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PubMed1985

An evaluation of the population and development program in Egypt.

Previous rural surveys analyzing the impact of the Egyptian Population and Development Program on KAP variables (knowledge, attitudes, and practices of contraception) have produced mixed results. In 1982 a survey specifically designed to measure program impact contained refinements in questionnaire measurement, sampling, and analysis. Each refinement intensified the apparent program impact. Fertility itself still appears unresponsive, and attitudes toward family size have changed little, but marked differences between program and nonprogram areas in contraceptive knowledge, attitudes, and practice suggest imminent fertility declines in program areas.

Adolescent↗
PubMed2003

Evaluation of a pilot mentoring programme for nurse managers.

BACKGROUND: The Institute of Nursing Executives is a professional organization with a membership of approximately 150 Australian nurse managers and administrators. Members of rural zones were concerned by the lack of support available to new managers working in isolated areas and sought to develop a mentoring programme that would establish both professional development and support networks for these managers. A pilot programme was developed for two rural areas of New South Wales and one metropolitan site (the city of Sydney). AIM: The evaluation reported here aimed to determine participant expectations of mentoring and outcomes of the pilot programme. METHOD: The programme included matching and self-selection of mentor and mentee roles and attendance at a full-day Mentoring Workshop. The programme was evaluated by voluntary and anonymous pre- and postworkshop questionnaires sent to all participants, and postworkshop telephone interviews. RESULTS: Thirty-seven participants (79% of those enrolled in workshop) responded to the preworkshop questionnaire (20 identifying as mentees; 17 as mentors). Findings reiterated the lack of professional support and access for rural/remote area nurse managers and illustrated that new nurse managers lacked confidence in coaching and stimulating staff. Expectations of both mentors and mentees were similar in valuing a confidential, on-going mentoring relationship. Postworkshop questionnaires (n = 16) and telephone interviews (n = 11) highlighted issues about personal choice and timing, expectations of a structured programme and making greater use of existing technology to support and maintain networks. CONCLUSION: The pilot mentoring programme was highly successful in identifying strategies for the development of a tailored and sustainable programme for newly appointed nurse managers. Provision of a highly structured and facilitated programme carries high expectations of continued external support. Nurse managers also expressed a desire to choose when, how and whom they would select as mentors. Suggestions for the future included a greater use of technology to facilitate e-mail and internet-based discussion groups and mentor support.

Attitude of Health Personnel↗
PubMed2005

Predictive value of frequency doubling technology perimetry for detecting glaucoma in a developing country.

PURPOSE: To determine the feasibility and diagnostic precision of Frequency Doubling Technology (FDT) perimetry as a method to detect glaucoma in rural villages of a developing country. DESIGN: Cross-sectional study. METHODS: Testing included FDT perimetry (C-20-5 screening protocol), tonometry, anterior segment biomicroscopy, and dilated ophthalmoscopy in 296 rural, non-English speaking residents of Southern India over 35 years old. Participants repeated the FDT if they had a location with reduced sensitivity or an unreliable result. We defined an abnormal FDT as one location of reduced sensitivity present on both the initial and repeat examination. We determined the diagnostic precision of FDT separately for a glaucomatous optic disc, a cup to disc ratio (C/D) > or = 0.7, and a C/D > or = 0.8. RESULTS: Ninety-three percent of subjects were able to complete the test satisfactorily. With repeat FDT testing, 37% of eyes with abnormal FDT results subsequently converted to normal and 67% of eyes with unreliable results subsequently became reliable. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for a glaucomatous optic disc were 7%, 87%, 13%, 76%, and 69%, respectively; for a C/D > or = 0.7, they were 0%, 87%, 0%, 91%, and 81%, respectively; and for a C/D > or = 0.8, they were 0%, 87%, 0%, 99%, and 87%, respectively. CONCLUSION: Clinicians can use FDT perimetry to rapidly screen for glaucoma in rural villages of a developing country. FDT testing had high specificity and negative predictive value, but low sensitivity and positive predictive value. The low sensitivity suggests that FDT has limited applicability as the sole test for glaucoma screening in this population. Repeat testing of FDT results that are unreliable or suspected of being abnormal is beneficial for this screening procedure.

Adult↗
PubMedDate not supplied

Symptoms related to the reproductive tract and mental health among women in rural southern India.

BACKGROUND: Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India. METHODS: The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ). RESULTS: Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors. CONCLUSION: The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

Adolescent↗
PubMed1996

Free-living energy expenditure assessed by two different methods in rural Gambian men.

OBJECTIVE: To assess total free-living energy expenditure (EE) in Gambian farmers with two independent methods, and to determine the most realistic free-living EE and physical activity in order to establish energy requirements for rural populations in developing countries. DESIGN: In this cross-sectional study two methods were applied at the same time. SETTING: Three rural villages and Dunn Nutrition Centre Keneba, MRC, The Gambia. SUBJECTS: Eight healthy, male subjects were recruited from three rural Gambian villages in the sub-Sahelian area (age: 25 +/- 4y; weight: 61.2 +/- 10.1 kg; height: 169.5 +/- 6.5 cm, body mass index: 21.2 +/- 2.5 kg/m2). INTERVENTION: We assessed free-living EE with two inconspicuous and independent methods: the first one used doubly labeled water (DLW) (2H2 18O) over a period of 12 days, whereas the second one was based on continuous heart rate (HR) measurements on two to three days using individual regression lines (HR vs EE) established by indirect calorimetry in a respiration chamber. Isotopic dilution of deuterium (2H2O) was also used to assess total body water and hence fat-free mass (FFM). RESULTS: EE assessed by DLW was found to be 3880 +/- 994 kcal/day (16.2 +/- 4.2 MJ/day). Expressed per unit body weight the EE averaged 64.2 +/- 9.3 kcal/kg/d (269 +/- 38 kJ/kg/d). These results were consistent with the EE results assessed by HR: 3847 +/- 605 kcal/d (16.1 +/- 2.5 MJ/d) or 63.4 +/- 8.2 kcal/kg/d (265 +/- 34kJ/kg/d). Physical activity index, expressed as a multiple of basal metabolic rate (BMR), averaged 2.40 +/- 0.41 (DLW) or 2.40 +/- 0.28 (HR). CONCLUSIONS: These findings suggest an extremely high level of physical activity in Gambian men during intense agricultural work (wet season). This contrasts with the relative food shortage, previously reported during the harvesting period. We conclude that the assessment of EE during the agricultural season in non-industrialized countries needs further investigations in order to obtain information on the energy requirement of these populations. For this purpose the use of the DLW and HR methods have been shown to be useful and complementary.

Adult↗
PubMed1997

The influence of quality of care upon contraceptive use in rural Bangladesh.

Efforts to develop quantitative indicators of quality of care for family planning services, and to evaluate its role in contraceptive behavior, remain at an early stage. The present study, based upon an analysis of prospective data from a sample of 7,800 reproductive-aged rural Bangladeshi women, provides empirical evidence on the importance of quality of care for contraceptive practice. The results demonstrate that the perceptions of women regarding the quality of field-worker care were significantly related to the probability of subsequent adoption of a family planning method. Women who were not using a method and who scored high on an index of perceived quality of care were 27 percent more likely to adopt a method subsequently, compared with women with a low score. Effects were even more pronounced for contraceptive continuation; high quality of care was associated with a 72 percent greater likelihood of continued use of any method of contraception.

Adult↗
PubMed2004

Developing complex interventions for rigorous evaluation--a case study from rural Zimbabwe.

Much attention has been placed on the need to develop and evaluate complex interventions targeting public health issues, such as reproductive health. However, and as has been the case in the recent past, even well-designed trials will be flawed unless meticulous attention is paid to ensuring the most appropriate intervention is designed and developed. This requires a well-resourced and carefully planned feasibility study, incorporating both formative and process evaluation, with particular attention being paid to the context of the proposed intervention. In this paper, we describe the way in which a feasibility study helped redesign and shape a complex intervention targeting adolescent sexual health in rural Zimbabwe. By using a mixture of in-depth interviews, focus groups and participant observation with pupils, parents, teachers and education officers, we were able to show that the intervention as originally conceived was unlikely to be deliverable. Process evaluation findings from the feasibility study led to substantial changes to both the content and delivery of the proposed intervention, which is now subject to testing for effectiveness in a large community randomized trial.

Adolescent↗
PubMed2003

Tele-education in child mental health for rural allied health workers.

We developed a tele-education programme in child mental health for rural allied health workers. The programme was delivered in two parts, each consisting of six sessions. Videoconferencing at 384 kbit/s was used. Satisfactory retention rates were maintained throughout. Participants consistently reported increases in knowledge and skills as a result of attending the programme. The project resulted in a high rate of reported changes to practice. An unanticipated outcome was the value placed on the opportunities for local networking provided by the project for participants. Videoconferencing can deliver effective professional development to allied health workers in child mental health.

Attitude of Health Personnel↗
PubMed1986

Priority for primary health care: its development and problems.

National health policies of many countries stress priority for primary health care (PHC). This emphasis has arisen as a reaction to large expenditures on hospitals and sophisticated technology in major cities of developing countries, while vast rural populations have been virtually ignored. The paradox developed from colonial and neo-colonial emulation of European and North American medical models. In 1978, an international conference of WHO/UNICEF at Alma-Ata, USSR defined the meaning of PHC, along with several principles of organization and equity under which it should be provided. To reach rural people with PHC, thousands of community health workers have been prepared and stationed in villages. Their training, however, is very brief and, with weak supervision, their performance has been disappointing. To achieve the WHO goal of "Health for All" through PHC requires greatly expanded education of public health leaders, who can supervise and inspire community personnel.

Global Health↗
PubMed2001

Specificity for field enumeration of Escherichia coli in tropical surface waters.

In remote rural areas in developing countries, bacteriological monitoring often depends on the use of commercial field media. This paper evaluates a commercial field medium used for the enumeration of Escherichia coli in different surface waters under primitive field conditions in rural Pakistan. In order to verify the field kit, 117 presumptive E. coli isolates have been tested, finding a specificity of only 40%. By excluding some strains based on colony colours, the calculated specificity could be increased to 65%. Thus, it is suggested that prior to use in a tropical environment, the specificity of any commercial medium used should be tested with representative tropical isolates, in order to increase the specificity.

Colony Count, Microbial↗
PubMed1999

Development of an activities of daily living scale to screen for dementia in an illiterate rural older population in India.

OBJECTIVE: to develop a measure of activities of daily living appropriate for use in assessing the presence of dementia in illiterate rural elderly people in India. DESIGN: identification of relevant items, pre-testing of items and refinement of administrative procedures and scoring in four successive groups of 30 subjects each, pilot testing in a group of 100 subjects comparable to those for whom the measure is intended, administration to a representative sample of 387 people aged 55 and older, and assessment of the reliability of the final measure. SETTING AND SUBJECTS: age-stratified random sample of older men and women in rural areas of Ballabgarh, Northern India. RESULTS: the original pool of 35 items covering mobility, instrumental and personal care activities was reduced to an 11-item unidimensional scale (to which an additional item on mobility was added) with internal consistency (Cronbach's alpha)=0.82, perfect inter- and intra-rater reliability, test-retest reliability (intraclass correlation)=0.82 (any disability) and 0.92 (unable to perform for 'mental' reasons). Women, older subjects, the totally illiterate and subjects with poorer cognitive function performed significantly more poorly (P < or = 0.02 for all). PRODUCT: a brief, reliable and valid activities of daily living measure, with norms, which is appropriate for use in assessing dementia in illiterate rural elderly people in India.

Activities of Daily Living↗
PubMed2001

Developmental screenings in rural settings: a comparison of the child development review and the Denver II Developmental Screening Test.

Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.

Chi-Square Distribution↗
PubMed2003

Information technology creeps into rural general practice.

This study looked at the effect of information technology on rural medical practice. Eight GPs in rural medical practice in Victoria were interviewed, and World Wide Web sites were accessed for information relevant to the rural GPs use of information technology. The results indicated that rural GPs are developing their use of information technology according to their needs. The use of information technology is changing the nature of rural medical practice, and bringing more support and information to rural GPs. However, some of the technologies now available are of little perceived use to the GPs, and GPs with good support staff are better able to take advantage of the technology than GPs with little or inadequate support. The findings of this study have implications for policies being implemented to increase the availability of information technology to support rural health care.

Diffusion of Innovation↗
PubMed2005

Why do neonates die in rural Gadchiroli, India? (Part II): estimating population attributable risks and contribution of multiple morbidities for identifying a strategy to prevent deaths.

OBJECTIVES: The understanding about why neonates die in rural areas in developing countries is limited. In the first year (1995 to 1996) of the field trial of home-based neonatal care in rural Gadchiroli, India, we prospectively observed a cohort of neonates in 39 villages. In Part I of this article, we presented the primary causes of death. The data were further analyzed: To estimate the population attributable risk (PAR) of death for the main causes of neonatal mortality. To evaluate the effect of a multiplicity of morbidities and to identify which morbidity combinations cause neonatal deaths. To develop a hypothesis about how best to reduce neonatal mortality. STUDY DESIGN: We analyzed the observational data by logistic regression to estimate the PAR of death for six major morbidities. The effect of the number of morbidities per neonate on case fatality (CF) was estimated. Then we identified the main combinations of morbidities as the component causes leading to death. We estimated the excess deaths attributable to sepsis. RESULTS: This cohort included 763 neonates among whom 40 neonatal deaths occurred. Six major morbidities were associated with the following proportion of deaths: preterm, 62.5%; sepsis, 60%; intrauterine growth restriction (IUGR), 27.5%; asphyxia, 25%; hypothermia, 22.5%, and feeding problems, 15%. The estimated PARs were: preterm, 0.74; IUGR, 0.55; sepsis, 0.55; asphyxia, 0.35; hypothermia, 0.08, and feeding problems, 0.04. The CF associated with the number of morbidities per neonate was: with no morbidity, 0.3%; one morbidity, 2.1%; two morbidities, 15.3%; three or more morbidities, 41.4% (p<0.001). In all, 82.5% of all deaths occurred in neonates with two or more morbidities. The proportion of total deaths associated with only preterm was 7.5%, and with only IUGR was 2.5%; however, with the main morbidity combinations it was preterm+sepsis, 35%; IUGR+sepsis, 22.5%; preterm+asphyxia, 20%; preterm+hypothermia, 15%; and preterm+feeding problem, 12.5%. The % CF with low birth weight (LBW) <2500 g alone was 5.2% and with infection alone was 1.9%, but with LBW+infection it was 31.9%. The estimated excess deaths caused by sepsis over and above LBW was 44% of the total deaths. CONCLUSIONS: Preterm and IUGR are ubiquitous components, but usually not sufficient to cause death. Most deaths occur due to a combination of preterm or IUGR with other comorbidities. If preterm birth or IUGR cannot be prevented, the strategy should be to ensure neonatal survival by addressing comorbidities, that is, infections, asphyxia, hypothermia, and feeding problems in that order of priority. We hypothesize that the prevention and/or management of neonatal infections will reduce neonatal mortality by 40 to 50%.

Cause of Death↗
PubMed2001

Sociodemographic, environmental and clinical risk factors for developing persistent diarrhoea among infants in a rural community of Egypt.

The study documents the incidence of persistent diarrhoea and its sociodemographic, household, environmental and clinical risk factors. One hundred and fifty-two newborns were followed for the first 12 months of life in Bilbeis, Egypt. The household of each participant was surveyed at baseline and was visited twice a week. The study infants experienced persistent diarrhoea at a rate of 0.51 episode/case per year. Development of persistent diarrhoea was associated with water storage in mud-containers (Odds ratio [OR] = 4.36, confidence interval [CI] 1.4-14.8), pump-water supply (OR = 3.5, CI 1.2-10.2), and absence of a latrine in the household (OR = 2.74, CI 1.01-7.38). Detection of faecal IgE (OR = 3.32, CI 1.0-10.9) and high stool frequency (OR = 2.95, CI 1.1-7.8) appeared as important clinical predictors for the onset of persistent diarrhoea. The incidence of persistent diarrhoea among young infants in Bilbeis, Egypt, was high. Sociodemographic, environmental and clinical parameters were important risk factors for the development of persistent diarrhoea.

Chronic Disease↗
PubMed2006

Last menstrual period provides the best estimate of gestation length for women in rural Guatemala.

The accurate estimation of gestational age in field studies in rural areas of developing countries continues to present difficulties for researchers. Our objective was to determine the best method for gestational age estimation in rural Guatemala. Women of childbearing age from four communities in rural Guatemala were invited to participate in a longitudinal study. Gestational age at birth was determined by an early second trimester measure of biparietal diameter, last menstrual period (LMP), the Capurro neonatal examination and symphysis-fundus height (SFH) for 171 women-infant pairs. Regression modelling was used to determine which method provided the best estimate of gestational age using ultrasound as the reference. Gestational age estimated by LMP was within +/-14 days of the ultrasound estimate for 94% of the sample. LMP-estimated gestational age explained 46% of the variance in gestational age estimated by ultrasound whereas the neonatal examination explained only 20%. The results of this study suggest that, when trained field personnel assist women to recall their date of LMP, this date provides the best estimate of gestational age. SFH measured during the second trimester may provide a reasonable alternative when LMP is unavailable.

Adult↗
PubMed2005

Revisiting community-based distribution programs: are they still needed?

Community-based distribution (CBD) programs are the optimum way of reaching people in rural areas of developing countries where conventional methods of delivery do not exist or fail. This paper reviews findings and experiences from over 30 years of efforts to implement CBD of family planning methods around the world. Although research suggests that community-based service delivery can contribute to contraceptive use, the magnitude of impact is often in doubt or its existence is questionable when compared to alternative family planning delivery services. After the review of more than 30 years of CBD work, we found that these programs are still needed to meet the needs for contraception in rural communities and isolated city neighborhoods in developing countries. Integration with other health outreach programs, effective management, keeping training of agents brief and letting them distribute contraceptives and keeping all or part of the profits instead of paying them salaries are some of the strategies that can make CBD programs more efficient.

Contraception↗