Barriers and enablers to breast cancer screening in rural South Africa.

BACKGROUND:  The breast cancer burden on the South African healthcare system is severe, with rural South African women often diagnosed at an advanced stage of the disease. South Africa's rural areas are classified as low-resource settings with limited medical services and infrastructure. The impact of breast cancer on rural communities in South Africa requires ongoing research to better understand the severity of this disease among one of the most vulnerable populations. OBJECTIVES:  This study aimed to explore the barriers and enablers of breast cancer screening among rural South African women. METHOD:  An exploratory qualitative study was utilised. A semi-structured interview was conducted with 22 rural South African women. Data were analysed using thematic analysis. This study utilised the care-seeking behaviour theory as its theoretical framework. RESULTS:  Participants identified many barriers to breast cancer screening, including individual affordability, transportation, rural services, infrastructure, health professional behaviour, and the lack of educational materials. Several factors are suggested to enable the screening of breast cancer in rural South Africa, including breast cancer campaigns, health education, the involvement of key stakeholders, and promotional materials. CONCLUSION:  Despite the many barriers to breast cancer screening among rural South African women, there is still hope in implementing the various promotional tools outlined in this study and ensuring that breast self-examination is an alternative, affordable screening method.Contribution: The purpose of this article is to contribute to the attainment of the Sustainable Development Goal (SDG) 3, which focusses reducing premature mortality from non-communicable diseases, including cancer.

Caregivers' expectations of their non-verbal autistic children in rural KwaZulu-Natal.

BACKGROUND:  Caregiver expectations have been shown to impact child outcomes. There is limited research regarding caregivers of non-verbal autistic children in rural South Africa. Autistic individuals form part of a larger environment, which they influence and which impacts them. Caregivers form part of this environment. OBJECTIVES:  This study aims to explore caregivers' expectations of communication, education, social implications and intervention for their non-verbal autistic child in rural KwaZulu-Natal (KZN). METHOD:  Bronfenbrenner's ecological and bioecological systems theory framed the study and allowed the child's interaction with their environment to be understood through the use of a qualitative study design via interviews. Eleven caregivers (pilot study: n = 1 and main study: n = 10) of non-verbal autistic children were selected and interviewed. Data were analysed thematically. RESULTS:  Caregivers had varied expectations. Grandparents were often the primary caregivers (microsystem). Relationships within the mesosystem (caregiver and therapist) and caregiver's understanding affected their feelings and expectations that changed over time (chronosystem). Education was the predominant expectation. The study highlighted limited resources (schools) within the exosystem. Caregivers reported both support and judgement from their communities. CONCLUSION:  There is a need for public awareness, caregiver counselling and autism support groups in rural KZN and more specialised education options in order to improve caregivers' expectations.Contribution: This study contributes to the limited literature in the field of autism in South Africa, more specifically the rural context and communication disorders.

The requirements of providing health education for rural people through electronic methods: the experiences and perspectives of community health workers.

BACKGROUND: Reliance solely on traditional approaches in health education is no longer considered sufficient, and electronic/digital education can be a complementary approach. Implementing electronic methods in health education requires identifying the requirements from the perspective of the service providers. Therefore, this study aimed to elucidate the experiences and perspectives of community health workers (Behvarzan) regarding the requirements for providing health education for rural people through electronic/digital means. METHODS: This descriptive qualitative study was conducted in 2022 at Alborz University of Medical Sciences. Data were collected through semi-structured interviews with 14 Behvarzan from Health Houses (HH) in Karaj City. The data were analyzed using the inductive Elo & Kyngas approach and conventional content analysis facilitated with MAXQDA software. RESULTS: After analyzing the results, we extracted 139 open codes, and by merging them for more precise coding and to facilitate the research process, we formed three main themes and ten subthemes. The themes included Technology (technical infrastructure, content production, content delivery methods, and content delivery channels), Facilities and equipment (communication equipment and electronic content repositories), and Stakeholders (training of providers, motivating providers, persuading learners and target groups, and reference groups). CONCLUSION: From the perspective of rural healthcare workers, the implementation of electronic education requires necessary technology, equipment, facilities, processes, and content should be pursued and provided through specialized working groups, extending from the Ministry of Health and Medical Education to local HHs. These resources should be available to the healthcare workers and their target populations. Concurrently, educational programs and incentives should be defined and offered at the university level and within health networks for rural healthcare workers and their populations.

Multivariable modeling: A retrospective cohort study exploring the impact of socioeconomic status and distance to a rural academic center on all-cause preterm delivery.

OBJECTIVE: Hospital-based labor and delivery units are closing at increasing rates in the rural US, significantly impacting maternal and newborn health. The objective of this study to determine if rurality-measured as distance from the hospital-and socioeconomic status-measured as insurance payor-impact both spontaneous and medically indicated preterm birth incidence at a single rural academic institution. METHODS: This was a retrospective cohort study using electronic medical records of patients with singleton pregnancies delivering at a single rural academic institution between 2016-2018. The primary outcome was preterm delivery (PTD) and secondary outcomes included low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included (1) travel time from a patient's address to the hospital and (2) insurance carrier as a proxy for socioeconomic status. Bivariate analyses indicated that travel time, insurance status, race, ethnicity, marital status, number of prenatal visits, gravida and para, and smoking status were significant predictors of all outcomes (LBW, ICN admission, and PTD). Therefore, these predictors were included in the multivariable logistic models. RESULTS: Within the multivariable logistic model, patients traveling 1-1.5 hours had approximately twice the odds of PTD (Odds Ratio, OR: 2.08, 95% Confidence Interval CI, 1.32, 3.29, p = .002), birth of a LBW neonate (OR: 2.15; 95% CI: 1.29-3.58, p = .005), and infant admission to the ICN (OR 1.83, 95% CI: 1.22-2.76, p = .004) compared to patients traveling under 30 minutes,. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission. CONCLUSION: Patients living 1-to-1.5 hours from the hospital had an increased risk for LBW, ICN admission, and PTD, despite living in zip codes with less social deprivation than zip codes further away from the hospital.

Prevention & management of snakebite envenomation: A qualitative study on perspectives & practices in Maharashtra & Odisha.

Background & objectives Snakebite envenoming (SBE) is a major public health concern, with India bearing the highest global burden of SBE-related deaths. SBE is concentrated in rural and tribal regions of India, where the knowledge, attitude and behaviour of the dwelling communities largely influence mortality and morbidity. Understanding these factors is crucial to designing effective SBE prevention and management strategies. The present study's objective was to document the perspectives of community members and practices in selected blocks of Maharashtra and Odisha States regarding SBE prevention, first aid and health-seeking behaviour. Methods Between March and April 2022, 28 focus group discussions (FGDs) were conducted. Study sites included Shahapur block in Thane district, Aheri block in Gadchiroli district of Maharashtra, and Khordha block in Khordha district, Kasipur block in Rayagada district of Odisha. Separate FGDs were held for males (n=14) and females (n=14), involving about 8-16 participants above 18 yr. All discussions were audio recorded, and a grounded theory approach was employed to identify key themes from the translated transcripts. Results The findings of this study revealed a variety of perspectives and practices determining the SBE burden at the study sites. The findings included insufficient knowledge about snake species and their nature of toxicity, use of non-scientific first aid techniques, inaccessible health care and reliance on traditional healers, non-utilization of prevention methods, varied cultural beliefs and practices, and differential treatments based on gender. The findings have been collated in two simplistic frameworks; barriers to effective prevention and barriers to effective management. Interpretation & conclusions SBE burden results from a complex interplay between socioeconomic, cultural, and demographic factors, necessitating a collaborative inter-sectoral effort for adequate control. Through crucial regional inputs and the barriers to prevention and management models, this study provides critical insights and priority intervention areas to strengthen India's upcoming National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) in all high-burden States.

Exploring the child marriage practices and their impact on women's lives in Pakistan: A qualitative analysis.

The study aimed to qualitatively explore the relationship between intimate partner violence and early marriage, focusing on the psychological and physical health issues faced by married women in rural Pakistan. Specifically, it investigated how resilience moderates the effects of early marriage, physical health problems, intimate partner abuse, and psychological issues. Using an intrinsic qualitative approach, the research involved interviews with 20 household heads, 62 husbands, and 40 wives in Sindh province. The findings indicated significant differences related to early marriage, intimate partner abuse, physical health issues, stress, anxiety, and depression. The results align with other South Asian studies, highlighting early marriage as a major risk factor for physical health issues and intimate partner violence. Additionally, the study underscores the widespread nature of violence as a social problem affecting married couples' health in Pakistan.

L'étude visait à explorer qualitativement la relation entre la violence conjugale et le mariage précoce, en se concentrant sur les problèmes de santé psychologique et physique rencontrés par les femmes mariées dans les zones rurales du Pakistan. Plus précisément, elle a étudié comment la résilience atténue les effets du mariage précoce, des problèmes de santé physique, de la violence conjugale et des problèmes psychologiques. Utilisant une approche qualitative intrinsèque, la recherche a impliqué des entretiens avec 20 chefs de famille, 62 maris et 40 épouses dans la province du Sind. Les résultats ont indiqué des différences significatives liées au mariage précoce, à la violence conjugale, aux problèmes de santé physique, au stress, à l'anxiété et à la dépression. Les résultats concordent avec d'autres études sud-asiatiques, soulignant le mariage précoce comme un facteur de risque majeur de problèmes de santé physique et de violence conjugale. En outre, l'étude souligne le caractère répandu de la violence en tant que problème social affectant la santé des couples mariés au Pakistan.

Hypertension in India: a gender-based study of prevalence and associated risk factors.

BACKGROUND: Hypertension, a major non-communicable disease, is responsible for a significant number of global deaths, including approximately 17.9 million yearly. The Global Burden of Disease 2019 (GBD 2019) estimates that 19% of global deaths are attributed to elevated blood pressure. India, with a population of over 1.4 billion, is facing a serious challenge in combating this silent killer. This study aims to analyze the gender-based prevalence of hypertension in India and explore its associated risk factors using data from the fifth National Family Health Survey (NFHS-5). METHODS: NFHS-5 collected data from 636,699 households across all states and union territories. The study includes standardized blood pressure measurements for 17,08,241 individuals aged 15 and above. The data were analyzed using Stata, employing descriptive statistics for the assessment of the prevalence and binary logistic regression to identify predictors of hypertension. RESULTS: The study found the overall prevalence of hypertension in India to be 22.6%, with men (24.1%) having a higher prevalence than women (21.2%). Prevalence increased with age, reaching 48.4% in individuals aged 60 and above. Urban residents had a slightly higher prevalence (25%) than rural residents (21.4%), indicating the rapid spread of hypertension across all populations. Regional variations were observed, with the highest prevalence in Sikkim (37.9%) and the lowest in Rajasthan (16.5%). Increasing age, urban residence, belonging to certain religions (Muslim and other than Hindu or Muslim), and being classified as Scheduled Tribes (ST) were associated with a higher likelihood of hypertension. Conversely, belonging to Scheduled Castes (SC) or Other Backward Classes (OBC), being currently unmarried, and having higher education were associated with a lower likelihood of hypertension. Wealth index analysis revealed that those in the richest quintile were more likely to have hypertension. Behavioural risk factors, such as alcohol consumption, overweight, obesity, increased waist circumference, and high blood glucose levels, are positively associated with hypertension. CONCLUSION: Hypertension is a significant health burden in India, affecting both men and women. Age is the strongest non-modifiable predictor for both men and women. However, ageing women have higher odds of hypertension than ageing men, and this distinction becomes much more evident in their older ages. Obese women, based on BMI, have higher odds of hypertension than men. However, hypertension prevalence is slightly higher among men who are overweight or obese compared to women. BMI, waist circumference, random glucose level, alcohol use, and education level emerged as major predictors. Health education and awareness campaigns are critical to control the growing burden of hypertension in India. Policymakers must focus on preventive measures, targeting lifestyle changes and improved healthcare access for both men and women. By addressing these risk factors, India can make significant progress in controlling hypertension and reducing its impact on public health.

A multi-dimensional Sustainable Diet Index (SDI) for Ghanaian adults under transition: the RODAM Study.

BACKGROUND: The sustainability of diets consumed by African populations under socio-economic transition remains to be determined. This study developed and characterized a multi-dimensional Sustainable Diet Index (SDI) reflecting healthfulness, climate-friendliness, sociocultural benefits, and financial affordability using individual-level data of adults in rural and urban Ghana and Ghanaian migrants in Europe to identify the role of living environment in dietary sustainability. METHODS: We used cross-sectional data from the multi-centre Research on Obesity and Diabetes among African Migrants Study (N = 3169; age range: 25-70 years). For the SDI construct (0-16 score points), we used the Diet Quality Index-International, food-related greenhouse gas emission, the ratio of natural to processed foods, and the proportion of food expenditure from income. In linear regression analyses, we estimated the adjusted ß-coefficients and 95% confidence intervals (CIs) for the differences in mean SDI across study sites (using rural Ghana as a reference), accounting for sociodemographic and lifestyle factors. RESULTS: The overall mean SDI was 8.0 (95% CI: 7.9, 8.1). Participants in the highest SDI-quintile compared to lower quintiles were older, more often women, non-smokers, and alcohol abstainers. The highest mean SDI was seen in London (9.1; 95% CI: 8.9, 9.3), followed by rural Ghana (8.2; 95% CI: 8.0, 8.3), Amsterdam (7.9; 95% CI: 7.7, 8.1), Berlin (7.8; 95% CI: 7.6, 8.0), and urban Ghana (7.7; 95% CI: 7.5, 7.8). Compared to rural Ghana, the differences between study sites were attenuated after accounting for age, gender and energy intake. No further changes were observed after adjustment for lifestyle factors. CONCLUSION: The multi-dimensional SDI describes four dimensions of dietary sustainability in this Ghanaian population. Our findings suggest that living in Europe improved dietary sustainability, but the opposite seems true for urbanization in Ghana.

Induction of Labour in a District Hospital of Rural Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Induction of labour, a medical intervention before spontaneous onset, is employed when the risk of continuing pregnancy is elevated. Common indications include intrauterine growth restriction, preeclampsia, gestational diabetes, placental abnormalities, prelabor rupture of membranes, post-term pregnancy, and intrauterine foetal demise. The objective of this study was to find out the prevalence of induction of labour in a rural setting in Nepal. METHODS: We conducted a descriptive cross-sectional study in the District Hospital Tehrathum using patients' record files from 14 January 2021 to 14 January 2023. Ethical approval was obtained from Nepal Health Research Council. Demographic variables were collected along with maternal outcomes which include indication of induction of labour, mode of delivery, indication of lower segment caesarean section and foetal outcomes include APGAR score at one and five minutes, birthweight and liquor colour. A total population sampling method was used in the study and 95% confidence Interval was used to calculate the point estimate. RESULTS: Among 640 deliveries during the study period 118 (18.43%) (15.43- 21.43, 95% Confidence Interval) underwent induction of labour. Sixty-three (53.4%) of the 118 patients who underwent induction of labour were primigravida. CONCLUSIONS: The prevalence of induction of labour was comparable with previous studies. Neonatal outcome, rate of vaginal and lower segment C-section deliveries after induction of labour using misoprostol is comparable with other studies.

Younger and rural children are more likely to be hospitalized for SARS-CoV-2 infections.

PURPOSE: To identify characteristics of SARS-CoV-2 infection that are associated with hospitalization in children initially evaluated in a Pediatric Emergency Department (ED). METHODS: We identified cases of SARS-CoV-2 positive patients seen in the Arkansas Children's Hospital (ACH) ED or hospitalized between May 27, 2020, and April 28, 2022, using ICD-10 codes within the Pediatric Hospital Information System (PHIS) Database. We compared infection waves for differences in patient characteristics and used logistic regressions to examine which features led to a higher chance of hospitalization. FINDINGS: We included 681 pre-Delta cases, 673 Delta cases, and 970 Omicron cases. Almost 17% of patients were admitted to the hospital. Compared to Omicron-infected children, pre-Delta and Delta-infected children were twice as likely hospitalized (OR = 2.2 and 2.0, respectively; p<0.0001). Infants under one year were >3 times as likely to be hospitalized than children ages 5-14 years regardless of wave (OR = 3.42; 95%CI = 2.36-4.94). Rural children were almost three times as likely than urban children to be hospitalized across all waves (OR = 2.73; 95%CI = 1.97-3.78). Finally, those with a complex condition had nearly a 15-fold increase in odds of admission (OR = 14.6; 95%CI = 10.6-20.0). CONCLUSIONS: Children diagnosed during the pre-Delta or Delta waves were more likely to be hospitalized than those diagnosed during the Omicron wave. Younger and rural patients were more likely to be hospitalized regardless of the wave. We suspect lower vaccination rates and larger distances from medical care influenced higher hospitalization rates.

Feasibility and acceptability pilot study of an online weight loss program in rural, underserved communities.

Background: The purpose of this intervention was to investigate the feasibility, acceptability, and preliminary effectiveness of an online weight loss program, EMPOWER, in rural, underserved communities. Methods: Adults with a body mass index (BMI) ≥ 25 kg/m2 living in rural counties were recruited through collaboration with University of Illinois Extension. The intervention lasted 1 year including online educations sessions, nutrition and lifestyle coaching, and diet and weight monitoring via a novel web application, MealPlot. Feasibility was measured by enrollment attainment, participant retention, online education session completion, and completion of anthropometric and dietary measures. Acceptability was measured by survey using Likert scales of satisfaction for all program components. Anthropometric measurements, 24-h dietary records, and food frequency questionnaires (FFQs) were measures of program efficacy. Additionally, two interviews were collected for program feedback. Results: Enrollment of 16 participants was attained, however due to higher than anticipated dropout (retention 62.5%, N = 10) at 3-months, 62.5% of the education sessions were completed and 75.0% of anthropometric and dietary measures. The average satisfaction rating for the comprehensive program was 4.2/5 with lowest satisfaction being the MealPlot web application 2.7/5 (N = 11). On average a clinically significant (≥5% baseline weight) weight loss of 6.2 ± 6.0% body weight or 5.7 ± 5.3 kg and improvements to protein and fiber intake at 12 months (N = 10) were observed. Conclusions: A novel online weight loss program showed adequate to strong feasibility and acceptability and preliminary results indicating efficacy among a pilot sample of rural residents. Future studies are required to investigate means of improving retention and reducing the burden on program collaborators.

Water insecurity is associated with intimate partner violence among female adolescents and youth but not males in rural Tanzania: A cross-sectional study.

Food insecurity increases intimate partner violence (IPV), but less is known about water insecurity (WI) and IPV. We examined the association between household WI and IPV among adolescents and youth in the Mbeya and Iringa regions of Tanzania. The cross-sectional sample comprised 977 males and females aged 18-23 years living in rural, impoverished households. We conducted multivariate logistic regression analyses to estimate the association between experiences of WI [measured by the Household Water Insecurity Experiences (HWISE-4) Scale] and physical and/or emotional IPV (measured by an adapted Conflict Tactics Scale). Overall, WI (HWISE ≥4) was associated with 74% higher odds of any IPV (marginal effects (ME) of 7.8 percentage points (pp)), compared to those not WI. Among females (but not males), WI was associated with 3-fold higher odds of any IPV (OR = 3.00; 95% CI: [1.52, 5.94]; ME = 14 pp). Compared to non-WI females, WI females had 5- and 2-fold higher odds of IPV (ME = 30.8 and 11.3 pp) among the ever married and never married sub-samples, respectively. The association between WI and IPV among females was attenuated (OR = 1.93; 95% CI: [0.93, 3.97]) when adjusting for household food insecurity. Ameliorating water insecurity is a promising avenue for IPV reduction.

Oral health status and factors associated with oral health of primary school children in Gulu district, northern Uganda.

BACKGROUND: Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda. METHODS: A comparative cross-sectional study was conducted among 356 school children aged 11-13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding. RESULTS: Of the 356 children (11-13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0-7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1-6), 5.40 ± 1.81 (range, 0-9), 25.66 ± 4.29 (range 9-54) and 2.1 ± 1.65 (range, 0-6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02-1.39). CONCLUSION: The prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education.

Depression and stigma experience among patients with tuberculosis in urban and rural settings.

BACKGROUND: Tuberculosis is one of the leading causes of morbidity and mortality in the globe. The most common infectious disease-related death in the world is tuberculosis. In 2020, an estimated 9.9 million people became ill with tuberculosis (TB), translating to 127 cases per 100,000 people. The stigma associated with tuberculosis (TB) causes people to put off seeking treatment and adhering to their treatment regimen. India has the highest prevalence of tuberculosis in the world. Depression and stigma oftem co-exist in people with tuberculosis. OBJECTIVE: To estimate the prevalence of depression and stigma experience among patients with tuberculosis, and to determine the association of socio-demographic variables and stigma experience with depression in urban and rural field practice areas. METHODOLOGY: This is a cross-sectional study where purposive sampling method was adopted. A house-to-house and phone interview was conducted using a pre-designed, pre-tested questionnaire. Depression was assessed using the PHQ-9 and stigma experience was assessed using the Stigma Scale for Chronic Illness - 8 items (SSCI -8 Items). SPSS version 25 was used (licensed to the institution)for analysis. Descriptive statistics was used to calculate proportions, mean, standard deviation. Inferential statistics like Chi-square analysis/Fisher's exact analysis were used to find the association between various socio-demographic variables with the depression among patients with tuberculosis and association between stigma experience and depression. (Yates continuity Highlights correction applied wherever required) p < 0.5 was considered to be statistically significant. RESULTS: The overall prevalence of depression was 57.8%. The association between number of family members and type of tuberculosis with depression was statistically significant. 28.6% did not experience stigma, while 71.6% did. The association between depression score and stigma experience was not statistically significant. CONCLUSION: More than half of the study's participants had depression and had encountered stigma. There was significant association between depression scores with family size and type of tuberculosis.

Financial hardship of tuberculosis patients registered under National Tuberculosis Elimination Programme (NTEP) in rural India: A longitudinal study.

BACKGROUND: India shares a significant proportion of the Tuberculosis (TB) burden of the world. TB diagnosis, treatment, and success are complicated by the chronic nature of the disease as well as additional stressors including financial, psychological, and social hardships, adverse events associated with management, and poor compliance towards anti-tuberculosis medications. METHODS: This is a longitudinal study conducted in the Tuberculosis Units (TUs) of rural field practice areas of the Department of Community Medicine and Family Medicine in a tertiary care hospital in Odisha. 168 diagnosed TB patients from the TUs were enrolled after registration in NTEP and were followed up every month for 6 months or treatment completion. TB patient's cost estimate tool was used to collect data regarding the cost incurred by the patients before and during the diagnosis as well as in the post-diagnosis or treatment period. RESULTS AND CONCLUSION: Out-of-pocket expenditure was calculated as direct, indirect, and total cost in the pre and post-diagnostic phases of the disease. The median pre and post-diagnosis direct, indirect and total costs were ₹ 12,805, ₹ 16,960 and ₹ 31,192, respectively, with almost 62 % of participants spending more than 20 % of their annual income. In this study, 41 % of participants had to stop working for more than 60 days, and 53.1 % faced distress financing due to the disease. Through this study, we found that more than half of rural TB patients still visit private health facilities, and 20 % start anti-TB drugs by purchasing them from private pharmacies, which incur substantial out-of-pocket expenditure. Most participants faced catastrophic costs associated with hospitalisation, lower family income, and a delay in disease diagnosis.

Cross-national variation in the prevalence and correlates of current use of reusable menstrual materials: Analysis of 42 cross-sectional surveys in low-income, lower-middle-income, and upper-middle-income countries.

OBJECTIVES: This study investigates the prevalence of the use of reusable menstrual materials in LMICs, examines differences in prevalence between countries and areas, and identifies individual and country-level factors associated with their use. METHODS: Data from Multiple Indicator Cluster surveys conducted between 2017 and 2020 in LMICs were used. Prevalence estimates and 95% CIs were calculated for overall, rural, and urban areas. Multivariable logistic regression was used to identify individual and country-level factors associated with the use of reusable menstrual materials. RESULTS: The study included 42 surveys from LMICs, with 1653850 weighted women and girls aged 15-49 years. The overall prevalence of the use of reusable menstrual materials was 12.1% (95% CI 12.1-12.2), with significant variation between and within countries, ranging from 0.5% (0.3-0.8) in Serbia to 97.2% (96.5-97.9) in Sao Tome and Principe. The prevalence was higher in rural areas (23.9% [23.8-24.0]) than in urban areas (6.2% [6.2-6.2]), with significant differences between most countries. Use of reusable menstrual materials was associated with lower education levels, being married, low economic status, living in Asia and Africa, living in countries with lower GDP, living in rural areas, and limited availability of private places to wash menstrual materials. The prevalence of the use of reusable menstrual materials had an inverse linear relationship with the country's GDP. CONCLUSIONS: The study found that the use of reusable menstrual materials is more prevalent among women and girls in rural areas, those with lower education levels, lower economic status, and those living in countries with lower GDP. Given these disparities, policies and initiatives targeted at improving menstrual health in LMICs should focus on socioeconomically disadvantaged groups to ensure they have access to safe and appropriate menstrual materials.

Examining multidimensional health poverty and determining factors among rural women of childbearing age in ningxia, china.

BACKGROUND: The multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies. METHODS: Based on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age. RESULTS: With k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer. CONCLUSIONS: Even with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age.

Is home environment associated with child fluid reasoning abilities in middle childhood in high-risk settings? findings from a cross-sectional study in Pakistan.

BACKGROUND: Evidence from low- and middle-income countries (LMIC) suggests that home environment is associated with early childhood development outcomes. However, studies from LMIC that have examined how the home environment during middle childhood is associated with intellectual abilities are scarce. The objective of the study was to explore the association between different aspects of the home environment at 7-8 years and fluid reasoning abilities in a rural, high-risk cohort in Pakistan. METHODS: We employed a cross-sectional research design to examine 1172 children between 7 and 8 years and their families, utilizing the Home Observation for Measurement of Environment for Middle Childhood (HOME-MC) to evaluate various aspects of the home environment and the Fluid Reasoning Index (FRI) of the Wechsler Intelligence for Children (WISC)-5th edition to assess the fluid reasoning abilities of the children. Multivariable regression analyses were used to examine the association between different components of HOME-MC (scored as indices) and FRI scores. FINDINGS: Learning materials and opportunities (ß = 1.74, 95% CI = 1.15, 2.33) and Responsivity (ß = 1.73, 95% CI = 1.07, 2.38) indices had the strongest association with FRI score followed by Family companionship index (ß = 1.27, 95% CI = 0.63, 1.90). The eight different indices of the HOME-DC explained 22% of the total variation in FRI scores. CONCLUSION: We conclude that concurrent learning opportunities, parental responsivity and family companionship at home are associated with fluid reasoning abilities during middle childhood which is comparable to what has been found in early childhood years.

Regional variation in prevalence of frailty in India: Evidence from longitudinal ageing study in India (LASI) wave-1.

Background & objectives Frailty is a geriatric syndrome with clinical and public health implications. It represents the state of increased vulnerability. This study aimed to estimate the prevalence of frailty and pre-frailty by demographic characteristics and geographical regions in India. Furthermore, it also aimed to examine the association of this prevalence with selected health outcomes using data from the Longitudinal Ageing Study of India (LASI). Methods This is a secondary analysis of LASI wave-1 data. A total of 26,058 respondents aged ≥60 yr were included for analysis. Frailty was assessed using Fried's frailty phenotype, including slowness, shrinking, low physical activity, weakness, and low endurance. Descriptive statistics were used to study frailty distribution. The odds ratio (OR) of health events across the frailty categories was computed using ordinal logistic regression. Results The findings of this study suggest that the prevalence of frailty and pre-frailty was 29.2 and 58.8 per cent, respectively. The prevalence of frailty was higher among women (37.3%), illiterate (37%) and rural residents (31%). It ranged between 14.5 per cent in Uttarakhand and 41.3 per cent in Arunachal Pradesh. Frailty was strongly associated with depression [OR: 2.09, Confidence Interval (CI): 1.98-2.21] and activities of daily living (ADL) difficulty (OR: 1.75, CI: 1.64-1.86). Higher odds were reported for fracture (OR: 1.24, CI: 1.01-1.51) and multimorbidity (OR: 1.18, CI: 1.04-1.33) among frailty. Interpretation & conclusions The heterogeneity of frailty prevalence across States indicates the need for population-specific strategies. A sharp age-related increase in prevalence highlights the need for preventive measures. Furthermore, the high prevalence of frailty among women, illiterate and rural residents indicates the target population for receiving preventive interventions. Lastly, a heterogeneity in frailty prevalence across different States indicates the scope for region-specific programmes.