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PubMed1998

Quality differences between rural and urban primary care: the case of a cervical cancer screening programme.

OBJECTIVE: To measure the difference between rural and urban primary care quality in terms of an early cervical cancer detection programme. LOCATIONS: Seven hundred and fifty smear reports from rural primary care units and 750 from urban primary care units were selected at random from three institutions: the Ministry of Health, the largest Mexican social security institution, and one University Hospital, during August 1995-March 1996. Excluded were reports from women who were pregnant, menopausal or those who had undergone hysterectomy, as well as those tested positive for dysplasia and cancer. ACTIVITIES: Quality was measured through indicators and standards set by consensus of recognized field experts, based mainly on recommended national and international parameters. RESULTS: There was no difference between the overall quality of the urban and rural units. Both registered fairly satisfactory levels (achievement: 76.2%; 95% CI: 72.7-77.0%, versus 75.2; 95% CI: 69.8-78.9%, respectively). The quality of the smear sampling was highly unsatisfactory in rural units and unsatisfactory in urban units (achievement: 64.2%; 95% CI: 58.2-70.0%, versus 47.3%, 95% CI: 42-52.7%; P < 0.00001). Quality of coverage was unsatisfactory for both regions. Quality of smear processing and timeliness were highly satisfactory for both rural and urban units. RECOMMENDATIONS: Efforts should be directed toward smear quality improvement, especially in rural units. Health care workers who take smears need training programmes and better instruments. They should receive feedback on smear adequacy from the laboratory. Health education is necessary to improve utilization and programme coverage quality.

Adult↗
PubMed1994

Breastfeeding in Africa and the Latin American and Caribbean region: the potential role of urbanization.

This paper compares breastfeeding patterns in Africa (AFR) and the Latin American and Caribbean region (LATCAR) based on demographic and health surveys conducted in 23 countries between 1986 and 1990. Results indicate that the proportion of infants who are never breastfed is twice as high in LATCAR than in AFR. The average median breastfeeding duration is 1.64 times higher in AFR (19.3 months) than in LATCAR (11.8 months). The longer breastfeeding duration found in AFR was due to a better lactation performance in both rural and urban areas. In both LATCAR and AFR 71 per cent of the 0-4-month infants were not breastfed exclusively during the first 4 months of life and breastfeeding duration was longer in rural than in urban areas. However, the degree of urbanization had a stronger negative effect on breastfeeding in LATCAR than in AFR. It is concluded that: (a) while LATCAR is in great need of breastfeeding promotion programmes, breastfeeding in AFR should be protected as it becomes more urbanized; (b) the promotion of exclusive breastfeeding remains a priority in both regions; and (c) the magnitude of the inverse association between urbanization and breastfeeding is likely to vary among regions with different socio-economic and cultural backgrounds.

Africa↗
PubMed2003

HIV prevalence in 72 000 urban and rural male army recruits, Ethiopia.

BACKGROUND: The recent estimate of around 2 million HIV-infected people in Ethiopia derives from data that are sparse, especially in the rural areas where the majority (> 85%) of the population lives. We assessed HIV prevalence in almost 72 000 army recruits who resided in urban and rural areas prior to recruitment. METHODS: Rapid HIV tests, HIVSPOT and Determine, were conducted on blood samples drawn at enrolment from almost 10 000 urban recruits, in 1999, and 62 000 rural recruits, in 2000. Socio-demographic data from recruits were available. RESULTS: In urban recruits, overall HIV prevalence was 7.2%, ranging from 4.3 to 10.5% depending on region. In rural recruits, overall HIV prevalence was 3.8%, but the majority were farmers (57%) and students (18%) with an HIV prevalence of 2.7% and 2.6%, respectively. (Higher) level of education in rural recruits was associated with HIV infection. Rural recruits of the Muslim religion were less likely to be HIV infected than recruits of the Orthodox Christian religion (odds ratio: 0.7; 95% confidence interval, 0.65-0.84). Urban and rural residents of Amhara region were at higher risk of HIV infection. CONCLUSION: Prevalence in both rural and urban army recruits is below previous estimates. Geographic distribution of HIV is uneven. The impact of religion, education, and region on HIV prevalence suggests avenues for targeting HIV prevention efforts in Ethiopia.

Adult↗
PubMed2001

Injection-related risk behaviors in young urban and suburban injection drug users in Chicago (1997-1999).

We compared injection-related risk practices between urban and suburban injection drug users (IDUs) in a large cross-sectional sample of young IDUs. From 1997 to 1999, we recruited 700 active IDUs aged 18 to 30 years in Chicago and its suburbs. A suburban residence was reported by 38% of participants. Participants were interviewed at four urban locations and screened for HIV and hepatitis C virus antibodies. Receptive sharing of syringes and other paraphernalia by urban and suburban IDUs in the preceding 6 months was compared using univariable and multivariable models. Sharing injection paraphernalia in the total sample was high, with 50% of participants reporting receptive syringe sharing and 70% reporting sharing cotton, cookers, and/or rinse water. After adjusting for demographic characteristics, injection settings, frequency, and duration of injection as well as ease of acquiring new syringes, suburban IDUs were significantly more likely than urban IDUs to share syringes (adjusted odds ratio = 1.7; 95% confidence interval: 1.1-2.5); however, the likelihood of sharing cotton, cookers, or rinse water was roughly equal. Despite overall higher risk profiles among suburban IDUs, HIV and hepatitis C prevalence levels were significantly lower than among urban participants. Current high levels of injection risk behaviors in suburban groups represent a potential for rapid dissemination of infection.

Adolescent↗
PubMed2004

Sexual behavior is more risky in rural than in urban areas among young women in Nyanza province, Kenya.

BACKGROUND: HIV/sexually transmitted disease interventions in sub-Saharan Africa have largely been focused on urban areas, where sexual behavior is supposed to be more risky than in rural areas. GOAL: The goal of this study was to measure sexual risk behavior among young adults in Nyanza province in Kenya and to compare rural and urban areas. STUDY: In a cross-sectional study, 584 household members aged 15 to 29 years in Kisumu town and the rural districts Siaya and Bondo were selected by multistage random sampling and were administered a face-to-face questionnaire. RESULTS: For women, sexual behavior was more risky in rural than in urban areas, also after adjusting for sociodemographic differences. Rural women reported less frequently being a virgin at marriage, a higher number of lifetime partners, and less consistent condom use with nonspousal partners. For men, sexual risk behavior was equally high in urban and rural areas. CONCLUSIONS: The potential for further HIV spread in rural Nyanza is large. HIV/sexually transmitted disease interventions should be expanded from urban to rural areas in Nyanza.

Adolescent↗
PubMed2004

Urbanization and hospital admission rates for alcohol and drug abuse: a follow-up study of 4.5 million women and men in Sweden.

AIMS: This study analyses whether the level of urbanization is associated with hospital admissions for alcohol and drug abuse, after adjustment for individual demographic and socio-economic characteristics. DESIGN: Follow-up study from 31 December 1996 to 31 December 1999. SETTING: Sweden. PARTICIPANTS: The entire Swedish population aged 25-64 yeras, in total 4.5 million women and men. MEASUREMENTS: Hospital admission rates for alcohol abuse (12,812 events) and drug abuse (6459 events). Level of urbanization was defined by population density and divided into quintiles. Cox proportional hazard models were used to analyse the data. FINDINGS: The results showed an apparent gradient for both women and men; with increasing level of urbanization the hospital admission rates for alcohol abuse and drug abuse increased sharply. After adjustment for age, marital status, education and immigrant status, the hazard ratios for hospital admission for alcohol abuse were 1.76 [confidence interval (CI) = 1.58-1.96] for women and 1.71 (CI = 1.60-1.82) for men in the most densely populated areas (quintile 5). For drug abuse the corresponding hazard ratios were 1.89 (CI = 1.67-2.15) for women and 2.38 (CI = 2.12-2.67) for men. CONCLUSIONS: A high level of urbanization was associated with increased hospital admission rates for alcohol abuse and drug abuse. The level of urbanization should be considered in the distribution of resources for prevention and treatment of alcohol and drug abuse.

Adult↗
PubMed2004

Prevalence and associated factors of atopic dermatitis symptoms in rural and urban Ethiopia.

BACKGROUND: Allergic diseases, including atopic dermatitis (AD), are increasingly becoming a clinical problem in developing countries. OBJECTIVE: We investigated the prevalence of AD symptoms and the effects of potential environmental aetiologies in rural and urban areas of Jimma in southwestern Ethiopia. METHODS: Information on allergic disease symptoms and lifestyle factors was gathered in an interviewer-led cross-sectional questionnaire-based population survey of 9844 urban and 3032 rural participants of all ages. A one-in-four subsample underwent skin prick testing for hypersensitivity to Dermatophagoides pteronyssinus, mixed threshings, and aspergillus. RESULTS: Around 95% of those eligible took part in the survey. Lifetime cumulative prevalence of AD symptoms was generally low with an overall prevalence of 1.2%, but was higher in the urban (1.5%) than in the rural area (0.3%; odds ratio (OR)=4.45 [95% CI 2.34-8.47]). AD symptoms were strongly associated with wheeze (adjusted OR=22.03 [15.45-31.42]) and rhinitis symptoms (61.94 [42.66-89.95]). Of several environmental exposures assessed, residence in a house made of brick (rather than mud) walls with wooden (rather than clay) floor, exposure to cigarette smoke as a child, having lived outside of Jimma in the past, and being of the Tigrean ethnic group were associated with an increased risk of AD symptoms. CONCLUSION: Although the overall prevalence of AD symptoms was low in this Ethiopian population, a marked urban-rural gradient was evident. Lifestyle factors linked to urbanization were associated with an increased risk of AD symptoms.

Adolescent↗
PubMed2006

Comparative academic performance of medical students in rural and urban clinical settings.

OBJECTIVE: To determine whether the academic performance of medical students learning in rural settings differs from those learning in urban settings. DESIGN: Comparison of results of assessment for 2 full cohorts and 1 part cohort of medical students learning in rural and urban settings in 2002 (209 students), 2003 (226 students) and 2004 (220 students), including results for each specialist rotation in the 3rd year and end-of-year examinations in the 2nd and 4th years. SETTING: University of Queensland School of Medicine, Brisbane. Students spent the whole 3rd year (of a 4-year graduate entry programme) conducting 5 specialist 8-week rotations in either the rural clinical division (rural students) or in Brisbane (urban students), all following the same curriculum and taking the same examinations. RESULTS: For the 2002 cohort there were no statistically significant differences in academic performance between rural and urban students. For the 2003 cohort the only significant difference was a higher score for rural students in the end of the 4th-year clinical skills examination (65.7 versus 62.3%, P = 0.025). For the 2004 cohort, rural students scored higher in the 3rd-year mental health rotation (79.3 versus 76.2%, P = 0.038) and lower in the medicine rotation (65.5 versus 68.6%, P = 0.037). CONCLUSION: Academic performance among students studying in rural and urban settings is comparable.

Clinical Competence↗
PubMed2005

Lymphatic filariasis in Ghana: establishing the potential for an urban cycle of transmission.

Lymphatic filariasis is a significant public health and economic problem in many tropical and sub-tropical regions. Unplanned urbanization leading to a lack of proper sanitary conditions has resulted in an increase in the urban-based transmission of a number of vector-borne diseases, including lymphatic filariasis. It has been well established that lymphatic filariasis is endemic in rural areas of Ghana. The goal of this study was to determine if there is a potential of establishing urban transmission cycles in Ghana's major cities. We clinically and immunologically assessed 625 individuals from the three major urban areas (Bawku, Bolgatanga and Secondi/Takoradi), finding that the prevalence of infection with Wuchereria bancrofti ranged from 0 to 12.5%. The results of a polymerase chain reaction based analysis of mosquitoes collected from these areas suggested that there is a low but detectable prevalence of mosquitoes infected with W. bancrofti. We conclude that there may be a potential for an established urban transmission of lymphatic filariasis in Ghana.

Adult↗
PubMed1992

A profile of respiratory symptoms in urban and rural South Australian school children.

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.

Adolescent↗
PubMed2005

New South Wales trends in mortality differentials between small rural and urban communities over a 25-year period, 1970-1994.

OBJECTIVE: To identify trends in premature mortality differences between urban and small rural communities in NSW over a 25-years period. DESIGN: A longitudinal population-based study. ABS population and death data by local government area, sex and age for the period 1970 to 1994, were used to derive mortality measures for urban and small rural communities in NSW. SETTING: NSW local government areas categorised by the Rural and Remote Metropolitan Area Classification system as 'capital city' (the Sydney Statistical Division) and 'other rural area' and 'other remote area'. SUBJECTS: All persons aged 0-74 years resident in the aforementioned NSW local government areas between 1970 and 1994 inclusive. MAIN OUTCOME MEASURE: Whether premature mortality differentials have widened, narrowed or remained the same over the study period and the magnitude of any identified changes. RESULT: There was a decrease in premature mortality rates for men and women in both urban and small rural communities. However, the decline was less in small rural communities, with the differential between small rural and urban areas increasing 2-3% every 5 years. CONCLUSIONS: Differences in age structure, proportion of indigenous and migrant populations between small rural communities and urban NSW can not fully account for the increasing differential. Other possible explanatory factors include socioeconomic status and different exposures and practices in rural areas.

Adolescent↗
PubMed1996

Managing fear associated with nursing in urban environments: first steps.

Improvement of the health of the nation demands that we prepare nurses to deliver care to those within our urban settings. Yet students frequently are uncomfortable visiting clients in urban settings. Our initial efforts were to refine the Environmental Comfort Scale (Carter, Carroll, & Hayes, 1994), an instrument developed to measure comfort levels in various urban scenarios. This article reports the results of this instrument refinement as well as the inductive process leading to the initial conceptualization of a model that addresses threats to safety. These threats, in turn, generate fear of nursing in community-based settings. The study participants were 120 volunteer junior students in a baccalaureate nursing program. The Environmental Comfort Scale II was administered to students at the beginning of an orientation session prior to their initial clinical nursing course. The instrument consisted of 15 items: 3 demographic items, 11 items asking students to rate their level of comfort and of fear in relation to various urban situations, and 1 open-ended question. Analysis of data led to conceptualization of two factors that could influence comfort levels in the urban environment. The first factor was personal-emotional (affective) and the second factor was cognitive (objective). The interaction and interdependency of these two factors led to the creation of a model.

Adult↗
PubMed1997

Identification of needs of and utilization of resources by rural and urban elders after hospital discharge to the home.

The recent reductions in lengths of hospital stays may particularly affect the elderly in rural communities where resources may be scarce. The purpose of this descriptive, comparative study was to assess and evaluate the match of formal and informal resources with individual functional, behavioral, knowledge, and skilled care needs of rural and urban elderly during a 21-day transition period following hospital discharge to the home. Eighty-one elderly patients discharged to one urban and two frontier rural counties were selected. There were no significant differences in demographic variables between rural and urban participants. The Comprehensive Health Care Needs Assessment (CHCNA) questionnaire was used to assess needs and utilization of resources at 3 days and 3 weeks after discharge. Using repeated measure analyses of variance, there were significantly fewer needs identified at 3 weeks than at 3 days after discharge. Rural dwellers identified significantly more skilled care needs than their urban counterparts; however, none were highly technical in nature. Unexpectedly, at 3 weeks after discharge, considerably more functional needs were met by families in the urban setting than in the rural setting. Although only a small number of participants reported unmet needs in multiple domains, the complexity of the unmet needs requires further exploration.

Aged↗
PubMed1986

Differences in total tooth extraction between an urban and a rural area in the Netherlands.

Differences in total tooth loss between an urban and a rural area (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this study were those who received total tooth extraction during the calendar yr 1982 (urban area) and 1983 (rural area). The overall dentist response was 90%, the combined patient response was 75%. During the year, in the urban area 137 cases of total tooth extraction were recorded; in the rural area this was 237. This frequency is equivalent to 109 and 226 total tooth extractions per 100,000 inhabitants, respectively. The age and sex distribution of the urban and rural population could not account for this difference. The rural population had a lower educational level and more people insured in a State Health Scheme, which is related to income. The frequency of symptomatic attenders was highest in the rural area among those who were insured in a State Health Scheme. It is concluded that differences in numbers of total extractions between the rural and urban areas cannot be explained entirely by differences in population characteristics.

Adult↗
PubMed1988

Prevalence and severity of periodontal conditions among adults in urban and rural Morogoro, Tanzania.

A study to assess the prevalence and severity of periodontal conditions among 809 adults in Tanzania was carried out in 1982 in Morogoro District. The prevalence of plaque (99.6%), calculus (95.7%) and gingivitis (93.8%) among them was high. The mean number of teeth per person with pockets between 3.5 and 5.5 mm was 3.5 for the urban and 4.2 for the rural population. Pockets of more than 5.5 mm were found on average in 0.1 (urban) and 0.2 (rural) teeth per person. In the 45+ age group on average 3.0 teeth per person were missing in urban areas and 6.9 teeth in rural areas. There were no statistically significant differences found in periodontal conditions between urban and rural adults, except for the 45+ age group. In this age group a higher mean number of teeth per person with recession, calculus, pockets, gingivitis and missing were found among the rural than the urban population. The study suggests that high prevalence of plaque, calculus and gingivitis at a young age, if untreated, does not lead for all persons to severe periodontal breakdown with ultimately tooth loss in old age in this population. Effects of the study in terms of planning primary health care teaching programs have been presented.

Adolescent↗
PubMed2004

Knowledge on gingivitis and oral hygiene practices among secondary school adolescents in rural and urban Morogoro, Tanzania.

OBJECTIVES: To assess and compare knowledge on gingivitis and oral hygiene practices among rural and urban secondary school students. DESIGN: A cross-section descriptive study involving secondary school students aged between 13 and 17 years in Morogoro rural and urban districts. METHODS: Questionnaire was used to collect information about knowledge on causes, signs, symptoms, complications, treatment modalities and prevention of gingivitis, as well as on oral hygiene practices. RESULTS: A total of 196 students participated in this study, of which 58.7% were females, and 52% were from urban schools. The responses were graded into three criteria namely 'lack of knowledge', 'partial knowledge' and 'total or full knowledge'. There was a partial knowledge about gingivitis and full knowledge of the basic oral hygiene measures among secondary school teenagers. The difference between rural and urban residence on the level of understanding was statistically significant in relation to tooth brushing practices (P = 0.0088), necessity of using toothpaste (P = 0.0204), reasons for using toothpaste (P = 0.0057), signs and symptoms of gingivitis (P = 0.0261) and treatment of gingivitis (P = 0.0106). However, there were no statistically significant differences in distribution of study participants, understanding of tooth brushing practices, reasons for tooth brushing, causes, prevention and complications of gingivitis. CONCLUSION: Secondary school teenagers have partial knowledge about gingivitis and a good knowledge of the basic oral hygiene measures necessary to maintain proper oral health. A small difference on knowledge in specific areas was noted among rural and urban respondents.

Adolescent↗
PubMed2000

Nurse practitioners: a comparison of rural-urban practice patterns and willingness to serve in underserved areas.

PURPOSE: To determine nurse practitioners' (NPs) practice patterns and willingness to practice in underserved areas in both rural and urban settings in a largely rural state. DATA SOURCES: A census of all NPs holding a Pennsylvania license and providing addresses in Pennsylvania or one of the contiguous states was conducted in 1996. The ZIP codes of practice sites were matched with 1990 census data. CONCLUSIONS: Nurse practitioners in rural areas are more likely than their urban counterparts to provide primary care in primary care practice settings, they see more patients per week, and they are more likely to be the principal provider of care for a higher percentage of their patients. Experience with managed care contracts is greater for urban NPs as is their willingness to practice in urban underserved areas. Rural NPs were more willing to practice in rural underserved areas than their urban counterparts. IMPLICATIONS FOR PRACTICE: Access to primary care continues to be a concern in rural areas. The increasing market penetration of managed care and the deficit of primary care providers in rural environments may lead to increased opportunities for NPs in the rural health care delivery system.

Adult↗
PubMed1987

Stressful life events among women: a rural-urban comparison.

This retrospective comparative study assessed the levels and types of stressful life events among rural versus urban women in Wyoming (n = 157). No significant difference in total life events scores, negative life events scores, positive life events scores, or total number of life events reported was found between the rural and urban samples. Rural women tended to report environmentally related stressors more frequently than urban women, while urban women reported more financially related stressors. The findings suggest that the levels of stress among rural and urban women are comparable, but the types of stressors experienced may vary.

Female↗