beijing Rural Commercial Bank (BRCB) will be the first domestic Rural Commercial Bank at the provincial level and will put on the new label at the end of the year. After that, BRCB will be oriented to put its feet on the urban and rural areas, serve agriculture, countryside and farmers and small and middle-size enterprises, base on the strategy of city and country integration, absorb more social resources to flow into rural areas.

  4. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana

    NARCIS (Netherlands)

    Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

    2016-01-01

    BACKGROUND: 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. METHODS: A cross-sectional analysis of the baseline data

  5. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana

    NARCIS (Netherlands)

    Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

    2016-01-01

    BACKGROUND: 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. METHODS: A cross-sectional analysis of the baseline data

  6. 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.

  7. 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…

  8. Closing the cycle on food and energy resource flows in order to create a more sustainable rural economy in Nicaragua

    Science.gov (United States)

    Casillas, C. E.

    2009-12-01

    The ecologically sustainable development of economies is often discussed at the urban scale and framed in terms of the environmental threats that accompany rapid growth. The dynamics of rural economies are less complex and provide valuable insights into how resource flows may be better utilized, as well what are the critical roles and relationships of government and society. This paper will present a case study of economic and ecologically appropriate innovations that can be made to the production and consumption behavior within a community on the Atlantic Coast of Nicaragua. Orinoco is a small Garifuna community situated on the Pearl Lagoon basin. It has a population of over 1000 people and its economy is primarily based on the exploitation of declining shrimp and fish resources. This paper will quantify the monetary and material resource flows comprising the current economy, and present technically viable alternatives that would utilize the abundant natural resources in a more ecologically sustainable manner, while decreasing the dependence on imported food and fuels. Specifically, the paper will describe how recently implemented projects of energy conservation can be coupled with improved agricultural and fishing practices in order to meet local and external market demands for fish and vegetable oil. Secondary products can be utilized to eliminate the dependence on imported liquid and gas fossil fuels for cooking and electricity generation.

  9. Comprehensive yet scalable health information systems for low resource settings: a collaborative effort in sierra leone.

    Science.gov (United States)

    Braa, Jørn; Kanter, Andrew S; Lesh, Neal; Crichton, Ryan; Jolliffe, Bob; Sæbø, Johan; Kossi, Edem; Seebregts, Christopher J

    2010-11-13

    We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone.

  10. Supporting research sites in resource-limited settings: challenges in implementing information technology infrastructure.

    Science.gov (United States)

    Whalen, Christopher J; Donnell, Deborah; Tartakovsky, Michael

    2014-01-01

    As information and communication technology infrastructure becomes more reliable, new methods of electronic data capture, data marts/data warehouses, and mobile computing provide platforms for rapid coordination of international research projects and multisite studies. However, despite the increasing availability of Internet connectivity and communication systems in remote regions of the world, there are still significant obstacles. Sites with poor infrastructure face serious challenges participating in modern clinical and basic research, particularly that relying on electronic data capture and Internet communication technologies. This report discusses our experiences in supporting research in resource-limited settings. We describe examples of the practical and ethical/regulatory challenges raised by the use of these newer technologies for data collection in multisite clinical studies.

  11. 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.

  12. 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.

  13. Congestion Control in WMSNs by Reducing Congestion and Free Resources to Set Accurate Rates and Priority

    Directory of Open Access Journals (Sweden)

    Akbar Majidi

    2014-08-01

    Full Text Available The main intention of this paper is focus on mechanism for reducing congestion in the network by free resources to set accurate rates and priority data needs. If two nodes send their packets in the shortest path to the parent node in a crowded place, a source node must prioritize the data and uses data that have lower priorities of a suitable detour nodes consisting of low or non- active consciously. The proposed algorithm is applied to the nodes near the base station (which convey more traffic after the congestion detection mechanism detected the congestion. Obtained results from simulation test done by NS-2 simulator demonstrate the innovation and validity of proposed method with better performance in comparison with CCF, PCCP and DCCP protocols.

  14. 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

  15. The benefits of international rotations to resource-limited settings for U.S. surgery residents.

    Science.gov (United States)

    Henry, Jaymie A; Groen, Reinou S; Price, Raymond R; Nwomeh, Benedict C; Kingham, T Peter; Hardy, Mark A; Kushner, Adam L

    2013-04-01

    U.S. surgery residents increasingly are interested in international experiences. Recently, the Residency Review Committee approved international surgery rotations for credit toward graduation. Despite this growing interest, few U.S. surgery residency programs offer formal international rotations. We aimed to present the benefits of international surgery rotations and how these rotations contribute to the attainment of the 6 Accreditation Council for Graduate Medical Education (ACGME) competencies. An e-mail-based survey was sent in November 2011 to the 188 members of Surgeons OverSeas, a group of surgeons, residents, fellows, and medical students with experience working in resource-limited settings. They were asked to list 5 benefits of international rotations for surgery residents. The frequency of benefits was qualitatively grouped into 4 major categories: educational, personal, benefits to the foreign institution/Global Surgery, and benefits to the home institution. The themes were correlated with the 6 ACGME competencies. The 58 respondents (31% response rate) provided a total of 295 responses. Fifty themes were identified. Top benefits included learning to optimally function with limited resources, exposure to a wide variety of operative pathology, exposure to a foreign culture, and forming relationships with local counterparts. All ACGME competencies were covered by the themes. International surgery rotations to locations in which resources are constrained, operative diseases vary, and patient diversity abound provide unique opportunities for surgery residents to attain the 6 ACGME competencies. General surgery residency programs should be encouraged to establish formal international rotations as part of surgery training to promote resident education and assist with necessary oversight. Copyright © 2013 Mosby, Inc. All rights reserved.

  16. Identification of Barriers to Pediatric Care in Limited-Resource Settings: A Simulation Study.

    Science.gov (United States)

    Shilkofski, Nicole; Hunt, Elizabeth A

    2015-12-01

    Eighty percent of the 10 million annual deaths in children aged education for pediatric emergency management being a key factor. Education must take into account cultural considerations to be effective. Study objectives were: (1) to use simulation to identify factors posing barriers to patient care in limited resource settings (LRS); and (2) to understand how simulations in LRS can affect communication and decision-making processes. A qualitative study was conducted at 17 different sites in 12 developing countries in Asia, Latin America, and Africa. Data from observations of 68 in situ simulated pediatric emergencies were coded for thematic analysis. Sixty-two different "key informants" were interviewed regarding perceived benefit of simulations. Coding of observations and interviews yielded common themes: impact of culture on team hierarchy, impact of communication and language barriers on situational awareness, systematic emergency procedures, role delineation, shared cognition and resource awareness through simulation, logistic barriers to patient care, and use of recognition-primed decision-making by experienced clinicians. Changes in clinical environments were implemented as a result of simulations. Ad hoc teams in LRS face challenges in caring safely for patients; these include language and cultural barriers, as well as environmental and resource constraints. Engaging teams in simulations may promote improved communication, identification of systems issues and latent threats to target for remediation. There may be a role for training novices in use of recognition-primed or algorithmic decision-making strategies to improve rapidity and efficiency of decisions in LRS. Copyright © 2015 by the American Academy of Pediatrics.

  17. Malnutrition and frailty in community dwelling older adults living in a rural setting.

    Science.gov (United States)

    Boulos, Christa; Salameh, Pascale; Barberger-Gateau, Pascale

    2016-02-01

    Malnutrition and frailty are frequent and serious conditions within the geriatric population. Both are of multifactorial origin and linked to adverse outcomes. The purpose of this study was to analyze the relationships between these two concepts in a representative sample of rural elderly Lebanese with a high prevalence of malnutrition. A cross-sectional study including a representative sample of 1200 elderly Lebanese aged 65 and over living in the community. The following measurements were recorded: information on socio-demographic status, comorbidities, Activities of Daily Living (ADL), screening for depression (5 item Geriatric Depression Scale [GDS]) and cognitive status (Mini-Mental-State [MMS]). Frailty was assessed through the Study of Osteoporotic Fractures (SOF) index whereas nutritional status was measured through the Mini Nutritional Assessment (MNA). Stepwise backwards multinomial logistic regression was used to analyze the association between nutritional status and frailty, independent of these covariates. Frailty or prefrailty were present in respectively 36.4% and 30.4% of the participants. The proportion of individuals suffering from poor nutritional status increased with growing level of frailty (p malnutrition and risk of malnutrition were related to a significantly increased risk of frailty, respectively (OR: 3.72, 95% IC: 1.40-9.94/OR: 3.66, 95% IC: 2.32-5.76), whereas the relation between poor nutritional status and prefrailty was not significant, independently of reporting less than three comorbidities, being ADL independent, depressive symptoms, illiteracy, and low cognitive status. Frailty and malnutrition are two closely related but distinct concepts that share common determinants in this elderly population. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  18. Feasibility of HIV point-of-care tests for resource-limited settings: challenges and solutions.

    Science.gov (United States)

    Stevens, Wendy; Gous, Natasha; Ford, Nathan; Scott, Lesley E

    2014-09-08

    Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted.

  19. Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination.

    Science.gov (United States)

    Ahmed, Muhammed

    2011-07-01

    We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9 ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.

  20. Quality improvement activity in radiology reading and reporting in a rural setting hospital in Indonesia.

    Science.gov (United States)

    Frelita, Grace; Wongso, Christlyn; Pasaribu, Marganda Dapot Asi

    2012-01-01

    The Republic of Indonesia is an archipelago country, which is located between Asia and Australia. With a population of more than 200 million people, Indonesia only has about 600 Radiologists, whose majority resides in urban areas. In such a challenging situation, the Siloam Hospitals Group (SHG) established a strategy to improve its remote hospitals' Radiologists' quality care standard of patient safety. Although the strategy has produced a positive result, resistance towards cultural change was unavoidable throughout the strategy implementation. By learning from several resources and experiences, SHG's leaders tried to develop a strategy improvement towards better processes, particularly in recognizing and solving interpersonal conflicts.

  1. The time is now to implement HPV testing for primary screening in low resource settings.

    Science.gov (United States)

    Kuhn, Louise; Denny, Lynette

    2017-05-01

    Unacceptable disparities in cervical cancer between richer and poorer countries persist and serve as reminders of gross disparities in access to and quality of screening services. HPV testing is well-suited to address some of the barriers to implementing adequate screening programs in low resource settings. HPV testing has considerably better sensitivity than cytology providing the same extent of safety with fewer rounds of screening. New robust HPV testing platforms require little to no skill by laboratory workers and some can be used at the point-of-care. This allows for a round of screening to be accomplished in one or two visits, reducing costs and the inevitable attrition that occurs when women need to be recalled to obtain their results. HPV testing is ideal for incorporating into the new "screen-and-treat" approaches designed to overcome limitations of conventional, multi-visit, colposcopy-based approaches to screening. Visual inspection with acetic acid (VIA) is the screening test that has been used most widely in screen-and-treat programs to date but the performance characteristics of this test are poor. HPV-based screen-and-treat is more effective in reducing disease in the population and reduces over-treatment intrinsic to this approach. HPV testing can be adapted or combined with other molecular tests to improve treatment algorithms. Infrastructure established to support VIA-based screen-and-treat can effectively incorporate HPV testing. We are poised at a critical juncture in public health history to implement HPV testing as part of primary screening and thereby improve women's health in low resource settings.

  2. 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.

  3. 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.

  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 in...... a potential to improve the economic situation of women through increased production and sale of soumbala.......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...

  5. Have health human resources become more equal between rural and urban areas after the new reform?

    Science.gov (United States)

    Yang, Qian; Dong, Hengjin

    2014-12-01

    The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.

  6. Evaluation of Malaria Diagnoses Using a Handheld Light Microscope in a Community-Based Setting in Rural Côte d'Ivoire.

    Science.gov (United States)

    Coulibaly, Jean T; Ouattara, Mamadou; Keiser, Jennifer; Bonfoh, Bassirou; N'Goran, Eliézer K; Andrews, Jason R; Bogoch, Isaac I

    2016-10-05

    Portable microscopy may facilitate quality diagnostic care in resource-constrained settings. We compared a handheld light microscope (Newton Nm1) with a mobile phone attachment to conventional light microscopy for the detection of Plasmodium falciparum in a cross-sectional study in rural Côte d'Ivoire. Single Giemsa-stained thick blood film from 223 individuals were prepared and read by local laboratory technicians on both microscopes under 1,000× magnification with oil. Of the 223 samples, 162 (72.6%) were P. falciparum positive, and the overall mean parasite count was 1,392/μL of blood. Sensitivity and specificity of the handheld microscope was 80.2% (95% confidence interval [CI]: 73.1-85.9%) and 100.0% (95% CI: 92.6-100.0%), respectively, with a positive and negative predictive value of 100.0% (95% CI: 96.4-100.0%) and 65.6% (95% CI: 54.9-74.9%), respectively. If sensitivity can be improved, handheld light microscopy may become a valuable public health tool for P. falciparum diagnosis.

  7. Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting.

    Science.gov (United States)

    Burgess, Rochelle Ann

    2016-12-01

    The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.

  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. An oral health literacy intervention for Indigenous adults in a rural setting in Australia

    Directory of Open Access Journals (Sweden)

    Parker Eleanor J

    2012-06-01

    . Discussion This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

  10. Turning off the spigot: reducing drug-resistant tuberculosis transmission in resource-limited settings.

    Science.gov (United States)

    Nardell, E; Dharmadhikari, A

    2010-10-01

    Ongoing transmission and re-infection, primarily in congregate settings, is a key factor fueling the global multidrug-resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) epidemic, especially in association with the human immunodeficiency virus. Even as efforts to broadly implement conventional TB transmission control measures begin, current strategies may be incompletely effective under the overcrowded conditions extant in high-burden, resource-limited settings. Longstanding evidence suggesting that TB patients on effective therapy rapidly become non-infectious and that unsuspected, untreated TB cases account for the most transmission makes a strong case for the implementation of rapid point-of-care diagnostics coupled with fully supervised effective treatment. Among the most important decisions affecting transmission, the choice of an MDR-TB treatment model that includes community-based treatment may offer important advantages over hospital or clinic-based care, not only in cost and effectiveness, but also in transmission control. In the community, too, rapid identification of infectious cases, especially drug-resistant cases, followed by effective, fully supervised treatment, is critical to stopping transmission. Among the conventional interventions available, we present a simple triage and separation strategy, point out that separation is intimately linked to the design and engineering of clinical space and call attention to the pros and cons of natural ventilation, simple mechanical ventilation systems, germicidal ultraviolet air disinfection, fit-tested respirators on health care workers and short-term use of masks on patients before treatment is initiated.

  11. When to start antiretroviral therapy in resource-limited settings: a human rights analysis

    Directory of Open Access Journals (Sweden)

    Calmy Alexandra

    2010-03-01

    Full Text Available Abstract Background Recent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration. Discussion According to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs. Summary Widespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support.

  12. An innovative system for 3D clinical photography in the resource-limited settings

    Science.gov (United States)

    2014-01-01

    Background Kaposi’s sarcoma (KS) is the most frequently occurring cancer in Mozambique among men and the second most frequently occurring cancer among women. Effective therapeutic treatments for KS are poorly understood in this area. There is an unmet need to develop a simple but accurate tool for improved monitoring and diagnosis in a resource-limited setting. Standardized clinical photographs have been considered to be an essential part of the evaluation. Methods When a therapeutic response is achieved, nodular KS often exhibits a reduction of the thickness without a change in the base area of the lesion. To evaluate the vertical space along with other characters of a KS lesion, we have created an innovative imaging system with a consumer light-field camera attached to a miniature “photography studio” adaptor. The image file can be further processed by computational methods for quantification. Results With this novel imaging system, each high-quality 3D image was consistently obtained with a single camera shot at bedside by minimally trained personnel. After computational processing, all-focused photos and measurable 3D parameters were obtained. More than 80 KS image sets were processed in a semi-automated fashion. Conclusions In this proof-of-concept study, the feasibility to use a simple, low-cost and user-friendly system has been established for future clinical study to monitor KS therapeutic response. This 3D imaging system can be also applied to obtain standardized clinical photographs for other diseases. PMID:24929434

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

    OpenAIRE

    2015-01-01

    Background: Wheelchairs provide mobility that can enhance function and community integration. Function in a wheelchair is influenced by wheelchair design.Objectives: To explore the impact of wheelchair design on user function and the variables that guided wheelchair prescription in the study setting.Method: 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 S...

  14. Safety, efficacy, and pharmacokinetics of rilpivirine: systematic review with an emphasis on resource-limited settings

    Directory of Open Access Journals (Sweden)

    Ford N

    2011-04-01

    Full Text Available Nathan Ford1,2, Janice Lee1, Isabelle Andrieux-Meyer1, Alexandra Calmy1,31Médecins Sans Frontières, Geneva, Switzerland; 2Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; 3Service of Infectious Diseases, Geneva University Hospital, Geneva, SwitzerlandAbstract: The vast majority of people living with human immunodeficiency virus (HIV/acquired immune deficiency syndrome reside in the developing world, in settings characterized by limited health budgets, critical shortages of doctors, limited laboratory monitoring, a substantial burden of HIV in children, and high rates of coinfection, in particular tuberculosis. Therefore, the extent to which new antiretrovirals will contribute to improvements in the management of HIV globally will depend to a large extent on their affordability, ease of use, low toxicity profile, availability as pediatric formulations, and compatibility with tuberculosis and other common drugs. We undertook a systematic review of the available evidence regarding drug interactions, and the efficacy and safety of rilpivirine (also known as TMC-278, and assessed our findings in view of the needs and constraints of resource-limited settings. The main pharmacokinetic interactions relevant to HIV management reported to date include reduced bioavailability of rilpivirine when coadministered with rifampicin, rifabutin or acid suppressing agents, and reduced bioavailability of ketoconazole. Potential recommendations for dose adjustment to compensate for these interactions have not been elaborated. Trials comparing rilpivirine and efavirenz found similar outcomes up to 96 weeks in intent-to-treat analysis; failure of rilpivirine was mainly virological, whereas failure among those exposed to efavirenz was mainly related to the occurrence of adverse events. Around half of the patients who fail rilpivirine develop non-nucleoside reverse transcriptase inhibitor resistance mutations

  15. Prioritising prevention strategies for patients in Antiretroviral Treatment Programmes in Resource-Limited Settings

    Science.gov (United States)

    SPAAR, A.; GRABER, C.; DABIS, F.; COUTSOUDIS, A; BACHMANN, L.; MCINTYRE, J.; SCHECHTER, M.; PROZESKY, H.W.; TUBOI, S.; DICKINSON, D.; KUMARASAMY, N.; PUJDADES-RODRIQUEZ, M.; SPRINZ, E.; SCHILTHUIS, H.J.; CAHN, P.; LOW, N.; EGGER, M.

    2010-01-01

    Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; 8 (36%) from South Africa, 2 from Brazil, 2 from Zambia and 1 each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe. Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, 7 (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to-child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI, and reduction of stigma in the community, have not been implemented widely. PMID:20473792

  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 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. Evaluation of an immunoassay for determination of plasma efavirenz concentrations in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Alemseged Abdissa

    2014-06-01

    Full Text Available Introduction: Therapeutic drug monitoring (TDM may improve antiretroviral efficacy through adjustment of individual drug administration. This could result in reduced toxicity, prevent drug resistance, and aid management of drug–drug interactions. However, most measurement methods are too costly to be implemented in resource-limited settings. This study evaluated a commercially available immunoassay for measurement of plasma efavirenz. Methods: The immunoassay-based method was applied to measure efavirenz using a readily available Humastar 80 chemistry analyzer. We compared plasma efavirenz concentrations measured by the immunoassay with liquid chromatography tandem mass spectrometry (LC-MS/MS (reference method in 315 plasma samples collected from HIV patients on treatment. Concentrations were categorized as suboptimal4 µg/ml. Agreement between results of the methods was assessed via Bland-Altman plot and κ statistic values. Results: The median Interquartile range (IQR efavirenz concentration was 2.8 (1.9; 4.5 µg/ml measured by the LC–MS/MS method and 2.5 (1.8; 3.9 µg/ml by the immunoassay and the results were well correlated (ρ=0.94. The limits of agreement assessed by Bland–Altman plots were −2.54; 1.70 µg/ml. Although immunoassay underestimated high concentrations, it had good agreement for classification into low, normal or high concentrations (K=0.74. Conclusions: The immunoassay is a feasible alternative to determine efavirenz in areas with limited resources. The assay provides a reasonable approximation of efavirenz concentration in the majority of samples with a tendency to underestimate high concentrations. Agreement between tests evaluated in this study was clinically satisfactory for identification of low, normal and high efavirenz concentrations.

  18. 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.

  19. 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

  20. 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

  1. Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings.

    Science.gov (United States)

    Goga, Ameena Ebrahim; Singh, Yagespari; Singh, Michelle; Noveve, Nobuntu; Magasana, Vuyolwethu; Ramraj, Trisha; Abdullah, Fareed; Coovadia, Ashraf H; Bhardwaj, Sanjana; Sherman, Gayle G

    2017-01-01

    Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of

  2. Clinical care for severe influenza and other severe illness in resource-limited settings: the need for evidence and guidelines.

    Science.gov (United States)

    Ortiz, Justin R; Jacob, Shevin T; West, T Eoin

    2013-09-01

    The 2009 influenza A (H1N1) pandemic highlighted the importance of quality hospital care of the severely ill, yet there is evidence that the impact of the 2009 pandemic was highest in low- and middle-income countries with fewer resources. Recent data indicate that death and suffering from seasonal influenza and severe illness in general are increased in resource-limited settings. However, there are limited clinical data and guidelines for the management of influenza and other severe illness in these settings. Life-saving supportive care through syndromic case management is used successfully in high-resource intensive care units and in global programs such as the Integrated Management of Childhood Illness (IMCI). While there are a variety of challenges to the management of the severely ill in resource-limited settings, several new international initiatives have begun to develop syndromic management strategies for these environments, including the World Health Organization's Integrated Management of Adult and Adolescent Illness Program. These standardized clinical guidelines emphasize syndromic case management and do not require high-resource intensive care units. These efforts must be enhanced by quality clinical research to provide missing evidence and to refine recommendations, which must be carefully integrated into existing healthcare systems. Realizing a sustainable, global impact on death and suffering due to severe influenza and other severe illness necessitates an ongoing and concerted international effort to iteratively generate, implement, and evaluate best-practice management guidelines for use in resource-limited settings.

  3. Random blood glucose may be used to assess long-term glycaemic control among patients with type 2 diabetes mellitus in a rural African clinical setting

    DEFF Research Database (Denmark)

    Rasmussen, Jon B; Nordin, Lovisa S; Rasmussen, Niclas S

    2014-01-01

    OBJECTIVES: To investigate the diagnostic accuracy of random blood glucose (RBG) on good glycaemic control among patients with diabetes mellitus (DM) in a rural African setting. METHODS: Cross-sectional study at St. Francis' Hospital in eastern Zambia. RBG and HbA1c were measured during one...

  4. 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

  5. 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.

  6. Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings.

    Science.gov (United States)

    Zolfo, Maria; Iglesias, David; Kiyan, Carlos; Echevarria, Juan; Fucay, Luis; Llacsahuanga, Ellar; de Waard, Inge; Suàrez, Victor; Llaque, Walter Castillo; Lynen, Lutgarde

    2010-09-08

    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. 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. 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. 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.

  7. Evaluation of adjunctive tests for cervical cancer screening in low resource settings

    Directory of Open Access Journals (Sweden)

    Bhatla Neerja

    2007-01-01

    Full Text Available Background: Visual inspection of cervix after application of acetic acid (VIA is an effective screening tool for cervical cancer in low resource settings, but its low specificity leads to high referral rates. Adjunctive testing may overcome this drawback. Aims: This pilot study was aimed to assess test performances of VIA, human papillomavirus (HPV testing and Pap smear, individually and in simulated combinations, to determine the probable best screening option. Setting and Design: Gynecology outpatient department (OPD; cross-sectional study. Materials and Methods: One hundred women with complaints of irregular vaginal bleeding or discharge, post coital bleeding or unhealthy cervix on examination underwent Pap smear, HPV testing, VIA, colposcopy and biopsy, if indicated, in this screening order. Statistical Analysis: Sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV were calculated for each of the tests with a biopsy result of ≥HSIL taken as the gold standard. Simulated parallel and sequential combinations for VIA/Pap, VIA/HPV and HPV/Pap were calculated and compared with individual test performance. Results: Prevalence of abnormal Pap smears was 5%, VIA positive 51% and HPV positive 16%. Sensitivity and specificity of VIA were 100% and 53.3% respectively. For HPV and Pap tests corresponding figures were 85.7%, 89.7% and 50%, 98.9% respectively. The best simulated combination with a balance of sensitivity and specificity was of VIA followed by HPV testing (sensitivity 85.7%, specificity 95.4%. Conclusion: Addition of HPV testing to VIA can increase the specificity of VIA, thereby reducing the referral rates without compromising the sensitivity of the test.

  8. 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…

  9. New Resource-Wise Planning Strategies for Smart Urban-Rural Development in Finland

    Directory of Open Access Journals (Sweden)

    Emilia Rönkkö

    2017-02-01

    Full Text Available This article discusses the opportunities and challenges for resource-wise development strategies in regional planning. Spatial planning integrates the key aspects, transportation, housing, and food production which are, on many occasions, stated as the most significant consumption factors causing environmental impacts. In light of the challenges that regions are currently facing in Finland, we are drawing attention to the role of strategic spatial planning as demand-responsive resource management, a theme which is still inadequately addressed within regional development and planning in Finland. In many other fields of society, innovative data-based products and demand- and user-driven services are considered important sources of success in the future. Such strategies combine different types of service providers, like deliveries for groceries or restaurant meals, mobile healthcare services, or public transport with on-demand services. We highlight the fact that a regionally large and sparsely populated country, such as Finland, cannot achieve success solely through centralisation. Instead, smart networking, co-creation, and innovative cyber-physical solutions are vital for the utilisation of the entire country’s resource potentiality. In conclusion, we underpin the need for a framework, which would offer a strategic support scheme for resource-wise development, resource optimization, and closure of yield gaps. In our view it is necessary to begin to envision, strategise, and develop user- and demand-responsive development strategies with a specific aim for sustainable, resource-wise ways of life in northern regions, also outside the growing urban centres, and innovate solutions that help individuals, communities, and the whole society to renew and manage resources wisely.

  10. 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

  11. A microchip CD4 counting method for HIV monitoring in resource-poor settings.

    Directory of Open Access Journals (Sweden)

    William R Rodriguez

    2005-07-01

    Full Text Available BACKGROUND: More than 35 million people in developing countries are living with HIV infection. An enormous global effort is now underway to bring antiretroviral treatment to at least 3 million of those infected. While drug prices have dropped considerably, the cost and technical complexity of laboratory tests essential for the management of HIV disease, such as CD4 cell counts, remain prohibitive. New, simple, and affordable methods for measuring CD4 cells that can be implemented in resource-scarce settings are urgently needed. METHODS AND FINDINGS: Here we describe the development of a prototype for a simple, rapid, and affordable method for counting CD4 lymphocytes. Microliter volumes of blood without further sample preparation are stained with fluorescent antibodies, captured on a membrane within a miniaturized flow cell and imaged through microscope optics with the type of charge-coupled device developed for digital camera technology. An associated computer algorithm converts the raw digital image into absolute CD4 counts and CD4 percentages in real time. The accuracy of this prototype system was validated through testing in the United States and Botswana, and showed close agreement with standard flow cytometry (r = 0.95 over a range of absolute CD4 counts, and the ability to discriminate clinically relevant CD4 count thresholds with high sensitivity and specificity. CONCLUSION: Advances in the adaptation of new technologies to biomedical detection systems, such as the one described here, promise to make complex diagnostics for HIV and other infectious diseases a practical global reality.

  12. Management of children with acute malnutrition in resource-poor settings.

    Science.gov (United States)

    Brown, Kenneth H; Nyirandutiye, Daniele H; Jungjohann, Svenja

    2009-11-01

    Approximately 11% of children worldwide suffer from moderate or severe acute malnutrition, which is defined as low weight for height or mid-upper arm circumference with respect to international standards, or the presence of bipedal edema. These children have a considerably increased risk of dying. Experience from the past two decades indicates that children with uncomplicated moderate or severe acute malnutrition can be managed successfully as outpatients, by use of appropriate treatment of infections and either lipid-based, ready-to-use therapeutic foods or appropriately formulated home diets, along with psychosocial care. Children's caregivers prefer community-based treatment, which is also less costly than inpatient care. Children with severe acute malnutrition and life-threatening complications require short-term inpatient care for treatment of infections, fluid and electrolyte imbalances, and metabolic abnormalities. Initial dietary management relies on low-lactose, milk-based, liquid formulas but semi-solid or solid foods can be started as soon as appetite permits, after which children can be referred for ambulatory treatment. National programs for the community-based management of acute malnutrition (CMAM) provide periodic anthropometric and clinical screening of young children, and referral of those who meet established criteria. This Review describes the main components of the treatment of young children with acute malnutrition in resource poor settings and some recent advances in CMAM programs.

  13. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings.

    Science.gov (United States)

    Floyd, Jessica; Wu, Lindsey; Hay Burgess, Deborah; Izadnegahdar, Rasa; Mukanga, David; Ghani, Azra C

    2015-12-01

    It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children with severe pneumonia require oxygen treatment each year. We developed a deterministic compartmental model that links the care pathway to disease progression to assess the impact of introducing pulse oximetry as a prognostic tool to distinguish severe from non-severe pneumonia in under-5 year olds across 15 countries with the highest burden worldwide. We estimate that, assuming access to supplemental oxygen, pulse oximetry has the potential to avert up to 148,000 deaths if implemented across the 15 countries. By contrast, integrated management of childhood illness alone has a relatively small impact on mortality owing to its low sensitivity. Pulse oximetry can significantly increase the incidence of correctly treated severe cases as well as reduce the incidence of incorrect treatment with antibiotics. We also found that the combination of pulse oximetry with integrated management of childhood illness is highly cost-effective, with median estimates ranging from US$2.97 to $52.92 per disability-adjusted life year averted in the 15 countries analysed. This combination of substantial burden reduction and favourable cost-effectiveness makes pulse oximetry a promising candidate for improving the prognosis for children with pneumonia in resource-poor settings.

  14. Predictors of asymptomatic bacteriuria among pregnant women in a low-resource setting.

    Science.gov (United States)

    Awoleke, J O; Adanikin, A I; Ajayi, D D; Ayosanmi, O S

    2015-01-01

    This study aims at identifying predictors of asymptomatic bacteriuria (AB) among pregnant women in a low-resource setting, with the intent of recommending a guideline for screening during antenatal care. A total of 266 healthy pregnant women were antenatally recruited after informed consent. They had routine antenatal investigations, a 1 h 50-g oral glucose tolerance test and quantitative urine culture and sensitivity. The data collected were analysed using statistical software package SPSS v. 17. Prevalence of AB was 23 (8.6%). Escherichia coli was the commonest isolate (6, 26.1%), closely followed by Staphylococcus aureus (5, 21.7%). AB was commoner among patients aged 25-34 years, of low parity and higher education. Blood group B- rhesus-positive significantly predicts the likelihood of developing AB in pregnancy (adjusted OR: 0.36; 95% CI: 0.14-0.96). We conclude that blood group B-rhesus-positive in association with other patients' characteristics, such as age 25-34 years, low parity and higher education could form guidelines for a screening algorithm in our environment.

  15. Can we predict neuropathy risk before stavudine prescription in a resource-limited setting?

    Science.gov (United States)

    Affandi, Jacquita S; Price, Patricia; Imran, Darma; Yunihastuti, Evy; Djauzi, Samsuridjal; Cherry, Catherine L

    2008-10-01

    A toxic sensory neuropathy associated with exposure to inexpensive nucleoside analogue reverse transcriptase inhibitors (NRTIs) [particularly stavudine (d4T)] causes dilemmas in the management of patients with HIV, especially in resource-poor settings. Here patients (n = 96) attending Pokdisus AIDS Clinic at the Cipto Mangunkusumo Hospital, Jakarta who had been treated with d4T were screened for symptomatic neuropathy. Clinical, demographic, and genetic factors were considered as possible neuropathy risk factors. DNA from saliva was used to examine alleles of TNFA-308, BAT1 (intron 10), TNFA-1031, IL1A+4845, and IL12B (3' UTR). The prevalence of neuropathy (symptoms and signs) was 34%. On multivariate analysis, neuropathy following d4T exposure was associated with increasing age, increasing height, and TNFA-1031*2 (model p = 0.0009). Isoniazid exposure (present in 56% of patients) was not associated with neuropathy in this cohort, where all patients had received pyridoxine coadministration. These data suggest that a simple algorithm based on patient age, height, and TNF genotype could be used to predict the individual's risk of symptomatic neuropathy prior to prescription of d4T.

  16. Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges

    Science.gov (United States)

    Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary

    2009-01-01

    Context: 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…

  17. 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...... by a structured survey of 303 randomly selected households; income data were collected quarterly throughout 2008. Average environmental income was 15.7 % of total household income, ranging from 11.0 to 29.5 %. Environmental reliance decreased with rising income while absolute environmental income increased....... Ordinary least square regression analysis indicated that households having large areas of crop and other lands, many livestock, larger amount of bank saving and having at least one migrating household member generate significantly larger amount of total household income. Households having a larger...

  18. Dialogue with Asia's Rural Man. A Report of the Development of Human Resources in Rural Asia Workshop (DHRRAW) (Swanganivas, Thailand, August 4-25, 1974).

    Science.gov (United States)

    Ledesma, Antonio L., Comp.; And Others

    General objective of the workshop was to provide a forum for Asian rural leaders in which they could discern the significance and implication of crucial processes by which human potentialities are harnessed for the integral growth of rural peoples and communities. The central question addressed was how to combine economic growth with social…

  19. Dialogue with Asia's Rural Man. A Report of the Development of Human Resources in Rural Asia Workshop (DHRRAW) (Swanganivas, Thailand, August 4-25, 1974).

    Science.gov (United States)

    Ledesma, Antonio L., Comp.; And Others

    General objective of the workshop was to provide a forum for Asian rural leaders in which they could discern the significance and implication of crucial processes by which human potentialities are harnessed for the integral growth of rural peoples and communities. The central question addressed was how to combine economic growth with social…

  20. 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 cost of healthcare delivery is a prerequisite for allocating health resources, such as staff and medicines, in a way that is effective, efficient, just and fair. Nevertheless, health costs are often poorly understood, undermining effectiveness and efficiency of service delivery. We outline shortcomings, and consequences, of common approaches to estimating the cost of healthcare in low-resource settings, as well as advantages of a newly introduced approach in healthcare known as time-driven activity-based costing (TDABC). TDABC is a patient-centred approach to cost analysis, meaning that it begins by studying the flow of individual patients through the health system, and 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.

  1. An evaluation of the impact of a restrictive retail food environment intervention in a rural community pharmacy setting.

    Science.gov (United States)

    Minaker, Leia M; Olstad, Dana Lee; MacKenzie, Graham; Nguyen, Nghia; Azagba, Sunday; Cook, Brian E; Mah, Catherine L

    2016-07-16

    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. 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. 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. 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.

  2. COOPERATION BETWEEN ACTORS FOR TOURISM DEVELOPMENT: THE APRECIATION OF HERITAGE AND CULTURAL RESOURCES IN RURAL TERRITORIES

    Directory of Open Access Journals (Sweden)

    Marta Amaral

    2016-06-01

    Full Text Available Framed by the theoretical context concerning cooperation between tourism agents, the present paper aims to contribute for better understanding South Alentejo tourism agents’ perceptions on the areas in which they can cooperate for promoting development and competitiveness in the region. Furthermore, the paper also looks at the tourist agents’ perception on role that the dynamics of cultural resources play in promotion of development and competitiveness in the region. This paper reports results from a case study conducted in the frame of the thesis developed as requirement to get the PhD in Tourism. Data was gathered by a questionnaire developed for the study from a sample of tourism agents working in the public, private business and associative (non lucrative sectors. The study results has indicated that valuation of the existing culture, integrated development of tourism resources and products and organization of promotional activities are the areas considered more relevant for the tourism agents to cooperate among them. In particular, leaders of different sectors agree with the need to cooperate focusing on the valorisation of local and regional cultural resources. This is important because the South Alentejo region has excellent cultural resources that, if strategically used, can provide a major differentiating factor.

  3. Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India

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    Nirav P Trivedi

    2013-01-01

    Full Text Available Introduction: Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India. Materials and Methods: This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed. Results: We performed 22 cases of free flaps in a six-month period (2008-2009. Majority (17 of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9 and anterolateral thigh flap (ALT: 9 were the most commonly used flaps. A fibula flap (1 was done for an anterior mandible defect, whereas a jejunum free flap (1 was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps. Conclusion: Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.

  4. Setting up of a multicomponent biological resource center for Agroecology at INRA (Dijon, France)

    OpenAIRE

    Steinberg, Christian; Delaitre, Catherine; Duc, Gérard; Gianinazzi-Pearson, Vivienne; Héraud, Cécile; Lemanceau, Philippe; Monfort-Pimet, Valérie; Reboud, Xavier

    2010-01-01

    An innovative Biological Resource Center (BRC) including different types of plant and microbial resources is being created at Dijon (France) to study agro-ecosystems. This BRC aims at promoting technical aspects to preserve the diversity of organisms, to improve identification and characterization tools, to organize databases to merge taxonomic and ecological traits of organisms and to rise up the Quality Standard to provide biological resources on request following exchange of an MTA form.

  5. Evaluation of knowledge of cancer pain management among medical practitioners in a low-resource setting

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    Ogboli-Nwasor EO

    2013-02-01

    Full Text Available EO Ogboli-Nwasor,1 JG Makama,2 LMD Yusufu21Department of Anesthesia, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria; 2Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria, NigeriaBackground: Several factors considered to be barriers to cancer pain management have been reported in the past. The knowledge of cancer pain management may be a hindrance to the proper assessment and treatment of pain in cancer patients.Objective: This report presents an evaluation of the knowledge and practice of cancer pain management among medical practitioners in Ahmadu Bello University Teaching Hospital Shika, Zaria.Methods: This report involves medical practitioners at the Ahmadu Bello University Teaching Hospital who are directly involved in the management of cancer patients. Information was obtained using a structured questionnaire, and the data were analyzed using SPSS (version 11.5.Results: The response rate to the questionnaire was 82%, with an age range of 23 to 50 years (mean age, 34.9, and the majority of actual respondents, 55 (67%, were male. Thirty-six (44% strongly agreed that cancer patients require pain relief. Yet only 40% of the respondents routinely conducted pain assessments among cancer patients, while 51% only treated when patients complained of pain. Concerning the type of analgesic commonly used for cancer patients, 43% used weak opioids, 32% used NSAIDs, and only 20% used strong opioids. Seventy-five respondents (91.5% had no formal training on pain management.Conclusion: The knowledge of pain management for cancer patients among medical personnel at the Ahmadu Bello University Teaching Hospital appears to be elementary. We recommend that formal training in the form of lectures, seminars, and workshops on cancer pain management should be part of continuing medical education in low-resource settings like the Ahmadu Bello University Teaching Hospital.Keywords: cancer pain, management, evaluation

  6. Influenza transmission during extreme indoor conditions in a low-resource tropical setting

    Science.gov (United States)

    Tamerius, James; Ojeda, Sergio; Uejio, Christopher K.; Shaman, Jeffrey; Lopez, Brenda; Sanchez, Nery; Gordon, Aubree

    2017-04-01

    Influenza transmission occurs throughout the planet across wide-ranging environmental conditions. However, our understanding of the environmental factors mediating transmission is evaluated using outdoor environmental measurements, which may not be representative of the indoor conditions where influenza is transmitted. In this study, we examined the relationship between indoor environment and influenza transmission in a low-resource tropical population. We used a case-based ascertainment design to enroll 34 households with a suspected influenza case and then monitored households for influenza, while recording indoor temperature and humidity data in each household. We show that the indoor environment is not commensurate with outdoor conditions and that the relationship between indoor and outdoor conditions varies significantly across homes. We also show evidence of influenza transmission in extreme indoor environments. Specifically, our data suggests that indoor environments averaged 29 °C, 18 g/kg specific humidity, and 68 % relative humidity across 15 transmission events observed. These indoor settings also exhibited significant temporal variability with temperatures as high as 39 °C and specific and relative humidity increasing to 22 g/kg and 85 %, respectively, during some transmission events. However, we were unable to detect differences in the transmission efficiency by indoor temperature or humidity conditions. Overall, these results indicate that laboratory studies investigating influenza transmission and virus survival should increase the range of environmental conditions that they assess and that observational studies investigating the relationship between environment and influenza activity should use caution using outdoor environmental measurements since they can be imprecise estimates of the conditions that mediate transmission indoors.

  7. Risk factors and perinatal outcome of uterine rupture in a low-resource setting

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    Anthony Osita Igwegbe

    2013-01-01

    Full Text Available Background: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

  8. Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings.

    Science.gov (United States)

    Galler, Janina R; Koethe, John R; Yolken, Robert H

    2017-04-01

    Approximately 1 out of 5 children worldwide suffers from childhood malnutrition or stunting and associated health conditions, including an increased susceptibility to infections and inflammation. Due to improved early interventions, most children even in low-resource settings now survive early childhood malnutrition, yet exhibit continuing evidence of neurodevelopmental deficits, including poor school achievement and behavioral problems. These conditions are compounded in children who continue to be undernourished throughout the adolescent years. At present, these sequelae of malnutrition and infection are of major concern in the adolescent population, given that young people between the ages of 10 and 24 years represent nearly one-quarter of the world's population. Therefore, there is an urgent need to focus on the well-being of this age group and, in particular, on behavioral, cognitive, and brain disorders of adolescents who experienced malnutrition, infection, and inflammation prenatally, in early childhood, and during adolescence itself. Because one-third of all women globally become pregnant during their adolescent years, brain and behavioral disorders during this period can have an intergenerational impact, affecting the health and well-being of the next generation. This article summarizes the current state of knowledge and evidence gaps regarding childhood and adolescent malnutrition and inflammation and their impact on adolescent neurodevelopment, the limited evidence regarding nutrition and psychosocial interventions, and the role of resilience and protective factors in this age group. This overview should help to inform the development of new strategies to improve the neurodevelopmental outcomes of high risk adolescent populations. Copyright © 2017 by the American Academy of Pediatrics.

  9. Influenza transmission during extreme indoor conditions in a low-resource tropical setting

    Science.gov (United States)

    Tamerius, James; Ojeda, Sergio; Uejio, Christopher K.; Shaman, Jeffrey; Lopez, Brenda; Sanchez, Nery; Gordon, Aubree

    2016-08-01

    Influenza transmission occurs throughout the planet across wide-ranging environmental conditions. However, our understanding of the environmental factors mediating transmission is evaluated using outdoor environmental measurements, which may not be representative of the indoor conditions where influenza is transmitted. In this study, we examined the relationship between indoor environment and influenza transmission in a low-resource tropical population. We used a case-based ascertainment design to enroll 34 households with a suspected influenza case and then monitored households for influenza, while recording indoor temperature and humidity data in each household. We show that the indoor environment is not commensurate with outdoor conditions and that the relationship between indoor and outdoor conditions varies significantly across homes. We also show evidence of influenza transmission in extreme indoor environments. Specifically, our data suggests that indoor environments averaged 29 °C, 18 g/kg specific humidity, and 68 % relative humidity across 15 transmission events observed. These indoor settings also exhibited significant temporal variability with temperatures as high as 39 °C and specific and relative humidity increasing to 22 g/kg and 85 %, respectively, during some transmission events. However, we were unable to detect differences in the transmission efficiency by indoor temperature or humidity conditions. Overall, these results indicate that laboratory studies investigating influenza transmission and virus survival should increase the range of environmental conditions that they assess and that observational studies investigating the relationship between environment and influenza activity should use caution using outdoor environmental measurements since they can be imprecise estimates of the conditions that mediate transmission indoors.

  10. Evaluation of trans burr hole ultrasonography usefulness in a resource-limited setting

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    V de P. Djientcheu

    2013-01-01

    Full Text Available Purpose: Transcranial ultrasound (US imaging of intracranial structures is a reliable technique that requires an opening in the skull. In young children the fontanelle serves this purpose, but in adults a postoperative skull defect or some other acquired skull bone defect could be used as potential windows for transcranial US imaging. This study is an audit on the usefulness of the trans burr hole US intracranial imaging technique in a neurosurgical unit in Cameroon (sub-Saharan Africa. Materials and Methods: From January 2001 through December 2004, all files of patients consecutively operated in the neurosurgical unit of the Central Hospital of Yaounde, who underwent an US exploration in the postoperative period through the acquired bone defect or through a skull fracture were reviewed. Transcranial US results were validated by a complementary CT scan or postoperative findings. Results: Seventeen patients were included. Trans burr hole US was effective in diagnosing or in excluding postoperative complications. Hydrocephalus was diagnosed (two cases or excluded (five cases after posterior a fossa surgery (five cases or in case of suspicion of drain dysfunction (two cases. Abscess (one case or chronic subdural hematoma (two cases were detected or excluded after cranial surgery for tumours (three cases, aneurysm (one case, compound depressed skull fracture (one case, or intracranial hematoma (three cases. In one case of posttraumatic swelling of the scalp, the US technique revealed an acquired meningoencephalocele. In one case, residual subdural empyema was detected through trans burr hole US. Conclusion: Trans burr hole US technique may be considered in the diagnosis of postoperative complications (abscesses or hematoma in adults after intracranial surgery or ventriculoperitoneal drain dysfunction especially in resource-limited setting as it is both cheap and widely available.

  11. The Romanian Rural Economy – a Resource of Growth and Regional Cooperation, or a Source of Conflicts and Insecurity?

    OpenAIRE

    Gheorghe Savoiu; Camelia Manea; Constantin Manea

    2007-01-01

    In an attempt to answer such a delicate question, we try to present the characteristics of Romanian rural economy, underlining its political, social, demographic, cultural, and even religious specificity. It is a thorough analysis of the diminution of the force and impact of the rural traditions, of the inflexion in the dynamics of rural overpopulation, of the reduction of the aversion in comparison with the urban, which confers a new identity to the Romanian countryside. The rural economy is...

  12. Supporting learning in practice in the EBL curriculum: pre-registration students' access to learning resources in the placement setting.

    Science.gov (United States)

    Walton, Graham; Smith, Ann; Gannon-Leary, Pat; Middleton, Anne

    2005-07-01

    This paper explores access to learning resources for nursing students when on placement. It also examines, in parallel, the impact of the move to enquiry based learning has on learning resources use by nursing students. The increased time spent learning in the clinical setting means that a deeper understanding of the use of learning resources by nursing students is necessary. A questionnaire survey was completed by 247 nursing students at Northumbria University around their use of learning resources on placement. This corresponded with focus groups being run with University and NHS providers of learning resources to establish the impact of enquiry based learning. It was found that effective collaboration between different stakeholders was especially important. Nursing students are also becoming increasingly sophisticated in their use of electronic learning resources. The nature of support for effective learning resources use by nursing students whilst on placement in the NHS has also been identified as key. The work has shown that it is very difficult to establish the impact of enquiry based learning on learning resources, as there are so many other variables.

  13. Use of rural energy resources and eco-environmental degradation in Tibet

    Institute of Scientific and Technical Information of China (English)

    WEI Xing-hu; YANG Ping; WANG Ya-jun; XIE Zhong-kui

    2004-01-01

    Cattle dung, firewood, and crop straw have being used as survival necessities by farmers and herdsmen for thousands of years in Tibet. Until recently such biotic energy source still constitutes more than 92 per cent of total rural energy consumption due to lack of petroleum, coal and new alternative energy sources. As a result, environmental degradation such as land desertification, soil erosion, grassland degradation and soil fertility reduction is increasingly aggravated, the area of desertified land has increased 1467.5 km2 from 1991 to 1997. Degraded area of grassland has reached 2.60×107 hm2, increased by 116.1% from 1987 to 1996. To prevent further deterioration of eco-environment in Tibet great efforts should be made to make full use of ample solar energy, wind energy and other biotic energy of the Qinghai-Tibet Plateau. The solar cooking stoves and solar hothouse; expand forest area and replace existing abiotic energy sources with firewood forest should be popularized. This is an urgent task to protect the eco-environment of Tibet today.

  14. Implementation of the Clinical Facilitation Model within an Australian rural setting: the role of the Clinical Facilitator.

    Science.gov (United States)

    Sanderson, Helena; Lea, Jacqueline

    2012-11-01

    Education providers globally use various models for undergraduate nurse clinical education. This paper presents the major findings of a research project conducted by a rural university in Australia that aimed to explore the Clinical Facilitation Model of undergraduate nursing education from a rural perspective. In particular how the Clinical Facilitators enacted their role within the rural environment and to identify any barriers to the provision of effective clinical learning during facilitated clinical experience within this context. This qualitative study used a phenomenological approach to explore the experiences of Clinical Facilitators. Individual in-depth interviews were conducted with eight Clinical Facilitators. Data was analysed using thematic analysis and several themes emerged from the study. This paper will report two of the major findings which are based on how Clinical Facilitators enacted their role within the rural environment. Whilst this study has a rural focus the findings will add to the limited body of knowledge internationally regarding the Clinical Facilitation model used as a result of balancing educational needs of the student with the care needs of the patients in the current health policy climate. The findings will be useful for informing undergraduate curricula, and will assist faculty and health services in planning and implementation of models of clinical education that meet the needs of the student and that are specific to the rural environment. In addition, the findings will provide insight into strategies that the rural Clinical Facilitator can utilise to assist in fulfilling their teaching role.

  15. A model of the resources integrated planning for the rural electrification in the new Brazilian electric scenery; Um modelo do planejamento integrado de recursos para a energizacao rural no novo cenario eletrico brasileiro

    Energy Technology Data Exchange (ETDEWEB)

    Pazzini, Luiz Henrique Alves; Ribeiro, Fernando Selles; Kurahassi, Luiz Fernando; Galvao, Luiz Claudio Ribeiro; Udaeta, Miguel Edgar Morales [Sao Paulo Univ., SP (Brazil). Escola Politecnica. Dept. de Engenharia de Energia e Automacao Eletricas]. E-mail: pazzini@pea.usp.br

    2000-07-01

    The change to competitive atmosphere for the Brazilian electric sector is simultaneous to the social and economic changes in the rural zone: the agricultural traditional activities are expanding and new business are appearing, such as restaurants and fish-pay, as 'the new rural Brazilian'. Because that, the electrification of rural areas needs real and dynamic alternatives, that facilitate the access to energy, to meet the basic needs and for productivity. This paper presents a model of Integrated Resources Planning, based on the identification of the real demand of the interested ones and of the sources of existent resources for its attendance. The importance of the participation of several segments of the State, of private companies, of the stake holders, of the whole society is analyzed. It is founded that the alternative is viable and it stands out the role of the State regulator agents in the induction of mechanisms that turn more attractive the rural zone for investments. (author)

  16. The effects on tuberculosis treatment adherence from utilising community health workers: a comparison of selected rural and urban settings in Kenya.

    Directory of Open Access Journals (Sweden)

    Jane Rahedi Ong'ang'o

    Full Text Available INTRODUCTION: Community Health Workers (CHWs have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB control, there is need to demonstrate effects of utilising them. OBJECTIVES: This study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings. METHODS: A retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers. RESULTS: The study assessed 2778 tuberculosis patients and among them 1499 (54% utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001. Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001. In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001 respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001 for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86-2.73 p<0.001 and OR 1.98 (95% 1.51-2.5 p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02-3.48, p<0.001 in comparison to the rural set up, OR 0.74 (95% 0.56-0.97 p = 0.032. CONCLUSION: Utilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up.

  17. Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

    Science.gov (United States)

    Jan, Stephen; Bian, Ying; Jumpa, Manuel; Meng, Qingyue; Nyazema, Norman; Prakongsai, Phusit; Mills, Anne

    2005-10-01

    This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.

  18. Population pharmacokinetic characteristics of amikacin in suspected cases of neonatal sepsis in a low-resource African setting

    DEFF Research Database (Denmark)

    Amponsah, Seth K; Adjei, George O; Enweronu-Laryea, Christabel C

    2017-01-01

    BACKGROUND: Amikacin exhibits marked pharmacokinetic (PK) variability and is commonly used in combination with other drugs in the treatment of neonatal sepsis. There is a paucity of amikacin PK information in neonates from low-resource settings. OBJECTIVES: To determine the PK parameters of amika...

  19. 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.…

  20. Diagnosis and Management of Ureterovaginal Fistula in a Resource-Constrained Setting: Experience at a District Hospital in Northern Nigeria

    Directory of Open Access Journals (Sweden)

    Randawa AJ1, Khalid L2, Abbas A3

    2009-01-01

    Full Text Available During 2007 we were invited at different times to review and manage four women with ureterovaginalfistula following caesarean section performed in different rural hospitals. We describe our experienceof a simple technique of diagnosis and management of these indigent patients in a resourceconstrainedhospital. The condition was diagnosed by the three-swab test in all four patients, andabdominopelvic ultrasound was employed to help find the ureter involved. Transvesical ureteralimplantation with a stent was carried out. Stent was removed after 2 weeks. All four patients were dry.Amidst the complexity of and sophistication of modern health care, it is important to remind ourselvesof the common occurrence of this distressing condition following caesarean section and the use of awell known simple diagnostic technique and subsequent management in resource-poor communities.

  1. Increasing natural resource rents from Farmland: A curse or a blessing for the rural poor?

    DEFF Research Database (Denmark)

    Hvid, Anna

    2015-01-01

    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...... 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...

  2. 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.

  3. 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.

  4. Community Based Screening, Brief-Intervention and Referral for Treatment (SBIRT for unhealthy tobacco use: single arm study experience and Implementation Success in rural and semi-rural settings, South-West Nigeria

    Directory of Open Access Journals (Sweden)

    Victor Olufolahan Lasebikan

    2016-08-01

    Full Text Available Objective: To determine whether Screening, Brief Intervention and Referral to Treatment (SBIRT can reduce the prevalence of tobacco use in rural and semi-rural settings. Method: Design and participants: A non-randomized clinical trial with assessments at baseline and post-intervention assessments at 3 and 6 months was conducted in a rural and semi-rural district in South-West of Nigeria. A representative sample of 1203 persons consented to the study and had ASSIST administered to them by trained community healthcare extension workers between October, 2010 and April, 2011. Follow-up participation was more than 99% at all points. Intervention: Participants received a single ASSIST linked brief intervention (BI and referral for treatment (RT at entry, and a booster ASSIST BI and RT at 3 months.Main outcomes and measures: The primary outcome was self-reported scores on ASSIST. Results: At baseline, out of 1203 respondents, lifetime prevalence and current prevalence of any tobacco products was 405 (33.7% and 248 (20.6% respectively. Of the current users, on the ASSIST, 79 (31.9% scored 0-3 (low health risk, 130 (52.4% scored 4-26 (moderate risk, 39 (15.7% scored 27+ (high risk. At 3 months, out of 1199 respondents, prevalence of current users was 199 (16.5% and out of 1195 respondents, was 169 (14.1% at 6 months. Prevalence of tobacco use reduced significantly at 3 months Z = -3.1, p = 0.01 and at 6 months when compared with baseline Z = 4.2, p = 0.001, but not at 6 months compared with at 3 months, Z = 2.1, p = 0.09. Multivariate analysis revealed that age at initiation of tobacco use, gender, marital status, setting of dwelling and socioeconomic status were the only variables that were associated with current tobacco use at baseline, 3 months and 6 months.Conclusion: A one-time BI with a booster at 3 months had a significant effect on tobacco use in persons living in community settings. This finding suggests a need for promoting the adoption of

  5. Prevalence, correlates and pattern of hepatitis B surface antigen in a low resource setting

    Directory of Open Access Journals (Sweden)

    Ezebialu Ifeanyichukwu U

    2011-01-01

    Full Text Available Abstract Background Hepatitis B virus (HBV infection in Nigeria has remained a Public Health issue. It is a major cause of mortality, especially in developing countries. Vertical transmission of hepatitis B virus infection is thought to be a major route of transmission in low resource areas. In spite of this, routine antenatal screening for hepatitis B infection is not yet practiced in many Nigerian hospitals. This paper present the findings of a study conducted among antenatal women in Nnewi, Nigeria. Methods It was a cross-sectional study carried out over a 3-month period (August - October, 2009. Recruitment of 480 women attending antenatal clinics in Nnewi, Nigeria was done by simple random sampling using computer generated random numbers. HBsAg screening was done using rapid ELISA Kits. Statistical analysis was computed using STATA 11 package. The results were subjected to analysis using cross tabulations to explore statistical relationships between variables. Chi square test was used to explore proportional relationship between groups. The level of statistical significance was set at p Results Four hundred and eighty pregnant women were recruited into the study. Of these, 40 tested positive to HBsAg, accounting for 8.3% of the sample population. The age of the subjects studied varied from 14 to 45 years (mean age - 24.3 years while the mean parity was 2.18. The HIV/HBV co-infection rate was 4.2%. The vertical transmission rate was 51.6%. There were statistically significant relationships between HBV infection and previous history of tribal marks/tattoos (χ2 = 27.39, P = 0.001, df = 1, history of contact with previously infected HBV patients (χ2 = 23.11, P = 0.001, df = 1 and occupation of the women (χ2 = 51.22, P = 0.001, df = 1. Multiple sexual partners, blood transfusion, dental manipulations, sharing of sharps/needles, and circumcision were not significant modes of transmission. There was no statistically significant relationship

  6. 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

  7. Health Differences Among Lesbian, Gay, and Transgender Veterans by Rural/Small Town and Suburban/Urban Setting.

    Science.gov (United States)

    Kauth, Michael R; Barrera, Terri L; Denton, F Nicholas; Latini, David M

    2017-06-01

    We explored the relationship between geographic location and health indicators for lesbian, gay, and transgender veterans. We solicited participation in an online survey through national and city LGBT organizations and personal contacts to examine differences in depression, anxiety, alcohol and tobacco use, and body mass index among lesbian, gay, and transgender veterans (n = 252) in suburban/urban and rural/small town locations. Bisexual participants were too few to include in the analyses. As expected, rural/small town lesbian, gay, and transgender veterans spent more time traveling to their primary care provider. Travel time was also positively related to depressive and anxiety symptoms. However, only suburban/urban and rural/small town gay men differed in measures of depression and anxiety and tobacco use. That is, rural/small town gay men reported greater depressive and anxiety symptoms and greater tobacco use than their suburban/urban counterparts. Consistent with this finding, rural/small town gay men reported less community-related identity than suburban/urban men. Suburban/urban lesbian women showed a nonsignificant trend for community identity compared with rural/small town women. Similar to civilian studies, suburban/urban and rural/small town lesbian, gay, and transgender veterans evidenced few health differences, with the exception of suburban/urban gay men. Although rural/small town gay male veterans evidenced more depression and anxiety and less community identity than suburban/urban men, social networks likely differ for lesbian, gay, and transgender subgroups. Lesbian, gay, and transgender veterans may also differ from their civilian counterparts in ways that we do not yet understand.

  8. 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

  9. 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

    2010-12-01

    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 Educación Básica). Grounded within a partnership between teacher educators from Peru, Mexico and Canada, and rural Peruvian teachers, students and their communities, we offer reflections on a teacher education initiative which sought to support action-orientated inquiries as a mechanism for school/community development. Set against a background of poverty, hunger, isolation and an "educational crisis", we outline our pedagogy and describe two projects. We then reflect on the influences of our engagements and on associated tensions and ambiguities in our methods. We hope that such discussions might offer insights for others involved in international school/community development projects of this type.

  10. The Honey Ant Readers: An Innovative and Bold Approach to Engaging Rural Indigenous Students in Print Literacy through Accessible, Culturally and Linguistically Appropriate Resources

    Science.gov (United States)

    James, Margaret

    2014-01-01

    On entering school, rural Australian children from Indigenous backgrounds are thrown into an unfamiliar environment, linguistically and culturally, which sets them up for failure. The author, working closely with elders and community in Alice Springs, has drawn on her considerable experience in both Indigenous education and TESOL to address this…

  11. Diet quality and body mass index are associated with health care resource use in rural older adults.

    Science.gov (United States)

    Ford, Dara W; Hartman, Terryl J; Still, Christopher; Wood, Craig; Mitchell, Diane C; Bailey, Regan; Smiciklas-Wright, Helen; Coffman, Donna L; Jensen, Gordon L

    2014-12-01

    Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.

  12. A Study of the Management of Patients Taking Novel Oral Antiplatelet or Direct Oral Anticoagulant Medication Undergoing Dental Surgery in a Rural Setting

    OpenAIRE

    Steven Johnston

    2015-01-01

    Purpose: Novel oral antiplatelet (NOAP) (prasugrel and ticagrelor) and direct oral anticoagulant drugs (DOAC) (dabigatran, rivaroxaban and apixaban) have emerged in the last decade. This study was undertaken to determine current approaches taken to the management of patients taking these agents in dental practice in a remote and rural setting. Methods: A small retrospective study was carried out in a small island population that identified patients taking one of the above drugs. All national ...

  13. Community-Driven Multiple Use Water Services: Lessons Learned by the Rural Village Water Resources Management Project in Nepal

    Directory of Open Access Journals (Sweden)

    Sanna-Leena Rautanen

    2014-02-01

    Full Text Available This article examines community-driven multiple use water services (MUS as pioneered by the Rural Village Water Resources Management Project (RVWRMP in the Far and Mid-Western development regions of Nepal. These regions are characterised by poverty, remoteness, rugged terrain, food insecurity, water scarcity, and post-conflict legacy. Water provision for domestic and productive uses provides opportunities to address poverty and livelihoods in environments with highly decentralised governance. This study explores the first-hand lessons learned in the RVWRMP in Nepal since 2006. This project is embedded within the local government. Key project entry points are decentralisation, participation and empowerment. This article reflects how the community-managed systems are used for multiple uses whether they were designed for it or not. It focuses on household- and community-level changes and related institution building and participatory planning through Water Use Master Plans and a Step-by-Step approach. Recommendations are made for scaling up multiple use services.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. DATA ENVELOPMENT ANALYSIS APPROACH ON THE EFFICIENT USE OF RURAL HUMAN RESOURCES IN AGRICULTURE, INDUSTRY AND CONSTRUCTIONS DURING 2006-2013

    Directory of Open Access Journals (Sweden)

    Dorel MIHAI

    2014-12-01

    Full Text Available The paper studied the rural human resources efficiency at regional level by using the DEA nonparametric method (Data Envelopment Analysis. The application of this cutting edge method enables the calculation of efficiency scores based on a series of inputs (occupied population in agriculture, industry and construction and outputs (gross value added in agriculture, industry and construction. The data regarding the rural human resources are retrieved from the Amigo data base, the regional GVA from Tempo online data base and the analysis is performed by MAXDATA 6.3 Beta program. The results revealed that the majority of the regions reach performance with the current input structure, with the exception of the North-East and North-West regions which need to reduce the number of workers in agriculture and increase the GVA from industry and constructions to support real economic growth

  20. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

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    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.

  1. Large scale mapping of groundwater resources using a highly integrated set of tools

    DEFF Research Database (Denmark)

    Søndergaard, Verner; Auken, Esben; Christiansen, Anders Vest

    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......The aim of this abstract is to give a short description of the essential ideas of the Danish national strategy for large scale mapping of the groundwater resources.Emphasis will be put on a description of the advantages obtained by combining acquirement of spatially dense geophysical data covering...... 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...

  2. Lung cancer management in limited resource settings: guidelines for appropriate good care.

    Science.gov (United States)

    Macbeth, Fergus R; Abratt, Raymond P; Cho, Kwan H; Stephens, Richard J; Jeremic, Branislav

    2007-02-01

    Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in developing countries. It is important that, in countries where health care resources are limited, these resources are used most effectively and cost-effectively. The authors, with the support of the International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published systematic reviews and meta-analyses, as well as recent research publications, to summarise the current evidence and to make broad recommendations on the non-surgical treatment of patients with lung cancer. Tables were constructed which summarise the different treatment options for specific groups of patients, the increase in resource use for and the likely additional clinical benefit from each option. These tables can be used to assess the cost-effectiveness and appropriateness of different interventions in a particular health care system and to develop local clinical guidelines.

  3. 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

    BACKGROUND: Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions...... 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....

  4. Differences in vitamin D nutritional status between newly diagnosed cancer patients from rural or urban settings in Kentucky.

    Science.gov (United States)

    Christopher, K L; Wiggins, A T; Van Meter, E M; Means, R T; Hayslip, J W; Roach, J P

    2013-01-01

    Although poor nutritional status and weight loss in cancer patients is known to affect outcomes, little is known about malnutrition differences based on geographic location. We investigated nutritional and inflammatory status of 220 newly diagnosed adults with solid tumors at the University of Kentucky's Markey Cancer Center during December 2008 through October 2011. Chi-square tests were used to determine any associations between suboptimal nutritional levels and rural-urban areas of residence. Out of the 13 lab values collected, the only significant difference between rural and urban participants was found for vitamin D resulting in more rural subjects (67.4%) having a suboptimal vitamin D status as compared to those residing in urban areas (53.3%, P = 0.04). Controlling for baseline demographics including age, race, sex, body mass index, nutritional status, and type of cancer, logistic regression analyses concluded those in rural areas had nearly a twofold increase in the odds of having a suboptimal vitamin D level compared to those in urban areas (odd's ratio = 1.97; 95% confidence interval = 1.04, 3.74). Further investigation into the rural-urban differences in vitamin D needs to be investigated in order to improve outcomes during cancer treatment.

  5. 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

  6. Do Schools in Rural and Nonrural Districts Allocate Resources Differently? An Analysis of Spending and Staffing Patterns in the West Region States. Summary. Issues & Answers. REL 2011-No. 099

    Science.gov (United States)

    Levin, Jesse; Manship, Karen; Chambers, Jay; Johnson, Jerry; Blankenship, Charles

    2011-01-01

    This report presents the first detailed comparison of resource allocation between rural and nonrural districts in the West Region. Three regional characteristics often associated with rural districts were chosen for the analysis: district enrollment, student population density within a district (students per square mile), and drive time from the…

  7. Social determinants of health: Social forces that shape women and men's knowledge of reproductive health in a resource-limited setting.

    Science.gov (United States)

    Namasasu, Jane; Chivers, Sarah; Costello, Leesa

    2016-10-01

    Social forces shape people's reproductive health in many ways. We examined people's knowledge about reproductive health using focus group data collected from 93 participants in rural districts of Malawi. Participants' perspectives were contextualized by explaining the socioeconomic, cultural, and gender factors that determine reproductive health for rural Malawians. Strategies to improve reproductive health care in environments lacking in health infrastructure, staff, and economic resources are then provided. We call for a reproductive health agenda to target preventive care by providing information about anatomy and biology, communicating information in culturally competent ways, and educating men and women over the life course.

  8. Perceptions regarding menstruation and Practices during menstrual cycles among high school going adolescent girls in resource limited settings around Bangalore city, Karnataka, India

    Directory of Open Access Journals (Sweden)

    Shanbhag D

    2012-07-01

    Full Text Available Introduction: Hygiene-related practices of adolescents during menstruation are of importance, as it has a health impact in terms of increased vulnerability to reproductive tract infections (RTI. Therefore, increased knowledge about menstruation right from childhood may escalate safe practices and may help in mitigating the suffering of women.Objectives: To assess the perceptions and practices regarding menstrual hygiene among selected high school girls in a resource limited settings in area around Bangalore city. Methodology: This was a cross sectional study done in four selected Government High Schools in rural areas around Bangalore City. A pre-designed, pre-tested and structured questionnaire was administered. Results: A total of 506 girls were interviewed. The average age was 14.08 with Standard deviation of 1.06 and range between 12-16yrs. 99.6% of the students had heard of menstruation and 57.9% had acquired this even knowledge before attaining menarche. 73.7% knew that menstruation was a normal phenomenon but only 28.7% had knowledge regarding menstruation. 48.1% did not know that menstruation was related to pregnancy. Only 44.1% used sanitary pad during the menstrual cycles. Among those who used cloth, only 31.3% used soap and water to clean them. 56.8% used soap and water to clean their genital organs and 88.8% of the girls took bath daily during menstruation

  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 facilities. There is a shortage of health promoters in urban primary health facilities (P facilities.

  10. Predicting Plausible Impacts of Sets of Climate and Land Use Change Scenario on Water Resources

    Science.gov (United States)

    As the new decade ushers in, there will be new challenges. The world’s population is increasing and the land use patterns are changing. Inevitably with these global changes, there will be various environmental consequences. For example, our water resources, both in terms of qu...

  11. 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…

  12. 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…

  13. Affordable CD4 Enumeration for HIV staging in resource-constrained settings

    NARCIS (Netherlands)

    Li, Xiao

    2008-01-01

    HIV infection has become a major global pandemic health emergency since the official date of the first recognition of the AIDS epidemic in Los Angeles in 1981 (17). This epidemic has formed a serious, and in many countries, especially in resource-poor countries, devastating crisis. Recent years, the

  14. 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

  15. 基于SOA架构的农村信息资源集成平台设计%Design of Rural Information Resource Integration Platform Based on SOA

    Institute of Scientific and Technical Information of China (English)

    段延娥

    2012-01-01

    The rural informatization refers to the widespread application and promotion of communication technology and computer technology in rural production, life and social management, and is a very important part of social informatization. The information resource construction as the core content of rural informatization construction, has the direct impact on the level of rural informatization construction. On the basis of sufficient analyzing the current situation of our country rural information resources construction, the existing problems of the rural information resources construction were discussed in detail, and the concept, basic theory and implementation technique of service-oriented architecture (SOA) aredescribed. Using the designing theory of SOA, a comprehensive information resource integration platform based on SOA was presented, and the basic principle and model of design, and SSO design of the integration platform was discussed in details.%农村信息化是指通讯技术和计算机技术在农村生产、生活和社会管理中实现普遍应用和推广的过程,是社会信息化的重要组成部分。农村信息资源建设作为农村信息化建设的核心内容,直接影响着农村信息化建设的水平。在充分分析我国农村信息资源建设现状和发展瓶颈的基础上,详细探讨了农村信息资源建设中存在的问题,阐述了面向服务的体系架构SOA的基本内涵、工作原理、实现技术。利用面向服务架构的设计思想,提出了基于SOA架构的农村信息资源集成平台建设,重点讨论了集成平台的设计原则、设计模型及SSO安全性设计。

  16. 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.

  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. Long Standing Esophageal Perforation due to Foreign Body Impaction in Children: A Therapeutic Challenge in a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Ngo Nonga Bernadette

    2017-01-01

    Full Text Available Late presentation of foreign body impaction in the esophagus, complicated by perforation in children, has rarely been reported in the literature. Esophageal surgery is very difficult and challenging in Cameroon (a resource limited setting. We are reporting herein 2 cases of esophageal perforation in children seen very late (12 days and 40 days after foreign body impaction, complicated with severe sepsis, who were successfully operated upon with very good results.

  19. High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Hall, William; Bryan, Stirling; Donaldson, Cam; Peacock, Stuart; Gibson, Jennifer L; Urquhart, Bonnie

    2016-08-01

    Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.

  20. Medical rehabilitation of spinal cord injury following earthquakes in rehabilitation resource-scarce settings: implications for disaster research.

    Science.gov (United States)

    Gosney, J E; Reinhardt, J D; von Groote, P M; Rathore, F A; Melvin, J L

    2013-08-01

    Narrative literature review. To (1) summarize epidemiological and scientific research on spinal cord injury (SCI) populations from three severe earthquakes (EQs) in rehabilitation resource-scarce settings; (2) summarize SCI rehabilitation services by local and foreign providers in response to these EQs and (3) provide implications including research gaps for a supporting global scientific research agenda. International. A literature review was conducted using PubMed to identify epidemiological studies reporting data on SCI survivors of the 2005 Kashmir EQ in Pakistan, the Sichuan EQ of 2008 in China and the 2010 Haiti EQ. A follow-up review on the SCI rehabilitation services provided by local and foreign providers in response to these EQs was also performed. Review of the scientific literature revealed the qualitative trends in focused EQ victim epidemiological data, including SCI classification and types of medical complications. Selected EQ country narratives showed that post-disaster SCI rehabilitation services were expanded by adapting local resources with international assistance to manage the significant numbers of SCI survivors. The resulting SCI research was limited. A global disaster research agenda for SCI in EQs in rehabilitation resource-scarce settings is needed to strengthen the evidence base for improvement of clinical management and outcomes for SCI EQ survivors. Expansion of this limited narrative review into a systematic review to identify additional research gaps is a proposed next step. Effective disaster setting data management and research collaborations of foreign and local SCI disability and rehabilitation stakeholders will be required for agenda implementation.

  1. 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...

  2. Developmental Screenings in Rural Settings: A Comparison of the Child Development Review and the Denver II Developmental Screening Test.

    Science.gov (United States)

    Brachlow, Allison; Jordan, Augustus E.; Tervo, Raymond

    2001-01-01

    Two developmental screening tests were applied to 73 children, aged 1 month-6.7 years, in Sioux Falls and the Cheyenne River Reservation (South Dakota). There were no racial differences; compared to urban children, rural reservation children of any race were more likely to pass the Child Development Review and to fail the Denver II Developmental…

  3. A Case Study: Leadership and Its Effect on Achievement of Children from Poverty in a Rural Setting

    Science.gov (United States)

    Horst, Marilyn Dishman; Martin, Barbara N.

    2007-01-01

    The purpose of this study was to examine the perceived effectiveness of leadership in a Missouri rural K-8 school with a high incidence of poverty that consistently met federal and state accountability mandates. The concepts of accountability as measured by student achievement, the unique educational needs of children from poverty, and the…

  4. 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...

  5. Classroom Behaviors of Students in Rural Mainstreamed Settings: A Comparison of Students with Disabilities and Their Normative Peers.

    Science.gov (United States)

    Butera, Gretchen; And Others

    This study compared the behaviors of mainstreamed disabled students to those of their normative peers in the same classroom. Observational sessions were conducted in 48 classrooms in 3 rural West Virginia school districts. Data were collected on 71 disabled students in grades 3-7 over a 4-week period, including students with mild mental…

  6. Carotid intima-media thickness and apolipoproteins in patients of ischemic stroke in a rural hospital setting- in central India: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Jyoti Jain

    2012-01-01

    Full Text Available Context: Carotid intima-media thickness (CIMT and apolipoproteins have been found as a risk factor for ischemic stroke . Objective: The objective was to study the carotid intima-media thickness, apolipoproteins, and their relation in patients of ischemic stroke in central rural India. Settings and Design: A cross-sectional study was performed in a rural hospital in central India. Materials and Methods: In all patients of ischemic stroke proven by computerized tomography (CT, CIMT, apolipoprotein A-I (ApoA-I, and apolipoprotein B(ApoB were measured. Statistical Analysis Used: We used Student′s t-test to compare means, a chi-square test to compare proportions, and a Mann-Whitney test to compare medians. A P value 90 mg/dl with CIMT > 0.7 mm was statistically significant with P 0.7 mm was also statistically significant.

  7. Legal aspects of rural tourism in Uruguay

    Directory of Open Access Journals (Sweden)

    Hugo Ferreira Arizaga

    2017-04-01

    Full Text Available Rural tourism is now a growing modality in Uruguay and in the world.In the national legal norm that regulates this activity is Decree 371/2002, which established the characterization of rural tourism and the conditions of their providers.According to this rural tourism it is developed outside urban centers, with personalized service and spacious; uses natural, cultural, heritage, housing and services of the rural areas, it contributes to local development resources, diversification and tourism competitiveness.We intend to analyze the regulatory framework of the activity, with special emphasis on the categorization of the establishments and the set obligations for providers of rural tourism services, the liability regime established in the Law on Tourism and the application

  8. Sustainability of common pool resources

    Science.gov (United States)

    Timilsina, Raja Rajendra; Kamijo, Yoshio

    2017-01-01

    Sustainability has become a key issue in managing natural resources together with growing concerns for capitalism, environmental and resource problems. We hypothesize that the ongoing modernization of competitive societies, which we refer to as “capitalism,” affects human nature for utilizing common pool resources, thus compromising sustainability. To test this hypothesis, we design and implement a set of dynamic common pool resource games and experiments in the following two types of Nepalese areas: (i) rural (non-capitalistic) and (ii) urban (capitalistic) areas. We find that a proportion of prosocial individuals in urban areas is lower than that in rural areas, and urban residents deplete resources more quickly than rural residents. The composition of proself and prosocial individuals in a group and the degree of capitalism are crucial in that an increase in prosocial members in a group and the rural dummy positively affect resource sustainability by 65% and 63%, respectively. Overall, this paper shows that when societies move toward more capitalistic environments, the sustainability of common pool resources tends to decrease with the changes in individual preferences, social norms, customs and views to others through human interactions. This result implies that individuals may be losing their coordination abilities for social dilemmas of resource sustainability in capitalistic societies. PMID:28212426

  9. Sustainability of common pool resources.

    Science.gov (United States)

    Timilsina, Raja Rajendra; Kotani, Koji; Kamijo, Yoshio

    2017-01-01

    Sustainability has become a key issue in managing natural resources together with growing concerns for capitalism, environmental and resource problems. We hypothesize that the ongoing modernization of competitive societies, which we refer to as "capitalism," affects human nature for utilizing common pool resources, thus compromising sustainability. To test this hypothesis, we design and implement a set of dynamic common pool resource games and experiments in the following two types of Nepalese areas: (i) rural (non-capitalistic) and (ii) urban (capitalistic) areas. We find that a proportion of prosocial individuals in urban areas is lower than that in rural areas, and urban residents deplete resources more quickly than rural residents. The composition of proself and prosocial individuals in a group and the degree of capitalism are crucial in that an increase in prosocial members in a group and the rural dummy positively affect resource sustainability by 65% and 63%, respectively. Overall, this paper shows that when societies move toward more capitalistic environments, the sustainability of common pool resources tends to decrease with the changes in individual preferences, social norms, customs and views to others through human interactions. This result implies that individuals may be losing their coordination abilities for social dilemmas of resource sustainability in capitalistic societies.

  10. 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

  11. Unhealthy Fat in Street and Snack Foods in Low-Socioeconomic Settings in India: A Case Study of the Food Environments of Rural Villages and an Urban Slum

    Science.gov (United States)

    Gupta, Vidhu; Downs, Shauna M.; Ghosh-Jerath, Suparna; Lock, Karen; Singh, Archna

    2016-01-01

    Objective To describe the food environment in rural villages and an urban slum setting in India with reference to commercially available unbranded packaged snacks and street foods sold by vendors, and to analyze the type and quantity of fat in these foods. Design Cross-sectional. Setting Two low-income villages in Haryana and an urban slum in Delhi. Participants Street vendors (n = 44) were surveyed and the nutritional content of snacks (n = 49) sold by vendors was analyzed. Main Outcome Measures Vendors' awareness and perception of fats and oils, as well as the type of snacks sold, along with the content and quality of fat present in the snacks. Analysis Descriptive statistics of vendor survey and gas chromatography to measure fatty acid content in snacks. Results A variety of snacks were sold, including those in unlabeled transparent packages and open glass jars. Mean fat content in snacks was 28.8 g per 100-g serving in rural settings and 29.6 g per 100-g serving in urban settings. Sampled oils contained high levels of saturated fats (25% to 69% total fatty acids) and trans fats (0.1% to 30% of total fatty acids). Conclusions and Implications Interventions need to target the manufacturers of oils and fats used in freshly prepared products to improve the quality of foods available in the food environment of low-socioeconomic groups in India. PMID:26872553

  12. 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

  13. Is zidovudine first-line therapy virologically comparable to tenofovir in resource-limited settings?

    Science.gov (United States)

    Labhardt, Niklaus D; Bader, Joëlle; Lejone, Thabo Ismael; Ringera, Isaac; Puga, Daniel; Glass, Tracy R; Klimkait, Thomas

    2015-07-01

    To compare virologic success between adult patients on tenofovir (TDF) and zidovudine (AZT)-containing first-line antiretroviral (ART) regimens in 10 rural clinics in Lesotho, Southern Africa. Multicentre cross-sectional study, patients ≥16 years, on first-line ART ≥6 months, receiving AZT/lamivudine (3TC) or TDF/3TC combined with efavirenz (EFV) or nevirapine (NVP). Patient characteristics and clinical/therapeutic history were collected on the day of blood draw for viral load (VL). Analysis was stratified for non-nucleoside reverse transcriptase inhibitor (EFV or NVP). A logistic regression model weighted for patients' baseline characteristics was used to assess the likelihood of virologic success (<80 copies/ml) in patients with TDF- as compared to AZT-backbones. In total 1539 patients were included in the analysis. Most were clinically and immunologically stable (clinical failure: 2.7% (AZT) and 2.8% (TDF); immunological failure: 4.6% (AZT) and 4.8% (TDF)). In EFV-based regimens (n = 1162), TDF was significantly associated with higher rates of virologic suppression than AZT (93.8% vs. 88.1%; weighted odds ratio: 2.15 (95% CI: 1.29-3.58; P = 0.003)). In NVP-based regimens, a similar trend was observed, but not significant (89.4% vs. 86.7%; 1.99 (0.83-4.75, P = 0.121)). These findings support the WHO recommendation to use TDF/3TC/EFV as first-line regimen. They do, however, not support the recommendation that patients who are clinically stable on AZT should continue on this first-line regimen. © 2015 John Wiley & Sons Ltd.

  14. Malaria and Anemia among Children in a Low Resource Setting In Nigeria

    Directory of Open Access Journals (Sweden)

    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.

  15. Risk factors for dental caries among children with cerebral palsy in a low-resource setting.

    Science.gov (United States)

    Akhter, Rahena; Hassan, Nur Mohammad Monsur; Martin, Elizabeth F; Muhit, Mohammad; Haque, Mohammad Raziul; Smithers-Sheedy, Hayley; Jones, Cheryl; Badawi, Nadia; Khandaker, Gulam

    2017-05-01

    To describe the oral health status and investigate factors affecting dental caries experience among children with cerebral palsy (CP) in rural Bangladesh. A cross-sectional study was conducted among children with CP who are part of the Bangladesh Cerebral Palsy Register (BCPR) study. Caries experience was measured by identifying decayed, missing, and filled teeth for deciduous and permanent teeth (dmft/DMFT). Clinical periodontal index, body mass index, oral hygiene behaviour, masticatory ability, and dietary habits were recorded. CP motor types and severity of functional mobility (Gross Motor Function Classification System [GMFCS]) were assessed. Of 90 children with CP (mean age 9y 7mo, range 2-17y, 37.8% female and 62.2% male), 35% of 2 to 6 year olds, and 70% of 7 to 11 year olds (p=0.014) experienced caries (dmft+DMFT>0). The mean values (standard deviation [SD]) of dmft and DMFT were 2.46 (3.75) and 0.72 (1.79) respectively. After adjusting for age and sex, binary logistic regression analysis showed a significant relationship with dental caries for children who had quadriplegia (odds ratio [OR] 5.56, p=0.035), tooth cleaning less than one time/day (OR 0.08, p=0.016), using toothpowder or charcoal for cleaning (OR 7.63, p=0.015), and snacking between meals more than one time/day (OR 6.93, p=0.012). Early oral health preventive care is required for children with CP because dental caries is highly prevalent in these children. © 2016 Mac Keith Press.

  16. Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis

    Science.gov (United States)

    Manyazewal, Tsegahun; Oosthuizen, Martha J; Matlakala, Mokgadi C

    2016-01-01

    Objectives Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings. Design Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method. Setting Public hospitals in central Ethiopia. Participants 406 healthcare professionals and 10 senior health policy experts. Findings The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a ‘one-stop shopping’ approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies. Conclusions Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions

  17. Trends and issues in land and water resources management: Setting the agenda for change

    Science.gov (United States)

    Cortner, Hanna J.; Moote, Margaret A.

    1994-03-01

    The classical model of a paradigm shift is used to explore changes that are occurring in public lands and water resources management. Recent policy developments suggest that the traditional paradigm, which is characterized by sustained yield, is in the process of being invalidated. While no new paradigm has been fully accepted, the emerging paradigm does appear to be based on two principles: ecosystem management and collaborative decision making. Implementation of these two principles is likely to require extensive revision of traditional management practices and institutions. Failure to address these issues could result in adoption of the rhetoric of change without any lasting shift in management practices or professional attitudes.

  18. Overcoming limits set by scarce resources - role of local food production and food imports

    Science.gov (United States)

    Porkka, Miina; Guillaume, Joseph H. A.; Schaphoff, Sibyll; Siebert, Stefan; Gerten, Dieter; Kummu, Matti

    2017-04-01

    There is a fundamental tension between population growth and carrying capacity, i.e. the population that could potentially be supported using the resources and technologies available at a given time. This makes the assessments of resource use and agricultural productivity central to the debate on future food security. Local carrying capacity can be increased by expanding (e.g. through land conversion and irrigation infrastructure) or intensifying (e.g. through technologies and practices that increase efficiency) the resource use in agriculture. Food imports can be considered another way of overcoming current local limits and continuing growth beyond the local human-carrying capacity. Focusing on water as the key limiting resource, we performed a global assessment of the capacity for food self-sufficiency at sub-national and national scale for 1961-2009, taking into account the availability of both green and blue water as well as technology and management practices affecting water productivity at a given time, and using the hydrology and agriculture model LPJmL as our primary tool. Furthermore, we examined the use of food imports as a strategy to increase carrying capacity in regions where the potential for food self-sufficiency was limited by water availability and productivity. We found that the capacity for food self-sufficiency reduced notably during the study period due to the rapid population growth that outpaced the substantial improvements in water productivity. In 2009 more than a third (2.2 billion people) of the world's population lived in areas where sufficient food production to meet the needs of the population was not possible, and some 800 million people more were approaching this threshold. Food imports have nearly universally been used to overcome these local limits to growth, though the success of this strategy has been highly dependent on economic purchasing power. In the unsuccessful cases, increases in imports and local productivity have not

  19. 农村公路交通安全设施的选用与设置研究%Selecting and Setting Rural Road Traffic Safety Facilities

    Institute of Scientific and Technical Information of China (English)

    阮志刚

    2013-01-01

      公路交通中护栏、标柱、标志标线等是为保障行车和行人的安全必须配备的交通安全设施,虽然我国制定了一系列标准规范交通安全设置的配备,但我国农村的公路建设存在技术等级低以及缺乏建设养护资金等问题。基于对农村公路现状的调查,分析了山区农村公路的交通特点,在此基础上对农村公路交通安全设置的选用与设置进行了研究。论文分别从路侧防撞设施、交通标志等方面,对比现有标准结合农村公路实际给出了选用类型,设置参数等实际可行的解决方案。%  Highway guardrail, pillar, signs and markings are traffic safety facilities for protection of traffic and pedestrian safety must be equipped with, although China has formulated a series of standards of traffic security settings equipped, but China's rural highway construction technical level is low and lack of funds for construction and maintenance etc. Based on the investigation of rural highway, the traffic characteristics analysis of mountainous rural highway is made, on the basis of the research on the selection and setting of road traffic safety in rural settings. This paper, from the aspects of anti-collision facilities, roadside traffic signs, in contrast to the existing standard, and combining with rural highway reality, gives selection type, the parameters and other practical solution.

  20. Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting

    NARCIS (Netherlands)

    Browne, J. L.; Vissers, K. M.; Antwi, E.; Srofenyoh, E. K.; Van der Linden, E. L.; Agyepong, I. A.; Grobbee, D. E.; Klipstein-Grobusch, K.

    2015-01-01

    Objective: The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting. Methods: A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal cli

  1. 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.

  2. Study on the Current Status and Solutions of Rural Human Resources Development in Anhui Province%安徽省农村人力资源的现状与开发策略

    Institute of Scientific and Technical Information of China (English)

    丁静

    2012-01-01

    In recent years,the economic development of rural areas in Anhui province has slowed down,the gap between urban and rural areas has widened.Rural human resources development is a main factor influence the progress of rural areas.The development of rural human resources and improving the quality of rural human resources are the important method to solve the issues concerning agriculture.The rural human resources total quantity of Anhui province is a large scale,but the overall quality is a low level and the human resources structure is unreasonable.This paper analyzes the current status and put forward some suggestions for rural human resources development in Anhui province from perfecting rural education system,promoting the movement of rural human resources and optimizing the human resources environment.Education is an important way to develop human resources.From strengthening rural education and training,it can improve the overall quality of rural human resources.From speeding up rural human resources mobility,it can promote the transfer development.It refers to improve the rural social security system and the level of rural human resources security.At last,this paper can help to strengthen human resource inputs and realize the goal of Human resources strong province.%从近几年来看,安徽省农村地区的经济发展速度较慢,城乡差距不断扩大,农村人力资源开发是影响农村发展的一个非常重要的问题。开发农村人力资源,提高农村人力资源素质,是解决"三农"问题的重要途径。安徽省农村人力资源数量巨大,但素质较低,结构不合理。论文针对安徽省农村人力资源的现状,从完善农村教育体系、促进农村人力资源转移、优化人力资源环境几个方面提出了对策建议。教育是开发人力资源的主要手段,通过加强农村教育培训,提高农村人力资源的综合素质。通过加快农村人力资源的合理流动,促进迁移性开发。

  3. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  4. Car windshield fragments as cheap alternative glass beads for homogenization of Mycobacterium tuberculosis cultures in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Ernest Afu Ochang

    2014-01-01

    Full Text Available Tuberculosis is a global health problem which has been compounded by the emergence and rapid spread of drug resistant strains. Phenotypic drug susceptibility testing of Mycobacterium tuberculosis usually requires homogenization of cultures using 3–5 mm glass beads. In resource limited settings, these important material may either not be readily available in the country as in our case requiring that one orders them from abroad or they may be too expensive. In both situations, this would impact on the usually lean budget. In our centre were we recently introduced tuberculosis culture and drug susceptibility testing using the Microscopic Observation Drug Susceptibility (MODS technique, we successfully used glass fragments from a broken car windshield obtained from a mechanic workshop to homogenize solid cultures to prepare positive controls. All cultures homogenized with these local beads gave consistent MODS results. The challenge of the limited availability of resources for research in resource limited settings can be met by adapting available materials to achieve results.

  5. Exploring parameter effects on the economic outcomes of groundwater-based developments in remote, low-resource settings

    Science.gov (United States)

    Abramson, Adam; Adar, Eilon; Lazarovitch, Naftali

    2014-06-01

    Groundwater is often the most or only feasible safe drinking water source in remote, low-resource areas, yet the economics of its development have not been systematically outlined. We applied AWARE (Assessing Water Alternatives in Remote Economies), a recently developed Decision Support System, to investigate the costs and benefits of groundwater access and abstraction for non-networked, rural supplies. Synthetic profiles of community water services (n = 17,962), defined across 13 parameters' values and ranges relevant to remote areas, were applied to the decision framework, and the parameter effects on economic outcomes were investigated. Regressions and analysis of output distributions indicate that the most important factors determining the cost of water improvements include the technological approach, the water service target, hydrological parameters, and population density. New source construction is less cost-effective than the use or improvement of existing wells, but necessary for expanding access to isolated households. We also explored three financing approaches - willingness-to-pay, -borrow, and -work - and found that they significantly impact the prospects of achieving demand-driven cost recovery. The net benefit under willingness to work, in which water infrastructure is coupled to community irrigation and cash payments replaced by labor commitments, is impacted most strongly by groundwater yield and managerial factors. These findings suggest that the cost-benefit dynamics of groundwater-based water supply improvements vary considerably by many parameters, and that the relative strengths of different development strategies may be leveraged for achieving optimal outcomes.

  6. Survey and Risk Assessment of Apis mellifera (Hymenoptera: Apidae) Exposure to Neonicotinoid Pesticides in Urban, Rural, and Agricultural Settings.

    Science.gov (United States)

    Lawrence, T J; Culbert, E M; Felsot, A S; Hebert, V R; Sheppard, W S

    2016-04-01

    A comparative assessment of apiaries in urban, rural, and agricultural areas was undertaken in 2013 and 2014 to examine potential honey bee colony exposure to neonicotinoid insecticides from pollen foraging. Apiaries ranged in size from one to hundreds of honey bee colonies, and included those operated by commercial, sideline (semicommercial), and hobbyist beekeepers. Residues in and on wax and beebread (stored pollen in the hive) were evaluated for the nitro-substituted neonicotinoid insecticides imidacloprid and its olefin metabolite and the active ingredients clothianidin, thiamethoxam, and dinotefuran. Beebread and comb wax collected from hives in agricultural landscapes were more likely to have detectable residues of thiamethoxam and clothianidin than that collected from hives in rural or urban areas (∼50% of samples vs. <10%). The maximum neonicotinoid residue detected in either wax or beebread was 3.9 ppb imidacloprid. A probabilistic risk assessment was conducted on the residues recovered from beebread in apiaries located in commercial, urban, and rural landscapes. The calculated risk quotient based on a dietary no observable adverse effect concentration (NOAEC) suggested low potential for negative effects on bee behavior or colony health.

  7. Diagnostic work-up of neurological syndromes in a rural African setting: knowledge, attitudes and practices of health care providers.

    Directory of Open Access Journals (Sweden)

    Alain Mpanya

    Full Text Available BACKGROUND: Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo. METHODS: We used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti. RESULTS: Care providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a "diviner" do not enhance any use of laboratory or other diagnostic methods. CONCLUSION: Innovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.

  8. Panel Resource Management (PRM) Implementation and Effects within Safety Review Panel Settings and Dynamics

    Science.gov (United States)

    Taylor, Robert W.; Nash, Sally K.

    2007-01-01

    While technical training and advanced degree's assure proficiency at specific tasks within engineering disciplines, they fail to address the potential for communication breakdown and decision making errors familiar to multicultural environments where language barriers, intimidating personalities and interdisciplinary misconceptions exist. In an effort to minimize these pitfalls to effective panel review, NASA's lead safety engineers to the ISS Safety Review Panel (SRP), and Payload Safety Review Panel (PSRP) initiated training with their engineers, in conjunction with the panel chairs, and began a Panel Resource Management (PRM) program. The intent of this program focuses on the ability to reduce the barriers inhibiting effective participation from all panel attendees by bolstering participants confidence levels through increased communication skills, situational awareness, debriefing, and a better technical understanding of requirements and systems.

  9. Rural gifted students who are deaf or hard of hearing: how electronic technology can help.

    Science.gov (United States)

    Belcastro, Frank P

    2004-01-01

    Electronic technology can be used to overcome many of the barriers and other factors that restrict delivery of services to rural schools; it can also expand the world of rural gifted students who are deaf or hard of hearing. Online college and high school Web sites that offer courses are listed, as well as a Web site for tutoring and one offering help for teachers of rural gifted students who are deaf or hard of hearing. Recommendations are made for ways that legislatures and rural school districts can make Internet resources and assistive technology more widely available in rural educational settings.

  10. New nucleic acid testing devices to diagnose infectious diseases in resource-limited settings.

    Science.gov (United States)

    Maffert, P; Reverchon, S; Nasser, W; Rozand, C; Abaibou, H

    2017-06-01

    Point-of-care diagnosis based on nucleic acid testing aims to incorporate all the analytical steps, from sample preparation to nucleic acid amplification and detection, in a single device. This device needs to provide a low-cost, robust, sensitive, specific, and easily readable analysis. Microfluidics has great potential for handling small volumes of fluids on a single platform. Microfluidic technology has recently been applied to paper, which is already used in low-cost lateral flow tests. Nucleic acid extraction from a biological specimen usually requires cell filtration and lysis on specific membranes, while affinity matrices, such as chitosan or polydiacetylene, are well suited to concentrating nucleic acids for subsequent amplification. Access to electricity is often difficult in resource-limited areas, so the amplification step needs to be equipment-free. Consequently, the reaction has to be isothermal to alleviate the need for a thermocycler. LAMP, NASBA, HDA, and RPA are examples of the technologies available. Nucleic acid detection techniques are currently based on fluorescence, colorimetry, or chemiluminescence. For point-of-care diagnostics, the results should be readable with the naked eye. Nowadays, interpretation and communication of results to health professionals could rely on a smartphone, used as a telemedicine device. The major challenge of creating an "all-in-one" diagnostic test involves the design of an optimal solution and a sequence for each analytical step, as well as combining the execution of all these steps on a single device. This review provides an overview of available materials and technologies which seem to be adapted to point-of-care nucleic acid-based diagnosis, in low-resource areas.

  11. Rural nurses

    DEFF Research Database (Denmark)

    Wilson, Rhonda L.; Usher, Kim

    2015-01-01

    with descriptive techniques. In-depth interviews were conducted and the transcribed data were analysed using thematic techniques. Results: The results of this study demonstrate that in general rural people are willing to seek mental health care, and that rural nurses are well suited to provide initial care...... to young people. Conclusions: Non-traditional venues such as community, school and justice settings are ideal places where more convenient first conversations about mental health with young people and their families, and rural nurses should be deployed to these settings. Relevance to Clinical Practice......: Rural nurses are able to contribute important initial engagement interventions that enhance the early mental health care for young people when it is needed....

  12. Oxygen and pulse oximetry in childhood pneumonia: a survey of healthcare providers in resource-limited settings.

    Science.gov (United States)

    Ginsburg, Amy Sarah; Van Cleve, William C; Thompson, Mary I W; English, Mike

    2012-10-01

    Globally, pneumonia is the leading cause of death in children provider perceptions and practices regarding their role in childhood pneumonia, we conducted a survey using a convenience sampling strategy targeting clinicians working in resource-limited countries. Most respondents were physicians from public district and provincial hospitals with access to oxygen and pulse oximetry; however, reported therapeutic use for childhood pneumonia was low. Common barriers included insufficient supply, competition for use, lack of policies, guidelines and training and perceived high cost. Despite the frequency of hypoxemia, the inaccuracy of clinical predictors, the poor outcome hypoxemia portends and the effectiveness of pulse oximetry and oxygen in childhood pneumonia, our data indicate that these tools may be underused in resource-limited settings.

  13. Patterns of fruit and seed set within inflorescences of Pancratium maritimum (Amaryllidaceae): nonuniform pollination, resource limitation, or architectural effects?

    Science.gov (United States)

    Medrano, M; Guitián, P; Guitián, J

    2000-04-01

    We investigated patterns of fruit and seed production on inflorescences of a population of Pancratium maritimum in northwest Spain over a 2-yr period. Initial findings showed that the earliest opening flowers on an inflorescence are more likely to set fruit and produce more seeds than later opening flowers and that this pattern is maintained throughout the flowering season. Supplementary pollination and flower-removal experiments were performed to investigate whether the observed pattern is attributable (a) to variation in pollen receipt, (b) to sequestration of resources by the earliest flowers on an inflorescence, and/or (c) to "architectural" limitations on the fruit/seed production of later flowers. Supplementary pollination did not improve fruit or seed production by late flowers in either of the 2 yr of study. In flower-removal experiments, the remaining flowers showed improved fruit set and mean number of seeds per flower, by comparison with flowers in the same position on control inflorescences. When all flowers except the latest third were removed, these showed fruit set and seed production similar to those of early flowers on control inflorescences. These results strongly suggest that the observed within-inflorescence patterns of fruit and seed production in P. maritimum are mainly attributable to competition for resources (i.e., explanation b), though other adaptive explanations cannot be ruled out.

  14. 统筹城乡医疗保障制度的资源分配效应研究%Effects of Coordinating Urban-rural Medical Security System on Medical Resources Distribution

    Institute of Scientific and Technical Information of China (English)

    李佳佳; 顾海; 徐凌忠

    2013-01-01

    Objectives: To empirically study the distributional effects of Coordinating Urban-rural Medical Security System (CMS) on medical resources, and whose mode is more conducive to the rational allocation. Methods: Conducting the household investigation by applying multi-stage stratified cluster random sampling method, and using Heckit model to study the distributional effects of CMS and different modes on medical resources. Conclusions: The CMS basically safeguards the medical resources allocated to those in need. Gradually raising the co-ordinate level, and setting up a number of insurance contracts and allowing insured people freely choose mode is more conducive to the rational allocation between urban and rural groups and among different income groups.%  目的:实证研究统筹城乡医疗保障制度能否促进医疗资源的合理分配,哪种模式更有利于合理分配。方法:采取多阶段随机整群抽样方法抽取研究样本,结合Heckit两阶段样本选择模型,实证分析统筹城乡医疗保障制度及不同模式的医疗资源分配效应。结论:统筹城乡医保制度基本保障了医疗资源分配给有需要的人群。其中,逐步提高统筹层次并设立多个保险合约允许自由选择的统筹模式更有利于医疗资源在城乡间、不同收入阶层间的合理分配。

  15. Critical control points for avian influenza A H5N1 in live bird markets in low resource settings.

    Science.gov (United States)

    Samaan, Gina; Gultom, Anita; Indriani, Risa; Lokuge, Kamalini; Kelly, Paul M

    2011-06-01

    Live bird markets can become contaminated with and become a source of transmission for avian influenza viruses including the highly pathogenic H5N1 strain. Many countries affected by the H5N1-virus have limited resources for programs in environmental health, sanitation and disease control in live bird markets. This study proposes five critical control points (CCPs) to reduce the risk of H5N1-virus contamination in markets in low resource settings. The CCPs were developed based on three surveys conducted in Indonesia: a cross-sectional survey in 119 markets, a knowledge, attitudes and practice survey in 3 markets and a microbiological survey in 83 markets. These surveys assessed poultry workflow, market infrastructure, hygiene and regulatory practices and microbiological contamination with the H5N1-virus. The five CCPs identified were (1) reducing risk of receiving infected birds into the market, (2) reducing the risk of virus spread between different bird flocks in holding cages, (3) reducing surface contamination by isolating slaughter processes from other poultry-related processes, (4) minimizing the potential for contamination during evisceration of carcasses and (5) reducing the risk of surface contamination in the sale zone of the market. To be relevant for low resource settings, the CCPs do not necessitate large infrastructure changes. The CCPs are suited for markets that slaughter poultry and have capacity for daily disposal and removal of solid waste from the market. However, it is envisaged that the CCPs can be adapted for the development of risk-based programs in various settings.

  16. Sankofa pediatric HIV disclosure intervention cyber data management: building capacity in a resource-limited setting and ensuring data quality.

    Science.gov (United States)

    Catlin, Ann Christine; Fernando, Sumudinie; Gamage, Ruwan; Renner, Lorna; Antwi, Sampson; Tettey, Jonas Kusah; Amisah, Kofi Aikins; Kyriakides, Tassos; Cong, Xiangyu; Reynolds, Nancy R; Paintsil, Elijah

    2015-01-01

    Prevalence of pediatric HIV disclosure is low in resource-limited settings. Innovative, culturally sensitive, and patient-centered disclosure approaches are needed. Conducting such studies in resource-limited settings is not trivial considering the challenges of capturing, cleaning, and storing clinical research data. To overcome some of these challenges, the Sankofa pediatric disclosure intervention adopted an interactive cyber infrastructure for data capture and analysis. The Sankofa Project database system is built on the HUBzero cyber infrastructure ( https://hubzero.org ), an open source software platform. The hub database components support: (1) data management - the "databases" component creates, configures, and manages database access, backup, repositories, applications, and access control; (2) data collection - the "forms" component is used to build customized web case report forms that incorporate common data elements and include tailored form submit processing to handle error checking, data validation, and data linkage as the data are stored to the database; and (3) data exploration - the "dataviewer" component provides powerful methods for users to view, search, sort, navigate, explore, map, graph, visualize, aggregate, drill-down, compute, and export data from the database. The Sankofa cyber data management tool supports a user-friendly, secure, and systematic collection of all data. We have screened more than 400 child-caregiver dyads and enrolled nearly 300 dyads, with tens of thousands of data elements. The dataviews have successfully supported all data exploration and analysis needs of the Sankofa Project. Moreover, the ability of the sites to query and view data summaries has proven to be an incentive for collecting complete and accurate data. The data system has all the desirable attributes of an electronic data capture tool. It also provides an added advantage of building data management capacity in resource-limited settings due to its

  17. Allocating limited resources in a time of fiscal constraints: a priority setting case study from Dalhousie University Faculty of Medicine.

    Science.gov (United States)

    Mitton, Craig; Levy, Adrian; Gorsky, Diane; MacNeil, Christina; Dionne, Francois; Marrie, Tom

    2013-07-01

    Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.

  18. Developing capacity in health informatics in a resource poor setting: lessons from Peru

    Directory of Open Access Journals (Sweden)

    Segovia-Juarez Jose

    2009-10-01

    Full Text Available Abstract The public sectors of developing countries require strengthened capacity in health informatics. In Peru, where formal university graduate degrees in biomedical and health informatics were lacking until recently, the AMAUTA Global Informatics Research and Training Program has provided research and training for health professionals in the region since 1999. The Fogarty International Center supports the program as a collaborative partnership between Universidad Peruana Cayetano Heredia in Peru and the University of Washington in the United States of America. The program aims to train core professionals in health informatics and to strengthen the health information resource capabilities and accessibility in Peru. The program has achieved considerable success in the development and institutionalization of informatics research and training programs in Peru. Projects supported by this program are leading to the development of sustainable training opportunities for informatics and eight of ten Peruvian fellows trained at the University of Washington are now developing informatics programs and an information infrastructure in Peru. In 2007, Universidad Peruana Cayetano Heredia started offering the first graduate diploma program in biomedical informatics in Peru.

  19. The impact of antiretroviral therapy in resource-limited settings and current HIV therapeutics.

    Science.gov (United States)

    Kumarasamy, N

    2016-04-01

    Four million people of the global total of 35 million with HIV infection are from South-East Asia. ART is currently utilized by 15 million people and has led to a dramatic decline in the mortality rate, including those in low- and middle-income countries. A reduction in sexually transmitted HIV and in comorbidities including tuberculosis has also followed. Current recommendations for the initiation of antiretroviral therapy in people who are HIV+ are essentially to initiate ART irrespective of CD4 cell count and clinical stage. The frequency of HIV testing should be culturally specific and based on the HIV incidence in different key populations but phasing in viral load technology in LMIC is an urgent priority and this needs resources and capacity. With the availability of simplified potent ART regimens, persons with HIV now live longer. The recent WHO treatment guidelines recommending routine HIV testing and earlier initiation of treatment should be the stepping stone for ending the AIDS epidemic and to meet the UNAIDS mission of 90*90*90.

  20. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

    Science.gov (United States)

    Penno, Erin C; Baird, Sarah J; Crump, John A

    2015-10-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

  1. Delivering pediatric HIV care in resource-limited settings: cost considerations in an expanded response.

    Science.gov (United States)

    Tolle, Michael A; Phelps, B Ryan; Desmond, Chris; Sugandhi, Nandita; Omeogu, Chinyere; Jamieson, David; Ahmed, Saeed; Reuben, Elan; Muhe, Lulu; Kellerman, Scott E

    2013-11-01

    If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.

  2. Tracing defaulters in HIV prevention of mother-to-child transmission programmes through community health workers: results from a rural setting in Zimbabwe

    Directory of Open Access Journals (Sweden)

    Florian Vogt

    2015-10-01

    test result collection. Conclusions: The CHW-DT intervention did not reduce perinatal HIV transmission significantly. Retention improved moderately during the post-natal period, but cumulative retention decreased rapidly even after the intervention. We showed that transmission in resource-limited settings can be as low as in resource-rich countries if patients are fully retained in care. This requires structural changes to the regular PMTCT services, in which community health workers can, at best, play a complementary role.

  3. Pressure sores and pressure sore prevention in a rehabilitation setting: building information for improving outcomes and allocating resources.

    Science.gov (United States)

    Baggerly, J; DiBlasi, M

    1996-01-01

    Quantifiable information regarding pressure sore prevention and management is a prerequisite for program development, outcome evaluation, and resource allocation. In this study, all patients admitted to an acute rehabilitation setting (N = 446) during a 2-month period were assessed for the presence of a pressure sore, the risk for developing a pressure sore, the rate of agreement between "objective" (Braden scale) and "subjective" (standard nursing admission data) measures of risk and outcome, and the status of pressure sores at discharge. This article provides the details of the project and implications for rehabilitation nursing practice.

  4. Measuring health-related quality of life of HIV-positive adolescents in resource-constrained settings.

    Directory of Open Access Journals (Sweden)

    Caroline Masquillier

    Full Text Available BACKGROUND AND OBJECTIVES: Access to antiretroviral treatment among adolescents living with HIV (ALH is increasing. Health-related quality of life (HRQOL is relevant for monitoring the impact of the disease on both well-being and treatment outcomes. However, adequate screening tools to assess HRQOL in low-resource settings are scarce. This study aims to fill this research gap, by 1 assessing the psychometric properties and reliability of an Eastern African English version of a European HRQOL scale for adolescents (KIDSCREEN and 2 determining which version of the KIDSCREEN (52-, 27- and 10-item version is most suitable for low-resource settings. METHODS: The KIDSCREEN was translated into Eastern African English, Luganda (Uganda and Dholuo (Kenya according to standard procedures. The reconciled version was administered in 2011 to ALH aged 13-17 in Kenya (n = 283 and Uganda (n = 299. All three KIDSCREEN versions were fitted to the data with confirmatory factor analysis (CFA. After comparison, the most suitable version was adapted based on the CFA outcomes utilizing the results of previous formative research. In order to develop a general HRQOL factor, a second-order measurement model was fitted to the data. RESULTS: The CFA results showed that without adjustments, the KIDSCREEN cannot be used for measuring the HRQOL of HIV-positive adolescents. After comparison, the most suitable version for low-resource settings--the 27-item version--was adapted further. The introduction of a negative wording factor was required for the Dholuo model. The Dholuo (CFI: 0.93; RMSEA: 0.039 and the Luganda model (CFI: 0.90; RMSEA: 0.052 showed a good fit. All cronbach's alphas of the factors were 0.70 or above. The alpha value of the Dholuo and Lugandan HRQOL second-order factor was respectively 0.84 and 0.87. CONCLUSIONS: The study showed that the adapted KIDSCREEN-27 is an adequate tool for measuring HRQOL in low-resource settings with high HIV prevalence.

  5. Measuring health-related quality of life of HIV-positive adolescents in resource-constrained settings.

    Science.gov (United States)

    Masquillier, Caroline; Wouters, Edwin; Loos, Jasna; Nöstlinger, Christiana

    2012-01-01

    Access to antiretroviral treatment among adolescents living with HIV (ALH) is increasing. Health-related quality of life (HRQOL) is relevant for monitoring the impact of the disease on both well-being and treatment outcomes. However, adequate screening tools to assess HRQOL in low-resource settings are scarce. This study aims to fill this research gap, by 1) assessing the psychometric properties and reliability of an Eastern African English version of a European HRQOL scale for adolescents (KIDSCREEN) and 2) determining which version of the KIDSCREEN (52-, 27- and 10-item version) is most suitable for low-resource settings. The KIDSCREEN was translated into Eastern African English, Luganda (Uganda) and Dholuo (Kenya) according to standard procedures. The reconciled version was administered in 2011 to ALH aged 13-17 in Kenya (n = 283) and Uganda (n = 299). All three KIDSCREEN versions were fitted to the data with confirmatory factor analysis (CFA). After comparison, the most suitable version was adapted based on the CFA outcomes utilizing the results of previous formative research. In order to develop a general HRQOL factor, a second-order measurement model was fitted to the data. The CFA results showed that without adjustments, the KIDSCREEN cannot be used for measuring the HRQOL of HIV-positive adolescents. After comparison, the most suitable version for low-resource settings--the 27-item version--was adapted further. The introduction of a negative wording factor was required for the Dholuo model. The Dholuo (CFI: 0.93; RMSEA: 0.039) and the Luganda model (CFI: 0.90; RMSEA: 0.052) showed a good fit. All cronbach's alphas of the factors were 0.70 or above. The alpha value of the Dholuo and Lugandan HRQOL second-order factor was respectively 0.84 and 0.87. The study showed that the adapted KIDSCREEN-27 is an adequate tool for measuring HRQOL in low-resource settings with high HIV prevalence.

  6. Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors

    Science.gov (United States)

    Ngugi, Anthony K.; Agoi, Felix; Mahoney, Megan R.; Lakhani, Amyn; Mang’ong’o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah

    2017-01-01

    Background and methods Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. Results and conclusions 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05–0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of

  7. Innovative use of resources and diversification of the economic structure of rural areas on the basis of local action group MROGA experience

    Directory of Open Access Journals (Sweden)

    Ewelina Dzikowska

    2012-09-01

    Full Text Available One of the tasks of local action groups is to support diversification of the economic structure of rural areas. Projects which make use of local resources in unique, non-standard ways (with reference to the achievements of the French school of Economie de la Proximie may be called innovative. Analysis was applied to one of the local action groups from the Łódź voivodeship – MROGA Association for the Local Community Development. The aim of this analysis was to estimate the potential of this structure as regards innovative use of local resources in diversification of the local economy by creating non-agricultural jobs. The case study method was applied; analysis of secondary materials was carried out (the local development strategy and competition documentation regarding to the development of local economy in the area supported by this organization. The selected association (realising own projects contributes to the innovative development of rural economy. Moreover, in supported area, new non-agricultural workplaces are created in which local resources are also used in a non-standard way.

  8. 广西融安县乡村旅游资源调查与分析%Investigation and Analysis on Rural Tourism Resources in Rong'an County of Guangxi

    Institute of Scientific and Technical Information of China (English)

    韦飞

    2011-01-01

    为了探讨广西乡村旅游资源的特征与分布,揭示乡村旅游资源的基本规律,深入研究乡村旅游资源的发展与利用,更好地为开发与保护提供理论依据,对全区乡村旅游资源及发展现状展开专项调查.在广西融安县乡村旅游资源调查中,对融安县乡村旅游资源调查数据进行分析,总结融安县乡村旅游资源开发与保护成果,以利于融安县旅游业的可持续发展.%To explore the characteristics of rural tourism resources in Guangxi and distribution, reveal the basic rules of rural tourism resources and study the development and utilization of rural tourism resources deeply, which provide theoretical basis for better protection and development. Therefore, special survey on rural tourism resources and its development status are carried out by Guangxi Zhuang Autonomous Region Tourism Board. During the investigation of rural tourism resources in Guangxi Rong'an, The analysis on survey data of rural tourism resources in Rong'an are carried out, moreover, the development and conservation outcomes of rural tourism resources in Rong' an are summarized, which are beneficial to the sustainable development of tourism in Rong' an.

  9. Reducing maternal mortality due to elective abortion: Potential impact of misoprostol in low-resource settings.

    Science.gov (United States)

    Harper, C C; Blanchard, K; Grossman, D; Henderson, J T; Darney, P D

    2007-07-01

    Over 99% of deaths due to abortion occur in developing countries. Maternal deaths due to abortion are preventable. Increasing the use of misoprostol for elective abortion could have a notable impact on maternal mortality due to abortion. As a test of this hypothesis, this study estimated the reduction in maternal deaths due to abortion in Africa, Asia and Latin America. The estimates were adjusted to changes in assumptions, yielding different possible scenarios of low and high estimates. This simple modeling exercise demonstrated that increased use of misoprostol, an option for pregnancy termination already available to many women in developing countries, could significantly reduce mortality due to abortion. Empirical testing of the hypothesis with data collected from developing countries could help to inform and improve the use of misoprostol in those settings.

  10. Added value of antigen ELISA in the diagnosis of neurocysticercosis in resource poor settings.

    Directory of Open Access Journals (Sweden)

    Sarah Gabriël

    Full Text Available BACKGROUND: Neurocysticercosis (NCC is the most common cause of acquired epilepsy in Taenia solium endemic areas, primarily situated in low-income countries. Diagnosis is largely based upon the "Del Brutto diagnostic criteria" using the definitive/probable/no NCC diagnosis approach. Neuroimaging and specific T. solium cysticercosis antibody detection results are at the mainstay of this diagnosis, while antigen detection in serum has never been included. This study aimed at evaluating the addition of antigen detection as a major diagnostic criterion, especially in areas where neuroimaging is absent. METHODS: The B158/B60 monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA for the detection of circulating cysticercus antigen was carried out retrospectively on serum samples collected during a hospital-based study from 83 people with epilepsy (PWE in an endemic area. RESULTS: The addition of antigen results as a major criterion allowed the correct diagnosis of definitive NCC in 10 out of 17 patients as opposed to 0/17 without antigen results in the absence of neuroimaging. A sensitivity of 100% and a specificity of 84% were determined for the diagnosis of active NCC using antigen ELISA. While the use of a higher cutoff improves the specificity of the test to 96%, it decreases its sensitivity to 83%. CONCLUSIONS: In areas where neuroimaging is absent, NCC diagnosis according to the existing criteria is problematic. Taking into account its limitations for diagnosis of inactive NCC, antigen detection can be of added value for diagnosing NCC in PWE by supporting diagnostic and treatment decisions. Therefore, we recommend a revision of the "Del Brutto diagnostic criteria" for use in resource poor areas and suggest the inclusion of serum antigen detection as a major criterion.

  11. Offering an American graduate medical HIV course to health care workers in resource-limited settings via the Internet.

    Science.gov (United States)

    Chung, Michael H; Severynen, Anneleen O; Hals, Matthew P; Harrington, Robert D; Spach, David H; Kim, H Nina

    2012-01-01

    Western accredited medical universities can offer graduate-level academic courses to health care workers (HCWs) in resource-limited settings through the Internet. It is not known whether HCWs are interested in these online courses, whether they can perform as well as matriculated students, or whether such courses are educationally or practically relevant. In 2011, the University of Washington (UW) Schools of Medicine and Nursing offered the graduate course, "Clinical Management of HIV", to HCWs that included a demographic survey, knowledge assessment, and course evaluation. UW faculty delivered HIV clinical topics through ten 2-hour weekly sessions from the perspectives of practicing HIV medicine in developed and developing settings. HCWs viewed lectures through Adobe Acrobat Connect Pro (Adobe Systems, San Jose, CA), and completed online homework on HIV Web Study (http://depts.washington.edu/hivaids/) and online quizzes. HCWs, who met the same passing requirements as UW students by attending 80% lectures, completing ≥90% homework, and achieving a cumulative ≥70% grade on quizzes, were awarded a certificate. 369 HCWs at 33 sites in 21 countries joined the course in 2011, a >15-fold increase since the course was first offered in 2007. The majority of HCWs came from Africa (72%), and most were physicians (41%), nurses (22%), or midlevel practitioners (20%). 298 HCWs (81%) passed all requirements and earned a certificate. In a paired analysis of pre- and post-course HIV knowledge assessments, 56% of HCWs improved their post-course score (p<0.0001) with 27% improving by at least 30%. In the course evaluation, most HCWs rated the course as excellent (53%) or very good (39%). This online HIV course demonstrated that opening a Western graduate medical and nursing curriculum to HCWs in resource-limited settings is feasible, popular, and valuable, and may address logistic and economic barriers to the provision of high quality education in these settings.

  12. Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015.

    Science.gov (United States)

    Colson, K Ellicott; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Conde-Glez, Carlos J; Gagnier, Marielle C; Palmisano, Erin; Ranganathan, Dharani; Usmanova, Gulnoza; Salvatierra, Benito; Nazar, Austreberta; Tristao, Ignez; Sanchez Monin, Emmanuelle; Anderson, Brent W; Haakenstad, Annie; Murphy, Tasha; Lim, Stephen; Hernandez, Bernardo; Lozano, Rafael; Iriarte, Emma; Mokdad, Ali H

    2015-01-01

    Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. We also collected dried blood spots (DBS) from children aged 12 to 23 months to compare crude and effective coverage of measles immunization. We used survey-weighted logistic regression to identify individual, maternal, household, community, and health facility characteristics that predict gaps between crude coverage and effective coverage. We found that crude coverage was significantly higher than effective coverage (83% versus 68% in Mexico; 85% versus 50% in Nicaragua). A large proportion of children (19% in Mexico; 43% in Nicaragua) had health card documentation of measles immunization but lacked antibodies. These discrepancies varied from 0% to 100% across municipalities in each country. In multivariate analyses, card-positive children in Mexico were more likely to lack antibodies if they resided in urban areas or the jurisdiction of De Los Llanos. In contrast, card-positive children in Nicaragua were more likely to lack antibodies if they resided in rural areas or the North Atlantic region, had low weight-for-age, or attended health facilities with a greater number of refrigerators. Findings highlight that reliance on child health cards to measure population protection against measles is unwise. We call for the evaluation of immunization programs using serological methods, especially in poor areas where the cold chain is likely to be compromised. Identification of within-country variation in effective coverage of measles immunization will allow researchers and public health

  13. Innovative strategies for transforming internal medicine residency training in resource-limited settings: the Mozambique experience.

    Science.gov (United States)

    Mocumbi, Ana Olga; Carrilho, Carla; Aronoff-Spencer, Eliah; Funzamo, Carlos; Patel, Sam; Preziosi, Michael; Lederer, Philip; Tilghman, Winston; Benson, Constance A; Badaró, Roberto; Nguenha, A; Schooley, Robert T; Noormahomed, Emília V

    2014-08-01

    With approximately 4 physicians per 100,000 inhabitants, Mozambique faces one of the most severe health care provider shortages in Sub-Saharan Africa. The lack of sufficient well-trained medical school faculty is one of Mozambique's major barrier to producing new physicians annually. A partnership between the Universidade Eduardo Mondlane and the University of California, San Diego, has addressed this challenge with support from the Medical Education Partnership Initiative. After an initial needs assessment involving questionnaires and focus groups of residents, and working with key members from the Ministry of Health, the Medical Council, and Maputo Central Hospital, a set of interventions was designed. The hospital's internal medicine residency program was chosen as the focus for the plan. Interventions included curriculum design, new teaching methodologies, investment in an informatics infrastructure for access to digital references, building capacity to support clinical research, and providing financial incentives to retain junior faculty. The number of candidates entering the internal medicine residency program has increased, and detailed monitoring and evaluation is measuring the impact of these changes on the quality of training. These changes are expected to improve the long-term quality of postgraduate training in general through dissemination to other departments. They also have the potential to facilitate equitable distribution of specialists nationwide by expanding postgraduate training to other hospitals and universities.

  14. Acute rheumatic fever: a public health concern in resource-poor settings

    Directory of Open Access Journals (Sweden)

    Olusegun Busari

    2013-04-01

    Full Text Available Acute rheumatic fever remains a public health concern in developing countries as well as in poorer communities and among indigenous populations in some developed nations. It poses serious economic problem at individual, communal and national levels through direct and indirect health care costs. The objective of this article is to review acute rheumatic fever in the global context with some emphasis on the continuing burden of this disease in the developing settings. The Cochrane Database of Systematic Reviews, PubMed, EMBASE and AJOL were searched with focus on epidemiology, pathogenesis, diagnosis and treatment, and control of acute rheumatic fever. The review shows that acute rheumatic fever still occurs under conditions of impoverished overcrowding and poor sanitation and where access to healthcare services is limited. Since acute rheumatic fever is a preventable disease, improved housing and sanitation, access to effective healthcare services, early diagnosis, registration of cases and follow up remain the bedrock of the control of this disease [Archives Medical Review Journal 2013; 22(2.000: 153-169

  15. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations.

    Science.gov (United States)

    Haberer, Jessica E; Sabin, Lora; Amico, K Rivet; Orrell, Catherine; Galárraga, Omar; Tsai, Alexander C; Vreeman, Rachel C; Wilson, Ira; Sam-Agudu, Nadia A; Blaschke, Terrence F; Vrijens, Bernard; Mellins, Claude A; Remien, Robert H; Weiser, Sheri D; Lowenthal, Elizabeth; Stirratt, Michael J; Sow, Papa Salif; Thomas, Bruce; Ford, Nathan; Mills, Edward; Lester, Richard; Nachega, Jean B; Bwana, Bosco Mwebesa; Ssewamala, Fred; Mbuagbaw, Lawrence; Munderi, Paula; Geng, Elvin; Bangsberg, David R

    2017-01-01

    Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care

  16. Fine Needle Aspiration of Thyroid Nodules Using the Bethesda System for Reporting Thyroid Cytopathology: An Institutional Experience in a Rural Setting

    Science.gov (United States)

    Kaminoh, Yuuki; Forward, Terra; Schwartz, Frank L.; Jenkinson, Scott

    2017-01-01

    Background. Fine needle aspiration (FNA) remains the first-line diagnostic in management of thyroid nodules and reduces unnecessary surgeries. However, it is still challenging since cytological results are not always straightforward. This study aimed to examine the results of thyroid FNA using the Bethesda system for reporting thyroid cytopathology (TBSRTC) to establish the level of accuracy of FNA procedures in a rural practice setting. Method. A retrospective chart review was conducted on existing thyroid FNA performed in a referral endocrine center between December 2011 and November 2015. Results. A total of 159 patients (18–88 years old) and 236 nodule aspirations were performed and submitted for evaluation. 79% were benign, 3% atypia/follicular lesion of unknown significance (AUS/FLUS), 5% follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 4% suspicious for malignancy (one case was indeed an atypical parathyroid neoplasm by surgical pathology), 2% malignant, and 7% nondiagnostic. Two cases also had advanced molecular analysis on FNA specimens before thyroidectomy. Conclusion. The diagnostic yield of FNA cytology from our practice in a rural setting suggests that accuracy and specificity are comparable to results from larger centers. PMID:28280507

  17. Malarial anaemia and anaemia severity in apparently healthy primary school children in urban and rural settings in the Mount Cameroon area: cross sectional survey.

    Science.gov (United States)

    Sumbele, Irene Ule Ngole; Kimbi, Helen Kuokuo; Ndamukong-Nyanga, Judith Lum; Nweboh, Malaika; Anchang-Kimbi, Judith Kuoh; Lum, Emmaculate; Nana, Yannick; Ndamukong, Kenneth K J; Lehman, Leopold G

    2015-01-01

    This study examines the relative importance of living in an urban versus rural setting and malaria in contributing to the public health problem of malarial anaemia (MA) and anaemia respectively in apparently healthy primary school children. A cross-sectional study was conducted among 727 school children aged between four and 15 years living in an urban (302) and rural (425) settings in the Mount Cameroon area. Blood sample collected from each child was used for the preparation of blood films for detection of malaria parasites and assessment of malaria parasite density as well as full blood count determination using an automated haematology analyzer. Based on haemoglobin (Hb) measurements, children with malaria parasitaemia were stratified into MA (Hbanaemia was performed by multinomial logistic-regression analysis and odds ratios used to evaluate risk factors. Out of the 727 children examined, 72 (9.9%) had MA. The prevalence of MA and anaemia were significantly higher (χ2 = 36.5, P anaemia. In addition, low parasite density was associated with MA while malaria parasite negative and microcytosis were associated with anaemia. Malarial anaemia and anaemia display heterogeneity and complexity that differ with the type of settlement. The presence of severe MA and the contributions of the age group ≤6 years, low parasite density and microcytosis to the public health problem of MA and anaemia are noteworthy.

  18. Review of the safety, efficacy, and pharmacokinetics of elvitegravir with an emphasis on resource-limited settings

    Directory of Open Access Journals (Sweden)

    Lee JSF

    2012-01-01

    Full Text Available Janice Soo Fern Lee1, Alexandra Calmy1,2, Isabelle Andrieux-Meyer1, Nathan Ford1,31Médecins Sans Frontières, 2HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland; 3Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South AfricaAbstract: Integrase inhibitors represent an important new class of antiretroviral drugs. Elvitegravir, the second available integrase inhibitor to be submitted for regulatory approval appears to be a promising once-daily agent when combined with other antiretroviral drugs. Elvitegravir has demonstrated good efficacy and safety, with minimal side effects and no specific requirements in terms of laboratory monitoring. In addition, elvitegravir is available as a fixed-dose combination. However, the drug requires boosting and this leads to a number of drug–drug interactions and necessary dose adjustment when dosing with certain drugs, including dose reduction in the presence of atazanavir, lopinavir, rifabutin, and ketoconazole, and dose increase for ethinyl estradiol when co-administered with boosted elvitegravir. The main advantage of elvitegravir lies in its potential to be administered as a once-daily, single pill. Limitations include dose adjustment requirements, a relatively low genetic barrier to resistance, high price, and lack of data for use in children. Clinical trials addressing specific challenges encountered in resources-limited settings should be encouraged.Keywords: elvitegravir, efficacy, safety, resistance, resource-limited settings

  19. Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings.

    Science.gov (United States)

    Acestor, Nathalie; Goett, Jane; Lee, Arthur; Herrick, Tara M; Engelbrecht, Susheela M; Harner-Jay, Claudia M; Howell, Bonnie J; Weigl, Bernhard H

    2016-01-01

    In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

  20. Patient needs and point-of-care requirements for HIV load testing in resource-limited settings.

    Science.gov (United States)

    Usdin, Martine; Guillerm, Martine; Calmy, Alexandra

    2010-04-15

    Medecins Sans Frontieres (MSF) is an international, independent medical nongovernmental organization. One way in which MSF acts to improve patient care is to assist in the identification and development of adapted and appropriate tools for use in resource-limited settings. One strategy to achieve this goal is through active collaborations with scientists and developers, to make some of the field needs known and to help define the medical strategy behind the implementation of new diagnostic tests. Tests used in the field need to be effective in often extreme conditions and must also deliver high-quality, reliable results that can be used in the local context. In this article, we discuss some patient and health care provider needs for human immunodeficiency virus (HIV) load measurement in resource-limited settings. This is just one of the areas in which effective, quality tools are desperately needed, not only by MSF and other international nongovernmental organizations, but also by many other health service providers. We hope that, by clearly defining the needs of patients in MSF clinics-as well as we can assess this-and by explaining why these tools are needed, how they should perform, and how their results can be integrated into a program, we will encourage the development of such tools and hasten their implementation in areas where they are so urgently needed.

  1. When Care is a "Systematic Route of Torture": Conceptualizing the Violence of Medical Negligence in Resource-Poor Settings.

    Science.gov (United States)

    Heckert, Carina

    2016-12-01

    Descriptions of patient mistreatment fill ethnographic accounts of healthcare in resource-poor settings. Often, anthropologists point to structural factors and the ways that the global political economy produces substandard care. This approach makes it difficult to hold parties accountable when there is blatant disregard for human life on the part of individuals providing care. In this article, I draw on the illness narrative of Magaly Chacón, the first HIV positive individual in Bolivia to file charges of medical negligence after failing to receive care to prevent mother-to-child transmission. Magaly's narrative demonstrates how structural conditions are often used to explain away poor patient outcomes, shifting attention away from and normalizing the symbolic violence that also perpetuates substandard care of marginalized patients. I use Magaly's accusations to interrogate how defining acts of mistreatment as medical negligence can be a productive exercise, even when it is difficult to disentangle structural constraints from blatant acts of negligence. Defining who is negligent in resource-poor settings is not easy, as Magaly's case demonstrates. However, Magaly's case also demonstrates that accusations of negligence themselves can demand accountability and force changes within the local structures that contribute to the systematic mistreatment of marginalized patients.

  2. International neurocognitive normative study: neurocognitive comparison data in diverse resource-limited settings: AIDS Clinical Trials Group A5271.

    Science.gov (United States)

    Robertson, K; Jiang, H; Evans, S R; Marra, C M; Berzins, B; Hakim, J; Sacktor, N; Silva, M Tulius; Campbell, T B; Nair, A; Schouten, J; Kumwenda, J; Supparatpinyo, K; Tripathy, S; Kumarasamy, N; la Rosa, A; Montano, S; Mwafongo, A; Firnhaber, C; Sanne, I; Naini, L; Amod, F; Walawander, A

    2016-08-01

    Infrastructure for conducting neurological research in resource-limited settings (RLS) is limited. The lack of neurological and neuropsychological (NP) assessment and normative data needed for clinical interpretation impedes research and clinical care. Here, we report on ACTG 5271, which provided neurological training of clinical site personnel and collected neurocognitive normative comparison data in diverse settings. At ten sites in seven RLS countries, we provided training for NP assessments. We collected normative comparison data on HIV- participants from Brazil (n = 240), India (n = 480), Malawi (n = 481), Peru (n = 239), South Africa (480), Thailand (n = 240), and Zimbabwe (n = 240). Participants had a negative HIV test within 30 days before standardized NP exams were administered at baseline and 770 at 6 months. Participants were enrolled in eight strata, gender (female and male), education (normative data needed to build infrastructure for future neurological and neurocognitive studies in diverse RLS. These normative data are a much-needed resource for both clinicians and researchers.

  3. Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario.

    Science.gov (United States)

    Meleskie, Jessica; Eby, Don

    2009-01-01

    Standardized, preprinted or computer-generated physician orders are an attractive project for organizations that wish to improve the quality of patient care. The successful development and maintenance of order sets is a major undertaking. This article recounts the collaborative experience of the Grey Bruce Health Network in adapting and implementing an existing set of physician orders for use in its three hospital corporations. An Order Set Committee composed of primarily front-line staff was given authority over the order set development, approval and implementation processes. This arrangement bypassed the traditional approval process and facilitated the rapid implementation of a large number of order sets in a short time period.

  4. Economic feasibility of a new method to estimate mortality in crisis-affected and resource-poor settings.

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    Bayard Roberts

    Full Text Available INTRODUCTION: Mortality data provide essential evidence on the health status of populations in crisis-affected and resource-poor settings and to guide and assess relief operations. Retrospective surveys are commonly used to collect mortality data in such populations, but require substantial resources and have important methodological limitations. We evaluated the feasibility of an alternative method for rapidly quantifying mortality (the informant method. The study objective was to assess the economic feasibility of the informant method. METHODS: The informant method captures deaths through an exhaustive search for all deaths occurring in a population over a defined and recent recall period, using key community informants and next-of-kin of decedents. Between July and October 2008, we implemented and evaluated the informant method in: Kabul, Afghanistan; Mae La camp for Karen refugees, Thai-Burma border; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We documented the time and cost inputs for the informant method in each site, and compared these with projections for hypothetical retrospective mortality surveys implemented in the same site with a 6 month recall period and with a 30 day recall period. FINDINGS: The informant method was estimated to require an average of 29% less time inputs and 33% less monetary inputs across all four study sites when compared with retrospective surveys with a 6 month recall period, and 88% less time inputs and 86% less monetary inputs when compared with retrospective surveys with a 1 month recall period. Verbal autopsy questionnaires were feasible and efficient, constituting only 4% of total person-time for the informant method's implementation in Chiradzulu District. CONCLUSIONS: The informant method requires fewer resources and incurs less respondent burden. The method's generally impressive feasibility and the near real-time mortality data it provides warrant further work to

  5. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

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    Afolabi Muyiwa Owojuyigbe

    2016-01-01

    Full Text Available Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4% presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32% followed by ventriculoperitoneal shunt insertion (26.4% for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32% belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

  6. Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review.

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    Reisman, Jonathan; Arlington, Lauren; Jensen, Lloyd; Louis, Henry; Suarez-Rebling, Daniela; Nelson, Brett D

    2016-08-01

    Birth asphyxia contributes substantially to neonatal mortality in low- and middle-income countries (LMICs). The effects of training birth attendants in neonatal resuscitation (NR) on mortality are limited by falloff of skills and knowledge over time and transference of learned skills into clinical practice. This review examined acquisition and retention of NR knowledge and skills by birth attendants in LMICs and the effectiveness of interventions to improve them. Medline, Cochrane, Embase, CINAHL, Bireme, and African Index Medicus databases were searched. We reviewed Web pages and reports from non-peer-reviewed (or "gray") literature sources addressing NR training in LMICs. Articles on acquisition and retention of NR knowledge and skills, and interventions to improve them, were limited to LMICs. The initial search identified 767 articles, of which 45 met all inclusion criteria. Of these, 31 articles analyzed acquisition of knowledge and skills, and 19 analyzed retention. Most studies found high acquisition rates, although birth attendants struggled to learn bag-mask ventilation. Although significant falloff of knowledge and skills occurred after training, refresher training seemed to improve retention. Results of the gray literature analysis suggest that formal, structured practice sessions improve retention. This review did not analyze training's direct impact on mortality. Knowledge and skills falloff is a significant barrier to the success of NR training programs and possibly to reducing newborn mortality in LMICs. Refresher training and structured practice show significant promise. Additional research is needed to implement and assess retention improvement strategies in classroom and clinical settings. Copyright © 2016 by the American Academy of Pediatrics.

  7. Epidemiological, clinical and prognostic profile of childhood acute bacterial meningitis in a resource poor setting

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    Bankole Peter Kuti

    2015-01-01

    Full Text Available Background: Childhood bacterial meningitis is a neurologic emergency that continues to kill and maims children particularly in developing countries with poor immunization coverage. Objective: This study set out to assess the hospital incidence, pattern of presentation, etiologic agents, outcome and determinants of mortality among the children admitted with bacterial meningitis at the Wesley Guild Hospital (WGH, Ilesa. Patients and Methods: We carried out a retrospective review of admitted cases of bacterial meningitis in children aged one month to 15 years at the WGH, Ilesa over a three year period by looking at the hospital records. Factors in the history and examinations were compared among survivors and those that died to determine factors significantly associated with mortality in these children. Results: Eighty-one (5.5% of the 1470 childhood admissions during the study period had bacterial meningitis. Male preponderance was observed and two-thirds of the children were infants. More cases were admitted during the wet rainy season than during the dry harmattan season. Haemophilus influenzae type B and Streptococcus pneumoniae were the leading etiologic agents and ciprofloxacin and ceftriaxone adequately cover for these organisms. Twenty-two (27.2% of the 81 children died, while 34 (42.0% survived with neurologic deficits. Children with multiple seizures, coma, neck retraction, hyponatremia, hypoglycorrhachia, turbid CSF as well as Gram positive meningitis at presentation were found to more likely to die (P < 0.05. None of these factors however independently predict mortality. Conclusion: Childhood bacterial meningitis often results in death and neurologic deficit among infants and young children admitted at the WGH, Ilesa. Children diagnosed with meningitis who in addition had multiple seizures, neck retraction and coma at presentation are at increased risk of dying.

  8. Geologic setting of the Central Alaskan Hot Springs Belt: Implications for geothermal resource capacity and sustainable energy production

    Science.gov (United States)

    Kolker, Amanda M.

    The Central Alaskan Hot Springs Belt (CAHSB) is a vast stretch of low-temperature hydrothermal systems that has the potential to be a geothermal energy resource for remote communities in Alaska. Little exploration has occurred in the CAHSB and the resource is poorly understood. A geothermal power plant was installed in 2006 at Chena Hot Springs (CHS), one of the 30-plus hot springs in the CAHSB. This, in addition to the multiple direct use projects at CHS, could serve as a model for geothermal development elsewhere in the CAHSB. This dissertation evaluates the geologic setting of the CAHSB and explores the implications for resource capacity and sustainable energy production. The local geology and geochemical characteristics of CHS are characterized, with a focus on identifying ultimate heat source responsible for the hot springs. A radiogenic heat source model is proposed and tested for the entire CAHSB, wherein the anomalously radioactive plutons that are associated with nearly every hot spring are providing the source of heat driving the geothermal activity. This model appears to be feasible mechanism for the observed heat transfer. This implies that CAHSB "reservoir" fluids are probably low-temperature. It also suggests that individual hydrothermal systems are small-scale and localized features, unlike the types of hydrothermal systems that are conventionally exploited for energy (i.e., those that derive their heat from magmatic or deep crustal sources, which have higher reservoir temperatures and larger spatial extent). In this context, the individual capacity of several CAHSB resources close to communities is assessed, and a preliminary evaluation of the sustainability of the power production scheme at CHS is given. As another approach to the question of sustainability, this dissertation explores the ways in which external benefits of geothermal energy can influence the economics of a project. In sum, producing geothermal energy from CAHSB resources is

  9. An Evaluation Research on the Construction Problems of Market Integration of Urban And Rural Human Resources%城乡人力资源市场一体化构建问题评价研究

    Institute of Scientific and Technical Information of China (English)

    史洁

    2015-01-01

    The integration of urban and rural human resource markets is an important content for the integration of urban and rural development .Hence, we must focus on guiding the rational flow of productive factors including human resources between urban and rural markets , promoting equal exchange of all kinds of productive factors between urban and rural areas , and implementing equilibrium configuration of public resources.To promote the integration of urban and rural human resource markets , its process and present situation should be combined .In order to accelerate the process of the integration of urban and rural human resource markets , the integrated evaluation index systems and evaluation methods must be established .Scientific evaluation systems in urban and rural human resources markets could not only present the process of the integration, but make effective policies and measures on this account .%城乡人力资源市场一体化是城乡发展一体化的重要内容,必须注重引导包括人力资源在内的生产要素在城乡市场间合理流动,推动城乡各种生产要素平等交换,实现公共资源均衡配置。城乡人力资源市场一体化应结合其进程和现状,通过构建一体化评价指标体系和评价方法来推进。科学的城乡人力资源市场评价体系有助于我们制