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PubMed1991

Complications of methods of fracture treatment used by traditional healers: a report of three cases necessitating amputation at Ihiala, Nigeria.

Three fracture cases treated by immobilization with bamboo sticks by traditional bone setters ended up with amputation in a rural hospital, two for gangrene and the third for diaphyseal sequestration. Venous occlusion, followed by interruption of arterial blood supply and immobilization in a dependent position are responsible for the gangrene. Overwhelming sepsis accounted for diaphyseal sequestration in the third patient. These cases illustrate the need for more emphasis to be placed on primary surgical care, centred on rural hospitals, in the developing world.

Adult↗
PubMed1989

Evaluation of a simplified method for estimation of early childhood mortality in small populations.

The provision of simple health technologies in less developed countries has far outpaced the capabilities to evaluate their impact on health in general, and early childhood survival in particular. In rural Haiti, attempts to monitor the impact of health care delivery programmes have been frustrated by some of the same problems encountered elsewhere; ie lack of practicable yet scientifically sound methodologies that interface well with ongoing service delivery programmes. The 'preceding birth' technique, originally advanced by Brass and Macrae, holds promise as just such a method. Its practical appeal derives largely from simple data requirements. In its simplest form, the method requires only responses to a single question put to mothers at delivery regarding the survival status of her previous child. They have shown that the proportion of immediately preceding births dying before the 'index' birth date provides a good approximation of the standard life table probability of death before the second birthday. Given that in rural Haiti, as in much of the less developed world, few women deliver in clinic or hospital where such data could be systematically obtained, exploitation of the preceding birth method would require identification of a convenient and unobtrusive point of contact between questioner and mothers who have recently delivered. In Haiti, two options arose: (1) interview women at home after childbirth, and (2) interview women when they bring the 'index' child seeking vaccination or some other child survival intervention. Both of these deviate from the original technique of Brass and Macrae with respect to the timing and method of data collection, and could therefore introduce serious complications to the interpretation of trends in child mortality. To study this, we examined the effects of adapting the preceding birth method to a rural less developed country setting in Mirebalais, where since 1983 primary health care activities have been administered by MARCH (Management and Resources for Community Health), a private voluntary health organization. The Mirebalais study used a pregnancy register, originally developed for targeting of services, to identify women who were expected to have given birth during the 12-month period before each of two survey rounds. Brief interviews with these women would provide direct life table estimates of child mortality level and trend with which to compare estimates produced from use of the preceding birth method in modified form. Direct estimates of the probability of dying before the second birthday were 138/1000 from first round data and 134/1000 from second round data, indicating a 3% decline.(ABSTRACT TRUNCATED AT 400 WORDS)

Data Collection↗
PubMed2005

Nutrition knowledge and practices, and consumption of vitamin A--rich plants by rural Nepali participants and nonparticipants in a kitchen-garden program.

Food-based nutrition interventions, including kitchen gardens and nutrition education, offer a potentially sustainable approach to reducing multiple nutritional deficiencies, but they have been poorly evaluated in developing countries. In a poor region of the terai (the flat, subtropical agricultural region that borders on India) in rural Nepal, we developed and evaluated the impact of a nutrition program added to the Market Access for Rural Development (MARD) Project. The primary objective of the MARD Project was to augment household income by increasing the production of high-economic-value crops. The objective of the nutrition program was to increase vitamin A and iron intakes by promoting kitchen gardens (training, technical assistance, and seed distribution) and nutrition education. One-third of the kitchen-garden program participants also attended nutrition education or agricultural training sessions that were part of the MARD Project. The program was evaluated after 36 months by a cross-sectional nutrition survey in 430 MARD households with kitchen gardens and 389 non-MARD control households. The lack of knowledge about nutrition, including the causes, prevention, and treatment of night-blindness and anemia, was remarkable. However, compared with control households, the kitchen-gardens group had significantly more nutrition knowledge (38% vs. 13% knew one of the causes of night-blindness, and 17% vs. 3% knew one of the causes of anemia), were more likely to feed special complementary foods to infants and to preserve food, and consumed more of 16 types of home-produced micronutrient-rich vegetables and fruits. Although the cross-sectional nature of the study limits our ability to attribute these differences to the program, we observed a striking lack of nutrition knowledge in these communities, and a clear opportunity to increase the intake of vitamin A through home production of vitamin A-rich plants.

Adult↗
PubMed2005

Evaluation of the ACRRM national radiology program for Australian rural and remote medical practitioners.

INTRODUCTION: In 2000, the Australian College of Rural and Remote Medicine (ACRRM) developed a national radiology quality assurance (QA) and continuing medical education (CME) program for rural and remote non-specialist Australian doctors. The program commenced on 1 January 2001. It required rural doctors to obtain 30 radiology QA/CME points over a 4 year period. At least 15-20 of these points had to be obtained by one of two mandatory options of the program, either: (1) film interpretation, report and review clinical audit activity; or (2) a radiology clinical attachment. METHOD: Doctors submitted their completed film review forms and clinical attachment logbooks to the program manager as confirmation of their educational activity to receive their professional development points. Data from film review forms and clinical attachment logbooks were de-identified and entered into two Microsoft EXCEL spreadsheets. The data were categorised and analysed in EXCEL. RESULTS: From 1 January 2001 to September 2004, 823 rural and remote doctors enrolled in the ACRRM radiology program. This included 281 locums who enrolled in the short-term locum option of the program and 563 doctors who enrolled in the full program. In September 2004, 419 doctors had completed a radiology film review with a radiologist and 41 doctors completed a radiology clinical attachment in 31 different public and private radiology practices. One hundred and ninety-five doctors completed the short-term locum activity. Ninety-two different specialist radiologists participated in the program and assisted rural and remote doctors to enhance their radiology knowledge, confidence and skills. This article describes results from the two mandatory activities. CONCLUSION: The evaluation of the ACRRM radiology program after its first 3 years and 9 months shows there are a large number of rural and remote Australian doctors undertaking professional development and quality assurance activities in radiology.

Attitude of Health Personnel↗
PubMed1983

A rural regional trauma center.

New developments in the organization of trauma care management at the Mayo Clinic are presented along with a review of the first 4 years' experience of a Regional Trauma Center at the Mayo Clinic-affiliated Saint Marys Hospital. Application of the Injury Severity Score (ISS) in the analysis of blunt traumatic deaths has permitted an internal evaluation of trauma care, as well as comparison with other reported emergency trauma care delivery systems. Although additional challenges remain, results indicate that the trauma center concept can be applied just as effectively in a rurally located tertiary facility as in a large metropolitan area.

Accidents, Traffic↗
PubMed2004

An issue of culture: the effects of daily activities on prenatal care utilization patterns in rural South Africa.

Utilization of healthcare facilities has been extensively analyzed in developed countries by researchers from a wide range of disciplines. However, there is still a need to develop a better understanding of the temporal and spatial factors that affect rural women within developing countries. An important piece of this exploration is addressing time constraints and the cultural context. After time has been spent attending to essential tasks that the entire family is dependent upon, do rural women have "disposable time" left to visit a healthcare facility? The setting for this study is the Ubombo Magisterial District, a northern rural area of KwaZulu Natal, South Africa. Environmental factors and socio-economical factors that motivate or discourage women from utilizing prenatal care are addressed using a multinomial logit model. Many of the factors documented in literature as affecting prenatal care utilization, i.e. age and parity, do not apply in this area. On the other hand, fetching water as a daily activity, which is usually not associated with prenatal care utilization, has a significant effect on utilization.

Adolescent↗
PubMed2001

Training to provide for healthy rural aging.

More than 60 percent of the worlds aged population is in developing countries, the majority living in rural and remote areas. Resources in these areas are scarce and there is a lack of services and programs, especially in the areas of health, housing and social welfare. The most serious deficiency faced by many countries in meeting the challenges of population aging is the pronounced scarcity of trained caregivers. Little attention has been given to developing effective training policies and programs. Most of the people providing a service to older people lack basic training and this is more so in rural and remote areas. The processes for extending healthy aging and postponing the onset of chronic diseases and disabling conditions exist already. Unfortunately, these processes are not disseminated in appropriate ways. It is therefore imperative to disseminate this information by training people at the grass roots level to reach the most vulnerable and isolated older people. Primary care workers should have the necessary skills, knowledge and techniques to facilitate good care of older people in their environment. This article reviews and analyzes attempts being made by a number of countries to meet this need. Though the basic issues dealt with are often the same, the approach used differs.

Aged↗
PubMed1998

Cattle markets and local festivals: development of HIV/AIDS prevention interventions for specific risk situations in rural northeast Thailand.

In rural Northeast Thailand, risk of sexual transmission of HIV is popularly perceived to be site-specific. Risk of HIV transmission in local scenarios like cattle markets and village festivals has not been adequately addressed. This paper assesses the use of community consultation and formative research to overcome prevailing assumptions about HIV risk by involving community members in the process of identifying risks and developing HIV prevention strategies. This participatory approach can be used to develop prevention programs that are responsive to the specific context of risk behavior in rural environments.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Appropriate starter culture technologies for small-scale fermentation in developing countries.

Modern food biotechnology has moved a long way since ancient times of empirical food fermentations. Preservation and safeguarding of food are, however, still major objectives of fermentation. In addition, other aspects, such as wholesomeness, acceptability and overall quality, have become increasingly important and valued features to consumers even in developing countries where old traditions and cultural particularities in food fermentations are generally well maintained. Due to limitations in infrastructure and existing low technologies, rural areas in most developing countries have not been able to keep abreast of global developments toward industrialisation. At the same time, fermented foods play a major role in the diet of numerous regions in Africa and Asia. In many traditional approaches, the advantages of some form of inoculation of a new batch, e.g. by back-slopping or the repeated use of the same container (e.g. a calabash) is appreciated and generally practised. Still, the benefits of small-scale starter culture application as a means of improved hygiene, safety and quality control, in support of HACCP approaches, are not yet realised in small-scale fermentation operations. Approaches and considerations for the selection of pure cultures for small-scale, low-tech applications may differ in some respects from the large-scale industrial approaches practised since 100 years. Selection criteria should take account of the substrate, technical properties of the strain, food safety requirements and quality expectations. Lack of experience in the application of starter cultures in small-scale operations and under rural conditions presents a major obstacle but also an exciting challenge to food microbiologist and technologist. Culture preservation, maintenance and distribution demand special logistic and economic considerations. Quality, safety and acceptability of traditional fermented foods may be significantly improved through the use of starter cultures selected on the basis of multifunctional considerations, also taking into account the probiotic concept and possibilities offered for improved health benefits.

Bacteria↗
PubMed2003

Travel and the spread of HIV-1 genetic variants.

HIV-1 comprises three groups, the main (M group), O (outlier) and N (non-M, non-O). The M group, divided into 11 subtypes, is responsible for the global HIV-1 pandemic. Recombination between M subtypes has resulted in the generation of multiple circulating recombinant forms (CRFs) consisting of mosaic lineages. Most subtypes and CRFs are represented in Africa, whereas predominance of one or a few subtypes was reported initially elsewhere. This finding reflects the African origin of the epidemic. In western countries, where the B subtype is predominant, there is a steep increase in non B-subtypes and CRFs, while new recombinants emerge worldwide. Travellers contribute to the spread of HIV-1 genetic diversity worldwide, and in the developing world migration of rural populations and civil war are additional contributing factors. The spreading of HIV-1 variants has implications for diagnostic, treatment, and vaccine development.

Female↗
PubMed2003

Improving access to and consumption of animal source foods in rural households: the experiences of a women-focused goat development program in the highlands of Ethiopia.

Ethiopia is one of the poorest countries in Africa and its population experiences low and falling life expectancy rates, high infant, child and maternal mortality and high rates of child malnutrition. This is exacerbated by the fact that Ethiopia is not self-sufficient in animal products and is a net importer of food. For the majority of the population, most food energy (93%) is derived from vegetable products with 7% coming from animal source foods (ASF). FARM-Africa hypothesizes that the inadequate nutritional status of the population, which contributes to the high mortality rates in the country, is related to the population's low consumption of ASF, such as milk and meat. This article presents the findings of the Dairy Goat Project, the objectives of which included the improvement of family welfare through the generation of increased income and milk consumption. The project adopted an integrated approach and increased the productivity of local goats managed by women through a combination of better management techniques, genetic improvements and information exchange. Through pre- and post-intervention analysis of data of those households within the project area, FARM-Africa demonstrated a considerable improvement in the nutritional status and family welfare of project participants. There was increased appearance of milk and meat products in local diets, and the addition of other foods, such as eggs and fresh vegetables, as a result of complementary activities established with funds generated through the principal activities of the Dairy Goat Project.

Animals↗
PubMed1996

Ruralising the undergraduate medical curriculum through consultation with key stake holders.

This paper describes the approach taken at the University of Queensland to broaden the scope of curriculum design to involve rural general practitioners, medical students and rural health care consumers. A form of nominal group process in serial telephone teleconferences was used, with a group of rural general practitioners, to develop and pilot curriculum content, learning strategies and assessment methods. Medical students assisted in the evaluation of the curriculum and representatives of rural organisations were consulted about the value of hosting medical students in rural communities. The three groups made significant contributions to the project. The results will be trialed for the entire year 6 cohort (240 students) in 1995 and will form the basis of the planned rural practice term in the new graduate course.

Community Participation↗
PubMed1994

Health and health care of rural populations in the UK: is it better or worse?

OBJECTIVE--To review available evidence on the problems facing rural health care in the UK. In particular, to determine whether the health of rural populations is worse than that of town dwellers and how the quality of health care is influenced by rurality. CRITERIA FOR INCLUSION AND EXCLUSION OF ARTICLES--A wide variety of publications and data sources were used. A number of computerised databases with different specialisations (for example medical, health care management) were used to identify relevant published articles. In addition, reports, reviews, and surveys produced by agencies for local circulation were identified by approaching academic, service, and voluntary bodies thought likely to have an interest in rural health. Although this "grey" literature is not subject to peer review, the relative lack of relevant UK publications made it a useful data source for illustrative purposes. Similarly, published articles based on rural health in other developed countries were used when UK data were lacking. CONCLUSIONS--Although the evidence concerning the health and health care of the UK rural populations is suggestive, it is very general and further research is needed. Levels of urban health seem to be generally worse than in rural areas, but contradictions do exist. The evidence on quality of care suggests that service accessibility is a central problem, and rural populations have poorer access than others. Within rural populations, such disadvantage is not uniformly experienced--it affects some groups more than others. In addition, the NHS does not seem to have a consistent policy about whether rurality should influence resource allocation, and how it should be incorporated.

Health Care Rationing↗
PubMed1990

Iowa hospital's expansion plans tap rural networks.

Iowa Methodist Medical Center, Des Moines, is expanding in size and reach by developing centers of excellence, tapping rural networks and forming alliances with primary-care physicians to increase referrals.

Hospital Bed Capacity, 500 and over↗
PubMed1976

Mobile hearing program in central rural Manitoba.

A mobile hearing program was developed to detect and alleviate deafness and rehabilitate deaf individuals in rural Manitoba. The first project was established in central Manitoba in December 1973 for children, whose school performance can be affected by minimal hearing loss. Volunteers from the community, trained by an audiologist, conduct screening procedures, and children with possible hearing impairment receive audiologic and otolaryngologic assessment. Close clinical liaison between audiologist and otologist is important.

Child↗
PubMed1990

The Sample Registration System: an innovative system for monitoring demographic dynamics.

"The International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has been at the forefront of the development of longitudinal systems for demographic surveillance. The Demographic Surveillance System from the Matlab study area is internationally recognized as a unique source of accurate and complete demographic data for a large rural population within a developing setting. In this paper, an overview is presented of a second demographic surveillance system--the Sample Registration System (SRS)--which has been in operation for six years in two other areas of rural Bangladesh." Fertility and mortality rates for the period 1983-1988 are calculated from the SRS data.

Asia↗
PubMed2005

The role of helminth infections in protection from atopic disorders.

PURPOSE OF REVIEW: The observation that allergies are less prevalent in developing countries, especially in rural areas, has stimulated considerable research to identify environmental factors associated with protection against allergic disorders. Here, we review recent studies conducted in developing countries. RECENT FINDINGS: Epidemiological studies conducted in South America, Asia and Africa have attempted to identify factors associated with differences in prevalence of atopy, asthma and atopic dermatitis. Particular attention is given to the complex relationship between helminth infections and allergies. In answer to the question of whether helminth infections are associated with protection against allergic disorders, conflicting data have been generated. In addition to epidemiological studies, animal models have been utilized to gain insight into the immunological mechanisms involved in the interaction between helminth infections and allergies. These animal studies are discussed. The possible explanations for discrepancies found within both human and murine studies have been considered, highlighting the need for further research. SUMMARY: An in-depth understanding of the relevant protective mechanisms against allergic disorders will open the possibility of developing novel therapeutics to prevent the allergic march worldwide.

Allergens↗