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PubMed2005

Analysis of information and communication needs in rural primary health care in developing countries.

This article presents three studies dealing with information and communication needs in rural primary health care from Peru and Nicaragua. Results show that primary health-care systems in rural areas of developing countries are very inefficient. Among the main reasons we found factors related to communication infrastructure, information sharing, and continuous training of health professionals. We conclude that telemedicine systems can improve this situation, but the lack of infrastructures, low income levels, and other conditions, impose strong limits to the introduction of new technologies. The main conclusion is that differences in needs and conditions between developing countries and industrialized ones force to use different solutions and approaches. This article presents some proposals on technology requirements and how to deal with the use of telemedicine in rural areas of developing countries. These proposals can be useful to all kind of actors (national public administrations, multilateral institutions, industry, academy, civil society, etc.) in order to promote really relevant and sustainable proposals in telemedicine for rural regions of developing countries.

Developing Countries↗
PubMed1996

Rates and risk factors for mortality during the first two years of life in rural Malawi.

Developing nations in sub-Saharan Africa experience childhood mortality rates that are much higher than any other region of the world. In a rural Malawian community we investigated risk factors for deaths occurring during the neonatal (birth-28 days), postneonatal (29-365 days), infant (birth-365 days), and second-year (366-730 days) periods among a cohort of 3,724 infants monitored from birth. The neonatal mortality rate in this cohort was 48.6 per 1,000 live births (LB); the postneonatal mortality rate was 108.7/1,000 LB. The overall infant mortality rate was 157.3 deaths/1,000 LB and the mortality rate for the first two years of life was 223.7 deaths/1,000 LB. The predominate risk factors for neonatal deaths identified in multivariate analysis were low (hazard ratio [HR] = 2.3) and very low birth weight (HR = 12.7), first pregnancy (HR = 1.8) and maternal syphilis infection (HR = 2.4). Maternal infection with human immunodeficiency virus (HIV) (HR = 1.5) predominated for postneonatal deaths. Low (HR = 1.4) and very low (HR = 5.0) birth weight, first pregnancy (HR = 1.6), maternal HIV infection (HR = 2.4), and the combination of low education and low socioeconomic status (SES) of the mother (HR = 2.0) were the most important factors during the infant period. Maternal HIV infection (HR = 3.3) and the combination of low education and low SES of the mother (HR = 2.6) were the predominate risk factors for mortality occurring during the second year. Factors that were significant in univariate analysis but not significant in the final multivariate models included prematurity, previous adverse reproductive outcome, dying during high malaria transmission season, and being born at home. Interventions to prevent maternal HIV infection and low birth weight and treatment of syphilis infection would have a great impact on reducing early childhood deaths. Improving the delivery of health care and education to women during their first pregnancy and to the most socially disadvantaged women may also help reduce the burden of early childhood mortality in communities such as the one studied in Malawi.

Cohort Studies↗
PubMed1995

Child abuse notification in a country town.

This paper reports a study of child abuse notification in a small remote country town in Queensland, Australia. Aims were to investigate how strongly residents felt about child abuse; how likely they were to notify suspected abuse; indicators of abuse; notification facilitators and inhibitors; and the notification process. A cross-sectional survey design was used involving semi-structured interviews with a simple random sample of 60 living groups. Residents felt strongly about child abuse. They were more likely to notify physical and sexual abuse than neglect and emotional abuse. They emphasized obvious physical indicators, but also recognized behavioral and emotional indicators. Residents would notify primarily out of concern for the child's welfare but would hesitate to notify because of fear of retaliation against the child, because they had a relationship with the suspect family, because the suspect family presented a positive public image, and because respondents valued family privacy. Residents were more likely to notify locally accessible professionals rather than geographically distant statutory authorities. Women were more involved than men in the process, and residents discussed possible notification within their intimate social networks before notifying. Some results are related to the specifically rural context. Implications are developed for rural policy, services and public education.

Adult↗
PubMed2004

Introducing a professional development programme to a rural area mental health service: the importance of context.

OBJECTIVE: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms. CONCLUSIONS: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments.

Adolescent↗
PubMed1990

[Urgent tasks of rural public health].

The fundamental guidelines for the complex development of rural health services are suggested: enhancing the capacity of multidisciplinary central regional hospitals, development of district hospitals, rural medical ambulatories, feldsher-midwifery units, emergency care services; the installation of appointments for family and workshop physicians, the provision of favourable terms for physicians working in rural areas, the introduction of radical economic reform into the system of public health. All this would promote the successful realization of new agrarian policy of CPSU.

Adult↗
PubMed2003

Life events, social support and depression in childbirth: perspectives from a rural community in the developing world.

BACKGROUND: High rates of depression associated with childbirth have been reported in many parts of the developing world. However, the prevalence and associations of antenatal and post-natal depression in the rural population remain unknown. Disability associated with depression and its impact on infant health and development could have important public health implications for many developing countries where large proportions of the population are rural. METHOD: All women living in southern Kahuta, Pakistan, in their third trimester of pregnancy were interviewed at 6 weeks before delivery (N = 632) and again at 10-12 weeks after delivery (N = 541), using WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Personal Information Questionnaire (PIQ) and Brief Disability Questionnaire (BDQ). RESULTS: The point prevalence of ICD-10 depressive disorder was 25% in the antenatal period and 28 % in the post-natal period. Depressed mothers were significantly more disabled, had more threatening life events, and poorer social and family support than non-depressed mothers. Vulnerable mothers were more likely to be depressed during pregnancy, rather than have an onset in the post-natal period. CONCLUSION: Over one-quarter of mothers in a rural sub-district of Pakistan suffer from depression shortly before and after childbirth. Rapidly changing traditional family structures and practices may be increasing the risk of depression in many women. Recognizing and treating depression should be initiated during the antenatal, rather than post-natal period.

Adult↗
PubMed1987

Gay women, men, and families in rural settings: toward the development of helping communities.

The urban biases of empirical research on gay men, women, and families have resulted in minimal knowledge about gay people in rural settings. The diversity of lives of rural gay women and men and the variety of patterns of meeting the challenges of rural living are described. Processes of help-seeking and help-giving are discussed and the need for a helping community of family, friends, and caring others is affirmed. Collaboration between rural gay people and rural community psychologists is suggested to promote the development of helping communities for gay people and thereby initiate a process of change in rural settings.

Adaptation, Psychological↗
PubMed2006

If you build it, they will come: lessons from developing walking trails in rural Missouri.

Given the high rates of sedentary behaviors, attempts to increase physical activity have incorporated individual and, more recently, policy and environmental approaches for promotion of activity. This article presents a summary of the approaches being used by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In summarizing these approaches the authors describe 10 lessons with the aim of articulating the process and, thereby, increasing interest and capacity in development of walking trails. Qualitative and quantitative data were used to show burden and priorities and build support with numerous stakeholders. Stakeholders were engaged to identify common objectives, obtain land and funding, and determine trail size, materials, and time needed for construction. Implementation activities focused on trail maintenance and addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect data via interviews with walkers on trails and community telephone surveys.

Community-Based Participatory Research↗