Development, implementation, and evaluation of a local community-based ophthalmology sentinel surveillance system in a remote rural area in Japan.

INTRODUCTION: Solid and sensitive infectious disease surveillance systems need to be developed and implemented to prevent and control epidemics. Although statutory national infectious disease surveillance systems have been developed in many countries, some challenges remain, such as their limited timeliness, representativeness, and sensitivity, as well as the fact that they cannot capture all local outbreaks that occur in small communities. To overcome these limitations, local community-based infectious disease surveillance systems that meet local needs and can operate with constrained resources need to be developed, especially in remote and rural low-resource areas. This study aimed to develop, implement, and evaluate a voluntary and unique local community-based ophthalmology sentinel surveillance system in Isa city (OSSS-Isa), a remote rural area in Japan. METHODS: For the development of OSSS-Isa, one hospital in Isa city assumed a leading role and developed a network with all medical institutions - 20 hospitals and clinics in the local community, including two ophthalmology clinics - as sentinel reporting sites. Surveillance was conducted on a weekly basis from Monday to Sunday. The collection, aggregation, and reporting of the surveillance data were implemented promptly on the same day, Monday, using a paper-based form and fax. For the evaluation of OSSS-Isa, the study followed the updated guidelines for evaluating public health surveillance systems proposed by the Centers for Disease Control and Prevention to select the evaluation criteria and develop a questionnaire. The questionnaires were then distributed to 20 hospitals and clinics, with the responses evaluated on a five-point Likert scale. RESULTS: For the implementation of OSSS-Isa, the system issued alerts twice to the networked hospitals and clinics when signs of an increase in the prevalence of a target infectious eye disease appeared in Isa city. After the alerts, the number of cases decreased in the community. Regarding the evaluation survey, physicians from 18 hospitals and clinics responded to the questionnaire (response rate 90%). In contrast to flexibility, more than 75% of the respondents gave high ratings to simplicity, data quality, acceptability, timeliness, and stability in evaluating OSSS-Isa, with the mean score for these evaluation criteria higher than 3.67. CONCLUSION: The present results indicate that OSSS-Isa has high simplicity, data quality, acceptability, timeliness, and stability, which is highly embedded with the local healthcare providers in Isa city. OSSS-Isa contributed to the early and accurate detection of signs of infectious eye disease outbreaks emerging in a small remote rural local community. The success factors seem to include its simple well-designed implementation methods, good external factors, and active human factors suited to the characteristics of the small remote rural community. The OSSS-Isa initiative appears to be a meaningful practical example of successful health advocacy by healthcare providers by developing a system at the local social level while going beyond the boundaries of routine medical practice. If voluntary small-scale surveillance systems can complement statutory large-scale ones and work together locally, nationally, and internationally, it might be possible to detect small, unusual happenings that occur in the community, such as emerging infectious diseases, and thereby help avert global outbreaks.

[Relationship between Personality Traits and Nutrition Package Feeding Behaviors of Infant Caregivers in Remote Rural Areas of Sichuan Province].

Objective To analyze the personality traits and nutrition package feeding behaviors of infant caregivers in remote rural areas of Sichuan province and explore the relationship between them. Methods A multi-stage random cluster sampling method was employed to select the infants of 6-24 months old and their caregivers in the remote rural areas of Sichuan province.A structured questionnaire was designed to collect the basic characteristics of infants and their caregivers,as well as the feeding behaviors of the caregivers.The Ten-Item Personality Inventory in China was used to evaluate the caregivers' personality traits in five dimensions:extraversion,agreeableness,conscientiousness,emotional stability,and openness.Multivariate Logistic regression was adopted to analyze the relationship between personality traits and nutrition package feeding behaviors of infant caregivers. Results A total of 895 pairs of infants and their caregivers were investigated.The caregivers showed the average scores of 9.01±2.64,10.60±1.99,9.41±2.06,9.01±2.38,and 8.57±2.29 in the dimensions of extraversion,agreeableness,conscientiousness,emotional stability,and openness,respectively.The effective feeding rate of nutrition package was 53.3% (477/895).The results of regression analysis showed that under the premise of controlling for other factors,the caregiver's conscientious personality (OR=1.08,95%CI=1.004-1.153,P=0.038) was the protective factor for the effective feeding of nutrition package. Conclusion The feeding behavior of infant caregivers in the remote rural areas of Sichuan province remains to be improved,and the caregivers with high conscientious personality are more likely to feed their infants effectively.

Why do Mothers from Remote Rural Areas opt for Cesarean Delivery: An Observational Analytical Study from West Bengal, India.

Background: The percentage of cesarean section (C-section) deliveries has doubled in the last two decades in India. Although C-section delivery is a life-saving intervention, multiple maternal and neonatal morbidities are often associated with this procedure, adversely affecting the quality of life of both the mother and child. Material and Methods: This community-based cross-sectional study was conducted to assess the point of view of mothers who delivered from January 2020 to June 2021. Results: The mean (standard deviation (SD)) age of the 866 study participants at delivery was 24.5 (4.8) years, and 60.2% were primigravidas. A total of 613 (70.8%; 95% CI: 67.8-73.8) C-sections were conducted, of which 65.9% (n = 404) were planned and 21.9% were done on maternal request. C-sections were significantly associated with private institutes (adjusted prevalence ratio (aPR) 1.90; 95% CI: 1.70-2.11), at-risk pregnancy (aPR 1.37; 95% CI: 1.26-1.49), and primigravida (aPR 1.16; 95% CI: 1.05-1.29). About 55.3%, 29.8%, and 14.9% of women considered vaginal delivery to be risky, painful, and inconvenient, respectively. Conclusion: It is imperative to generate awareness regarding modes of delivery during antenatal care (ANC) so that mothers can make better-informed choices.

Unified, simple and decentralized treatment process for synthetic and real-time dye contaminated wastewaters.

The aim of this study is to develop a simple, economical and effective treatment scheme to treat effluents from small scale textile dyeing units and tanneries, which have been set up in rural areas. The physicochemical properties of real time effluents procured from these industries were analysed. The workflow required for treating these effluents were ascertained by preliminary tests carried out on synthetically created solutions. A novel treatment scheme for tannery and textile dye effluents sludge volume reduction by the use of sodium hypochlorite was identified. Effective methods for the safe disposal and recycling of all the by-products generated from different steps were discussed. The proposed scheme was successfully able to decolourize and detoxify both the tannery and textile dyeing effluent with over 90% removal of both COD and BOD. The impacts of the treatment scheme on 14 different effluent parameters were reported. The methodology developed in this study may be utilized to construct simple localized treatment units for handling effluents in isolated rural areas. This preliminary treatment at the source, will help in the reduction of the load on the local treatment plants and prevent their choking.

Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study.

OBJECTIVE: Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS: We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS: We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS: There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.