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PubMedDate not supplied

[Bases for the development of teaching, research and maternal and infant care in the rural area. The Temascalcingo plan].

The Instituto de Ensenanza e Investigaciones Rurales (Institute for Rural Training and Research) has been established in Solís, Municipality of Temascalcingo, State of Mexico. The institute is part of the Institucion Mexicana de Asistencia a la Ninez, IMAN (Mexican Institution for the Assistance of Childhood). The institute will study a system of healthy delivery in its (rural) zone of activity, based principally in programes with a strong content in the preventive and promotional aspects. For this purpose it will use in a preferential way, auxiliary and technical personnel which is being trained by the institute and that is original from the community where it will serve. At the professional level, the institute will mainly employ pediatricians, nurses and social workers that are completing their residency at the Hospital del Nino IMAN in Mexico City. These professional will obtain important supplementary training through their participation in the rural community health programes that the institute will develop.

Adolescent↗
PubMed2001

Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study.

BACKGROUND: Epilepsy is a controllable disorder if detected and treated early. For most families in rural areas of less developed countries, however, treatment can be delayed because of the inaccessibility of specialist neurological assessment facilities. We aimed to find a practical solution to rural epilepsy control by doing a non-randomised trial in south India. METHODS: 135 patients with partial or generalised tonic-clonic seizures agreed to long-term treatment with phenobarbital (n=68), phenytoin (n=60), or both (n=7). Drugs were given once daily, and at the lowest effective dose, by trained primary-care physicians and health workers. All management was entirely clinical. The main outcome measure was absence of seizures of any type for at least 2 years (terminal remission). Analysis was by intention to treat. FINDINGS: The proportion with terminal remission at each of 4 successive years of follow-up ranged from 58% to 66% for patients who were drug compliant and who had a lifetime total of 30 or fewer generalised tonic-clonic seizures. The corresponding range for patients who were not compliant and who had ever had more than 30 such seizures was 6-16%. Multivariate logistic regression analysis confirmed that strict drug compliance and early treatment were important predictors of a 2-year terminal remission. Clinical adverse effects were noted in three (4%) patients on phenobarbital and 67 (43%) of those on phenytoin (mainly in the form of gingival hyperplasia). INTERPRETATION: In rural areas of less developed countries, epilepsy control in its early stages can be practical and effective with existing resources. The key to success is a combination of trained primary-care physicians, health workers, inexpensive phenobarbital, drug compliance, health education, and follow-up.

Adult↗
PubMed1993

Emotional illness in a pediatric population in Nigeria.

In a survey of 500 children aged between 5 and 15 years in a small rural community in Nigeria, 15 per cent were found to suffer from mental morbidity. Disturbances of emotion and conduct disorder constituted 67 per cent of total morbidity detected. Children from disrupted families (due to divorce, separation, and widowhood) were found to be significantly more likely to suffer from psychiatric morbidity. The need to train primary health care workers, and for them to work closely with families and school teachers in the provision of community mental health care services for children in the rural communities of developing countries is emphasized.

Child↗
PubMed1997

Control of iodine deficiency using iodination of water in a goitre endemic area.

Salt iodination is the method of choice for prevention of iodine deficiency in most parts of the world. However, establishment of such a program frequently involves considerable changes in the marketing and distribution patterns and requires years to achieve. This study was conducted to evaluate the efficiency of using well-defined water sources containing iodine-saturated silicon matrices for providing adequate iodine supply to an iodine deficient population in Kordofan State, Western Sudan. A system of water iodination using silicon matrices containing 30% sodium iodide placed in polyethylene baskets was used in four villages using either traditional wells or hand pumps. Before and every 6 months after iodination of water, urine and blood samples were obtained for determination of iodine and thyroid-related hormones, respectively. Goitre assessment on the village populations were performed at the start and 2 years later. Improvements in iodine status were recorded in all the study villages. The water iodine concentrations increased and a higher iodine content was observed in the hand pumps compared to the traditional wells. The median urinary iodine concentrations increased significantly, from 0.19, 0.20, 0.19, 0.11 to 1.20, 1.10, 0.37, 0.30 mumol/l in the four villages, respectively. The percentages of subjects with serum TSH above 4 mU/l were decreased from more than 30% before iodination to less than 15% at 2 years after iodine supply and the mean serum thyroxine hormone values rose. The rates of goitre decreased from 69% to less than 25%. The study shows that this system is effective, cheap, safe and practically applicable under conditions prevailing in rural areas in developing countries with iodine deficiency.

Female↗
PubMed1997

Politics, practical logic, and primary health care in rural Haiti.

During the 1980s, an ambitious project for health development restructured medical services throughout rural Haiti. The "Rural Health Delivery System" (RHDS) pursued several goals of primary health care, including dispensary-based maternal and child health services and the provision of low-cost drugs. Based on fieldwork in a single village, this article examines how local residents pushed the project in unpredictable and ironic directions. People did not regard dispensary services-which were planned and financed by international health agencies-as essentially foreign elements in the local health-care system. They rather engaged with the dispensary according to long-standing local strategies for prestige and economic advance. Despite the dramatically new shape of biomedicine introduced by the RHDS, the dispensary remained for most people a recognizable arena to gain access to state resources or to contest state control over their lives. The "success" of clinic services, and the "failure" of the project to distribute essential drugs arose more from people's practical routes to symbolic and material power than from the formal plans of health planners or state bureaucrats. This practice-based analysis provides another dimension to both the liberal and neo-Marxist critiques of international health development.

Delivery of Health Care↗
PubMed2004

Door-to-door survey of major neurological diseases in rural Ecuador--the Atahualpa Project: methodological aspects.

We carried out a door-to-door survey to assess the prevalence, incidence, risk factors and possible etiology of major neurological diseases in Atahualpa, a rural village located in the coastal region of Ecuador. A total of 2,548 individuals were interviewed with standardized screening questionnaires to detect suspected cases of epilepsy, stroke and dementia, and they underwent a serum immunoblot test for the detection of anticysticercal antibodies (phase I). Positive individuals and a random sample of negative subjects were examined by neurologists (phase II). Then, patients with clinically confirmed disease and a control group of healthy subjects were further evaluated with complementary examinations (phase III). Here, we describe the methodology of this field study that may be used as a model for the evaluation of neurological disorders in rural communities of developing countries.

Adult↗
PubMed2004

Competencies for rural health administrators.

Rural healthcare and rural health administration have been changing rapidly. An evolution in policies, regulations and reimbursement practices combine to make the skills required of the new health service administration graduate significantly different from those required even a few years ago. This paper forms an initial articulation of core competencies required for rural health administrators. It focuses on health administration education programs that focus on or offer learning experiences in rural health administration. To competently address the unique characteristics of rural populations and facilities, administrators should demonstrate capability in multiple areas. These include unique applications of health management tools to rural environments, understanding designated reimbursement mechanisms for financing rural facilities, and development of leadership skills for dealing with multi-disciplinary management teams and evaluation of small organizations.

Curriculum↗
PubMed2005

Challenges of preparing allied health professionals for interdisciplinary practice in rural areas.

Meeting the health needs of individuals in rural communities involves addressing the challenges of complex multifaceted health problems, limited local health resources and services, isolation, and distance. Interdisciplinary collaboration can create solutions to health care problems that transcend conventional, discipline-specific methods, procedures, and techniques. This paper reports on the four-pronged approach of the Western Maryland Area Health Education Center used to prepare allied health students to be interdisciplinary team members in rural areas. It describes the development of four interdisciplinary instructional team member training venues (in-class instruction, Web-based modules, service-learning programs, and faculty development workshops) that integrate opportunities to develop and practice interdisciplinary health promotion skills in rural communities. Challenges to implementing the model are described, including developing faculty and student training participation, integrating training venues into existing programs at participating institutions, and designing a unified program evaluation.

Allied Health Personnel↗
PubMed2005

Community assessment of availability, consumption, and cultural acceptability of food sources of (pro)vitamin A: toward the development of a dietary intervention among preschool children in rural Burkina Faso.

BACKGROUND: Vitamin A deficiency remains a public health problem in Burkina Faso and elsewhere in the developing world. Dietary diversification is a promising strategy that needs to be explored to strengthen the country's ongoing supplementation program. OBJECTIVE: The purpose of this study was to identify locally available and acceptable (pro)vitamin A-rich foods to be included in a dietary intervention addressing vitamin A deficiency in children aged six months to three years. METHODS: A food ethnographic study combining recall methods, observation, and focused group discussion was conducted in the dry and rainy seasons. Thirty-five mother-child pairs were randomly selected and included in the study. RESULTS: The dietary pattern of children was characterized by low diversity with extremely low energy and vitamin A intake in both seasons. The study identified the availability of numerous (pro)vitamin A-rich foods, but these foods are either not consumed or consumed by few in low amounts and/or in low frequencies. The main constraining factors identified are related to financial accessibility (for liver), seasonal availability (for egg, milk, mango, papaya, and green leafy vegetables), and beliefs related to consumption and preparation (for green leafy vegetables). However, the study also revealed that the study population associated all identified (pro)vitamin A-rich foods with positive attributes such as health, strength, and vitamin richness, which might offer an entry point for designing and implementing dietary interventions. CONCLUSIONS: Based on the findings of this formative research, intervention strategies with mango and liver are proposed to improve the vitamin A intake and status of children in the rural areas of Burkina Faso.

Anthropometry↗
PubMed1988

Bacteriological contamination of water in rural areas: an intervention study from Malawi.

The bacteriological quality of drinking water sources and of stored household water was examined in a rural area of Malawi, before and after improvement of the method of water supply. Among the traditional water sources, water quality was better in springs than in wells and rivers. During the rainy season, there was a considerable deterioration of water quality, which was most pronounced in wells. The improved water supply system consisted of piped, untreated surface water from an uninhabited mountain area. This water contained a mean value of 54 faecal coliforms per 100 ml which can be regarded as acceptable in this setting. During collection of drinking water and during household storage, there was considerable contamination, which mirrored the unhygienic environment. Contamination was worse during the rainy season than during the dry season. Technical interventions aimed at improving water supply in rural areas of developing countries will probably not become effective unless combined with comprehensive health education programmes for the population concerned.

Animals↗
PubMed1998

Role of a general surgeon in obstetrics and gynaecology in a rural setting.

In a rural hospital in northern Nigeria, general surgeons performed 217 obstetric and gynaecologic operations over a five-year period. These operations were responsible for 23% of all operations at the hospital. Emergency operations were most frequent with caesarean section accounting for 90%. Eighty five per cent of the caesarean sections were performed for cephalopelvic dysproportion. The complications encountered were mostly septic complications, predominantly in patients who had caesarean section for obstructed labour. The overall mortality was 5.1% and neonatal mortality from caesarean section was 4.8%. It is concluded that in the abscence of an obstetrician and gynaecologist general surgery experience is required to manage obstetric and gynaecologic problems in rural areas. Such experience should be considered when recruiting doctors for rural hospitals in developing countries.

Cesarean Section↗
PubMed1984

Infant feeding practices among Bedouins in transition from seminomadic to settlement conditions in the Negev area of Israel.

Infant feeding practices among 353 Bedouin families in transition from seminomadic to settlement conditions in the Negev area of Israel were compared with those of 302 Jewish families from the same area. Over 99% of the Bedouin infants were initially breast-fed, in contrast to 79% of the Jewish infants; none of the Jewish infants continued to be breast-fed by the end of the first year of life, while 63% of the Bedouins were. Rice was the first solid food to be introduced to Bedouin infants, while fruits and vegetables were the first solids introduced to the Jewish infants. Rice was not an important constituent of the Jewish infants' diet. By the age of 6 months, 93% of the Jewish infants were eating fruits and vegetables, 78% meat, 49% bread and 55% eggs, in contrast to 20, 13, 8 and 18% among the Bedouins, respectively. Introduction of meat lagged significantly among the Bedouin infants, taking place after the 8th month of life for greater than 50%. Bedouin infant-feeding practices resembled those prevalent among rural populations in developing countries. It is likely that with increasing modernization this pattern will gradually disappear and will be replaced by that prevalent among Western populations.

Adult↗
PubMed2002

Serological screening for tuberculosis in the community: an evaluation of the Mycodot procedure in an African population with high HIV-2 prevalence (Republic of Guinea-Bissau).

The immuno-dot-blot assay MycoDot, which detects lipoarabinomannan (LAM) antibodies, was evaluated for the serological diagnosis of active pulmonary tuberculosis in patients in a rural community in the Republic of Guinea-Bissau. Sera from 269 adults (age > 15) and 33 children (age < 5) were assayed for antibodies in a blind manner and the results compared to the clinical status of tuberculosis. The assay had a specificity and a sensitivity of 92.4% and 63.0% respectively, when applied to the adult population. In HIV-2 infected individuals (27/269), the specificity and sensitivity of the assay were similar, 94.7% and 62.5% respectively. The assay did not provide high sensitivity for the diagnosis of tuberculosis in children. Sera from patients with leprosy cross-reacted with the antigen of the assay. It is concluded that this easily performed assay may be useful for the presumptive diagnosis of tuberculosis in adult populations in rural areas of developing countries where routine screening is not readily available.

Adolescent↗
PubMed2005

Issues and options for the safe destruction and disposal of used injection materials.

It has long been known that the re-use of syringes can cause the spread of infections such as HIV and hepatitis. The production of disposable syringes was undertaken as a solution to the infection problem. In developing countries, however, there has been an unwanted result: the re-use and recycling of disposable syringes. One response has been "auto-disable" syringes that lock the plug and piston in place after a single use. These types of approaches, however, have resulted in greatly increased volumes of used injection materials. This is a particular problem in developing countries where contaminated medical wastes find their way into municipal garbage where people are known to scavenge and recycle. This poses obvious health risks, both in terms of direct exposure and environmental contamination. This study of issues and options for the safe destruction and disposal of used injection materials was undertaken using document analysis was to bring together and summarise approaches to the inter-related issues of "syringe re-use" and "clinical waste disposal". The authors suggest that holistic approaches to syringe use and clinical waste disposal need to be utilized in addressing the situation outlined. The focus is on technology and procedures that may be adaptable to rural areas in developing countries.

Developing Countries↗
PubMedDate not supplied

[Prevalence of Taenia solium antibodies in humans and in pigs in an endemic area of Colombia].

INTRODUCTION: Cysticercosis (CC) caused by Taenia solium in humans and in pigs is endemic in many rural communities in developing countries. The use of Western blot assays (WB) to determine T. solium antibodies has become the best serological tool available to date for identifying positive individuals in field conditions. AIMS: The aim of this study was to determine the prevalence of T. solium antibodies in humans and in pigs in two rural communities in Antioquia, Colombia. PATIENTS, MATERIALS AND METHODS: Serological identification of humans and pigs with T. solium antibodies was performed using WB assays in two communities in Ituango, Antioquia. During the study, demographic variables, housing and health conditions were taken into account. Contingency tables were drawn up using c2 to compare the proportion of seronegative individuals and seropositive individuals with headache, fainting or convulsions. RESULTS: The prevalence of human and porcine CC obtained was 2.23 and 6.82% in Pascuita and 1.17 and 2.33% in Guacharaquero, both respectively. Of the 11 WB positive patients evaluated by imaging techniques, two individuals were found to have single calcifications in the TAC scan and RMI showed another to have an unspecified lesion. The prevalence of infection in humans and in pigs in two rural communities in the north of the district of Antioquia, Colombia, shows that CC is endemic and that steps must be taken to control it.

Animals↗
PubMed2005

Incidence rates and risk factors for injury events in high school students in Lijin County, China.

PROBLEM: Most investigations of injuries among Chinese populations are focused on urban or better developed areas, fewer on rural or poor areas. METHODS: From September 21 to 27, 2002, an epidemiological investigation of eight kinds of injury-related events was carried out among 1,944 students in 39 classes randomly sampled from middle schools in Lijin County, a rural area. The eight kinds of events were: (a) traffic accidents, (b) poisoning, (c) fall, (d) burn or scald, (e) blunt or sharp tools contact, (f) electrical contact, (g) animal or insect bites, and (h) non-fatal drowning. RESULTS: The total incidence rate of eight kinds of injuries in the previous year was 21.1%. The incidence rate among boys was 24.2%, while that among girls was 17.4%, which was significant (chi-square=13.4, P<0.05). The incidence rate among junior high school students was 23.1%, while that among senior high school students was 15.5%, which was also significant (chi-square=13.2, P<0.05). A case-control study of 410 students with at least one of eight kinds of injury events indicated that students' gender and their mothers' health status were related to their injuries. CONCLUSION: The injury incidence rate in a rural area was less than other results in urban or developed areas. Students' gender and mothers' health status were important factors associated with the occurrence of injury. IMPACT ON INDUSTRY: In order to improve the surroundings of the growing population of adolescents, some preventive measures should be put forward, especially to the high-risk students of injury.

Adolescent↗
PubMed1981

Delivery of Health-related information to rural practitioners.

A program to develop library resources was instituted in eight hospitals and one ambulatory care facility in the rural low country of South Carolina from July 1978 to July 1979. The program's goal was to increase availability and awareness of informational resources and their value in the continuing and in-service education of health personnel. This paper reports on the program's inception, components, evaluation, success, and implications for similar programs.

Information Services↗