Resolution No. 44/78. Improvement of the Situation of Women in Rural Areas, 8 December 1989.
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Demography↗
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Problems of rodent control in rural tropical areas.
Rodent control strategies, techniques, and research needs in rural tropical environments are reviewed and discussed with special reference to Mastomys natalensis, the possible reservoir of Lassa fever in West Africa.Public health rodent problems are far more serious and widespread in rural tropical areas than in developed countries. In the latter, only the commensal rodents constitute a major problem, whereas in rural tropical areas, native semidomestic species also serve as disease reservoirs and sources of infection to man. The success of rodent control programmes in developed countries depends in large part on the willingness and ability of people and governments to spend relatively large sums on research and control, on an acquired intolerance of people to rats and disease, and on a substantial economic base. These prerequisites are not usually to be found in rural tropical areas. Consequently, the rodent control techniques and programme organizations of developed countries are not directly applicable to such areas, even though the principles are the same. For this reason, it is suggested that a well-funded, integrated research and control programme should be undertaken in a known Lassa fever area, stressing public education, personnel training, and environmental management as well as rodenticidal approaches.
Africa, Western↗
Pattern of poisoning in rural Sri Lanka.
An epidemiology study of poisoning was done in a geographically defined area in rural Sri Lanka, a developing agricultural country. The incidence of poisoning was 75 per 100,000 population and the death rate was very high (22 per 100,000 population). Both were highest in the age group 15-34 and there were significant ethnic differences in the incidence of poisoning. Agrochemicals were responsible for 59% of all poisonings. Paraquat was the commonest poisoning agent with a high fatality rate of 68%. Use of highly toxic agents may have resulted in deaths where there was no intention to commit suicide. Strict legislation regarding the sale, distribution and storage of agrochemicals could result in the reduction of mortality and perhaps the incidence of poisoning, in developing agricultural countries.
Adolescent↗
The Tippy Tap: a simple handwashing device for rural areas.
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Developing Countries↗
MEDICOL: online learning in medicine and dentistry.
OBJECTIVE: MEDICOL (Medicine and Dentistry Integrated Curriculum Online) provides a variety of Web-based resources that act as important adjuncts to all the teaching components of the medical and dental undergraduate curriculum. It uses WebCT, a course-management system, to provide the following educational functions: (1) track students' progress and present course information such as time-tables, learning objectives, handout materials, images, references, course assignments, and evaluations; (2) promote student-to-student and student-to-instructor interactions (through e-mail and bulletin boards); and (3) deliver self-directed learning components, including weekly self-assessment quizzes that provide immediate feedback and multimedia learning modules (clinical skills, radiology, evidence-based medicine, etc.). DESCRIPTION: The University of British Columbia Faculties of Medicine and Dentistry feature a problem-based learning (PBL) curriculum in which students access many of the same tools they will utilize in their professional practice. In the PBL curriculum, students must access the relevant clinical data and educational resources. A MEDICOL site has also been developed for medical students to use during their rural family practice, a four- to six-week experience in the summer after their second year. This site has been designed to be a supplemental learning environment for not only these students, but also for their physician preceptors. It is intended to foster communication among participants, bring new resources to the rural setting, and allow preceptors to develop their Internet skills with the help of students who are already familiar with the electronic environment. The MEDICOL sites enable the exchange of information about the learning issues between, as well as within, tutorial groups. MEDICOL also provides students with faculty-reviewed resources that are listed online; multimedia presentations; and access to histology, radiology, and pathology images through an online image database. Each week, students have access to a new interactive and automatically graded self-assessment quiz for individual study. These quizzes test learning objectives from tutorial, lecture, and lab material for each week of the curriculum and are modeled after summative examinations held twice each year. Question authors provide immediately accessible quality feedback to students. A comprehensive quiz databank of approximately 1,500 questions has been attained. WebCT enables MEDICOL to deliver anonymous, online program-evaluation questionnaires during clinical clerkships (resulting in a 99% response rate after a few e-mail reminders), with easy and timely data collection and reporting methods. Summative assessments have also been delivered through MEDICOL. DISCUSSION: Use statistics indicate that over 90% of students regularly use the MEDICOL sites and have found them helpful. University of British Columbia medical school enrollment will increase because of collaborations with campuses and medical centers across the province. MEDICOL will likely play an increased role in distance learning by continuing to deliver the resources already described, as well as facilitating synchronous communications (e.g., PBL chat rooms) and teaching (e.g., video-streamed lectures) to students located across the province.
Education, Dental↗
An educational workshop program for rural practitioners to encourage best practice for delivery of systemic adjuvant therapy.
BACKGROUND: The Rural Systemic Adjuvant Therapy Project was initiated to encourage best practice in the treatment of women from rural areas who have breast cancer. METHOD: We developed an educational program, piloted it and conducted it in 5 regions. In a pre-evaluation/post-evaluation, we assessed participants' perceived knowledge about systemic adjuvant therapy. RESULTS: A statistically significant increase occurred in participants' reported knowledge about all program topics. Improved communication links with the local or visiting medical oncologist were planned. CONCLUSION: The workshop program was found to be a successful tool for delivering evidence-based information about the use of systemic adjuvant therapy.
Analysis of Variance↗
Kerala State, India: radical reform as development.
Kerala State in southwestern India has achieved some of the third world's best rates of life expectancy, literacy, and infant mortality, despite one of the lowest per capita incomes. Especially notable is the nearly equal distribution of development benefits to urban, rural, male, female, high-caste, and low-caste sections of the populations. An even population distribution, a cosmopolitan trading history, and the development of militant worker and small farmer organizations led by dedicated activists provide the main explanations for Kerala's achievements. Land reform has redistributed wealth and political power from a rich elite to small holders and landless laborers. Public food distribution at controlled prices, large-scale public health actions, accessible medical facilities, and widespread literacy combine with and reinforce each other to maintain and expand Kerala's achievements. Serious unemployment threatens the Kerala experiment, but Kerala nonetheless offers important lessons to development planners, policymakers, and third world activists.
Communism↗
Measles control in a rural area in Zimbabwe.
In the rural district of Chimanimani in Zimbabwe, the Expanded Programme on Immunisation (EPI) which started in January 1982 has achieved measles coverage of between 50 and 80% in the 12-23 months age group, from 1984 to 1988, through 65 outreach centres, and 15 static health centres serving 93985 people in 119 villages. Facility based data as well as community based surveys have failed to show serious measles transmission in children under nine months of age, a common observation in high population density urban areas in Africa. Instead there has been a reduction in measles incidence and age distribution of measles has shifted to older children. The lowest measles incidence rate of 0.8 per 100 children occurred in the 0-5 months age group and the highest incidence rate of 4.0 per 100 children in the 48-59 months of age group. Only 7.9% of measles cases occurred in children under nine months of age. The high vaccination coverage rates were made possible by the post-independence government commitment, community involvement and dedicated staff. Our observations support the current one-dose 9 months minimum age measles vaccination policy for the low density rural areas in the developing countries.
Age Factors↗
Risk factors for development of first symptomatic Giardia infection among infants of a birth cohort in rural Egypt.
Giardia infection is associated with diarrheal diseases among infants and young children in both industrialized and developing countries. A study was conducted to demonstrate the predisposing factors for occurrence of the first symptomatic Giardia infection among infants in rural Egypt. The study cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data revealed that infants less than six months of age were at special risk for developing their first symptomatic infection compared with infants more than six months of age. Analysis of the data, furthermore, revealed an increased risk of infant Giardia infection associated with living in a household without a latrine (relative risk [RR] = 2.63, confidence interval [CI] = 1.4-4.9, P < 0.05), a mud floor in the sleeping rooms (RR = 1.79, CI = 1.O30-3.0, P < 0.05), and household exposure to more than 10 chickens (RR = 2.5, CI = 1.13-5.56, P < 0.05). In contrast, the mother's education beyond the primary level (RR = 0.28, CI = 0.09-0.85, P < 0.05), drinking water stored in metallic containers (RR = 0.33, CI = 0.11-0.98, P < 0.05), and male sex (RR = 0.52, CI = 0.3-0.89, P < 0.05) were associated with decreased risk of Giardia infection. These data suggest that in addition to age of infants, poverty, low education, gender discrimination, and certain environmental conditions potentiated the risk for developing the first symptomatic infection.
Animals↗
Building capacity to provide palliative care in rural and remote communities: does education make a difference?
One strategy for improving access to palliative care services in rural and remote communities is to educate community-based health professionals in the knowledge and skills required to provide end-of-life care. It is, therefore, important to evaluate palliative care educational initiatives. This article provides an evaluation of the interdisciplinary education program at Lakehead University which aims to: improve the knowledge and skills of individual providers; contribute to the development of palliative care programs in rural communities; and develop palliative care trainers to educate their co-workers in the workplace. A survey of 353 providers who participated in the education program was completed after eight years of providing education. Results confirm that the goals of the education program were met, and that rural and remote communities reported a greater capacity to deliver palliative care. Nevertheless, respondents identified a lack of resources, especially home care visits, as an obstacle to improving care.
Analysis of Variance↗
Outcomes of rural training tracks: a review.
Rural training tracks (RTTs) have developed as a strategy to encourage family medicine resident entrance into rural practice. Because most programs are small (two to four residents), data must be aggregated to determine RTT impact on practice preparation and location. Several studies over the last decade reveal that 76 percent of RTT graduates are practicing in rural America and that graduates describe themselves as prepared for rural practice. Sixty-five percent are providing obstetrical services, and half are performing cesarean sections. From 1989 to 1999, there were a total of 107 graduates of rural training programs, making it unlikely that, without significant investment, this model could supply an adequate quantity of family physicians for rural America.
Career Choice↗
Using grant funding for innovative projects.
As part of the Balanced Budget Act of 1997, Congress created the Medicare Rural Hospital Flexibility Program for limited-service hospitals. The program is intended to bolster fragile rural service through network development. As part of the program, states may create a program to convert hospitals to critical access hospital (CAH) status. CAH designation gives very small, rural hospitals staffing flexibility for providing emergency, outpatient, and short-stay inpatient services and Medicare reimbursement on a reasonable cost basis. Michigan now has 14 critical access hospitals.
Disease Management↗
Policy aspects of development and individual mobility: migration and circulation from Ecuador's rural Sierra.
"Individual out-migration and out-circulation from Ecuador's rural Sierra during the period 1974-1982 are jointly examined to identify differences in each process. Personal attributes operate similarly, but place characteristics associated with development do not. Particular attention is given to land reform policies and related occurrences as forces of regional change, which in turn affect population movements. Also highlighted is the importance of place knowledge, particularly in drawing substantively informed conclusions from statistical analyses of data with broad geographic coverage."
Americas↗
Implementing a rural nursing course.
Southern Alberta is essentially a rural Canadian province and therefore an ideal setting for offering a rural-focused nursing course. Considering the need for professional nurse preparation with a rural focus, three schools of nursing in the Province collaborated to launch their first rural nursing course. The authors elaborate on the process of developing the course, then establishing partnerships with rural communities to provide opportunities for a nursing practicum.
Alberta↗
Use of a clinical audit to promote the quality use of medicines to rural and remote general practitioners.
Very few methods have been shown to change prescribing behaviour. Queensland Rural Medical Support Agency's Quality Use of Medicines (QUM) Program aims to engage rural general practitioners (GPs) in the development of strategies to improve health outcomes in relation to the quality use of medicines. The present paper describes the development of a tool to audit the management of heart failure in rural general practice and to encourage rural GPs to undertake such an audit as a method of continuing medical education. A self-administered retrospective clinical audit of heart failure patients was undertaken by rural and remote GPs. Fourteen doctors undertook the audit, providing data on 270 patient cases. Patient data collected include 30% not receiving adequate angiotensin-converting enzyme inhibitor doses, 45% of patients who may benefit from a beta-blocker and 14% of patients taking a drug known to aggravate heart failure. The majority of participants would review a patient following the audit and 93% confirmed that the audit assisted them in identifying patients whose heart failure management could be enhanced. The clinical audit provided results and a commentary to allow GPs reflective educational opportunities through the dissemination of results and engagement with appropriate educational organisations (e.g. Australian College of Rural and Remote Medicine) to inform the development of educational standards for personal development programs in QUM. Audits must be relevant and practical to meet the learning needs of GPs.
Adrenergic beta-Antagonists↗
NGOs in community health insurance schemes: examples from Guatemala and the Philippines.
In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.
Accreditation↗
The benefits of the CAGE as a screening tool for alcoholism in a closed rural South African community.
OBJECTIVE: Testing the benefits of the CAGE questionnaire (a four-item test with questions on Cutting down, Annoyance at criticism, Guilty feelings and use of Eye-openers) in screening for possible alcoholism in rural underserviced South Africa. DESIGN: The CAGE questionnaire and the Diagnostic and Statistical Manual i.v. diagnostic criteria for substance abuse and dependence were used to screen a representative sample (N = 96) of a rural community in the North West province of South Africa. SETTING: The closed community of Ammerville situated at Fraserburg, approximately 500 km from Cape Town. SUBJECTS: Adults above the age of 18 years. RESULTS: The prevalence of alcohol dependence in this community was 56%. The 'positive' CAGE (two or more affirmative replies) showed a sensitivity of 100% and a specificity of 78% for alcohol dependence. This compared favourably with similar screening results in other clinical settings. CONCLUSIONS: The high prevalence of alcohol dependence (56%) in this community, and the possibility of comparable results in many similar rural South African communities, reflect a startling reality that should be addressed. Use of the CAGE by other than traditional sources is recommended and emphasised. Treatment modalities for alcohol dependence and abuse in rural areas should be developed.
Adult↗
Can structural adjustment work for women farmers.
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Agriculture↗
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