Science.gov

Sample records for rural kenyan district

  1. Congenital and neonatal malaria in a rural Kenyan district hospital: An eight-year analysis

    PubMed Central

    2010-01-01

    Background Malaria remains a significant burden in sub-Saharan Africa. However, data on burden of congenital and neonatal malaria is scarce and contradictory, with some recent studies reporting a high burden. Using prospectively collected data on neonatal admissions to a rural district hospital in a region of stable malaria endemicity in Kenya, the prevalence of congenital and neonatal malaria was described. Methods From 1st January 2002 to 31st December 2009, admission and discharge information on all neonates admitted to Kilifi District Hospital was collected. At admission, blood was also drawn for routine investigations, which included a full blood count, blood culture and blood slide for malaria parasites. Results Of the 5,114 neonates admitted during the eight-year surveillance period, blood slide for malaria parasites was performed in 4,790 (93.7%). 18 (0.35%) neonates with Plasmodium falciparum malaria parasitaemia, of whom 11 were admitted within the first week of life and thus classified as congenital parasitaemia, were identified. 7/18 (39%) had fever. Parasite densities were low, ≤50 per μl in 14 cases. The presence of parasitaemia was associated with low haemoglobin (Hb) of <10 g/dl (χ2 10.9 P = 0.001). The case fatality rate of those with and without parasitaemia was similar. Plasmodium falciparum parasitaemia was identified as the cause of symptoms in four neonates. Conclusion Congenital and neonatal malaria are rare in this malaria endemic region. Performing a blood slide for malaria parasites among sick neonates in malaria endemic regions is advisable. This study does not support routine treatment with anti-malarial drugs among admitted neonates with or without fever even in a malaria endemic region. PMID:21054891

  2. Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization.

    PubMed

    Mwaniki, Michael; Mathenge, Ali; Gwer, Samson; Mturi, Neema; Bauni, Evasius; Newton, Charles R J C; Berkley, James; Idro, Richard

    2010-03-17

    Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya. From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days) admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint) was modelled from the census data. Seizures were reported in 142/1572 (9.0%) of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI) 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%), neonatal encephalopathy in 30 (21%) and meningitis in 21 (15%), but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR) 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02). Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates >or= 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46), P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge. There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available to the neonates.

  3. Neonatal seizures in a rural Kenyan District Hospital: aetiology, Incidence and outcome of hospitalization

    PubMed Central

    2010-01-01

    Background Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya. Methods From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days) admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint) was modelled from the census data. Results Seizures were reported in 142/1572 (9.0%) of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI) 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%), neonatal encephalopathy in 30 (21%) and meningitis in 21 (15%), but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR) 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02). Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates ≥ 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46), P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge. Conclusion There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available

  4. Urban-rural differences in questionnaire-derived markers of asthma in Kenyan school children.

    PubMed

    Odhiambo, J A; Ng'ang'a, L W; Mungai, M W; Gicheha, C M; Nyamwaya, J K; Karimi, F; Macklem, P T; Becklake, M R

    1998-11-01

    Grade 4 Kenyan children attending 10 randomly selected public primary schools in Nairobi (urban) and the Muranga District (rural) were surveyed to establish the prevalence of symptom markers of asthma and to assess the impact of urbanization. A respiratory health and home environment questionnaire was administered at school to parents or guardians. The questionnaire response rates were 94.2% (568/ 603) for Nairobi and 89.6% (604/674) for Muranga. The prevalence rates for asthma, defined as "attacks of shortness of breath with wheeze", were 9.5% for urban and 3.0% for rural children (odds ratio (OR) urban versus rural: 3.42; 95% confidence interval (CI): -1.96-5.91). This urban-rural gradient persisted after adjusting for urban-rural differences in host factors (including duration of breastfeeding and family history of asthma and/or allergy), but was largely explained by urban-rural differences in environmental factors, including indoor animals, sharing a bedroom with a smoker, parental education, house ventilation and exposure to motor vehicle fumes en route to school (adjusted OR: 1.59; 95% CI: 0.70-3.55). Similar results were obtained for all other symptoms. These findings confirm the clinical impression that asthma is an important illness in Kenya and underline the need for the further study of environmental factors amenable to intervention, particularly in urban areas.

  5. Minor surgery at hospitals and clinics in a Kenyan district.

    PubMed

    Nordberg, E; Mwobobia, I; Muniu, E

    2001-02-01

    Minor surgical operations are performed at almost all hospitals, health centres and dispensaries in Africa. A large proportion of the operations are urgent, prompted by injuries and acute infections. They are rarely recorded and reported systematically, and rates and patterns are poorly known. To describe of all minor surgery performed on a rural African population during one year. Prospective recording and analysis of minor surgical procedures and of the patients undergoing the same procedures. Hospitals, health centres, dispensaries and mission clinics in Meru district, Kenya. Out of 26,858 minor operations performed (2,066/100,000 people/year) 22,838 were done at the five hospitals in the district while 2,510 were done at 49 mission clinics (4.3/clinic/month), 764 at ten health centres (6.4/health centre/month) and 620 at 29 dispensaries (1.8/dispensary/month). The most common operations were episiotomy, tooth extraction, wound suture and incision and drainage of abscess. More minor surgery is done on women than on men, and the difference is related to obstetrical procedures. Relatively few operations were performed at health centres, dispensaries and mission clinics. Possible explanations include perceived quality of care, staff motivation, poor service access outside office hours and service charges.

  6. Industrialization Stresses, Alcohol Abuse & Substance Dependence: Differential Gender Effects in a Kenyan Rural Farming Community

    ERIC Educational Resources Information Center

    Walt, Lisa C.; Kinoti, Elias; Jason, Leonard A.

    2013-01-01

    Developing countries' industrialization and urbanization attempts have been linked to psychological distress and alcohol abuse. We used Hobfoll's COR theory to examine the relationship between gender, perceived resource loss (an indicator of industrialization stress), and alcohol abuse and dependence in a sample of Kenyan rural village men and…

  7. Integrated Literacies in a Rural Kenyan Girls' Secondary School Journalism Club

    ERIC Educational Resources Information Center

    Kendrick, Maureen; Early, Margaret; Chemjor, Walter

    2013-01-01

    Our purpose in this paper is to foreground contextual issues in studies of situated writing practices. During a year-long case study in a rural Kenyan secondary school, we applied a number of ethnographic techniques to document how 32 girls (aged 14-18 years) used local cultural and digital resources (i.e., donated digital cameras, voice…

  8. Industrialization Stresses, Alcohol Abuse & Substance Dependence: Differential Gender Effects in a Kenyan Rural Farming Community

    ERIC Educational Resources Information Center

    Walt, Lisa C.; Kinoti, Elias; Jason, Leonard A.

    2013-01-01

    Developing countries' industrialization and urbanization attempts have been linked to psychological distress and alcohol abuse. We used Hobfoll's COR theory to examine the relationship between gender, perceived resource loss (an indicator of industrialization stress), and alcohol abuse and dependence in a sample of Kenyan rural village men and…

  9. Integrated Literacies in a Rural Kenyan Girls' Secondary School Journalism Club

    ERIC Educational Resources Information Center

    Kendrick, Maureen; Early, Margaret; Chemjor, Walter

    2013-01-01

    Our purpose in this paper is to foreground contextual issues in studies of situated writing practices. During a year-long case study in a rural Kenyan secondary school, we applied a number of ethnographic techniques to document how 32 girls (aged 14-18 years) used local cultural and digital resources (i.e., donated digital cameras, voice…

  10. Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs

    PubMed Central

    Amendah, Djesika D.; Mukamah, George; Komba, Albert; Ndila, Carolyne; Williams, Thomas N.

    2013-01-01

    Background More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya. Objective To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital. Methods We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate. Results We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229. Conclusion This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts. PMID:23593408

  11. Prevalence of exercise induced bronchospasm in Kenyan school children: an urban-rural comparison.

    PubMed

    Ng'ang'a, L W; Odhiambo, J A; Mungai, M W; Gicheha, C M; Nderitu, P; Maingi, B; Macklem, P T; Becklake, M R

    1998-11-01

    Higher rates of exercise induced bronchospasm (EIB) have been reported for urban than for rural African schoolchildren. The change from a traditional to a westernized lifestyle has been implicated. This study was undertaken to examine the impact of various features of urban living on the prevalence of EIB in Kenyan school children. A total of 1226 children aged 8-17 years attending grade 4 at five randomly selected schools in Nairobi (urban) and five in Muranga district (rural) underwent an exercise challenge test. A respiratory health and home environment questionnaire was also administered to parents/guardians. This report is limited to 1071 children aged < or = 12 years. Prevalence rates of EIB for the two areas were compared and the differences analysed to model the respective contributions of personal characteristics, host and environmental factors implicated in childhood asthma. A fall in forced expiratory volume in one second (FEV1) after exercise of > or = 10% occurred in 22.9% of urban children and 13.2% of rural children (OR 1.96, 95% CI 1.41 to 2.71). The OR decreased to 1.65 (95% CI 1.10 to 2.47) after accounting for age, sex, and host factors (a family history of asthma and breast feeding for less than six months), and to 1.21 (95% CI 0.69 to 2.11) after further adjustment for environmental factors (parental education, use of biomass fuel and kerosene for cooking, and exposure to motor vehicle fumes). The EIB rates in this study are higher than any other reported for African children, even using more rigorous criteria for EIB. The study findings support a view which is gaining increasing credence that the increase in prevalence of childhood asthma associated with urbanisation is the consequence of various harmful environmental exposures acting on increasingly susceptible populations.

  12. Unique Rural District Politics

    ERIC Educational Resources Information Center

    Farmer, Tod Allen

    2009-01-01

    The politics of rural educational leadership are both intense and concentrated. Rural educational leaders need to be savvy and politically skilled if they are to inspire educational stakeholders and accomplish organizational objectives. The local school system is an organization with a political culture that can be characterized as a competitive…

  13. A Multifaceted Intervention to Implement Guidelines and Improve Admission Paediatric Care in Kenyan District Hospitals: A Cluster Randomised Trial

    PubMed Central

    Ayieko, Philip; Ntoburi, Stephen; Wagai, John; Opondo, Charles; Opiyo, Newton; Migiro, Santau; Wamae, Annah; Mogoa, Wycliffe; Were, Fred; Wasunna, Aggrey; Fegan, Greg; Irimu, Grace; English, Mike

    2011-01-01

    Background In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. Methods and Findings This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n = 4) and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n = 4). Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both groups performance improved from baseline. Completion of admission assessment tasks was higher in intervention sites at 18 months (mean = 0.94 versus 0.65, adjusted difference 0.54 [95% confidence interval 0.05–0.29]). Uptake of guideline recommended therapeutic practices was also higher within intervention hospitals: adoption of once daily gentamicin (89.2% versus 74.4%; 17.1% [8.04%–26.1%]); loading dose quinine (91.9% versus 66.7%, 26.3% [−3.66% to 56.3%]); and adequate prescriptions of intravenous fluids for severe dehydration (67.2% versus 40.6%; 29.9% [10.9%–48.9%]). The proportion of children receiving inappropriate doses of drugs in intervention hospitals was lower (quinine dose >40 mg/kg/day; 1.0% versus 7.5%; −6.5% [−12.9% to 0.20%]), and inadequate gentamicin dose (2.2% versus 9.0%; −6.8% [−11.9% to −1.6%]). Conclusions Specific efforts are needed to improve hospital care in developing countries. A full, multifaceted intervention was associated with

  14. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children.

    PubMed

    Noor, Abdisalan M; Amin, Abdinasir A; Akhwale, Willis S; Snow, Robert W

    2007-08-01

    Inexpensive and efficacious interventions that avert childhood deaths in sub-Saharan Africa have failed to reach effective coverage, especially among the poorest rural sectors. One particular example is insecticide-treated bed nets (ITNs). In this study, we present repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assess changes in coverage across socioeconomic groups. We undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0-4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: 2004 (most poor [2.9%] versus least poor [15.6%]; concentration index 0.281); 2005 (most poor [17.5%] versus least poor [37.9%]; concentration index 0.131), and 2006 with near-perfect equality (most poor [66.3%] versus least poor [66.6%]; concentration index 0.000). The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social

  15. Blood pressure and associated factors in a rural Kenyan community.

    PubMed

    Poulter, N; Khaw, K T; Hopwood, B E; Mugambi, M; Peart, W S; Rose, G; Sever, P S

    1984-01-01

    Blood pressure (BP) and associated factors were determined in 1737 men in a remote Kenyan agricultural community. Systolic BP showed no significant rise with age until after 54 years; diastolic BP showed a small rise with age. Both systolic and diastolic BP correlated with weight independent of age. Systolic and diastolic BP correlated positively with casual urinary sodium/potassium and negatively with potassium/creatinine ratios. Both systolic and diastolic BP correlated significantly with the number of years of education, as did urinary sodium/potassium and sodium/creatinine ratios. Potassium/creatinine ratios were negatively correlated with the number of years of education. Blood pressure and urinary sodium/creatinine ratios were significantly lower in subsistence farmers compared with those in other occupations, and potassium/creatinine ratios were significantly higher. Two pilot studies of Luo tribesmen showed a strong correlation between casual urinary electrolyte ratios and those derived from 24-hour urine samples and a greater variance of sodium excretion between these people than that found within individuals. These results suggest that a relationship between BP and casual urine electrolyte estimations may be identifiable in communities where there is less day-to-day dietary variation. They also suggest that some of the changes in BP associated with urbanization could be mediated by changes in dietary electrolytes.

  16. RICKETS IN RURAL KENYAN PRESCHOOL CHILDREN: CASE REPORT.

    PubMed

    Bwibo, N O; Nyawade, S; Neumann, C G

    2013-03-01

    Clinical rickets has not been reported previously in Embu district, Kenya. Baseline clinical assessments performed for a nutrition intervention study in preschool children (n=324) identified 28 cases of rickets (8.6% of study sample). Clinical characteristics included: delays of sitting, walking, and teething; bone and chest deformities; widened wrists and ankles; and bowed lower extremities. Risk factors identified were short duration of breastfeeding with feeding of cereal-based supplements with little or no milk, low calcium intake, limited sunlight exposure. Vitamin D and calcium deficiencies likely contributed to these cases. Treatment with Vitamin D3 and milk resulted in clinical improvement.

  17. Designing snacks to address micronutrient deficiencies in rural Kenyan schoolchildren.

    PubMed

    Murphy, Suzanne P; Gewa, Constance; Grillenberger, Monika; Bwibo, Nimrod O; Neumann, Charlotte G

    2007-04-01

    Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy.

  18. Rural Districts Bolster Choices with Online Learning

    ERIC Educational Resources Information Center

    Brown, Don

    2012-01-01

    All schools can benefit from giving students the option of online learning, but for many rural schools, online learning is a lifeline. In the past two years, Lane Education Service District in Oregon, USA, has developed online resources for 14 Lane County school districts, which vary in size from 170 students to as many as 17,000. Many of the…

  19. Risk factors for type 2 diabetes mellitus among patients attending a rural Kenyan hospital

    PubMed Central

    2010-01-01

    ABSTRACT Background The Diabetes Management and Information Center in Nairobi has conducted population surveys among rural and urban Kenyans during the last decade. They have reported a rise in the prevalence of diabetes among rural Kenyans from 3% in 2003 to 7% in 2007. Our study was undertaken to investigate rural factors for type 2 diabetes and determine those that could be responsible for this rise in prevalence. Objectives To describe the risk factors for type 2 diabetes mellitus among patients attending the outpatient clinics in a rural mission hospital in Kenya. Method Forty-five diabetics and forty-five non-diabetics, resident in this rural hospital's catchment area for at least 10 years, were randomly selected from patients attending outpatient clinics. Diabetics in a stable condition (not requiring hospitalisation), whose fasting blood sugars were below 6.1 mmol/L, were matched for age and gender with the non-diabetics who came to the hospital for outpatient services. A pilot-tested questionnaire on demography, current and past dietary habits, social habits, and family history was used to collect data. Waist circumference, height and weight were measured and BMI calculated. Data was analysed using SPSS for Windows. The Kruskal–Wallis test was used to compare the medians for the continuous variables, while the chi-squared test was used for the categorical variables. The z-test was used to calculate the relative risk. Results Ninety participants (26 males, 64 females). The mean age was 61.8 for diabetics and 61.4 for non-diabetics. Childhood starvation (relative risk 2.08, p = 0.0090) and use of cassava for sustenance during childhood starvation (relative risk 3.12, p = 0.0090) were identified as risk factors. Diabetes in close relatives, another risk factor for this population (relative risk 2.2, p = 0.0131). Abdominal obesity was a risk factor for this population (in females relative risk 2.0, p = 0.0010). Conclusion The risk factors for type 2 diabetes

  20. Industrialization Stresses, Alcohol Abuse & Substance Dependence: Differential Gender Effects in a Kenyan Rural Farming Community

    PubMed Central

    Walt, Lisa C.; Kinoti, Elias; Jason, Leonard A.

    2014-01-01

    Developing countries’ industrialization and urbanization attempts have been linked to psychological distress and alcohol abuse. We used Hobfoll’s COR theory to examine the relationship between gender, perceived resource loss (an indicator of industrialization stress), and alcohol abuse and dependence in a sample of Kenyan rural village men and women (N = 186). Regression analyses indicated that both gender and COR loss predicted alcohol abuse and dependence. Additionally, results suggested that gender moderated the relationship between COR loss and alcohol dependence; such that higher COR loss scores predicted higher alcohol dependence for men, but COR loss scores did not predict alcohol dependence for women. Thus, we suggest that gender differences in substance abuse may be due less to actual differences in resource loss, but rather to gender differences in the response to resource loss. Limitations and opportunities for future research are discussed. PMID:24489525

  1. A strategy to increase adoption of locally-produced, ceramic cookstoves in rural Kenyan households

    PubMed Central

    2012-01-01

    Background Exposure to household air pollutants released during cooking has been linked to numerous adverse health outcomes among residents of rural areas in low-income countries. Improved cookstoves are one of few available interventions, but achieving equity in cookstove access has been challenging. Therefore, innovative approaches are needed. To evaluate a project designed to motivate adoption of locally-produced, ceramic cookstoves (upesi jiko) in an impoverished, rural African population, we assessed the perceived benefits of the cookstoves (in monetary and time-savings terms), the rate of cookstove adoption, and the equity of adoption. Methods The project was conducted in 60 rural Kenyan villages in 2008 and 2009. Baseline (n = 1250) and follow-up (n = 293) surveys and a stove-tracking database were analyzed. Results At baseline, nearly all respondents used wood (95%) and firepits (99%) for cooking; 98% desired smoke reductions. Households with upesi jiko subsequently spent <100 Kenyan Shillings/week on firewood more often (40%) than households without upesi jiko (20%) (p = 0.0002). There were no significant differences in the presence of children <2 years of age in households using upesi jiko (48%) or three-stone stoves (49%) (p = 0.88); children 2–5 years of age were less common in households using upesi jiko versus three-stone stoves (46% and 69%, respectively) (p = 0.0001). Vendors installed 1,124 upesi jiko in 757 multi-family households in 18 months; 68% of these transactions involved incentives for vendors and purchasers. Relatively few (<10%) upesi jiko were installed in households of women in the youngest age quartile (<22 years) or among households in the poorest quintile. Conclusions Our strategy of training of local vendors, appropriate incentives, and product integration effectively accelerated cookstove adoption into a large number of households. The strategy also created opportunities to reinforce health messages

  2. Hamilton County: A Rural School District Profile.

    ERIC Educational Resources Information Center

    Harned, Catherine

    Using state education agency, census, industry employment and occupational information data, this paper provides a detailed picture of a rural school district in Southern Illinois. Mining and agriculture are the major industries in Hamilton County. The major mining employer closed in February 1988, and the drought of 1988 is likely to adversely…

  3. Morbidity and nutrition status of rural drug-naïve Kenyan women living with HIV.

    PubMed

    Neumann, Charlotte G; Nyandiko, Winstone; Siika, Abraham; Drorbaugh, Natalie; Samari, Goleen; Ettyang, Grace; Ernst, Judith A

    2016-09-01

    This paper describes morbidity in a group of HIV-positive drug-naïve rural women in western Kenya. A total of 226 drug-naïve HIV-positive women were evaluated for baseline morbidity, immune function, and anthropometry before a food-based nutrition intervention. Kenyan nurses visited women in their homes and conducted semi-structured interviews regarding symptoms and physical signs experienced at the time of the visit and during the previous week and physical inspection. Blood and urine samples were examined for determination of immune function (CD4, CD8, and total lymphocyte counts), anaemia, malaria, and pregnancy status. Intradermal skin testing with tuberculin (PPD), candida, and tetanus toxoid antigens was also performed to evaluate cell-mediated immunity. Anthropometry was measured, and body mass index (BMI) was calculated. Seventy-six per cent of the women reported being sick on the day of the interview or within the previous week. Illnesses considered serious were reported by 13.7% of women. The most frequent morbidity episodes reported were upper respiratory tract infections (13.3%), suspected malaria (5.85%), skeletal pain (4.87%), and stomach pain (4.42%). The most common morbidity signs on physical inspection were respiratory symptoms, most commonly rhinorrhea and coughing. Confirmed malaria and severe diarrhea were significantly associated with a higher BMI.

  4. Impact of biogas digesters on cookhouse volatile organic compound exposure for rural Kenyan farmwomen.

    PubMed

    Dohoo, Carolyn; Read Guernsey, Judith; Gibson, Mark D; VanLeeuwen, John

    2015-01-01

    Women living on rural Kenyan smallholder dairy farms burn wood as biofuel in family cookhouses. Unventilated biofuel combustion produces harmful levels of respirable particles and volatile organic compound (VOC) emissions in indoor environments. Biogas digesters, which can generate high methane-content biogas from livestock manure composting were recently installed on 31 farms. The study objectives were to compare VOC exposure profiles for women cooking on farms with and without biogas digesters, and to compare seasonal variations in VOC exposures for those women cooking with biogas. Participants (n=31 biogas farms, n=31 referent farms) wore passive thermal desorption VOC sampling tubes and recorded cookhouse fuel use on time activity sheets for 7 days. Women using biogas spent significantly less time (mean=509 min/week) exposed to cookhouse wood smoke compared with the referent group (mean=1122 min/week) (P<0.01). Total VOC exposure did not differ between farm groups (P=0.14), though concentrations of trans-1,3-dichloropropene, bromoform, and 1,4-dichlorobenzene in biogas cookhouses were significantly lower than in referent cookhouses, even after Bonferroni correction. The composition of VOC species was also significantly different, reflecting the different fuel sources. Biogas digester technologies have great potential for reducing exposure to wood smoke VOCs in low-income countries.

  5. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children.

    PubMed

    Ferguson, Elaine; Chege, Peter; Kimiywe, Judith; Wiesmann, Doris; Hotz, Christine

    2015-12-01

    Poor quality infant and young child (IYC) diets contribute to chronic under-nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food-based strategies can improve dietary adequacy is required. We collected 24-h dietary recalls from children 6-23 months of age (n = 401) in two rural agro-ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food-based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6-8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12-23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3-5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6-11 and 12-23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level. © 2015 John Wiley & Sons Ltd.

  6. Systematic Research and Evaluation in a Rural Pennsylvania School District.

    ERIC Educational Resources Information Center

    Leopold, Greg; And Others

    This report summarizes the evaluation of a rural school district in Pennsylvania and offers recommendations reflecting the district's goals for school improvement and construction. Specifically, the objectives of the study were to identify curricular needs of the district and individual schools; review and assess district facilities with respect…

  7. Recruiting and Interviewing in Rural School Districts: Protocol or Potluck

    ERIC Educational Resources Information Center

    Nichols, Joe

    2004-01-01

    Through administrator and teacher surveys and interviews, this study examined recruiting and interviewing practices of eighty-three rural school districts located in, and between, the rural Ozark Plateau and Mississippi River Delta. Survey results indicated that districts with smaller student populations were far less likely to have an identified…

  8. Principal Selection in Rural School Districts: A Process Model.

    ERIC Educational Resources Information Center

    Richardson, M. D.; And Others

    Recent research illustrates the increasingly important role of the school principal. As a result, procedures for selecting principals have also become more critical to rural school districts. School systems, particularly rural school districts, are encouraged to adopt systematic, rational means for selecting administrators. Such procedures will…

  9. Satellite Receiving Station Handbook for Rural School Districts.

    ERIC Educational Resources Information Center

    Adams, James C.; And Others

    This handbook gives the historical background of a 2-year project conducted in a rural Wisconsin school district, outlining the planning and actual construction of a high school satellite receiving station. It is written to aid rural school districts in purchasing, installing, and using a satellite receiving station to improve the quality of…

  10. Factors influencing uptake of contraceptive implants in the immediate postpartum period among HIV infected and uninfected women at two Kenyan District Hospitals.

    PubMed

    Shabiby, Mufida M; Karanja, Joseph G; Odawa, Francis; Kosgei, Rose; Kibore, Minnie W; Kiarie, James N; Kinuthia, John

    2015-08-19

    Family planning is a cost effective strategy for prevention of mother to child transmission of HIV and reduction of maternal/infant morbidity and mortality. Contraceptive implants are a safe, effective, long term and reversible family planning method whose use remains low in Kenya. We therefore set out to determine and compare the uptake, and factors influencing uptake of immediate postpartum contraceptive implants among HIV infected and uninfected women at two hospitals in Kenya. This cross sectional study targeted postpartum mothers at two Kenyan district hospitals (one urban and one rural). All participants received general family planning and method specific (Implant) counseling followed by immediate insertion of contraceptive implants to those who consented. The data was analyzed by descriptive analysis, T-test, Chi square tests and logistic regression. One hundred eighty-five participants were enrolled (91 HIV positive and 94 HIV negative) with a mean age of 26 years. HIV positive mothers were significantly older (27.5 years) than their HIV negative counterparts (24.5 years), P = 0.001. The two groups were comparable in education, employment, marital status and religious affiliation. Overall, the uptake of contraceptive implants in the immediate postpartum period was 50.3% and higher among HIV negative than HIV positive participants (57% vs. 43%, P = 0.046). Multivariate analysis revealed that a negative HIV status (P = 0.017) and prior knowledge of contraceptive implants (P = 0.001) were independently associated with increased uptake of contraceptive implants. There was a high uptake of immediate postpartum contraceptive implants among both HIV infected and un-infected women; efforts therefore need to be made in promoting this method of family planning in Kenya and providing this method to women in the immediate postpartum period so as to utilize this critical opportunity to increase uptake and reduce the high unmet need for family planning.

  11. Collaborating with the Community: Lessons from a Rural School District

    ERIC Educational Resources Information Center

    Walker, Anne

    2012-01-01

    This article, based on case study research, highlights how a rural school district in the midwestern United States collaborated with local community organizations to meet the needs of English language learners after the district and community experienced rapid ethnic diversification. In particular, the district EL coordinator spearheaded the…

  12. Economic Role of School Districts in Rural Communities.

    ERIC Educational Resources Information Center

    Sederberg, Charles H.

    1987-01-01

    Explores secondary economic effects of rural Minnesota school districts, including purchasing power of payrolls, employment, retail stimulus, recapture of taxes, property values, and banking services. Provides nontechnical approach to interpreting how school operations offset costs of rural education. Study can be replicated by rural educators.…

  13. An exploration of rural and urban Kenyan women's knowledge and attitudes regarding breast cancer and breast cancer early detection measures.

    PubMed

    Muthoni, Ann; Miller, Ann Neville

    2010-09-01

    Many women in Kenya with breast cancer symptoms do not seek medical attention until their cancer is very advanced, leading to high mortality rates and a heavy cancer burden on the nation. In this study we employed eight focus groups with low- and middle-income rural and urban Kenyan women to explore their knowledge, attitudes, and behaviors concerning breast cancer and its early detection measures. Topics for discussion were derived from the components of the Health Belief Model (HBM). Findings revealed a huge divide between urban middle-income women and all other groups with respect to knowledge of breast cancer and early detection measures. In addition, women viewed breast cancer as a highly severe disease. Perceived benefits of early detection measures centered around preparing themselves for what was assumed to be inevitable death.

  14. The Kenyan Language Setting.

    ERIC Educational Resources Information Center

    Sedlak, Philip

    Despite considerable linguistic diversity in Kenya, the country is increasingly trilingual, with individual Kenyans tending toward varying degrees of proficiency in the vernacular, Swahili, and English. The vernacular is acquired at home and in the neighborhood with co-ethnics in both rural and urban contexts. Swahili is typically learned…

  15. Rural Districts in Crisis: When a Community Is Divided.

    ERIC Educational Resources Information Center

    Glascock, Catherine H.

    One of the results of rural school district consolidation has been the potential for schisms that develop among the divergent populations with distinct traditions, culture, and customs. This paper presents research on an Appalachian school district that remains in cultural turmoil after 25 years of consolidation. The population of the three…

  16. Impact of Digital Learning in a Rural School District

    ERIC Educational Resources Information Center

    Neal, Carla Eleanor Purvis

    2016-01-01

    In order to promote 21st century learning and the skills needed for students to be successful both in school and after graduation, districts nationwide are increasing the amount of technology available to students. In this study, the researcher reviewed data collected from three targeted schools in a rural district that hosts approximately 13,000…

  17. Potential Synergy: Rural School Districts and International Student Programs

    ERIC Educational Resources Information Center

    Casto, Hope G.; Steinhauer, Alexandra; Pollock, Pamela M.

    2012-01-01

    Many rural school districts face declining enrollments. A few districts have taken the unusual path of recruiting international students in order to boost their enrollments. This study examines a community using this strategy and the resulting financial, academic, and social situations for the school, community, and students, both local and…

  18. Child obesity and fitness levels among Kenyan and Canadian children from urban and rural environments: a KIDS-CAN Research Alliance Study.

    PubMed

    Adamo, Kristi Bree; Sheel, Andrew William; Onywera, Vincent; Waudo, Judith; Boit, Michael; Tremblay, Mark Stephen

    2011-06-01

    This study was designed to gather anthropometric and fitness-related data on Kenyan children living in urban (UKEN) and rural (RKEN) environments and to compare them with previous data collected on Canadian children in order to examine the potential nutrition-physical activity transition. Height, weight, waist circumference, triceps skinfolds were directly measured on rural (RKEN) and urban Kenyan (UKEN) children (n = 179, 9-13 years) and compared with existing data from Canadian children living in urban and rural environments (n = 274, 9-13 years). Aerobic fitness was measured using the 20 m shuttle run, flexibility using the sit-and-reach test and isometric handgrip strength was assessed. None of the RKEN children were overweight or obese (OWO). However, 6.8% of UKEN boys and 16.7% of girls were OWO. The RKEN children had lower BMI, waist circumference, and triceps skinfolds than all other groups (UKEN, and Canadian: p < 0.05). UKEN children were leaner than Canadian children (p < 0.05). Male and female RKEN children had higher running speeds, and aerobic fitness than UKEN children (p < 0.001). Isometric strength was not different between Kenyan groups and was not different from urban living Canadian children. UKEN children were the least flexible group, and girls were more flexible than boys in all groups. Urban Kenyan children appear to be showing signs of the nutrition-physical activity transition, as judged by the anthropometric similarities to contemporary living Canadian children. Further support is provided by examining the difference in prevalence of overweight/obesity among UKEN compared with their RKEN counterparts and their lower aerobic fitness level.

  19. Substance Use in Urban and Rural Texas School Districts

    ERIC Educational Resources Information Center

    Maxwell, Jane Carlisle; Tackett-Gibson, Melissa; Dyer, James

    2006-01-01

    The aim of this study is to compare substance use between urban and rural secondary school districts in Texas between 1998 and 2003. The differences were analyzed using chi-square and analysis of variance. The analysis found that rural schools had students who reported higher rates of use of tobacco, frequent binge drinking, and driving while…

  20. Substance Use in Urban and Rural Texas School Districts

    ERIC Educational Resources Information Center

    Maxwell, Jane Carlisle; Tackett-Gibson, Melissa; Dyer, James

    2006-01-01

    The aim of this study is to compare substance use between urban and rural secondary school districts in Texas between 1998 and 2003. The differences were analyzed using chi-square and analysis of variance. The analysis found that rural schools had students who reported higher rates of use of tobacco, frequent binge drinking, and driving while…

  1. Impact of biogas digesters on wood utilisation and self-reported back pain for women living on rural Kenyan smallholder dairy farms.

    PubMed

    Dohoo, Carolyn; VanLeeuwen, John; Read Guernsey, Judith; Critchley, Kim; Gibson, Mark

    2013-01-01

    Women living on rural Kenyan dairy farms spend significant amounts of time collecting wood for cooking. Biogas digesters, which generate biogas for cooking from the anaerobic decomposition of livestock manure, are an alternative fuel source. The objective of this study was to quantify the quality of life and health benefits of installing biogas digesters on rural Kenyan dairy farms with respect to wood utilisation. Women from 62 farms (31 biogas farms and 31 referent farms) participated in interviews to determine reliance on wood and the impact of biogas digesters on this reliance. Self-reported back pain, time spent collecting wood and money spent on wood were significantly lower (p < 0.01) for the biogas group, compared to referent farms. Multivariable linear regression showed that wood consumption increased by 2 lbs/day for each additional family member living on a farm. For an average family of three people, the addition of one cow was associated with increased wood consumption by 1.0 lb/day on biogas farms but by 4.4 lbs/day on referent farms (significant interaction variable - likely due to additional hot water for cleaning milk collection equipment). Biogas digesters represent a potentially important technology that can reduce reliance on wood fuel and improve health for Kenyan dairy farmers.

  2. Rural Districts Left Behind? Rural Districts and the Challenges of Administering the Elementary and Secondary Education Act

    ERIC Educational Resources Information Center

    Yettick, Holly; Baker, Robin; Wickersham, Mary; Hupfeld, Kelly

    2014-01-01

    The purpose of this study was to inform the upcoming and overdue reauthorization of the Elementary and Secondary Education Act (ESEA) by exploring whether rural school districts face disadvantages as they attempt to follow the law's provisions and, if so, if the law's rural-specific section ameliorates these disadvantages. The research drew upon…

  3. Rural Districts Left Behind? Rural Districts and the Challenges of Administering the Elementary and Secondary Education Act

    ERIC Educational Resources Information Center

    Yettick, Holly; Baker, Robin; Wickersham, Mary; Hupfeld, Kelly

    2014-01-01

    The purpose of this study was to inform the upcoming and overdue reauthorization of the Elementary and Secondary Education Act (ESEA) by exploring whether rural school districts face disadvantages as they attempt to follow the law's provisions and, if so, if the law's rural-specific section ameliorates these disadvantages. The research drew upon…

  4. Around the Table: Food Insecurity, Socioeconomic Status, and Instrumental Social Support among Women Living in a Rural Kenyan Island Community.

    PubMed

    Nagata, Jason M; Fiorella, Kathryn J; Salmen, Charles R; Hickey, Matthew D; Mattah, Brian; Magerenge, Richard; Milner, Erin M; Weiser, Sheri D; Bukusi, Elizabeth A; Cohen, Craig R

    2015-01-01

    The objective of this study was to investigate the relationship among socioeconomic status, social support, and food insecurity in a rural Kenyan island community. A cross-sectional random sample of 111 female heads of households representing 583 household members were surveyed in Mfangano Island, Kenya from August to October 2010 using adaptations of the Household Food Insecurity Access Scale and the Medical Outcomes Study Social Support Survey. In multiple linear regression models, less instrumental social support, defined as concrete direct ways people help others (B = -0.81; 95% confidence interval [CI] -1.45 to -0.17), and decreased ownership scale based on owning material assets (B = -2.93; 95% CI -4.99 to -0.86) were significantly associated with increased food insecurity, controlling for age, education, marital status, and household size. Social support interventions geared at group capacity and resilience may be crucial adjuncts to improve and maintain the long term food security and health of persons living in low-resource regions.

  5. Freeing the Hand of the Lord: Securing Constructivist Pedagogy through Professional Development in Kenyan Rural Schools

    ERIC Educational Resources Information Center

    Ngundi, James

    2013-01-01

    This study explores the use of constructivist pedagogy promoting learner-centered teaching in Kenya's rural primary schools. It explores both the school-based as well as bureaucratic hurdles to the success of constructivist pedagogy. Teacher ideologies, issues of diverse cultures and traditional beliefs, the rural context characterized by…

  6. Use of intermittent presumptive treatment and insecticide treated bed nets by pregnant women in four Kenyan districts.

    PubMed

    Guyatt, H L; Noor, A M; Ochola, S A; Snow, R W

    2004-02-01

    The roll back malaria (RBM) movement promotes the use of insecticide-treated bednets (ITNs) and intermittent presumptive treatment (IPT) of malaria infection as preventive measures against the adverse effects of malaria among pregnant women in Africa. To determine the use of these preventive measures we undertook a community-based survey of recently pregnant women randomly selected from communities in four districts of Kenya in December 2001. Of the 1814 women surveyed, only 5% had slept under an ITN. More than half of the 13% of women using a bednet (treated or untreated) had bought their nets from shops or markets. Women from rural areas used bednets less than urban women (11% vs. 27%; P < 0.001), and 41% of the bednets used by rural women had been obtained free of charge from a research project in Bondo or a nationwide UNICEF donation through antenatal clinics (ANCs). Despite 96% of ANC providers being aware of IPT with sulphadoxine-pyrimethamine (SP), only 5% of women interviewed had received two or more doses of SP as a presumptive treatment. The coverage of pregnant women with at least one dose of IPT with SP was 14%, though a similar percentage also had received at least a single dose as a curative treatment. The coverage of nationally recommended strategies to prevent malaria during pregnancy during 2001 was low across the diverse malaria ecology of Kenya. Rapid expansion of access to these services is required to meet international and national targets by the year 2005. The scaling up of malaria prevention programmes through ANC services should be possible with 74% of women visiting ANCs at least twice in all four districts. Issues of commodity supply and service costs to clients will be the greatest impediments to reaching RBM targets.

  7. Implementing the No Child Left Behind Act: Implications for Rural Schools and Districts. Educational Policy Publications.

    ERIC Educational Resources Information Center

    Reeves, Cynthia

    The No Child Left Behind Act of 2001 poses unique challenges for rural schools and districts. Small schools are more likely to be labeled as needing improvement due to the volatility of annual test scores for small student populations. Rural districts are limited in their capacity to provide parents with school choice, and rural districts face…

  8. A Research Report of Small/Rural School Districts in New Mexico Compared to School Districts of Similiar Size Nationwide.

    ERIC Educational Resources Information Center

    Barker, Bruce O.; Muse, Ivan D.

    A 1982-83 survey produced data used to compare 17 small/rural K-12 New Mexico school districts (900 students or fewer) with 642 similar districts nationwide. Of New Mexico's 88 school districts, 43 were identified as qualifying (48.9%, enrolling 16,648 students), for comparison to 4,125 similar districts nationwide. A questionnaire mailed to…

  9. Responsiveness to HIV education and VCT services among Kenyan rural women: a community-based survey.

    PubMed

    Karau, Paul Bundi; Winnie, Mueni Saumu; Geoffrey, Muriira; Mwenda, Mukuthuria

    2010-09-01

    Uptake of VCT and other HIV prevention strategies among rural African women is affected by various socio-cultural and economic factors which need elucidation. Our aim was to establish the responsiveness to HIV education among rural women attending three dispensaries in Kenya. This study was designed to assess gender and psycho-social factors that influence HIV dynamics in rural Kenya. This was a cross-sectional questionnaire based study of 1347 women, conducted in October 2009. Socio-economic status as well as knowledge on methods of HIV transmission was assessed. Testing status, knowledge on existing VCT services and willingness to share HIV information with their children was assessed. Majority of the women have heard about VCT services, but significantly few of them have been tested. Those with secondary school education and above are more knowledgeable on methods of HIV transmission, while those with inadequate education are more likely to cite shaking hands, sharing utensils, mosquito bites and hugging as means of transmission (p = 0.001). 90% of educated women are willing to share HIV information with their children, compared to 40% of uneducated women. Marital status is seen to positively influence testing status, but has no significant effect on dissemination of information to children. We conclude that despite the aggressive HIV education and proliferation of VCT services in Kenya, women are not heeding the call to get tested. Education has a positive impact on dissemination of HIV information. Focus needs to shift into increasing acceptability of testing by women in rural Kenya.

  10. Rural School District Reorganization on the Great Plains.

    ERIC Educational Resources Information Center

    Bryant, Miles

    2002-01-01

    Rural school district reorganization and school consolidation are put into perspective by reviewing the large population increases that fueled small-school growth in the Great Plains, 1870-1930. Since the Dust Bowl and Great Depression, population losses, improvements in transportation, and arguments advocating economies of scale and increased…

  11. Rural School District Reorganization on the Great Plains.

    ERIC Educational Resources Information Center

    Bryant, Miles

    2002-01-01

    Rural school district reorganization and school consolidation are put into perspective by reviewing the large population increases that fueled small-school growth in the Great Plains, 1870-1930. Since the Dust Bowl and Great Depression, population losses, improvements in transportation, and arguments advocating economies of scale and increased…

  12. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years.

    PubMed

    Mwaniki, Michael K; Gatakaa, Hellen W; Mturi, Florence N; Chesaro, Charles R; Chuma, Jane M; Peshu, Norbert M; Mason, Linda; Kager, Piet; Marsh, Kevin; English, Mike; Berkley, James A; Newton, Charles R

    2010-10-06

    Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old) admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1(st) 1990 up to December 31(st) 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45-1.21). Most of the increase in burden was from neonates born in hospital and very young neonates aged < 7 days. Hospital deliveries also increased significantly. Clinical diagnoses of neonatal sepsis, prematurity, neonatal jaundice, neonatal encephalopathy, tetanus and neonatal meningitis accounted for over 75% of the inpatient neonatal admissions. Inpatient case fatality for all ≤ 5 years declined significantly over the 19 years. However, neonatal deaths comprised 33% of all inpatient death among children aged ≤ 5 years in 1990, this increased to 55% by 2008. Tetanus 256/390 (67%), prematurity 554/1,280(43%) and neonatal

  13. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years

    PubMed Central

    2010-01-01

    Background Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Methods Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old) admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1st 1990 up to December 31st 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. Results The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45 -1.21). Most of the increase in burden was from neonates born in hospital and very young neonates aged < 7days. Hospital deliveries also increased significantly. Clinical diagnoses of neonatal sepsis, prematurity, neonatal jaundice, neonatal encephalopathy, tetanus and neonatal meningitis accounted for over 75% of the inpatient neonatal admissions. Inpatient case fatality for all ≤ 5 years declined significantly over the 19 years. However, neonatal deaths comprised 33% of all inpatient death among children aged ≤ 5 years in 1990, this increased to 55% by 2008. Tetanus 256/390 (67%), prematurity 554

  14. Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study.

    PubMed

    Pelto, Gretel H; Armar-Klemesu, Margaret

    2015-12-01

    essential for child growth and development. This indicates that caregivers in these rural Kenyan communities have adopted the basic biomedical interpretation of the importance of child nutrition as an integral part of their 'knowledge frameworks'. © 2015 John Wiley & Sons Ltd.

  15. Use of combined measures from capillary blood to assess iron deficiency in rural Kenyan children.

    PubMed

    Shell-Duncan, Bettina; McDade, Thomas

    2004-02-01

    Community-based surveys of iron deficiency (ID) require simple, accurate methods that can be used in remote areas. The objective of this study was to assess iron status in rural Kenya using "field-friendly" methods for capillary blood, including an improved dried blood spot assay for transferrin receptor (TfR). A single finger stick was used to obtain capillary blood from 275 school-age children. Whole blood was applied directly to filter paper, dried, and later analyzed for TfR, as well as C-reactive protein (CRP), an acute-phase protein that serves as a general marker of inflammation. Capillary blood was also used to measure hemoglobin (Hb) concentration and the ratio of zinc protoporphyrin to heme (ZPP:H). The Hb concentration alone provides the lowest estimate of the prevalence of ID (8.0%). Because ZPP:H is reported to be elevated in the presence of inflammation, we constructed a preliminary diagnostic model based on elevated ZPP:H and normal CRP level, estimating the prevalence of ID at 25.9%. When TfR is added to a multiple criteria model (elevated ZPP:H in the absence of elevated CRP and/or elevated TfR level) the prevalence of ID is estimated to be 31.2%. This study demonstrates the diagnostic utility of combining TfR with other indexes of iron status, enabling the detection of ID in both the presence and absence of infection. Furthermore, this study is the first field application of TfR blood-spot methods, and it demonstrates their feasibility in remote field settings.

  16. Service delivery in Kenyan district hospitals - what can we learn from literature on mid-level managers?

    PubMed

    Nzinga, Jacinta; Mbaabu, Lairumbi; English, Mike

    2013-02-26

    There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level managers to help us understand how they might influence service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments who are also clinical or nursing service providers might play. A computerized search strategy was run in Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to 2011. In addition, citation searching from excluded and included articles was used and relevant unpublished literature systematically identified. A total of 23 articles were finally included in the review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, we identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. The majority of studies included in the review concerned the roles that mid-level managers are expected to play in times of organizational change. This review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan public hospitals and strongly suggests that

  17. Service delivery in Kenyan district hospitals – what can we learn from literature on mid-level managers?

    PubMed Central

    2013-01-01

    Background There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level managers to help us understand how they might influence service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments who are also clinical or nursing service providers might play. Methods A computerized search strategy was run in Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to 2011. In addition, citation searching from excluded and included articles was used and relevant unpublished literature systematically identified. Results and discussion A total of 23 articles were finally included in the review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, we identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. The majority of studies included in the review concerned the roles that mid-level managers are expected to play in times of organizational change. Conclusion This review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan

  18. Recruiting and Retaining Teachers in a Rural School District: A Phenomenological Study of Rural Teachers

    ERIC Educational Resources Information Center

    Taylor, Laura U.

    2012-01-01

    The purpose of this qualitative, phenomenological research study was to explore the effectiveness of programs and strategies used to recruit and retain highly qualified teachers in accordance with the No Child Left Behind Act (2001) from the perspective of highly qualified teachers in a rural school district in Central Virginia. The data…

  19. Recruiting and Retaining Teachers in a Rural School District: A Phenomenological Study of Rural Teachers

    ERIC Educational Resources Information Center

    Taylor, Laura U.

    2012-01-01

    The purpose of this qualitative, phenomenological research study was to explore the effectiveness of programs and strategies used to recruit and retain highly qualified teachers in accordance with the No Child Left Behind Act (2001) from the perspective of highly qualified teachers in a rural school district in Central Virginia. The data…

  20. Social marketing in a rural African district.

    PubMed

    Kipp, W; Kabwa, P; Mwesigye, B

    1992-01-01

    21 focus group discussions were held in 5 locations of Kabarole district, Uganda, with 200 male and female participants to assess the demand for and acceptability of condoms in the region. The discussions were also held to obtain information related to the design of products and motivational materials, and included people believed to engage in high-risk sex, lower-risk members of the general population, and shop owners. Condoms and condom use are strongly desired within this population, with participants expressing interest in high-quality products of uniform size which are continuously available at convenient outlets. Moreover, shop and pharmacy owners were more than willing to display subtle messages about condoms and advertise their availability. The main barriers to use were low female acceptance, unavailability, societal attitudes, high cost, and the inability to buy condoms at night when shops are closed. Feedback led to the development of the logo of a man holding a spear and a shield and the adoption of the brand name Engabu, Rutooro terminology for a wooden shield. Comparatively stronger, yet sensitive, brown condoms were eventually packaged in dark brown wrappings in groups of 5. Vendors are offered the packets of 5 condoms for US$0.06, which they are expected t sell at US$0.08; owners expressed the preference for slot-box distribution containers. In addition, people in the sales network were all trained so they could explain proper condom use to clients. A post-study assessment found people content with the product and its presentation, so the social marketing program was officially launched in September, 1992. Condoms were sold heavily in the 1st few weeks of the program despite the lack of media and newspaper coverage per national government condom policy. Knowledge of the availability of condoms will instead be spread through counseling and health education sessions, seminars, and informal talks.

  1. The Poor Little Rich District: The Effects of Suburbanization on a Rural School and Community

    ERIC Educational Resources Information Center

    Howley, Aimee; Carnes, Marilyn; Eldridge, Anita; Huber, Donna; Lado, Longun Moses; Kotler, Ruth; Turner, Maryalice

    2005-01-01

    Contextualized in relationship to other case studies about rural districts that have experienced population growth and decline as well as in relationship to the small sociological literature on "boom towns," this study considered the dynamics that seem to be interfering with one previously rural and now suburbanizing district's ability to address…

  2. The Poor Little Rich District: The Effects of Suburbanization on a Rural School and Community

    ERIC Educational Resources Information Center

    Howley, Aimee; Carnes, Marilyn; Eldridge, Anita; Huber, Donna; Lado, Longun Moses; Kotler, Ruth; Turner, Maryalice

    2005-01-01

    Contextualized in relationship to other case studies about rural districts that have experienced population growth and decline as well as in relationship to the small sociological literature on "boom towns," this study considered the dynamics that seem to be interfering with one previously rural and now suburbanizing district's ability to address…

  3. Physical Education for Individuals with Disabilities in Washington State's Rural School Districts.

    ERIC Educational Resources Information Center

    Palma, Gloria M.

    This study investigated the nature and extent of physical education programs for individuals with disabilities in Washington State's small rural public school districts. Questionnaires were sent to 185 superintendents of small rural school districts in the state. Of the 128 responses, 70.3% enrolled individuals with disabilities. Fifty-eight…

  4. "…still waiting for chloroquine": the challenge of communicating changes in first-line treatment policy for uncomplicated malaria in a remote Kenyan district.

    PubMed

    Okungu, Vincent; Gilson, Lucy

    2014-07-08

    Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing advertisements of other drugs and conflicts between

  5. “…still waiting for chloroquine”: the challenge of communicating changes in first-line treatment policy for uncomplicated malaria in a remote Kenyan district

    PubMed Central

    2014-01-01

    Background Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. Objectives To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Methods Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Results Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing

  6. Spontaneous adverse drug reaction reporting in rural districts of Mozambique.

    PubMed

    Sevene, Esperança; Mariano, Alda; Mehta, Ushma; Machai, Maria; Dodoo, Alexander; Vilardell, David; Patel, Sam; Barnes, Karen; Carné, Xavier

    2008-01-01

    The roll out of various public health programmes involving mass administration of medicines calls for the deployment of responsive pharmacovigilance systems to permit identification of signals of rare or even common adverse reactions. In developing countries in Africa, these systems are mostly absent and their performance under any circumstance is difficult to predict given the known shortage of human, financial and technical resources. Nevertheless, the importance of such systems in all countries is not in doubt, and research to identify problems, with the aim of offering pragmatic solutions, is urgently needed. To examine the impact of training and monitoring of healthcare workers, making supervisory visits and the availability of telecommunication and transport facilities on the implementation of a pharmacovigilance system in Mozambique. This was a descriptive study enumerating the lessons learnt and challenges faced in implementing a spontaneous reporting system in two rural districts of Mozambique - Namaacha and Matutuíne - where remote location, poor telecommunication services and a low level of education of health professionals are ongoing challenges. A 'yellow card' system for spontaneous reporting of adverse drug reactions (ADRs) was instituted following training of health workers in the selected districts. Thirty-five health professionals (3 medical doctors, 2 technicians, 24 nurses, 4 basic healthcare agents and 2 pharmacy agents) in these districts were trained to diagnose, treat and report ADRs to all medicines using a standardized yellow card system. There were routine site visits to identify and clarify any problems in filling in and sending the forms. One focal person was identified in each district to facilitate communication between the health professionals and the National Pharmacovigilance Unit (NPU). The report form was assessed for quality and causality. The availability of telecommunications and transport was assessed. Fourteen months after

  7. Prevalence of Goiter in Rural Area of Belgaum District, Karnataka

    PubMed Central

    Kamath, R; Bhat, Vinod; Rao, RSP; Das, Acharya; KS, Ganesh; Kamath, Asha

    2009-01-01

    Background: To determine the prevalence of goiter and to study the factors influencing goiter among people of the rural community in Karnataka state, a community based study. Setting and Study Design: A cross sectional study was carried out to find out the prevalence of goiter in a rural community of Belgaum district. The study was conducted by house-to-house survey for a period of one month. Materials and Methods: Two villages (Handiganur and Gundwad) were selected randomly from Belgaum and Raibag taluks of Belgaum district. All the family members in each household were examined for the presence of goiter using WHO criteria. Iodine content of the salt sample obtained from each household was estimated by using spot testing kits. Information regarding the determinants of goiter was collected and recorded in a pre tested proforma. Data collected was analyzed using SPSS statistical packages. Results: The prevalence of goiter among rural population was found to be 16.6%. Goiter of grade 1 was 15.7% and that of grade 2 was 0.9%. Prevalence among males and females were 7.2% and 21.8%, respectively. The prevalence of goiter was highest among adolescents. Estimation of iodine content in the salt sample revealed that 50% of samples had adequate iodine content (≥15 ppm). Multiple Logistic Regression Analysis revealed that females of the age group 10-49 years were independently associated with goiter. Conclusion: Prevalence of goiter was relatively high and therefore constituted a public health problem in this region. PMID:19876455

  8. Estimating the Efficiency of Michigan's Rural and Urban Public School Districts

    ERIC Educational Resources Information Center

    Maranowski, Rita

    2012-01-01

    This study examined student achievement in Michigan public school districts to determine if rural school districts are demonstrating greater financial efficiency by producing higher levels of student achievement than school districts in other geographic locations with similar socioeconomics. Three models were developed using multiple regression…

  9. Estimating the Efficiency of Michigan's Rural and Urban Public School Districts

    ERIC Educational Resources Information Center

    Maranowski, Rita

    2012-01-01

    This study examined student achievement in Michigan public school districts to determine if rural school districts are demonstrating greater financial efficiency by producing higher levels of student achievement than school districts in other geographic locations with similar socioeconomics. Three models were developed using multiple regression…

  10. Expanding the Vision: New Roles for Educational Service Agencies in Rural School District Improvement.

    ERIC Educational Resources Information Center

    Stephens, E. Robert

    This book examines the role of the educational service agency (ESA) in the process of enabling and facilitating rural school improvement. The introductory chapter discusses the continuing significance of rural education, service to rural districts as an explicit reason for establishing ESAs, and the characteristics of several types of ESAs.…

  11. Human Capital Problems in Zimbabwean Rural Schools: A Case Study of Mazowe District

    ERIC Educational Resources Information Center

    Zvavahera, Promise

    2014-01-01

    This study focused on the management of human capital in Zimbabwean rural schools. It was observed that teachers in rural schools preferred urban postings which turned out to have better facilities and incentives. Rural to urban migration of teachers is a cause for concern in Mazowe District. This study was motivated by the high teacher-turnover…

  12. Conceptualization of appropriate technology in Lundazi district of rural Zambia

    SciTech Connect

    Tembo, M.S.

    1987-01-01

    A sample of 144 people from the Lundazi District of the Eastern Province of rural Zambia in Central Africa responded to a questionnaire. The first objective of the study was to determine how men and women conceptualize and evaluated appropriate technology for food production, processing, preservation, and storage; second, to investigate if participation in modern institutions (COSISOCHINS) was related to conceptualization of appropriate technology. There were no significant gender differences in how men and women viewed appropriate technology. Participation in modern institutions was not significantly related to how people conceptualized and evaluated appropriate technology. There were significant gender differences in participation in modern institutions; men participated more than women. The findings remained the same when age, education, income and marital status held constant. Sex-role task overlap and exclusiveness in gender division of labor account for lack of significant gender differences. Modern institutions can be useful if they are effectively integrated with the social structure, gender division of labor, and social organization of the production process of the rural communities of the Third World.

  13. Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting

    PubMed Central

    GARRETT, V.; OGUTU, P.; MABONGA, P.; OMBEKI, S.; MWAKI, A.; ALUOCH, G.; PHELAN, M.; QUICK, R. E.

    2008-01-01

    SUMMARY Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries. We evaluated the impact of household water treatment, latrines, shallow wells, and rainwater harvesting on diarrhoea incidence in rural Kenyan children. We compared diarrhoea rates in 960 children aged <5 years in 556 households in 12 randomly selected intervention villages and six randomly selected comparison villages during weekly home visits over an 8-week period. On multivariate analysis, chlorinating stored water [relative risk (RR) 0·44, 95% confidence interval (CI) 0·28–0·69], latrine presence (RR 0·71, 95% CI 0·54–0·92), rainwater use (RR 0·70, 95% CI 0·52–0·95), and living in an intervention village (RR 0·31, 95% CI 0·23–0·41), were independently associated with lower diarrhoea risk. Diarrhoea risk was higher among shallow well users (RR 1·78, 95% CI 1·12–2·83). Chlorinating stored water, latrines, and rainwater use all decreased diarrhoea risk; combined interventions may have increased health impact. PMID:18205977

  14. Diarrhoea prevention in a high-risk rural Kenyan population through point-of-use chlorination, safe water storage, sanitation, and rainwater harvesting.

    PubMed

    Garrett, V; Ogutu, P; Mabonga, P; Ombeki, S; Mwaki, A; Aluoch, G; Phelan, M; Quick, R E

    2008-11-01

    Lack of access to safe water and sanitation contributes to diarrhoea moribidity and mortality in developing countries. We evaluated the impact of household water treatment, latrines, shallow wells, and rainwater harvesting on diarrhoea incidence in rural Kenyan children. We compared diarrhoea rates in 960 children aged <5 years in 556 households in 12 randomly selected intervention villages and six randomly selected comparison villages during weekly home visits over an 8-week period. On multivariate analysis, chlorinating stored water [relative risk (RR) 0.44, 95% confidence interval (CI) 0.28-0.69], latrine presence (RR 0.71, 95% CI 0.54-0.92), rainwater use (RR 0.70, 95% CI 0.52-0.95), and living in an intervention village (RR 0.31, 95% CI 0.23-0.41), were independently associated with lower diarrhoea risk. Diarrhoea risk was higher among shallow well users (RR 1.78, 95% CI 1.12-2.83). Chlorinating stored water, latrines, and rainwater use all decreased diarrhoea risk; combined interventions may have increased health impact.

  15. A computer-based medical record system and personal digital assistants to assess and follow patients with respiratory tract infections visiting a rural Kenyan health centre

    PubMed Central

    Diero, Lameck; Rotich, Joseph K; Bii, John; Mamlin, Burke W; Einterz, Robert M; Kalamai, Irene Z; Tierney, William M

    2006-01-01

    Background Clinical research can be facilitated by the use of informatics tools. We used an existing electronic medical record (EMR) system and personal data assistants (PDAs) to assess the characteristics and outcomes of patients with acute respiratory illnesses (ARIs) visiting a Kenyan rural health center. Methods We modified the existing EMR to include details on patients with ARIs. The EMR database was then used to identify patients with ARIs who were prospectively followed up by a research assistant who rode a bicycle to patients' homes and entered data into a PDA. Results A total of 2986 clinic visits for 2009 adult patients with respiratory infections were registered in the database between August 2002 and January 2005; 433 patients were selected for outcome assessments. These patients were followed up in the villages and assessed at 7 and 30 days later. Complete follow-up data were obtained on 381 patients (88%) and merged with data from the enrollment visit's electronic medical records and subsequent health center visits to assess duration of illness and complications. Symptoms improved at 7 and 30 days, but a substantial minority of patients had persistent symptoms. Eleven percent of patients sought additional care for their respiratory infection. Conclusion EMRs and PDA are useful tools for performing prospective clinical research in resource constrained developing countries. PMID:16606466

  16. You cannot prevent a disease; you only treat diseases when they occur: knowledge, attitudes and practices to water-health in a rural Kenyan community.

    PubMed

    Levison, M M; Elliott, S J; Karanja, D M S; Schuster-Wallace, C J; Harrington, D W

    2011-06-01

    Almost 1 billion individuals lack access to improved water supplies, with 2.6 billion lacking adequate sanitation. This leads to the propagation of multiple waterborne diseases. The objective of this study was to explore local knowledge, attitudes and practices to understand the mechanisms and pre-conditions for sustainable uptake and use of these facilities. Data collection took place in a rural Kenyan community in September 2009. A qualitative approach was taken, with 4 focus groups and 25 in-depth interviews conducted. Participant characteristics varied by age, gender, education, marital status, employment and community standing. Few participants reported current access to improved water and sanitation facilities. Though they expressed desire for latrines and water sources, barriers including lack of funds and social capital, decrease the ability for installation. Participants understood that there was a link between the quality of water and their health, however, perceived benefits of current contaminated sources outweigh the potential health impacts and proliferate their continued use. While water-health links are understood to varying degrees within the community, contextual (physical environment), compositional (individual) and collective (community) factors interact to influence health. Community challenges, such as lack of unity, lack of education and lack control were identified as the main barriers to initiating change, despite a desire for increased access to safe water and sanitation.

  17. No Child Left Behind Act: Additional Assistance and Research on Effective Strategies Would Help Small Rural Districts. Report to Congressional Requesters. GAO-04-909

    ERIC Educational Resources Information Center

    Hickok, Eugene W.

    2004-01-01

    Congress has raised concerns about difficulties rural school districts face implementing the No Child Left Behind Act (NCLBA). This report describes: key challenges rural states and districts face; strategies rural districts have developed; expenditures and resources related to rural districts? compliance; and guidance and assistance from the…

  18. Experiences of Successful Novice Alternative Certification Teachers in Rural School Districts

    ERIC Educational Resources Information Center

    Mariani, Tamari L.

    2015-01-01

    This phenomenological narrative study investigated the perceptions of successful experiences of novice alternative certification teachers in Northeast Texas rural school districts. The five questions that guided the research examined participant's personal characteristics, classroom strategies, administrative support, challenges to overcome for…

  19. Vaccination perceptions of school employees in a rural school district.

    PubMed

    Macintosh, Janelle; Luthy, Karlen E; Beckstrand, Renea L; Eden, Lacey M; Orton, Jennifer

    2014-08-20

    There continues to be a need for increases in adult vaccination rates, especially among those working in environments which may easily become communicable disease outbreak centers, such as school employees in the school environment. The purpose of this study was to evaluate why rural Utah school employees were non-compliant with the influenza and measles, mumps, and rubella (MMR) vaccines, as well as to identify their views on mandatory vaccination policies. A questionnaire was distributed to all school employees in a rural Utah school district. Data analysis included frequencies and measures of central tendency and dispersion for quantitative items and theme identification for qualitative items. Only 51% of school employees were adequately vaccinated for influenza. Reasons for noncompliance with the influenza vaccine included inconvenience, lack of perceived need, and questionable vaccine efficacy. There were 39.3% school employees who had not received an MMR during adulthood, which was commonly attributed to lack of knowledge regarding the need for this vaccine. Almost half (45.7%) of school employees believed a mandatory vaccination policy should be instituted, although 24.2% of school employees were opposed to mandatory adult vaccination policies. Reasons for opposing vaccination mandates included violation of personal choice, lack of perceived vaccination safety and efficacy, lack of perceived need for adult vaccines, and vaccine cost. Suboptimal vaccination rates of school employees may negatively affect the health and well-being of individuals in the school environment. School employees report a variety of beliefs regarding the influenza and MMR vaccines. While over half of school employees support mandatory vaccination policies for adults working in the school environment, those opposing such a policy report concerns regarding violation of personal choice. Public health officials and school administrators should coordinate efforts to increase vaccination

  20. Obstacles to surgical services in a rural Cameroonian district hospital.

    PubMed

    Ilbawi, André M; Einterz, Ellen M; Nkusu, Daniel

    2013-06-01

    There are significant obstacles to the delivery of surgical care in low income countries. Few studies have defined or characterized these constraints. The present study aimed to identify financial and demographic factors limiting the utilization of surgical services in rural Cameroon. A review was performed of all surgical records for patients presenting for surgery at the District Hospital of Kolofata in rural Cameroon over the 3-year study period (2004-2007). Disability-adjusted life years (DALYs) were calculated using disease- and patient-specific outcomes while accounting for postoperative morbidity. Univariate and multivariate analysis identified factors associated with failure to return for care. During the study period, 1,213 patients presented for preoperative evaluation, were informed of the cost to be paid preoperatively, and had surgery scheduled. Of these, 544 patients did not return for treatment, representing 2,163 DALYs potentially lost. Multivariate analysis revealed significant factors associated with increased likelihood of not returning for care as required preoperative payment >$US 310 (OR 0.44-0.86) and a recommended procedure for cancer (OR 0.47-0.86) or cutaneous disease (OR 0.28-0.95). Factors associated with increased odds of returning were male gender (OR 1.03-1.98), preoperative payment <$US 50 (OR 2.86-16.2), and a procedure with low DALYs (OR 1.71-9.89). The average cost per DALY for all operations performed was $US 27.13. Although surgery addresses a significant disease burden and is reported to be a cost-effective public health intervention, utilization is limited by high costs, demographic factors, and patient perceptions of surgical diseases.

  1. Decision Points and Considerations for Identifying Rural Districts That Have Closed Student Achievement Gaps. REL 2016-130

    ERIC Educational Resources Information Center

    Culbertson, Michael J.; Billig, Shelley H.

    2016-01-01

    Rural districts have long faced challenges in closing achievement gaps between subgroups of students. This brief report describes key decision points and considerations for decision-makers interested in identifying rural districts that have closed academic achievement gaps. Examining practices in these districts may suggest activities associated…

  2. A Study of Factors that Impact Recruitment and Retention in a Selected Rural School District in South Carolina

    ERIC Educational Resources Information Center

    Gadson, Denise Brooks

    2010-01-01

    Recruiting and retaining highly qualified teachers has been a challenge for many rural school districts. Lower salaries, working conditions, and geographic location are some of the challenges rural districts face when staffing their schools. The challenges of recruiting teachers in rural areas are compounded by competition from larger districts…

  3. Selected Variables as Discriminators between Financially Troubled and Non-Troubled Rural Ohio School Districts.

    ERIC Educational Resources Information Center

    Berny, Charles A.

    1982-01-01

    Analysis of 1976-78 data on rural Ohio school districts found that of six fiscal and demographic variables (geographic size, children with special needs, fiscal capacity, tax effort, total revenues, and excess staff over state minimum requirements), none could distinguish financially troubled from untroubled districts. (RW)

  4. Factors That Influence Special Education Teachers' Career Decisions in a Rural School District in Southern Indiana

    ERIC Educational Resources Information Center

    Lemons, Theresa

    2013-01-01

    Attrition of special education teachers is a national problem resulting in lost monetary resources, school climate discontinuity, and lower student achievement. Within a small, rural district in southern Indiana, special education teacher attrition has risen since 2008 and continues to rise. District administrators want to retain teachers to…

  5. Factors That Influence Special Education Teachers' Career Decisions in a Rural School District in Southern Indiana

    ERIC Educational Resources Information Center

    Lemons, Theresa

    2013-01-01

    Attrition of special education teachers is a national problem resulting in lost monetary resources, school climate discontinuity, and lower student achievement. Within a small, rural district in southern Indiana, special education teacher attrition has risen since 2008 and continues to rise. District administrators want to retain teachers to…

  6. Staff Development in Small and Rural School Districts. AASA Small School Series #1.

    ERIC Educational Resources Information Center

    Pelton, Mary Helen White

    Staff development is the small school district's key to survival in the 1980's. Although small rural districts may face problems like isolation and limited resources, they have distinct advantages. Chapter 1 of this guide provides a list of advantages, which include close contact between teachers and administrators, strong ties to the local…

  7. An Examination of State Takeover as a School Reform Strategy in a Small Rural School District

    ERIC Educational Resources Information Center

    Brookover, Chester Wayne

    2010-01-01

    The purpose of this qualitative study was to explore state takeover as a school reform strategy in a small rural school district. Since 1988, more than 50 U.S. school districts in 20 states have been subject to some form of state takeover. A number of factors generally contribute to a state takeover, some of which include: poor student…

  8. Bringing the Community Along: A Case Study of a School District's Information Technology Rural Development Initiative

    ERIC Educational Resources Information Center

    Schafft, Kai A.; Alter, Theodore R.; Bridger, Jeffrey C.

    2006-01-01

    We draw on interactional community theory to analyze the relationship between information technology and local development through a case study of a geographically isolated and economically disadvantaged rural school district. This district has used state-of-the-art information technology infrastructure in a broad-based community and economic…

  9. The Importance of a Small Rural School District to the Community

    ERIC Educational Resources Information Center

    Reynolds, Richard Kent

    2013-01-01

    Hallsburg ISD is a small, rural, K-6 school district struggling to sustain its operations due to reduced funding from the state, decreased enrollment, and a decrease in the local tax base. This Problem in Practice Record of Study examines the sustainability issues associated with this school district and its importance to the community. Key…

  10. An Examination of State Takeover as a School Reform Strategy in a Small Rural School District

    ERIC Educational Resources Information Center

    Brookover, Chester Wayne

    2010-01-01

    The purpose of this qualitative study was to explore state takeover as a school reform strategy in a small rural school district. Since 1988, more than 50 U.S. school districts in 20 states have been subject to some form of state takeover. A number of factors generally contribute to a state takeover, some of which include: poor student…

  11. Elementary School and Middle School Principals' Theories of Action in Two Rural School Districts

    ERIC Educational Resources Information Center

    Lisy-Macan, Lynn

    2012-01-01

    This dissertation was designed to answer the following question. What are elementary and middle school principals' theories of action in two rural school districts? Sub-questions included the superintendent-principal relationship and its influence on the principal's theories of action and the extent to which rural context impacts…

  12. Elementary School and Middle School Principals' Theories of Action in Two Rural School Districts

    ERIC Educational Resources Information Center

    Lisy-Macan, Lynn

    2012-01-01

    This dissertation was designed to answer the following question. What are elementary and middle school principals' theories of action in two rural school districts? Sub-questions included the superintendent-principal relationship and its influence on the principal's theories of action and the extent to which rural context impacts…

  13. Leveraging Rural America in the Fight Against Terrorism in America Through the Use of Conservation Districts

    DTIC Science & Technology

    2010-03-01

    RURAL AMERICA IN THE FIGHT AGAINST TERRORISM IN AMERICA THROUGH THE USE OF CONSERVATION DISTRICTS by William L. Eller March 2010 Thesis...REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE: Leveraging Rural America in the Fight Against Terrorism in America Through the...untapped resource is available to the federal government and the Department of Homeland Security in the war on terror. The citizens that comprise rural

  14. Similar Districts with Different Results: Using the Baldrige Scale to Understand Outcome Differences in Rural School Districts in the Lower Rio Grande Valley

    ERIC Educational Resources Information Center

    Gonzalez, Miguel Angel

    2009-01-01

    The research for this study describes the organizational characteristics and the personnel behaviors distinctive to high-achieving rural school districts. A comparison between two rural school districts, one high-achieving and the other low-achieving was completed using a survey instrument. The Baldrige National Quality Program instrument was…

  15. Similar Districts with Different Results: Using the Baldrige Scale to Understand Outcome Differences in Rural School Districts in the Lower Rio Grande Valley

    ERIC Educational Resources Information Center

    Gonzalez, Miguel Angel

    2009-01-01

    The research for this study describes the organizational characteristics and the personnel behaviors distinctive to high-achieving rural school districts. A comparison between two rural school districts, one high-achieving and the other low-achieving was completed using a survey instrument. The Baldrige National Quality Program instrument was…

  16. Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

    PubMed Central

    Boulanger, L. L.; Lee, L. A.; Odhacha, A.

    1999-01-01

    Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used. PMID:10593034

  17. The Impact of Hotspot-Targeted Interventions on Malaria Transmission in Rachuonyo South District in the Western Kenyan Highlands: A Cluster-Randomized Controlled Trial

    PubMed Central

    Bradley, John; Knight, Philip; Stone, William; Osoti, Victor; Makori, Euniah; Owaga, Chrispin; Odongo, Wycliffe; China, Pauline; Shagari, Shehu; Doumbo, Ogobara K.; Sauerwein, Robert W.; Kariuki, Simon; Drakeley, Chris; Stevenson, Jennifer; Cox, Jonathan

    2016-01-01

    Background Malaria transmission is highly heterogeneous, generating malaria hotspots that can fuel malaria transmission across a wider area. Targeting hotspots may represent an efficacious strategy for reducing malaria transmission. We determined the impact of interventions targeted to serologically defined malaria hotspots on malaria transmission both inside hotspots and in surrounding communities. Methods and Findings Twenty-seven serologically defined malaria hotspots were detected in a survey conducted from 24 June to 31 July 2011 that included 17,503 individuals from 3,213 compounds in a 100-km2 area in Rachuonyo South District, Kenya. In a cluster-randomized trial from 22 March to 15 April 2012, we randomly allocated five clusters to hotspot-targeted interventions with larviciding, distribution of long-lasting insecticide-treated nets, indoor residual spraying, and focal mass drug administration (2,082 individuals in 432 compounds); five control clusters received malaria control following Kenyan national policy (2,468 individuals in 512 compounds). Our primary outcome measure was parasite prevalence in evaluation zones up to 500 m outside hotspots, determined by nested PCR (nPCR) at baseline and 8 wk (16 June–6 July 2012) and 16 wk (21 August–10 September 2012) post-intervention by technicians blinded to the intervention arm. Secondary outcome measures were parasite prevalence inside hotpots, parasite prevalence in the evaluation zone as a function of distance from the hotspot boundary, Anopheles mosquito density, mosquito breeding site productivity, malaria incidence by passive case detection, and the safety and acceptability of the interventions. Intervention coverage exceeded 87% for all interventions. Hotspot-targeted interventions did not result in a change in nPCR parasite prevalence outside hotspot boundaries (p ≥ 0.187). We observed an average reduction in nPCR parasite prevalence of 10.2% (95% CI −1.3 to 21.7%) inside hotspots 8 wk post

  18. Why do Kenyan children live on the streets? Evidence from a cross-section of semi-rural maternal caregivers.

    PubMed

    Goodman, Michael L; Martinez, Kelli; Keiser, Philip H; Gitari, Stanley; Seidel, Sarah E

    2017-01-01

    Globally, study of factors contributing to the street-migration of the tens of millions of street-involved children focus almost exclusively on children's perspectives. In this study, we assess household and maternal factors associated with street-migration of children through self-report of 1974 randomly selected women in semi-rural Kenya. Contributing new perspectives on this global phenomenon, data show a statistically significant association between increased maternal childhood adversities and street-migration of children (p<0.001). Higher household wealth (p<0.01) and maternal education (p<0.05) were associated with lower odds of street-migration of children. Social support, reporting HIV+, school enrollment of biologically-related children, overall health, reported alcohol use, and functional literacy significantly mediated these pathways. Protecting children from street-migration in the next generation requires reducing childhood adversities in the present generation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Compounding Challenges: Student Achievement and the Distribution of Human and Fiscal Resources in Oregon's Rural School Districts

    ERIC Educational Resources Information Center

    Johnson, Jerry

    2006-01-01

    This report presents findings from an investigation into relationships between academic achievement and the distribution of fiscal resources among rural school districts in Oregon. The investigation was prompted by earlier-reported findings suggesting the critical nature of both achievement gaps and resource gaps among rural school districts in…

  20. An Analysis of Rural Buildings in the Tombigee River Multi-Resource District, Alabama and Mississippi.

    DTIC Science & Technology

    1982-12-01

    north Alabama with a rea - sonably good network along which all rural houses observed on the tran- sects would be classified. More than 17,000 dwellings...EiEEElEEEEEEEE EEEEEEBBEEEEE lEggEEIw I~1220 MICROCOPY RLSOLUTION TEST CHART O A BRAl l SANAR !-( AA An Analysis of Rural Buildings itre Tombigbee...TITLE (and Subtl(e) S. TYPE OF REPORT & PERIOD COVERED An Ana’ysis of Rural Buildings in the Tombigbee River Multi-Resource District, Alabama and Final

  1. [The bioindication of mutagens in the soil of rural districts].

    PubMed

    Nechkina, M A; Zhurkov, V S

    1997-01-01

    The cumulative mutagenic activity (CMA) of soil pollution was investigated in rural areas. The use of pesticides in agricultural practice increased soil mutagen levels. There was also higher mutagenic pollution for soil along the road with heavy traffic.

  2. Do Schools in Rural and Nonrural Districts Allocate Resources Differently? An Analysis of Spending and Staffing Patterns in the West Region States. Issues & Answers. REL 2011-No. 099

    ERIC Educational Resources Information Center

    Levin, Jesse; Manship, Karen; Chambers, Jay; Johnson, Jerry; Blankenship, Charles

    2011-01-01

    This report presents the first detailed comparison of resource allocation between rural and nonrural districts in the West Region. Three regional characteristics often associated with rural districts were chosen for the analysis: district enrollment, student population density within a district (students per square mile), and drive time from the…

  3. The Effect of Accelerated Reader on Reading Scores in a Rural School District

    ERIC Educational Resources Information Center

    Hunter, Teresa A.

    2013-01-01

    In this study, the implementation of Accelerated Reader (AR), a computer-assisted supplemental reading program, was investigated as a research-based instructional strategy to assess whether it aided a high-performing, rural school district in meeting adequate yearly progress goals. The theoretical framework was based on Vygotsky's zone of…

  4. Working against Ourselves: Decision Making in a Small Rural School District

    ERIC Educational Resources Information Center

    Patterson, Jean A.; Koenigs, Andrew; Mohn, Gordon; Rasmussen, Cheryl

    2006-01-01

    Purpose: The purpose of this paper is to examine decision making and resource allocation in a small, rural district in a Midwestern state of the USA during a time of economic retrenchment. Design/methodology/approach: Qualitative case study methods were used, including focus groups and personal interviews with current and former district…

  5. Effects of State Policies on Facilities Planning and Construction in Rural Districts. ERIC Digest.

    ERIC Educational Resources Information Center

    Lawrence, Barbara Kent

    State policies greatly affect the decisions rural districts make about building or renovating school facilities. State, federal, and local mechanisms for funding school facilities are briefly described. Some states require a specific percentage of growth or decline in student population or a minimum number of students as a prerequisite for…

  6. Working against Ourselves: Decision Making in a Small Rural School District

    ERIC Educational Resources Information Center

    Patterson, Jean A.; Koenigs, Andrew; Mohn, Gordon; Rasmussen, Cheryl

    2006-01-01

    Purpose: The purpose of this paper is to examine decision making and resource allocation in a small, rural district in a Midwestern state of the USA during a time of economic retrenchment. Design/methodology/approach: Qualitative case study methods were used, including focus groups and personal interviews with current and former district…

  7. Improving Immunization Coverage in a Rural School District in Pierce County, Washington

    ERIC Educational Resources Information Center

    Peterson, Robin M.; Cook, Carolyn; Yerxa, Mary E.; Marshall, James H.; Pulos, Elizabeth; Rollosson, Matthew P.

    2012-01-01

    Washington State has some of the highest percentages of school immunization exemptions in the country. We compared school immunization records in a rural school district in Pierce County, Washington, to immunization records in the state immunization information system (IIS) and parent-held records. Correcting school immunization records resulted…

  8. How Talented Students in a Rural School District Experience School Mathematics

    ERIC Educational Resources Information Center

    Howley, Aimee; Pendarvis, Edwina; Gholson, Melissa

    2005-01-01

    This study examined the mathematics experiences of talented children in an impoverished rural school district located in a coal-mining area of Appalachia. Using interview methods, the researchers explored the children's ideas about the nature of mathematics, their perceptions of the mathematics instruction they received at school, and their…

  9. Improving Immunization Coverage in a Rural School District in Pierce County, Washington

    ERIC Educational Resources Information Center

    Peterson, Robin M.; Cook, Carolyn; Yerxa, Mary E.; Marshall, James H.; Pulos, Elizabeth; Rollosson, Matthew P.

    2012-01-01

    Washington State has some of the highest percentages of school immunization exemptions in the country. We compared school immunization records in a rural school district in Pierce County, Washington, to immunization records in the state immunization information system (IIS) and parent-held records. Correcting school immunization records resulted…

  10. Managing Teacher Retention in a Rural School District in South Africa

    ERIC Educational Resources Information Center

    Mafora, Patrick

    2013-01-01

    Retaining quality teachers is a global challenge for schools, particularly those in rural districts. A nation-wide study conducted by the Human Sciences Research Council (HSRC) found that 55 % of teachers in South Africa would leave teaching if they could. Resignation was found to be one of the three largest causes of attrition (Hall et al.…

  11. AIDS Education in Rural Oregon School Districts: Compliance with State Curriculum Guidelines.

    ERIC Educational Resources Information Center

    Hales, Loyde W.; McGrew, Robin R.

    The Oregon State Department of Education mandates age-appropriate curricula for all grade levels on infectious diseases, including AIDS, ARC, HIV, and Hepatitis B. The objectives of this study were: (1) to determine the extent to which AIDS education was occurring in three remote rural Oregon school districts; (2) to examine the focus of the…

  12. Preparing Educational Leaders for Rural School Districts: New Mexico's State-Wide Collaborative Approach.

    ERIC Educational Resources Information Center

    Milstein, Mike; And Others

    Educational administration faculty from five public higher education institutions in New Mexico formed a consortium to address the need for effective educational leaders in rural school districts. Members established the New Mexico Partners for Educational Leadership (PEL), composed of faculty from the five universities, leading educational…

  13. Meeting the Needs of Rural School Districts in Georgia: One ESA's Story.

    ERIC Educational Resources Information Center

    Nelson, Terry T.

    2003-01-01

    Rural Georgia schools have unique needs arising from inequitable funding and high teacher and administrator turnover. Central Savannah River Area Regional Educational Service Agency, which serves 12 school districts, assists with teacher recruitment and preparation, federal regulations, school improvement planning and implementation, and…

  14. Using Appreciative Inquiry to Create a Sustainable Rural School District and Community

    ERIC Educational Resources Information Center

    Calabrese, Raymond; Hester, Michael; Friesen, Scott; Burkhalter, Kim

    2010-01-01

    Purpose: The purpose of this paper is to document how a doctoral research team applied an action research process to improve communication and collaboration strategies among rural Midwestern school district stakeholders. Design/methodology/approach: An appreciative inquiry (AI) action research methodology framed as a qualitative case study using…

  15. Managing Teacher Retention in a Rural School District in South Africa

    ERIC Educational Resources Information Center

    Mafora, Patrick

    2013-01-01

    Retaining quality teachers is a global challenge for schools, particularly those in rural districts. A nation-wide study conducted by the Human Sciences Research Council (HSRC) found that 55 % of teachers in South Africa would leave teaching if they could. Resignation was found to be one of the three largest causes of attrition (Hall et al.…

  16. AEL Study of KERA Implementation in Four Rural Kentucky School Districts. 1993-94 Annual Report.

    ERIC Educational Resources Information Center

    Coe, Pamelia; And Others

    A 5-year qualitative study of implementation of the Kentucky Education Reform Act (KERA) analyzes the effects on four rural school districts of large-scale changes in state policy. This annual report of the project focuses on five key KERA "strands." First, KERA mandates that grades K-3 be replaced with an ungraded primary program…

  17. Evaluation of a Year-Round Schedule in a Rural School District.

    ERIC Educational Resources Information Center

    Pittman, Robert B.; Herzog, Mary Jean Ronan

    1998-01-01

    Evaluation of year-round education (YRE) in a rural North Carolina school district found disruption to "sense of community;" positive attitudes among participating teachers, students, and parents (primarily based on personal scheduling preferences); but no advantages in attendance or achievement. Results suggest that decisions to use YRE…

  18. English Language Learner Resource Guide: A Guide for Rural Districts with a Low Incidence of ELLs

    ERIC Educational Resources Information Center

    Hill, Jane Donnelly; Flynn, Kathleen

    2004-01-01

    This resource guide will help rural school districts with a low incidence of English language learners (ELLs) develop the capacity to build and implement a comprehensive program that meets both the academic and language proficiency needs of ELLs. Under Title III of the No Child Left Behind Act of 2001, ELLs must show increased academic achievement…

  19. Part Digital Training, Part Human Touch: Rural District Mixes Its Offering of Staff Development Services.

    ERIC Educational Resources Information Center

    Barkley, Steve; Bianco, Terri

    2002-01-01

    Describes how one rural school district provides staff development through an on-line program that is followed up with on-site training. Teachers learn key concepts of learning styles via the on-line program, then receive on-site training followed by 8 hours of field practice. A sidebar examines different learning styles. (SM)

  20. Organizational Practices of High-Achieving Rural School Districts in California's San Joaquin Valley

    ERIC Educational Resources Information Center

    Doerksen, Amanda López; Wise, Donald

    2016-01-01

    For over 25 years, researchers have identified "best practices" used by high-achieving school districts. However, little research exists regarding rural school systems, making it difficult to determine whether the best practices identified are relevant within this context. This study filled a void in research by focusing on the…

  1. The Effect of Accelerated Reader on Reading Scores in a Rural School District

    ERIC Educational Resources Information Center

    Hunter, Teresa A.

    2013-01-01

    In this study, the implementation of Accelerated Reader (AR), a computer-assisted supplemental reading program, was investigated as a research-based instructional strategy to assess whether it aided a high-performing, rural school district in meeting adequate yearly progress goals. The theoretical framework was based on Vygotsky's zone of…

  2. The New Zealand District High School: A Case Study of the Conservative Politics of Rural Education

    ERIC Educational Resources Information Center

    Lee, Howard

    2005-01-01

    From the late 1860s, when they were established in New Zealand, the district high (now area) schools have sought to provide academically able rural youth with the opportunity to study a high status, abstract, examination-oriented curriculum. This curriculum enabled them to pursue clerical and professional careers in the towns and cities. However,…

  3. Leadership Behaviors of Superintendent/Principals in Small, Rural School Districts in Texas

    ERIC Educational Resources Information Center

    Canales, Maria T.; Tejeda-Delgado, Carmen; Slate, John R.

    2008-01-01

    In this study, 206 teachers, 35 school board presidents, and 37 superintendents/principals (n = 278) were surveyed regarding their views of effective leadership behaviors demonstrated by school leaders with dual role responsibilities through serving as both a school principal and as a superintendent in small rural school districts. Data were…

  4. Studies on dengue in rural areas of Kurnool District, Andhra Pradesh, India.

    PubMed

    Arunachalam, N; Murty, U Suryanarayana; Kabilan, Lalitha; Balasubramanian, A; Thenmozhi, V; Narahari, D; Ravi, Alaham; Satyanarayana, K

    2004-03-01

    A dengue case was reported for the 1st time in a rural area of Kurnool District, Andhra Pradesh, India. Entomological and serological investigations were carried out to determine the prevalence of dengue vectors and dengue virus. Aedes aegypti was recorded for the 1st time in rural areas of Andhra Pradesh. Breeding of Ae. aegypti was observed only in containers with nonpotable water. Cement cisterns and tanks, stone tubs, and clay pots were the major breeding habitats of Ae. aegypti. Larval indices for Ae. aegypti ranged as follows: house index 28-40%, container index 13-37%, and Breteau index 32-60. A serological survey indicated that humans in Kurnool District have been exposed to dengue virus infections. The potential threat of an outbreak of dengue fever in rural areas because of the prevalence of the vector (Ae. aegypti) and dengue virus is discussed.

  5. Is Bigger Better? A Comparison of Rural School Districts

    ERIC Educational Resources Information Center

    Yan, Wenfan

    2006-01-01

    School district size is important to policymakers and educators who need to determine the most effective way to structure school organization. For more than 40 years, a growing body of research has focused on the relationship between school size and school effectiveness (Monk & Plecki, 1999). Early studies did not address the effect of school…

  6. Coaching Protocol Gives Rural District a Common Language for Learning

    ERIC Educational Resources Information Center

    Ringler, Marjorie C.; O'Neal, Debra

    2012-01-01

    Academic language has been referred to as a gatekeeper, something that stands in the way of academic success for native and nonnative speakers alike. In rural eastern North Carolina, many students do double the work because they speak nonstandard dialects, lack the background knowledge for school success, and thereby disengage from the classroom.…

  7. Computer-Aided School Bus Routing for Rural Districts.

    ERIC Educational Resources Information Center

    Nygard, Kendall E.; And Others

    1982-01-01

    The computer-based system for routing school buses in rural areas which is discussed minimizes both transportation costs and the average student ride time. Route generation methodology is described and a flowchart of the algorithm is included. (Author/JJD)

  8. Leadership Strategies for Maintaining Success in a Rural School District

    ERIC Educational Resources Information Center

    Freeman, Greta G.; Randolph, Ivan

    2013-01-01

    Success in a PK-12 educational environment begins at the top with school leadership. Due to economic problems, poverty and added responsibilities, leaders in rural communities throughout the United States face sensitive and distinctive challenges. Based on research and years of administrative experience as school and school system leaders, the…

  9. What keeps health professionals working in rural district hospitals in South Africa?

    PubMed

    Jenkins, Louis S; Gunst, Colette; Blitz, Julia; Coetzee, Johan F

    2015-06-26

    The theme of the 2014 Southern African Rural Health Conference was 'Building resilience in facing rural realities'. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. CONFERENCE WORKSHOP: The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, 'What is it that keeps you going to work every day?' Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported.

  10. Planning for district mental health services in South Africa: a situational analysis of a rural district site.

    PubMed

    Petersen, Inge; Bhana, Arvin; Campbell-Hall, Victoria; Mjadu, Sithembile; Lund, Crick; Kleintjies, Sharon; Hosegood, Victoria; Flisher, Alan J

    2009-03-01

    The shift in emphasis to universal primary health care in post-apartheid South Africa has been accompanied by a process of decentralization of mental health services to district level, as set out in the new Mental Health Care Act, no. 17, of 2002 and the 1997 White Paper on the Transformation of the Health System. This study sought to assess progress in South Africa with respect to deinstitutionalization and the integration of mental health into primary health care, with a view to understanding the resource implications of these processes at district level. A situational analysis in one district site, typical of rural areas in South Africa, was conducted, based on qualitative interviews with key stakeholders and the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). The findings suggest that the decentralization process remains largely limited to emergency management of psychiatric patients and ongoing psychopharmacological care of patients with stabilized chronic conditions. We suggest that, in a similar vein to other low- to middle-income countries, deinstitutionalization and comprehensive integrated mental health care in South Africa is hampered by a lack of resources for mental health care within the primary health care resource package, as well as the inefficient use of existing mental health resources.

  11. Health seeking behaviour and health awareness among rural and urban adolescents in Dehradun District, Uttarakhand, India.

    PubMed

    Kumar, Tuhin; Pal, Piyalee; Kaur, Prabhdeep

    2017-04-01

    Adolescents constituted 19% population of India in 2011. Adolescents have health seeking behaviour different from that of adults. We estimated the utilisation of available health care services by adolescents and awareness regarding various health issues in the urban and rural Dehradun District, Uttarakhand, India. We also described knowledge and practices of public sector health care providers. We conducted a cross-sectional survey among adolescents 10-19 years in the urban Dehradun and rural Chakrata block of the Dehradun District. We used cluster sampling with sample size 680 each in urban and rural areas. We collected data from adolescents using semi structured questionnaire on health awareness and utilisation of health care services. Public sector health care providers were surveyed about their knowledge and practices regarding adolescents health. We surveyed 1463 adolescents. The overall mean age was 14.4 (2.6) years, about half being females. Half of the adolescents who had any illness used the public sector. Awareness about anaemia was 48% in urban and 12% in rural areas. A higher proportion of females (Rural: 89%, Urban: 76%) were aware of condoms as contraceptives than males (Rural: 68%, Urban: 12%). Only 62% of doctors and 49% of paramedical staff had knowledge regarding services under Adolescents Reproductive and Sexual Health (ARSH). Awareness regarding various health issues was low among males as compared to females, especially in rural areas. School based health promotion programs should be carried out to increase awareness among adolescents. Health facilities should be strengthened to provide adolescent friendly health services to enhance utilisation.

  12. Costs and revenue of health care in a rural Zimbabwean district.

    PubMed

    Vander Plaetse, B; Hlatiwayo, G; Van Eygen, L; Meessen, B; Criel, B

    2005-07-01

    The District Health Executive of Tsholotsho district in south-west Zimbabwe conducted a health care cost study for financial year 1997-98. The study's main purpose was to generate data on the cost of health care of a relatively high standard, in a context of decentralization of health services and increasing importance of local cost-recovery arrangements. The methodology was based on a combination of step-down cost accounting and detailed observation of resource use at the point of service. The study is original in that it presents cost data for almost all of the health care services provided at district level. The total annualized cost of the district public health services in Tsholotsho amounted to US$10 per capita, which is similar to the World Bank's Better Health in Africa study (1994) but higher than in comparable studies in other countries of the region. This can be explained by the higher standards of care and of living in Zimbabwe at the time of the study. About 60% of the costs were for the district hospital, while the different first-line health care facilities (health centres and rural hospitals together) absorbed 40%. Some 54% of total costs for the district were for salaries, 20% for drugs, 11% for equipment and buildings (including depreciation) and 15% for other costs. The study also looked into the revenue available at district level: the main source of revenue (85%) was from the Ministry of Health. The potential for cost recovery was hardly exploited and revenue from user fees was negligible. The study results further question the efficiency and relevance of maintaining rural hospitals at the current level of capacity, confirm the soundness of a two-tiered district health system based on a rational referral system, and make a clear case for the management of the different elements of the budget at the decentralized district level. The study shows that it is possible to deliver district health care of a reasonable quality at a cost that is by no

  13. No Child Left Behind and Its Effect on Recruiting and Retaining Special Education Teachers in Rural South Carolina School Districts

    ERIC Educational Resources Information Center

    Martin, Deborah S.

    2010-01-01

    The study examined the No Child Left Behind Act as it relates to the recruiting and retention of special education teachers in rural school districts. The focus of the research was to examine those factors that have influenced teachers to leave the profession or to seek employment in more urban school districts. Data for the study were collected…

  14. Rural District Nursing Experiences of Successful Advocacy for Person-Centered End-of-Life Choice.

    PubMed

    Reed, Frances M; Fitzgerald, Les; Bish, Melanie R

    2016-05-05

    Choices in care during the end stages of life are limited by the lack of resources and access for rural people. Nursing advocacy based on the holistic understanding of people and their rural communities may increase the opportunity for choice and improve the quality of care for people living and dying at home. Pragmatism and nurse agency theory were used for a practical exploration of how district nurses successfully advocate for rural Australian end-of-life goals to begin the development of a practice model. In two stages of data collection, rural district nurse informants (N = 7) were given the opportunity to reflect on successful advocacy and to write about their experiences before undertaking further in-depth exploration in interviews. They defined successful advocacy as "caring" that empowers people in the "big and small" personal goals important for quality of life. The concepts described that enable successful advocacy were organized into a network with three main themes of "willing" investment in holistic person-centered care, "knowing" people and resources, and feeling "supported." The thematic network description provides deep insight into the emotional skill and moral agency involved in successful end-of-life nurse advocacy and can be used as a sound basis for modeling and testing in future research.

  15. Science achievement as an indicator of educational opportunity available in rural K--12 districts in Texas

    NASA Astrophysics Data System (ADS)

    Capehart, Cheryl Louise

    Purpose of the study. This study examined Rural K--12 Texas districts to investigate whether science achievement could serve as a gauge to measure the availability and quality of rigorous educational opportunities in Rural Texas districts. Procedure. A Case II criterion-group design was used; 2 groups of districts were selected based on their 3-year performances on the 8th grade Science Texas Assessment of Academic Skills (TAAS)---the statewide criterion-referenced test. The High Performing Group (HPG) was composed of 30 top performing districts; the Low Performing Group (LPG) was composed of 30 lowest performing districts. Data collection was limited to archived quantitative data from Texas Education Agency's open records. Achievement variables were percent passing (1) Science TASS, (2) Biology End-of-Course (EoC) test and (3) the composite passing all Reading, Writing, and Mathematics TAAS. Academic variables were percent participating in (1) advanced courses, (2) rigorous graduation programs, and (3) college entrance examinations. District quality indicators also included 3 budget variables: (1) average teacher salary, (2) per pupil instructional expenditure, (3) percent allocated for instructional leadership; and 4 staff variables: (1) percent teachers fully certified, (2) percent teachers with advanced degrees, (3) average years teacher experience, (4) average percent non-turnover of teachers. One score per variable was obtained for each district. The HPG and LPG were compared on each variable using the group means, standard deviations, standard errors of the mean, Levene's test for equality of variance, and a t test for equality of means with a 95% confidence level. The Pearson correlation with two-tailed significance calculated the relationship of each independent variable (budget and staff factors) to each dependent variable (performance measures). Science TASS and a Combined Science score (grand mean of Science TASS & Biology EoC passing rates) were

  16. Biomass District Heat System for Interior Rural Alaska Villages

    SciTech Connect

    Wall, William A.; Parker, Charles R.

    2014-09-01

    Alaska Village Initiatives (AVI) from the outset of the project had a goal of developing an integrated village approach to biomass in Rural Alaskan villages. A successful biomass project had to be ecologically, socially/culturally and economically viable and sustainable. Although many agencies were supportive of biomass programs in villages none had the capacity to deal effectively with developing all of the tools necessary to build a complete integrated program. AVI had a sharp learning curve as well. By the end of the project with all the completed tasks, AVI developed the tools and understanding to connect all of the dots of an integrated village based program. These included initially developing a feasibility model that created the capacity to optimize a biomass system in a village. AVI intent was to develop all aspects or components of a fully integrated biomass program for a village. This meant understand the forest resource and developing a sustainable harvest system that included the “right sized” harvest equipment for the scale of the project. Developing a training program for harvesting and managing the forest for regeneration. Making sure the type, quality, and delivery system matched the needs of the type of boiler or boilers to be installed. AVI intended for each biomass program to be of the scale that would create jobs and a sustainable business.

  17. Heterogeneity of prevalence and risk factors for Active Convulsive Epilepsy in a rural district of Kenya

    PubMed Central

    Edwards, T; Scott, JAG; Munyoki, G; Odera, V Mung’ala; Chengo, E; Bauni, E; Kwasa, T; Sander, JW; Neville, BG; Newton, CR

    2014-01-01

    Background There are few large-scale studies of epilepsy in sub-Saharan Africa. We estimate the prevalence, treatment gap and risk factors for active convulsive epilepsy (ACE) in Kenyans aged ≥6 years in a rural area. Methods A three-phase screening survey of 151,408 individuals followed by a nested community case-control study. Findings The overall prevalence of ACE was 2.9 per 1000 (95%CI: 2.6 to 3.2 per 1000) and after adjustment for non-response and sensitivity, 4.5 per 1000 (95%CI; 4.1 to 4.9). There was substantial heterogeneity in the prevalence, with evidence of clustering. The treatment gap was 70.3% (95%CI: 65.9 to 74.5) with weak evidence of a difference in sex and residential division. Adjusted odds of ACE for all ages were increased for family history of non-febrile convulsions (OR 3.3, 95%CI: 2.4 to 4.7), family history of febrile convulsions (OR 14.6, 95%CI: 6.3 to 34.1), history of both seizure types (OR 7.3, 95% CI: 3.3 to 16.4) and previous head injury (OR 4.1, 95%CI: 2.1 to 8.1). In multivariable analyses in children, adverse perinatal events increased odds (OR 5.7, 95%CI: 2.6 – 12.7) as did paternal orphanhood (OR 5.1, 95%CI 2.4 to 11.0). Interpretation This survey demonstrates significant heterogeneity in the prevalence of ACE in large population in Africa and identifies subgroups in greatest need of targeted interventions through assessment of prevalence, treatment adherence and demographic variation in screening response. Adverse perinatal events, febrile illness and head injury are potentially preventable risk factors of epilepsy in this region. PMID:18068520

  18. What keeps health professionals working in rural district hospitals in South Africa?

    PubMed Central

    Gunst, Colette; Blitz, Julia; Coetzee, Johan F.

    2015-01-01

    Background The theme of the 2014 Southern African Rural Health Conference was ‘Building resilience in facing rural realities’. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. Conference workshop The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, ‘What is it that keeps you going to work every day?’ Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Results Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Conclusion Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported. PMID:26245623

  19. Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study

    PubMed Central

    2011-01-01

    Background In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women's perceptions of homebirths in the medical districts of Ouargaye and Diapaga. Methods A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30 women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software. Results The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities. Conclusion The study echoes the need for policy makers to make health facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts. PMID:21276252

  20. A Study on Nutritional Status of Rural School going Children in Kavre District.

    PubMed

    Mansur, D I; Haque, M K; Sharma, K; Mehta, D K; Shakya, R

    2015-01-01

    Background Childhood is a time of active growth in terms of physical size, mental, emotional and psychological development. Normal growth is dependent on adequate nutrition and encompasses major transformations from birth to adulthood. Nutrition is a focal point for health and well being; and has special significance in countries with disadvantages in socioeconomic and hygienic standards. Objective The objective of the present study was to assess the nutritional status in terms of prevalence of underweight, stunting and thinness among rural school going children. Method The present study was cross-sectional study, conducted on 438 rural school going children (169 male and 259 female) with the age group 4-16 years, during the period from April 2014 to July 2014. Age was recorded in year; height and weight were measured in centimeter and kilogram respectively. BMI was calculated by using standard equation. Result The present study concluded that the nutritional status in terms of prevalence of underweight, stunting and thinness were found to be 30.85%, 24.54% and 10.05% respectively among rural school going children of Kavre district. It was revealed that 37.87% was underweight, 29.59% was stunted and 11.25% was thinness among male children whereas in female children, 26.27% was underweight, 21.24% was stunted and 9.27% was thinness. Hence, high prevalence of underweight, stunting and thinness were observed in male than in female children. Conclusion The present study has successfully documented the nutritional status in terms of prevalence of underweight, stunting and thinness among the rural school going children of Kavre district. The results of the present study will be useful for policy makers in their endeavor to formulate various developmental and health care programs.

  1. Cognitive Potential And Its Predictors In Children From A Rural District Of Pakistan.

    PubMed

    Gilani, Irum

    2017-01-01

    Effective interventions are available to reduce cognitive deficit currently estimated to affect more than 200 million children under 5 years of age in developing countries. However, developing world's investment is negligible in this regard mainly because of non-existent global indicators to monitor progress with respect to the childhood cognitive development. Intelligence Quotient (IQ) or Full Scale Intelligence Quotient (FSIQ) is an indicator of the cognitive development. This study was designed to assess cognitive potential of 6-7 years old children from a rural district of Pakistan by calculating their FSIQ. Predictors of the FSIQ were also determined. This cross-sectional research was carried out in 40 rural Union Councils (UCs) of 2 subdistricts in district Rawalpindi utilizing simple random sampling technique. Wechsler Pre-school and Primary Scale of Intelligence (WPPSI-IV) was administered to 6-7 years old children (n=300) for measuring their FSIQ. FSIQ of rural Pakistani children, relative to the normative sample, was found to be in the category of low-average. Findings of multiple regression analysis concluded grade/class of the child as the most influential predictor of the FSIQ followed by the level of mother's and then father's education. FSIQ of the rural Pakistani children, relative to the normative sample, was found to be in the category of low-average. Predictors of the FSIQ, seen in this research, were school grades and non-educated parents of the children warranting future research on the contribution of environmental influences to the variability in cognitive potential.

  2. A program to enhance k-12 science education in ten rural New York school districts.

    PubMed

    Goodell, E; Visco, R; Pollock, P

    1999-04-01

    The Rural Partnership for Science Education, designed by educators and scientists in 1991 with funding from the National Institutes of Health, works in two rural New York State counties with students and their teachers from kindergarten through grade 12 to improve pre-college science education. The Partnership is an alliance among ten rural New York school districts and several New York State institutions (e.g., a regional academic medical center; the New York Academy of Sciences; and others), and has activities that involve around 4,800 students and 240 teachers each year. The authors describe the program's activities (e.g., summer workshops for teachers; science exploration camps for elementary and middle-school students; enrichment activities for high school students). A certified science education specialist directs classroom demonstrations throughout the academic year to support teachers' efforts to integrate hands-on activities into the science curriculum. A variety of evaluations over the years provides strong evidence of the program's effectiveness in promoting students' and teachers' interest in science. The long-term goal of the Partnership is to inspire more rural students to work hard, learn science, and enter the medical professions.

  3. Governing the implementation of emergency obstetric care: experiences of rural district health managers, Tanzania.

    PubMed

    Mkoka, Dickson Ally; Kiwara, Angwara; Goicolea, Isabel; Hurtig, Anna-Karin

    2014-08-03

    Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development. The study revealed that

  4. Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

    PubMed Central

    2014-01-01

    Background Many health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects. Methods The study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach. Results Implementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development

  5. Pilot study on the impact of biogas as a fuel source on respiratory health of women on rural Kenyan smallholder dairy farms.

    PubMed

    Dohoo, Carolyn; Guernsey, Judith Read; Critchley, Kimberley; VanLeeuwen, John

    2012-01-01

    Biomass burning in indoor environments has been highlighted as a major cause of respiratory morbidity for women and children in low-income countries. Inexpensive technological innovations which reduce such exposures are needed. This study evaluated the impact of low tech compost digesters, which generate biogas for cooking, versus traditional fuel sources on the respiratory health of nonsmoking Kenyan farmwomen. Women from 31 farms with biogas digesters were compared to age-matched women from 31 biomass-reliant farms, in June 2010. Only 43% of the biogas group reported any breathing problems, compared to 71% in the referent group (P = 0.03). Referent women self-reported higher rates of shortness of breath (52% versus 30%), difficulty breathing (42% versus 23%), and chest pain while breathing (35% versus 17%) during the last 6 months (P = 0.09 to 0.12) compared to biogas women. Biogas women demonstrated slightly better spirometry results but differences were not statistically significant, likely due to limited latency between biogas digester installation and spirometry testing. Most biogas women reported improved personal respiratory health (87%) and improved children's health (72%) since biogas digester installation. These findings suggest that using biogas in cookhouses improves respiratory symptoms but long-term impacts on lung function are unclear.

  6. Pilot Study on the Impact of Biogas as a Fuel Source on Respiratory Health of Women on Rural Kenyan Smallholder Dairy Farms

    PubMed Central

    Dohoo, Carolyn; Guernsey, Judith Read; Critchley, Kimberley; VanLeeuwen, John

    2012-01-01

    Biomass burning in indoor environments has been highlighted as a major cause of respiratory morbidity for women and children in low-income countries. Inexpensive technological innovations which reduce such exposures are needed. This study evaluated the impact of low tech compost digesters, which generate biogas for cooking, versus traditional fuel sources on the respiratory health of nonsmoking Kenyan farmwomen. Women from 31 farms with biogas digesters were compared to age-matched women from 31 biomass-reliant farms, in June 2010. Only 43% of the biogas group reported any breathing problems, compared to 71% in the referent group (P = 0.03). Referent women self-reported higher rates of shortness of breath (52% versus 30%), difficulty breathing (42% versus 23%), and chest pain while breathing (35% versus 17%) during the last 6 months (P = 0.09 to 0.12) compared to biogas women. Biogas women demonstrated slightly better spirometry results but differences were not statistically significant, likely due to limited latency between biogas digester installation and spirometry testing. Most biogas women reported improved personal respiratory health (87%) and improved children's health (72%) since biogas digester installation. These findings suggest that using biogas in cookhouses improves respiratory symptoms but long-term impacts on lung function are unclear. PMID:22969815

  7. First steps towards interprofessional health practice in Tanzania: an educational experiment in rural Bagamoyo district.

    PubMed

    Leshabari, Sebalda; Lubbock, Lindsey A; Kaijage, Herbert; Kalala, Willbrord; Koehler, Gary; Massawe, Siriel; Muganyizi, Projestine; Macfarlane, Sarah B; O'Sullivan, Patricia S

    2012-01-01

    Health workers in Tanzania struggle to provide adequate health care for populations with high maternal, neonatal, and child mortality and high prevalence of communicable and non-communicable diseases. There are longstanding shortages of staff and resources. Universities are training more health professionals and revising curricula to be sure that staff have the specific skills needed to work in rural districts. This includes training people from different disciplines to work more effectively together. While teamwork is important in all settings, it is particularly critical in rural areas where there are few trained professionals. The health professional schools at Muhimbili University of Health and Allied Sciences (MUHAS) developed curricula that share common competencies to promote interprofessional cooperation. In this article, we describe a pilot program developed by MUHAS to train its professional students (dentists, doctors, environmental health officers, nurses, and pharmacists) to work collaboratively with each other and with other health staff at the district level. We describe the reactions of participants, and identify some considerations for taking such an exercise to scale for education.

  8. Dental caries management at a rural district hospital in northern Rwanda: a neglected disease

    PubMed Central

    Uzabakiriho, B.; Amoroso, C. L.; Mpunga, T.; Odhiambo, J.; Mukashema, P.; Seymour, B. A.; Sindayigaya, J. de D.; Hedt-Gauthier, B. L.

    2015-01-01

    Setting: While some studies have reported the prevalence of dental caries in sub-Saharan Africa, little is known about care-seeking behavior or how dental caries are managed, particularly at rural district hospitals. Objective: To describe the management of patients seeking care for dental caries at Butaro District Hospital (BDH) in rural Rwanda. Design: This cross-sectional descriptive study was conducted in BDH, in northern Rwanda. A sample of 287 patient encounters for dental caries between January and December 2013 was randomly selected and stratified by age group (⩽5 years, 6–21 years and >21 years). We estimated the treatment received with 95% confidence intervals in each age group, and differences between age groups were assessed using Fisher's exact test. Results: Nearly all patients (97.6%) underwent tooth extraction, and this did not vary significantly by age group (P = 0.558). In addition to dental caries, most patients also had chronic pulpitis (74.9%). Conclusion: Caries prevention and care should be prioritized through a developed community program on oral health. We recommend introducing advanced training, equipment and materials for dental caries management other than tooth extraction, and increasing the number of qualified dentists. PMID:26399283

  9. [Declared diseases, observed diseases and health priorities in a Benin rural district].

    PubMed

    Stoffel, V; Chagué, F

    2001-03-01

    A project of a humanitarian action was preceded by a health diagnosis of a population in the rural district Bonou in Bénin. A diagnosis of perception was set up by the interviews among the population and the local health professionals. That diagnosis was completed by an objectified diagnosis originating from the analysis of 460 consultations performed in Bénin end 1998- beginning 1999. The cross-sorting between the diagnosis of perception and the objectified diagnosis pointed out four public health problems: malaria, bronchial asthma, infectious diarrhoeas and Buruli ulcer with respective prevalences of 9%, 6%, 3% and 0.9%. The prevalence of bronchial asthma fluctuates from 4% in dry areas to 8% in wet areas (Chi 2 = 3.50; p = 0.06). The role of house dust mites is suspected because of those ecological arguments to which is added clinical reasoning. Bronchial asthma was chosen as a priority health problem because of the feasibility and acceptance of a survey which aims at pointing out the allergic etiology. The confirmation of that etiology will enable in that case the decrease of the allergenic pressure, particularly well adapted solution in the Southern countries. Therefore a humanitarian action is foreseen to apprehend the etiologies of bronchial asthma in the rural district Bonou in Bénin in 2000.

  10. Why Rural Community Day Secondary Schools Students' Performance in Physical Science Examinations Is Poor in Lilongwe Rural West Education District in Malawi

    ERIC Educational Resources Information Center

    Mlangeni, Angstone Noel J. Thembachako; Chiotha, Sosten Staphael

    2015-01-01

    A study was conducted to investigate factors that affect students' poor performance in physical science examinations at Malawi School Certificate of Education and Junior Certificate of Education levels in Community day secondary schools (CDSS) in Lilongwe Rural West Education District in Malawi. Students' performance was collected from schools'…

  11. Why Rural Community Day Secondary Schools Students' Performance in Physical Science Examinations Is Poor in Lilongwe Rural West Education District in Malawi

    ERIC Educational Resources Information Center

    Mlangeni, Angstone Noel J. Thembachako; Chiotha, Sosten Staphael

    2015-01-01

    A study was conducted to investigate factors that affect students' poor performance in physical science examinations at Malawi School Certificate of Education and Junior Certificate of Education levels in Community day secondary schools (CDSS) in Lilongwe Rural West Education District in Malawi. Students' performance was collected from schools'…

  12. Learning and Community Transition in the Lakes District Rural Dialogue. Rural Dialogue Summary Report (Burns Lake, British Columbia, Canada, March 29, 2006)

    ERIC Educational Resources Information Center

    Canadian Rural Partnership, 2006

    2006-01-01

    This report is a summary of discussions that took place at the Learning and Community Transition, Lakes District Rural Dialogue, held in Burns Lake, British Columbia, on March 29, 2006. This dialogue emerged further to a meeting of northern federal representatives which was organized to better coordinate federal support for northern B.C.…

  13. Using community informants to estimate maternal mortality in a rural district in Pakistan: a feasibility study.

    PubMed

    Mir, Ali Mohammad; Shaikh, Mohammad Saleem; Qomariyah, Siti Nurul; Rashida, Gul; Khan, Mumraiz; Masood, Irfan

    2015-01-01

    We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.

  14. School District Personnel Selection Practices: Exploring the Effects of Demographic Factors on Rural Values within a Person-Organization Fit Model.

    ERIC Educational Resources Information Center

    Little, Paula S.; Miller, Stephen K.

    A study examined the extent to which demographic factors predict rural values in Kentucky public school district hiring officials. Among the demographic factors considered were school district metropolitan classification, school district size, community racial composition, decision makers' position in the organizational hierarchy, and decision…

  15. Do Schools in Rural and Nonrural Districts Allocate Resources Differently? An Analysis of Spending and Staffing Patterns in the West Region States. Summary. Issues & Answers. REL 2011-No. 099

    ERIC Educational Resources Information Center

    Levin, Jesse; Manship, Karen; Chambers, Jay; Johnson, Jerry; Blankenship, Charles

    2011-01-01

    This report presents the first detailed comparison of resource allocation between rural and nonrural districts in the West Region. Three regional characteristics often associated with rural districts were chosen for the analysis: district enrollment, student population density within a district (students per square mile), and drive time from the…

  16. A Research Report of Small/Rural School Districts in Texas Compared to School Districts of Similar Size Nationwide.

    ERIC Educational Resources Information Center

    Barker, Bruce O.; Muse, Ivan D.

    The study compared nationwide research findings about the districts, superintendents, teachers, programs, and student performance in 642 public school districts with an enrollment of 900 or less to data from a random sample of school districts of similar size in Texas. Data were gathered from superintendents by questionnaire during the 1982-83…

  17. Integration of Interactive Whiteboards within Classroom Instruction in a Small, Rural School District in the Southeastern United States

    ERIC Educational Resources Information Center

    Stewart, Stacy Denise

    2013-01-01

    The purpose of this study was to identify the extent IWB integration occurs in instruction and its impact on student engagement in a small, rural school district in the southeastern United States. A study was conducted in core subject areas across K-12 grade spans involving 50 teachers using a mixed methods approach. Teachers were observed twice…

  18. A Study of the Roles and Responsibilities of Superintendent/Principals in Small, Rural School Districts in Northern California

    ERIC Educational Resources Information Center

    Geivett, Morton J., II

    2010-01-01

    Purpose. The purpose of this study was to identify and describe the roles and responsibilities of the superintendent/principal in small, rural school districts in northern California perceived to be the most important by the superintendent/principal. In addition, it was the purpose of this study to identify the challenges of serving as the…

  19. Integration of Interactive Whiteboards within Classroom Instruction in a Small, Rural School District in the Southeastern United States

    ERIC Educational Resources Information Center

    Stewart, Stacy Denise

    2013-01-01

    The purpose of this study was to identify the extent IWB integration occurs in instruction and its impact on student engagement in a small, rural school district in the southeastern United States. A study was conducted in core subject areas across K-12 grade spans involving 50 teachers using a mixed methods approach. Teachers were observed twice…

  20. Rural School Districts and the Fight for Funding Adequacy: The Legal Challenge of "CASFG v. State of Georgia"

    ERIC Educational Resources Information Center

    Cornelius, Luke M.; Robinson, Charlotte Bunn

    2006-01-01

    On June 23, 2005, oral arguments were heard in the Fulton County Superior Court in the first round of Georgia's current school finance litigation, "CASFG v. State of Georgia." The hearing was on the state's motion to dismiss the action by a coalition of rural school districts, parents, and students. Four months later Senior Judge…

  1. A Study of the Roles and Responsibilities of Superintendent/Principals in Small, Rural School Districts in Northern California

    ERIC Educational Resources Information Center

    Geivett, Morton J., II

    2010-01-01

    Purpose. The purpose of this study was to identify and describe the roles and responsibilities of the superintendent/principal in small, rural school districts in northern California perceived to be the most important by the superintendent/principal. In addition, it was the purpose of this study to identify the challenges of serving as the…

  2. Urban versus rural: fertility decline in the cities and rural districts of Prussia, 1875 to 1910.

    PubMed

    Galloway, P R; Lee, R D; Hammel, E A

    1998-09-01

    This study examined the level and pace of fertility decline in 54 large cities in Prussia during 1875-1910. Data were obtained from census records for 1875, 1880, 1885, 1890, 1895, 1900, 1905, and 1910. Analysis was based on pooled cross sectional time series methods and theories that structural socioeconomic change was a key factor in the decline of fertility in Prussian cities. During 1875-1910, city population grew from 3.8 to 9.6 million. The general marital fertility rate (GMFR) in the 54 cities declined from 281 to 164 during 1875-1910. Catholicism, female labor force participation (FLFP), manufacturing, mining, banking, and communication were statistically positively related to urban fertility level. Pace of decline was related significantly to language, education, FLFP, income, communications, insurance, population size, infant mortality, and married sex ratio. Population size was related to pace but not level. Education and banking had a stronger impact in rural areas. In the city equation, the variables plus dummies accounted for 90% of the variance. A very important variable explaining change in fertility level in Prussia was Catholicism. The most important variables for explaining fertility change in Prussia were infant mortality rate and insurance. Infant mortality, communications, insurance, and income increased in importance over time. FLFP declined over time, but contributed the most to predicted change in GMFR throughout the period, especially in nontraditional occupations. The analysis explained both rapid and slow urban fertility declines and closely approximated predicted fertility. Prussia differs from present developing country contexts in that the population was largely agrarian but literate.

  3. Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District, Equatorial Guinea

    PubMed Central

    Romay-Barja, Maria; Jarrin, Inma; Ncogo, Policarpo; Nseng, Gloria; Sagrado, Maria Jose; Santana-Morales, Maria A.; Aparcio, Pilar; Valladares, Basilio; Riloha, Matilde; Benito, Agustin

    2015-01-01

    Background Malaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District. Methodology A cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively. Results Differences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata. Conclusions The delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors. PMID:26284683

  4. Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District, Equatorial Guinea.

    PubMed

    Romay-Barja, Maria; Jarrin, Inma; Ncogo, Policarpo; Nseng, Gloria; Sagrado, Maria Jose; Santana-Morales, Maria A; Aparicio, Pilar; Aparcio, Pilar; Valladares, Basilio; Riloha, Matilde; Benito, Agustin

    2015-01-01

    Malaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District. A cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively. Differences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata. The delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors.

  5. The Art of the Impossible? A Case Study and Reflections on the Experience of Art in a Rural Kenyan Primary School

    ERIC Educational Resources Information Center

    Gregory, Peter

    2012-01-01

    The arguments for, and justification of, the value of teaching art in school have been made previously, but contextually these are often situated in Western affluence. This article explores the issues with a strikingly contrasted setting. The rural school in the study is approximately 30 minutes' drive from the nearest town, and the pupils are…

  6. Development of a scalable mental healthcare plan for a rural district in Ethiopia

    PubMed Central

    Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

    2016-01-01

    Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174

  7. Visitor perceptions of rural landscapes: a case study in the Peak District National Park, England.

    PubMed

    Suckall, Natalie; Fraser, Evan D G; Cooper, Thomas; Quinn, Claire

    2009-02-01

    Maintaining national parks is an integral policy tool to conserve rare habitats. However, because national parks are funded by taxpayers, they must also serve the needs of the general public. Increasingly, and thanks to today's diverse society, there is evidence that this creates challenges for park managers who are pulled in two opposing directions: to conserve nature on the one hand and to meet different visitor expectations on the other. This tension was explored in the Peak District National Park, a rural landscape dominated by heather moorland and sheep farming in Northern England where research was conducted to determine how social class and ethnicity shaped perceptions of the park. Results uncovered that social class played a very strong role in shaping perceptions of this region with 'middle class' respondents reacting far more favourably to the park than people from more working class backgrounds. We observed ethnicity playing a similar role, though our results are less significantly different.

  8. Development of a scalable mental healthcare plan for a rural district in Ethiopia.

    PubMed

    Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

    2016-01-01

    Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. © The Royal College of Psychiatrists 2016.

  9. Career Aspirations of Kenyan Women.

    ERIC Educational Resources Information Center

    Lindsay, Beverly

    1980-01-01

    Examines the relationship between socioeconomic status and ethnic characteristics of the family and the female Kenyan student's perception of her career opportunities. Presents 1975 data collected from students in six secondary and higher educational institutions in Kenya. (Author/GC)

  10. Making progress towards food security: evidence from an intervention in three rural districts of Rwanda.

    PubMed

    Nsabuwera, Vincent; Hedt-Gauthier, Bethany; Khogali, Mohammed; Edginton, Mary; Hinderaker, Sven G; Nisingizwe, Marie Paul; Tihabyona, Jean de Dieu; Sikubwabo, Benoit; Sembagare, Samuel; Habinshuti, Antoinette; Drobac, Peter

    2016-05-01

    Determining interventions to address food insecurity and poverty, as well as setting targets to be achieved in a specific time period have been a persistent challenge for development practitioners and decision makers. The present study aimed to assess the changes in food access and consumption at the household level after one-year implementation of an integrated food security intervention in three rural districts of Rwanda. A before-and-after intervention study comparing Household Food Insecurity Access Scale (HFIAS) scores and household Food Consumption Scores (FCS) at baseline and after one year of programme implementation. Three rural districts of Rwanda (Kayonza, Kirehe and Burera) where the Partners In Health Food Security and Livelihoods Program (FSLP) has been implemented since July 2013. All 600 households enrolled in the FSLP were included in the study. There were significant improvements (P<0·001) in HFIAS and FCS. The median decrease in HFIAS was 8 units (interquartile range (IQR) -13·0, -3·0) and the median increase for FCS was 4·5 units (IQR -6·0, 18·0). Severe food insecurity decreased from 78% to 49%, while acceptable food consumption improved from 48% to 64%. The change in HFIAS was significantly higher (P=0·019) for the poorest households. Our study demonstrated that an integrated programme, implemented in a setting of extreme poverty, was associated with considerable improvements towards household food security. Other government and non-government organizations' projects should consider a similar holistic approach when designing structural interventions to address food insecurity and extreme poverty.

  11. Creating Rural Allied Health Leadership Structures Using District Advisors: An Action Research Project Using Program Logic.

    PubMed

    Schmidt, David; Kurtz, Megan; Davidson, Stuart

    2017-01-01

    District advisors in five allied health disciplines were introduced in a local health district in rural Australia in 2013. These strategic leadership roles provide support to clinicians and managers. As there is little research exploring allied health leadership models from a strategic and operational perspective, the coordinated commencement of these roles provided opportunity to study the creation of this leadership structure. Four advisors participated in this action research study which used focus groups and program logic processes to explore the inputs, outputs, barriers, outcomes to date, and preferred future outcomes of the leadership model. A purpose-built questionnaire was sent to 134 allied health clinicians or managers with questionnaire responses used by advisors to visualise the leadership model. Advisors prioritised policy development, representing the profession outside the organisation, and supporting department managers, whilst clinicians prioritised communication and connection-building within the organisation. Outcomes of the leadership model included connection, coordination, and advocacy for clinicians. Future preferred outcomes included increased strategic and workforce planning. Barriers included limited time, a widespread workforce and limited resourcing. Instituting a leadership model improved communication, cohesion, and coordination within the organisation. Future increases in workforce planning and coordination are limited by advisor capacity and competing workloads.

  12. Predictors of knowledge towards malaria of rural tribal communities in Dhalai District of Tripura, India.

    PubMed

    Kumar, S; Debbarma, A

    2013-10-01

    Reduction of malarial morbidity and mortality is one of the top public health priorities in Tripura and the Country. To achieve these targets it is imperative to have active community participation to control malaria. Community participation in turn depends on people's knowledge and attitude towards the disease. This study was conducted to examine the factors that predict the knowledge of rural tribal communities in Dhalai district of Tripura towards malaria. This community based epidemiological cross-sectional descriptive study was carried out in Dhalai district of Tripura. A pre-tested structured questionnaire collecting socio-demographic and malaria-related KAP information was administered to the 216 adult respondents from a representative sample of households. As a whole, there were 147(68.1%) illiterate respondents. Out of them, 89(41.2%) persons were male and 58(26.9%) were female. Correct knowledge about the cause of malaria was 2.77 times higher in males than females and 11.53 times higher in literate tribal people than in illiterate. Correct knowledge about the symptoms fever, chills, and rigors of malaria were also higher in male sex and in literate tribal people. Use of smoke as preventive measure was very high among the respondents. Common predictors of correct knowledge about etiology and clinical features of malaria were in male Tripuri and Reang community. Use of smoke for killing of adult mosquito was predicted by illiteracy. Promotion of literacy and participation in health education are vital component in terms of knowledge and practice.

  13. Reproductive health rights of women in the rural areas of meherpur district in bangladesh.

    PubMed

    Hossain, Md Kamal; Mondal, Md Nazrul Islam; Akter, Mst Nazniz

    2011-01-01

    This study evaluated the reproductive health rights, women empowerment and gender equity in a rural area of Bangladesh. Three hundred married women of reproductive age (15-49 years) in Meherpur District, Bangladesh were interviewed using a structured questionnaire and purposing sampling techniques. The logistic regression analysis was used to determine the dominating factors affecting reproductive health rights. To fulfill the objectives of the study the two main factors, age at marriage and family planning acceptance of the respondents, were regarded as the determinants. The study results revealed that almost all the respondents were housewives (82.3%), one-third (31.0%) did not avail any modern facility, and their yearly income was very low. Moreover, about half of the women (52.7%) were very young (≤30 years), most of them (79.0%) had married early (<18 years) and about half of them (53.3%) had taken contraceptives based on their husbands' choice. Finally, multi-variate analysis identified the relationship between the profession of the respondents, yearly income, number of family members, and the availability of modern facilities with age at marriage (Model 1). The study also identified the relationship between the age of respondents, education, occupation, yearly income, and the total number of family members with family planning acceptance (Model 2). Regarding the results of this study, women's reproductive health rights, marriage after the age of 18 and family planning acceptance among couples needs to be enhanced in Mehrpur District in Bangladesh.

  14. Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam

    PubMed Central

    Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter

    2013-01-01

    Introduction Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. Aim This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. Methods A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18–60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. Results The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Conclusion Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy

  15. Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam.

    PubMed

    Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter

    2013-01-28

    Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18-60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.

  16. Motivation of human resources for health: a case study at rural district level in Tanzania.

    PubMed

    Zinnen, Véronique; Paul, Elisabeth; Mwisongo, Aziza; Nyato, Daniel; Robert, Annie

    2012-01-01

    An increasing number of studies explore the association between financial and non-financial incentives and the retention of health workers in developing countries. This study aims to contribute to empirical evidence on human resource for health motivation factors to assist policy makers in promoting effective and realistic interventions. A cross-sectional survey was conducted in four rural Tanzanian districts to explore staff stability and health workers' motivation. Data were collected using qualitative and quantitative techniques, covering all levels and types of health facilities. Stability of staff was found to be quite high. Public institutions remained very attractive with better job security, salary and retirement benefits. Satisfaction over working conditions was very low owing to inadequate working equipment, work overload, lack of services, difficult environment, favouritism and 'empty promotions'. Positive incentives mentioned were support for career development and supportive supervision. Attracting new staff in rural areas appeared to be more difficult than retaining staff in place. The study concluded that strategies to better motivate health personnel should focus on adequate remuneration, positive working and living environment and supportive management. However, by multiplying health facilities, the latest Tanzanian human resource for health plan could jeopardize current positive results.

  17. High Schistosoma mansoni disease burden in a rural district of western Zambia.

    PubMed

    Mutengo, Mable M; Mwansa, James C L; Mduluza, Takafira; Sianongo, Sandie; Chipeta, James

    2014-11-01

    Schistosoma mansoni disease is endemic in most parts of rural Zambia, and associated complications are common. We conducted a cross-sectional study among 754 people in rural communities of Kaoma District, western Zambia to determine the burden of S. mansoni infection and associated morbidity. Parasitology and ultrasonography assessments were conducted on consenting participants. The overall prevalence of S. mansoni infection and geometric mean egg count (GMEC) were 42.4% (304) and 86.6 eggs per gram (95% confidence interval = 75.6-99.6), respectively. Prevalence was highest in the age group of 15-19 years old (adjusted prevalence ratio = 1.70, P = 0.017). S. mansoni-related portal fibrosis was detected in 26% of the participants screened. Participants above 39 years old were 2.93 times more likely to have fibrosis than the 7-9 years old age group (P = 0.004). The study highlights the high burden of S. mansoni disease in this area and calls for immediate interventions to avert complications associated with the disease.

  18. High Schistosoma mansoni Disease Burden in a Rural District of Western Zambia

    PubMed Central

    Mutengo, Mable M.; Mwansa, James C. L.; Mduluza, Takafira; Sianongo, Sandie; Chipeta, James

    2014-01-01

    Schistosoma mansoni disease is endemic in most parts of rural Zambia, and associated complications are common. We conducted a cross-sectional study among 754 people in rural communities of Kaoma District, western Zambia to determine the burden of S. mansoni infection and associated morbidity. Parasitology and ultrasonography assessments were conducted on consenting participants. The overall prevalence of S. mansoni infection and geometric mean egg count (GMEC) were 42.4% (304) and 86.6 eggs per gram (95% confidence interval = 75.6–99.6), respectively. Prevalence was highest in the age group of 15–19 years old (adjusted prevalence ratio = 1.70, P = 0.017). S. mansoni-related portal fibrosis was detected in 26% of the participants screened. Participants above 39 years old were 2.93 times more likely to have fibrosis than the 7–9 years old age group (P = 0.004). The study highlights the high burden of S. mansoni disease in this area and calls for immediate interventions to avert complications associated with the disease. PMID:25246696

  19. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

    PubMed Central

    2011-01-01

    Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with

  20. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals--interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies.

    PubMed

    English, Mike; Nzinga, Jacinta; Mbindyo, Patrick; Ayieko, Philip; Irimu, Grace; Mbaabu, Lairumbi

    2011-12-02

    We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator) based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped create a soft-contract with senior managers clarifying

  1. Identifying implementation bottlenecks for maternal and newborn health interventions in rural districts of the United Republic of Tanzania

    PubMed Central

    Peterson, Stefan; Marchant, Tanya; Mbaruku, Godfrey; Temu, Silas; Manzi, Fatuma; Hanson, Claudia

    2015-01-01

    Abstract Objective To estimate effective coverage of maternal and newborn health interventions and to identify bottlenecks in their implementation in rural districts of the United Republic of Tanzania. Methods Cross-sectional data from households and health facilities in Tandahimba and Newala districts were used in the analysis. We adapted Tanahashi’s model to estimate intervention coverage in conditional stages and to identify implementation bottlenecks in access, health facility readiness and clinical practice. The interventions studied were syphilis and pre-eclampsia screening, partograph use, active management of the third stage of labour and postpartum care. Findings Effective coverage was low in both districts, ranging from only 3% for postpartum care in Tandahimba to 49% for active management of the third stage of labour in Newala. In Tandahimba, health facility readiness was the largest bottleneck for most interventions, whereas in Newala, it was access. Clinical practice was another large bottleneck for syphilis screening in both districts. Conclusion The poor effective coverage of maternal and newborn health interventions in rural districts of the United Republic of Tanzania reinforces the need to prioritize health service quality. Access to high-quality local data by decision-makers would assist planning and prioritization. The approach of estimating effective coverage and identifying bottlenecks described here could facilitate progress towards universal health coverage for any area of care and in any context. PMID:26240459

  2. Comparison between an independent midwifery program and a district hospital in rural Tanzania: observations regarding the treatment of female patients.

    PubMed

    Miller, Kathleen; McLoughlin, Michael

    2014-01-01

    Tanzania faces a significant shortage of physicians. In light of this, nurse-midwives have been critical in reducing maternal mortality in Tanzania in recent years. Despite the importance of both entities in providing health care to women in Tanzania, there have been few studies addressing the cultural competency of each entity. We shadowed and assisted both an independent nurse-midwife as well as physicians and nurse-midwives at a large district hospital in rural Tanzania. In this article we describe our observations regarding the treatment of female patients within the culture of an independent midwifery practice and at a large district hospital.

  3. Deaths ascribed to non-communicable diseases among rural Kenyan adults are proportionately increasing: evidence from a health and demographic surveillance system, 2003-2010.

    PubMed

    Phillips-Howard, Penelope A; Laserson, Kayla F; Amek, Nyaguara; Beynon, Caryl M; Angell, Sonia Y; Khagayi, Sammy; Byass, Peter; Hamel, Mary J; van Eijk, Anne M; Zielinski-Gutierrez, Emily; Slutsker, Laurence; De Cock, Kevin M; Vulule, John; Odhiambo, Frank O

    2014-01-01

    Non-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). Data from health and demographic surveillance systems (HDSS) can contribute towards this goal. Between 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the HDSS census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to NCDs, 60% to communicable diseases (CDs), 3% to injuries, and <1% maternal causes. Median age at death for NCDs was 66y and 71y for females and males, respectively, with 43% (39% male, 48% female) of NCD deaths occurring prematurely among adults aged below 65y. NCD deaths were mainly attributed to cancers (35%) and cardio-vascular diseases (CVDs; 29%). The proportionate mortality from NCDs rose from 35% in 2003 to 45% in 2010 (χ2 linear trend 93.4; p<0.001). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per 100,000 population, mainly due to increasing deaths in adults aged 65y and older, and to respiratory neoplasms in all age groups. The substantial fall in CD MRs resulted in similar MRs for CDs and NCDs among all adult females by 2010. NCD MRs for adults aged 15y to <65y fell from 409 to 183 per 100,000 among females and from 517 to 283 per 100,000 population among males. NCD MRs were higher among males than females aged both below, and at or above, 65y. NCDs constitute a significant proportion of deaths in rural western Kenya. Evidence of the increasing contribution of NCDs to overall mortality supports international recommendations to introduce or enhance prevention, screening, diagnosis and treatment programmes in LMICs.

  4. Community involvement in obstetric emergency management in rural areas: a case of Rukungiri district, Western Uganda

    PubMed Central

    2012-01-01

    Background Maternal mortality is a major public health problem worldwide especially in low income countries. Most causes of maternal deaths are due to direct obstetric complications. Maternal mortality ratio remains high in Rukungiri district, western Uganda estimated at 475 per 100,000 live births. The objectives were to identify types of community involvement and examine factors influencing the level of community involvement in the management of obstetric emergencies. Methods We conducted a descriptive study during 2nd to 28th February 2009 in rural Rukungiri district, western Uganda. A total of 448 heads of households, randomly selected from 6/11 (54.5%) of sub-counties, 21/42 (50.0%) parishes and 32/212 (15.1%) villages (clusters), were interviewed. Data were analysed using STATA version 10.0. Results Community pre-emergency support interventions available included community awareness creation (sensitization) while interventions undertaken when emergency had occurred included transportation and referring women to health facility. Community support programmes towards health care (obstetric emergencies) included establishment of community savings and credit schemes, and insurance schemes. The factors associated with community involvement in obstetric emergency management were community members being employed (AOR = 1.91, 95% CI: 1.02 - 3.54) and rating the quality of maternal health care as good (AOR = 2.22, 95% CI: 1.19 - 4.14). Conclusions Types of community involvement in obstetric emergency management include practices and support programmes. Community involvement in obstetric emergency management is influenced by employment status and perceived quality of health care services. Policies to promote community networks and resource mobilization strategies for health care should be implemented. There is need for promotion of community support initiatives including health insurance schemes and self help associations; further community sensitization by empowered

  5. The challenges of improving emergency obstetric care in two rural districts in Mali.

    PubMed

    Otchere, S A; Kayo, A

    2007-11-01

    We describe a collaboration between Save the Children USA, the Averting Maternal Death and Disability (AMDD) program and the Ministry of Health of Mali, to improve the availability, quality and utilization of emergency obstetric care (EmOC) in Yanfolila and Bougouni rural districts in Sikasso Region of Mali. Project planning, interventions and strategies between 2001 and 2004 were aimed at improving the capacity of 2 district hospitals to provide quality EmOC, sensitizing the community as partners to use services and to influence changes in policy at a national level through advocacy efforts. By the end of 2004, despite many health systems' challenges, the 2 hospitals were providing comprehensive EmOC. Providing 24-hour service proved difficult and, though not effectively institutionalized in the 2 hospitals, the UN Process Indicators showed modest improvements in quality and utilization of EmOC. Met need for EmOC increased from 9% in 2001 to 15% in 2004 in Bougouni and from 6% in 2001 to 15% in 2004 in Yanfolila. Case fatality rates declined by 69% (from 7% in 2001 to 2% in 2004) and by 38% (from 8% in 2001 to 5% in 2004) in Bougouni and Yanfolila, respectively. Although useful policy changes were achieved at the national level, more are needed if UN Guidelines are to be met. Availability of more obstetric functions at the community level, and fewer staff transfers are among policy changes needed. Save the Children's project experience showed that it is possible to improve the quality and use of EmOC in hospitals despite challenges; we drew national attention to EmOC as a key strategy in maternal mortality reduction, and raised awareness of the need for improved EmOC services at clinics that are more accessible to the community.

  6. Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

    PubMed Central

    Zachariah, R.; Kumar, A. M. V.; Trelles, M.; Caluwaerts, S.; van den Boogaard, W.; Manirampa, J.; Tayler-Smith, K.; Manzi, M.; Nanan-N’zeth, K.; Duchenne, B.; Ndelema, B.; Etienne, W.; Alders, P.; Veerman, R.; Van den Bergh, R.

    2017-01-01

    Objectives In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. Methods A retrospective analysis of EmOC data (2011 and 2012). Results A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. Conclusion Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa. PMID:28170398

  7. Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

    PubMed

    De Plecker, E; Zachariah, R; Kumar, A M V; Trelles, M; Caluwaerts, S; van den Boogaard, W; Manirampa, J; Tayler-Smith, K; Manzi, M; Nanan-N'zeth, K; Duchenne, B; Ndelema, B; Etienne, W; Alders, P; Veerman, R; Van den Bergh, R

    2017-01-01

    In a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes. A retrospective analysis of EmOC data (2011 and 2012). A total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%). A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by 'general practitioners with surgical skills' and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died. Overall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

  8. Prevalence of canine gastrointestinal helminths in urban Lusaka and rural Katete Districts of Zambia.

    PubMed

    Bwalya, Eugene C; Nalubamba, King S; Hankanga, C; Namangala, B

    2011-07-01

    Faecal samples were collected from January 2010 through September 2010 to determine the prevalence of gastrointestinal (GI) helminths infestation in dogs in urban Lusaka and rural Katete Districts of Zambia. A total of 452 faecal samples (n=160 Katete, n=292 Lusaka) were examined by faecal flotation for the presence of helminth eggs and 82.5% of dogs were positive for GI helminths in Katete compared to 76% for Lusaka. Positive results with the presence of at least one parasite corresponded to 72.9% Ancylostoma caninum, 11% Toxocara canis, 4.8% Toxascaris leonina, 2.4% Dipylidium caninum, 0.7% Taeniidae and 0.3% T. vulpis, species for Lusaka while Katete recorded 70.6% A. caninum, 18.1% T. vulpis, 11.1% T. canis, 13.1% D. caninum, 3.8% T. leonina, and 0.6% Taeniidae. Except for T. vulpis and D. caninum (p<0.05) the results indicated no significant difference in the prevalence of the identified GI helminth between Lusaka and Katete. There was no significant difference in the prevalence between genders of GI helminth infestation demonstrated in this study and only A. caninum showed significant difference in prevalence by age category. The study also showed the presence of zoonotic intestinal helminths A. caninum, T. canis and D. caninum. The study highlights that there was no significant difference in spectrum and prevalence of GI helminths between urban and rural areas in Zambia. It further brings to light the importance of educating owners of dogs on the importance of regular deworming of dogs and control of ectoparasites in order to minimise the risk that these dogs pose to them and the public.

  9. Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence.

    PubMed

    Phillips-Howard, Penelope A; Otieno, George; Burmen, Barbara; Otieno, Frederick; Odongo, Frederick; Odour, Clifford; Nyothach, Elizabeth; Amek, Nyanguara; Zielinski-Gutierrez, Emily; Odhiambo, Frank; Zeh, Clement; Kwaro, Daniel; Mills, Lisa A; Laserson, Kayla F

    2015-10-01

    Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. Responses from 3418 menstruating females aged 13-29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25-7.12) and single females (AOR 2.17, 95% CI 1.04-4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21-0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53-0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04-4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89-9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06-11.43). Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required to strengthen knowledge and to evaluate interventions to reduce these

  10. Menstrual Needs and Associations with Sexual and Reproductive Risks in Rural Kenyan Females: A Cross-Sectional Behavioral Survey Linked with HIV Prevalence

    PubMed Central

    Otieno, George; Burmen, Barbara; Otieno, Frederick; Odongo, Frederick; Odour, Clifford; Nyothach, Elizabeth; Amek, Nyanguara; Zielinski-Gutierrez, Emily; Odhiambo, Frank; Zeh, Clement; Kwaro, Daniel; Mills, Lisa A.; Laserson, Kayla F.

    2015-01-01

    Abstract Background: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. Methods: Responses from 3418 menstruating females aged 13–29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. Results: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls <15 years old depending on makeshift items. Two-thirds of females with no education relied on traditional items. Having attended secondary school increased the odds of using commercial pads among married (adjusted odds ratios [AOR] 4.8, 95% confidence interval [CI] 3.25–7.12) and single females (AOR 2.17, 95% CI 1.04–4.55). Married females had lower odds of pad use if they reported early (<12 years of age) compared with later (≥18 years) sexual debut (64% vs. 78%, AOR 0.45, 95% CI 0.21–0.97). Two-thirds of pad users received them from sexual partners. Receipt was lower among married females if partners were violent (AOR 0.67, 95% CI 0.53–0.85). Receipt among single females was higher if they had two or more sexual partners in the past year (AOR 2.11, 95% CI 1.04–4.29). Prevalence of engaging in sex for money to buy pads was low (1.3%); however, 10% of 15-year-olds reported this, with girls ≤15 having significantly higher odds compared with females over 15 (AOR 2.84, 95% CI 0.89–9.11). The odds of having transactional sex for pads was higher among females having two or more partners in the past 12 months (AOR 4.86, 95% CI 2.06–11.43). Conclusions: Menstrual needs of impoverished females in rural LMICs settings likely leads to increased physical and sexual harms. Studies are required

  11. Less – Known Medicinal Uses of Plants Among the Rural Women of Shahjahanpur District, U.P.

    PubMed Central

    Sharma, S.C.

    2000-01-01

    During the present study a valuable phytotherepeutic information on the various ailments of women was collected from the district, Traditionally the rural women prefer plant medicines than the modern medicines for their diseases including abortion, menstrual trouble, conception disorders, sterility, delivery problems etc, prevailing among them, Eighteen medicinal plants have been reported after making interview of medicine of the villages. The plants are arranged in alphabetical order according to the botanical names followed by family, vernacular names and herbarium number. PMID:22556995

  12. Demographic and financial characteristics of school districts with low and high à la Carte sales in rural Kansas Public Schools.

    PubMed

    Nollen, Nicole L; Kimminau, Kim S; Nazir, Niaman

    2011-06-01

    Reducing à la carte items in schools-foods and beverages sold outside the reimbursable meals program-can have important implications for childhood obesity. However, schools are reluctant to reduce à la carte offerings because of the impact these changes could have on revenue. Some foodservice programs operate with limited à la carte sales, but little is known about these programs. This secondary data analysis compared rural and urban/suburban school districts with low and high à la carte sales. Foodservice financial records (2007-2008) were obtained from the Kansas State Department of Education for all public K-12 school districts (n=302). χ² and t tests were used to examine the independent association of variables to à la carte sales. A multivariate model was then constructed of the factors most strongly associated with low à la carte sales. In rural districts with low à la carte sales, lunch prices and participation were higher, lunch costs and à la carte quality were lower, and fewer free/reduced price lunches were served compared to rural districts with high à la carte sales. Lunch price (odds ratio=1.2; 95% confidence interval, 1.1 to 1.4) and free/reduced price lunch participation (odds ratio=3.0; 95% confidence interval, 1.0 to 9.8) remained in the multivariate model predicting low à la carte sales. No differences were found between urban/suburban districts with low and high à la carte sales. Findings highlight important factors to maintaining low à la carte sales. Schools should consider raising lunch prices and increasing meal participation rates as two potential strategies for reducing the sale of à la carte items without compromising foodservice revenue. Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  13. Demographic and Financial Characteristics of School Districts with Low and High À La Carte Sales in Rural Kansas Public Schools

    PubMed Central

    Nollen, Nicole L.; Kimminau, Kim; Nazir, Niaman

    2013-01-01

    Reducing à la carte (ALC) items in schools – i.e., foods and beverages sold outside the reimbursable meals program -- may have important implications for childhood obesity. However, schools are reluctant to reduce ALC offerings because of the impact these changes could have on revenue. Some food service programs operate with limited ALC sales, but little is known about these programs. This secondary data analysis compared rural and urban/suburban school districts with low and high ALC sales. Food service financial records (2007–2008) were obtained from the Kansas State Department of Education (KSDE) for all public K-12 school districts (n=302). Chi-square and t-tests were used to examine the independent association of variables to ALC sales. A multivariate model was then constructed of the factors most strongly associated with low ALC sales. In rural districts with low ALC sales, lunch prices and participation were higher; lunch costs and ALC quality were lower; and fewer free/reduced price lunches were served compared to rural districts with high ALC sales. Lunch price (OR=1.2, 95% CI = 1.1–1.4) and free/reduced price lunch participation (OR=3.0, 95% CI=1.0–9.8) remained in the multivariate model predicting low ALC sales. No differences were found between urban/suburban districts with low and high ALC sales. Findings highlight important factors to maintaining low ALC sales. Schools should consider raising lunch prices and increasing meal participation rates as two potential strategies for reducing the sale of ALC items without compromising food service revenue. PMID:21616201

  14. Hope and despair: community health assistants’ experiences of working in a rural district in Zambia

    PubMed Central

    2014-01-01

    Background In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. Methods A phenomenological approach was used to examine CHAs’ experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach. Results Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs’ ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs’ ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA’s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs’ ability to deliver services

  15. The Impact of a State Takeover on Academic Achievement, School Performance, and School Leadership in a Rural South Carolina School District

    ERIC Educational Resources Information Center

    Bishop, Janice Zissette

    2009-01-01

    This case study on the impact of a state takeover in one of South Carolina's most rural school districts ("referred to as the County School District") was completed using a quasi-experimental mixed methods design to examine the impact on academic achievement, school performance, and school leadership as a result of the South Carolina…

  16. Evaluation of School Incentive Teams and Multicultural Training To Increase Success for High-Risk Students in a Rural City School District.

    ERIC Educational Resources Information Center

    O'Sullivan, Rita G.; Baber, Ceola R.

    This paper presents the results of a study of a low-cost dropout prevention program in a rural, small city school district (approximately 3,500 students) that used school incentive teams and multicultural training to increase success for students at risk of dropping out of school. Selected teachers in the eight schools in the district were…

  17. The Impact of a State Takeover on Academic Achievement, School Performance, and School Leadership in a Rural South Carolina School District

    ERIC Educational Resources Information Center

    Bishop, Janice Zissette

    2009-01-01

    This case study on the impact of a state takeover in one of South Carolina's most rural school districts ("referred to as the County School District") was completed using a quasi-experimental mixed methods design to examine the impact on academic achievement, school performance, and school leadership as a result of the South Carolina…

  18. Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda.

    PubMed

    Musoke, David; Ekirapa-Kiracho, Elizabeth; Ndejjo, Rawlance; George, Asha

    2015-05-01

    Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. From the study, known health systems problems including inadequate transport, long distance to health facilities, long waiting times at facilities and poor quality of care were confirmed, but other aspects that needed to be addressed were also established. These included key gender-related determinants of maternal health, such as domestic violence, low contraceptive use and early teenage pregnancy, as well as problems of unclean water, poor sanitation and women's lack of income. Community members appreciated learning about the research findings precisely hence designing and implementing appropriate solutions to the problems identified because they could see photographs from their own local area. Photovoice's strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders. Copyright © 2015. Published by Elsevier Ltd.

  19. Household Expenditure on Tobacco Consumption in a Poverty-Stricken Rural District in Sri Lanka.

    PubMed

    Perera, K Manuja N; Guruge, G N Duminda; Jayawardana, Pushpa L

    2017-03-01

    Tobacco is a determinant of poverty and a barrier for development. Monaragala, a rural, agricultural district, reports the highest poverty-related indicators in southern Sri Lanka. A cross-sectional study was used to describe the household expenditure on tobacco and its association with food- and education-related expenditures at household level. This study used a 4-stage cluster sampling method to recruit a representative sample of 1160 households. Response rate was 98.6%. Median monthly household income was LKR 20 000 (interquartile range [IQR] = LKR 12 000-30 000). The median monthly expenditure on tobacco was LKR 1000 (IQR = LKR 400-2000) with the highest spending tertile reporting a median of LKR 2700 (IQR = LKR 2000-3600).The proportionate expenditure from the monthly income ranged from 0.0% to 50% with a median of 5.0% (IQR = 2.0-10.0) and a mean of 7.4% (7.6). The poorest reported the highest mean proportionate expenditure (9.8%, SD = 10) from the household income. Household expenditure on tobacco negatively associated with expenditure on education.

  20. A study on attitude towards blood donation among people in a rural district, Thailand.

    PubMed

    Wiwanitkit, V

    2000-09-01

    Blood and blood components are important in many situations. At present, there is only a donation system for blood banks to get blood in Thailand. Although the blood bank process has been founded in Thailand for many years, there is still an insufficient amount of blood for use. There are misguided attitudes on blood donation among the people in the rural areas. This study has been designed as a cross-sectional descriptive study to study attitude towards blood donation among the people in Bang Sapan District, Prachuab Kiri Khan Province, Thailand. Data from self-administered questionnaires were collected and statistical analysis was performed. We found that people in that area had a rather good attitude but this was still found in less than 50%. We found the attitude of the subjects only significantly correlated with the level of education. We concluded that improving the people's attitude on blood donation is important. We suggest that every blood bank should design a program for providing knowledge in order to improve the attitude of the people in that area. We also suggest that knowledge on blood donation should be repeatedly taught at any education level including the school system. This study can provided preliminary results for other studies.

  1. [Research of the Stormwater Runoff and Pollution Characteristics in Rural Area of Yuhang District, Hangzhou].

    PubMed

    Duan, Sheng-hui; Zhao, Yu; Shan, Bao-qing; Tang, Wen-zhong; Zhang, Wen-qiang; Zhang, Shu-zhen; Lang, Chao

    2015-10-01

    In order to investigate the pollution characteristics of stormwater runoff in the southern developed rural region, the runoff samples were collected from four different underlying surfaces during three storm events in Caoqiao and Pujia Tou, which are two typical villages and are located in Yuhang District of Hangzhou. The content of nutrition (nitrogen and phosphorus) and heavy metals (Mn, Cu, Zn, Ni, Cr, Cd, As, Pb) in the simples were analyzed, and the difference of EMC ( event mean concentration) and pollution load of the contaminants in the runoff on different underlying surfaces were compared. The results showed that the EMC of TSS, COD, NH4(+)-N, TP and TN were 16.19, 21.01, 0.74, 1.39 and 2.39 mg x L(-1) in the Caoqiao, respectively; as to Pujia Tou, they were 3.10, 15.69, 0.90, 0.78 and 3.58 mg x L(-1), respectively. The content of heavy metals was all lower than the national surface water quality of two type water in the runoff. Compared with the quality standards for surface water, the EMC of TP was 9 times and 3. 5 times higher and TN was 1. 8 times and 1. 2 times higher in two areas. Besides, the pollution loads of TSS and COD were the highest in farmland.

  2. Sustainability of donor-funded rural water supply and sanitation projects in Mbire district, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Kwangware, Johnson; Mayo, Aloyce; Hoko, Zvikomborero

    The sustainability of donor-funded rural water supply and sanitation projects was assessed in Mbire district, Zimbabwe in terms of level of community participation, quality of implementation and reliability of the systems. The study was carried out through questionnaires, focus group discussions, interviews and field observations. The results show that the quality of implementation of the projects was deemed to be good and participation of the communities in project ideas initiation and choice of technology was found to be very low. Reliability of the systems was found to be very high with 97% of the boreholes in all the three wards studied being functional. Financial management mechanisms were very poor because water consumers were not willing to pay for operation and maintenance. The projects were classified as potentially sustainable with sustainability index between 5.00 and 6.67. Poor financial management mechanisms for effective borehole maintenance, poor quality of construction and lack of community participation in project planning were found to be potential threats to the sustainability of the projects. Future projects should establish the need for the service and should thus be demand driven to ensure effective participation of the water consumers and enhance project's potential for sustainability.

  3. Age-dependent decline and association with stunting of Giardia duodenalis infection among schoolchildren in rural Huye district, Rwanda.

    PubMed

    Heimer, Jakob; Staudacher, Olga; Steiner, Florian; Kayonga, Yvette; Havugimana, Jean Marie; Musemakweri, Andre; Harms, Gundel; Gahutu, Jean-Bosco; Mockenhaupt, Frank P

    2015-05-01

    Giardia duodenalis infection is highly prevalent and a cause of underweight in pre-school children in rural Rwanda. The present study aimed at assessing the age-pattern of Giardia infection and its manifestation in older children, i.e., during school age. Stool samples were collected from 622 schoolchildren at two schools in the Huye district of southern Rwanda (rural, 301; urban, 321) and subjected to G. duodenalis specific PCR assays. Clinical and anthropometric data, socio-economic status and factors potentially associated with G. duodenalis infection were assessed. Of the 622 children (mean age, 10.4 years), 35.7% were infected with G. duodenalis (rural, 43.9%; urban, 28.0%; P<0.0001). Only few indicators of low socio-economic status were found to be associated with infection. In rural but not urban schoolchildren, infection prevalence declined significantly with age. G. duodenalis infection more than doubled the odds of stunting in both rural (adjusted OR, 2.35 (95%CI, 1.25-4.41)) and urban children (adjusted OR, 2.27 (95%CI, 1.01-5.09)). In the study area of rural southern Rwanda, G. duodenalis prevalence among children declined throughout school-age. The data suggest that while lacking overt clinical manifestation at high endemicity, G. duodenalis infection is a common cause of stunting in schoolchildren.

  4. Providing Psychological Consultative Services to Students with Emotional/Behavioral Disabilities: A Collaborative Effort between Rural School Districts and a University Training Program.

    ERIC Educational Resources Information Center

    Jerez, Ric; Brady, Sharon; Cates, Dennis

    A project of Cameron University increases the availability of psychological services to rural schools in southwestern Oklahoma. Rural districts identified needs for professionals to conduct psychological evaluations, develop and help in the implementation of behavioral intervention plans, and consult with teachers regarding plan implementation and…

  5. Examining the relationship between school district size and science achievement in Texas including rural school administrator perceptions of challenges and solutions

    NASA Astrophysics Data System (ADS)

    Mann, Matthew James

    Rural and small schools have almost one-third of all public school enrollment in America, yet typically have the fewest financial and research based resources. Educational models have been developed with either the urban or suburban school in mind, and the rural school is often left with no other alternative except this paradigm. Rural based educational resources are rare and the ability to access these resources for rural school districts almost non-existent. Federal and state based education agencies provide some rural educational based programs, but have had virtually no success in answering rural school issues. With federal and state interest in science initiatives, the challenge that rural schools face weigh in. To align with that focus, this study examined Texas middle school student achievement in science and its relationship with school district enrollment size. This study involved a sequential transformative mixed methodology with the quantitative phase driving the second qualitative portion. The quantitative research was a non-experimental causal-comparative study conducted to determine whether there is a significant difference between student achievement on the 2010 Texas Assessment of Knowledge and Skills 8 th grade science results and school district enrollment size. The school districts were distributed into four categories by size including: a) small districts (32-550); b) medium districts (551-1500); c) large districts (1501-6000); and d) mega-sized districts (6001-202,773). A one-way analysis of variance (ANOVA) was conducted to compare the district averages from the 2010 TAKS 8th grade science assessment results and the four district enrollment groups. The second phase of the study was qualitative utilizing constructivism and critical theory to identify the issues facing rural and small school administrators concerning science based curriculum and development. These themes and issues were sought through a case study method and through use of semi

  6. From Attitudes to Practice: Utilising Inclusive Teaching Strategies in Kenyan Primary Schools

    ERIC Educational Resources Information Center

    Elder, Brent C.; Damiani, Michelle L.; Oswago, Benson O.

    2016-01-01

    The purpose of this paper is to provide evidence of Kenyan primary school teachers using inclusive teaching strategies in a rural setting with many known barriers to the development of a sustainable inclusive education system. This qualitative study examines teachers' uses of inclusive teaching strategies in primary schools following a series of…

  7. From Attitudes to Practice: Utilising Inclusive Teaching Strategies in Kenyan Primary Schools

    ERIC Educational Resources Information Center

    Elder, Brent C.; Damiani, Michelle L.; Oswago, Benson O.

    2016-01-01

    The purpose of this paper is to provide evidence of Kenyan primary school teachers using inclusive teaching strategies in a rural setting with many known barriers to the development of a sustainable inclusive education system. This qualitative study examines teachers' uses of inclusive teaching strategies in primary schools following a series of…

  8. Education Quality and the Kenyan 8-4-4 Curriculum: Secondary School Learners' Experiences

    ERIC Educational Resources Information Center

    Milligan, Lizzi O.

    2017-01-01

    This article explores the implementation of Kenyan secondary education in rural Western Kenya, focusing on learners' experiences. One of the key challenges to educational quality is shown to be the size and breadth of the secondary education curriculum. Learners are in school 12 hours a day with those approaching their final exams working three to…

  9. Factors Influencing Teacher Job Satisfaction and Their Alignment with Current District Practices in a Rural School District

    ERIC Educational Resources Information Center

    Wallace, Taneal Marie

    2010-01-01

    School districts' decisions across the country are influencing the satisfaction level of teachers, in both positive and negative ways. With statistics reporting as high as fifty percent of teachers leaving the profession in the first five years of experience (Ingersoll, 2003), determining the reasons for teacher dissatisfaction are important in…

  10. Factors Influencing Teacher Job Satisfaction and Their Alignment with Current District Practices in a Rural School District

    ERIC Educational Resources Information Center

    Wallace, Taneal Marie

    2010-01-01

    School districts' decisions across the country are influencing the satisfaction level of teachers, in both positive and negative ways. With statistics reporting as high as fifty percent of teachers leaving the profession in the first five years of experience (Ingersoll, 2003), determining the reasons for teacher dissatisfaction are important in…

  11. Tracing the Development of a Rural University-District Partnership: Encouraging District Voice and Challenging Assumptions Leadership

    ERIC Educational Resources Information Center

    Myran, Steve; Sanzo, Karen L.; Clayton, Jennifer

    2011-01-01

    The increase in accountability on both preK-12 districts and institutes of higher education has heightened the demands for partnerships between the two. Such programs have the ability to provide contextually focused, meaningful experiences by combining the theory and research knowledge of university faculty with the practical experience of…

  12. Assessment of drinking water quality and rural household water treatment in Balaka District, Malawi

    NASA Astrophysics Data System (ADS)

    Mkwate, Raphael C.; Chidya, Russel C. G.; Wanda, Elijah M. M.

    2017-08-01

    Access to drinking water from unsafe sources is widespread amongst communities in rural areas such as Balaka District in Malawi. This situation puts many individuals and communities at risk of waterborne diseases despite some households adopting household water treatment to improve the quality of the water. However, there still remains data gaps regarding the quality of drinking water from such sources and the household water treatment methods used to improve public health. This study was, therefore, conducted to help bridge the knowledge gap by evaluating drinking water quality and adoption rate of household water treatment and storage (HWTS) practices in Nkaya, Balaka District. Water samples were collected from eleven systematically selected sites and analyzed for physico-chemical and microbiological parameters: pH, TDS, electrical conductivity (EC), turbidity, F-, Cl-, NO3-, Na, K, Fe, Faecal Coliform (FC) and Faecal Streptococcus (FS) bacteria using standard methods. The mean results were compared to the World Health Organization (WHO) and Malawi Bureau of Standards (MBS) (MS 733:2005) to ascertain the water quality for drinking purposes. A total of 204 randomly selected households were interviewed to determine their access to drinking water, water quality perception and HWTS among others. The majority of households (72%, n = 83) in Njerenje accessed water from shallow wells and rivers whilst in Phimbi boreholes were commonly used. Several households (>95%, n = 204) were observed to be practicing HWST techniques by boiling or chlorination and water storage in closed containers. The levels of pH (7.10-7.64), F- (0.89-1.46 mg/L), Cl- (5.45-89.84 mg/L), NO3- (0-0.16 mg/L), Na (20-490 mg/L), K (2.40-14 mg/L) and Fe (0.10-0.40 mg/L) for most sites were within the standard limits. The EC (358-2220 μS/cm), turbidity (0.54-14.60 NTU), FC (0-56 cfu/100 mL) and FS (0-120 cfu/100 mL) - mainly in shallow wells, were found to be above the WHO and MBS water quality

  13. [Transportation by ambulance in a rural district in Iceland during the years 1990-1996.].

    PubMed

    Valdimarsson, H

    1997-09-01

    The Health Centre at Kirkjubaejarklaustur serves a large rural district with a population a little over 600. Agriculture and various services including tourism are the main occupations. Almost 20% of the population are over 65 years of age, which is an unusually high figure compared to the rest of the country. Ambulance transports are one of the health centre's responsibilities. Most of these are surface transports to hospitals, 200-250 kilometres away. The purpose of this study was to explore and explain the nature of all ambulance transports provided by the Kirkjubaejarklaustur Health Centre from 1990-1996. A retrospective analysis was performed on all ambulance transports provided by the Kirkjubaejarklaustur Health Centre during the period. The data provided by the Health Centre and by transport personnel was used. Information was relatively easy to get since documentation was done by very few persons. The transports were looked at in terms of prevalence, age, gender, points of departure and destination, diagnosis, time of day, attending person and whether a local person or a tourist was being transported. Annual ambulance transport prevalence is 50 for every 1000 inhabitants. The prevalence for the whole country is 72, for the city of Reykjavik 90. Tourists account for 27% of transports. Accidents were the reason for transport in almost one third of cases. Males and elderly persons account for a significant number of the transports. This is congruent with other studies. Ambulance transport decreased significantly during the last two years of the study period. The most plausible explanation of this is the opening of a 20 bed nursing home in the district in mid year 1994. Ambulance transport including the preparation of the sick or injured person is an important part of health care in this region. General practitioners need to be well versed in emergency medicine and ambulance attendants in preparing the patient for transport. Therefore continuing education is an

  14. Dental caries management at a rural district hospital in northern Rwanda: a neglected disease.

    PubMed

    Mukashyaka, C; Uzabakiriho, B; Amoroso, C L; Mpunga, T; Odhiambo, J; Mukashema, P; Seymour, B A; Sindayigaya, J de D; Hedt-Gauthier, B L

    2015-09-21

    Contexte : Si certaines études rapportent des taux de prévalence des caries dentaires en Afrique sub-saharienne, on sait peu de choses sur le comportement en termes de recherche de soins ni de prise en charge des caries, surtout dans les hôpitaux de district ruraux.Objectif : Décrire la prise en charge des patients sollicitant des soins pour caries dentaires à l'Hôpital de District de Butaro (BDH) en zone rurale du Rwanda.Schéma : Cette étude descriptive transversale a été réalisée au BDH, au nord du Rwanda. Un échantillon de 287 consultations de patients pour caries dentaires entre janvier et décembre 2013 a été sélectionné de façon aléatoire et stratifié sur l'âge (⩽5 ans, 6–21 ans et >21 ans). Nous avons estimé le traitement reçu avec des intervalles de confiance de 95% dans chaque tranche d'âge et les différences entre les groupes d'âge ont été évaluées grâce au test exact de Fisher.Résultats : Presque tous les patients (97,6%) ont eu une extraction de la dent cariée et cela n'a pas varié de façon significative en fonction du groupe d'âge (P = 0,558). En plus des caries, la majorité des patients avait également une pulpite chronique (74,9%).Conclusion : La prévention des caries et les soins conservateurs devraient être une priorité grâce à un programme de santé orale communautaire. Nous recommandons l'introduction d'une formation avancée, d'équipement et de matériels de prise en charge des caries dentaires autres que l'extraction des dents et l'augmentation du nombre de dentistes qualifiés.

  15. Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

    PubMed

    Schnippel, Kathryn; Lince-Deroche, Naomi; van den Handel, Theo; Molefi, Seithati; Bruce, Suann; Firnhaber, Cynthia

    2015-01-01

    Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model. The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district) and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs), breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD. Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts); the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost. Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to health care

  16. Cost Evaluation of Reproductive and Primary Health Care Mobile Service Delivery for Women in Two Rural Districts in South Africa

    PubMed Central

    Schnippel, Kathryn; Lince-Deroche, Naomi; van den Handel, Theo; Molefi, Seithati; Bruce, Suann; Firnhaber, Cynthia

    2015-01-01

    Background Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model. Methods The evaluation was retrospective (October 2012–September 2013 for one district and April–September 2013 for the second district) and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs), breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD. Results Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts); the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost. Conclusions Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to

  17. Rural School District Enrollment and Building Capacity: Projections for the Next 10 Years

    ERIC Educational Resources Information Center

    Yan, Wenfan

    2009-01-01

    Given the shifting population trends across the U.S. and Pennsylvania, it is important for policy makers and school districts to know what to expect, in terms of school district enrollment and facility needs, in the coming years. This research was conducted to provide a perspective on the potential building needs of school districts over the next…

  18. Epidemiology of diabetes mellitus in young population in rural districts of northern Bihar.

    PubMed

    Tewary, Kamlesh; Singh, Vijoy Kumar; Singh, Satish Kumar; Tiwary, Pamit; Garg, Amit; Joshi, Kalpesh Keshav

    2013-02-01

    Diabetes mellitus is a major public health problem worldwide, and it is a known risk factor for coronary artery disease. Younger population, a group which lacks epidemiological data on diabetes mellitus, the prevalence of diabetes in them was investigated in the rural districts of north Bihar (India). Furthermore, the risk factors associated with diabetes mellitus in this younger population were also assessed. A total of 3957 subjects in the age group of 12-30 years from northern Bihar participated in the study. Data were obtained from history, random capillary blood glucose levels detected by glucometer and body mass index. Of the available 3955 results, glucometer identified 103 subjects (2.6%) as positives with the cut-off value of 150 mg/dl. Out of these, 12 (0.3%) were diabetic while 35 (0.88%) had impaired glycaemic control by intravenous blood sugar method. The random blood glucose levels varied from 53-391 mg/dl (mean and SD: 105.3 and 21.2). Amongst these subjects; only 103 (2.6%) were declared to be diabetic. The fasting and postprandial blood glucose levels for diabetic subjectes were 148.5 and 227.1 mg/dl respectively. The logistic regression evidenced that positive glucometer results was associated with age (> 25 years), sex (male), high BMI (> 18.5), high BP (> 120/80) and occupation. The increasing prevalence of diabetes in young may have adverse effects on nation's health and economy. Data from this study highlights the importance of early screening, diagnosis and management of diabetes mellitus.

  19. Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

    PubMed Central

    Chiringa, Irene O.; Mashau, Ntsieni S.

    2016-01-01

    Background Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. Purpose The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. Methods The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. Results Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). Conclusion Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services. PMID:27380850

  20. Predictors of depression among patients on art in a rural health district in North West Cameroon.

    PubMed

    Asangbeh, Serra Lem; Sobngwi, Joëlle Laure; Ekali, Gabriel Loni; Eyoum, Christian; Msellati, Philippe

    2016-01-01

    Depression in people living with HIV/AIDS (acquired immune-deficiency syndrome) (PLWHA) increases risky HIV transmission behaviour, disease progression to AIDS, negatively affects drug adherence and is thus a risk for the development of drug-resistant strains. This study sought to identify predictors of depression in rural Cameroon. A cross-sectional analytic study was carried out from September 2013 to November 2013 in the Mbengwi district hospital of the North West region. We measured depression (PHQ-9 (nine-item Patient Health Questionnaire)), clinical and demographic characteristics of patients on antiretroviral therapy (ART). Means, proportions and a stepwise logistic regression model were fit to describe participants' characteristics and predictors of depression in the study population. Of the 202 recruited patients, 58(28.7%) had a positive depression screen. Independent predictors of depression included monthly income less than 20,000 FCFA (US$40), (adjusted odds ratio (aOR) = 2.47; 95% CI = 1.18-5.18), CD4 count <200 cls/µl (aOR = 7.56; 95% CI = 2.46-23.30) and presence of AIDS symptoms (aOR = 4.29; 95% CI = 2.09-8.81). There was no significant correlation between duration on ART, marital status, age, gender and depression. Early diagnosis and treatment of depressed patients need to be incorporated into intervention programmes, which might improve patient outcomes. More research is needed to investigate the impact of antidepressant therapy in PLWHA on the evolution of treatment.

  1. Study on radionuclides in granite quarries of Bangalore rural district, Karnataka, India.

    PubMed

    Ningappa, C; Sannappa, J; Karunakara, N

    2008-01-01

    Studies on natural radiation levels and radionuclides were carried out extensively in the environment of granite quarries of Kanakapura, Ramanagara Taluks and Bidadi Hobli in Bangalore rural District and Bangalore city. The indoor and outdoor gamma exposure rate in air was measured using an environmental dosemeter, and it is converted into absorbed dose using suitable conversion factor. The activity concentrations of natural radionuclides in rock samples and also in soil samples were measured using an HPGe gamma-ray spectrometer. The results reveal that the activity concentrations of (226)Ra, (232)Th and (40)K in rocks are found to be vary from 32.2 to 163.6, 128.3 to 548.6 and 757.4 to 1418.4 Bq kg(-1), respectively, with corresponding arithmetic mean values of 93.2, 306.2 and 1074.4 Bq kg(-1). Activity concentrations of (226)Ra, (232)Th and (40)K in soil samples were found to vary from 32.4 to 55.2, 39.9 to 214.3 and 485.4 to 1150.2 Bq kg(-1), respectively, with corresponding arithmetic mean values of 40.7, 93.1 and 750.4 Bq kg(-1). The average activity levels of all these radionuclides are above the global average. This is consistent with the geological and geo-chemical significance of the rocks of the area under investigation. The results of these systematic investigations are discussed in detail and compared with the literature values represented for other environments.

  2. Dietary patterns and household food insecurity in rural populations of Kilosa district, Tanzania.

    PubMed

    Ntwenya, Julius Edward; Kinabo, Joyce; Msuya, John; Mamiro, Peter; Majili, Zahara Saidi

    2015-01-01

    Few studies have investigated the relationship between dietary pattern and household food insecurity. The objective of the present analysis was to describe the food consumption patterns and to relate these with the prevalence of food insecurity in the context of a rural community. Three hundred and seven (307) randomly selected households in Kilosa district participated in the study. Data were collected during the rainy season (February-May) and post harvest season (September-October) in the year 2011. Food consumption pattern was determined using a 24-h dietary recall method. Food insecurity data were based on the 30 day recall experience to food insecurity in the household. Factor analysis method using Principal Components extraction function was used to derive the dietary patterns and correlation analysis was used to establish the existing relationship between household food insecurity and dietary patterns factor score. Four food consumption patterns namely (I) Meat and milk; (II) Pulses, legumes, nuts and cooking oils; (III) fish (and other sea foods), roots and tubers; (IV) Cereals, vegetables and fruits consumption patterns were identified during harvest season. Dietary patterns identified during the rainy season were as follows: (I) Fruits, cooking oils, fats, roots and tubers (II) Eggs, meat, milk and milk products (III) Fish, other sea foods, vegetables, roots and tubers and (IV) Pulses, legumes, nuts, cereals and vegetables. Household food insecurity was 80% and 69% during rainy and harvest-seasons, respectively (P = 0.01). Household food insecurity access scale score was negatively correlated with the factor scores on household dietary diversity. Food consumption patterns and food insecurity varied by seasons with worst scenarios most prevalent during the rainy season. The risk for inadequate dietary diversity was higher among food insecure households compared to food secure households. Effort geared at alleviating household food insecurity could

  3. Dietary Patterns and Household Food Insecurity in Rural Populations of Kilosa District, Tanzania

    PubMed Central

    Ntwenya, Julius Edward; Kinabo, Joyce; Msuya, John; Mamiro, Peter; Majili, Zahara Saidi

    2015-01-01

    Introduction Few studies have investigated the relationship between dietary pattern and household food insecurity. The objective of the present analysis was to describe the food consumption patterns and to relate these with the prevalence of food insecurity in the context of a rural community. Methodology Three hundred and seven (307) randomly selected households in Kilosa district participated in the study. Data were collected during the rainy season (February–May) and post harvest season (September–October) in the year 2011. Food consumption pattern was determined using a 24-h dietary recall method. Food insecurity data were based on the 30 day recall experience to food insecurity in the household. Factor analysis method using Principal Components extraction function was used to derive the dietary patterns and correlation analysis was used to establish the existing relationship between household food insecurity and dietary patterns factor score. Results Four food consumption patterns namely (I) Meat and milk; (II) Pulses, legumes, nuts and cooking oils; (III) fish (and other sea foods), roots and tubers; (IV) Cereals, vegetables and fruits consumption patterns were identified during harvest season. Dietary patterns identified during the rainy season were as follows: (I) Fruits, cooking oils, fats, roots and tubers (II) Eggs, meat, milk and milk products (III) Fish, other sea foods, vegetables, roots and tubers and (IV) Pulses, legumes, nuts, cereals and vegetables. Household food insecurity was 80% and 69% during rainy and harvest–seasons, respectively (P = 0.01). Household food insecurity access scale score was negatively correlated with the factor scores on household dietary diversity. Conclusion Food consumption patterns and food insecurity varied by seasons with worst scenarios most prevalent during the rainy season. The risk for inadequate dietary diversity was higher among food insecure households compared to food secure households. Effort geared at

  4. Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe.

    PubMed

    Chiringa, Irene O; Ramathuba, Dorah U; Mashau, Ntsieni S

    2016-05-31

    Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15-29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.

  5. Factors affecting the utilisation of improved ventilated latrines among communities in Mtwara Rural District, Tanzania

    PubMed Central

    Kema, Koronel; Semali, Innocent; Mkuwa, Serafina; Kagonji, Ignatio; Temu, Florence; Ilako, Festus; Mkuye, Martin

    2012-01-01

    Introduction The Tanzania government, working in partnership with other stakeholders implemented a community-based project aimed at increasing access to clean and safe water basic sanitation and promotion of personal hygiene in Mtwara Rural District. Mid-term evaluation revealed that progress had been made towards improved ventilated latrines; however, there was no adequate information on utilisation of these latrines and associated factors. This study was therefore conducted to establish the factors influencing the utilisation of these latrines. Methods A cross-sectional study was conducted among 375 randomly selected households using a pre-tested questionnaire to determine whether the households owned improved ventilated latrines and how they utilised them. Resuls About half (50.5%) of the households had an improved ventilated latrine and households with earnings of more than 50,000 Tanzanian Shillings were two times more likely to own an improved latrine than those that earned less (AOR 2.1, 95% CI=1.1-4.0, p= 0.034). The likelihood of owning an improved latrine was reduced by more than 60 percent for female-headed households (AOR=0.38; 95% CI=0.20-0.71; p=0.002). Furthermore, it was established that all members of a household were more likely to use a latrine if it was an improved ventilated latrine (AOR=2.4; 95% CI=1.1-5.1; p= 0.024). Conclusion Findings suggest adoption of strategies to improve the wellbeing of households and deploying those who had acquired improved ventilated latrines as resource persons to help train others. Furthermore, efforts are needed to increase access to soft loans for disadvantaged members and increasing community participation. PMID:23467697

  6. Challenges faced by professional nurses when implementing the Expanded Programme on Immunisation at rural clinics in Capricorn District, Limpopo

    PubMed Central

    Tladi, Flora M.

    2016-01-01

    Background Immunisation is the cornerstone of primary healthcare. Apart from the provision of safe water, immunisation remains the most cost-effective public health intervention currently available. Immunisation prevents infectious conditions that are debilitating, fatal and have the potential to cause huge public health burdens, both financially and socially, in South Africa. Aim To determine the challenges faced by professional nurses when implementing the Expanded Programme on Immunisation (EPI) at rural clinics in Capricorn District, Limpopo Province, South Africa. Setting The study was conducted in selected primary healthcare clinics of Capricorn District, Limpopo Province. Methods A qualitative explorative descriptive contextual research design was used to gather data related to the challenges faced by professional nurses when implementing EPI at rural clinics in Capricorn District. Results The findings revealed that professional nurses had knowledge of the programme, but that they experienced several challenges during implementation of EPI that included staff shortages and problems related to maintenance of the vaccines’ potency. Conclusions The Department of Health as well as the nursing administration should monitor policies and guidelines, and especially maintenance of a cold chain for vaccines, to ensure that they are practised throughout Limpopo Province. The problem of staff shortages also needs to be addressed so that the EPI can achieve its targeted objectives. PMID:27380844

  7. Human Resource Management in Small Rural Districts: The Administrator's Role in Recruitment, Hiring and Staff Development

    ERIC Educational Resources Information Center

    Townsell, Rhodena

    2007-01-01

    The purpose of this article is to review the rural area administrator's role in the areas of teacher recruitment, hiring and staff development. State and Regional Policies reveal that these areas are chief among the concerns of rural school leaders (Johnson, 2005). The rural school administrator's role often requires him/her to become involved in…

  8. Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District

    PubMed Central

    Ng’anjo Phiri, Selia; Fylkesnes, Knut; Moland, Karen Marie; Byskov, Jens; Kiserud, Torvid

    2016-01-01

    Background Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district. Method A cross-sectional survey was conducted in 2011 as part of the ‘Response to Accountable priority setting for Trust in health systems’ (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas. Results A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71–75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60–2.71%) than in rural areas 0.4% (95% CI 0.27–0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55–8.76). Conclusions Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths. PMID:26824599

  9. Preliminary observations on accessibility and utilisation of water in selected villages in Dodoma Rural and Bagamoyo Districts, Tanzania

    NASA Astrophysics Data System (ADS)

    Kusiluka, L. J. M.; Mlozi, M. R. S.; Munishi, P. K. T.; Karimuribo, E. D.; Luoga, E. J.; Mdegela, R. H.; Kambarage, D. M.

    A study was carried out to establish the availability and utilisation of water in eight villages in Dodoma Rural and Bagamoyo districts, Tanzania. A total of 128 respondents were interviewed, involving 64 people in each district. The study revealed that the main sources of water for domestic and animal uses in Dodoma district were wells and dams, while in Bagamoyo district; the main sources were dams and ponds. Nine percent of the respondents reported water to be ‘readily available’, whereas 50% and 41% reported water to be ‘not easily available’ and ‘problematic’, respectively. Distances travelled to the nearest water source were in the range of 0.5-2.0, 0.25-15.00 and 0.5-14.40 km for the respondents who reported water as “readily available”, “not easily available” and “problematic”, respectively and, the corresponding time taken to the nearest water source was 0.17-2.00; 0.10-6.00 and 0.17-5.00 hours for the three categories of respondents respectively. More than two-thirds of the respondents reported that water sources were shared between households and also 71.9% reported sharing of water sources with animals, particularly cattle, sheep and goats. The proportions of respondents that reported occurrence of enteric or diarrhoeic cases amongst household members within the past three months before the study were 35.9% and 37.5% in Dodoma and Bagamoyo districts, respectively. All respondents in Dodoma district had latrines whereas 84% in Bagamoyo district had these facilities. All except one of the respondents who had no latrines in Bagamoyo district were based in Chamakweza, a village dominated by a Maasai pastoral community. Interestingly, a significantly higher proportion of diarrhoeic cases were reported in this village compared to the other three villages in Bagamoyo district ( p = 0.029). These findings show that availability of safe water is a serious problem in the study areas and that this may have serious consequences on public

  10. Nursing personnel planning for rural hospitals in Burdwan District, West Bengal, India, using workload indicators of staffing needs.

    PubMed

    Shivam, Swapnil; Roy, Rabindra Nath; Dasgupta, Samir; Das Bhattacharyya, Krishna; Misra, Raghu Nath; Roy, Sima; Indranil, Saha

    2014-12-01

    Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO-Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel.

  11. Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

    PubMed

    Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

    2016-07-22

    Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

  12. Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

    PubMed

    Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian

    2017-02-07

    The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local

  13. Professional Quality of Life and Associated Factors Among Ugandan Midwives Working in Mubende and Mityana Rural Districts.

    PubMed

    Muliira, Rhoda Suubi; Ssendikadiwa, Vito Bosco

    2016-03-01

    To explore the professional quality of life and associated factors among Ugandan midwives working in Mubende and Mityana rural district to recommend interventions to improve professional well-being and outcomes of midwifery care. Professional quality of life of midwives working in rural areas may be influenced by several personal and work setting factors of care professionals often impacting the quality and outcomes of patient care. A cross-sectional study design was used to collect data from 224 midwives working in two rural districts of Uganda. The majority of participants were female (80 %), with an associate degree in midwifery (92 %). The mean age and years of experience were 34 ± 6.3 and 4 ± 2.1 years, respectively. The mean scores on the professional quality of life scale showed average compassionate satisfaction (19 ± 4.88), burnout (36.9 ± 6.22) and secondary traumatic stress (22.9 ± 6.69). The midwives' compassion satisfaction was related to psychological well-being (p < 0.01) and job satisfaction (p < 0.01). Conversely, their burnout levels and secondary traumatic stress were associated with education level (p < 0.01), marital status (p < 0.01), involvement in non-midwifery health care activities (p < 0.01), and physical well-being (p < 0.01). CONCLUSION AND IMPLICATION TO PRACTICE: Midwives working in rural areas of resource-poor countries have moderate professional quality of life and tend to experience moderate to high levels of burnout, secondary traumatic stress and compassion satisfaction in their professional work. Therefore, employers need to provide deliberate work based services such as counselling, debriefing, training and social support to enhance midwives professional quality of life and quality of midwifery care and practice.

  14. Mentoring future Kenyan oncology researchers

    PubMed Central

    2013-01-01

    This is a summary of the 1st Academic Model Providing Access to Healthcare (AMPATH) Oncology Institute research grant writing workshop organized in collaboration with the Kenya Medical Research Institute (KEMRI) and held in Kisumu, Kenya from January 16th to 18th, 2013. The goal of this meeting was to mentor future Kenyan scientists and prioritize research topics that would lead to improved cancer care and survival for the citizens of Kenya. PMID:24099090

  15. Improving the Small Rural or Remote School: The Role of the District

    ERIC Educational Resources Information Center

    Clarke, Simon; Wildy, Helen

    2011-01-01

    There is a robust body of work highlighting distinctive challenges encountered by leaders of small schools in pursuit of school improvement but this work has focused on the school as the unit of change and neglects the role of the district. As the district potentially influences what principals know and how they use their knowledge, this article…

  16. The Past and Performance of Six Small Rural High School Districts in Iowa.

    ERIC Educational Resources Information Center

    Dreier, William H.

    Questions about effects of consolidation on Iowa's small schools can be answered through historical review and current assessment of nine small districts. By 1966, Iowa's 1912 School Consolidation Law and subsequent legislation had reduced 4,500 taxing units to 455, with each district offering K-12 programs to a total enrollment of at least 300…

  17. Urban-rural disparities in the nutritional status of school adolescent girls in the Mizan district, south-western Ethiopia.

    PubMed

    Berheto, Tezera M; Mikitie, Wondafrash K; Argaw, Alemayehu

    2015-01-01

    Malnutrition that occurs during adolescence has important consequences for the future growth and development of the individual, particularly in girls in developing countries. Besides limiting growth, adolescent malnutrition has important consequences for society. Despite this, there is a lack of information on the nutritional status of adolescent girls in Ethiopia. This study was therefore performed to help redress this lack of data and to provide information for future improvements by health planners and policy makers. A comparative cross-sectional study design was employed to determine the urban-rural disparity in nutritional status of adolescent school girls in the Mizan district in south-western Ethiopia. A two-stage sampling procedure was used to randomly select 622 adolescent girls, 311 each from urban and rural locations. Trained field workers used structured questionnaires to obtain the desired information from the respondents. Anthropometric measurements of height and weight were collected using standard procedures and appropriate quality control measures. Height-for-age Z-scores and body mass index (BMI)-for-age Z-scores were generated using AnthroPlus software. The independent sample t-test and χ2 test were used to determine statistical significance. There were no significant differences in the ages or physical activities of the two populations of girls studied. Consumption of cereal, vegetables, sweets, sugars, fats, meat, and eggs was similar between the two groups, although slight differences were found with regard to legumes, milk, and fruit consumption. No significant differences were found in the prevalence of mild underweight girls and overweight girls in the urban and rural groups (26.5% vs 22.3% and 7.5% vs 5.2%, respectively). Significant stunting was, however, present in the rural population (40.9% vs. 17.8% in the urban group). Although overall lower than the reference data provided by WHO, the mean BMI-for-age Z-scores and height-for-age Z

  18. Associations between trematode infections in cattle and freshwater snails in highland and lowland areas of Iringa Rural District, Tanzania.

    PubMed

    Nzalawahe, Jahashi; Kassuku, Ayub A; Stothard, J Russell; Coles, Gerald C; Eisler, Mark C

    2015-09-01

    The epidemiology of trematode infections in cattle was investigated within highland and lowland areas of Iringa Rural District, in southern Tanzania. Fecal samples were collected from 450 cattle in 15 villages at altitudes ranging from 696 to 1800 m above the sea level. Freshwater snails were collected from selected water bodies and screened for emergence of cercariae. The infection rates in cattle were Fasciola gigantica 28·2%, paramphistomes 62·8% and Schistosoma bovis 4·8%. Notably, prevalence of trematode infections in cattle was much higher in highland (altitude > 1500 m) as compared with lowland (altitude < 1500 m) areas and was statistically significant (P-value = 0·000) for F. gigantica and paramphistomes but not for S. bovis. The snails collected included Lymnaea natalensis, Bulinus africanus, Bulinus tropicus, Bulinus forskali, Biomphalaria pfeifferi, Melanoides tuberculata and Bellamya constricta with a greater proportion of highland (75%) than lowland (36%) water bodies harbouring snails. Altitude is a major factor shaping the epidemiology of F. gigantica and paramphistomes infections in cattle in Iringa Rural District with greater emphasis upon control needed in highland areas.

  19. Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal

    PubMed Central

    Thiam, Sokhna; Diène, Aminata N.; Sy, Ibrahima; Winkler, Mirko S.; Schindler, Christian; Ndione, Jacques A.; Faye, Ousmane; Vounatsou, Penelope; Utzinger, Jürg; Cissé, Guéladio

    2017-01-01

    We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011–2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health–climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming. PMID:28895927

  20. Dental caries and their treatment needs in 3-5 year old preschool children in a rural district of India.

    PubMed

    Gupta, Devanand; Momin, Rizwan K; Mathur, Ayush; Srinivas, Kavuri Teja; Jain, Ankita; Dommaraju, Neelima; Dalai, Deepak Ranjan; Gupta, Rajendra Kumar

    2015-04-01

    Dental problems in the preschool children are neglected by their parents as the deciduous teeth are going to shed off, and hence considered to be of no importance and more of economic burden if attended to them. This study was to determine the caries prevalence in preschool children (3-5-year-old) of rural Moradabad district, to analyze the specific pattern of dental caries experience in this population and to assess the treatment needs among them. Children within the age group of 3-5 years attending Anganwadi centers of rural Moradabad district were included in the study. Caries diagnosis was based on decayed, extracted, filled surface (defs) and the treatment needs were recorded using World Health Organization (WHO) oral health assessment form 1997. Out of 1,500 children examined, 48.7% males and 52.6% females did not require any treatment. The mean decayed, extracted, filled teeth (deft) value was found to be significantly high in 5-year-old participants when compared to 3-year-old participants (P < 0.01). Majority of the children required one surface filling followed by two surface fillings, caries arresting sealant care, extraction, crown bridge element, pulp care, and space maintainer. The most common pattern was pit and fissure, then maxillary anterior pattern, posterior proximal pattern, and posterior buccal lingual smooth surface pattern. The mean deft value was higher in males as compared to females. There is a greater need for oral health education among parents and teachers.

  1. Prevalence and risk factors of iron-deficiency anaemia among pregnant women in rural districts of Menoufia governorate, Egypt.

    PubMed

    Rezk, M; Marawan, H; Dawood, R; Masood, A; Abo-Elnasr, M

    2015-01-01

    This cross-sectional community-based study with analytic component was conducted among Egyptian pregnant women in rural districts during January to December 2013. A total of 2470 pregnant women were enrolled for laboratory tests for iron- deficiency anaemia (IDA). The prevalence of IDA was 51.3% (1267 of 2470); IDA affects about one in every two pregnant women in rural districts in Egypt. Women who are older than 30 years (Odds ratio [OR], 0.73) had more than three children (OR, 0.73), with body mass index less than 20 (OR, 1.57), shorter birth spacing less than 2 years (OR, 0.68), lack of antenatal care visits (OR, 1.25), low intake of foods of animal origin (OR, 1.57), vegetables and fruits (OR, 1.29) and having intestinal parasites (OR, 0.74) were positively associated with anaemia [at confidence interval 95%]. In addition to nutritional deficiency, multiparity and increasing maternal age are the main causes of IDA.

  2. Female High School Principals in Rural Midwestern School Districts: Their Lived Experiences in Leadership

    ERIC Educational Resources Information Center

    Bartling, Ellen M.

    2013-01-01

    This study was explored the leadership experiences of female principals of rural high schools in a Midwestern state. The study sought to describe the leadership styles used by these principals to make changes within their schools. Qualitative methodology was used, and four female rural high school principals were interviewed during a series of…

  3. Attracting and Retaining Rural Teachers in Ghana: The Premise and Promise of a District Sponsorship Scheme

    ERIC Educational Resources Information Center

    Cobbold, Cosmas

    2006-01-01

    Recruiting and retaining qualified teachers for schools in rural communities is both an issue and a problem in many countries. The very nature of rural communities and perceptions of teaching in such environments tend to discourage qualified experienced and new teachers from taking appointments there. Education jurisdictions, therefore, use…

  4. Attracting and Retaining Rural Teachers in Ghana: The Premise and Promise of a District Sponsorship Scheme

    ERIC Educational Resources Information Center

    Cobbold, Cosmas

    2006-01-01

    Recruiting and retaining qualified teachers for schools in rural communities is both an issue and a problem in many countries. The very nature of rural communities and perceptions of teaching in such environments tend to discourage qualified experienced and new teachers from taking appointments there. Education jurisdictions, therefore, use…

  5. Female High School Principals in Rural Midwestern School Districts: Their Lived Experiences in Leadership

    ERIC Educational Resources Information Center

    Bartling, Ellen M.

    2013-01-01

    This study was explored the leadership experiences of female principals of rural high schools in a Midwestern state. The study sought to describe the leadership styles used by these principals to make changes within their schools. Qualitative methodology was used, and four female rural high school principals were interviewed during a series of…

  6. How Has the Free Obstetric Care Policy Impacted Unmet Obstetric Need in a Rural Health District in Guinea?

    PubMed Central

    Delamou, Alexandre; Dubourg, Dominique; Beavogui, Abdoul Habib; Delvaux, Thérèse; Kolié, Jacques Seraphin; Barry, Thierno Hamidou; Camara, Bienvenu Salim; Edginton, Mary; Hinderaker, Sven; De Brouwere, Vincent

    2015-01-01

    Introduction In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. Objective This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. Methods We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. Results No statistical difference was observed in women’s sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p<0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. Conclusion The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends. PMID:26047472

  7. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

    PubMed Central

    Naidoo, Logandran

    2016-01-01

    Background Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators. PMID:27543283

  8. How Has the Free Obstetric Care Policy Impacted Unmet Obstetric Need in a Rural Health District in Guinea?

    PubMed

    Delamou, Alexandre; Dubourg, Dominique; Beavogui, Abdoul Habib; Delvaux, Thérèse; Kolié, Jacques Seraphin; Barry, Thierno Hamidou; Camara, Bienvenu Salim; Edginton, Mary; Hinderaker, Sven; De Brouwere, Vincent

    2015-01-01

    In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section. This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea. We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014. No statistical difference was observed in women's sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p < 0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012. The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends.

  9. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.

    PubMed

    Naidoo, Logandran; Mahomed, Ozayr H

    2016-07-26

    Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

  10. Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013.

    PubMed

    Ncogo, Policarpo; Romay-Barja, Maria; Benito, Agustin; Aparicio, Pilar; Nseng, Gloria; Berzosa, Pedro; Santana-Morales, Maria A; Riloha, Matilde; Valladares, Basilio; Herrador, Zaida

    2017-01-01

    Anemia in children under 5 years of age is a global public health problem. According to the World Health Organization the current rate of anemia among preschool aged children in Equatorial Guinea is 66%. No information is available above this age. The cross-sectional Prevamal Survey was conducted in 2013 aimed at providing baseline data on malaria prevalence in children aged 2 months-15 years old. Sampling was carried out with the use of a multistage, stratified cluster strategy in the district of Bata, Equatorial Guinea. The χ2 test and adjusted Poisson regression models were applied to assess the association between social-demographic and economic factors, malaria and anemia. A total of 1436 children were tested, out of which 1,421 children (99%) were tested for anemia. Over 85% were anemic; out of them, 284 (24%), 815 (67%) and 111 (9%) children had mild, moderate and severe anemia, respectively. Severe anemia was more frequent among children aged 2-12 months old and those living in rural sites. About 47% tested positive for malaria via a rapid diagnostic test (RDT). This rate was significantly higher in rural villages (66%; p<0.001). The prevalence of anemia and malaria was higher in rural settings (p<0.001). On the other hand, anemia in urban areas displayed a heterogeneity and complexity that differed from the rural environment: in urban neighbourhoods, children with concomitant malaria infection were more likely to be anemic (adjusted prevalence rate (aPR):1.19; CI 95%: 1.12-1.28). Moreover, the prevalence of anemia was higher in children aged above 13 months compared to younger children (p<0.005). Belonging to the poorest wealth tertile were positively (aPR: 1.14, 95% CI: 1.05-1.24) and children' parents being employees (aPR: 0.86, 95% CI: 0.76-0.96) or self-employed (aPR: 0.86, 95% CI: 0.76-0.97) vs. working in agriculture and/or fishing negatively associated with anemia among urban children. This marked urban-rural variation indicates the importance of

  11. Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013

    PubMed Central

    Ncogo, Policarpo; Romay-Barja, Maria; Benito, Agustin; Aparicio, Pilar; Nseng, Gloria; Berzosa, Pedro; Santana-Morales, Maria A.; Riloha, Matilde; Valladares, Basilio

    2017-01-01

    Anemia in children under 5 years of age is a global public health problem. According to the World Health Organization the current rate of anemia among preschool aged children in Equatorial Guinea is 66%. No information is available above this age. The cross-sectional Prevamal Survey was conducted in 2013 aimed at providing baseline data on malaria prevalence in children aged 2 months-15 years old. Sampling was carried out with the use of a multistage, stratified cluster strategy in the district of Bata, Equatorial Guinea. The χ2 test and adjusted Poisson regression models were applied to assess the association between social-demographic and economic factors, malaria and anemia. A total of 1436 children were tested, out of which 1,421 children (99%) were tested for anemia. Over 85% were anemic; out of them, 284 (24%), 815 (67%) and 111 (9%) children had mild, moderate and severe anemia, respectively. Severe anemia was more frequent among children aged 2–12 months old and those living in rural sites. About 47% tested positive for malaria via a rapid diagnostic test (RDT). This rate was significantly higher in rural villages (66%; p<0.001). The prevalence of anemia and malaria was higher in rural settings (p<0.001). On the other hand, anemia in urban areas displayed a heterogeneity and complexity that differed from the rural environment: in urban neighbourhoods, children with concomitant malaria infection were more likely to be anemic (adjusted prevalence rate (aPR):1.19; CI 95%: 1.12–1.28). Moreover, the prevalence of anemia was higher in children aged above 13 months compared to younger children (p<0.005). Belonging to the poorest wealth tertile were positively (aPR: 1.14, 95% CI: 1.05–1.24) and children’ parents being employees (aPR: 0.86, 95% CI: 0.76–0.96) or self-employed (aPR: 0.86, 95% CI: 0.76–0.97) vs. working in agriculture and/or fishing negatively associated with anemia among urban children. This marked urban-rural variation indicates the

  12. Prevalence of anemia amongst adolescents in Nepal: a community based study in rural and urban areas of Morang District.

    PubMed

    Baral, K P; Onta, S R

    2009-09-01

    Adolescence covers 10-19 years of human age and is the transition period of life. In Nepal around 23 percent population are in this age group. A cross sectional community based study was carried out in Morang district to determine prevalence and distribution of anemia in terms of age, sex and locations (urban and rural) among adolescent population. Sahli method was used to determine the hemoglobin level. Three hundred and eight adolescents (127 urban, 181 rural in terms of location and 151 male, 157 female in terms of sex) participated in the study. The overall prevalence of iron deficiency anemia among adolescent population was 65.6% with the distribution of rural 62.4%, urban 70.0%, male 52.3% and female 78.3%. Sufficiency or deficiency of iron makes the living of adolescents different as it affects their growth requirement and cognitive performance. Iron reserve in female result better reproductive outcome. In Nepal, iron deficiency anemia among male adolescent has not been documented yet and this study reports more than half of them are found anemic which warrant further study.

  13. Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

    PubMed

    Iyer, Hari S; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R; Drobac, Peter C

    2015-01-01

    While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use of limited resources, improve facility

  14. Politics of Implementation: A Study of Rural Development Programme (SGSY) in the Hill Areas of Manipur with Reference to Churachandpur District

    NASA Astrophysics Data System (ADS)

    2012-10-01

    There could be variety of factors involves in the process of implementation of rural development programmes. Deeper analysis of these factors brings out fundamental questions involved in the implementation of rural development programmes i.e questions about conflict, decision making and who gets what, when and how in a society. This study examines the politics involved in the implementation of Swarnjayanti Gram Swarozgar Yojana(SGSY) programme and its influence on the programmeís outcome among the tribal in Churachandpur District of Manipur. It shows that politics pervades and impedes the implementation of rural development programmelike SGSY and has negative influences on its outcome.

  15. Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

    PubMed Central

    2013-01-01

    Background Epidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years. Methods This study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non- clinical variable using Microsoft™ Excel® 2010. Results Our findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district. Conclusions The outbreak raises several concerns regarding the epidemiology of diphtheria in

  16. Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India.

    PubMed

    Phalkey, Revati K; Bhosale, Rajesh V; Joshi, Abhijeet P; Wakchoure, Sushil S; Tambe, Muralidhar P; Awate, Pradip; Marx, Michael

    2013-04-08

    Epidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years. This study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non- clinical variable using Microsoft™ Excel® 2010. Our findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district. The outbreak raises several concerns regarding the epidemiology of diphtheria in Dhule. The reason for shift in the median

  17. A Student-Led Global Health Education Initiative: Reflections on the Kenyan Village Medical Education Program

    PubMed Central

    John, Christopher; Asquith, Heidi; Wren, Tom; Mercuri, Stephanie; Brownlow, Sian

    2016-01-01

    The Kenyan Village Medical Education Program is a student-led global health initiative that seeks to improve health outcomes in rural Kenya through culturally appropriate health education. The month-long program, which is organised by the Melbourne University Health Initiative (Australia), is conducted each January in southern rural Kenya. Significance for public health The Kenyan Village Medical Education (KVME) Program is a student-led global health initiative that involves exploring well-established strategies for the prevention of disease through workshops that are conducted in southern rural Kenya. These workshops are tailored to the unique needs and circumstances of rural Kenyan communities, and are delivered to community leaders, as well as to adults and children within the wider community. Aside from the KVME Program’s emphasis on reducing the burden of preventable disease through health education, the positive impact of the KVME Program on the Program’s student volunteers also deserves consideration. Throughout the month-long KVME Program, student volunteers are presented with opportunities to develop their understanding of cultural competency, the social and economic determinants of health, as well as the unique challenges associated with working in resource-poor communities. Importantly, the KVME Program also represents an avenue through which global health leadership can be fostered amongst student volunteers. PMID:27190974

  18. Undiagnosed hypertension in a rural district in Bangladesh: The Bangladesh Population-based Diabetes and Eye Study (BPDES).

    PubMed

    Islam, F M A; Bhuiyan, A; Chakrabarti, R; Rahman, M A; Kanagasingam, Y; Hiller, J E

    2016-04-01

    Hypertension is mainly asymptomatic and remains undiagnosed until the disease progresses. The objective of the study was to determine the prevalence of and risk factors for hypertension in rural Bangladesh. Using a population-based cluster random sampling strategy, 3096 adults aged ⩾30 years were recruited from a rural district in Bangladesh. Data collected included two blood pressure (BP) measurements, fasting blood glucose, socio-demographic and anthropometric measurements. Hypertension was defined as systolic BP (SBP) ⩾140 mm Hg or diastolic BP (DBP) ⩾90 mm Hg or self-reported diagnosed hypertension. Logistic regression techniques were used for data analyses. The crude prevalence of hypertension was 40% (95% confidence interval (CI) 38-42%) of which 82% were previously undiagnosed. People from lower socio-economic status (SES) had a significantly higher percentage of undiagnosed hypertension compared with people with higher SES (P<0.001). There was no significant gender difference in severity of hypertension. Males with higher education level compared with no education had a higher prevalence of hypertension (odds ratio 2.34, 95% CI 1.49-3.69). Older age and waist circumference in both genders, and diabetes, lack of physical activity in females were found to be associated with higher prevalence of hypertension. Our research suggests the prevalence of undiagnosed hypertension was higher in the rural area in Bangladesh than that reported from the rural area in neighbouring India and China. Lower SES was associated with a higher risk of undiagnosed hypertension. Public health programs at the grass-roots level must emphasise the provision of primary care and preventive services in managing this non-communicable disease.

  19. OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA

    PubMed Central

    Ouma, S.; Turyasima, M.; Acca, H.; Nabbale, F.; Obita, K. O.; Rama, M.; Adong, C. C.; Openy, A.; Beatrice, M. O.; Odongo-Aginya, E. I.; Awor, S.

    2016-01-01

    Background Uganda’s rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. Objective To determine obstacles to family planning use among rural women in Northern Uganda. Design A descriptive cross-sectional analytical study. Setting Atiak Health Centre IV, Amuru District, rural Northern Uganda. Subjects Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. Results There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders’ involvement in family planning programme. Conclusions In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family

  20. OBSTACLES TO FAMILY PLANNING USE AMONG RURAL WOMEN IN ATIAK HEALTH CENTER IV, AMURU DISTRICT, NORTHERN UGANDA.

    PubMed

    Ouma, S; Turyasima, M; Acca, H; Nabbale, F; Obita, K O; Rama, M; Adong, C C; Openy, A; Beatrice, M O; Odongo-Aginya, E I; Awor, S

    Uganda's rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. To determine obstacles to family planning use among rural women in Northern Uganda. A descriptive cross-sectional analytical study. Atiak Health Centre IV, Amuru District, rural Northern Uganda. Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders' involvement in family planning programme. In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty.

  1. The Impact of Cooperative and Traditional Learning on the Academic Achievement of Third Grade Students in Selected Rural School Districts in Northeast, South Carolina

    ERIC Educational Resources Information Center

    Johnson, Shawn Lamont L.

    2013-01-01

    This study examined the impact that cooperative learning and traditional learning have on the academic performance of elementary school students in rural school districts. Cooperative learning is considered a typical model that can maximize the effectiveness of constructivism. Slavin (1991, p. 71) completed a synthesis of research on cooperative…

  2. Providing for the Needs of New Teachers: A Study of New Teacher Induction in a Rural School District in Central North Carolina

    ERIC Educational Resources Information Center

    Powell, Lori T.

    2016-01-01

    This study evaluated the effectiveness of a new teacher induction program as implemented in a rural school district in central North Carolina. All beginning teachers with 3 or less years of experience, all school-based administrators, and all mentoring teachers were the target participants. The purpose of the study was to evaluate the…

  3. The Impact of Cooperative and Traditional Learning on the Academic Achievement of Third Grade Students in Selected Rural School Districts in Northeast, South Carolina

    ERIC Educational Resources Information Center

    Johnson, Shawn Lamont L.

    2013-01-01

    This study examined the impact that cooperative learning and traditional learning have on the academic performance of elementary school students in rural school districts. Cooperative learning is considered a typical model that can maximize the effectiveness of constructivism. Slavin (1991, p. 71) completed a synthesis of research on cooperative…

  4. Implementation of an Aggressive Random Drug-Testing Policy in a Rural School District: Student Attitudes Regarding Program Fairness and Effectiveness

    ERIC Educational Resources Information Center

    Evans, Garret D.; Reader, Steven; Liss, Heidi J.; Wiens, Brenda A.; Roy, Antara

    2006-01-01

    School districts are increasingly initiating random drug-testing (RDT) programs in an effort to curb substance-use rates among students, yet little is known about student attitudes toward RDT and potential obstacles to program acceptance and effectiveness. The authors surveyed 1011 9th through 11th grade students in 2 rural high schools in North…

  5. Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape.

    PubMed

    Schoevers, Johan; Jenkins, Louis

    2015-04-21

    Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability.Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7%-71.4% and 58.1%-74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.

  6. Providing for the Needs of New Teachers: A Study of New Teacher Induction in a Rural School District in Central North Carolina

    ERIC Educational Resources Information Center

    Powell, Lori T.

    2016-01-01

    This study evaluated the effectiveness of a new teacher induction program as implemented in a rural school district in central North Carolina. All beginning teachers with 3 or less years of experience, all school-based administrators, and all mentoring teachers were the target participants. The purpose of the study was to evaluate the…

  7. A Descriptive Study of Superintendents' and School Board Members' Perceptions of the Superintendent's Leadership in Rural Districts in Three Mid-Atlantic States

    ERIC Educational Resources Information Center

    Wilson, Janet S.

    2011-01-01

    The purpose of this study was to ascertain if perceptual differences exist between superintendents and board members regarding superintendents' leadership behaviors in rural school districts. Transformational leadership is considered necessary for organizations to move forward in the 21st century. This research sought to determine if…

  8. Implementation of an Aggressive Random Drug-Testing Policy in a Rural School District: Student Attitudes Regarding Program Fairness and Effectiveness

    ERIC Educational Resources Information Center

    Evans, Garret D.; Reader, Steven; Liss, Heidi J.; Wiens, Brenda A.; Roy, Antara

    2006-01-01

    School districts are increasingly initiating random drug-testing (RDT) programs in an effort to curb substance-use rates among students, yet little is known about student attitudes toward RDT and potential obstacles to program acceptance and effectiveness. The authors surveyed 1011 9th through 11th grade students in 2 rural high schools in North…

  9. A Descriptive Study of Superintendents' and School Board Members' Perceptions of the Superintendent's Leadership in Rural Districts in Three Mid-Atlantic States

    ERIC Educational Resources Information Center

    Wilson, Janet S.

    2011-01-01

    The purpose of this study was to ascertain if perceptual differences exist between superintendents and board members regarding superintendents' leadership behaviors in rural school districts. Transformational leadership is considered necessary for organizations to move forward in the 21st century. This research sought to determine if…

  10. A Comparative Study on Nutritional Status and Body Composition of Urban and Rural Schoolchildren from Brandsen District (Argentina)

    PubMed Central

    Cesani, Maria Florencia; Garraza, Mariela; Bergel Sanchís, María Laura; Luis, María Antonia; Torres, María Fernanda; Quintero, Fabián Aníbal; Oyhenart, Evelia Edith

    2013-01-01

    The purpose of this study was to analyze whether nutritional status and body composition varies according to the environment of residence (urban or rural) of children in the Brandsen district (Argentina). Weight, height, arm circumference and tricipital and subscapular skinfolds were performed in 1368 schoolchildren aged 3 to 14. NHANES III reference was used to estimate nutritional status -underweight, stunting, wasting, overweight, and obesity- and to evaluate body composition -deficit and excess of adipose (DA, EA) and muscular (DM, EM) tissues of the arm-. Central fat distribution (CFD) was estimated using the subscapular-tricipital index. A structured questionnaire was implemented to evaluate socio-environmental characteristics. Nutritional categories based on body size and body composition were compared between urban and rural areas of residence using Chi-squared tests (χ2). The results indicated for the total sample: 1.1% underweight, 6.9% stunting, 0.4% wasting, 12.1% overweight, 9.7% obesity, 22.0% DM, 2.5% EM, 0.1% DA, 17.6% EA, and 8.5% CFD. Significant differences between urban and rural areas were found only for CFD. The socio-environmental analysis showed that while access to public services and housing quality was significantly better in the urban area, a considerable number of city households lived under deficient conditions, lacked health insurance and had low socioeconomic level. Fifty-three percent of the undernourished children had DM without urban-rural significant differences, and none of them showed DA. In the overweight plus obesity group, 62.8% presented EA, 6.4% EM, 4.7% DM, and 22.8% CFD. The highest percentages of DM and CFD were recorded in rural areas (p = 0.00). We conclude that the child population shows the “double burden” of malnutrition. The environment of residence does not promote any differentiation in the nutritional status. Nevertheless, the increment of central adiposity and, in some cases of muscle deficit in rural

  11. Tuberculosis in developing countries: conditions for successful use of a decentralized approach in a rural health district.

    PubMed

    Méda, Ziemlé Clément; Huang, Chung-Chien; Sombié, Issiaka; Konaté, Lassina; Somda, Paulin Küssome; Djibougou, Arthur Diakourga; Sanou, Moussa

    2014-01-01

    smears were 16.11% (11.00% in 2005) and 10.42 per 100,000 inhabitants per year (6.88 per 100,000 inhabitants in 2005), respectively. There were 29 patients positive for TB: 41.37% of these had cough lasting 10 to 15 days, 10.34% were also positive for HIV, and 68.97% were from rural areas. Health workers and patients reported satisfaction with the intervention. It was found that implementing a decentralized approach to TB prevention in rural areas is plausible and effective under some conditions: considering that health district system is functional; carefully designing the intervention for TB case management; setting up and implementing of decentralized approach including strong monitoring; and taking into account the all financing, community and volunteer involvement, evaluation of the cost savings from integrating specific donor funding, and being supported by regional and central levels including National TB program. The study has shown that TB detection rate can be increased by implementing a decentralized approach to primary care. When carefully implemented, a decentralized approach is a suitable approach to TB and HIV prevention in rural and inaccessible settings.

  12. Dental Caries and Their Treatment Needs in 3-5 Year Old Preschool Children in a Rural District of India

    PubMed Central

    Gupta, Devanand; Momin, Rizwan K; Mathur, Ayush; Srinivas, Kavuri Teja; Jain, Ankita; Dommaraju, Neelima; Dalai, Deepak Ranjan; Gupta, Rajendra Kumar

    2015-01-01

    Background: Dental problems in the preschool children are neglected by their parents as the deciduous teeth are going to shed off, and hence considered to be of no importance and more of economic burden if attended to them. Aims: This study was to determine the caries prevalence in preschool children (3-5-year-old) of rural Moradabad district, to analyze the specific pattern of dental caries experience in this population and to assess the treatment needs among them. Material and Methods: Children within the age group of 3-5 years attending Anganwadi centers of rural Moradabad district were included in the study. Caries diagnosis was based on decayed, extracted, filled surface (defs) and the treatment needs were recorded using World Health Organization (WHO) oral health assessment form 1997. Results: Out of 1,500 children examined, 48.7% males and 52.6% females did not require any treatment. The mean decayed, extracted, filled teeth (deft) value was found to be significantly high in 5-year-old participants when compared to 3-year-old participants (P < 0.01). Majority of the children required one surface filling followed by two surface fillings, caries arresting sealant care, extraction, crown bridge element, pulp care, and space maintainer. Conclusion: The most common pattern was pit and fissure, then maxillary anterior pattern, posterior proximal pattern, and posterior buccal lingual smooth surface pattern. The mean deft value was higher in males as compared to females. There is a greater need for oral health education among parents and teachers. PMID:25973401

  13. Impact of HIV Comprehensive Care and Treatment on Serostatus Disclosure among Cameroonian Patients in Rural District Hospitals

    PubMed Central

    Suzan-Monti, Marie; Kouanfack, Charles; Boyer, Sylvie; Blanche, Jérôme; Bonono, Renée-Cécile; Delaporte, Eric; Carrieri, Patrizia M.; Moatti, Jean-Paul; Laurent, Christian; Spire, Bruno

    2013-01-01

    This work aimed to analyze the rate of disclosure to relatives and friends over time and to identify factors affecting disclosure among seropositive adults initiating antiretroviral therapy (ART) in rural district hospitals in the context of decentralized, integrated HIV care and task-shifting to nurses in Cameroon. Stratall was a 24-month, randomized, open-label trial comparing the effectiveness of clinical monitoring alone with laboratory plus clinical monitoring on treatment outcomes. It enrolled 459 HIV-infected ART-naive adults in 9 rural district hospitals in Cameroon. Participants in both groups were sometimes visited by nurses instead of physicians. Patients with complete data both at enrolment (M0) and at least at one follow-up visit were included in the present analysis. A mixed Poisson regression was used to estimate predictors of the evolution of disclosure index over 24 months (M24).The study population included 385 patients, accounting for 1733 face-to-face interviews at follow-up visits from M0 to M24. The median [IQR] number of categories of relatives and friends to whom patients had disclosed was 2 [1]–[3] and 3 [2]–[5] at M0 and M24 (p-trend<0.001), respectively. After multiple adjustments, factors associated with disclosure to a higher number of categories of relatives and friends were as follows: having revealed one’s status to one’s main partner, time on ART, HIV diagnosis during hospitalization, knowledge on ART and positive ratio of follow-up nurse-led to physician-led visits measuring task-shifting. ART delivered in the context of decentralized, integrated HIV care including task-shifting was associated with increased HIV serological status disclosure. PMID:23383117

  14. Impact of HIV comprehensive care and treatment on serostatus disclosure among Cameroonian patients in rural district hospitals.

    PubMed

    Suzan-Monti, Marie; Kouanfack, Charles; Boyer, Sylvie; Blanche, Jérôme; Bonono, Renée-Cécile; Delaporte, Eric; Carrieri, Patrizia M; Moatti, Jean-Paul; Laurent, Christian; Spire, Bruno

    2013-01-01

    This work aimed to analyze the rate of disclosure to relatives and friends over time and to identify factors affecting disclosure among seropositive adults initiating antiretroviral therapy (ART) in rural district hospitals in the context of decentralized, integrated HIV care and task-shifting to nurses in Cameroon. Stratall was a 24-month, randomized, open-label trial comparing the effectiveness of clinical monitoring alone with laboratory plus clinical monitoring on treatment outcomes. It enrolled 459 HIV-infected ART-naive adults in 9 rural district hospitals in Cameroon. Participants in both groups were sometimes visited by nurses instead of physicians. Patients with complete data both at enrolment (M0) and at least at one follow-up visit were included in the present analysis. A mixed Poisson regression was used to estimate predictors of the evolution of disclosure index over 24 months (M24).The study population included 385 patients, accounting for 1733 face-to-face interviews at follow-up visits from M0 to M24. The median [IQR] number of categories of relatives and friends to whom patients had disclosed was 2 [1]-[3] and 3 [2]-[5] at M0 and M24 (p-trend<0.001), respectively. After multiple adjustments, factors associated with disclosure to a higher number of categories of relatives and friends were as follows: having revealed one's status to one's main partner, time on ART, HIV diagnosis during hospitalization, knowledge on ART and positive ratio of follow-up nurse-led to physician-led visits measuring task-shifting. ART delivered in the context of decentralized, integrated HIV care including task-shifting was associated with increased HIV serological status disclosure.

  15. Evaluation of a Shared Services Compact in Two Rural Ohio School Districts

    ERIC Educational Resources Information Center

    Dziczkowski, Jennifer E.

    2011-01-01

    School funding adequacy is a topic that has received increased attention throughout the United States since the late 1990s. Current economic conditions, deficit spending, and burgeoning health care costs have caused school districts to compete with state governments for scarce monetary resources. Ohio is one such state. In December of 2008, the…

  16. Evaluation of a Shared Services Compact in Two Rural Ohio School Districts

    ERIC Educational Resources Information Center

    Dziczkowski, Jennifer E.

    2011-01-01

    School funding adequacy is a topic that has received increased attention throughout the United States since the late 1990s. Current economic conditions, deficit spending, and burgeoning health care costs have caused school districts to compete with state governments for scarce monetary resources. Ohio is one such state. In December of 2008, the…

  17. Study of rogi kalyan samitis in strengthening health systems under national rural health mission, district pune, maharashtra.

    PubMed

    Adsul, Neha; Kar, Manoj

    2013-10-01

    With objective of health systems strengthening, as visualized under National Rural Health Mission (NRHM); one key strategic intervention is up-gradation of health service delivery facilities so as to provide sustainable quality care with accountability and people's participation, which required the development of a proper management structure called Rogi Kalyan Samitis (RKS). It is the State's attempt to make health everyone's business by de-mystifying health-care delivery at district and sub-district levels with reference to facility based health-care delivery by encouraging citizen's participation in management bodies. The study was an attempt to define 'functional Health Systems' with a focus on strategic issues concerning RKS operations. A mixed-method, multi-site, collective case study approach was adopted. In-depth interviews of key-stakeholders were conducted. Qualitative data were analyzed thematically and coded inductively. RKS is yet to bring out quality component to the health services being provided through facilities. This can be attributed to structural and managerial weakness in the system; however, certainly NRHM has been consistent in creating a road-map for benefitting local community and their participation through RKS. The progress of the RKS can further be enhanced by giving due priority to critical areas. Furthermore, the results emphasize an urgent need for devising strategies and actions to overcome significant systemic constraints as highlighted in the present study.

  18. Strategy for Cost Recovery in the Rural Water Sector: A Case Study of Nsukka District, Anambra State, Nigeria

    NASA Astrophysics Data System (ADS)

    Whittington, Dale; Okorafor, Apia; Okore, Augustine; McPhail, Alexander

    1990-09-01

    In-depth interviews were conducted with 395 households in three rural communities in the Nsukka district of Anambra State, Nigeria, concerning their household water use practices, water expenditures to vendors, willingness to pay for improved water supplies, and household socioeconomic characteristics. Households in Nsukka district do not want to pay for water in advance or commit themselves to a fixed monthly payment for water. They want the freedom to buy water only when they use it, partly due to the seasonal nature of water use and partly because they want control over their cash flow in order to meet other more immediately pressing needs. Equally important, they do not trust government to provide a reliable public water supply. They do not want to pay in advance for a service they are not sure they will ever get. If they are required to pay a fixed fee every month, households are willing to pay only relatively small amounts for improved services, even less than they are currently paying water vendors. Current arrangements for cost recovery, fixed monthly fees for both public taps and unmetered private connections, are inappropriate. Kiosk systems, or kiosk systems with metered private connections for some households, are the most promising way to improve cost recovery and meet consumers' cash flow needs.

  19. Trauma services requirements in a district general hospital serving a rural area.

    PubMed Central

    Kinny, S J; Jones, D H

    1990-01-01

    OBJECTIVE--To assess the demands made on a regional trauma centre by a district trauma unit. DESIGN--Two part study. (1) Prospective analysis of one month's workload. (2) Retrospective analysis of one year's workload by using a computer based records system. Comparison of two sets of results. SETTING--Accident unit in Gwynedd Hospital, Bangor. PATIENTS--(1) All patients who attended the accident unit in August 1988. (2) All patients who attended the accident unit in the calendar year April 1988-April 1989. MAIN OUTCOME MEASURE--Workload of a district trauma unit. RESULTS--In August 1988 there were 2325 attendances; 2302 of these were analysed. In all, 1904 attendances were for trauma; 213 patients were admitted to the trauma ward and 103 required an operation that entailed incision. Patients who attended the unit had a mean (range) injury severity score of 2-13 (0-25). Only two patients had injuries that a district general hospital would not be expected to cope with (injury severity score greater than 20). In the year April 1988-April 1989, 21,007 patients attended the unit. In all, 17,958 attendances were for orthopaedic injuries or injuries caused by an accident; 1966 patients were admitted to the unit. CONCLUSIONS--Most trauma is musculoskeletal and relatively minor according to the injury severity score. All but a few injuries can be managed in district general hospitals. In their recent report the Royal College of Surgeons has overestimated the requirements that a British district general hospital would have of a regional trauma centre. PMID:2107928

  20. Unit cost analysis of training and deploying paid community health workers in three rural districts of Tanzania.

    PubMed

    Tani, Kassimu; Exavery, Amon; Baynes, Colin D; Pemba, Senga; Hingora, Ahmed; Manzi, Fatuma; Phillips, James F; Kanté, Almamy Malick

    2016-07-08

    Tanzania, like other African countries, faces significant health workforce shortages. With advisory and partnership from Columbia University, the Ifakara Health Institute and the Tanzanian Training Centre for International Health (TTCIH) developed and implemented the Connect Project as a randomized cluster experimental trial of the childhood survival impact of recruiting, training, and deploying of a new cadre of paid community health workers (CHW), named "Wawazesha wa afya ya Jamii" (WAJA). This paper presents an estimation of the cost of training and deploying WAJA in three rural districts of Tanzania. Costing data were collected by tracking project activity expenditure records and conducting in-depth interviews of TTCIH staff who have led the training and deployment of WAJA, as well as their counterparts at Public Clinical Training Centres who have responsibility for scaling up the WAJA training program. The trial is registered with the International Standard Randomized Controlled Trial Register number ( ISRCTN96819844 ). The Connect training cost was US$ 2,489.3 per WAJA, of which 40.1 % was for meals, 20.2 % for accommodation 10.2 % for tuition fees and the remaining 29.5 % for other costs including instruction and training facilities and field allowance. A comparable training program estimated unit cost for scaling-up this training via regional/district clinical training centres would be US$ 833.5 per WAJA. Of this unit cost, 50.3 % would involve the cost of meals, 27.4 % training fees, 13.7 % for field allowances, 9 % for accommodation and medical insurance. The annual running cost of WAJA in a village will cost US$ 1.16 per capita. Costs estimated by this study are likely to be sustainable on a large scale, particularly if existing regional/district institutions are utilized for this program.

  1. Overweight Relation to Liver Fluke Infection among Rural Participants from 4 Districts of Nakhon Ratchasima Province, Thailand.

    PubMed

    Kaewpitoon, Soraya J; Rujirakul, Ratana; Wakkuwattapong, Parichart; Matrakool, Likit; Tongtawee, Taweesak; Panpimanmas, Sukij; Kujapun, Jirawoot; Norkaew, Jun; Photipim, Mali; Ponphimai, Sukanya; Chavengkun, Wassugree; Kompor, Pontip; Padchasuwan, Natnapa; Sawaspol, Sudaporn; Phandee, Mattika Chaimeerang; Phandee, Wichan; Phanurak, Wassana; Kaewpitoon, Natthawut

    2016-01-01

    A cross-sectional survey was conducted among 730 participants from 4 rural districts of Nakhon Ratchasima province, Thailand, with a reported high incidence of liver fluke infection. This study was aimed to examine and evaluate the nutritional status in relation to Opisthorchis viverrini infection. Participants were purposive selected from Chum Phuang, Mueang Yang, Bua Yai, and Kaeng Sanam Nang districts. Stool samples were prepared by Kato Katz technique and then assessed by microscopy. Anthropometry was evaluated according to the body mass index from weight and height. Descriptive statistics and Spearman rank correlation coefficients were used to evaluate the association between the nutritional status and O. viverrini infection. Of 1.64% infected with O. viverrini the highest proportions were found in age groups ≥61 and 41-50 years old, Mueang Yang district. The majorities of participants had normal weight (32.2%), followed by class II obesity (28.1%), class I obesity (21.8%), underweight (10.3%), and class III obesity (8.63%). Nutritional status with class II obesity (rS=0.639, <0.01) and class I obesity (rS=0.582, <0.05), had moderately statistical significant correlations with O. viverrini infection. Meanwhile, normal weight (rS=0.437, <0.05) and class III obesity (rS=0.384, <0.05) demonstrated lower statistical significance. These findings raise the possibility that infection with O. viverrini may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand whether O. viverrini contributes directly to fat deposition and possible mechanisms.

  2. A knowledge, attitude and practices (KAP) study on dengue among selected rural communities in the Kuala Kangsar district.

    PubMed

    Hairi, Farizah; Ong, Cyril-H S; Suhaimi, Anwar; Tsung, Teoh-Wei; bin Anis Ahmad, Mohd Azhar; Sundaraj, Charlotte; Soe, Myint Myint

    2003-01-01

    A cross-sectional survey was conducted to assess the level of knowledge, attitude and practices concerning dengue and its vector Aedes mosquito among selected rural communities in the Kuala Kangsar district from 16-25th June, 2002. It was found that the knowledge of the community was good. Out of the 200 respondents, 82.0% cited that their main source of information on dengue was from television/radio. The respondents' attitude was found to be good and most of them were supportive of Aedes control measures. There is a significant association found between knowledge of dengue and attitude towards Aedes control (p = 0.047). It was also found that good knowledge does not necessarily lead to good practice. This is most likely due to certain practices like water storage for domestic use, which is deeply ingrained in the community. Mass media is an important means of conveying health messages to the public even among the rural population, thus research and development of educational strategies designed to improve behaviour and practice of effective control measures among the villagers are recommended.

  3. Prevalence of Thinness among Rural Bengalee Pre-school Children in Chapra, Nadia District, West Bengal, India.

    PubMed

    Biswas, S; Bose, K; Bisai, S; Chakraborty, R

    2009-09-01

    This-cross sectional study investigated the age and sex variations in thinness among 2016 (930 boys and 1086 girls) 3-5 years old rural children of Bengalee ethnicity. The children were randomly recruited from 66 Integrated Child Development Service (ICDS) centres of Chapra Block, Nadia District, West Bengal, India. The area is remote and mostly inhabited by Bengalee Muslims. All preschool children (3-5 years old) living in Chapra Block are enrolled at these centres. Anthropometric measures taken included height and weight using standard techniques and then body mass index (BMI) was computed. Age and sex specific cut-off values of body mass index (BMI) were utilised to identify thinness. Overall prevalence of thinness was 49.68% and 51.57% among boys and girls, respectively. There were significant (p< 0.05) sex differences in height, weight and BMI. In general, the frequency of thinness increased with increasing age in both sexes. The rates of Grade-III and Grade-II thinness were higher among girls (Grade-III = 7.46%, Grade-II = 13.44%) compared with boys (Grade-III = 5.48%, Grade-II = 11.72%). In contrast, Grade-I thinness was higher among boys. The results from this study indicate that the nutritional status of rural Bengalee pre-school children is unsatisfactory. These children are experiencing marked nutritional stress. There is scope for much improvement in the form of enhanced supplementary nutrition.

  4. Community Knowledge and Acceptance of Larviciding for Malaria Control in a Rural District of East-Central Tanzania

    PubMed Central

    Mboera, Leonard E. G.; Kramer, Randall A.; Miranda, Marie Lynn; Kilima, Stella P.; Shayo, Elizabeth H.; Lesser, Adriane

    2014-01-01

    The use of microbial larvicides, a form of larval source management, is a less commonly used malaria control intervention that nonetheless has significant potential as a component of an integrated vector management strategy. We evaluated community acceptability of larviciding in a rural district in east-central Tanzania using data from 962 household surveys, 12 focus group discussions, and 24 in-depth interviews. Most survey respondents trusted in the safety (73.1%) and efficacy of larviciding, both with regards to mosquito control (92.3%) and to reduce malaria infection risk (91.9%). Probing these perceptions using a Likert scale provides a more detailed picture. Focus group participants and key informants were also receptive to larviciding, but stressed the importance of sensitization before its implementation. Overall, 73.4% of survey respondents expressed a willingness to make a nominal household contribution to a larviciding program, a proportion which decreased as the proposed contribution increased. The lower-bound mean willingness to pay is estimated at 2,934 Tanzanian Shillings (approximately US$1.76) per three month period. We present a multivariate probit regression analysis examining factors associated with willingness to pay. Overall, our findings point to a receptive environment in a rural setting in Tanzania for the use of microbial larvicides in malaria control. PMID:24830448

  5. Revenues and Spending of Michigan's Urban, Suburban, Town and Rural School Districts, 2004-2010

    ERIC Educational Resources Information Center

    Van Beek, Michael

    2011-01-01

    In the passionate debates over providing equal educational opportunity for all children, it's frequently argued that large financial inequities create challenges for many public schools, particularly those in lower-income urban areas. This study compares the revenues and operating expenditures of Michigan's urban, suburban, town and rural school…

  6. A Comparative Analysis of the Educational Priorities and Capacity of Rural School Districts

    ERIC Educational Resources Information Center

    Wallin, Dawn

    2008-01-01

    This article outlines a comparative analysis of three studies (one provincial, and two school division) that examined the congruence between the priorities of the Manitoba government's "Kindergarten to Senior 4 (K-S4) Education Agenda for Student Success" and priorities identified by stakeholders in a rural Manitoba (Canada) school…

  7. Districts on the Edge: The Impact of Urban Sprawl on a Rural Community.

    ERIC Educational Resources Information Center

    Theobald, Paul

    1988-01-01

    Portrays the controversy surrounding schools and education in a rural community experiencing both an influx of urban and suburban newcomers and the effects of urban sprawl. Reports on surveys of student educational attitudes, household information, and outside activities, and on interviews with teachers, school administrators, and residents.…

  8. A Comparative Analysis of the Educational Priorities and Capacity of Rural School Districts

    ERIC Educational Resources Information Center

    Wallin, Dawn

    2008-01-01

    This article outlines a comparative analysis of three studies (one provincial, and two school division) that examined the congruence between the priorities of the Manitoba government's "Kindergarten to Senior 4 (K-S4) Education Agenda for Student Success" and priorities identified by stakeholders in a rural Manitoba (Canada) school…

  9. HIGH LONESOME: A School Community Survey of the Encino Rural Independent School District.

    ERIC Educational Resources Information Center

    Church, Mary Josephine; And Others

    An assessment of school facilities and services and a survey of staff, student, and community attitudes was undertaken at the request of the Encino School Board to aid in educational planning and improvement for its small rural school which is faced with the problems of declining population (from 400 to 150 in the past 20 years), declining…

  10. Districts on the Edge: The Impact of Urban Sprawl on a Rural Community.

    ERIC Educational Resources Information Center

    Theobald, Paul

    1988-01-01

    Portrays the controversy surrounding schools and education in a rural community experiencing both an influx of urban and suburban newcomers and the effects of urban sprawl. Reports on surveys of student educational attitudes, household information, and outside activities, and on interviews with teachers, school administrators, and residents.…

  11. HIGH LONESOME: A School Community Survey of the Encino Rural Independent School District.

    ERIC Educational Resources Information Center

    Church, Mary Josephine; And Others

    An assessment of school facilities and services and a survey of staff, student, and community attitudes was undertaken at the request of the Encino School Board to aid in educational planning and improvement for its small rural school which is faced with the problems of declining population (from 400 to 150 in the past 20 years), declining…

  12. The Development of Telematics in a Rural District in Western Australia.

    ERIC Educational Resources Information Center

    Bowden, J.

    A case study investigated the use of telematics technology in the delivery of learning programs from a rural high school in Western Australia to four receiver schools. Telematics is an audiographic computer system that simultaneously links a teacher to classrooms in one to five other schools. The program was introduced in 1991 to widen curriculum…

  13. An Analysis of a Rural Pennsylvania School District's Transient Population and NCLB Scores

    ERIC Educational Resources Information Center

    Lesisko, Lee J.; Wright, Robert J.

    2009-01-01

    Pennsylvania System of School Assessment (PSSA) data from one rural school system covering four groups of children for a consecutive three year period was used to study the impact of transient students entering the school system. The analysis compared native children (those on roll since the first year) with transient children added to or deleted…

  14. Roles and challenges of the multidisciplinary team involved in prosthetic rehabilitation, in a rural district in South Africa.

    PubMed

    Ennion, Liezel; Rhoda, Anthea

    2016-01-01

    Major lower limb amputations result in a significant sense of loss, psychological stress, and decrease in function and overall quality of life for the amputee. The holistic, patient-centered prosthetic rehabilitation of an amputee requires input from a team of dedicated health professionals from different disciplines commonly referred to as a multidisciplinary team (MDT). MDT rehabilitation is considered crucial in the reintegration of the amputee into the community, as well as for providing psychological support after limb loss. Multidisciplinary and interdisciplinary rehabilitation has been proven to be more successful than therapy provided by individual therapists in a number of different populations, regardless of the population studied. However, in most developing countries, there is a significant lack of multidisciplinary rehabilitation. To explore the roles and challenges of the members of the MDT involved in trans-tibial amputation rehabilitation in a rural community in South Africa (SA). An explorative sequential qualitative descriptive study. A rural district in the KwaZulu Natal province in SA. Nine prosthetic users, three surgeons, three traditional healers, 17 therapists, four prosthetists, and four community health workers. Semistructured interviews and focus group discussions. The roles of the members of the MDT were clarified, and various members of the MDT highlighted specific challenges relating to their experiences and roles in the rehabilitation team. Lack of interdisciplinary rehabilitation and communication among team members, as well as lack of resources, and patient education negatively impact the rehabilitation of trans-tibial amputees. Aiming to address the limited resources available to health care professionals, as well as improved communication and interdisciplinary rehabilitation, could potentially improve the overall rehabilitation of persons with a lower limb amputation in the rural setting.

  15. Roles and challenges of the multidisciplinary team involved in prosthetic rehabilitation, in a rural district in South Africa

    PubMed Central

    Ennion, Liezel; Rhoda, Anthea

    2016-01-01

    Background Major lower limb amputations result in a significant sense of loss, psychological stress, and decrease in function and overall quality of life for the amputee. The holistic, patient-centered prosthetic rehabilitation of an amputee requires input from a team of dedicated health professionals from different disciplines commonly referred to as a multidisciplinary team (MDT). MDT rehabilitation is considered crucial in the reintegration of the amputee into the community, as well as for providing psychological support after limb loss. Multidisciplinary and interdisciplinary rehabilitation has been proven to be more successful than therapy provided by individual therapists in a number of different populations, regardless of the population studied. However, in most developing countries, there is a significant lack of multidisciplinary rehabilitation. Aim To explore the roles and challenges of the members of the MDT involved in trans-tibial amputation rehabilitation in a rural community in South Africa (SA). Design An explorative sequential qualitative descriptive study. Setting A rural district in the KwaZulu Natal province in SA. Participants Nine prosthetic users, three surgeons, three traditional healers, 17 therapists, four prosthetists, and four community health workers. Instruments for data collection Semistructured interviews and focus group discussions. Results The roles of the members of the MDT were clarified, and various members of the MDT highlighted specific challenges relating to their experiences and roles in the rehabilitation team. Lack of interdisciplinary rehabilitation and communication among team members, as well as lack of resources, and patient education negatively impact the rehabilitation of trans-tibial amputees. Conclusion Aiming to address the limited resources available to health care professionals, as well as improved communication and interdisciplinary rehabilitation, could potentially improve the overall rehabilitation of persons

  16. An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi.

    PubMed

    Kaplan, Julika Ayla; Kandodo, Jonathan; Sclafani, Joseph; Raine, Susan; Blumenthal-Barby, Jennifer; Norris, Alison; Norris-Turner, Abigail; Chemey, Elly; Beckham, John Michael; Khan, Zara; Chunda, Reginald

    2017-06-19

    Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi

  17. Kenyan Nurses Involvement in National Policy Development Processes

    PubMed Central

    Juma, Pamela Atieno

    2014-01-01

    The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses' involvement in national policy processes, factors hindering nurses' engagement in policy processes, and ways to enhance nurses' involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses' involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing professional issues were the primary barriers constraining nurses' involvement in policy processes. Thus, there is need to address these factors both by nurses themselves and by nonnursing decision makers, in order to enhance nurses engagement in policy making and further the contribution to quality of services to the communities. PMID:25349731

  18. Kenyan nurses involvement in national policy development processes.

    PubMed

    Juma, Pamela Atieno; Edwards, Nancy; Spitzer, Denise

    2014-01-01

    The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses' involvement in national policy processes, factors hindering nurses' engagement in policy processes, and ways to enhance nurses' involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses' involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing professional issues were the primary barriers constraining nurses' involvement in policy processes. Thus, there is need to address these factors both by nurses themselves and by nonnursing decision makers, in order to enhance nurses engagement in policy making and further the contribution to quality of services to the communities.

  19. Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach

    PubMed Central

    Sa’avu, Martin; Duke, Trevor; Matai, Sens

    2014-01-01

    Background In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. Method A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. Results In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3–6% and up to 15% among sick neonates. Pneumonia accounts for 28–37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick

  20. Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach.

    PubMed

    Sa'avu, Martin; Duke, Trevor; Matai, Sens

    2014-05-01

    In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

  1. Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

    PubMed Central

    Iyer, Hari S.; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R.; Drobac, Peter C.

    2015-01-01

    Background While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Conclusions Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use

  2. Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda.

    PubMed

    Iyer, Hari S; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R; Drobac, Peter C

    2015-01-01

    Background While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4, p=0.0001), clinical services (+1.2, p=0.03), infection and sanitation control (+0.6, p=0.03), medical equipment (+1.0, p=0.02), information use (+2, p=0.002)]. Composite score across domains improved from 6.2 at baseline to 7.4 at 12 months (p=0.002). Across facilities, 50% had composite scores greater than the average score among reference facilities (7.4) at 12 months compared to none at baseline. Conclusions Rapid facility surveys, stakeholder engagement, and information feedback can be used for gap analysis and resource allocation. This approach can achieve effective use

  3. Prevalence and impact of water-borne zoonotic pathogens in water, cattle and humans in selected villages in Dodoma Rural and Bagamoyo districts, Tanzania

    NASA Astrophysics Data System (ADS)

    Kusiluka, L. J. M.; Karimuribo, E. D.; Mdegela, R. H.; Luoga, E. J.; Munishi, P. K. T.; Mlozi, M. R. S.; Kambarage, D. M.

    A study on the prevalence of water-borne zoonotic pathogens in water, cattle and humans was conducted in six villages in Dodoma Rural (5) and Bagamoyo (1) districts, Tanzania. Water sources were screened for faecal coliform organisms, thermophilic Campylobacter, Salmonella, Cryptosporidium and Giardia. Faecal samples from cattle and humans were also analysed for the above specific pathogens. Results indicate that 70.8% ( n = 48) of the water sources screened were contaminated with faecal coliform organisms. Water sources in two villages, one each in Dodoma Rural and Bagamoyo districts were also contaminated with Giardia lamblia. The overall prevalence of Campylobacter jejuni in cattle in the two study areas was 2.3% ( n = 942) and at least one animal in each village was infected with C. jejuni. Cryptosporidium parvum was detected in 0.5% ( n = 942) of the cattle examined in three villages in Dodoma district. Salmonella spp. was demonstrated in only 1.4% ( n = 144) of the cattle in Chalinze village in Dodoma Rural district while G. lamblia was only detected in 1.5% ( n = 202) of the animals examined in Chamakweza village in Bagamoyo district. Nine (1.9%) of the people screened at three heath centres in the study areas were infected with C. jejuni while 3.7% ( n = 484) of the people had C. parvum oocysts. G. lamblia was detected in 2.5% of the 202 people screened at the Chalinze health centre in Bagamoyo district. Analysis of the secondary data revealed that clinical complaints related to enteric diseases were prevalent in humans in the two areas throughout the year and the prevalence varied from about 1% to 25% in both <5 years and ⩾5 years patients. In conclusion, this study has highlighted the possible public health risks, which may be associated with keeping of animals and sharing of water sources between humans and animals.

  4. Assessment of arsenic, fluoride, bacteria, and other contaminants in drinking water sources for rural communities of Kasur and other districts in Punjab, Pakistan.

    PubMed

    Arshad, Nasima; Imran, Saiqa

    2017-01-01

    High levels of arsenic contamination in drinking water of two villages, Badarpur and Ibrahimabad of district Kasur, central Punjab, Pakistan is reported first time in present studies. Groundwater quality situation was found to be impaired when samples of different rural areas of district Kasur were monitored according to Pakistan Standards and Quality Control Authority (PSQCA) for all significant water quality constituents and analyzed for trace elements, physico-chemical, and microbiological parameters. Out of 35water sources, 97 % were found unsafe and only 3 % of the sources were within safe limits. High concentrations of arsenic, fluoride, and bacteria were found in 91, 74, and 77 % sources of drinking water, respectively. Very high concentrations of arsenic ranging 58-3800 μg/L were found in the water samples obtained from Badarpur and Ibrahimabad. A decrease in water contamination was observed with increase in source depth. The health issues like arsenicosis and skeletal/dental flourosis were observed in the residents of the monitored areas. Drinking water quality conditions of some rural areas of northen and southern districts of Punjab was also analyzed and compared with Kasur district. High levels of nitrates were found in the samples of Islamabad and Rawalpindi, while high levels of arsenic, iron, fluoride, and TDS were found in Bahawalpur district. Graphical abstract ᅟ.

  5. Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

    PubMed Central

    Bossyns, Paul; Abache, Ranaou; Abdoulaye, Mahaman S; Miyé, Hamidou; Depoorter, Anne-Marie; Van Lerberghe, Wim

    2006-01-01

    Background The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. Methods Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. Results The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. Conclusion Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with. PMID:16608534

  6. Monthly deposition of cadmium in rural and industrial areas of Germany (Bayern, Pfalz, Ruhr district) and its influences upon an agricultural model system

    SciTech Connect

    Runkel, K.H.; Payer, H.D.

    1983-02-01

    Monthly depositions of cadmium were collected by a modified Bergerhoff method and measured by AAS during a 3-year period in rural areas of the Pfalz and in an industrial area of the Ruhr district. Another one year period included measurements in rural areas of southern Bavaria and on a Dutch island. The log-normally distributed deposition rates of cadmium at the rural areas in southern Germany amounted to only 20% of those of the industrial district. The depositions on the Dutch island were twice as high as the depositions on the rural areas of southern Germany. The monthly cadmium deposition rates show only little periodical fluctuation during the year and scatter around more or less constant median values of 25 and 120 micrograms . m-2 . month-1 at the rural and industrial areas, respectively. When open air mass cultures of algae were taken as an agricultural model, the organisms, depending on their growth rate, accumulated 0.4-4.0 ppm of cadmium (dry matter based). The course of the cadmium accumulation reflects the deposition rate of the area where the algae were grown. No growth depression of the algae due to cadmium can be observed under the given deposition rates.

  7. Health and quality of life among older rural people in Purworejo District, Indonesia

    PubMed Central

    Ng, Nawi; Hakimi, Mohammad; Byass, Peter; Wilopo, Siswanto; Wall, Stig

    2010-01-01

    Introduction Increasing life expectancy and longevity for people in many highly populated low- and middle-income countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia. Objective To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia. Methods In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes. Results Women, older age groups, people not in any marital relationship and low educational and socio-economic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR = 3.35; 95% CI = 2.73–4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR = 1.67; 95% CI = 1.35–2.06) and the lowest overall health score quintile (OR = 1.66; 95% CI = 1.36–2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia

  8. Adult Psychotic Symptoms, Their Associated Risk Factors and Changes in Prevalence in Men and Women Over a Decade in a Poor Rural District of Kenya

    PubMed Central

    Jenkins, Rachel; Othieno, Caleb; Ongeri, Linnet; Ogutu, Bernards; Sifuna, Peter; Kingora, James; Kiima, David; Ongecha, Michael; Omollo, Raymond

    2015-01-01

    There have been no repeat surveys of psychotic symptoms in Kenya or indeed subSaharan Africa. A mental health epidemiological survey was therefore conducted in a demographic surveillance site of a Kenyan household population in 2013 to test the hypothesis that the prevalence of psychotic symptoms would be similar to that found in an earlier sample drawn from the same sample frame in 2004, using the same overall methodology and instruments. This 2013 study found that the prevalence of one or more psychotic symptoms was 13.9% with one or more symptoms and 3.8% with two or more symptoms, while the 2004 study had found that the prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms. This change was accounted for by a striking increase in psychotic symptoms in women (17.8% in 2013 compared with 6.9% in 2004, p < 0.001), whereas there was no significant change in men (10.6% in 2013 compared with 9.4% in 2004, p = 0.582). Potential reasons for this increase in rate of psychotic symptoms in women are explored. PMID:25996885

  9. Adult psychotic symptoms, their associated risk factors and changes in prevalence in men and women over a decade in a poor rural district of Kenya.

    PubMed

    Jenkins, Rachel; Othieno, Caleb; Ongeri, Linnet; Ogutu, Bernards; Sifuna, Peter; Kingora, James; Kiima, David; Ongecha, Michael; Omollo, Raymond

    2015-05-19

    There have been no repeat surveys of psychotic symptoms in Kenya or indeed subSaharan Africa. A mental health epidemiological survey was therefore conducted in a demographic surveillance site of a Kenyan household population in 2013 to test the hypothesis that the prevalence of psychotic symptoms would be similar to that found in an earlier sample drawn from the same sample frame in 2004, using the same overall methodology and instruments. This 2013 study found that the prevalence of one or more psychotic symptoms was 13.9% with one or more symptoms and 3.8% with two or more symptoms, while the 2004 study had found that the prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms. This change was accounted for by a striking increase in psychotic symptoms in women (17.8% in 2013 compared with 6.9% in 2004, p < 0.001), whereas there was no significant change in men (10.6% in 2013 compared with 9.4% in 2004, p = 0.582). Potential reasons for this increase in rate of psychotic symptoms in women are explored.

  10. A comparison of triage methods for Kenyan women who screen positive for cervical intraepithelial neoplasia by visual inspection of the cervix with acetic acid.

    PubMed

    Lewis, K C L; Tsu, V D; Dawa, A; Kidula, N A; Chami, I N; Sellors, J W

    2011-09-01

    Only about one in seven visual inspection with acetic acid (VIA)-positive women has high-grade disease; further confirmatory testing could rule out false positives. To determine if visual inspection with Lugol's iodine (VILI) or visual inspection with acetic acid and magnification (VIAM) can accurately confirm the presence of disease among rural Kenyan women referred to a district hospital because of a VIA-positive result at a primary health facility. Referred women received cervical cytology and either VILI and/or VIAM as triage methods. All women were assessed by colposcopy and biopsied, if necessary. Of the 490 VIA-positive subjects referred, 332 (68%) attended the district hospital and received at least one of two triage tests and cervical cytology. The sensitivity and specificity for histologically-confirmed CIN 2 and 3 were 93% (14/15) and 32% (52/161) for VIAM; 100% (3/3) and 77% (49/64) for VILI; and 80% (16/20) and 48% (110/228) for cervical cytology. VILI reduced the number of false-positive screening results by 73%, without missing any true positives. VILI had comparable sensitivity and significantly higher specificity compared to VIAM and cervical cytology. VILI may be a promising triage test for screen-positive women in low-resource settings; additional research is required.

  11. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya.

    PubMed Central

    Weiner, Renay; Ronsmans, Carine; Dorman, Ed; Jilo, Hilton; Muhoro, Anne; Shulman, Caroline

    2003-01-01

    OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting. PMID:14576887

  12. Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal

    PubMed Central

    2014-01-01

    Background Cardiovascular disease (CVD) is emerging as a public health menace among low and middle income countries. It has particularly affected the poorest. However, there is paucity of information about CVD risk factors profile among Nepalese rural communities where the majority of people live in poverty. Therefore, this study aimed to identify the prevalence of cardiovascular health risk behaviors in an outback community of Nepal. Methods We conducted a descriptive cross-sectional study in Tinkanya Village Development Committee (VDC), Sindhuli between January and March, 2014. Total 406 participants of age 20 to 50 years were selected randomly. Data were collected using WHO-NCD STEPwise approach questionnaires and analyzed with SPSS V.16.0 and R i386 2.15.3 software. Result The mean age of participants was 36.2 ± 9 years. Majority of participants (76.3%) were from lower socio-economic class, Adibasi/Janajati (63.1%), and without formal schooling (46.3%). Smoking was present in 28.6%, alcohol consumption in 47.8%, insufficient fruits and vegetables intake in 96.6%, insufficient physical activity in 48.8%; 25.6% had high waist circumference, 37.4% had overweight and obesity. Average daily salt intake per capita was 14.4 grams ±4.89 grams. Hypertension was detected in 12.3%. It had an inverse relationship with education and socio-economic status. In binary logistic regression analysis, age, smoking, body mass index (BMI) and daily salt intake were identified as significant predictors of hypertension. Conclusion Present study showed high prevalence of smoking, alcohol consumption, insufficient fruit and vegetable intake, daily salt intake, overweight and obesity and hypertension among remote rural population suggesting higher risk for developing CVD in future. Nepalese rural communities, therefore, are in need of population-wide comprehensive intervention approaches for reducing CVD health risk behaviors. PMID:25066117

  13. Matching services with local preferences: managing primary education services in a rural district of India.

    PubMed

    Subrahmanian, R

    1999-02-01

    India's poorest households have particularly little access to education. Urgent reforms are therefore needed to improve the universal availability of quality basic services and universal access to those services. At least 32 million children in India are estimated to not be enrolled and attending school. These children must be brought into schools in order to meet the goal of Universal Elementary Education (UEE). Widespread support exists for the decentralization of public services due to the equity and efficiency benefits associated with it. In particular, decentralization is seen to facilitate the matching of services with local preferences, increasing the chances of meeting policy goals. This approach is explored in the context of research conducted in a village of Raichur district, where poor households' preferences with regard to school timing are analyzed. Sections consider the equity and efficiency merits of decentralization, the agenda for improving education service delivery in India, users' relationship to the education system in Raichur district, how preferences are revealed, whose preferences are important in the conflict between local and policy perspectives, preference heterogeneity in the village context, and whether aspects of education services can be selectively decentralized.

  14. School wellness policy implementation: insights and recommendations from two rural school districts.

    PubMed

    Sánchez, Victoria; Hale, Ron; Andrews, Mark; Cruz, Yolanda; Bettencourt, Vonnell; Wexler, Perdita; Halasan, Corazon

    2014-05-01

    Although school wellness policies have the potential to transform school environments, relatively little has been written about postadoption policy implementation and evaluation (policy to practice). The authors report results of a research study that examined the implementation of school wellness policies in two school districts in northern New Mexico. Through nine key informant interviews with administrators and two focus groups with students, they found that physical activity and nutrition policies were implemented inconsistently in both districts. Study participants identified facilitating factors (e.g., champions, grant funding) and barriers (e.g., competitive food sales, lack of clarity about responsibility for policy enforcement) to policy implementation. Participants also provided recommendations to improve policy implementation, including wellness policy training for school personnel and parents, improving the taste, nutritional value of, and choices in cafeteria food; and involving the community health council to promote community understanding and support of the policies. This study underscores the need to identify and address factors involved in the successful implementation of school wellness policies, looking at schools in the larger context of their communities. It also serves as an example of the potential for communities, schools, and others to work together to address a locally identified health priority.

  15. Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso.

    PubMed

    Duclos, Vincent; Yé, Maurice; Moubassira, Kagoné; Sanou, Hamidou; Sawadogo, N Hélène; Bibeau, Gilles; Sié, Ali

    2017-07-12

    The implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. By contrast, the expectations of direct and indirect mHealth users are not often examined. In preparation for a proposed intervention in the Nouna Health District, in rural Burkina Faso, this study investigates the expected benefits, challenges and limitations associated with mHealth, approaching these expectations as a form of situated knowledge, inseparable from local conditions, practices and experiences. The study was conducted within the Nouna Health District. We used a qualitative approach, and conducted individual semi-structured interviews and group interviews (n = 10). Participants included healthcare workers (n = 19), godmothers (n = 24), pregnant women (n = 19), women with children aged 12-24 months (n = 33), and women of childbearing age (n = 92). Thematic and content qualitative analyses were conducted. Participants expect mHealth to help retrieve patients lost to follow-up, improve maternal care monitoring, and build stronger relationships between pregnant women and primary health centres. Expected benefits are not reducible to a technological realisation (sending messages), but rather point towards a wider network of support. mHealth implementation is expected to present considerable challenges, including technological barriers, organisational challenges, gender issues, confidentiality concerns and unplanned aftereffects. mHealth is also expected to come with intrinsic limitations, to be found as obstacles to maternal care access with which pregnant women are confronted and on which mHealth is not expected to have any significant impact. mHealth expectations appear as situated knowledges, inseparable from local health-related experiences, practices and constraints. This problematises universalistic approaches to mHealth knowledge, while nevertheless hinting at

  16. Determinants of institutional childbirth service utilisation among women of childbearing age in urban and rural areas of Tsegedie district, Ethiopia.

    PubMed

    Hailu, Desta; Berhe, Hailemariam

    2014-11-01

    despite receiving greater attention, optimal maternal health remains a challenge in developing countries such as Ethiopia. Evidence from various studies shows that skilled attendance during childbirth is among the key strategies to reduce maternal mortality. However, in Ethiopia, the use of institutional childbirth services is very low. In Ethiopia, studies dealing with factors affecting women׳s use of institutional childbirth services are scarce and generally focus on urban settings. As such, this study aimed to explore the determinants of institutional childbirth service utilisation among urban and rural women who gave birth in the previous two years in Tsegedie district, Ethiopia. a community-based cross-sectional study was performed from 20 November 2012 to 30 June 2013 on 485 mothers. The participants were selected systematically using a multistage sampling technique. A pre-tested structured questionnaire, administered by an interviewer, was used to collect quantitative data. Focus group discussions and in-depth interviews were used to triangulate the evidence from the quantitative study. Bivariate and multivariate data analysis was performed using Statistical Package for the Social Sciences Version 17.0. this study found that 31.5% of the respondents used institutional childbirth services. The main reason for home birth was close attention from family (47%). Women׳s educational status [adjusted odds ratio (AOR) 5.3, 95% confidence interval (CI) 1.59-17.87], time taken to reach the nearest health facility (AOR 3.3, 95% CI 1.15-9.52), ultimate decision maker regarding the place of childbirth (AOR 3.7, 95% CI 1.08-12.63) and receipt of maternal and child health care information (AOR 9.4, 95% CI 2.4-36.38) were significantly associated with the use of institutional childbirth services. the proportion of births attended in health facilities was low in the study district. Women׳s educational status, distance to the nearest health facility, women׳s decision

  17. An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District

    PubMed Central

    2017-01-01

    Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as “high vulnerability.” Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment. PMID:28352286

  18. An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District.

    PubMed

    Houghton, Adele; Austin, Jessica; Beerman, Abby; Horton, Clayton

    2017-01-01

    Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

  19. Overweight and obesity in an ethnically diverse rural school district: the Healthy Kids Project.

    PubMed

    Eichner, June E; Moore, William E; Perveen, Ghazala; Kobza, Cee E; Abbott, Kathryn E; Stephens, Aietah L

    2008-02-01

    Data on Native American children and adolescents are rarely reported along with other racial and ethnic groups. The Healthy Kids Project is part of an effort to describe the prevalence of overweight and obesity in a racially mixed rural area where Native American, Hispanic, African American, and white children reside. We measured height and weight of students in Anadarko, Oklahoma public schools (n = 1,980) in 2002-2003. All available students (95.7%) whose parents had not opted out of school health assessments were included. From these data, we calculated BMI (weight (kg) / height (m(2))) and used the International Obesity Task Force reference to classify children into BMI categories. Native American, Hispanic, African American, and white children who live and attend school in the same surroundings are at risk of overweight and obesity. White children had the lowest combined prevalence of overweight and obesity (37.6%), and Native American children had the highest (53.8%) followed closely by African American (51.7%) and Hispanic children (50.5%). The childhood obesity epidemic includes all racial and ethnic groups to different degrees. In a rural public school, Native American, Hispanic, and African children had higher rates of overweight/obesity than white children.

  20. Impact of information technology reliance and innovativeness on rural healthcare services: study of dindigul district in Tamilnadu, India.

    PubMed

    Lakshmi, K Bhagya; Rajaram, M

    2012-06-01

    The aim of this report was to analyze the influence of information technology (IT) applications and innovativeness on the acceptance of rural healthcare services. The impact of IT application, domain-specific innovativeness, and technology acceptance model (TAM) variables on future health IT (HIT) utilization intention has been tested through structural equation modeling techniques. The sample consisted of 465 rural health personnel from the Dindigul District of Tamilnadu, India, who had never had access to IT. Data analysis showed that health workers' innovativeness and IT application have a direct and positive influence on future HIT utilization intention and that the basic TAM hypotheses are fulfilled. IT application can be increased with interfaces that are easier to use, but only if perceived usefulness remains high. Health personnel's innovativeness positively influences technology exposure and the ease of use perception of the IT medium, referred to throughout this article as the "health channel." This research enables health departments to know which aspects of their communication strategies to highlight in order to get health personnel and other service providers to adopt IT. Perceived ease of use and IT application has a significant influence on health personnel's willingness to adopt HIT. This shows that health information and adoption by health personnel are key tools in the increase of future HIT. It is also recommended that health directors target some of their health campaigns to the more innovative beneficiaries. There are still too few studies that have analyzed the effects of innovativeness and IT adoption on behavior of health personnel. This work aimed to combine the influence of IT adoption, innovativeness, and the traditional TAM in order to construct an improved model for HIT acceptance. It will require an integrated model to do so.

  1. [Association between family history and the risk of hypertension in rural districts of Hanzhong in Shaanxi province].

    PubMed

    Wu, X Y; Li, Q; Yan, H; Liu, D M; Gao, J Y; Zhao, Y L

    2017-08-10

    Objective: To understand the prevalence of hypertension and quantitative relationship between family history and the risk of hypertension among rural residents living in Hanzhong District, Shaanxi province. Methods: A multistage random sampling survey was conducted. Data on the characteristics related to hypertension were collected and physical examination was conducted. Logistic regression was used to analyze the relationship between family history and hypertension. Results: A total number of 2 817 rural residents aged 18-80 with complete information were recruited. The crude prevalence of hypertension was 33.7%. Results from the logistic regression analysis showed that the OR was 2.06 (95% CI: 1.70-2.50) between family histories with or without hypertension. When the first-degree relatives were with the degrees of family history of hypertention as Ⅰ, Ⅱ or Ⅲ, the OR values of hypertension appeared as 1.83 (95% CI: 1.47-2.27), 2.94 (95% CI: 2.09-4.13) and 4.48 (95% CI: 2.17-9.27) respectively. Either father or mother having the positive family history of hypertension, the corresponding OR values appeared as 2.50 (95% CI: 1.84-3.40), 1.61(95% CI: 1.22-2.12) seen in mothers. However, when both father and mother having the family history of hypertention, the OR value was seen 2.82 (95%CI: 1.76-4.51) in the mothers. Conclusion: Family history appeared as a risk factor for hypertension. The number of first-degree relatives with positive family history showed a dose-response relationship to the occurrence of hypertension. Family history in both father or mother might further affect the incidence of hypertension.

  2. Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique.

    PubMed

    Nhampossa, Tacilta; Sigaúque, Betuel; Machevo, Sónia; Macete, Eusebio; Alonso, Pedro; Bassat, Quique; Menéndez, Clara; Fumadó, Victoria

    2013-09-01

    To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. Rural Mozambican district hospital. All children aged <5 years admitted with severe malnutrition. During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence. Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

  3. Factors influencing attendance to immunization sessions for children in a rural district of Ghana.

    PubMed

    Bosu, W K; Ahelegbe, D; Edum-Fotwe, E; Bainson, K A; Turkson, P K

    1997-12-01

    Improving immunization coverage is vital to promoting child health and reducing childhood diseases and deaths. In spite of being actively promoted as a major public health intervention for national development since the late 1970s, immunization coverage in Ghana remains low. We investigated factors that influence attendance to immunization sessions in the Komenda-Edina-Eguafo-Abrem District of Ghana. The major factors hindering attendance were poor knowledge about immunization, lack of suitable venues and furniture at outreach clinics, financial difficulties, long waiting times, transport difficulties, poorly motivated service providers and weak intersectoral collaboration. The timing of immunization sessions, length of prior notice to the community, attitude of service providers and fear of side-effects generally did not deter attendance.

  4. Otitis Media and Its Sequelae in Kenyan Schoolchildren.

    PubMed

    Simões, Eric A F; Kiio, Francis; Carosone-Link, Phyllis J; Ndegwa, Serah N; Ayugi, John; Macharia, Isaac M

    2016-12-01

    The goal of this study was to obtain representative Kenyan data on the point prevalence of acute otitis media (AOM) and its sequelae (otitis media with effusion [OME] and chronic suppurative otitis media [CSOM]), a major cause of preventable hearing loss in children in developing countries. In Africa, there are limited studies on the prevalence of AOM and its sequelae in children. Study subjects were children aged 2 to 15 years and were enrolled from randomly selected preprimary and primary schools. After parental or guardian consent, subjects had a questionnaire administered, otoscopy and tympanometry were done, and audiometry was performed on those with ear problems detected on these examinations. A total of 9825 (75%) children was from rural schools. The prevalence of CSOM was 15 of 1000, OME was 15 of 1000, and AOM was 7 of 1000 children. Rural Rift Valley schoolchildren had the highest prevalence of CSOM (24 of 1000) compared with other regions (12 of 1000; P < .0001). Ear discharge occurred before 3.5 years in 50% of 901 children with ear discharge. A history of ear discharge was associated with abnormal tympanograms (odds ratio [OR], 11.9-19.2) and mild-to-severe hearing loss (OR, 21.6-38.6), even in children without ear disease (OR, 10.7-24.4). The burden of AOM sequelae in Kenyan preschool and schoolchildren is significant, and it occurs mostly in the first 4 years of life. By preventing early recurrent AOM, pneumococcal vaccination might partly avert nonreversible sequelae. © The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  5. Non-Attendance of Treatment Review Visits among Epileptic Patients in a Rural District, Zimbabwe

    PubMed Central

    Dewa, Evans; Nyati-Jokomo, Zibusiso; Mafaune, Patron T.; Muteti, Shamiso; Maradzika, Julita

    2014-01-01

    Epilepsy is the most common condition reported through the psychiatric returns surveillance system in Gokwe South District. Review visits attendance is crucial to the successful control of seizures among epilepsy patients. We sought out to establish the attendance pattern of epileptic patients, prevalence of non-attendance and the associated factors. An analytic cross-sectional study was conducted where consenting respondents (N=110) were selected randomly from the district epilepsy register. Interviewer-administered questionnaires were used to collect data. Odds ratios were calculated to determine associations. Logistic regression analysis was done to identify independent risk factors and to control for confounding variables. A total of 110 epileptic patients were included in the study. The patients missed treatment review visits ranging from 1 to 11 of the expected 12 visits between June 2011 and June 2012. Most (70.9%) missed at least 2 visits in a 12month period while 46.4% missed 2 or more consecutive visits. Knowledge of treatment duration [prevalence odds ratio (POR) 0.24 (95% confidence interval (CI) 0.08-0.74)] and high risk perception [POR 0.14 (95% CI: 0.06-0.33)] were associated with a lower likelihood of missing review visits. Barriers such as shortage of drugs [POR 7.09 (95% CI: 3.00-16.72)] and long distances to health facilities [POR 6.63 (95% CI: 2.63-16.76)] were associated with high likelihood of missing two or more review visits consecutively. Shortage of drugs [adjusted odds ratio (AOR) 6.7336 (95% CI: 1.8538-24.4581)] and higher risk perception [AOR 0.1948 (95% CI: 0.0625-0.6071)] remained significant on logistic regression analysis. A high number of epileptic patients miss their review visits mainly owing to shortage of drugs, and long distances from health facilities.

  6. Direct observation of outpatient management of malaria in a rural ghanaian district

    PubMed Central

    Ameme, Donne Kofi; Afari, Edwin Andrews; Nyarko, Kofi Mensah; Malm, Keziah Laurencia; Sackey, Samuel; Wurapa, Fred

    2014-01-01

    Introduction In Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines. Methods We conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median. Results Of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message. Conclusion Conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement. PMID:25932080

  7. Direct observation of outpatient management of malaria in a rural Ghanaian district.

    PubMed

    Ameme, Donne Kofi; Afari, Edwin Andrews; Nyarko, Kofi Mensah; Malm, Keziah Laurencia; Sackey, Samuel; Wurapa, Fred

    2014-01-01

    In Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines. We conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median. Of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message. Conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement.

  8. Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy

    PubMed Central

    2010-01-01

    Background Artesunate-amodiaquine (AS-AQ) was introduced in Ghana as the first line drug for treatment of uncomplicated malaria in 2004. We report the perceptions of malaria and malaria treatment behaviour, the community awareness of and perceptions about AS-AQ two years after the introduction of this ACT treatment for malaria. Methods Two surveys were conducted; a cross-sectional survey of 729 randomly selected household heads (urban-362, rural-367) and 282 women with children < 5 years (urban-121, rural-161) was conducted in 2006. A district wide survey was conducted in 2007 to assess awareness of AS-AQ. These were complemented with twenty-eight focus group discussions (FGDs) and 16 key informant interviews (KII) among community members and major stakeholders in the health care delivery services. All nine (9) health facilities and five (5) purposively selected drug stores were audited in order to identify commonly used anti-malarials in the study area at the time of the survey. Results Majority of respondents ( > 75%) in the sampled survey mentioned mosquito bites as the cause of malaria. Other causes mentioned include environmental factors (e.g. dirty surroundings) and standing in the sun. Close to 60% of the household heads and 40% of the care-givers interviewed did not know about AS-AQ. The community respondents who knew about and had ever taken AS-AQ perceived it to be a good drug; although they mentioned they had experienced some side effects including headaches and body weakness. Co-blistered AS-AQ was available in all the government health facilities in the study area. Different formulations of ACTs were however found in urban chemical shops but not in rural chemical stores where monotherapy antimalarials were predominant. Conclusion The knowledge of fever as a symptom of malaria is high among the study population. The awareness of AS-AQ therapy and its side-effect was low in the study area. Community education and sensitization, targeting all categories

  9. Prevalence and correlates of depressive symptoms among in-school adolescents in a rural district in southwest Nigeria.

    PubMed

    Fatiregun, A A; Kumapayi, T E

    2014-02-01

    This study was conducted to assess the prevalence and correlates of depressive symptoms among in-school adolescents in a rural district in southwest Nigeria. A cross-sectional survey involving 1713 adolescents from four private and three public secondary schools were selected using a stratified cluster sampling technique. Patient Health Questionnaire (PHQ)-9, with a maximum score of 27, was used to assess the presence (score ≥ 5) and severity (score ≥ 15) of the symptoms of depression. Multiple logistic regression was used to identify the correlates. The prevalence was 21.2%; 5.1% of the respondents had moderately severe to severe depression. Significant predictors included "not living with parents" (OR = 1.69; 95%CI, 1.14-2.38), not participating in sports (OR = 1.45; 95%CI; 1.11-1.92), a large number of siblings (OR = 1.69; 95%CI; 1.11-2.63), and a change in place of residence (OR = 1.46; 95%CI, 1.13-1.88). A need exists to plan and implement health education measures to reduce the burden of the disease. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  10. Community knowledge of and attitudes toward epilepsy in rural and urban Mukono district, Uganda: A cross-sectional study.

    PubMed

    Kaddumukasa, Mark; Kakooza, Angelina; Kayima, James; Kaddumukasa, Martin N; Ddumba, Edward; Mugenyi, Levi; Furlan, Anthony; Lhatoo, Samden; Sajatovic, Martha; Katabira, Elly

    2016-01-01

    The lack of adequate knowledge poses a barrier in the provision of appropriate treatment and care of patients with epilepsy within the community. The purpose of this study was to determine the knowledge of and attitude towards epilepsy and its treatment by community dwellers in Uganda. A cross sectional population survey was conducted in urban and rural Mukono district, central Uganda. Adult respondents through multistage stratified sampling were interviewed about selected aspects of epilepsy knowledge, attitudes, and perception using a pretested structured questionnaire. Ninety-one percent of the study respondents had heard or read about epilepsy or knew someone who had epilepsy and had seen someone having a seizure. Thirty-seven percent of the respondents did not know the cause of epilepsy, while 29% cited genetic causes. About seventeen percent of the subjects believed that epilepsy is contagious. Only 5.6% (21/377) of the respondents would take a patient with epilepsy to hospital for treatment. Adults in Mukono are very acquainted with epilepsy but have many erroneous beliefs about the condition. Negative attitudes are pervasive within communities in Uganda. The national epilepsy awareness programs need to clarify the purported modes of transmission of epilepsy, available treatment options, and care offered during epileptic seizures during community sensitizations in our settings. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

    PubMed

    Coffey, Diane

    2014-08-01

    The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes.

  12. Costs and Consequences of a Cash Transfer for Hospital Births in a Rural District of Uttar Pradesh, India

    PubMed Central

    Coffey, Diane

    2014-01-01

    The Janani Suraksha Yojana, India’s “safe motherhood program,” is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program’s apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. PMID:24911512

  13. Epidemiological investigation of grass seed foreign body-related disease in dogs of the Riverina District of rural Australia.

    PubMed

    Hicks, A; Golland, D; Heller, J; Malik, R; Combs, M

    2016-03-01

    To characterise disease presentations caused by grass seed foreign body-related disease (GSFBD) in dogs, identify predisposing risk factors and suggest effective prevention strategies. A retrospective, case-control, telephone survey was conducted to obtain information on GSFBD in dogs from the Riverina district of New South Wales (NSW). Additionally, retrospective case records were obtained from Wagga Wagga Veterinary Hospital and Charles Sturt University Veterinary Teaching Hospital over the period July 2006 to October 2011. Signalment, history, investigative strategies, location and severity of lesion(s), cost of therapy, length of hospitalisation, recurrence rate and microbiology data were recorded. Cases (473 dogs) meeting stringent inclusion criteria were identified. GSFBD comprised 2.0% of hospital presentations. Breeds with high-density coats were overrepresented. Otitis externa was the most common manifestation of GSFBD in the general practice (47%). In the referral practice pyothorax was the most common entity (34%). In both practices the range of clinical manifestations was broad, including a small number of dogs with catastrophic intracranial disease. Univariable and multivariable logistic regression analyses demonstrated dogs with GSFBD had 3-fold greater odds of having medium coats than short coats and 5-fold less odds of being groomed. Grass seeds are a major cause of disease in the dogs of south-west rural NSW, with presentations ranging from mild lameness to severe neurological disease. Some protection from GSFBD was achieved with frequent grooming. Clipping or coat searching without grooming was ineffective as a prevention strategy. © 2016 Australian Veterinary Association.

  14. Processing of complementary food does not increase hair zinc levels and growth of infants in Kilosa district, rural Tanzania.

    PubMed

    Lachat, Carl K; Van Camp, John H; Mamiro, Peter S; Wayua, Francis Obuoro; Opsomer, Anne S; Roberfroid, Dominique A; Kolsteren, Patrick W

    2006-01-01

    A community-based, randomized, placebo-controlled, double-blind trial was conducted from March 2001 to March 2002 in Kilosa, a rural district of Morogoro Region in Tanzania. One hundred and fifty-eight infants were selected randomly from lists of local Maternal and Child Health Care Centres and received either processed complementary food (PCF) or unprocessed complementary food (UPCF) from age 6 to 12 months. Processing increased Zn solubility and energy density of the porridge prepared from the complementary food (CF) as determined in vitro. Phytate:Zn molar ratio of the PCF and UPCF was 25.8 and 47.5, respectively. Under the study conditions, the processing of CF did not improve Zn status as measured by hair analysis. No significant correlations were found between hair Zn values and anthropometric measurements. Our findings suggest that processing alone of cereal-based CF may be insufficient to ensure an adequate supply of Zn to improve growth and Zn status of infants. Dietary modification to tackle Zn deficiencies in similar target groups may therefore only be successful when other Zn-rich foods such as meat and fish are included.

  15. Study of gastro-intestinal helminths of scavenging chickens in four rural districts of Amhara region, Ethiopia.

    PubMed

    Eshetu, Y; Mulualem, E; Ibrahim, H; Berhanu, A; Aberra, K

    2001-12-01

    A total of 267 rural scavenging chickens were examined from October 1998 to August 1999 in four woredas (districts) of the Amhara Region, Ethiopia. Of these chickens, 243 (91.01%) were found to harbour one to nine different helminth parasites and 24 (8.99%) were free of helminth parasites. A significant difference (P < 0.01) was found between the prevalence rates of helminth parasites in the different agro-ecological zones; the highest prevalence was observed in the lowland areas. This suggests that agro-ecology has a major influence on the distribution of helminth parasites. Nematodes recovered included Heterakis gallinarum (17.28%), Subulura brumpti (17.60%), Ascaridia galli (35.58%), Cheilospirura hamulosa (0.75%) and Dyspharynx spiralis (2.62%). The principal cestode species encountered were Raillietina echinobothrida (25.84%), Raillietina tetragona (45.69%), Raillietina cesticillus (5.62%), Amoebotaenia sphenoides (40.45%), Davainea proglottina (1.12%) and Choanotaenia infundibulum (4.49%).

  16. Prevalence of leptospirosis and toxoplasmosis: a study of rodents and shrews in cultivated and fallow land, Morogoro rural district, Tanzania.

    PubMed

    Mgode, Georgies F; Katakweba, Abdul S; Mhamphi, Ginethon G; Fwalo, Frank; Bahari, Mohamed; Mdangi, Mashaka; Kilonzo, Bukheti S; Mulungu, Loth S

    2014-07-01

    Leptospirosis and toxoplasmosis are among understudied zoonotic diseases that are also not diagnosed routinely in Tanzania. Humans get leptospirosis and toxoplasmosis through contact with an environment contaminated with Leptospira bacteria and Toxoplasma protozoa from reservoir hosts, which are rodents and cats, respectively. The objective of this study was to determine the prevalence of Leptospira and Toxoplasma infections in rodents and shrews in Mikese area of Morogoro Rural District in eastern Tanzania. A total of 89 rodents and one shrew from cultivated and fallow land were tested for leptospirosis using six Leptospira serovars: Sokoine, Kenya, Canicola, Lora, Hebdomadis and Pomona. Toxoplasmosis was determined in 46 rodents brain smears. The prevalence of leptospirosis was 25.8%, and Leptospira serovar Sokoine was the most prevalent serovar (16.9%). Toxoplasma was detected in one rodent (2.17%) individual while three rodent individuals had Toxoplasma-like parasites hence were considered suspect positive. Findings suggest potential existence of human leptospirosis which needs to be further investigated. Public awareness of leptospirosis and toxoplasmosis should be promoted and their diagnosis considered in patients in health care facilities.

  17. Availability of essential medicines in selected public, primary and secondary health care institutions of a rural Sri Lankan district: a spot survey.

    PubMed

    Rathish, Devarajan; Premarathna, Indika; Jayathilake, Thiwanka; Kandegedara, Chathurika; Punchihewa, Kalani; Ananda, Lakmali; Bandara, Thejani; Jayasumana, Channa; Siribaddana, Sisira

    2017-01-05

    Assessment of the availability of essential medicines, in rural areas of countries with free state health care system, is scarce. Dependence on essential medicines among the population in rural sector is considered to be high. Assessing the availability of essential medicines in selected state owned primary and secondary health care institutions of a rural district will help to identify areas where improvement is needed. A descriptive cross sectional study, covering selected five primary and one secondary care institutions of a rural Sri Lankan district, was conducted. The national list of essential medicines, Sri Lanka was used as the check list and the guidelines of the WHO-Health Action International were adapted. The secondary care institution recorded an overall availability of 71%, whereas the average overall availability of the primary care institutions was 56%. Central dispensaries recorded the lowest availability. Lack of availability of medicines needed for the management of chronic kidney disease, snake bite and poisoning was noted. Availability of essential medicines in most of the primary and the secondary care institutions were fairly high. Deficiency in medicines needed for the management of emergencies was noted. A need based annual estimate of medicines based on an essential medicine list is suggested.

  18. [Ecological risk assessment of rural-urban ecotone based on landscape pattern: A case study in Daiyue District of Tai' an City, Shandong Province of East China].

    PubMed

    Shi, Hao-Peng; Yu, Kai-Qin; Feng, Yong-jun

    2013-03-01

    Based on the remote sensing data in 2000, 2005, and 2010, this paper analyzed the variation trends of the land use type and landscape pattern in Daiyue District of Tai' an City from 2000 to 2010. The ecological risk index was built, that of the District was re-sampled and spatially interpolated, and the spatiotemporal pattern of the ecological risk in the rural-urban ecotone of the District was analyzed. In 2000-2010, the main variation trend of the land use type in the District was the shift from natural landscape to artificial landscape. The intensity of human disturbance was larger in cultivated land, garden plot, and forestland than in other landscape types, while the human disturbance in water area was smaller. The ecological loss degree of cultivated land and water area decreased somewhat, while that of the other land use types presented an increasing trend. The ecological risk distribution in the District was discrete in 2000 and 2010, but most centralized in 2005. The ecological risk of each ecological risk sub-area had an increasing trend in 2000-2005, but was in adverse in 2005-2010. In 2000-2010, the ecological risk of the District was mainly at medium level. Spatially, the distribution of the ecological risk in the District had an obvious differentiation, with an overall diffusive increasing from forestland as the center to the surrounding areas. In the District, the ecological risk was mainly at medium and higher levels, the area with lower ecological risk had an obvious dynamic change, while that with the lowest and highest ecological risk had less change.

  19. Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhiça district

    PubMed Central

    Nhacolo, Ariel Q; Nhalungo, Delino A; Sacoor, Charfudin N; Aponte, John J; Thompson, Ricardo; Alonso, Pedro

    2006-01-01

    Background In Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet. Methods Data from the DSS were used to estimate the levels and trends of fertility, mortality and migration in Manhiça, between 1998 and 2005. The estimates from Manhiça were compared with estimates from Maputo province using the 1997 National census and 1997 Demographic and Health Survey (DHS). The DHS data were used to estimate levels and trends of adult mortality using the siblings' histories and the orphanhood methods. Results The populations in Manhiça and in Maputo province are young (44% <15 years in Manhiça and 42% in Maputo); with reduced adult males when compared to females (all ages sex ratio of 78.7 in Manhiça and 89 in Maputo). Fertility in Manhiça is at a similar level as in Maputo province and has remained around 5 children per woman, during the eight years of surveillance in Manhiça. Although the infant mortality rate (IMR) in Mozambique has decreased during the last two decades (from 148 deaths per 1000 live births in 1980 to 101 in 2003), it has remained stable around 80 in Manhiça during the surveillance period. Adult mortality has increased both in Manhiça (probability of dying from ages 15 to 60 increased from 0.4 in 1998 to 0.6 in 2005 in Manhiça, from 0.3 in 1992 to 0.4 in 1997 in Maputo province and from 0.1 in 1980 to 0.6 in 2000 in Mozambique). Consequently, the life expectancy decreased from 53 to 46 in Manhiça and from 42 years in 1997 to 38 in 2004 in Mozambique. Migration is high in Manhiça but tends to stabilise after the movements of resettlement that followed the end of the civil war in 1992

  20. Nitrate pollution in groundwater in some rural areas of Nalgonda district, Andhra Pradesh, India.

    PubMed

    Brindha, K; Rajesh, R; Murugan, R; Elango, L

    2012-01-01

    Intake of water with high concentration of nitrate is a major problem in many countries as it affects health of humans. The present study was carried out with the objective of determining the causes for higher nitrate concentration in groundwater in parts of Nalgonda district, Andhra Pradesh, India. The study area is located at a distance of about 135 km towards ESE direction from Hyderabad. Nitrate concentration in groundwater of this area was analysed by collecting groundwater samples from 46 representative wells. Samples were collected once in two months from March 2008 to January 2009. The nitrate concentration was analysed in the laboratory using Metrohm 861 advanced compact ion chromatograph using appropriate standards. The highest concentration recorded during the sampling period was 879.65 mg/L and the lowest concentration was below detection limit. Taking into consideration 45 mg/L of nitrate as the maximum permissible limit for drinking water set by BIS, it was found that 13.78% of the groundwater samples collected from this study area possessed nitrate concentration beyond the limit. Overall, wells present in agricultural fields had nitrate levels within permissible limits when compared to those groundwater samples from wells present in settlements which are used for domestic purpose. This indicates that the high nitrate concentration in groundwater of this area is due to poor sanitation facilities and leaching from indiscriminate dumping of animal waste.

  1. Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

    PubMed Central

    2011-01-01

    Background Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants. Methods This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description. Results Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains. Conclusions Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization. PMID:22176816

  2. Motivations for food prohibitions during pregnancy and their enforcement mechanisms in a rural Ghanaian district.

    PubMed

    Arzoaquoi, Samson K; Essuman, Edward E; Gbagbo, Fred Y; Tenkorang, Eric Y; Soyiri, Ireneous; Laar, Amos K

    2015-07-17

    Food taboos are known from virtually all human societies and pregnant women have often been targeted. We qualitatively assessed food taboos during pregnancy, its motivating factors, and enforcement mechanisms in the Upper Manya Krobo district of Ghana. This was an exploratory cross sectional study using qualitative focus group discussions (FGDs). Sixteen FGDs were conducted. Participants were purposively selected using the maximum variation sampling technique. Tape recorded FGDs were transcribed verbatim and analyzed using Malterudian systematic text condensation technique. All the participants were aware of the existence of food prohibitions and beliefs targeting pregnant women in Upper Manya Krobo. The study identified snails, rats, hot foods, and animal lungs as tabooed during pregnancy. Adherence motivators included expectation of safe and timely delivery, avoidance of "monkey babies" (deformed babies); respect for ancestors, parents, and community elders. Enforcement mechanisms identified included constant reminders by parents, family members and significant others. Stigmatization and community sanctions are deployed sparingly. Food taboos and traditional beliefs targeting pregnant women exist in Upper Manya Krobo. Pregnant women are forbidden from eating snails, rats, snakes, hot foods and animal lungs. To a large extent, socio-cultural, and to a lesser, health concerns motivate the practice.

  3. Factors associated with undernutrition among children in a rural district of Kelantan, Malaysia.

    PubMed

    Cheah, Whye Lian; Wan Muda, Wan Abdul Manan; Mohd Hussin, Zabidi Azhar; Thon, Chang Ching

    2012-03-01

    The aim of the study was to identify the factors associated with undernutrition indicators in children 5 years and younger in a rural community in Malaysia. A total of 295 children and their carers were selected from community clinics based on a multistage sampling method. Pretested questionnaire, anthropometric measurement, and dietary assessment were used for data collection. There was 69% stunting, 63.4% underweight, 40% wasting, and 26.8% with mid-upper-arm circumference (MUAC) for age below a z score of -2 among children. In all, 10 factors were found to be associated with different indicators of undernutrition. Age was the only factor that had association with all the undernutrition indicators. Total household income and total expenditure showed significant association with underweight. Birth weight was reported to have significant association with underweight, stunting, and low MUAC-for-age. The findings suggest that the factors of undernutrition were different for different indicators of undernutrition and thus give a more comprehensive picture on factors contributing to acute and chronic malnutrition.

  4. People's perspective on access to health care services in a rural district of Nepal.

    PubMed

    Paudel, R; Upadhyaya, T; Pahari, D P

    2012-01-01

    Over the past several decades, Nepal has attempted to increase the access of health care services, however progress toward achieving high coverage of health care services in rural communities is still low. Therefore this study attempts to provide a perspective on access to basic health care services in government health facility. Descriptive cross-sectional study with quantitative and qualitative methods was designed and applied to identify the access to health care services. The study population were people who were sick within three months prior to the study where basic sampling unit was household. Total sample size was 96 through the application of simple random sampling method. Bivariate analysis with 95% confidence interval was used to identify the association of variables with access to health care services. Among the total population, 28% of households in the study area received health care services at government health facility. The reasons for not accessing health care were insufficient drugs (61%), distance (22%), staff unavailability (19%), sickness (9%), money (7%), and facility hours (4%). Sex, ethnicity and distance were found significantly associated with access to health care services. Less than one third of households had access to health care services in government health facility. Addressing the important factors such as drug problems, staff unavailability, long distance to health institutions and inconvenient health facility hours may help to increase access to health care services at government health facility.

  5. Attitudes and Orientations of Rural Groups and Effects on Educational Decision-Making and Innovation in Rural School Districts: A Synthesis of Research.

    ERIC Educational Resources Information Center

    Hughes, Larry W.; Spence, Dolphus L.

    The rural community is characterized by a decreasing population and an eroding of local taxable wealth which contribute to the ineffectiveness of community agencies or institutions to serve citizens' needs. The rural community resists widespread effort to change existing conditions since rural people are generally conservative and often do not…

  6. Behavioral change communication strategy vital in malaria prevention interventions in rural communities: Nakasongola district, Uganda

    PubMed Central

    Mugisa, Margaret; Muzoora, Abel

    2012-01-01

    Introduction Malaria is a leading killer disease in Uganda and it accounts for significant morbidity in pregnant women and children. Pregnant women are more susceptible to malaria, which causes adverse effects including abortion, low birth weight and maternal anaemia. Children with severe malaria frequently develop one of these symptoms including: severe anaemia, respiratory distress, Prostration, convulsions and cerebral malaria. Due to the severity of the disease there is need for multiple interventions to reduce the disease burden. African Medical and Research Foundation (AMREF) adopted community based approaches to improve malaria prevention. Behavioral change communication (BCC) was fundamental at every process of Project implementation. This paper shares AMREF's experience in using BCC strategies amidst other interventions in malaria prevention approaches involving use of insecticide treated nets and environment management. Methods AMREF through a Malaria project (2007-2010) in Nakasongola district supported BCC activities through training, community mobilization, mass media, health promotion and advocacy. Program performance was measured through baseline and evaluation surveys in 2007 and 2010. Results The final project evaluation indicated improvement from baseline values as follows: knowledge on prevention of malaria among school children from 76.6% to 90%, under five children sleeping under bed net the previous night from 51% to 74.7%, and from 24% to 78% among pregnant women. Conclusion Mobilization of malaria prevention interventions can be successful once BCC approaches are adequately planned and coordinated. Malaria prevention through BCC strategies are likely to be more effective with integration of other malaria interventions, and involvement of community based structures. PMID:23467840

  7. Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study

    PubMed Central

    Maina, Jackson Michuki; Kithuka, Peter; Tororei, Samuel

    2016-01-01

    Introduction In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district. Methods This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule. Results The median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake. Results Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake. PMID:27279952

  8. Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study.

    PubMed

    Maina, Jackson Michuki; Kithuka, Peter; Tororei, Samuel

    2016-01-01

    In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district. This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan district. The information was collected through a pretested interview schedule. The median age of the study participants was 28 years. Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8). Those with tertiary education were more likely to take up insurance AOR 5.1 (1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake. Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low and may provide a basis for policy changes among the insurance companies to increase the uptake.

  9. Genetic diversity of Leishmania tropica strains isolated from clinical forms of cutaneous leishmaniasis in rural districts of Herat province, Western Afghanistan, based on ITS1-rDNA.

    PubMed

    Fakhar, Mahdi; Pazoki Ghohe, Hossein; Rasooli, Sayed Abobakar; Karamian, Mehdi; Mohib, Abdul Satar; Ziaei Hezarjaribi, Hajar; Pagheh, Abdol Sattar; Ghatee, Mohammad Amin

    2016-07-01

    Despite the high incidence of cutaneous leishmaniasis (CL) in Afghanistan, there is a little information concerning epidemiological status of the disease and phylogenetic relationship and population structure of causative agents. This study was conducted to determine the prevalence and distribution of CL cases and investigate the Leishmania tropica population structure in rural districts of Heart province in the West of Afghanistan in comparison to neighboring foci. Overall, 4189 clinically suspected CL cases from 177 villages (including 12 districts) in Herat province were enrolled in the referral laboratory of WHO sub-office in Herat city from January 2012 to December 2013. 3861 cases were confirmed as CL by microscopic examination of Giemsa-stained slides. ITS1 PCR-RFLP analysis showed dominance of L. tropica (more than 98%) among 127 randomly chosen samples. Analysis of the ITS1 sequences revealed 4 sequence types among the 21 L. tropica isolates. Comparison of sequence types from Herat rural districts with the representatives of L. tropica from Iran, India, and Herat city showed two main population groups (cluster A and B). All isolates from Herat province, India and Southeast, East, and Central Iran were found exclusively in cluster A. The close proximity of West Afghanistan focus and Birjand county as the capital of Southern Khorasan province in East Iran can explain relatively equal to the genetic composition of L. tropica in these two neighboring regions. In addition, two populations were found among L. tropica isolates from Herat rural districts. Main population showed more similarity to some isolates from Birjand county in East Iran while minor population probably originated from the Southeast and East Iranian L. tropica. Recent study provided valuable information concerning the population structure of L. tropica and epidemiology of ACL in the West of Afghanistan, which could be the basis for molecular epidemiology studies in other regions of Afghanistan.

  10. Modeling and estimating manganese concentrations in rural households in the mining district of Molango, Mexico.

    PubMed

    Cortez-Lugo, Marlene; Rodríguez-Dozal, Sandra; Rosas-Pérez, Irma; Alamo-Hernández, Urinda; Riojas-Rodríguez, Horacio

    2015-12-01

    Airborne manganese (Mn) is considered the most hazardous route of exposure since Mn particles can enter into the body through the lung and may access the brain directly through olfactory uptake, thereby bypassing homeostatic excretory mechanisms. Environmental indoor and outdoor manganese concentrations in PM2.5 were monitored in ten rural households from two communities of Hidalgo, Mexico, from 2006 to 2007. Indoor and outdoor air samples of PM2.5 were collected using MiniVol samplers, and Mn concentrations in the filters were measured using proton-induced X-ray emission (PIXE). An adjusted generalized linear mixed model was applied and then used for estimating indoor concentrations in non-monitored households. Our monitoring results showed a higher daily average concentration of indoor PM2.5 vs. outdoor PM2.5 (46.4 vs. 36.2 μg/m(3), respectively); however, manganese concentration in PM2.5 indoor and outdoor was 0.09 μg/m(3) in both sceneries. Predictor variables of indoor Mn concentration were outdoor Mn concentration (64.5% increase per 0.1 μg/m(3) change in Mn) and keeping the windows open (4.2% increase). Using these predictors, the average estimated indoor Mn concentration in PM2.5 was 0.07 μg/m(3) (SD = 0.05). Our results confirm the direct effect of outdoor Mn levels, opening house windows, and the distance to the mining chimney in indoor Mn levels in houses.

  11. Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia.

    PubMed

    Heemelaar, Steffie; Habets, Nicole; Makukula, Ziche; van Roosmalen, Jos; van den Akker, Thomas

    2015-03-01

    To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. © 2014 John Wiley & Sons Ltd.

  12. Snakebites in Two Rural Districts in Lao PDR: Community-Based Surveys Disclose High Incidence of an Invisible Public Health Problem

    PubMed Central

    Vongphoumy, Inthanomchanh; Phongmany, Panom; Sydala, Sengdao; Prasith, Nouda; Reintjes, Ralf; Blessmann, Joerg

    2015-01-01

    Background The Lao PDR (Laos) is one of the least developed countries in Asia with an estimated 25% of the population living in poverty. It is the habitat of some highly venomous snakes and the majority of the population earns their living from agricultural activities. Under these circumstances the incidence of snakebites is expected to be high. Methods Two cross-sectional, community-based surveys were performed in Champone and Phin district, Savannakhet province, Lao PDR to estimate snakebite incidence. Multistage random sampling was used. In the first stage approximately 40% of all villages in each district were randomly selected. In the second stage 33% of all households in each village were randomly chosen. Members of the selected households were interviewed about snakebites during the previous 12 months. Results Thirty-five of 9856 interviewees reported a snakebite in a 12 month period in Champone district and 79 of 7150 interviewees in Phin district. The estimated incidence is 355 snakebites per 100,000 persons per year and 1105 per 100,000 in Champone and Phin district respectively. All snakebite victims received treatment by traditional healers or self-treatment at home and nobody went to a hospital. Incidence of snakebites, calculated on the basis of hospital records of 14 district hospitals and Savannakhet provincial hospital, ranged from 3 to 14 cases per 100,000 persons per year between 2012 and 2014. Conclusion Incidence of snakebites is high in rural communities in Laos with significant regional differences. Poverty most likely contributes significantly to the higher number of snakebites in Phin district. Hospital statistics profoundly underestimates snakebite incidence, because the majority of snakebite victims receive only treatment by traditional healers or self-treatment in their village. There is an urgent need to train medical staff and students in management of snakebite patients and make snake antivenom available to cope effectively with this

  13. Buruli ulcer in Nigeria: results of a pilot case study in three rural districts.

    PubMed

    Ukwaja, Kingsley N; Meka, Anthony O; Chukwuka, Alphonsus; Asiedu, Kingsley B; Huber, Kristina L; Eddyani, Miriam; Chukwu, Joseph N; Anyim, Moses C; Nwafor, Charles C; Oshi, Daniel C; Madichie, Nelson O; Ekeke, Ngozi; Njoku, Martin; Ntana, Kentigern

    2016-04-22

    Buruli ulcer (BU), also known as Mycobacterium ulcerans disease, is the third most common mycobacterial disease worldwide. Although BU disease has been diagnosed among Nigerians in neighbouring West African countries, data on the burden of the disease in Nigeria itself are scanty. This study aimed to assess the magnitude and epidemiology of BU in the South South region of Nigeria. We conducted a cross-sectional survey in the Ogoja territory (comprising 31 communities). We undertook sensitisation programmes centred on BU in 10 of the communities. Participants were asked to identify community members with long-standing ulcers, who were then invited for evaluation. We also contacted traditional healers to refer their clients who had non-healing ulcers. All suspected cases had a full clinical evaluation and laboratory testing. Confirmed cases were given treatment in a referral hospital in the territory. We diagnosed 41 clinical BU cases; 36 (87.8 %) of which were confirmed by quantitative polymerase chain reaction (qPCR). These 36 PCR-confirmed cases were diagnosed in a total population of 192,169 inhabitants. Therefore, the estimated crude prevalence of BU was 18.7 per 100,000 population, varying from 6.0 to 41.4 per 100,000 in the districts surveyed. The majority (66.7 %) of the cases were females. About 92 % of the BU lesions were located on the patients' extremities. No differences were observed between the sexes in terms of the location of the lesions. The age of the patients ranged from four to 60 years, with a median age of 17 years. All 35 (100 %) patients who consented to treatment completed chemotherapy as prescribed. Of the treated cases, 29 (82.9 %) needed and received surgery. All cases healed, but 29 (82.9 %) had some limitations in movement. Healing with limitations in movement occurred in 18/19 (94.7 %) and 8/10 (80.0 %) of patients with lesions >15 cm (Category III) and 6-15 cm in diameter (Category II), respectively. The median duration of treatment

  14. Birth preparedness and complication readiness among rural women of reproductive age in Abeshige district, Guraghe zone, SNNPR, Ethiopia

    PubMed Central

    Zepre, Kebebush; Kaba, Mirgissa

    2017-01-01

    Background Birth preparedness and complication readiness (BPCR) is a strategy that helps women to consider all available maternal health care services during pregnancy and prepare for potential complications. Federal Ministry of Health in Ethiopia has taken steps to roll out the strategy at community level. Yet, women in rural communities still do not make use of available services to avoid complications in connection to pregnancy and delivery. Objective This study aims to assess the current BPCR practice and determine associated factors among rural women of reproductive age in Abeshige district, Guraghe zone, SNNPR, Ethiopia. Methods A community-based cross-sectional study was carried out from February to March 2015. A total of 454 women were randomly selected and interviewed using pretested structured questionnaires, while opinion leaders, health extension workers, and selected women in the community were engaged in in-depth interviews and focus group discussions, using checklists prepared to guide the interviews. Data from different sources were analyzed, triangulated, and interpreted to respond to the objectives. Results Thirty-seven percent of the respondents were found to have prepared for birth and its complications. BPCR was higher among women who lived within a 1-hour walk from a health center (adjusted odds ratio [AOR] =3.51, 95% confidence interval [CI]: 1.78, 36.79) and who were aware of the danger signs of pregnancy (AOR =1.72, 95% CI: 1.78, 2.94) and postpartum complications (AOR =2.32, 95% CI: 1.32, 4.21). A major source of information was found to be health extension workers and one-to-five women networks (AOR =2.81, 95% CI: 1.34, 6.21) and (AOR =2.52, 95% CI: 1.17, 5.54), respectively. Qualitative finding revealed that lack of transportation and concern over cost of services are key barriers to BPCR. Conclusion BPCR in Abeshige was found to be relatively low, calling for more interventions beyond mere awareness. Availing transportation services and

  15. Estimating cause of adult (15+ years) death using InterVA-4 in a rural district of southern Ghana

    PubMed Central

    Awini, Elizabeth; Sarpong, Doris; Adjei, Alexander; Manyeh, Alfred Kwesi; Amu, Alberta; Akweongo, Patricia; Adongo, Philip; Kukula, Vida; Odonkor, Gabriel; Narh, Solomon; Gyapong, Margaret

    2014-01-01

    Background Data needed to estimate causes of death and the pattern of these deaths are scarce in sub-Saharan Africa. Such data are very important for targeting, monitoring, and evaluating health interventions. Objective To estimate the mortality rate and determine causes of death among adults (aged 15 years and older) in a rural district of southern Ghana, using the InterVA-4 model. Design Data used were generated from verbal autopsies conducted for registered adult members of the Dodowa Health and Demographic Surveillance System who died between 2006 and 2010. The InterVA-4 model was used to assign the cause of death. Results Overall, the mortality rate for the period under review was 7.5/1,000 person-years (py) for the general population and 10.4/1,000 py for those aged 15 and older. The leading cause of death was communicable diseases (CDs), with a malaria-specific mortality rate of 1.06/1,000 py. Pulmonary tuberculosis (TB)-specific mortality rate was the next highest (1.01/1,000 py). HIV/AIDS attributed deaths were lower among males than females. Non-communicable diseases (NCDs) contributed to 28.3% of the deaths with cause-specific mortality rate of 2.93/1,000 py. Stroke topped the list with cause-specific mortality rate of 0.69/1,000 py. As expected, young males (15–49 years) contributed to more road traffic accident (RTA) deaths; they had a lower RTA cause-specific mortality rate than older males (50–64 years). Conclusions Data indicate that CDs (e.g. malaria and TB) remain the major cause of death with NCDs (e.g. stroke) following closely behind. Verbal autopsy data can provide the causes of mortality in poorly resourced settings where access to timely and accurate data is scarce. PMID:25377337

  16. Educational Intervention Increased Referrals to Allopathic Care by Traditional Healers in Three High HIV-Prevalence Rural Districts in Mozambique

    PubMed Central

    Audet, Carolyn M.; Salato, José; Blevins, Meridith; Amsalem, David; Vermund, Sten H.; Gaspar, Felisbela

    2013-01-01

    Introduction Delayed uptake of clinical services impedes favorable clinical outcomes in Mozambique. Care is delayed among patients who initiate care with traditional healers; patients with conditions like human immunodeficiency virus (HIV) or tuberculosis are rarely referred to the health system in a timely fashion. Methods We conducted a pre-post educational intervention with traditional healers, assessing healer referral rates and HIV knowledge in three rural districts in Zambézia Province. Results The median monthly referral rate prior to the intervention was 0.25 patients (interquartile range [IQR]: 0–0.54) compared with a post-intervention rate of 0.34 patients (IQR: 0–0.71), a 35% increase (p = 0.046). A median HIV knowledge score of 67% (IQR: 59–78) was noted 4-months pre-intervention and a median score of 81% (IQR: 74–89) was recorded 2½ months post-intervention (p<0.001). One hundred and eleven healers referred 127 adults, 36 pregnant women, and 188 children to health facilities. Referred patients were most likely to be diagnosed with bronchopneumonia (20% adults; 13% children) and/or malaria (15% adults; 37% children). Of 315 non-pregnant persons referred, 3.5% were tested for HIV and 2.5% were tested for tuberculosis. Discussion We engaged traditional healers with some success; referral rates were low, but increased post-intervention. Once seen in the clinics, patients were rarely tested for HIV or tuberculosis, though symptoms suggested screening was indicated. We found increased referral rates through an inexpensive intervention with traditional healers, a viable, cost-effective method of directing patients to health facilities. However, quality improvement within the clinics is necessary before a substantial impact can be expected. PMID:23936407

  17. Prevalence of Dental Fluorosis Among Primary School Children in Rural Areas of Chidambaram Taluk, Cuddalore District, Tamil Nadu, India

    PubMed Central

    Saravanan, S; Kalyani, C; Vijayarani, MP; Jayakodi, P; Felix, AJW; Nagarajan, S; Arunmozhi, P; Krishnan, V

    2008-01-01

    Background: Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area. Materials and Methods: Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean's fluorosis index recommended by WHO (1997). Chi-square test, Chi-square trend test and Spearman's rank correlation coefficient test were used for statistical analysis. Results: Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls) were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI) score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant. Conclusion: Three out of six villages studied were in ‘borderline’ public health significance (CFI score 0.4-0.6). A well-designed epidemiological investigation can be undertaken to evaluate the risk factors associated with the

  18. Prevalence of dental fluorosis among primary school children in rural areas of chidambaram taluk, cuddalore district, Tamil Nadu, India.

    PubMed

    Saravanan, S; Kalyani, C; Vijayarani, Mp; Jayakodi, P; Felix, Ajw; Nagarajan, S; Arunmozhi, P; Krishnan, V

    2008-07-01

    Fluorosis is one of the common but major emerging areas of research in the tropics. It is considered endemic in 17 states of India. However, the Cuddalore district of Tamil Nadu is categorised as a fluorosis non-endemic area. But clinical cases of dental fluorosis were reported in the field practice area of Department of Community Medicine, Rajah Muthiah Medical College, Annamalai University, Chidambaram. Since dental fluorosis has been described as a biomarker of exposure to fluoride, we assessed the prevalence and severity of dental fluorosis among primary school children in the service area. Children studying in six primary schools of six villages in the field practice area of Rural Health Centre of Faculty of Medicine, Annamalai University, Chidambaram, were surveyed. Every child was clinically examined at the school by calibrated examiners with Dean's fluorosis index recommended by WHO (1997). Chi-square test, Chi-square trend test and Spearman's rank correlation coefficient test were used for statistical analysis. Five hundred and twenty-five 5- to 12-year-old school children (255 boys and 270 girls) were surveyed. The overall dental fluorosis prevalence was found to be 31.4% in our study sample. Dental fluorosis increased with age P < 0.001, whereas gender difference was not statistically significant. Aesthetically objectionable dental fluorosis was found in 2.1% of the sample. Villages Senjicherry, Keezhaperambai and Kanagarapattu revealed a community fluorosis index (CFI) score of 0.43, 0.54 and 0.54 with 5.6%, 4.8% and 1.4% of objectionable dental fluorosis, respectively. Correlation between water fluoride content and CFI values in four villages was noted to be positively significant. Three out of six villages studied were in 'borderline' public health significance (CFI score 0.4-0.6). A well-designed epidemiological investigation can be undertaken to evaluate the risk factors associated with the condition in the study region.

  19. Participatory rural appraisal to investigate constraints in reporting cattle mortalities in the Odi district of North West Province, south Africa.

    PubMed

    Makgatho, C N; McCrindle, C M E; Owen, J H

    2005-12-01

    Mortalities in cattle can have severe financial implications for small scale and communal farmers in South Africa. They could also be a measurable indicator for surveillance of animal diseases, such as those listed by the Office International des Epizooties (OIE), or diseases included in the regulations of the South African Animal Diseases Act, 1984 (Act 35 of 1984). In order to prevent further mortalities and for accurate surveillance and monitoring of diseases, it is important that farmers participate in the determination of causes of mortality in their cattle. This paper reports on constraints of the reporting diseases to the state veterinary services, the study area being Odi district, in the North West Province. The method that was followed was based on participatory rural appraisal. The selected cattle owners participated in every phase. They were the ones who first spoke to veterinary services about ways to decrease the diseases and mortalities of their cattle. A questionnaire to verify the facts complemented the survey. A total number of 60 farmers were randomly selected from 12 villages. One farmer withdrew, leaving 59 farmers. Most of the farmers in the study were men ( n = 55). The area of study was communal and the farming system traditional and extensive. It was suspected that there was a communication problem and this was proven by the results of the research, as 23 farmers were not even aware that mortalities have to be reported by law. The real problem was that causes of death were not being diagnosed because farmers were not aware that a necropsy could give information on the causes of death. Farmers were keen to receive training in elementary necropsy techniques so as to be able to discuss the cause of death of cattle with the state veterinarian.

  20. Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation.

    PubMed

    Rees, Kate; Zweigenthal, Virginia; Joyner, Kate

    2014-01-01

    Despite a high burden of disease, in South Africa, intimate partner violence (IPV) is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district. To evaluate the initiative from the perspectives of women using the service, service providers, and managers. A qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW), and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data. During the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV. This evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is a pressing need for clear policies and guidelines framing IPV as a

  1. Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation

    PubMed Central

    Rees, Kate; Zweigenthal, Virginia; Joyner, Kate

    2014-01-01

    Background Despite a high burden of disease, in South Africa, intimate partner violence (IPV) is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district. Objective To evaluate the initiative from the perspectives of women using the service, service providers, and managers. Design A qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW), and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data. Results During the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV. Conclusions This evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is a pressing need for

  2. Determinants of Patient's Adherence to Hypertension Medications in a Rural Population of Kancheepuram District in Tamil Nadu, South India

    PubMed Central

    Venkatachalam, J.; Abrahm, Sherin Billy; Singh, Zile; Stalin, P.; Sathya, G. R.

    2015-01-01

    Context: Non-communicable diseases, no longer a disease of the rich, impose a great threat in the developing nations due to demographic and epidemiological transition. This increasing burden of non-communicable diseases and their risk factors is worrisome. Adherence to hypertension (HT) medication is very important for improving the quality of life and preventing complications of HT. Aim: To study the factors determining adherence to HT medication. Settings and Design: A community-based cross-sectional study was conducted in a rural area of Kancheepuram district, Tamil Nadu, with a total population of around 16,005. Materials and Methods: This study was carried out over a period of 6 months (February-July) using a pre-structured and validated questionnaire. All eligible participants were selected by house-to-house survey and individuals not available on three consecutive visits were excluded from the study. The questionnaire included information on demographic characteristics, lifestyle habits, adherence to HT medication, blood pressure, and body mass index (BMI). Caste was classified based on Tamil Nadu Public Service commission. Statistical Analysis: Data were entered in MS Excel and analyzed in SPSS version 16. P value <0.05 was considered statistically significant. Ethical Consideration: Informed verbal consent was obtained prior to data collection. The patient's adherence to HT medication was assessed using the Morisky 4-Item Self-Report Measure of Medication-taking Behavior [MMAS-4]. Results: We studied 473 hypertensive patients of which 226 were males and 247 were females. The prevalence of adherence was 24.1% (n = 114) in the study population. Respondents with regular physical activity, non-smokers and non-alcoholics were more adherent to HT medication as compared with respondents with sedentary lifestyle, smoking and alcohol intake (P < 0.005). Based on health belief model, the respondents who perceived high susceptibility, severity, benefit had better

  3. Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator.

    PubMed

    Du Plessis, Dawie; Kapp, Paul Alfred; Jenkins, Louis S; Giddy, Laurel

    2016-06-30

    Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital. A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data. Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills. Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.

  4. Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator

    PubMed Central

    Plessis, Dawie Du; Alfred Kapp, Paul; Giddy, Laurel

    2016-01-01

    Background Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital. Methods A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data. Results Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills. Conclusions Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards. PMID:27380781

  5. Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.

    PubMed

    Dambach, Peter; Schleicher, Michael; Stahl, Hans-Christian; Traoré, Issouf; Becker, Norbert; Kaiser, Achim; Sié, Ali; Sauerborn, Rainer

    2016-07-22

    The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso. The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components. The average annual per capita costs of

  6. Undernutrition among Kenyan children: contribution of child, maternal and household factors.

    PubMed

    Gewa, Constance A; Yandell, Nanette

    2012-06-01

    To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s. Demographic and Health Survey data, multistage stratified cluster sampling methodology. Rural and urban areas of Kenya. A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya. Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children. The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on children's nutritional status varies with children's age.

  7. Low rate of Japanese encephalitis infection in rural children in Thanjavur district (Tamil Nadu), an area with extensive paddy cultivation.

    PubMed

    Vijayarani, H; Gajanana, A

    2000-06-01

    In Thanjavur district, the occurrence of Japanese encephalitis (JE) is very low and the district is free of epidemics. Among children aged 5-12 yr, the infection rates for JE in two consecutive transmission seasons of 1991-92 and 1992-93, were 1.8 and 5.1 per cent respectively. A high cattle to pigs ratio (400:1) could possibly be an important factor for the low JE infection rate in children in the district.

  8. Oral Health Status of Rural and Urban Population of Gurgaon Block, Gurgaon District Using WHO Assessment Form through Multistage Sampling Technique

    PubMed Central

    Prasad, Sumanth; Rajashekharappa, Chinmaya Byali; Garg, Aarti; Ryana, Haneet Kour; Khurana, Charu

    2016-01-01

    Introduction Oral health is an integral part of general health and well being. Poor oral health can affect a person physiologically and psychologically irrespective of age group. Aim To assess the oral health status and treatment needs of urban and rural population of Gurgaon Block, Gurgaon District, Haryana, India. Materials and Methods A descriptive cross-sectional study was conducted among 810 urban and rural subjects belonging to index age groups of 5, 12, 15, 35-44 and 65-74 years as recommended by WHO, in the city of Gurgaon, Haryana. The World Health Organization Oral Health Assessment Form (1997) was used for data collection in which clinical examination, soft and hard tissue findings as well as dentofacial anomalies were recorded. The subjects were selected by multistage random sampling and examined throughout the area by a house to house survey. Statistical Analysis The data was collected and subjected to analysis through SPSS 21. Chi-square was used for compilation of results. Results Of the total population 44.9% had dental caries with a mean DMFT of 1.61. Prevalence of periodontal diseases was 65%; 46% of the population suffered from malocclusions of which 21.19 % had the severe type. Dental fluorosis was found to be highly prevalent (46%) out of which 11.23% had moderate and 9.6% had severe type of fluorosis. Treatment was found to be required among 83% of population. Conclusion The dental health care needs are very high both in rural and urban areas in spite of basic facilities available in urban areas. Hence professional and administrative attention is required both in urban and rural areas. Gurgaon Block can be used as a model district to find the effectiveness of programs in bringing down the oral diseases and maintenance of the oral health of the people on a long term basis. PMID:27437359

  9. Socio-economic inequalities in the prevalence of multi-morbidity among the rural elderly in Bargarh District of Odisha (India).

    PubMed

    Banjare, Pallavi; Pradhan, Jalandhar

    2014-01-01

    Multi-morbidity among elderly is increasingly recognized as a major public health challenge in most of the developing countries. However, information on the size of population suffering from multi-morbidity and socio-economic differentials of multi-morbidity is scarce. The objectives of this paper are twofold; first, to assess the prevalence of various chronic conditions and morbidity among rural elderly and second, to examine the socio-economic and demographic factors that have a significant effect on the morbidity. A cross-sectional survey has been done using multi-stage random sampling procedure that was conducted among elderly (60+ years) in Bargarh District of Odisha during October 2011-February 2012. The survey was conducted among 310 respondents including 153 males and 157 females. Descriptive analyses were performed to assess the pattern of multi-morbidity. Logistic regression analyses were used to see the adjusted effect of various socio-economic and demographic covariates of multi-morbidity. The overall prevalence of multi-morbidity is 57% among rural elderly in Bargarh District of Odisha. The most common diseases in rural areas are: Arthritis, Chronic Obstructive Pulmonary Disease (COPD), High Blood Pressure and Cataract. Results from the logistic regression analyses show that age, state of economic independence and life style indicators are the most important measured predictors of multi-morbidity. Unlike earlier studies, wealth index and education have a marginal impact on multi-morbidity rate. Moreover, the occurrence of multi-morbidity is higher for elderly males compared to their female counterparts, though the difference is not significant. The high prevalence of morbidity observed in the present study suggests that there is an urgent need to develop geriatric health care services in a developing country like India. Any effort to reorganize primary care for elderly people should also consider the high prevalence of multi-morbidity among rural

  10. The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

    PubMed Central

    2011-01-01

    Background One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure. Methods We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance. Results At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample. Conclusions Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a similar policy to expand social

  11. Masculinity, social context and HIV testing: an ethnographic study of men in Busia district, rural eastern Uganda.

    PubMed

    Siu, Godfrey E; Wight, Daniel; Seeley, Janet A

    2014-01-13

    Uptake of HIV testing by men remains low in high prevalence settings in many parts of Africa. By focusing on masculinity, this study explores the social context and relations that shape men's access to HIV testing in Mam-Kiror, Busia district, rural eastern Uganda. From 2009-2010 in-depth interviews were undertaken with 26 men: nine being treated for HIV, eight who had tested but dropped out of treatment, six not tested but who suspected HIV infection and three with other health problems unrelated to HIV. These data were complemented by participant observation. Thematic analysis was undertaken. There were two main categories of masculinity in Mam-Kiror, one based on 'reputation' and the other on 'respectability', although some of their ideals overlapped. The different forms of masculine esteem led to different motives for HIV testing. Men positioned HIV testing as a social process understood within the social context and relationships men engaged in rather than an entirely self-determined enterprise. Wives' inferior power meant that they had less influence on men's testing compared to friends and work colleagues who discussed frankly HIV risk and testing. Couple testing exposed men's extra-marital relationships, threatening masculine esteem. The fear to undermine opportunities for sex in the context of competition for partners was a barrier to testing by men. The construction of men as resilient meant that they delayed to admit to problems and seek testing. However, the respectable masculine ideal to fulfil responsibilities and obligations to family was a strong motivator to seeking an HIV test and treatment by men. The two main forms of masculine ideals prevailing in Mam-Kiror in Busia led men to have different motives for HIV testing. Reputational masculinity was largely inconsistent with the requirements of couple testing, community outreach testing and the organisation of testing services, discouraging men from testing. Conversely, concern to perform one

  12. Assessment of the impacts of pit latrines on groundwater quality in rural areas: A case study from Marondera district, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Dzwairo, Bloodless; Hoko, Zvikomborero; Love, David; Guzha, Edward

    In resource-poor and low-population-density areas, on-site sanitation is preferred to off-site sanitation and groundwater is the main source of water for domestic uses. Groundwater pollution potential from on-site sanitation in such areas conflicts with Integrated Water Resources Management (IWRM) principles that advocate for sustainable use of water resources. Given the widespread use of groundwater for domestic purposes in rural areas, maintaining groundwater quality is a critical livelihood intervention. This study assessed impacts of pit latrines on groundwater quality in Kamangira village, Marondera district, Zimbabwe. Groundwater samples from 14 monitoring boreholes and 3 shallow wells were analysed during 6 sampling campaigns, from February 2005 to May 2005. Parameters analysed were total and faecal coliforms, NH4+-N, NO3--N, conductivity, turbidity and pH, both for boreholes and shallow wells. Total and faecal coliforms both ranged 0-TNTC (too-numerous-to-count), 78% of results meeting the 0 CFU/100 ml WHO guidelines value. NH4+-N range was 0-2.0 mg/l, with 99% of results falling below the 1.5 mg/l WHO recommended value. NO3--N range was 0.0-6.7 mg/l, within 10 mg/l WHO guidelines value. The range for conductivity values was 46-370 μS/cm while the pH range was 6.8-7.9. There are no WHO guideline values for these two parameters. Turbidity ranged from 1 NTU to 45 NTU, 59% of results meeting the 5 NTU WHO guidelines limit. Depth from the ground surface to the water table for the period February 2005 to May 2005 was determined for all sampling points using a tape measure. The drop in water table averaged from 1.1 m to 1.9 m and these values were obtained by subtracting water table elevations from absolute ground surface elevation. Soil from the monitoring boreholes was classified as sandy. The soil infiltration layer was taken as the layer between the pit latrine bottom and the water table. It averaged from 1.3 m to 1.7 m above the water table for two latrines

  13. [Management of sudden death in a semi-rural district, Seine-et-Marne: the DEFI 77 study].

    PubMed

    Pochmalicki, G; Le Tarnec, J-Y; Franchi, J-P; Empana, J-P; Genest, M; Foucher, R; Compagnon, F; Jouven, X; Lardoux, H; Guize, L

    2007-10-01

    Sudden death is a major problem in public health, affecting around 50 000 people a year in France. The prognosis for cardiac arrest is abysmal because for every minute lost the chances of survival diminish by 10%. The aim of this work was to prospectively evaluate the characteristics of cardiac arrest victims across an entire 6000 km? area, the Seine-et-Marne district, distinguished by the paradox of lying just outside the capital whilst actually being semi-rural, and to determine the current methods of dealing with this emergency. The DEFI 77 prospective epidemiological survey was carried out with the collaboration of the SAMU emergency medical service, the SDIS fire/ambulance service, the general hospitals and the Paris-Ile-de-France cardiological association. Between January 2001 and December 2005 there were 2001 cardiac arrests (mean age 68 +/- 20 years, 67% male) at home in 80% of cases. The arrest was in front of a witness in 72% of cases, but they performed resuscitation in only 14.3% of cases. The SAMU and SMUR emergency medical services attempted cardio-pulmonary resuscitation in 78% of cases. In 29% of cases, one or more external electric shocks were carried out, using a semi-automatic defibrillator 79% of the time. Only 11.5% of patients arrived at the emergency department alive, the overall hospital survival rate being less than 2%. Only eight patients subsequently underwent automatic defibrillator implantation. The results of this observational study are to a large extent explained by an extremely long delay (12 minutes) before help was called for, the delay between the call and the arrival of medical assistance (9.5 +/- 4 min), the low percentage of active witnesses, and the variability in management (invasive in particular). In conclusion, at the dawn of the third millennium the prognosis of cardiac arrest remains very poor and fully justifies educating the general public about calling for help early and about actions that can save lives

  14. Masculinity, social context and HIV testing: an ethnographic study of men in Busia district, rural eastern Uganda

    PubMed Central

    2014-01-01

    Background Uptake of HIV testing by men remains low in high prevalence settings in many parts of Africa. By focusing on masculinity, this study explores the social context and relations that shape men’s access to HIV testing in Mam-Kiror, Busia district, rural eastern Uganda. Methods From 2009–2010 in-depth interviews were undertaken with 26 men: nine being treated for HIV, eight who had tested but dropped out of treatment, six not tested but who suspected HIV infection and three with other health problems unrelated to HIV. These data were complemented by participant observation. Thematic analysis was undertaken. Results There were two main categories of masculinity in Mam-Kiror, one based on ‘reputation’ and the other on ‘respectability’, although some of their ideals overlapped. The different forms of masculine esteem led to different motives for HIV testing. Men positioned HIV testing as a social process understood within the social context and relationships men engaged in rather than an entirely self-determined enterprise. Wives’ inferior power meant that they had less influence on men’s testing compared to friends and work colleagues who discussed frankly HIV risk and testing. Couple testing exposed men’s extra-marital relationships, threatening masculine esteem. The fear to undermine opportunities for sex in the context of competition for partners was a barrier to testing by men. The construction of men as resilient meant that they delayed to admit to problems and seek testing. However, the respectable masculine ideal to fulfil responsibilities and obligations to family was a strong motivator to seeking an HIV test and treatment by men. Conclusion The two main forms of masculine ideals prevailing in Mam-Kiror in Busia led men to have different motives for HIV testing. Reputational masculinity was largely inconsistent with the requirements of couple testing, community outreach testing and the organisation of testing services, discouraging men

  15. The Perceived Impact of the Curriculum Administrator in Facilitating a Vision of Learning in Small, Rural Pennsylvania School Districts

    ERIC Educational Resources Information Center

    Wolf, Mary A.

    2010-01-01

    One important element of school district reform involves quality district leadership. Researchers have shown that effective school leadership requires numerous responsibilities including knowledge of curriculum, instruction, and assessment (Marzano, Waters & McNulty, 2005). Principals typically have difficulty being strong leaders in this…

  16. The Perceived Impact of the Curriculum Administrator in Facilitating a Vision of Learning in Small, Rural Pennsylvania School Districts

    ERIC Educational Resources Information Center

    Wolf, Mary A.

    2010-01-01

    One important element of school district reform involves quality district leadership. Researchers have shown that effective school leadership requires numerous responsibilities including knowledge of curriculum, instruction, and assessment (Marzano, Waters & McNulty, 2005). Principals typically have difficulty being strong leaders in this…

  17. Planning a School Construction Referendum: A Case Study of a Small Rural School District in Southern New Jersey

    ERIC Educational Resources Information Center

    Russo, Christopher J.

    2010-01-01

    The idea to do research in the area of school construction planning came from this writer's experience in a district that was still using a high school that was built in 1914 and the community was happy with that fact. During this writer's time the district had gone to referendum to ask the voters to approve a $67 million building project that…

  18. Use of traditional medicines in the management of HIV/AIDS opportunistic infections in Tanzania: a case in the Bukoba rural district

    PubMed Central

    Kisangau, Daniel P; Lyaruu, Herbert VM; Hosea, Ken M; Joseph, Cosam C

    2007-01-01

    Background Ethnobotanical surveys were carried out to document herbal remedies used in the management of HIV/AIDS opportunistic infections in Bukoba Rural district, Tanzania. The district is currently an epicenter of HIV/AIDS and although over 90% of the population in the district relies on traditional medicines to manage the disease, this knowledge is impressionistic and not well documented. The HIV/AIDS opportunistic conditions considered during the study were Tuberculosis (TB), Herpes zoster (Shingles), Herpes simplex (Genital herpes), Oral candidiasis and Cryptococcal meningitis. Other symptomatic but undefined conditions considered were skin rashes and chronic diarrhea. Methods An open-ended semi-structured questionnaire was used in collecting field information. Descriptive statistics were used to analyze the ethnobotanical data collected. Factor of informant consensus (Fic) was used to analyze the ethnobotanical importance of the plants. Results In the present study, 75 plant species belonging to 66 genera and 41 families were found to be used to treat one or more HIV/AIDS related infections in the district. The study revealed that TB and oral candidiasis were the most common manifestations of HIV/AIDS opportunistic infections affecting most of the population in the area. It unveils the first detailed account of ethnomedical documentation of plants focusing the management of HIV/AIDS related infections in the district. Conclusion It is concluded that the ethnopharmacological information reported forms a basis for further research to identify and isolate bioactive constituents that can be developed to drugs for the management of the HIV/AIDS opportunistic infections. PMID:17623081

  19. “It is not possible for me to have diabetes”–Community Perceptions on Diabetes and Its Risk Factors in Rural Purworejo District, Central Java, Indonesia

    PubMed Central

    Pujilestari, Cahya Utamie; Ng, Nawi; Hakimi, Mohammad; Eriksson, Malin

    2014-01-01

    Accumulating evidence suggests that negative perceptions towards diabetes can limit the management and prevention of the disease. The negative perceptions towards diabetes are prevalent in many different settings, especially among rural communities. Few qualitative studies have been performed to understand how the community views diabetes and its associated risk factors. This study aimed to explore general community perceptions of diabetes and its risk factors in rural Indonesia. A total of 68 participants were recruited to 12 focus group discussions (FGDs) comprised of different age groups and sexes. The FGDs were conducted in six villages in rural Purworejo District, Central Java, Indonesia, from 2011 to 2012. All FGDs were recorded and transcribed. Qualitative content analysis was performed to describe and analyse how the rural community perceived diabetes and its risk factors. Diabetes was perceived as a visible and scary sugar disease, and the affected individuals themselves were blamed for getting the disease. Recognised as ‘sugar’ or ‘sweet-pee’ disease with terrifying effects, diabetes was believed to be a disease with no cure. The participants seemed to have an unrealistic optimism with regards to the diabetes risk factors. They believed that diabetes would not affect them, only others, and that having family members with diabetes was necessary for one to develop diabetes. Our findings demonstrate that rural communities have negative perceptions about diabetes and at the same time individuals have unrealistic optimism about their own risk factors. Understanding how such communities perceive diabetes and its risk factors is important for planning prevention strategies. Health messages need to be tailored to health-related behaviours and the local culture’s concepts of diseases and risk factors. PMID:25168994

  20. "It is not possible for me to have diabetes"-community perceptions on diabetes and its risk factors in Rural Purworejo District, Central Java, Indonesia.

    PubMed

    Pujilestari, Cahya Utamie; Ng, Nawi; Hakimi, Mohammad; Eriksson, Malin

    2014-06-12

    Accumulating evidence suggests that negative perceptions towards diabetes can limit the management and prevention of the disease. The negative perceptions towards diabetes are prevalent in many different settings, especially among rural communities. Few qualitative studies have been performed to understand how the community views diabetes and its associated risk factors. This study aimed to explore general community perceptions of diabetes and its risk factors in rural Indonesia. A total of 68 participants were recruited to 12 focus group discussions (FGDs) comprised of different age groups and sexes. The FGDs were conducted in six villages in rural Purworejo District, Central Java, Indonesia, from 2011 to 2012. All FGDs were recorded and transcribed. Qualitative content analysis was performed to describe and analyse how the rural community perceived diabetes and its risk factors. Diabetes was perceived as a visible and scary sugar disease, and the affected individuals themselves were blamed for getting the disease. Recognised as 'sugar' or 'sweet-pee' disease with terrifying effects, diabetes was believed to be a disease with no cure. The participants seemed to have an unrealistic optimism with regards to the diabetes risk factors. They believed that diabetes would not affect them, only others, and that having family members with diabetes was necessary for one to develop diabetes. Our findings demonstrate that rural communities have negative perceptions about diabetes and at the same time individuals have unrealistic optimism about their own risk factors. Understanding how such communities perceive diabetes and its risk factors is important for planning prevention strategies. Health messages need to be tailored to health-related behaviours and the local culture's concepts of diseases and risk factors.

  1. A Comparison of Zimbabwe's Rural and Urban Primary School Pupils' Views about Homework: A Case of Masvingo District

    ERIC Educational Resources Information Center

    Mapako, Felix Petros; Mareva, Rugare; Chindedza, Winnet

    2013-01-01

    The study sought to establish and compare the views of rural and urban primary school pupils on homework in Zimbabwe, using six purposively sampled Masvingo rural and urban primary schools. The inquiry employed a qualitative methodology in which data were gathered through semi-structured personal interviews and document analysis. A sample of…

  2. Student Mobility in Rural and Nonrural Districts in Five Central Region States. Issues & Answers. REL 2010-No. 089

    ERIC Educational Resources Information Center

    Beesley, Andrea; Moore, Laurie; Gopalani, Sarah

    2010-01-01

    This report describes the extent and distribution of student mobility in five Central Region states. The study, which calculated student mobility percentages in each state and compared percentages by locale (city, suburb, town, and rural locale, and degree of rurality) within each state, found no consistent patterns across locales. Research…

  3. Coverage and predictors of vaccination among children of 1-4 years of age in a rural sub-district of Sindh.

    PubMed

    Shaikh, Shiraz; Taj, Tahir M; Kazi, Ambreen; Ahmed, Jamil; Fatmi, Zafar

    2010-12-01

    To estimate the proportion of children 1-4 years of age vaccinated in the first year of their life and determine socio-demographic factors associated with vaccination in the rural sub-district Khairpur, Sindh, Pakistan. Cross-sectional study. The study was conducted in 9 Union Councils of sub-district Gambat, district Khairpur, Sindh, from August to October 2008. A questionnaire based representative multi-stage cluster survey was conducted. A total of 549 children aged 1-4 years were assessed for coverage and predictors of vaccination. Univariate and multivariate analysis was done using logistic regression to determine the unadjusted and adjusted relationship between socio-demographic predictor and outcome (vaccination status). The coverage for complete vaccination was 71.9% (95%CI=68.1%-75.7%). Educational level of mother (p=0.042), father (p=0.001) and child birth at hospital (p=0.006) were significantly associated with the vaccination status. Mother's educational level of intermediate and above was the strongest predictor (OR=12.19, 95%CI=1.57-94.3) for vaccination. Education of parents, particularly mother's education was important determinant of vaccination status of the children. In addition, distance from taluka health facility and misconception of parents were among the main reasons of not getting the children vaccinated. There is a need to educate the parents especially mothers about the importance of vaccination and organize EPI services at Basic Health Unit level to improve the vaccination coverage in rural areas of Pakistan.

  4. Fatherhood in Kenyan Ethnic Communities: Implication for Child Development

    ERIC Educational Resources Information Center

    Lasser, Jon; Fite, Kathleen; Wadende, Akinyi P.

    2011-01-01

    This article reviews the traditional and evolving constructions of fatherhood in Kenyan society, with an emphasis on fatherhood's impact on child development outcomes. Western influence and increased access to technology have changed the role of the Kenyan father, and in turn affected his role in the family. Special attention is given to…

  5. Fatherhood in Kenyan Ethnic Communities: Implication for Child Development

    ERIC Educational Resources Information Center

    Lasser, Jon; Fite, Kathleen; Wadende, Akinyi P.

    2011-01-01

    This article reviews the traditional and evolving constructions of fatherhood in Kenyan society, with an emphasis on fatherhood's impact on child development outcomes. Western influence and increased access to technology have changed the role of the Kenyan father, and in turn affected his role in the family. Special attention is given to…

  6. Ethno-veterinary control of parasites, management and role of village chickens in rural households of Centane district in the Eastern Cape, South Africa.

    PubMed

    Mwale, M; Masika, P J

    2009-12-01

    Mwale and Masika 2009 Ethno-veterinary control of parasites, management and role of village chickens in rural households of Centane district in the Eastern Cape, South Africa. Tropical Animal Health and Production. Village chickens contribute significantly towards rural livelihood in the African continent through the provision of animal protein, income and socio-cultural uses. However, village chickens are susceptible to parasite infestation. Due to limitations of using western drugs to control these parasites, farmers resort to the use of ethno-veterinary medicine (EVM). However, there is dearth of information on EVM use in chickens. Therefore, the objective of the current study was to document various EVM practices used in controlling gastro-intestinal parasites in village chickens. Stratified random sampling was used to select 62 chicken farmers that were interviewed using a structured questionnaire About 70 and 96.7% of farmers provided housing and water for their chickens respectively whereas the rest did not. The chief role of chickens was meat provision (91.7%). Most households (86%) reported parasite problems in chickens, particularly gastro-intestinal parasites. Eighty-three percent of the interviewed respondents use medicinal plants to control both internal and external parasites in chickens. Use of plants increased with parasite incidences (r=0.347; P<0.01). Mainly gastro-intestinal parasites were problematic and were largely controlled by medicinal plants. Further research on pharmacological properties, safety and efficacy of these plants is important for improved chicken productivity and hence rural livelihood.

  7. Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district.

    PubMed

    Dhar, V; Jain, A; Van Dyke, T E; Kohli, A

    2007-01-01

    High prevalence of dental diseases has been recorded in Rajasthan, however, not much work has been done to ascertain the prevalence of dental diseases in Udaipur district. This study was conducted among 1,587 government school children of Udaipur district in the age group of 5-14 years for recording the prevalence of gingival diseases, fluorosis and malocclusion. Gingivitis was found in 84.37% of children, malocclusion in 36.42% and fluorosis in 36.36%.

  8. The Rural Bellwether.

    ERIC Educational Resources Information Center

    Walker, Sherry Freeland, Ed.

    2001-01-01

    This theme issue of "State Education Leader" contains eight articles on rural education. "The Rural Bellwether" (Kathy Christie) discusses declining enrollment in rural schools, rural problems with teacher shortages and special education funding, issues related to school size and school district size, and distance learning…

  9. Leadership for Rural Schools.

    ERIC Educational Resources Information Center

    Stephens, E. Robert; Turner, Walter G.

    The rural school superintendency is, in many ways, as demanding and difficult as the urban superintendency. Chapter 1 of this book provides a working definition of a rural small school district, an estimation of the number of rural systems in the nation that fit the criteria, and a profile of rural small school superintendents. Chapter 2 discusses…

  10. Prevalence and risk factors of intestinal protozoan infections: a population-based study in rural areas of Boyer-Ahmad district, Southwestern Iran.

    PubMed

    Sarkari, Bahador; Hosseini, Ghasem; Motazedian, Mohammad Hossein; Fararouei, Mohammad; Moshfe, Abdolali

    2016-11-25

    Parasitic infections are still a significant health problem in rural areas in developing countries including Iran. There is no recent population-based data about the prevalence of human intestinal parasites in most rural areas of Iran. The current study aimed to determine the prevalence of intestinal protozoan infection in inhabitants of rural areas of Boyer-Ahmad district, Southwestern Iran. A total of 1025 stool samples were collected from the inhabitant of 50 randomly selected villages in Boyer-Ahmad Township. The stool samples were evaluated by parasitological methods including, direct wet-mounting, formalin ethyl acetate concentration, zinc sulfate floatation, and Trichrome permanent stain for detection of protozoan infections. Diarrheic samples were further evaluated with a modified Ziehl-Neelsen staining method for detection of coccidian parasites. The prevalence of both pathogenic and nonpathogenic intestinal parasites in the population was 37.5% (385 out of 1025 cases), some individual with multiple infections. Giardia lamblia was detected in 179 (17.46%), Blastocystis hominis in 182 (17.76%), Entamoeba histolytica/dispar in 9 (0.87%), Endolimax nana in 216 (21.07%), Entamoeba coli in 151 (14.73%), Ioedamoeba butschlii in 45 (4.39%), Chillomastix mesnili in 22 (2.14%), Trichomonas hominis in 2 (0.19%) and Dientamoeba fragillis in 2 (0.19%) of cases. Multivariate logistic regression revealed significant associations between protozoan infection (pathogenic protozoa) and contact with animals (OR yes/no = 2.22, p < 0.001) and educational status (OR higher/illiterate = 0.40, P = 0.01). Findings of this study demonstrated that protozoan infection rate in rural areas of southwestern Iran is still high and remained as a challenging health problem in these areas.

  11. Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam

    PubMed Central

    Van Minh, Hoang; Tuan Anh, Tran; Rocklöv, Joacim; Bao Giang, Kim; Trang, Le Quynh; Sahlen, Klas-Göran; Nilsson, Maria; Weinehall, Lars

    2014-01-01

    Background As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. Objective This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. Design This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. Results 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely

  12. Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam.

    PubMed

    Van Minh, Hoang; Tuan Anh, Tran; Rocklöv, Joacim; Bao Giang, Kim; Trang, Le Quynh; Sahlen, Klas-Göran; Nilsson, Maria; Weinehall, Lars

    2014-01-01

    As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease

  13. Successful Tuberculosis Treatment Outcomes among HIV/TB Coinfected Patients Down-Referred from a District Hospital to Primary Health Clinics in Rural South Africa

    PubMed Central

    Jacobson, Karen B.; Moll, Anthony P.; Friedland, Gerald H.; Shenoi, Sheela V.

    2015-01-01

    Background HIV and tuberculosis (TB) coinfection remains a major public health threat in sub-Saharan Africa. Integration and decentralization of HIV and TB treatment services are being implemented, but data on outcomes of this strategy are lacking in rural, resource-limited settings. We evaluated TB treatment outcomes in TB/HIV coinfected patients in an integrated and decentralized system in rural KwaZulu-Natal, South Africa. Methods We retrospectively studied a cohort of HIV/TB coinfected patients initiating treatment for drug-susceptible TB at a district hospital HIV clinic from January 2012-June 2013. Patients were eligible for down-referral to primary health clinics(PHCs) for TB treatment completion if they met specific clinical criteria. Records were reviewed for patients’ demographic, baseline clinical and laboratory information, past HIV and TB history, and TB treatment outcomes. Results Of 657(88.7%) patients, 322(49.0%) were female, 558(84.9%) were new TB cases, and 572(87.1%) had pulmonary TB. After TB treatment initiation, 280(42.6%) were down-referred from the district level HIV clinic to PHCs for treatment completion; 377(57.4%) remained at the district hospital. Retained patients possessed characteristics indicative of more severe disease. In total, 540(82.2%) patients experienced treatment success, 69(10.5%) died, and 46(7.0%) defaulted. Down-referred patients experienced higher treatment success, and lower mortality, but were more likely to default, primarily at the time of transfer to PHC. Conclusion Decentralization of TB treatment to the primary care level is feasible in rural South Africa. Treatment outcomes are favorable when patients are carefully chosen for down-referral. Higher mortality in retained patients reflects increased baseline disease severity while higher default among down-referred patients reflects failed linkage of care. Better linkage mechanisms are needed including improved identification of potential defaulters, increased

  14. Working Together, Staying Vital. Proceedings of the Joint Conference of the Western Australian District High Schools Administrators' Association and the National Society for the Provision of Education in Rural Australia (20th, Fremantle, Western Australia, June 2004)

    ERIC Educational Resources Information Center

    Boylan, Colin, Ed.; Hemmings, Brian, Ed.

    2004-01-01

    The 20th National Society for the Provision of Education in Rural Australia (SPERA) and Western Australia District High School Administrators' Association (WADHSAA) joint conference proceedings, based on the theme "Working Together, Staying Vital," was held in Fremantle, Perth, Western Australia, in June 2004. The proceedings contain 13…

  15. Public accountability needs to be enforced -a case study of the governance arrangements and accountability practices in a rural health district in Ghana.

    PubMed

    Van Belle, Sara; Mayhew, Susannah H

    2016-10-12

    Improving public accountability is currently high on the global agenda. At the same time, the organisation of health services in low- and middle-income countries is taking place in fragmented institutional landscapes. State and non-state actors are involved in increasingly complex governance arrangements. This often leads to coordination problems, confusion of roles and responsibilities and possibly accountability gaps. This study aimed at assessing the governance arrangements and the accountability practices of key health actors at the level of a Ghanaian health district with the aim to understand how far public accountability is achieved. We adopted the case study design as it allows for in-depth analysis of the governance arrangements and accountability relations between actors, their formal policies and actual accountability practices towards the public and towards stakeholders. Data were collected at a rural health district using in-depth interviews, observation and document review. In the analysis, we used a four-step sequence: identification of the key actors and their relationships, description of the multi-level governance arrangements, identification of the actual accountability relations and practices between all actors and finally appraisal of the public accountability practices, which we define as those practices that ensure direct accountability towards the public. In this rural health district with few (international) non-governmental organisations and private sector providers, accountability linkages towards management and partners in health programmes were found to be strong. Direct accountability towards the public, however, was woefully underdeveloped. This study shows that in settings where there is a small number of actors involved in organising health care, and where the state actors are underfunded, the intense interaction can lead to a web of relations that favours collaboration between partners in health service delivery, but fails public

  16. A Comparative Study to Assess the Awareness of Palliative Care Between Urban and Rural Areas of Ernakulum District, Kerala, India

    PubMed Central

    Joseph, Nitin; S, Jayarama; Kotian, Shashidhar

    2009-01-01

    Aim: To assess the knowledge and attitude toward palliative care among people residing in urban and rural areas. Materials and Methods: This cross-sectional study was conducted among 185 urban and 165 rural households. Senior-most member of the household present was interviewed using a questionnaire. Only those people who have heard about palliative care were included in the study. Results: Out of 350 people, 47 (13.4%) have heard about palliative care. Of these 38 (20.5%) belonged to urban and 9 (5.4%) belonged to rural areas (P < 0.0001).Twenty-nine (15.7%) participants in urban and 7 (4.2%) in rural areas had some knowledge about palliative care (P = 0.0002). Source of information for 25 (53.2%) participants was newspapers followed by television 17 (36.2%). Thirty-three (86.8%) participants in urban and 7 (77.8%) in rural areas felt that palliative care helps in improving quality of life. Twenty (52.6%) participants in urban and 4 (44.4%) participants in rural areas felt that palliative care can be better provided at homes than hospitals. Thirty (78.9%) urban participants felt that bad news about the patient's condition needs to be told to the patient first and then to their family members. In case of rural participants majority 7 (77.8%) said vice versa (P = 0.0039). Conclusion: Overall awareness of palliative care was poor. This calls for large-scale awareness campaigns. As home-based palliative care was preferred by many, home visits by care providers and training of family members of patient's needing palliative care needs to be practiced widely. PMID:20668590

  17. Qualification of Staff, Organization of Services, and Management of Pregnant Women in Rural Settings: The Case of Diema and Kayes Districts (Mali)

    PubMed Central

    Dogba, Maman; Fournier, Pierre; Berthe-Cisse, Safoura

    2012-01-01

    In Mali, a poor sub-Saharan country, maternity referral systems were implemented to combat the still-high rates of maternal mortality. This qualitative study was aimed at understanding the relationships between the qualification of staff in community health centres, the organization of services, and the management of pregnant women in the maternity referral system in Kayes, a rural region of Mali. Physicians who managed CHCs actively or passively modified work organization, the level of technology, their obstetric skills, and staffing. They also created a competitive environment and developed relationships of trust with patients and with the district health centre. These findings are helpful in orienting decision-making for better personnel management. PMID:22619728

  18. Power imbalance and consumerism in the doctor-patient relationship: health care providers' experiences of patient encounters in a rural district in India.

    PubMed

    Fochsen, Grethe; Deshpande, Kirti; Thorson, Anna

    2006-11-01

    The aim of this study is to explore health care providers' experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor's dominance. A patient-centered approach, acknowledging patients' own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.

  19. [Funding of a free healthcare campaign in a rural district of Cameroon: optimizing the role of civil society in sub-Saharan Africa].

    PubMed

    Keugoung, B; Fouelifack Ymele, F; Dongtsa Mabou, J; Nangue, C; Ngouadjio Kougoum, P; Takoudjou, L; Hercot, D; Meli, J

    2013-05-01

    Financial barriers represent a major obstacle to access to health care in sub-Saharan Africa and thus to the implementation of the Bamako Initiative. We describe an experience in which a civil society organization financed a free healthcare campaign in a rural health district in Cameroon. In all, 2,073 patients received free consultations, laboratory tests, and drugs. Adults older than 40 years accounted for 55.7% of all patients. The most frequent diseases were: osteoarticular conditions (24.1%), malaria (20.8%), and intestinal parasitosis (12.5%). In health systems financed mainly by cost recovery, some population needs remain uncovered by health services. There is a need to involve and reinforce the role of civil society in health system financing. It can help to pool more funds and improve the management of health resources to increase financial access to health care for poor people.

  20. Diterpenoid derivatives of Kenyan Croton sylvaticus.

    PubMed

    Ndunda, Beth; Langat, Moses K; Midiwo, Jacob O; Omosa, Leonidah K

    2015-04-01

    Kenyan Croton sylvaticus Hochst. ex Krauss gave four clerodane diterpenoids, the new ent-3,13E-clerodadiene-15-formate (1), the known 15-acetoxy-ent-3,13E-clerodadiene (2), ent-3,13E-clerodadien-15-ol (3) and hardwickiic acid (4), two known halimane diterpenoids, penduliflaworosin (5) and crotohalimaneic acid (6) and one labdane diterpenoid, labda-13E-ene-8a,15-diol (7). The compounds, when tested for their anti-microbial activities against Bacillus subtilis, Xanthomonas campestris and Candida albicans, were found to be inactive.

  1. Disaster Risk Management - The Kenyan Challenge

    NASA Astrophysics Data System (ADS)

    Nabutola, W.; Scheer, S.

    2009-04-01

    Keywords: natural disasters; man-made disasters; terrorist attacks; land slides; disaster policies and legislations; fire; earthquakes; hurricanes; soil erosion; disaster research policy; Preamble: "Risk does not begin and end on the floor of the New York Stock Exchange. The vastness of the subject matter is daunting. Risk touches on the most profound aspects of psychology, mathematics, statistics and history. The literature is monumental; each day's headlines bring many new items of interest. But I know we are not unique, everywhere in the world risks abound." "AGAINST THE GODS the remarkable story of risk" by Peter L. Bernstein, 1998 The real challenge is what can we, as a nation do to avert, prevent them, or in the unfortunate event that they occur, how can we mitigate their impact on the economy? Introductory remarks: Disaster in Kenya, as indeed anywhere else, is not one of those happenings we can wish away. It can strike anywhere any time. Some of it is man-made but most of it is natural. The natural are sometimes induced by man in one way or another. For example, when we harvest trees without replacing them, this diminishes the forest cover and can lead to soil erosion, whose advanced form is land slides. Either way disasters in their different forms and sizes present challenges to the way we live our lives or not, perhaps, even how we die. Disasters in our country have reached crisis stage. ‘In Chinese language, crisis means danger, but it also means opportunity' Les Brown, motivational speaker in "the power of a larger vision" Why I am interested Whereas Kenya experiences man made and natural disasters, there are more sinister challenges of the man-made variety. These loom on the horizon and, from time to time raise their ugly heads, taking many Kenyan lives in their wake, and property destroyed. These are post election violence and terrorist attacks, both related to politics, internal and external. In January 2008, soon after presidential and national

  2. Disaster Risk Management - The Kenyan Challenges

    NASA Astrophysics Data System (ADS)

    Nabutola, W.

    2009-04-01

    Keywords: natural disasters; man-made disasters; terrorist attacks; land slides; disaster policies and legislations; fire; earthquakes; hurricanes; soil erosion; disaster research policy; Preamble: "Risk does not begin and end on the floor of the New York Stock Exchange. The vastness of the subject matter is daunting. Risk touches on the most profound aspects of psychology, mathematics, statistics and history. The literature is monumental; each day's headlines bring many new items of interest. But I know we are not unique, everywhere in the world risks abound." "AGAINST THE GODS the remarkable story of risk" by Peter L. Bernstein, 1998 The real challenge is what can we, as a nation do to avert, prevent them, or in the unfortunate event that they occur, how can we mitigate their impact on the economy? Introductory remarks: Disaster in Kenya, as indeed anywhere else, is not one of those happenings we can wish away. It can strike anywhere any time. Some of it is man-made but most of it is natural. The natural are sometimes induced by man in one way or another. For example, when we harvest trees without replacing them, this diminishes the forest cover and can lead to soil erosion, whose advanced form is land slides. Either way disasters in their different forms and sizes present challenges to the way we live our lives or not, perhaps, even how we die. Disasters in our country have reached crisis stage. ‘In Chinese language, crisis means danger, but it also means opportunity' Les Brown, motivational speaker in "the power of a larger vision" Why I am interested Whereas Kenya experiences man made and natural disasters, there are more sinister challenges of the man-made variety. These loom on the horizon and, from time to time raise their ugly heads, taking many Kenyan lives in their wake, and property destroyed. These are post election violence and terrorist attacks, both related to politics, internal and external. In January 2008, soon after presidential and national

  3. Unmet Needs of Family Planning Among Women: A Cross-Sectional Study in a Rural Area of Kanchipuram District, Tamil Nadu, South India.

    PubMed

    Vishnu Prasad, R; Venkatachalam, J; Singh, Zile

    2016-10-01

    Global contraceptive usage was 63.3 % in 2010 which was 9 % more than that in 1990. NFHS-III 2005-2006 revealed that the contraceptive prevalence rate was 56 % while in the past decade it was 48 %. In India, female sterilization is the most commonly preferred method of contraception accounting for 76 %, while in Tamil Nadu it was 90 %. Thus, this study aims at measuring the prevalence of unmet needs of family planning and its determinants in a rural area of Kancheepuram district, Tamil Nadu. The study was carried out as a community-based cross-sectional study in Chunambed panchayat, a rural area in Kanchipuram District, Tamil Nadu, India, among 505 women of age group 15-49 years. Cluster random sampling was done to select the households to include in the study. In every household, all the available and eligible women were explained about the study and recruited after obtaining informed consent. Chi-square test was applied for finding the difference in proportion, and p value <0.05 was considered statistically significant. The prevalence of unmet need for family planning in our study population was nearly 31 %; it was even more for younger age groups and for the women whose family size was less. 51.7 % of the participants were currently using a contraceptive measure and very few of their partners used contraception. Government health facilities were the major source of contraceptive service and majority of our participants were well aware about the various contraceptive methods. Unmet needs of family planning were high in our study population, and the knowledge about the contraceptive use and family planning was found to be fairly adequate.

  4. An assessment of the water quality of drinking water in rural districts in Zimbabwe. The case of Gokwe South, Nkayi, Lupane, and Mwenezi districts

    NASA Astrophysics Data System (ADS)

    Hoko, Zvikomborero

    Zimbabwe generally receives an average rainfall of 675 mm per annum of which only a maximum of 10% finds its way to rivers as runoff. Gokwe, Nkayi, Lupane and Mwenezi are some of the driest districts in Zimbabwe having mean annual runoffs (MAR) in the range 17-70 mm. River flows especially in Nkayi and Lupane are seasonal and often dry in the period June to November every year. The Kalahari sands predominantly found in such areas as Gokwe, Nkayi, and Lupane promote rapid percolation of rainwater leaving little runoff. The main source of water for domestic purposes in these areas is groundwater with very little reliance on surface water. This study analyzed the water quality of water points in Gokwe South, Nkayi, Lupane, and Mwenezi districts. Parameters analyzed were pH, temperature, dissolved oxygen (DO), turbidity and electrical conductivity (EC). Water quality perceptions from the villagers and the research team were investigated and possible correlations studied. Water quality perceptions included, taste and soap consumption and colour. The uses of the water at domestic level as well as available alternatives to borehole water were investigated. The pH generally ranged from 6.5 to 8.0, which is within the Canadian guidelines. DO was 0.3-5.9 mg/l while turbidity ranged from 0 to 259 NTU with Mwenezi having the highest turbidity value. Conductivity ranged from 70 to 9800 μS/cm with the lowest and highest values recorded in Gokwe and Mwenezi. It was found out that the water quality in terms of taste and odour was 97% satisfactory for Gokwe South, 85% Nkayi, 64% Lupane, and 62% for Mwenezi. High soap consumption which is related to hardness was perceived to be least in Lupane (14%) and highest in Mwenezi with 81%. In general taste complaints also corresponded to high soap consumption but the opposite was not true. It was observed that there was no clear correlation between the quality parameters studied and perceived quality as for example satisfactory taste

  5. Economic Assessment of Rural District Heating by Bio-Steam Supplied by a Paper Mill in Canada

    ERIC Educational Resources Information Center

    Marinova, Mariya; Beaudry, Catherine; Taoussi, Abdelaziz; Trepanier, Martin; Paris, Jean

    2008-01-01

    The article investigates the feasibility of district heating in a small town adjacent to a Kraft pulp mill in eastern Canada. A detailed heat demand analysis is performed for all buildings using a geographical information system and archived data provided by the municipality. The study shows that the entire space heating requirement of the town…

  6. Limited Access to AP Courses for Students in Smaller and More Isolated Rural School Districts. National Issue Brief Number 80

    ERIC Educational Resources Information Center

    Gagnon, Douglas J.; Mattingly, Marybeth J.

    2015-01-01

    This brief assesses trends in access to, enrollment in, and success in Advanced Placement (AP) coursework in relation to school district poverty, racial composition, and urbanicity. It uses data merged from the 2011-2012 Civil Rights Data Collection (CRDC), the 2012 Small Area Income and Poverty Estimates (SAIPE), and the 2010 Decennial U.S.…

  7. Trends and Options in the Reorganization or Closure of Small or Rural Schools and Districts. ERIC Digest.

    ERIC Educational Resources Information Center

    Lutz, Frank W.

    This ERIC digest examines the slowed pace of school district reorganization since 1970 and the expanded role of state education agencies (SEAs). It also reports trends that influence consideration of various reorganization forms and considers the framework in which future policy options may take shape. The decades from 1940 to 1970 show the…

  8. Urban, Suburban, and Rural Contexts of School Districts and Neighborhood Revitalization Strategies: Rediscovering Equity in Education Policy and Urban Planning

    ERIC Educational Resources Information Center

    Silverman, Robert Mark

    2014-01-01

    This article revisits the debate about school reform and homeownership-based strategies for neighborhood revitalization. It is based on an analysis of school districts in New York State using data from the American Community Survey (ACS) and the New York State Education Department (NYSED). Findings indicate that the relationship between schools…

  9. Urban, Suburban, and Rural Contexts of School Districts and Neighborhood Revitalization Strategies: Rediscovering Equity in Education Policy and Urban Planning

    ERIC Educational Resources Information Center

    Silverman, Robert Mark

    2014-01-01

    This article revisits the debate about school reform and homeownership-based strategies for neighborhood revitalization. It is based on an analysis of school districts in New York State using data from the American Community Survey (ACS) and the New York State Education Department (NYSED). Findings indicate that the relationship between schools…

  10. Economic Assessment of Rural District Heating by Bio-Steam Supplied by a Paper Mill in Canada

    ERIC Educational Resources Information Center

    Marinova, Mariya; Beaudry, Catherine; Taoussi, Abdelaziz; Trepanier, Martin; Paris, Jean

    2008-01-01

    The article investigates the feasibility of district heating in a small town adjacent to a Kraft pulp mill in eastern Canada. A detailed heat demand analysis is performed for all buildings using a geographical information system and archived data provided by the municipality. The study shows that the entire space heating requirement of the town…

  11. Meeting the Learning Needs of Students: A Rural High-Need School District's Systemic Leadership Development Initiative

    ERIC Educational Resources Information Center

    Browne-Ferrigno, Tricia; Maynard, Brenda

    2005-01-01

    The Principals Excellence Program (PEP), a cohort-based professional development project for administrator-certified practitioners, is one of 24 projects across the United States supported by federal funds from the No Child Left Behind legislation. The three-year program is conducted through a partnership between Pike County School District, a…

  12. Impact of the National Writing Project's College-Ready Writers Program in High-Need Rural Districts

    ERIC Educational Resources Information Center

    Gallagher, H. Alix; Arshan, Nicole; Woodworth, Katrina

    2017-01-01

    By 2013, all 50 states and the District of Columbia had adopted college- and career-ready standards in English language arts and mathematics, placing a greater emphasis on argument writing to prepare students for life after high school. Solving the specific problem of how to help teachers teach to new standards for argument writing as well as the…

  13. The Relationship between Oral Reading Fluency and Reading Comprehension for Third Grade Students in a Rural Louisiana School District

    ERIC Educational Resources Information Center

    Conway Sledge-Murphy, Felicia

    2011-01-01

    "Dynamic Indicators of Basic Early Literacy Skills (DIBELS)," a diagnostic reading tool used in the majority of school districts throughout the state of Louisiana, has been identified by many researchers as a reliable and valid tool to identify reading deficiencies in struggling readers (Good, Simmons, & Kame'enui, 2001; Ritchey,…

  14. Self-reported illness and use of health services in a rural district of Vietnam: findings from an epidemiological field laboratory.

    PubMed

    Giang, Kim Bao; Allebeck, Peter

    2003-01-01

    The aims of the study were to assess the pattern of self-reported illness as well as use of health services in a rural district in Vietnam, and to analyse these in relation to gender, age, education level, occupation, and economic status. A population-based survey of 11,089 households was conducted in 1999. Through household interviews, data were collected on self-reported health, use of health services during the four weeks prior to the interview, and other background factors. The prevalence of self-reported illness was 48%. Cough, fever, and headache were the most commonly reported symptoms (20%) while cardiovascular disorders were least reported (0.6%). Occurrence of illness was significantly lower in groups with higher education, especially among men, but there was no difference between occupational and economic groups. Self-treatment was very common (69%). Private health facilities were used to a large extent, while community health stations played a less important role. Use of district hospitals was significantly higher among employed people. An epidemiological field laboratory enabled analysis of self-reported illness and use of health services, which is important for planning of health services. We found a high level of reported illness but a very low utilization of community health services. Better knowledge about illness patterns could be important for improving quality of and access to community health services.

  15. Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia: a triangulated community-based cross-sectional study.

    PubMed

    Kifle, Dereje; Azale, Telake; Gelaw, Yalemzewod Assefa; Melsew, Yayehirad Alemu

    2017-01-13

    Regular utilization of maternal health care services reduces maternal morbidity and mortality. This study assessed the maternal health care seeking behavior and associated factors of reproductive age women in rural villages of Haramaya district, East Ethiopia. Community based cross sectional study supplemented with qualitative data was conducted in Haramaya district from November 15 to Decemeber 30, 2015. A total of 561 women in reproductive age group and who gave birth in the last 2 years were randomly included. Bivariate and multivariate logistic regressions model was used to identify the associated factors. Odds ratios with 95% CI were used to measure the strength of association. Maternal health care service seeking of women was found as; antenatal care 74.3% (95% CI; 72.5, 76.14), attending institutional delivery 28.7% (95% CI; 26.8, 30.6) and postnatal care 22.6% (95% CI; 20.84, 24.36). Knowledge of pregnancy complications, Educational status, and religion of women were found to be significantly associated with antenatal health care, delivery and postnatal health care service seeking behaviours triangulated with individual, institutional and socio-cultural qualitative data. The maternal health care service seeking behavior of women in the study area was low. Educational status of the women, birth order and knowledge about pregnancy complications were the major factors associated with maternal health care service seeking behavior Focused health education with kind and supportive health care provider counseling will improve the maternal health care seeking behaviors of women.

  16. Knowledge about diabetes and relationship between compliance to the management among the diabetic patients from Rural Area of Sangli District, Maharashtra, India.

    PubMed

    Chavan, Girish M; Waghachavare, Vivek B; Gore, Alka D; Chavan, Vishwajeet M; Dhobale, Randhir V; Dhumale, Girish B

    2015-01-01

    Diabetes is an important public health problem of India. Studies have shown that increase in patients' knowledge regarding the disease results in better compliance to treatment and decrease in complications. This study was planned to assess the knowledge about diabetes and its correlation with pharmacological and non-pharmacological compliance, among the diabetic patients attending rural health center from Sangli District, Maharashtra (India). The study was conducted during September to November 2014. The study subjects were all willing adult patients with type II diabetes mellitus attending a selected rural hospital. The study tool was pretested and self-administered questionnaire. Analysis was done using Microsoft Excel and SPSS-22. Total study participants were 307 in number, with the mean age of 55.6 years. The mean morbidity with diabetes was 10.7 years. Only 23.8% had good knowledge regarding diabetes, while 19.2% participants had poor knowledge. Knowledge was significantly associated with the compliance to the pharmacological and non-pharmacological management. Although most of the patients were suffering with diabetes for many years there is lack of knowledge regarding the disease and self care. The compliance to the management of diabetes was better in patients with good knowledge. Seminars, counseling sessions and workshop should be arranged periodically for diabetic patients to increase their awareness.

  17. Potential use of mobile phones in improving animal health service delivery in underserved rural areas: experience from Kilosa and Gairo districts in Tanzania.

    PubMed

    Karimuribo, Esron D; Batamuzi, Emmanuel K; Massawe, Lucas B; Silayo, Richard S; Mgongo, Frederick O K; Kimbita, Elikira; Wambura, Raphael M

    2016-10-07

    Sub-optimal performance of the animal health delivery system in rural areas is common in developing countries including Tanzania. However, penetration of mobile phones and availability of good road network and public transport systems offer opportunities for improving the access of rural communities to diagnostic and advisory services from facilities and expertise located in urban areas. A questionnaire survey on possession and use of mobile phones by pastoral and agro-pastoral communities in Kilosa and Gairo districts was carried out between November and December 2015. A total number of 138 livestock keepers from three villages of Chakwale (54), Mvumi (41) and Parakuyo (43) participated in the study. An e-based system was designed and tested to link rural communities with urban diagnostic facilities. It was observed that the average number of phones possessed by individuals interviewed and household families was 1.1 ± 0.26 (1-2) and 3.5 ± 2.23 (1-10), respectively. It was further observed that out of 138 livestock keepers interviewed, 133 (96.4 %) had feature phones while 10 (7.2 %) of them possessed smartphones. Mobile phone is currently used to support livestock production by communicating on animal health in Parakuyo (18, 41.9 %), Mvumi (18, 43.9 %) and Chakwale (14, 25.9 %). Other contributions of mobile phones in livestock and crop agriculture observed in the study area include: exchange of livestock price information, crop price information, communicating on plant health/diseases, livestock extension and advisory services as well as crop farming extension and advisory services. We also designed and tested an e-based SUAVetDiag® system to support timely diagnosis of infectious disease conditions and prompt advice on case management in veterinary underserved areas. Availability of mobile phones in rural areas, in combination with supporting infrastructure and facilities in urban areas, has potential to stimulate local development and improving

  18. The Impact an Integrated Workforce of a Rural Southwestern School District Has in the Making of a Blue Ribbon School

    ERIC Educational Resources Information Center

    Goolsby, Annie J.

    2013-01-01

    This study utilized a contemporary approach to qualitative research, the descriptive survey design, to discover whether a diverse workforce was a major influence in producing a rural Blue Ribbon School. The population represented the school systems of a county located in the West South Central region of the United States. In this study, the terms…

  19. An Investigation of Perceived Anxiety toward New Software Technologies among Teachers in a Mississippi Rural City School District

    ERIC Educational Resources Information Center

    Miller, Matilda

    2010-01-01

    Technological standards have existed for years encouraging the use of computer technology as a teaching tool. By increasing technology use in the classroom, educators are able to address teaching and learning opportunities for all students. The need for these opportunities is essential in the rural areas of the U. S. The purpose of this study…

  20. The Impact an Integrated Workforce of a Rural Southwestern School District Has in the Making of a Blue Ribbon School

    ERIC Educational Resources Information Center

    Goolsby, Annie J.

    2013-01-01

    This study utilized a contemporary approach to qualitative research, the descriptive survey design, to discover whether a diverse workforce was a major influence in producing a rural Blue Ribbon School. The population represented the school systems of a county located in the West South Central region of the United States. In this study, the terms…

  1. The Implementation of a Focused School Renewal Plan to Increase Student Achievement in a Low Performing Rural School District

    ERIC Educational Resources Information Center

    Williams, Sarah L.

    2010-01-01

    The following study was conducted using a mixed-methodology study design. The purpose of this study was to determine if a focused school renewal plan would increase student achievement at Rural Elementary. In order to accomplish this goal, baseline research data was gathered using the What Works in Schools Online Survey (Marzano, 2003) to…

  2. Nitrate in drinking water and vegetables: intake and risk assessment in rural and urban areas of Nagpur and Bhandara districts of India.

    PubMed

    Taneja, Pinky; Labhasetwar, Pawan; Nagarnaik, Pranav

    2017-06-06

    The study focuses on the estimation of health risk from nitrate present in the drinking water and vegetables in Nagpur and Bhandara districts in the state of Maharashtra, India. Drinking water samples from 77 locations from the rural as well as urban areas and 22 varieties of vegetable were collected and analyzed for the presence of nitrate for a period of 1 year (two seasons). The daily intake of nitrate from these water and vegetable samples was then computed and compared with standard acceptable intake levels to assess the associated health risk. The mean nitrate concentration of 59 drinking water samples exceeded the Bureau of Indian Standards limit of 45 mg/L in drinking water. The rural and urban areas were found to have mean nitrate concentration in drinking water as 45.69 ± 2.08 and 22.53 ± 1.97 mg/L, respectively. The estimated daily intake of drinking water samples from 55 study sites had nitrate concentration far below the safety margin indicating serious health risk. The sanitation survey conducted in 12 households reported contaminated source with positive E. coli count in 20 samples as the major factor of health risk. The average nitrate concentration was maximum in beetroot (1349.38 mg/kg) followed by spinach (1288.75 mg/kg) and amaranthus (1007.64 mg/kg). Among the samples, four varieties of the vegetables exceeded the acceptable daily intake (ADI) with an assumption of 0.5 kg consumption of vegetables for an average of a 60-kg individual. Therefore, irrigation of these locally grown vegetables should be monitored periodically for nitrogen accumulation by the crop above the ADI limit. The application of nitrogenous fertilizers should also be minimized in the rural areas to help protect the nitrate contamination in groundwater sources.

  3. Exploring the condom gap: is supply or demand the limiting factor - condom access and use in an urban and a rural setting in Kilifi district, Kenya.

    PubMed

    Papo, Jacqueline K; Bauni, Evasius K; Sanders, Eduard J; Brocklehurst, Peter; Jaffe, Harold W

    2011-01-14

    to explore the extent of the condom gap, investigating the relative roles of supply-side and demand-side factors in determining condom use. GPS mapping of condom outlets, and population-based survey. an urban and a rural site were selected within the Epidemiological and Demographic Surveillance Site in Kilifi district, Kenya. Potential condom outlets (n = 281) were mapped and surveyed, and questionnaires on condom access and use (n = 630) were administered to a random sample of men and women aged 15-49. Multivariate logistic regression was performed to assess the relative roles of supply-side and demand-side barriers on condom use. the median straight-line distance to free condoms was 18-fold higher in the rural versus urban site. Among sexually active respondents, 42% had ever used a condom, and 23% had used a condom over the past 12 months, with lower levels among rural versus urban respondents (P < 0.05). The mean number of condoms used was 2.2/person per year among all sexually active individuals (condom users and nonusers), amounting to 8.2% protected sex acts/person per year. The adjusted odds of condom use (past 12 months) were 8.1 times greater among individuals experiencing no supply-side or demand-side barriers, compared with individuals experiencing both types of barriers. Despite low levels of usage and the presence of supply-side and demand-side barriers, reported unmet need for condoms was low. there is an urgent need for renewed condom promotion efforts aimed at building demand, in addition to improving physical access, in resource-limited settings with generalized HIV epidemics in sub-Saharan Africa. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  4. Contribution of draft cattle to rural livelihoods in a district of southeastern Uganda endemic for bovine parasitic diseases: an economic evaluation.

    PubMed

    Okello, Walter O; Muhanguzi, Dennis; MacLeod, Ewan T; Welburn, Susan C; Waiswa, Charles; Shaw, Alexandra P

    2015-11-05

    A study was conducted in Tororo District in eastern Uganda to assess the socio-economic contribution of draft cattle to rural livelihoods. The aim of the study was to empirically quantify the economic value of draft cattle thus contributing to understanding the impact of endemic parasitic diseases of cattle on livestock productivity and subsequently household income, labor and food security. A total of 205 draft cattle keeping households (n = 205) were randomly selected and structured household questionnaires were administered, focusing on work oxen use, productivity, inputs and outputs. The data obtained was analyzed using standard statistical methods and used to calculate the gross margin from the draft cattle enterprise. Secondary data were obtained from focus group discussions and key informant interviews and these were analyzed using Bayesian methods. The study showed that, apart from being labor saving, the use of animal traction is highly profitable with the gross margin per year from the use of draft cattle amounting to 245 United States dollars per work oxen owning household. The cash obtained from hiring out draft animals was equivalent to nearly a quarter of the average local household's monetary receipts. It also revealed that endemic bovine parasitic diseases such as trypanosomiasis and tick-borne diseases reduced draft cattle output by 20.9 % and potential household income from the use of draft oxen by 32.2 %. The presence of endemic cattle diseases in rural Uganda is adversely affecting the productivity of draft cattle, which in turn affects household income, labor and ultimately food security. This study highlights the contribution of draft cattle to rural livelihoods, thus increasing the expected impact of cost-effective control strategies of endemic production limiting livestock diseases in Uganda.

  5. Rural School Busing. ERIC Digest.

    ERIC Educational Resources Information Center

    Howley, Aimee; Howley, Craig

    This digest summarizes information suggesting that long bus rides are part of the hidden costs of school and district consolidation. Rural school districts spend more than twice per pupil what urban districts spend on transportation. A review of studies shows that rural school children were more likely than suburban school children to have bus…

  6. Childhood overweight and obesity among Kenyan pre-school children: association with maternal and early child nutritional factors.

    PubMed

    Gewa, Constance A

    2010-04-01

    To report on the prevalence of overweight and obesity among pre-school children in Kenya and examine the associations between childhood overweight and selected maternal and child-related factors. Demographic Health Survey data, multistage stratified cluster sampling methodology. Rural and urban areas of Kenya. A total of 1495 children between the ages of 3 and 5 years in Kenya. Over 30 % of the children were stunted, approximately 16 % were underweight, 4 % were wasted, approximately 18 % were overweight and 4 % were obese; 8 % were both overweight/obese and stunted. Maternal overweight and obesity, higher levels of maternal education, being a large or very large child at birth, and being stunted were each associated with higher odds of overweight and obesity among Kenyan children. Older children and large household size were each associated with lower odds of overweight and obesity among Kenyan children. The analysis demonstrates the presence of under- and overnutrition among Kenyan pre-school children and the importance of focusing on expanding efforts to prevent and treat malnutrition within this population. It also identifies some of the modifiable factors that can be targeted in these efforts.

  7. Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

    PubMed

    Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

    2016-01-01

    The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. The use of institutional delivery service is low in the study

  8. Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

    PubMed Central

    Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

    2016-01-01

    Introduction The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones. Methods A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively. Result Only 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery. Conclusion The use of

  9. Assessment of physical disability using Barthel index among elderly of rural areas of district Jhansi (U.P), India

    PubMed Central

    Gupta, Shubhanshu; Yadav, Rashmi; Malhotra, Anil Kumar

    2016-01-01

    Introduction: The health of the elderly will be an important issue defining the health status of a population. With the rise in aged population, there is a greater need to look into their physical disability aspects, which is otherwise neglected. The rationale behind the study is to assess the physical disability of the elderly living in rural area of Jhansi. The aims of the study were to study the prevalence of physical disability among the elderly of rural area, and to find out the factors and association affecting the physical disability. Methods: A community-based cross-sectional study was carried out in a Baragaon block of rural area of Jhansi, Uttar Pradesh, India, from July 2015 to October 2015. Multistage random sampling was performed. A total of 265 participants of age 60 years and above were selected. Physical disability was assessed using Barthel index. Appropriate data entry and statistical analysis were done in EpiInfo. Frequency tables were used to calculate the prevalence, and Chi-square test was used to find out the association. Results: The overall prevalence of physical disability was 23.4%. 70% belongs to the age group from 60 to 69 years. Physical disability was significantly higher among age group >80 years. Similarly, women were more affected with physical disability than men. Conclusions: High prevalence of physical disability is the major area of concern. More extensive postdischarge health facilities to be provided to elderly. PMID:28349004

  10. Victimization and PTSD in A Rural Kenyan Youth Sample

    PubMed Central

    Karsberg, Sidsel H; Elklit, Ask

    2012-01-01

    Within the last ten years, there has been a growing number of epidemiological studies, examining the effect of trauma exposure in children and adolescents. Although studies concerning Post-traumatic Stress Disorder (PTSD) have been conducted in a wide array of different cultural contexts [1], the knowledge on traumatization and development of PTSD is still limited [2]. Most studies conducted are clinical studies, which deal with subjects that have already been traumatized or affected by specific single events such as war [3], natural disasters [1], serious accidents [4] or physical/sexual abuse [5-7]. Though research indicates that adolescents are very vulnerable to the exposure of Potentially Traumatic Events (PTEs) [8], studies targeting non-clinical youth populations and the impact of their life experiences are very few. With the increasing ethnic diversity of populations worldwide, it is of particular interest to compare the prevalence of exposure and PTSD in children and adolescents of different ethnic backgrounds. When designing preventive interventions and treatment programs for youth suffering from PTSD it is crucial to understand the complex interaction of variables behind the disorder. Differences in prevalence of exposure, PTSD and demographic variables between ethnicities may reveal some important clues to the etiology of the disease. The present study replicated six previous non-clinical studies which were designed to provide epidemiological information about exposure to PTEs, and the prevalence of PTSD among adolescents (see Table 1). The six studies were conducted in different countries and were very similar in their research methods and samples. The studies have been conducted in four European countries: Denmark [9], Iceland, [10], Lithuania [11], and the Faroe Islands [2], as well as in two Asian countries: Israel [12], and India [13] of which the four first samples were nationally representative. PMID:23002396

  11. Biogeochemistry of Kenyan Rift Valley Lake Sediments

    NASA Astrophysics Data System (ADS)

    Grewe, Sina; Kallmeyer, Jens

    2013-04-01

    The numerous lakes in the Kenyan Rift Valley show strong hydrochemical differences due to their varying geologic settings. There are freshwater lakes with a low alkalinity like Lake Naivasha on the one hand and very salt-rich lakes with high pH values like Lake Logipi on the other. It is known that the underlying lake sediments are influenced by the lake chemistry and by the microorganisms in the sediment. The aim of this work is to provide a biogeochemical characterization of the lake sediments and to use these data to identify the mechanisms that control lake chemistry and to reconstruct the biogeochemical evolution of each lake. The examined rift lakes were Lakes Logipi and Eight in the Suguta Valley, Lakes Baringo and Bogoria south of the valley, as well as Lakes Naivasha, Oloiden, and Sonachi on the Kenyan Dome. The porewater was analysed for different ions and hydrogen sulphide. Additionally, alkalinity and salinity of the lake water were determined as well as the cell numbers in the sediment, using fluorescent microscopy. The results of the porewater analysis show that the overall chemistry differs considerably between the lakes. In some lakes, concentrations of fluoride, chloride, sulphate, and/or hydrogen sulphide show strong concentration gradients with depth, whereas in other lakes the concentrations show only minor variations. Fluoride is present in all lakes; the lowest concentration is found in Lake Oloiden (60 - 90 mg/l), the highest one in Lake Bogoria (1,025 - 1,930 mg/l). The lakes show also large differences in sulphate concentrations. The values vary between 2 mg/l in Lake Baringo and 15,250 mg/l in Lake Eight. In all cores, sulphate concentration does not change significantly with depth; however, there is a distinct peak in each core, raising the question of synchronicity. As expected, chloride concentrations correlate with total salinity. There is no hydrogen sulphide present in the porewater of Lakes Naivasha, Baringo, and Oloiden, whereas in

  12. Speech and Language Disorders in Kenyan Children: Adapting Tools For Regions With Few Assessment Resources

    PubMed Central

    Carter, Julie Anne; Murira, Grace; Gona, Joseph; Tumaini, Judy; Lees, Janet; Neville, Brian George; Newton, Charles Richard

    2013-01-01

    This study sought to adapt a battery of Western speech and language assessment tools to a rural Kenyan setting. The tool was developed for children whose first language was KiGiryama, a Bantu language. A total of 539 Kenyan children (males=271, females=268, ethnicity=100% Kigiryama. Data were collected from 303 children admitted to hospital with severe malaria and 206 age-matched children recruited from the village communities. The language assessments were based upon the Content, Form and Use (C/F/U) model. The assessment was based upon the adapted versions of the Peabody Picture Vocabulary Test, Test for the Reception of Grammar, Renfrew Action Picture Test, Pragmatics Profile of Everyday Communication Skills in Children, Test of Word Finding and language specific tests of lexical semantics, higher level language. Preliminary measures of construct validity suggested that the theoretical assumptions behind the construction of the assessments were appropriate and re-test and inter-rater reliability scores were acceptable. These findings illustrate the potential to adapt Western speech and language assessments in other languages and settings, particularly those in which there is a paucity of standardised tools. PMID:24294109

  13. Speech and Language Disorders in Kenyan Children: Adapting Tools For Regions With Few Assessment Resources.

    PubMed

    Carter, Julie Anne; Murira, Grace; Gona, Joseph; Tumaini, Judy; Lees, Janet; Neville, Brian George; Newton, Charles Richard

    2012-02-01

    This study sought to adapt a battery of Western speech and language assessment tools to a rural Kenyan setting. The tool was developed for children whose first language was KiGiryama, a Bantu language. A total of 539 Kenyan children (males=271, females=268, ethnicity=100% Kigiryama. Data were collected from 303 children admitted to hospital with severe malaria and 206 age-matched children recruited from the village communities. The language assessments were based upon the Content, Form and Use (C/F/U) model. The assessment was based upon the adapted versions of the Peabody Picture Vocabulary Test, Test for the Reception of Grammar, Renfrew Action Picture Test, Pragmatics Profile of Everyday Communication Skills in Children, Test of Word Finding and language specific tests of lexical semantics, higher level language. Preliminary measures of construct validity suggested that the theoretical assumptions behind the construction of the assessments were appropriate and re-test and inter-rater reliability scores were acceptable. These findings illustrate the potential to adapt Western speech and language assessments in other languages and settings, particularly those in which there is a paucity of standardised tools.

  14. Neurocysticercosis in a rural population with extensive pig production in Angónia district, Tete Province, Mozambique.

    PubMed

    Assane, Yunus Amade; Trevisan, Chiara; Schutte, Clara Maria; Noormahomed, Emilia Virginia; Johansen, Maria Vang; Magnussen, Pascal

    2017-01-01

    Neurocysticercosis (NCC) is an important neurological disease in countries with high prevalence of Taenia solium infection and is emerging as a serious public health and economic problem. The aim of this study was to estimate the prevalence of NCC in Angónia district, Tete province, Mozambique based on: prevalence of human T. solium cysticercosis assessed by antigen Enzyme-linked Immunosorbent Assay (Ag-ELISA) seropositivity, history of epilepsy, and brain computed tomography (CT) scan results. A cross sectional study was conducted between September and November 2007 in Angónia district. Questionnaires and blood samples were collected from 1,723 study subjects. Brain CT-scans were carried out on 151 study subjects with confirmed history of epilepsy. A total of 77 (51.0% (95% CI, 42.7-59.2)) and 38 (25.2% (95% CI, 18.5-32.9)) subjects met the criteria for definitive and probable diagnosis of NCC, respectively. T. solium Ag-ELISA seropositivity was found in 15.5% (95% CI, 12.8-16.2) of the study subjects. The estimated life time prevalence of epilepsy was 8.8% (95% CI, 7.5-10.2). Highly suggestive lesions of NCC were found on CT-scanning in 77 (71.9%, (95% CI, 62.4-80.2)) of the seropositive and 8 (18.1%, (95% CI, 8.2-32.7)) of the seronegative study subjects, respectively. The present findings revealed a high prevalence of NCC among people with epilepsy in Angónia district. Determination of effective strategies for prevention and control of T. solium cysticercosis are necessary to reduce the burden of NCC among the affected populations. Copyright © 2016. Published by Elsevier B.V.

  15. The costs of introducing artemisinin-based combination therapy: evidence from district-wide implementation in rural Tanzania

    PubMed Central

    Njau, Joseph D; Goodman, Catherine A; Kachur, S Patrick; Mulligan, Jo; Munkondya, John S; Mchomvu, Naiman; Abdulla, Salim; Bloland, Peter; Mills, Anne

    2008-01-01

    Background The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Methods Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. Results The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. Conclusion The costs of implementing ACT are

  16. Factors affecting time of access of in-patient care at Webuye District hospital, Kenya

    PubMed Central

    Otsyula, Barasa K.; Downing, Raymond; Yakubu, Kenneth; Miima, Miriam; Ifeyinwa, Okoye

    2016-01-01

    Background Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so. Aim To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya. Setting Webuye District hospital in Western Kenya. Methods A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01. Results The median age of the respondents, majority of whom were female respondents (55%), was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62%) presented to the hospital within 2 weeks of onset of illness, while 151 (38%) presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital. Conclusion Ten-year increment in age, perception of a supernatural cause of illness (predisposing factors), having an illness that is considered bearable and belief in the effectiveness of treatment offered in hospital (need factors) affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access. PMID:27796120

  17. A Qualitative Evaluation of Hand Drying Practices among Kenyans

    PubMed Central

    Person, Bobbie; Schilling, Katharine; Owuor, Mercy; Ogange, Lorraine; Quick, Rob

    2013-01-01

    Background Recommended disease prevention behaviors of hand washing, hygienic hand drying, and covering one’s mouth and nose in a hygienic manner when coughing and sneezing appear to be simple behaviors but continue to be a challenge to successfully promote and sustain worldwide. We conducted a qualitative inquiry to better understand current hand drying behaviors associated with activities of daily living, and mouth and nose covering practices, among Kenyans. Methods and Findings We conducted 7 focus group discussions; 30 in-depth interviews; 10 structured household observations; and 75 structured observations in public venues in the urban area of Kisumu; rural communities surrounding Kisumu; and a peri-urban area outside Nairobi, Kenya. Using a grounded theory approach, we transcribed and coded the narrative data followed by thematic analysis of the emergent themes. Hand drying, specifically on a clean towel, was not a common practice among our participants. Most women dried their hands on their waist cloth, called a leso, or their clothes whether they were cooking, eating or cleaning the nose of a young child. If men dried their hands, they used their trousers or a handkerchief. Children rarely dried their hands; they usually just wiped them on their clothes, shook them, or left them wet as they continued with their activities. Many people sneezed into their hands and wiped them on their clothes. Men and women used a handkerchief fairly often when they had a runny nose, cold, or the flu. Most people coughed into the air or their hand. Conclusions Drying hands on dirty clothes, rags and lesos can compromise the benefits of handwashing. Coughing and sneezing in to an open hand can contribute to spread of disease as well. Understanding these practices can inform health promotion activities and campaigns for the prevention and control of diarrheal disease and influenza. PMID:24069302

  18. Outcome assessment of a Global Fund grant for tuberculosis control at the district level in rural Cameroon.

    PubMed

    Yumo, H A; Mbanya, D; Kuaban, C; Neuhann, F

    2011-03-01

    Batibo District Hospital (BDH), North-West Cameroon. To assess the outcome of the implementation of the Global Fund (GF) Grant Round 3 for tuberculosis (TB) control at the district level. A retrospective study for the period 2003-2008 comparing TB programme outcome indicators before (2003-2005) and after (2006-2008) the GF grant. During the study period 293 TB cases were enrolled on treatment. Comparing the cumulative outcome indicators for smear-positive pulmonary TB cases 3 years before and after the grant, case notification increased by >50%, case detection by almost 50% and treatment success by nearly 20% during the grant period. The case detection rate for smear-positive pulmonary TB nearly doubled, while the treatment success rate reached 100% in 2006. Default and mortality rates dropped to zero in 2006 and 2007 from maximum values of respectively 15% and 23% in 2004 and 2005. However, in 2008, there was a decline across all programme indicators, probably due to staff turnover. Outcome indicators of the TB programme in BDH increased markedly following the implementation of the GF grant. Nevertheless, if not tackled appropriately, staff turnover might impede the sustainability of this positive outcome.

  19. HIV testing among pregnant wives of migrant men in a rural district of India: urgent call for scale up.

    PubMed

    Sarin, Enisha; Nayak, Hiralal; Das, Madhumita; Nanda, Priya

    2013-01-01

    In India, despite the fact that more pregnant women are being tested for HIV under the purview of the Prevention of Parent-to-Child HIV Transmission program, official figures indicate low rates of HIV testing, evidencing missed opportunities for HIV prevention. The present study examined the prevalence of HIV testing and the barriers to testing among pregnant women, whose vulnerability to HIV is enhanced by their spouses' risky behaviors. A cross-sectional study was conducted from November 2010 to January 2011 among 357 women who had given birth in the last two years in a district in Orissa. Only one-third of women had been tested for HIV during pregnancy. Women with more than six years of education (OR: 2.39, 95% CI: 1.06-5.39), having knowledge of sexually transmitted infections (OR: 12.37, 95% CI: 5.55-27.58), having discussions with spouses about HIV (OR: 3.56, 95% CI: 1.61-7.86), and seeking antenatal care in government district hospitals and private clinics as opposed to peripheral community health centers, were more likely to receive HIV testing during pregnancy. The findings point to the need to widen HIV testing to community-based services, increase coverage of HIV/sexually transmitted infection awareness and prevention programs, and encourage spousal communication through quality counseling.

  20. Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso

    PubMed Central

    Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

    2016-01-01

    Background One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers’ preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. Design A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Results Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. Conclusions The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes. PMID:26739784

  1. Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries.

    PubMed

    Duysburgh, Els; Kerstens, Birgit; Kouanda, Seni; Kaboré, Charles Paulin; Belemsaga Yugbare, Danielle; Gichangi, Peter; Masache, Gibson; Crahay, Beatrice; Gondola Sitefane, Gilda; Bique Osman, Nafissa; Foia, Severiano; Barros, Henrique; Castro Lopes, Sofia; Mann, Susan; Nambiar, Bejoy; Colbourn, Tim; Temmerman, Marleen

    2015-06-03

    Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care. The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps 'systems thinking' approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and possible interventions were discussed; 3) based on comprehensive needs assessment findings, inputs from the stakeholders and existing knowledge regarding good postpartum care, a list of potential interventions was designed, and; 4) the stakeholders selected and agreed upon final context-specific intervention packages to be implemented to improve postpartum care. Needs assessment findings showed that in all study countries maternal, newborn and child health is a national priority but specific policies for postpartum care are weak and there is very little evidence of effective postpartum care implementation. In the study districts few women received postpartum care during the first week after childbirth (25 % in Burkina Faso, 33 % in Kenya, 41 % in Malawi, 40 % in Mozambique). Based on these findings the interventions selected by stakeholders mainly focused on increasing the availability and provision of postpartum services and improving the quality of postpartum care through strengthening postpartum services and care at facility and community level. This includes the introduction of postpartum home visits, strengthening postpartum outreach services, integration of postpartum services for the mother in child immunisation clinics, distribution of postpartum care guidelines among health workers and

  2. Building capacity for community mental health care in rural Malawi: Findings from a district-wide task-sharing intervention with village-based health workers.

    PubMed

    Wright, Jerome; Chiwandira, Chikayiko

    2016-09-01

    The mental health 'treatment gap' is at its widest in low-resource countries where the vast majority of its people have no access to mental health services and where developing effective models of primary mental health care that can expand from research pilot sites to large-scale population-based services is a major research and practice imperative. The Mental Health in Zomba initiative builds upon an earlier pilot project to establish and sustain a district-wide scale-up of a village-based health workers' mental health task-sharing intervention in Southern Malawi across a population of more than 600,000 people. The article describes the development, implementation and structured evaluation of the impact of this task-sharing initiative. Results from an examination of the care for 240 consecutive attendees show how the village-based workers recognised and responded to the needs of people experiencing both common and severe mental health problems and how they facilitated 850 mental health promotion events to more than 40,000 people within their communities. A new and essential district-wide tier of mental health service was established at the crucial intersection between health centre and the community. Within the socio-cultural context of rural Malawi with its diverse explanatory models for psychological distress, the approach of the village-based health worker was found to be both credible and practical in meeting the needs of the population and therefore responding to both the 'supply' and 'demand' elements of the mental health treatment gap. © The Author(s) 2016.

  3. Taking Specialist Surgical Services to the Rural District Hospitals at One Forth Cost: A Sustainable 'Return on Investment' Public Health Initiative of Patan Hospital, Patan Academy of Health Sciences, Nepal.

    PubMed

    Shah, J N

    2015-01-01

    The inequitable distribution and centralization of resources and services in urban area persists around the world, more so in developing countries. The challenge to meet the health needs of rural population requires health policy makers, government and concerned organization to put extra efforts. Such efforts require innovative, feasible and sustainable strategies to address the social justice of people living in districts away from capital and urban cities. At Patan Academy of Health Sciences, the medial school curriculum is designed to address these issues. Together with health professionals from Patan Hospital, the main teaching hospital on which the academy evolved, have initiated strategies to bring specialist services, starting with surgical services to remote district hospitals to serve the need of rural population. This initiative is 'desirable, doable and feasible'. Further more, this can be modified for replication and promotion by other academic institutions, central hospitals and government health system.

  4. Socioeconomic, cultural and behavioural features of prior and anticipated influenza vaccine uptake in urban and rural Pune district, India: a mixed-methods case study

    PubMed Central

    Kudale, Abhay; Purohit, Vidula Shridhar; Sundaram, Neisha; Schaetti, Christian; Weiss, Mitchell G

    2013-01-01

    Introduction Ensuring production capacity of efficacious vaccines for pandemic preparedness alone may not be sufficient for effective influenza control. Community willingness to accept the vaccine is also critical. Population acceptance must therefore be recognised as a major determinant of vaccine effectiveness, and the social, cultural and economic determinants of population acceptance require study for effective policy and action. Pune is a focus of pandemic influenza in India. The experience of the 2009/2010 pandemic in Pune, capacity for vaccine production and experience with vaccine use provide a unique opportunity to address key questions about an effective vaccine intervention strategy for influenza control in India. This study will examine the socioeconomic, cultural and behavioural determinants of anticipated acceptance of influenza vaccines among the urban and rural populations of Pune district. Additionally, community ideas about seasonal influenza and its distinction from pandemic influenza will be investigated. Proposed research also considers the influence of health professionals, policy makers and media professionals on the awareness, preference and use of influenza vaccines. Methods and analysis This is a mixed-methods study including urban and rural community surveys, in-depth interviews with health professionals, case studies at two hospitals where suspected influenza cases were referred during the pandemic and in-depth interviews with media professionals and public health policy makers. Ethics and dissemination This protocol was approved by the ethics review committees of the Maharashtra Association of Anthropological Sciences and the WHO, and by the Ethics Commission of Basel, Switzerland. The proposed research will provide a better understanding of communication and education needs for vaccine action for influenza control in India and other low-income and middle-income countries. The findings and the approach for health social science research

  5. Treatment-seeking behaviour for childhood fever among caretakers of Chivuna and Magoye rural communities of Mazabuka District, Zambia: a longitudinal study.

    PubMed

    Hamooya, Benson M; Chongwe, Gershom; Dambe, Rosalia; Halwiindi, Hikabasa

    2016-08-11

    Treatment-seeking for childhood fever among caretakers in most rural parts of African region is still a major challenge. The aim of this study was to determine the treatment seeking behaviour for fever in under-5 children of Magoye and Chivuna rural areas of Mazabuka district in Zambia. Treatment-seeking behaviour was explored longitudinally among caretakers of 362 children aged 12-59 months with fever. The data was collected from caretakers using a structured interviewer-administered questionnaire at their homes. Chi-square test, one-sample test of proportions and logistic regression were the statistical methods used for data analysis. Of the 362 children with fever, 77 % of them had their treatment sought externally. In which 64 % had their treatment at health facility (HF), 18 % from community health workers (CHW), and 18 % from other sources. Early treatment (≤ 24 h) was sought for 42 % of the fever episodes. In dry season, a child had 1.53 times more likely to have early treatment compared to rainy season [OR 1.53; 95 % CI 1.30, 1.80; p < 0.001]. A child in Chivuna was less likely to have early treatment compared to one in Magoye [OR 0.62; 95 % CI 0.50, 0.76; p < 0.001]. Caretakers had a reduced chance of 27 % [OR 0.73; 95 % CI 0.56, 0.95; p = 0.022] of seeking early treatment if they took a child to other sources compared to a HF. This study has revealed that seeking early and appropriate treatment was suboptimal in the study areas. Source of treatment, season and location were predictors of early treatment of fever among caretakers. Policies aimed at combating poor care-seeking behaviour should not omit to address these factors.

  6. Use of Lot quality assurance sampling surveys to evaluate community health worker performance in rural Zambia: a case of Luangwa district.

    PubMed

    Mwanza, Moses; Zulu, Japhet; Topp, Stephanie M; Musonda, Patrick; Mutale, Wilbroad; Chilengi, Roma

    2017-04-17

    The Better Health Outcomes through Mentoring and Assessment (BHOMA) project is a cluster randomized controlled trial aimed at reducing age-standardized mortality rates in three rural districts through involvement of Community Health Workers (CHWs), Traditional Birth Attendants (TBAs), and Neighborhood Health Committees (NHCs). CHWs conduct quarterly surveys on all households using a questionnaire that captures key health events occurring within their catchment population. In order to validate contact with households, we utilize the Lot Quality Assurance Sampling (LQAS) methodology. In this study, we report experiences of applying the LQAS approach to monitor performance of CHWs in Luangwa District. Between April 2011 and December 2013, seven health facilities in Luangwa district were enrolled into the BHOMA project. The health facility catchment areas were divided into 33 geographic zones. Quality assurance was performed each quarter by randomly selecting zones representing about 90% of enrolled catchment areas from which 19 households per zone where also randomly identified. The surveys were conducted by CHW supervisors who had been trained on using the LQAS questionnaire. Information collected included household identity number (ID), whether the CHW visited the household, duration of the most recent visit, and what health information was discussed during the CHW visit. The threshold for success was set at 75% household outreach by CHWs in each zone. There are 4,616 total households in the 33 zones. This yielded a target of 32,212 household visits by community health workers during the 7 survey rounds. Based on the set cutoff point for passing the surveys (at least 75% households confirmed as visited), only one team of CHWs at Luangwa high school failed to reach the target during round 1 of the surveys; all the teams otherwise registered successful visits in all the surveys. We have employed the LQAS methodology for assurance that quarterly surveys were

  7. Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan.

    PubMed

    Pradhan, Nousheen Akber; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

    2013-07-05

    Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition - the main targets of the strategy. The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities' survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies

  8. Social, economic and demographic determinants of sexual risk behaviors among men in rural Malawi: A district-level study.

    PubMed

    Soldan, Valerie A Paz; deGraft-Johnson, Joseph E; Bisika, Thomas; Tsui, Amy O

    2007-08-01

    Data from a survey of 715 men aged 20-44 from Mangochi district of Malawi were used to assess the sociodemographic and economic determinants of (1) having ever paid for sex, (2) total number of sex partners in the past year, and (3) having ever used condoms. Different individual characteristics were associated with each of these sexual behaviors. Polygamy and being a fisherman who has left home for over a month in the past year for work reasons were both positively associated with having ever paid for sex, whereas those with more household wealth were less likely to have paid for sex. The influence of education, age, age at sexual initiation, Muslim religion, polygamy, occupation, and having ever paid for sex on total number of sexual partners in the past year are all evident. Finally, secondary education, work-related migration, and having ever paid for sex were significantly associated with having used condoms.

  9. Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan

    PubMed Central

    Akber Pradhan, Nousheen; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

    2013-01-01

    Background Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition – the main targets of the strategy. Objective The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities’ survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed

  10. Prevalence of disability among adults using Rapid Assessment of Disability tool in a rural district of South India.

    PubMed

    Ramachandra, Srikrishna Sulgodu; Allagh, Komal Preet; Kumar, Hemanth; Grills, Nathan; Marella, Manjula; Pant, Hira; Mahesh, D; Soji, Fairlene; Mani, Srinivasan; Murthy, G V S

    2016-10-01

    There are different estimates of disability prevalence reported in India due to the differences in definitions and methodologies. Reliable data is needed to plan effective disability inclusive strategies. The objective of this study was to determine the prevalence and risk factors associated with disability among adults ≥18 years of age in Prakasam district of Andhra Pradesh using the Rapid Assessment of Disability (RAD) tool. The RAD survey was conducted in 50 villages (clusters) of Ongole division of Prakasam district. A two-stage cluster random sampling was used. Within each village 80 participants were surveyed. Compact segment sampling was used to determine the houses included. A person was reported as disabled based on their responses to the functioning section of the RAD tool. A total of 4134 adults were included. The overall prevalence of disability was 10.4% (431 adults). The highest prevalence of functional impairment was related to mobility (4.7%) followed by vision (2.1%) and fine motor (1.8%). The prevalence of psychological distress was 2.3%. Disability was significantly more prevalent in the poor socio economic group (OR 2.8; 95% CI: 1.5; 5.0) and among unemployed (OR 3.6; 95% CI: 2.3, 5.5). The prevalence of disability was strongly associated with age where, participants aged 70 years and over were eleven times more likely to report disability than younger age groups. The high prevalence of disability in the region points to disability being of public health concern and as a health condition needing urgent attention and specific interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Distance and utilisation of out-of-hours services in a Norwegian urban/rural district: an ecological study

    PubMed Central

    2013-01-01

    Background Long travel distances limit the utilisation of health services. We wanted to examine the relationship between the utilisation of a Norwegian out-of-hours service and the distance from the municipality population centroid to the associated casualty clinic. Methods All first contacts from ten municipalities in Arendal out-of-hours district were registered from 2007 through 2011. The main outcomes were contact and consultation rates for each municipality for each year. The associations between main outcomes and distance from the population centroid of the participating municipalities to the casualty clinic and were examined by linear regression. Demographic and socioeconomic factors were included in multivariate linear regression. Secondary endpoints include association between distance and rates of different first actions taken and priority grades assessed by triage nurses. Age and gender specific subgroup analyses were performed. Results 141 342 contacts were included in the analyses. Increasing distance was associated with marked lower rates of all contact types except telephone consultations by doctor. Moving 43 kilometres away from the casualty clinic led to a 50 per cent drop in the rate of face-to-face consultations with a doctor. Availability of primary care doctors and education level contributed to a limited extent to the variance in consultation rate. The rates of all priority grades decreased significantly with increasing distance. The rate of acute events was reduced by 22 per cent when moving 50 kilometres away. The proportion of patients above 66 years increased with increasing distance, while the proportion of 13- to 19 year olds decreased. The proportion of female patients decreased with increasing distance. Conclusions The results confirm that increasing distance is associated with lower utilisation of out-of-hours services, even for the most acute cases. Extremely long distances might compromise patient safety. This must be taken into

  12. Amyotrophic lateral sclerosis, rural environment and agricultural work in the Local Health District of Ferrara, Italy, in the years 1964-1998.

    PubMed

    Govoni, Vittorio; Granieri, Enrico; Fallica, Elisa; Casetta, Ilaria

    2005-11-01

    Previous epidemiological surveys, both analytic and descriptive, in the Local Health District (LHD) of Ferrara, northern Italy, have indicated that rural residence and agricultural work might constitute risk factors for Amyotrophic Lateral Sclerosis (ALS). The present investigation is a demographic survey in the LHD of Ferrara in the years 1964-1998 which aimed to verify whether the level of urbanization and agricultural activities might influence the risk of ALS. Based on the data obtained in a recent incidence study in the LHD of Ferrara which reported a mean annual crude incidence rate of ALS in the years 1964-1998 of 1.63 per 100,000 population (95 % CI 1.31-2.00), it was possible to compare the number of observed ALS cases and the number of expected ALS cases according to the level of urbanization and usual occupation on the basis of the residential and occupational pattern identified in the population of the LHD of Ferrara in the study period under the assumption of a homogeneous distribution of ALS. The present survey identified four different levels of urbanization in the LHD of Ferrara in the study period and for none of them was a difference between the number of observed and expected ALS cases found. Also in the most rural of the four identified levels of urbanization (small villages with an average population in the study period lower than 1,000 inhabitants and scattered houses in the countryside) no difference was found between observed and expected number of ALS cases (observed ALS cases 16, 95% Poisson CI 9.1-25.9, expected ALS cases 18.3). Based on the occupational pattern identified in the population of the LHD of Ferrara in the study period the number of incident cases of ALS whose usual occupation was in agricultural work exceeded the expected number (observed ALS cases 22, 95% Poisson CI 13.8-32.3, expected ALS cases 6.0). The present findings indicate that rural residence itself does not influence the risk of ALS while agricultural activities

  13. Agricultural practices and personal hygiene among agricultural workers in a rural area of Howrah district, West Bengal.

    PubMed

    Das, D K; Dey, T K

    2005-01-01

    The study attempted to assess agricultural practices and personal hygiene among 100 agricultural workers in a rural area of West Bengal in 1999. 69% of the study population was marginal farmer with less than 2 acres of land. Organophosphorus group of pesticides were most commonly used pesticides (68%); spraying was irregular in nature (98%), through semiautomatic sprayer (99%) and only 5% used any special dress while spraying pesticides. 40% of workers used to store pesticides either in living room or in food storage area. 88% of them did not take any food during work with pesticides, only 37% used to take regular bath after working with pesticides but regular hand washing was practiced by all of them.

  14. Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambézia, Mozambique.

    PubMed

    Cook, Rebecca E; Ciampa, Philip J; Sidat, Mohsin; Blevins, Meridith; Burlison, Janeen; Davidson, Mario A; Arroz, Jorge A; Vergara, Alfredo E; Vermund, Sten H; Moon, Troy D

    2011-04-01

    A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique. We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up. Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for early infant diagnosis were larger household size (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09-1.53), independent maternal source of income (OR, 10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR, 2.14; 95% CI, 1.01-4.51), and maternal receipt of antiretroviral therapy (OR, 3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range, 2-7); 16% of the tested infants were infected. Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of antiretroviral therapy has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care.

  15. Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambézia, Mozambique

    PubMed Central

    Cook, Rebecca E.; Ciampa, Philip J.; Sidat, Mohsin; Blevins, Meridith; Burlison, Janeen; Davidson, Mario A.; Arroz, Jorge A.; Vergara, Alfredo E.; Vermund, Sten H.; Moon, Troy D.

    2011-01-01

    Background A key challenge inhibiting the timely initiation of pediatric antiretroviral treatment is the loss to follow-up of mothers and their infants between the time of mothers' HIV diagnoses in pregnancy and return after delivery for early infant diagnosis (EID) of HIV. We sought to identify barriers to follow-up of HIV-exposed infants in rural Zambézia Province, Mozambique. Methods We determined follow-up rates for early infant diagnosis and age at first test in a retrospective cohort of 443 HIV-infected mothers and their infants. Multivariable logistic regression models were used to identify factors associated with successful follow-up. Results Of the 443 mother-infant pairs, 217 (49%) mothers enrolled in the adult HIV care clinic, and only 110 (25%) infants were brought for early infant diagnosis. The predictors of follow-up for EID were larger household size (OR=1.30; 95% CI, 1.09-1.53), independent maternal source of income (OR=10.8; 95% CI, 3.42-34.0), greater distance from the hospital (OR=2.14; 95% CI, 1.01-4.51) and maternal receipt of ART (OR=3.15; 95% CI, 1.02-9.73). The median age at first test among 105 infants was 5 months (interquartile range 2 to 7); 16% of the tested infants were infected. Conclusions Three of four HIV-infected women in rural Mozambique did not bring their children for early infant HIV diagnosis. Maternal receipt of ART has favorable implications for maternal health that will increase the likelihood of early infant diagnosis. We are working with local health authorities to improve the linkage of HIV-infected women to HIV care to maximize early infant diagnosis and care. PMID:21266912

  16. Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh

    PubMed Central

    Uddin, Mohammed Nazim; Bhar, Sunil; Al Mahmud, Abdullah; Islam, Fakir M Amirul

    2017-01-01

    Introduction A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life than those without MDs. Several studies have shown that in low-resource countries, a range of social determinants including poor health literacy is critical in the epidemiological transition of disease outcome. There is a lack of evidence of MDs literacy, the prevalence and risk factors of common mental health conditions, or any validated instruments to measure psychological distress or evaluate the quality of life in rural areas of Bangladesh. Aims The aims of this study are: (1) report the awareness, knowledge, attitudes and practice (KAP) of MDs; (2) estimate the prevalence of and risk factors for psychological distress; (3) measure association of psychological distress and other socio-demographic factors with quality of life and (4) test the feasibility to use Kessler 10-item (K10) and WHO Quality Of Life-BREF (WHOQOL-BREF) questionnaires in rural Bangladesh for measuring psychological distress and quality of life. Methods and analysis A sample of 1500 adults aged 18–59 years and 1200 older adults aged 60–90 years will be interviewed from a multistage cluster random sample. Each participant will go through a face-to-face interview to assess their awareness and KAP of MDs. Information about the participant’s sociodemographic and socioeconomic status will be collected along with the psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaires. Internal consistency, validity, reliability and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis and regression techniques. Ethics and dissemination Human Ethics Approval was received from the Swinburne University of Technology Human Ethics Committee. Results of this research will be disseminated via scientific forums including peer

  17. Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam.

    PubMed

    Nguyen, Quang Ngoc; Pham, Son Thai; Nguyen, Viet Lan; Wall, Stig; Weinehall, Lars; Bonita, Ruth; Byass, Peter

    2011-05-17

    Costly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam. In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme. Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme. Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.

  18. Assessment of oral health status and periodontal treatment needs among rural, semi-urban, urban, and metropolitan population of Gurgaon District, Haryana State

    PubMed Central

    Grover, Harpreet Singh; Bhardwaj, Amit; Yadav, Narender

    2016-01-01

    Background: Role of various etiologic factors in periodontal disease has been investigated by means of epidemiologic surveys and clinical studies. The community periodontal index of treatment needs (CPITN) provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions. Materials and Methods: This study was conducted on 4000 individuals among rural, semi-urban, and metro population of Gurgaon District, Haryana State, to find out the oral health status and periodontal treatment needs (TNs) using CPITN index. Results: An inference was drawn from the results that among 4000 participants from all the four population groups' maximum, i.e., 63.80% of individuals needed TN2 whereas 18.20% of individuals needed TN3 and 18.10% of individuals needed TN1. Conclusion: It can be concluded with a word of hope and a word of warning. Hope lies in the fact that the measurement of periodontal diseases by epidemiological study of this condition is improving and receiving wide spread attention. The warning lies in the varied nature of the condition which goes to make up periodontal disease and perplexing ways in which these conditions blend. In addition to dental practitioner, periodontist and public health workers must devote more time and effort toward controlling periodontal disease than they seem to be devoting at present. PMID:27143834

  19. HIV/AIDS, the erosion of social capital and the collapse of rural livelihoods in the Nkomazi district of South Africa.

    PubMed

    Dawson, Hannah

    2013-12-01

    HIV/AIDS is a major driver of livelihood insecurity. The AIDS epidemic, through the death or disability of economically productive adults, destabilises and erodes the social networks which sustain the livelihoods of vulnerable households. This paper draws upon research with home-based care workers and family members of 14 households directly affected by HIV/AIDS in the rural district of Nkomazi, South Africa. Through a social capital framework this study reveals the fragile linkages between households and broader kin networks demonstrating the (in)ability of the households to adapt and manage the economic and social impact of the epidemic. The chronic financial burden of the epidemic on poor households compounded by HIV/AIDS-related stigma undermines kinship ties resulting in the extended family becoming more conditional, temporary and at times destructive. The extended family cannot be romanticised as a 'safety net' and instead needs to be problematised for its complexities, limitations and constraints while ensuring sufficient external support is provided to sustain the care and support provided by the family and local community.

  20. Challenges and coping strategies of parents of children with autism on the Kenyan coast

    PubMed Central

    Gona, JK; Newton, CR; Rimba, KK; Mapenzi, R; Kihara, M; Vijver, FV; Abubakar, A

    2017-01-01

    Introduction Research on the challenges of raising a child with autism is mostly conducted in Europe, North America and Australia, and has revealed that parents have to come to terms with living with a lifelong developmental disability. In addition, parents are faced with numerous concerns, such as caring burdens, poor prognosis, and negative public attitudes. Virtually no research has been conducted in Africa on this subject. Methods Thirty-seven interviews and eight focus group discussions were conducted with parents of children with autism and professionals in regular contact with these parents from rural and urban counties of the Kenyan coast. The study investigated challenges faced by parents and how they cope with those challenges. A purposive–convenience sampling procedure was used in selecting the study participants. A digital recorder was used to record all the interviews and focus group discussions. Transcriptions were done in Swahili, translated into English, and then imported to the NVivo software program for content analysis. Results The results indicate that parents of children with autism on the Kenyan coast experience common challenges including stigma, lack of appropriate treatment, financial and caring burdens regardless of their religious and cultural backgrounds. Coping strategies applied by parents comprised problem-focused aspects that involve diet management and respite care, and emotion-focused aspects that consist of beliefs in supernatural powers, prayers and spiritual healing. Conclusions This qualitative study reveals a range of challenges that could have significant impact when caring for a child with autism. Coping strategies applied by parents target the physical health of the child and the psychological wellbeing of the parent. Consideration of these outcomes is vital as they could impact the initiation of a community-based rehabilitation service delivery in rural settings where parents play an active role. PMID:27098766

  1. Effectiveness of a Home-Based Counselling Strategy on Neonatal Care and Survival: A Cluster-Randomised Trial in Six Districts of Rural Southern Tanzania

    PubMed Central

    Hanson, Claudia; Manzi, Fatuma; Mkumbo, Elibariki; Shirima, Kizito; Penfold, Suzanne; Hill, Zelee; Shamba, Donat; Jaribu, Jennie; Hamisi, Yuna; Soremekun, Seyi; Cousens, Simon; Marchant, Tanya; Mshinda, Hassan; Schellenberg, David; Tanner, Marcel; Schellenberg, Joanna

    2015-01-01

    Background We report a cluster-randomised trial of a home-based counselling strategy, designed for large-scale implementation, in a population of 1.2 million people in rural southern Tanzania. We hypothesised that the strategy would improve neonatal survival by around 15%. Methods and Findings In 2010 we trained 824 female volunteers to make three home visits to women and their families during pregnancy and two visits to them in the first few days of the infant’s life in 65 wards, selected randomly from all 132 wards in six districts in Mtwara and Lindi regions, constituting typical rural areas in Southern Tanzania. The remaining wards were comparison areas. Participants were not blinded to the intervention. The primary analysis was an intention-to-treat analysis comparing the neonatal mortality (day 0–27) per 1,000 live births in intervention and comparison wards based on a representative survey in 185,000 households in 2013 with a response rate of 90%. We included 24,381 and 23,307 live births between July 2010 and June 2013 and 7,823 and 7,555 live births in the last year in intervention and comparison wards, respectively. We also compared changes in neonatal mortality and newborn care practices in intervention and comparison wards using baseline census data from 2007 including 225,000 households and 22,243 births in five of the six intervention districts. Amongst the 7,823 women with a live birth in the year prior to survey in intervention wards, 59% and 41% received at least one volunteer visit during pregnancy and postpartum, respectively. Neonatal mortality reduced from 35.0 to 30.5 deaths per 1,000 live births between 2007 and 2013 in the five districts, respectively. There was no evidence of an impact of the intervention on neonatal survival (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.9–1.2, p = 0.339). Newborn care practices reported by mothers were better in intervention than in comparison wards, including immediate breastfeeding (42% of 7

  2. National Advisory Council On Rural Development (1st, Washington, District of Columbia, April 14-15, 1982). Executive Summary of Proceedings.

    ERIC Educational Resources Information Center

    Rural Development Service (USDA), Washington, DC.

    The executive summary of the first meeting of the National Advisory Council on Rural Development gives highlights of remarks and presentations by 16 speakers and discussions by subgroups on supporting state and local government (management and rural development roles), on new ways for rural development, and on financing rural development. Purposes…

  3. Psychological distress and quality of life: rationale and protocol of a prospective cohort study in a rural district in Bangaladesh.

    PubMed

    Uddin, Mohammed Nazim; Bhar, Sunil; Al Mahmud, Abdullah; Islam, Fakir M Amirul

    2017-09-01

    A significant proportion of the global burden of disease has been attributed to mental and behavioural disorders. People with mental disorders (MDs) have lower levels of health-related quality of life than those without MDs. Several studies have shown that in low-resource countries, a range of social determinants including poor health literacy is critical in the epidemiological transition of disease outcome. There is a lack of evidence of MDs literacy, the prevalence and risk factors of common mental health conditions, or any validated instruments to measure psychological distress or evaluate the quality of life in rural areas of Bangladesh. The aims of this study are: (1) report the awareness, knowledge, attitudes and practice (KAP) of MDs; (2) estimate the prevalence of and risk factors for psychological distress; (3) measure association of psychological distress and other socio-demographic factors with quality of life and (4) test the feasibility to use Kessler 10-item (K10) and WHO Quality Of Life-BREF (WHOQOL-BREF) questionnaires in rural Bangladesh for measuring psychological distress and quality of life. A sample of 1500 adults aged 18-59 years and 1200 older adults aged 60-90 years will be interviewed from a multistage cluster random sample. Each participant will go through a face-to-face interview to assess their awareness and KAP of MDs. Information about the participant's sociodemographic and socioeconomic status will be collected along with the psychological distress (K10) and quality of life (WHOQOL-BREF) questionnaires. Internal consistency, validity, reliability and item discrimination of K10 and WHOQOL-BREF instruments will be determined by using Rasch analysis and regression techniques. Human Ethics Approval was received from the Swinburne University of Technology Human Ethics Committee. Results of this research will be disseminated via scientific forums including peer-reviewed publications and presentations at national and international

  4. Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.

    PubMed

    O'Meara, Wendy Prudhomme; Smith, Nathan; Ekal, Emmanuel; Cole, Donald; Ndege, Samson

    2011-01-01

    Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.

  5. Spatial Distribution of Bednet Coverage under Routine Distribution through the Public Health Sector in a Rural District in Kenya

    PubMed Central

    Prudhomme O'Meara, Wendy; Smith, Nathan; Ekal, Emmanuel; Cole, Donald; Ndege, Samson

    2011-01-01

    Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection. PMID:22022481

  6. Iodine nutritional status of school children in a rural area of Howrah district in the Gangetic West Bengal.

    PubMed

    Chandra, Amar K; Tripathy, Smritiratan; Lahari, Dishari; Mukhopadhyay, Sanjukta

    2004-04-01

    The objective of the study was to assess the status of iodine nutrition in an area of Howrah district where iodine deficiency disorders (IDD) were reported despite the introduction of iodised salt for general use. A total of 969 school children in the age group 6-12 years of both sexes were clinically examined for goitre. On the spot 242 urine samples were collected from the children to study the iodine and thiocyanate excretion pattern and 108 edible salt samples were collected from the homes of the children to measure iodine level. Drinking water samples were collected to evaluate the bioavailability of iodine in the region. The total goitre prevalence was 37.6% (Grade 1: 32.6%; Grade 2: 4.9%). The median urinary iodine level was 35 microg/dL, 12.5% urine samples had iodine level below 10 microg/dL and no sample was found to contain iodine below 5 microg/dL. In 51.9% salt samples iodine level was below 15 ppm and the iodine level in the drinking water was about 82 microg/L. The people of the area consume foods from the vegetables of the Brassica family and mean thiocyanate level was 0.747+/-0.21 mg/dL. The-findings of the present study indicated that as per clinical criteria of WHO/UNICEF/ICCIDD, IDD is a severe public health problem though apparently there is no biochemical iodine deficiency. Overall results indicate that factors other than iodine deficiency may have a role in the persistence of endemic goitre in the post salt-iodisation in this region.

  7. A study on knowledge and practice related to bird flu in a rural community of Hooghly District of West Bengal.

    PubMed

    Datta, Shibani; Sen, Shibotosh; Sengupta, Bhaswati

    2010-01-01

    For last few years in the early spring bird flu poses a threat to India. The causative agent H5N1 virus is also getting robust day by day acquiring an ability to cross the species barrier. It is now known as (H5N1) which is emerging as killer virus to man. Although human casualty is yet to be recorded from India, but the threat is not over. The present study had been undertaken in the village of Hakimpur of Singur Block of District Hooghly, West Bengal, with a population 862 of 215 families. The objective of the study was to assess the knowledge of the study population regarding bird flu and to study their practice regarding poultry maintenance. The head of the family from each family was interviewed. A house to house survey in the census method on a pre-designed, pre-tested, semi-structured schedule was done. Information regarding socio-demographic profile, poultry keeping, correct knowledge about bird flu, mode of transmission, culling, etc was recorded. The data were collected and analyzed by relevant statistical methods. The results showed that 46% respondents knew what bird flu is, 62.8% knew the mode of transmission, and 35.3% knew the procedure of culling. Out of literates about 53% and out of the illiterates only 0.93% were aware of the transmission of the virus through body fluids. The predominant source of information was mass media. 57.14% of the families rearing poultry, kept the birds in shed, 40.48% in cage, and 2.38% in living room.

  8. Birth weight and delivery practice in a Vietnamese rural district during 12 year of rapid economic development.

    PubMed

    Nguyen, Huong Thu; Eriksson, Bo; Tran, Toan Khanh; Nguyen, Chuc Thi Kim; Ascher, Henry

    2013-02-19

    Since the Doi Moi reform 1986 economic conditions in Vietnam have changed significantly and positive health and health care developments have been observed. International experience shows that improved economic conditions in a country can reduce the risk of perinatal mortality, decrease the risk of low birth weight and increase the mean birth weight in newborns. The Health and Demographic Surveillance Site (HDSS) FilaBavi in Bavi district outside Hanoi city has been operational since 1999. An open cohort of more than 12,000 households (52,000 persons) has been followed primarily with respect to demography, economy and education. The aim of this research is to study trends in birth weight as well as birth and delivery practices over the time period 1999-2010 in FilaBavi in relation to the social and economic development. Information about birth weight, sex, place and method of delivery, mother's age and education as well as household economy of 10,114 children, born from 1999 to 2010, was obtained from the routine data collection in the HDSS. Over the study period the mean birth weight remained at the same level, about 3,100 g, in spite of increased economic resources and technology development. At the individual child level we found associations between birth weight and household economy as well as the education of the mother. Hospital delivery increased from about 35% to 65% and the use of Caesarian section increased from 2.6% to 10.1%. During the twelve years studied, household income as well as the use of modern technology increased rapidly. In spite of that, the mean and variation of birth weight did not change systematically. It is suggested that increasing gaps in economic conditions and misallocation of resources, possibly to overuse of technology, are partly responsible.

  9. Respiratory symptoms and illnesses among brick kiln workers: a cross sectional study from rural districts of Pakistan.

    PubMed

    Shaikh, Shiraz; Nafees, Asaad Ahmed; Khetpal, Vikash; Jamali, Abid Ali; Arain, Abdul Manan; Yousuf, Akram

    2012-11-20

    Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work. This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu districts, Sindh, Pakistan. A total of 340 adult men were assessed using translated version of the American Thoracic Society Division of Lung Disease (ATS-DLD) questionnaire. Logistic regression analysis was done to determine the relationship between various socio-demographic and occupational factors (age, education, type of work, number of years at work, smoking status), and the respiratory symptoms and illnesses (chronic cough, chronic phlegm, wheeze, Chronic Bronchitis and asthma). Results of the study show that 22.4% workers had chronic cough while 21.2% reported chronic phlegm. 13.8% had two or more attacks of shortness of breath with wheezing. 17.1% workers were suffering from Chronic Bronchitis while 8.2% reported physician diagnosed asthma. Amongst the non-smoking workers 8.9% had Chronic Bronchitis. Multivariate analysis found that workers involved in brick baking were more likely to have Chronic Bronchitis (OR= 3.7, 95% CI 1.1-11.6, p=<0.05) and asthma (OR= 3.9, 95% CI 1.01-15.5, p=<0.05) compared to those involved in carriage and placement work. A high frequency of respiratory symptoms and illnesses was observed among brick kiln workers. Age, nature of work and smoking were strong predictors of developing these symptoms and illnesses.

  10. Respiratory symptoms and illnesses among brick kiln workers: a cross sectional study from rural districts of Pakistan

    PubMed Central

    2012-01-01

    Background Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work. Methods This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu districts, Sindh, Pakistan. A total of 340 adult men were assessed using translated version of the American Thoracic Society Division of Lung Disease (ATS-DLD) questionnaire. Logistic regression analysis was done to determine the relationship between various socio-demographic and occupational factors (age, education, type of work, number of years at work, smoking status), and the respiratory symptoms and illnesses (chronic cough, chronic phlegm, wheeze, Chronic Bronchitis and asthma). Results Results of the study show that 22.4% workers had chronic cough while 21.2% reported chronic phlegm. 13.8% had two or more attacks of shortness of breath with wheezing. 17.1% workers were suffering from Chronic Bronchitis while 8.2% reported physician diagnosed asthma. Amongst the non-smoking workers 8.9% had Chronic Bronchitis. Multivariate analysis found that workers involved in brick baking were more likely to have Chronic Bronchitis (OR= 3.7, 95% CI 1.1-11.6, p=<0.05) and asthma (OR= 3.9, 95% CI 1.01-15.5, p=<0.05) compared to those involved in carriage and placement work. Conclusion A high frequency of respiratory symptoms and illnesses was observed among brick kiln workers. Age, nature of work and smoking were strong predictors of developing these symptoms and illnesses. PMID:23164428

  11. Quality of home-based rapid HIV testing by community lay counsellors in a rural district of South Africa

    PubMed Central

    Jackson, Debra; Naik, Reshma; Tabana, Hanani; Pillay, Mogiluxmi; Madurai, Savathee; Zembe, Wanga; Doherty, Tanya

    2013-01-01

    Introduction Lack of universal, annual testing for human immunodeficiency virus (HIV) in health facilities suggests that expansion of HIV testing and counselling (HTC) to non-clinical settings is critical to the achievement of national goals for prevention, care and treatment. Consideration should be given to the ability of lay counsellors to perform home-based HTC in community settings. Methods We implemented a community cluster randomized controlled trial of home-based HTC in Sisonke District, South Africa. Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health department at the time of the study (SD Bioline and Sensa). To monitor testing quality and counsellor skill, additional dry blood spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay (ELISA) testing. Sensitivity and specificity were calculated using the laboratory result as the gold standard. Results and discussion From 3986 samples, the counsellor and laboratory results matched in all but 23 cases. In 18 cases, the counsellor judged the result as indeterminate, whereas the laboratory judged 10 positive, eight negative and three indeterminate, indicating that the counsellor may have erred on the side of caution. Sensitivity was 98.0% (95% CI: 96.3–98.9%), and specificity 99.6% (95% CI: 99.4–99.7%), for the lay counsellor field-based rapid tests. Both measures are high, and the lower confidence bound for specificity meets the international standard for assessing HIV rapid tests. Conclusions These findings indicate that adequately trained lay counsellors are capable of safely conducting high-quality rapid HIV tests and interpreting the results as per the kit guidelines. These findings are important given the likely expansion of community and home-based testing models and the shortage of clinically trained professional staff. PMID:24241957

  12. Community perceptions and practices of treatment seeking for childhood pneumonia: a mixed methods study in a rural district, Ghana.

    PubMed

    Abbey, Mercy; Chinbuah, Margaret A; Gyapong, Margaret; Bartholomew, L Kay; van den Borne, Bart

    2016-08-22

    The World Health Organization recommends community case management of malaria and pneumonia for reduction of under-five mortality in developing countries. Caregivers' perception and understanding of the illness influences the care a sick child receives. Studies in Ghana and elsewhere have routinely shown adequate recognition of malaria by caregivers. Similarly, evidence from Asia and some African countries have shown adequate knowledge on pneumonia. However, in Ghana, little has been documented about community awareness, knowledge, perceptions and management of childhood pneumonia particularly in the Dangme West district. Therefore this formative study was conducted to determine community perceptions of pneumonia for the purpose of informing the design and implementation of context specific health communication strategies to promote early and appropriate care seeking behaviour for childhood pneumonia. A mixed method approach was adopted. Data were obtained from structured interviews (N = 501) and eight focus group discussions made up of 56 caregivers of under-fives and eight community Key Informants. Descriptive and inference statistics were used for the quantitative data and grounded theory to guide the analysis of the qualitative data. Two-thirds of the respondents had never heard the name pneumonia. Most respondents did not know about the signs and symptoms of pneumonia. For the few who have heard about pneumonia, causes were largely attributed to coming into contact with cold temperature in various forms. Management practices mostly were self-treatment with home remedies and allopathic care. The low awareness and inadequate recognition of pneumonia implies that affected children may not receive prompt and appropriate treatment as their caregivers may misdiagnose the illness. Adequate measures need to be taken to create the needed awareness to improve care seeking behaviour.

  13. Kenyan and Ethiopian distance runners: what makes them so good?

    PubMed

    Wilber, Randall L; Pitsiladis, Yannis P

    2012-06-01

    Since the 1968 Mexico City Olympics, Kenyan and Ethiopian runners have dominated the middle- and long-distance events in athletics and have exhibited comparable dominance in international cross-country and road-racing competition. Several factors have been proposed to explain the extraordinary success of the Kenyan and Ethiopian distance runners, including (1) genetic predisposition, (2) development of a high maximal oxygen uptake as a result of extensive walking and running at an early age, (3) relatively high hemoglobin and hematocrit, (4) development of good metabolic "economy/efficiency" based on somatotype and lower limb characteristics, (5) favorable skeletal-muscle-fiber composition and oxidative enzyme profile, (6) traditional Kenyan/Ethiopian diet, (7) living and training at altitude, and (8) motivation to achieve economic success. Some of these factors have been examined objectively in the laboratory and field, whereas others have been evaluated from an observational perspective. The purpose of this article is to present the current data relative to factors that potentially contribute to the unprecedented success of Kenyan and Ethiopian distance runners, including recent studies that examined potential links between Kenyan and Ethiopian genotype characteristics and elite running performance. In general, it appears that Kenyan and Ethiopian distance-running success is not based on a unique genetic or physiological characteristic. Rather, it appears to be the result of favorable somatotypical characteristics lending to exceptional biomechanical and metabolic economy/efficiency; chronic exposure to altitude in combination with moderate-volume, high-intensity training (live high + train high), and a strong psychological motivation to succeed athletically for the purpose of economic and social advancement.

  14. "The problem is ours, it is not CRAIDS' ". Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia.

    PubMed

    Walsh, Aisling; Mulambia, Chishimba; Brugha, Ruairi; Hanefeld, Johanna

    2012-11-28

    While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn. In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011. All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. FUNDING opportunities for CBOs in Mumbwa in 2010 were scarce.Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics.Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers' skills levels had reduced. Whilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground

  15. “The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia

    PubMed Central

    2012-01-01

    Background While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn. Methods In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011. Results Funding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce. Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics. Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced. Conclusions Whilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of

  16. Exploring Kenyan Women's Perceptions of Intimate Partner Violence.

    PubMed

    Gillum, Tameka L; Doucette, Mitchell; Mwanza, Mtise; Munala, Leso

    2016-01-06

    Intimate partner violence (IPV) is a major public health problem and global human rights violation. Effective interventions can only be created upon conducting qualitative studies that explore the cultural context of an affected population and how they interpret the phenomenon. This qualitative study investigated Kenyan women's perceptions of IPV. Two community-based focus groups (n = 19) were conducted with Kenyan women in Nairobi. Conventional content analysis identified seven primary themes that emerged from focus group data: snapshot of violence; poverty; cultural context; masculinity; women taking action; resources; and, prevention strategies. Themes are described and implications for further research and intervention are presented. © The Author(s) 2016.

  17. Exploration of ethno-medicinal knowledge among rural communities of Pearl Valley; Rawalakot, District Poonch Azad Jammu and Kashmir

    PubMed Central

    Shaheen, Humaira; Qaseem, Mirza Faisal; Amjad, Muhammad Shoaib; Bruschi, Piero

    2017-01-01

    Background Medicinal plants are the basic source of health care in the Pearl Valley District Poonch, Azad Jammu, and Kashmir. The basic aim of present study was to record information about the use of plants in herbal preparation and quantification of recorded data. Materials and methods The research was conducted with the null hypothesis that there was no differential distribution of knowledge among the communities between genders and among different age groups in the study area and across cultural medicinal uses of the plants are similar. To check these hypotheses information about medicinal plants was collected from 46 laypeople and 18 herbalists by using an open ended and semistructured questionnaire. Different ethnobotanical indices were calculated in order to quantify the knowledge on the medicinal plants reported in the study. Results Our study recorded 136 species of medicinal plants belonging to 45 families with Asteraceae (14 species) as the dominant family of the area. Decoction (26 species), juice and powder (24 species each) were most common methods of preparation. Spearman’s correlation analysis showed that age and gender had the significant effect on both numbers of mentioned species and different uses. A number of known medicinal plants and the number of different uses (H: 38.51; p < 0.001) differ significantly as indicated by Kruskal-Wallis tests. These results showed that the knowledge about the plant varies among different age groups, which were the first hypothesis of the present study. The highest use values (UVs) were reported for Berberis lyceum and Ajuga bracteosa (1.13 each) followed by Abies pindrow (1.03). Highest informant consensus factor (ICF) values were recorded for digestive system diseases (ICF = 0.90) and muscular and skeletal system diseases (ICF = 0.89). The value of Jaccarad index ranged from 6.11 to 32.97 with an average value of 19.84, percentage of similarity was highest between study area and Pir Lasura National Park (34

  18. Predictors of couple HIV counseling and testing among adult residents of Bukomero sub-county, Kiboga district, rural Uganda.

    PubMed

    Muhindo, Richard; Nakalega, Annet; Nankumbi, Joyce

    2015-11-24

    Studies have shown that couple HIV counseling and testing (CHCT) increased rates of sero-status disclosure and adoption of safer sexual behaviors with better linkage to treatment and care. However, current evidence suggests that new HIV infections are occurring among heterosexual couples in stable relationships where the majority of the individuals are not aware of their partner's serostatus. This study examined the predictors of CHCT uptake among married or cohabiting couples of Bukomero sub-county Kiboga district in Uganda. This cross-sectional correlational study was conducted among 323 individuals who were either married or cohabiting, aged 18-49 years. Participants were enrolled from randomly selected households in Bukomero sub-county. Data were collected using an interviewer-administered questionnaire on socio-demographics, self-rating on awareness of CHCT benefits, couple discussion about HIV testing and CHCT practices. Couples were compared between those who had reported to have tested as a couple and those who had not. Binary logistic regression was performed to determine the adjusted odds ratio [aOR] and 95 % confidence intervals [CI] for CHCT uptake and the other independent variables. Of the participants 288 (89.2 %) reported to have ever taken an HIV test only 99 (34.4 %) did so as a couple. The predictors of testing for HIV as a couple were discussing CHCT with the partner (adjusted odds ratio 4.95[aOR], 95 % confidence interval [CI]:1.99-12.98; p < 0.001), awareness of CHCT benefits (aOR 3.23; 95 % CI 1.78-5.87; p < 0.001) and having time to test as a couple (aOR 2.61; 95 % CI 1.22-5.61; p < 0.05). Uptake of HIV counseling and testing among couples was low. Discussing CHCT with partner, awareness of CHCT benefits, and availability of time to test as a couple were predictive of CHCT uptake. Thus CHCT campaigns should emphasize communication and discussion of HIV counseling and testing among partners.

  19. Exploration of ethno-medicinal knowledge among rural communities of Pearl Valley; Rawalakot, District Poonch Azad Jammu and Kashmir.

    PubMed

    Shaheen, Humaira; Qaseem, Mirza Faisal; Amjad, Muhammad Shoaib; Bruschi, Piero

    2017-01-01

    Medicinal plants are the basic source of health care in the Pearl Valley District Poonch, Azad Jammu, and Kashmir. The basic aim of present study was to record information about the use of plants in herbal preparation and quantification of recorded data. The research was conducted with the null hypothesis that there was no differential distribution of knowledge among the communities between genders and among different age groups in the study area and across cultural medicinal uses of the plants are similar. To check these hypotheses information about medicinal plants was collected from 46 laypeople and 18 herbalists by using an open ended and semistructured questionnaire. Different ethnobotanical indices were calculated in order to quantify the knowledge on the medicinal plants reported in the study. Our study recorded 136 species of medicinal plants belonging to 45 families with Asteraceae (14 species) as the dominant family of the area. Decoction (26 species), juice and powder (24 species each) were most common methods of preparation. Spearman's correlation analysis showed that age and gender had the significant effect on both numbers of mentioned species and different uses. A number of known medicinal plants and the number of different uses (H: 38.51; p < 0.001) differ significantly as indicated by Kruskal-Wallis tests. These results showed that the knowledge about the plant varies among different age groups, which were the first hypothesis of the present study. The highest use values (UVs) were reported for Berberis lyceum and Ajuga bracteosa (1.13 each) followed by Abies pindrow (1.03). Highest informant consensus factor (ICF) values were recorded for digestive system diseases (ICF = 0.90) and muscular and skeletal system diseases (ICF = 0.89). The value of Jaccarad index ranged from 6.11 to 32.97 with an average value of 19.84, percentage of similarity was highest between study area and Pir Lasura National Park (34.62%). High similarity might be due to the

  20. Spatial, environmental and entomological risk factors analysis on a rural dengue outbreak in Lundu District in Sarawak, Malaysia.

    PubMed

    Cheah, Whye Lian; Chang, Moh Seng; Wang, Yin Chai

    2006-06-01

    The objective of this study was to elucidate the association of various risk factors with dengue cases reported in Lundu district, Sarawak, by analyzing the interaction between environmental, entomological, socio-demographic factors. Besides conventional entomological, serological and house surveys, this study also used GIS technology to generate geographic and environmental data on Aedes albopictus and dengue transmission. Seven villages were chosen based on the high number of dengue cases reported. A total of 551 households were surveyed. An overall description of the socio-demographic background and basic facilities was presented together with entomological and geographical profiles. For serological and ovitrap studies, systematic random sampling was used. Serological tests indicated that 23.7% of the 215 samples had a history of dengue, either recent or previous infections. Two samples (0.9%) were confirmed by IgM ELISA and 49 samples (22.8%) had IgG responses. A total of 32,838 Aedes albopictus eggs were collected in 56 days of trapping. Cluster sampling was also done to determine whether any of the risk factors (entomological or geographical) were influenced by geographical location. These clusters were defined as border villages with East Kalimantan and roadside villages along Lundu/Biawas trunk road. The data collected were analyzed using SPSS version 10.01. Descriptive analysis using frequency, means, and median were used. To determine the association between variables and dengue cases reported, and to describe the differences between the two clusters of villages, two-sample t-test, and Pearson's Chi-Square were used. Accurate maps were produced with overlay and density function, which facilitates the map visualization and report generating phases. This study also highlights the use of differential Global Positioning System in mapping sites of 1m accuracy. Analysis of the data revealed there are significant differences in clusters of villages attributable

  1. Experiences of households using integrated malaria prevention in two rural communities in Wakiso district, Uganda: a qualitative study.

    PubMed

    Musoke, David; Karani, George; Ndejjo, Rawlance; Okui, Peter; Musoke, Miph Boses

    2016-06-07

    The integrated approach to malaria prevention which advocates use of several methods in a holistic manner is being explored to complement existing strategies. A pilot project that promoted integrated malaria prevention established 40 demonstration households using the approach. As part of impact evaluation of the project 2 years after implementation, the experiences of these households using integrated malaria prevention were assessed. A qualitative cross-sectional survey was carried out in Wakiso district, Uganda which involved 40 in-depth interviews among households implementing integrated malaria prevention. The study assessed practices on malaria prevention, benefits and challenges of using integrated malaria prevention, preference of malaria prevention methods, and impact of the demonstration households on the community. Thematic analysis was employed using Atlas ti software. The households continued to use many of the malaria prevention methods in the integrated approach including sleeping under long-lasting insecticidal nets, screening in windows and ventilators, removing mosquito breeding sites, and closing of doors early in the evenings. The major benefits reported from using integrated malaria prevention were reduction in mosquito populations in their houses and less occurrence of malaria particularly among children. Although several community members learnt about and admired various malaria prevention methods from the demonstration households especially screening in windows and ventilators, the majority could not afford to implement some of them due to lack of resources. The main challenge established in using integrated malaria prevention was the much time required to implement the several methods some of which had to be done regularly such as early closing of windows. In addition, complacency had led to some households not utilizing a number of methods in the integrated approach because of using others. Use of the integrated approach to malaria

  2. Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital

    PubMed Central

    Jordan, Mark; Caesar, Jenny

    2016-01-01

    Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization service. Consequently, local recommendations on STEMI management exist to promote timely administration of thrombolysis within 30 minutes of patient arrival. However, translating updated clinical policy into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we noted a high incidence of patients presenting with STEMI receiving thrombolytic therapy outside the recommended 30 minutes door-to-needle time. Although final treatment was often only delayed by 5-10 minutes, we were concerned by the seemingly inconsistent management of these patients, often leading to unnecessary delays in the initiation of rapid reperfusion therapy. We therefore championed a newly updated clinical guideline and promoted an early STEMI recognition and treatment algorithm in our hospital to raise awareness amongst staff and improve door-to-needle times. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and cardiac nursing staff, as well as posters and training on the use of a remote electronic ECG interpretation system to streamline out-of-hours management. Overall, we found there to a be a steady improvement in door-to-needle times at our hospital, with 74% of patients receiving appropriate care within 30 minutes, compared to 43% prior to our interventions. This also translated to better patient outcomes

  3. Rural Education Issues: Rural Administrators Speak Out

    ERIC Educational Resources Information Center

    Williams, Julia; Nierengarten, Gerry

    2010-01-01

    The purpose of this study was to identify the issues that most affect Minnesota's rural public school administrators as they attempt to fulfill the mandates required from state legislation and communities. A second purpose was to identify exemplary practices valued by individual Minnesota rural schools and districts. Electronic surveys were sent…

  4. Health care decision making autonomy of women from rural districts of Southern Ethiopia: a community based cross-sectional study.

    PubMed

    Alemayehu, Mihiretu; Meskele, Mengistu

    2017-01-01

    traditional male dominance. Special attention has to be given to women living in rural areas in order to reduce their dependency through education and income generating activities.

  5. A Study on Gender Preference and Awareness Regarding Prenatal Sex Determination among Antenatal Women in a Rural Area of Darjeeling District, West Bengal, India

    PubMed Central

    Roy, Archak

    2017-01-01

    Introduction Sex ratio is one of the major indicators to find the gender preferences in the community. Change in sex ratio reflects underlying socioeconomic, cultural patterns of a society. Aim The present study was conducted with the aim to find out the knowledge of antenatal women regarding the prenatal sex determination and the Pre Natal Diagnostic Techniques (PNDT) Act in a rural area along with assessing the gender preference in family among the study population. Materials and Methods A community based, descriptive, cross-sectional study was undertaken in the villages of Matigara Block of Darjeeling district of West Bengal, which serves as a field practice area of North Bengal Medical College & Hospital for two months. A total of 116 pregnant women were included and a pre designed pre tested questionnaire was used to collect the socio demographic details. The data were analysed by SPSS 20.0 software for proportions with chi-square tests. Results Knowledge of sex determination and the PNDT Act were found to be 44.82% and 18.10% among antenatal women. Knowledge regarding assessment of gender preference showed 52.58% expect a boy in this pregnancy. It was found that the determinants for gender preference were caste, sex of the last pregnancy and current gender composition. It was found that the determinants for knowledge of sex determination are age of the mother and the gravida of the mother. It was also found that the factor for the knowledge regarding the PNDT Act is age of the mother. These associations are statistically significant. Conclusion This situation calls for a strategy which includes community based awareness campaigns, women employment, education, and empowerment and by ensuring effective implementation of PNDT Act by the government so that families find it difficult to undertake sex determination. PMID:28384893

  6. Adult population as potential reservoir of NTD infections in rural villages of Kwale district, Coastal Kenya: implications for preventive chemotherapy interventions policy.

    PubMed

    Njenga, Sammy M; Mwandawiro, Charles S; Muniu, Erastus; Mwanje, Mariam T; Haji, Fatma M; Bockarie, Moses J

    2011-09-14

    Neglected tropical diseases (NTDs) are major public health problems in developing countries where they contribute to suffering of populations living in poor settings. As part of a research project started in September 2009 in Kwale district, Coast Region, Kenya, a baseline cross-sectional survey was conducted in 5 rural villages to provide information on the status of NTDs, including urinary schistosomiasis, soil-transmitted helminthiasis (STH), and lymphatic filariasis. This paper presents the results of a parasitological investigation among adults in the study villages. A total of 599 adults in the 5 study villages were tested for NTD infections in urine, stool and blood. The presence of Schistosoma haematobium infection was determined by the urine filtration method. The presence of STH in stool was determined by Kato-Katz method while filarial antigenaemia was determined using immunochromatographic (ICT) test. The study revealed high prevalence of hookworm (41.7%) and schistosomiasis (18.2%) infections among adults in the study villages. Of the 599 individuals examined, 50.1% had one or more helminthic infections. There was low level of polyparasitism with helminthic NTDs in the study population with 9.5% and 1.7% of the participants having two and three infections, respectively. In the current study, hookworm and schistosomiasis infections were identified as important infections among adults living in areas of high endemicity for these infections. Thus, if this section of the population is left untreated it may remain an important potential reservoir and a source of re-infection for school-age children treated in school deworming programmes. Therefore, there is a need to design novel strategies for preventive chemotherapy interventions that could allow inclusion of adults in an effort to reduce force of infection in high endemic communities.

  7. Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan.

    PubMed

    Riaz, Atif; Zaidi, Shehla; Khowaja, Asif Raza

    2015-03-06

    A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong community-based behavior change strategies. © 2015 by Kerman University of Medical Sciences.

  8. Injury epidemiology after the 2001 Gujarat earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster

    PubMed Central

    Phalkey, Revati; Reinhardt, Jan D.; Marx, Michael

    2011-01-01

    Background The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation. Objective To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake. Design/Methods Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries. Results Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported. Conclusion The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning. PMID:21799668

  9. Self-medication with anti-malarials is a common practice in rural communities of Kilosa district in Tanzania despite the reported decline of malaria

    PubMed Central

    2014-01-01

    Background Self-medication has been widely practiced worldwide particularly in developing countries including Tanzania. In sub-Saharan Africa high incidences of malaria have contributed to self-medication with anti-malarial drugs. In recent years, there has been a gain in malaria control, which has led to decreased malaria transmission, morbidity and mortality. Therefore, understanding the patterns of self-medication during this period when most instances of fever are presumed to be due to non-malaria febrile illnesses is important. In this study, self-medication practice was assessed among community members and information on the habit of self-medication was gathered from health workers. Methods Twelve focus group discussions (FGD) with members of communities and 14 in-depth interviews (IDI) with health workers were conducted in Kilosa district, Tanzania. The transcripts were coded into different categories by MaxQDA software and then analysed through thematic content analysis. Results The study revealed that self-medication was a common practice among FGD participants. Anti-malarial drugs including sulphadoxine-pyrimethamine and quinine were frequently used by the participants for treatment of fever. Study participants reported that they visited health facilities following failure of self-medication or if there was no significant improvement after self-medication. The common reported reasons for self-medication were shortages of drugs at health facilities, long waiting time at health facilities, long distance to health facilities, inability to pay for health care charges and the freedom to choose the preferred drugs. Conclusion This study demonstrated that self-medication practice is common among rural communities in the study area. The need for community awareness is emphasized for correct and comprehensive information about drawbacks associated with self-medication practices. Deliberate efforts by the government and other stakeholders to improve health care

  10. Banning traditional birth attendants from conducting deliveries: experiences and effects of the ban in a rural district of Kazungula in Zambia.

    PubMed

    Cheelo, Chilala; Nzala, Selestine; Zulu, Joseph M

    2016-10-21

    In 2010 the government of the republic of Zambia stopped training traditional birth attendants and forbade them from conducting home deliveries as they were viewed as contributing to maternal mortality. This study explored positive and negative maternal health related experiences and effects of the ban in a