[Child physical development and the problems of primary medical health care in the rural areas of developing countries].
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The rural community care gerontologic nurse entrepreneur: role development strategies.
Rural elderly individuals are an underserved population with limited access to health care. There is an increasing need for independent community care nurses to provide assistance to home-based elderly individuals with chronic illnesses to prevent unnecessary medical and placement decisions and, thus, allow them to maintain independence and quality of life. This article describes the rural setting and why community care nurses are needed, and explores strategies for implementing the role of the independent nurse entrepreneur in caring for community-based elderly individuals in rural settings.
Aged↗
Integrated Child Development Services (ICDS) scheme: a program for holistic development of children in India.
The Integrated Child Development Services (ICDS) scheme is the largest program for promotion of maternal and child health and nutrition not only in India but in the whole world. The scheme was launched in 1975 in pursuance of the National Policy for Children. The scheme has expanded in the last twenty-seven years form 33 projects to 5171 blocks. ICDS is a multi-sectoral program and involves several government departments. The program services are coordinated at the village, block, district, state and central government levels. The primary responsibility for the implementation of the program lies with the Department of Women & Child Development at the Centre and nodal department at the states, which may be Social Welfare, Rural Development, Tribal Welfare or Health Department or an independent Department. The beneficiaries are children below 6 years, pregnant and lactating women and women in the age group of 15 to 44 yrs. The beneficiaries of ICDS are to a large extent identical with those under the Maternal and Child Health Program. The program provides an integrated approach for converging all the basic services for improved childcare, early stimulation and learning, health and nutrition, water and environmental sanitation aimed at the young children, expectant and lactating mothers, other women and adolescent girls in a community. ICDS program is the reflection of the Government of India to effectively improve the nutrition and health status of underprivileged section of the population through direct intervention mechanism. The program covers 27.6 million beneficiaries with supplementary nutrition. The program services and beneficiaries has essentially remained the same since 1975. Recently a review of the scheme was held, sponsored by Government of India, which suggested modifications in the health and nutrition component of ICDS scheme to improve the program implementation and efficiency.
Adolescent↗
Arguing for rural health in Medicare: a progressive rhetoric for rural America.
Rural health policy is the laws, regulations, rules, and interpretations that benefit or affect health and health care for rural populations. This paper examines how rural health policy is viewed in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. This paper critically reviews policy statements and policy positions taken by key opinion leaders and the leading stakeholders in rural health policy to determine how advocacy for rural communities is expressed. It is not clear how the rural health advocacy coalition is viewed by the professional policy world or the public: as an issues network pressing for fair and equal treatment or as an interest group seeking special advantages. This paper also explores the types of claims that rural advocates make in the specific context of Medicare policy to determine to what extent those claims reflect a central theme of fairness and inclusiveness in national policies versus claims that benefit special interests. The paper suggests that the rhetoric of rural advocates can be better structured to advocate for policies on the basis of a progressive sense of fairness.
Health Policy↗
Environmental management: a re-emerging vector control strategy.
Vector control may be accomplished by environmental management (EM), which consists of permanent or long-term modification of the environment, temporary or seasonal manipulation of the environment, and modifying or changing our life styles and practices to reduce human contact with infective vectors. The primary focus of this paper is EM in the control of human malaria, filariasis, arboviruses, Chagas' disease, and schistosomiasis. Modern EM developed as a discipline based primarily in ecologic principles and lessons learned from the adverse environmental impacts of rural development projects. Strategies such as the suppression of vector populations through the provision of safe water supplies, proper sanitation, solid waste management facilities, sewerage and excreta disposal systems, water manipulation in dams and irrigation systems, vector diversion by zooprophylaxis, and vector exclusion by improved housing, are discussed with appropriate examples. Vectors of malaria, filariasis, Chagas' disease, and schistosomiasis have been controlled by drainage or filling aquatic breeding sites, improved housing and sanitation, the use of expanded polystyrene beads, zooprophylaxis, or the provision of household water supplies. Community participation has been effective in the suppression of dengue vectors in Mexico and the Dominican Republic. Alone or combined with other vector control methods, EM has been proven to be a successful approach to vector control in a number of places. The future of EM in vector control looks promising.
Animals↗
Lesotho Housing and Land Development Corporation Order, 1988 (No. 12 of 1988).
This Order establishes the Lesotho Housing and Land Development Corporation, managed by a Board of Directors appointed by the Minister of the Interior, Chieftainship Affairs, and Rural Development. The objectives of the Corporation are the following: "1) implementing on a self-financing basis a broad array of schemes including self-help housing, sites and services, land development, and cooperative housing; 2) assisting private parties to develop land and deliver housing; 3) engaging in the development and management of rental housing schemes where it is deemed to be in the economic interest of the Corporation to manage the property; 4) assisting in the mobilization of capital available to the shelter sector by emphasizing in its activities efficiency and cost recovery programs to ensure a good return on investment; 5) developing a longterm capital program that will assure the Corporation's continuing financial viability and ability to remain a vital participant in Lesotho's shelter sector." Further provisions of the Order deal with administration and membership of the Board, financing, accounts, and annual reports, among other things.
Africa↗
Prevalence of tick-borne pathogens in Ixodes scapularis in a rural New Jersey County.
To assess the potential risk for other tick-borne diseases, we collected 100 adult Ixodes scapularis in Hunterdon County, a rapidly developing rural county in Lyme disease endemic western New Jersey. We tested the ticks by polymerase chain reaction for Borrelia burgdorferi, Babesia microti, and the rickettsial agent of human granulocytic ehrlichiosis (HGE). Fifty-five ticks were infected with at least one of the three pathogens: 43 with B. burgdorferi, five with B. microti, and 17 with the HGE agent. Ten ticks were coinfected with two of the pathogens. The results suggest that county residents are at considerable risk for infection by a tick-borne pathogen after an I. scapularis bite.
Animals↗
Eye diseases and services in Tanzania.
Since the Arusha Declaration of 1977, Tanzania has stressed the provision of essential services to rural areas as part of Rural Development. This was to provide essential services such as schools, hospitals and clean water, all of which were disproportionately available in the urban areas in spite of the fact that about 90% of the total population lived in rural areas. Thus the aim of the Ministry of Health was: (a) to strengthen primary health care; and (b) to train enough personnel to deliver the necessary services. In order to do this the Ministry had to reorganise its infrastructure and training programmes. This was achieved by building more primary health centres, rural health centres and by strengthening the District, Regional and Consultant hospitals. Tanzania, like any developing country, suffers from the triad of poverty, ignorance, and disease. To combat eye diseases we need more than just health workers. Planners, social workers, school teachers, agriculturists, politicians and the people themselves especially those living in rural areas have to be alerted and organised to combat the effects of eye diseases. Only by doing so can the specialist, the assistant medical officer ophthalmology and the ophthalmic nurse, do their jobs. Also needed are good and easy methods of delivery of these services. This means the availability of efficacious and cheap drugs and a good communication network.
Blindness↗
Selskar Gunn and China: The Rockefeller Foundation's "other" approach to public health.
The Rockefeller Foundation's program for rural development in China was developed by Selskar Gunn during the period 1932-34 and was initiated in 1935. It was multidisciplinary in nature, and its aim was to raise the educational, social, and economic standards of rural China. It was recognized by some at the time as an alternative to the International Health Division's approach to public health. This paper describes the program, what led Gunn to develop it in China, and the internal tensions that it created. Also addressed is the question of why this program had such limited impact on subsequent developments in the field of international health.
China↗
Training for rural practice in Australia 1990.
There is a shortage of general practitioners in rural Australia. Several recent State and federal government reports have highlighted the difficulties of rural practice. One of the reasons commonly cited for the shortage of country doctors is the lack of appropriate training in Australia's medical schools and the Family Medicine Programme. This survey of the heads of departments of community medicine/general practice of Australia's 10 medical schools and of the State directors of the Family Medicine Programme documents the present efforts to train doctors for rural general practice. A 100% response was achieved. The responses indicate much interest and effort from the Family Medicine Programme in developing rural training schemes. Though the community medicine/general practice departments demonstrate considerable interest and innovation, they are hampered by lack of resources and negative attitudes of some specialist colleagues. Overall, the main impediments are: lack of "affirmative action" admissions policies to recruit rural students; insufficient curricular time for teaching the principles of general practice; students' lack of confidence in the procedural aspects of rural practice; lack of appropriate training posts in anaesthetics; lack of appropriate general practice training posts at regional hospitals; and lack of financial resources. Some suggestions are given to improve training for rural practice in Australia.
Attitude of Health Personnel↗
Fertility and population policy in two counties in China 1980-1991.
A survey of women in two highly developed rural counties of China, Sichuan and Jiangsu Provinces, was carried out in late 1991, to gain information about demographic and economic change between 1980 and 1990. Three separate surveys were conducted: the first a questionnaire administered to married women aged 30-39, eliciting information about childbearing and contraception, as well as the social and economic background of the respondents; the second, focus group interviews emphasizing the motivation for childbearing. Official information about the selected villages, townships and counties was also collected. National level data in 1987 show that individual reproductive behaviour in China failed to conform to a universal, effectively implemented, population policy. They imply either a spatial range of policies, or great diversity in the demand for children, or perhaps a combination of both. Such diversity in reproductive behaviour is also found in the study area. The purpose of the analysis was to examine the diversity in reproductive behaviour and contraceptive practice, and to discover whether differentials are influenced by area, or else exist between individuals within areas. If the former, then the explanation may be found in differences in policy formulation and implementation between areas: and if the latter, to demand for children, or else differential application of policy restrictions. The main findings were that: (1) the explanation of the pattern of fertility and contraceptive use is to be found at the individual level (within locations) rather than in policy differences between administrative units; (2) the association between income and number of children is negative, as is that between income and the propensity for uniparous women to remain unsterilized. The theory that privilege may be exercised to gain concessions from birth planning cadres is therefore not supported; (3) ideal family size differentials are largely absent, showing that social (education) and economic (income, occupation) characteristics are not responsible for differences in reproductive motivations, and implying that the nature of the demand for children is very different from that in most rural areas of the Third World; (4) data on ideal family size by sex of the existing offspring indicate only a weak preference for sons. The low demand for children, and the weak son preference, may both be explained by the social acceptability of uxorilocal marriages, and of village endogamy, together with the prohibitive costs of children, and especially of sons. This partly results from the expense of education, but most mothers emphasize marriage costs. It is speculated that the circumstances responsible for the escalating costs of children in the two countries are likely to pertain in growing areas of the country, with the privatization of education and health services, the declining support of collective institutions, and the replacement of this function by kinship networks. These on-going changes imply that any policy of reproductive restriction for the purposes of population control is likely soon to meet with diminishing resistance; and it may later be rendered unnecessary in the eyes of government officials, as fulfilled reproductive intentions lead to a fertility level below replacement level.
Adult↗
Viral infections during pregnancy and in early life.
There is evidence that fetal antigenic stimulation and intrauterine infection is much more frequent in developing rural populations than in industrialized societies. A similar contrast is observed for postnatal intestinal infection that is significantly greater in the less developed areas. The differences are explained by the divergence in environmental sanitation and personal hygiene. Intestinal infection is important in that diarrheal disease is one of the main factors leading to malnutrition. It is apparent that for developing nations to attain better nutrition, much of the present burden of intestinal infection needs to be controlled.
Feces↗
Africa: addressing growing threats to food security.
Africa remains the only region in the world where the number of hungry people will still be on the increase in 2020, and the number of malnourished children will have increased correspondingly. In this report I have acknowledged the general public policy trends across Africa in terms of macroeconomic policy reforms and political transitions. These welcome trends have to still produce stable nations and economies. Although economic development is the long-term solution to Africa's challenge on hunger and poverty, this will take time. And it follows therefore that African nations have to pursue policies and strategies that promote long-term growth while at the same time offering short-term safety nets for the poorest of the poor. The growth and development strategy will have at its core the need to increase significantly the levels of public-sector investment in agriculture and rural development and to give top priority to the commercialization of smallholder agriculture so as to increase productivity and competitiveness. But food security at the household level is ultimately a balance between availability and access, and in this regard governments need complementary food security policies that increase the probability of food access by the vulnerable groups.
Africa↗
Environmental, health and economic conditions perceived by 50 rural communities in Bangladesh.
For randomly selected 50 villages in Bangladesh, an interview survey with a structured questionnaire was conducted to reveal their perception on the environmental, health and economic conditions at present and for the past 10-year change. The eight following items were analyzed in this paper: air pollution and water pollution, which represent environmental conditions with close relation to health conditions, soil degradation and deforestation, which represent environmental conditions with close relation to economic conditions, epidemic diseases and malnutrition, which represent health conditions, and poverty and jobless, which represent economic conditions. Among the 50 villages, deforestation was most frequently perceived serious at present and worsened in the past 10 years. Of the remaining seven items, those related to economic conditions were more seriously perceived than those related to health and environmental conditions. As revealed by the cluster analysis for the inter-item relations, epidemic diseases, which formed the same cluster with the environmental items, were recognized less serious whereas malnutrition, which formed the same cluster with the economic items, was recognized more serious. These findings are useful not only for rural development programs but also for mitigation programs toward health and environmental hazards in Bangladesh.
Bangladesh↗
Sudan: national health programme and primary health care, 1977/78-1983/84.
As a follow-up to the national health programming process developed in 1975 in Sudan, a primary health care programme for the whole country was formulated with assistance from WHO. In this article the methods used in the programming and formulation are described and discussed. These methods ensured an intersectoral approach on which technical, cultural, socioeconomic, financial, and political considerations were based. Areas in the field of health and rural development requiring government and community action during the period 1977/78-1983/84 are identified. Details on the strategies for population coverage of rural and nomadic communities with primary health care are given. Fundamental to these strategies is community participation in the development of primary health care within community development as a whole.The guiding principles of these strategies are their technical, political, social and financial feasibility. The social relevance of the primary health care programme for the community and the developmental sectors is emphasized.
Health Planning↗
Prevalence and risk factors of chlamydia and gonorrhea among rural Nepali women.
OBJECTIVES: The epidemiology of sexually transmitted infections (STI) in rural, developing world populations is poorly understood. We estimated the prevalence and risk factors of Neisseria gonorrhoeae and Chlamydia trachomatis in a female population in rural Nepal. METHODS: We conducted a cross sectional study in a sample of 1177 postpartum women participating in a micronutrient supplementation trial in Nepal. Urine samples were collected to test for the two infections using the ligase chain reaction (LCR). RESULTS: C trachomatis was detected in 1.0% (95% confidence intervals (CI): 0.4 to 1.5) and N gonorrhoeae in 2.3% (95% CI: 1.2 to 3.4) of women. None of the women tested positive for both. Self report of all three symptoms of lower abdominal pain, pain and burning on urination, and vaginal discharge was associated with the presence of gonorrhoea (odds ratio (OR): 12.1, 95% CI: 1.3 to 115.0). Neonatal eye discharge was associated with maternal gonococcal infection (OR = 5.2, 95% CI: 1.1 to 24.9). Incidence of low birth weight was not related to these maternal infections, but very preterm delivery (<32 weeks) was higher among women positive for gonorrhoea (OR = 4.7, 95% CI: 1.0 to 22.0). In a multivariable analysis, low body mass index (<18.5) and cattle ownership were associated with gonorrhoea (p <0.05), whereas woman's literacy was associated with chlamydia (p = 0.06). CONCLUSION: We found the rates of N gonorrhoeae and C trachomatis to be low among women in this rural population of Nepal.
Body Mass Index↗
Ageing in rural China: impacts of increasing diversity in family and community resources.
The majority of China's population lives in rural areas and a pattern is emerging of very uneven provision of support for rural elderly people. Local economic conditions and broad demographic trends are creating diversity in the ability both of rural families to care for their elderly kin and in the capacity of communities to support their elderly residents and family carers. In part as a consequence of China's population policy and the 'one-child policy', future Chinese families will have fewer members and be 'older', but they will continue to be regarded emotionally and in policy as the main source of economic and social support for the elderly. The increasing involvement of women in the paid workforce and the changing geographical distribution of family members resulting from work-related migration, are reducing the ability of families to care for their elderly relatives. The availability of resources other than the family for the care of older persons therefore becomes a key issue. Communities in more prosperous, modernising rural areas are often able to provide their elderly residents with welfare and social benefits previously found almost exclusively in urban areas. However, in poorly developed rural areas, provision is either very patchy or non-existent and the local economy cannot support expansion or improvement. A case study in Zhejiang Province illustrates the favourable provision for ageing in a prosperous modernising rural community, in which entitled elderly residents are provided with an impressive array of financial and social benefits. The paper concludes with a consideration of the policy implications of the growing differentiation of the social and economic capacity of rural communities to support their elderly members.
Journal Article↗
The Farmer Field School: a method for enhancing the role of rural communities in malaria control ?
Malaria has strong linkages with agriculture, and farmers in malarious regions have a central position in creating or controlling the conditions that favour disease transmission. An interdisciplinary and integrated approach is needed to involve farmers and more than one sector in control efforts. It is suggested that malaria control can benefit from a complementary intervention in rural development, the Farmer Field School (FFS) on Integrated Pest Management (IPM). This is a form of education that uses experiential learning methods to build farmers' expertise, and has proven farm-level and empowerment effects. The benefits of incorporating malaria control into the IPM curriculum are discussed. An example of a combined health-agriculture curriculum, labeled Integrated Pest and Vector Management (IPVM), developed in Sri Lanka is presented. Institutional ownership and support for IPVM could potentially be spread over several public sectors requiring a process for institutional learning and reform.
Agriculture↗