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PubMed2000

Quality-of-care challenges for rural health.

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable.

Health Services Accessibility↗

PubMed1998

Rural psychiatry in developing countries.

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.

Developing Countries↗

PubMed2003

Estimation of methane emission from rice cultivation in Korea.

This study focused on estimating a methane (CH4) inventory and developing mitigation options in South Korea, and was performed jointly in an integrated national research program on CH4 from rice fields conducted by three National Agricultural Research Institutes, under the Rural Development Administration during 1993-1997. Methane emissions were measured by a closed chamber method, in rice plots at three locations (Suwon, Iksan, and Milyang) with the single rice cropping system. All experimental data from 5 years of study were summarized and used for calculating nation-wide CH4 emissions. Temperature, soil type, cultural practices, water management, organic matter management, and cultivar selection significantly affected the fluctuations of CH4 emissions. The two most promising mitigation options for reducing emissions were altered water management, in particular mid-season aeration by short-term drainage, and improved organic matter management, by promotion of aerobic degradation through composing or soil incorporation. Annual total CH4 emission in Korea changed from 410Gg in 1990 to 339Gg in 2000, due mainly to a decrease in the cultivated area of paddy rice. If we convert annual CH4 emission to Global Warming Potential as CO2 equivalent, it amounts to 7.1 M CO2 t yr(-1) of greenhouse gas emitted to the atmosphere in 2000 from the rice fields in Korea, which is just 5.3% of the annual CO2 emission from the industry and energy sector. More importantly, the balance between CO2 uptake by photosynthesis and CO2 emission is positive (a net sink), so that rice culture actually has net benefits for the global atmospheric carbon issue. Further reductions in emission amounts, by following recommendations in this article, could make these benefits even greater.

Agriculture↗

PubMed2005

[Feasibility of the programme of focusing on early childhood development in impoverished rural areas in China].

OBJECTIVE: To study the feasibility of the programme "Focusing on early childhood development" in impoverished rural areas in China. METHODS: A questionnaire survey was conducted among 100 mothers, about half with junior middle school education, 18% with grade-school education, and 29% being illiterate, of children aged under two years in 7 villages in Changfeng County, Anhui Province, a native impoverished county, to understand their knowledge and attitudes about child healthcare. Then these mothers were randomly divided into 2 equal groups: experimental group, receiving face-to-face guidance in the practice of early healthcare for children at home with a pamphlet developed by WHO as teaching material; and control group without receiving guidance. Two months later the mothers received the second session of guidance. Six months after the same questionnaire survey was conducted among the 100 mothers to investigate the changes in knowledge and practice and Gesell development test was made to observe the changes in mental development. Two-days' training on the technique of early child healthcare in the form of reading, videotape presenting, and exercise, was given to 29 village doctors. Questionnaire survey was conducted among them before and 1 month after the training to understand the changes of their knowledge and attitudes towards early child healthcare. RESULTS: After the guidance the knowledge and fostering skills in terms of early child healthcare were improved significantly among the mothers of the experimental group in comparison with the mothers of the control group (P < 0.01). After the training most of the village doctors managed put the knowledge they had learned into practice, however, the percentage of those who lacked confidence in the smooth implementation of the programme remained unchanged (38% vs. 41%). Before the experiment the abilities in different fields were not significantly different between the children in these 2 groups. Six months after the implementation of the programme the abilities in fine motion, speech, and interpersonal communication were improved significantly among the children of the experimental group (all P < 0.05). CONCLUSION: Economic, simple, and effective, the programme "Focusing on early childhood development" is suitable for the impoverished rural areas in China.

Child Development↗

PubMed1996

Access to care in post-economic reform rural China: results from a 1994 cross-sectional survey.

The purpose of this paper is to assess the current level of access to care in rural China based on results from a 1994 random, cross-sectional survey of three rural counties in China. A total of 722 people were interviewed. The results of the study indicate there is currently a significant gap among rural Chinese communities in terms of access to health care, particularly with regard to availability (e.g., cooperative health plan or other insurance plans) and acceptability (e.g., health care spending burden). Less developed rural communities are placed in double jeopardy: not only are residents paying a higher amount for health care, they have to do so with significantly less income.

Analysis of Variance↗

PubMedDate not supplied

[An American in Clamency: closing of small hospitals in France].

This article chronicles events in 1993-1994 in the small rural town of Clamecy, located in the Burgundy region of France, stemming from proposals of regional planning authorities to close the maternity and emergency services of the local hospital. This possibility engendered a series of protests and maneuvers by town notables, hospital personnel, and local physicians to halt such plans. The situation provided an opportunity for a sociological examination of the role of the hospital in the social and economic life of a rural community. This included a series of unstructured interviews with various townspeople and health professionals conducted within a sociological framework and with the benefit of the author's status as a foreign observer, beholden to no particular French political affiliation or health policy position. The results of the study reveal profoundly held perceptions that the hospital was a key element in the social, cultural, and economic life of the community, far surpassing its "mere" role as a health delivery organization. These findings are placed in the French context of rural development on the one hand, and rationalization of the health delivery system on the other.

France↗

PubMed2004

Novel application of a whole blood intracellular cytokine detection assay to quantitate specific T-cell frequency in field studies.

We optimized a whole blood intracellular cytokine assay to quantitate the frequency of specific CD4+ and CD8+ T cells in small volumes of whole blood from infants from developing countries. The assay is performed in two steps. First, whole blood is stimulated in the presence of specific antigens for 6-18 h, ending with cryopreservation of fixed white cells. These stimulation steps were specifically adapted to be practical and reliable in a rural, developing country field setting. Later, in a more resourceful setting, interferon-gamma producing CD4+ or CD8+ T cells are detected by flow cytometry. The assay proved sensitive and specific for detecting mycobacteria-specific immunity 10 weeks after Bacillus Calmette-Guerin (BCG) vaccination of newborns from a rural field site.

BCG Vaccine↗

PubMed1998

Maternal carriage of group B streptococci in developing countries.

BACKGROUND: Group B streptococcus (GBS) is a leading cause of neonatal sepsis in many industrialized countries, but reports from the developing world infrequently identify this pathogen among newborns with sepsis. Studies of GBS colonization among women living in developing countries were reviewed to determine whether lower colonization rates might account for these findings. METHODS: Literature was reviewed with the use of Medline Express (1980 to 1996) and Abstracts on Tropical Agriculture and Rural Development in the Tropics (1975 to 1995). The methods of each report were considered adequate if specimens were collected from the vagina and if selective broth media were used. RESULTS: Thirty-four studies reported results of cultures from 7730 women; overall colonization was 12.7%. Among only those studies in which methods were adequate, 17.8% (675 of 3801) women were identified as colonized. Studies with adequate methods found significantly higher colonization rates (relative risk, 2.3; 95% confidence interval, 2.0 to 2.6) than those using inadequate methods. When analysis was restricted to reports with adequate methods, the prevalence of colonization by region was as follows: Middle East/North Africa, 22%; Asia/Pacific, 19%; Sub-Saharan Africa, 19%; India/Pakistan, 12%; and Americas, 14%. CONCLUSION: Although there is significant geographic variation in the proportion of women colonized with GBS, the range of colonization reported from developing countries is similar to that identified in populations studied in the United States. Specimen collection and microbiologic methods are important factors in identification of women colonized with GBS.

Adult↗

PubMed1985

Cropping systems and household food security: evidence from three West African countries.

The following four articles describe several aspects of the complex yet basic processes of food production and consumption in African settings. Three elements in the picture stand out as subjects of current research and development action: traditional food crops, seasonality and women's activities. It is important that specialists enhance their understanding of those processes and the dynamic interrelations among particular elements, in the interests of improved nutrition and rural development.

Agriculture↗

PubMed1998

Testing a causal model of community-based education in the Sudan.

PURPOSE: To develop and test a model of community-based education. METHOD: In 1995, after developing a hypothesized causal model for community-based education, the authors collected data for 106 students at the University of Gezira, the Sudan, who had participated over three summers in an interdisciplinary field training research and rural development course. The students rated each other on leadership, interaction with the community, subject-matter contributions, and effort. Teaching staff assessed the readiness of the community to collaborate. The students' achievement was measured by short essays measuring knowledge, supervisors' assessments of the students' performances in the community, the community's observations of the students' activities, the community's satisfaction, and a group-produced report evaluated by faculty. The effect of the students' activities on the community was measured by comparing baseline and post-intervention community health data. The students also indicated their levels of interest in the community's problems. The authors analyzed the resulting covariances using structural-equations modeling. RESULTS: After minor adaptations, the model fitted the data reasonably well. The path coefficients were quite high, particularly among the peer ratings. Leadership had a potent effect on the outcome measures, as did, to a lesser extent, the readiness of the community to collaborate with the students. CONCLUSION: This study was the first reported attempt to test a model of community-based education. Although the fit of the data to the model in the study was reasonable, further study is needed to unearth additional important elements of community-based education. This article also discusses methodologic shortcomings of the present study, such as a possible "halo effect" in the peer ratings and the retrospective nature of many of the measurements.

Ambulatory Care Facilities↗

PubMedDate not supplied

[An approach to food consumption in an urban environment. The case of west Africa].

West Africa has undergone rapid economic and political changes during the last 20 years. After the failure of economic policies implemented since independence, programs for structural adjustment have strongly influenced the economy. Food problems affect each country differently. The Sahel has experienced food shortages and starvation whereas in forested countries the food supply has remained stable. Nevertheless, food policies have not succeeded in contributing to urban and rural development. The rate of urbanization in west Africa is generally low but the rate of urban population growth is particularly high, much more than the growth rates of industry and infrastructure. Although metropolitan areas are affected by poverty, they offer more hope and opportunities than rural areas. Urban markets have expanded and diversified as social differences have also increased and contributed to changes in consumption structure. Urban growth has contributed to the increase of imported food: this is indicated by both the strong dependency and the change of food habits towards western food patterns. Recently however, west African urban dwellers are still preferring local items if they are affordable. When imported products are used, they are integrated within a stable meal plan consisting of a single dish with a base and a sauce, which is typical of African food preparation. Surveys of consumption-budgets are still only available on a national scale. These can provide accurate information about food consumption patterns of families, particularly for significant trends. However, they do not provide information about the dynamics of food consumption, neither for urban areas or the individual. Now a significant proportion of individual food consumption occurs outside of the home, mainly with food provided by street vendors. This new consumption habit is a response to the urban food crisis. Consumption of street-vendor-food comprises one component but this cannot be dissociated from in-home food consumption. Despite the growing importance of street-vendor food consumption, it has still not been adequately documented. Theoretically, food consumption is an evolving concept. Single disciplines, such as economics or nutrition, first studied food consumption. More recently, social sciences developed new approaches with various interpretations, which were sometimes contradictory. The evolution of urban food consumption and the numerous related problems support the approach proposed by some authors suggesting a mixed analysis integrating both economics and cultural factors. Operationally, a global and dynamic approach to food styles must consider urban heterogeneity and diversity of situations. For example, food consumption by people maintaining their in-home food habits shows the pertinence of studies focusing on individuals. Therefore, the food course concept may be a useful method for the study of food consumption.

Africa, Western↗

PubMed2005

Emergency medical services in Zimbabwe.

Emergency medical services in Zimbabwe are of a very variable standard, and exist in many forms: *Reasonably well-developed urban emergency medical services systems mixed with very poorly resourced and under-developed rural services. *Very high patient workloads, with severely ill medical patients and a large proportion of major trauma and multiple-casualty situations (public safety is given a low priority, and public transport is poorly regulated). *Long emergency response times and patient transport distances. *Somewhat under resourced and under developed emergency departments, with large numbers of critically ill acute patients, as well as many non-emergency/chronic patients who have no other access to appropriate health care. This paper provides a description of the development of ambulance services and acute health care in Zimbabwe, and outline the current demands on the system. Particular reference is made to the City of Harare Ambulance Service, which is considered to be the most developed of the local authority services.

Allied Health Personnel↗

PubMed2000

Gender, socioeconomic development and health-seeking behaviour in Bangladesh.

In efforts to reduce gender and socioeconomic disparities in the health of populations, the provision of medical services alone is clearly inadequate. While socioeconomic development is assumed important in rectifying gender and socioeconomic inequities in health care access, service use and ultimately, outcomes, empirical evidence of its impact is limited. Using cross-sectional data from the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper examines the impact of membership in BRAC's integrated Rural Development Programme (RDP) on gender equity and health-seeking behaviour. Differences in health care seeking are explored by comparing a sample of households who are BRAC members with a sample of BRAC-eligible non-members. Individuals from the BRAC member group report significantly less morbidity (15-day recall) than those from the non-member group, although no gender differences in the prevalence of self-reported morbidity are apparent in either group. Sick individuals from BRAC member households tend to seek care less frequently than non-members. When treatment is sought, BRAC members rely to a greater extent on home remedies, traditional care, and unqualified allopaths than non-member households. While reported treatment seeking from qualified allopaths is more prevalent in the BRAC group, non-members use the para-professional services of community health care workers almost twice as frequently. In both BRAC member and non-member groups, women suffering illness report seeking care significantly less often than men. The policy and programmatic implications of between group and gender differences in care seeking are discussed with reference to the literature.

Adolescent↗

PubMed1983

Nutritional surveillance.

The concept of nutritional surveillance is derived from disease surveillance, and means "to watch over nutrition, in order to make decisions that lead to improvements in nutrition in populations". Three distinct objectives have been defined for surveillance systems, primarily in relation to problems of malnutrition in developing countries: to aid long-term planning in health and development; to provide input for programme management and evaluation; and to give timely warning of the need for intervention to prevent critical deteriorations in food consumption. Decisions affecting nutrition are made at various administrative levels, and the uses of different types of nutritional surveillance information can be related to national policies, development programmes, public health and nutrition programmes, and timely warning and intervention programmes. The information should answer specific questions, for example concerning the nutritional status and trends of particular population groups.Defining the uses and users of the information is the first essential step in designing a system; this is illustrated with reference to agricultural and rural development planning, the health sector, and nutrition and social welfare programmes. The most usual data outputs are nutritional outcome indicators (e.g., prevalence of malnutrition among preschool children), disaggregated by descriptive or classifying variables, of which the commonest is simply administrative area. Often, additional "status" indicators, such as quality of housing or water supply, are presented at the same time. On the other hand, timely warning requires earlier indicators of the possibility of nutritional deterioration, and agricultural indicators are often the most appropriate.DATA COME FROM TWO MAIN TYPES OF SOURCE: administrative (e.g., clinics and schools) and household sample surveys. Each source has its own advantages and disadvantages: for example, administrative data often already exist, and can be disaggregated to village level, but are of unknown representativeness and often cannot be linked with other variables of interest; sample surveys provide integrated data of more or less known representativeness, but sample sizes usually do not allow disaggregation to, for example, specific villages. A combination of these sources, with a capability for ad hoc surveys (formal or informal) is often the best solution. Finally, much depends on adequate facilities for data analysis, even though simple, comprehensible data outputs are what is required. Intersectoral cooperation is needed to provide realistic options for the decision-making process.

Agriculture↗

PubMed1996

Proliferation of Nonconforming Land Uses in Agricultural Envelope of Urban Hong Kong

Until the late 1960s rural Hong Kong had an attractive rustic landscape and a small but active farming population. The recent widespread agricultural decline provided opportunities for urban-oriented activities to invade, mainly as open storage and workshops unsuitable in city areas. Rapid container-port expansion and cross-border China trade generate demands for cheap and accessible land for non-conforming uses (NCU). Rural development control and land-use planning are inherently weak, and formal provision for such uses is lacking. An unfavorable landmark court judgement allows landowners to degrade the countryside. The activities have caused acute environmental problems, telescoped into a small territory, including visual blight, pollution, drainage blockage, loss of wetland habitats, and increased flooding hazard. The distinction between urban and rural has been blurred in the destruction of the valuable countryside heritage. An interim legislative amendment fails to stop unauthorized conversion of farmland. In the long term, an integrated and comprehensive rural planning strategy to conserve inherent elements, as well as accommodating selected urban spillover in properly located and serviced sites, is needed.

Journal Article↗

PubMed2000

Scaling Up HIV/AIDS programs to national coverage.

The most important issue in the fight against HIV/AIDS is how to scale up existing programs that are only reaching small numbers of people to the national level. Here, I present suggestions on how to tackle the daunting challenge of building truly national HIV/AIDS programs, based on insights gained from participatory, decentralized rural development experiences and from HIV/AIDS programs.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Wildlife resource utilisation at Moremi Game Reserve and Khwai community area in the Okavango Delta, Botswana.

This paper uses the concept of sustainable development to examine the utilisation of wildlife resources at Moremi Game Reserve (MGR) and Khwai community area (NG 18/19) in the Okavango Delta, Botswana. Using both secondary and primary data sources, results show that the establishment of MGR in 1963 led to the displacement of Khwai residents from their land; affected Basarwa's hunting and gathering economy; marked the beginning of resource conflicts between Khwai residents and wildlife managers; and, led to the development of negative attitudes of Khwai residents towards wildlife conservation. Since the late 1980s, a predominantly foreign owned tourism industry developed in and around MGR, however, Khwai residents derive insignificant benefits from it and hence resource conflicts increased. In an attempt to address problems of resource conflicts and promote sustainable wildlife utilisation, the Botswana Government adopted the Community-Based Natural Resource Management (CBNRM) programme, which started operating at Khwai village in 2000. The CBNRM programme promotes local participation in natural resource management and rural development through tourism. It is beginning to have benefits to Khwai residents such as income generation, employment opportunities and local participation in wildlife management. These benefits from CBNRM are thus having an impact in the development of positive attitudes of Khwai residents towards wildlife conservation and tourism development. This paper argues that if extended to MGR, CBNRM has the potential of minimising wildlife conflicts between Khwai residents and the wildlife-tourism sectors. This approach may in the process promote the sustainable wildlife use in and around MGR.

Animals↗

PubMed1991

Control of tsetse flies and trypanosomiasis: Myth or reality?

The African trypanosomiasis are among Africa's most devastating diseases. The human disease, sleeping sickness, and the animal disease, nagana, are caused by trypanosomes, protozoan parasites transmitted by tsetse flies, Glossina spp. Attempts have been made to control tsetse and trypanosomiasis for over 70 years, supported by ever-increasing amounts of foreign aid. Although progress has been made in the control of sleeping sickness, this disease still persists in many countries. Nogono excludes cattle from many of the potentially most productive areas of Africa and is a major constraint on economic development. In this paper, Robert Dransfield, Brian Williams and Robert Brightwell review the control of tsetse and trypanosomiasis in the light of recent progress in our understanding of tsetse population dynamics, with special reference to the experience gained in tsetse control on a Maasai ranch at Ngurumon in the Rift Valley of Kenya, and make suggestions for the management and funding of future control programmes in relation to rural development.

Journal Article↗