Exploring the shift in newborn care practices among mothers and grandmothers in rural Odisha, India - a qualitative study.

BACKGROUND: This study delves into newborn care and infant-feeding practices in rural Odisha, specifically focusing on the rural KBK + region of Odisha (Kalahandi-Bolangir-Koraput region), inhabited predominantly by Schedule Tribes and Schedule Castes individuals. There has been an improvement in the health indicators in these areas in recent times. In the background of improved health indicators in these areas, this research explores the current and changing newborn care practices and attempts to gain insight into people's perceptions of the factors that brought about the changes. METHODS: This qualitative study was conducted between February and July 2023 at Christian Hospital, Bissamcuttack in Odisha. The methodology involved focused group discussions with mothers and grandmothers. RESULTS: Analysis revealed healthy practices like exclusive breastfeeding till six months of age, appropriate timing of the first bath, and prompt healthcare-seeking behavior for minor illnesses among the mothers. The use of cow ghee or breast milk in a baby's eyes, the application of ash on the umbilical cord, and the use of herbal medicines for minor illnesses were practiced more by the grandmothers in the past and were not as popular among the mothers. It is noteworthy that the cultural practices to ward off the 'evil eye' were practiced by both mothers and grandmothers alike. Despite the influence of traditional cultural practices on the beliefs and norms of the community, the study identified a shift in health-seeking behavior, with increased reliance on healthcare providers and safe healthcare practices. The study identifies the pivotal role of Accredited Social Health Activists (ASHAs) as a bridge between the rural communities and the healthcare system. CONCLUSIONS: This research provides valuable insights for healthcare providers aiming to enhance community-centric safe newborn care practices in rural settings. The emphasis is on the importance of understanding the current and changing local practices. This would help the healthcare providers to encourage healthy practices while eliminating the harmful practices related to newborn care through community workers like ASHA and Anganwadi workers.

Improving Access to Eye Care in Rural Communities: PocDoc's Web-Based Visual Acuity Screening Tool.

Objective: Visual acuity (VA) testing is crucial for early intervention in cases of visual impairment, especially in rural health care. This study aimed to determine the potential of a web-based VA test (PocDoc) in addressing the unique health care needs of rural areas through the comparison in its effectiveness against the conventional VA test in identifying visual impairment among an Indian rural population. Methods: Prospective comparative study conducted in December 2022 at a tertiary referral eye care center in central India. We evaluated all patients with the PocDoc VA tests using three device types, and the conventional VA test. Bland-Altman plot (BAP) compared PocDoc and conventional VA tests. Fisher's exact tests evaluated associations between categorical parameters. Kruskal-Wallis tests followed by post hoc Dunn's tests identified association between categorical parameters and numerical parameters. Results: We evaluated 428 patients (792 measurements of VA) with mean age 36.7 (±23.3) years. PocDoc resulted in slightly worse VA scores (mean logMAR: 0.345) than conventional (mean logMAR: 0.315). Correlation coefficient between the conventional and PocDoc logMAR VA values was rho = 0.845 and rho2 = 0.7133 (p = 6.617 × 10-215; adjusted p = 2.205 × 10-214). Most data points fell within the interchangeable range of ±0.32 on BAP. Difference between the two methods increased with higher logMAR values, indicating poorer agreement for worse VA scores. Conclusions: Identifying and addressing the unique health care needs of rural populations is critical, including access to appropriate and effective VA testing methods. Validating and improving VA testing methods can ensure early intervention and improve the quality of life for individuals with visual impairment.

Sense of community affects community satisfaction: Mediating role of community participation.

Community satisfaction is a central component of community development because it indicates the overall contentment of residents with their community. As such, it can indicate the directions for community development. This study is aimed at examining a sense of community and community participation as factors influencing community satisfaction in the Yirgachefe district of Ethiopia. We collected data from 360 randomly selected household heads (male = 80.2%, female = 19.2%) residing in 12 rural communities. We used structural equation modeling to analyze the data. Results revealed that residents with a higher sense of community were more likely to have participated in their community and to be satisfied with their community. However, sense of community only indirectly influenced community satisfaction and had an insignificant direct effect on community satisfaction. There is a fully mediating effect of community participation between sense of community and community satisfaction. We propose policy implications based on the study.

Assessment of the status of improved F&E trachoma control practices among children of agro-pastoralists in Southern Ethiopia: a mixed design survey using theory of triadic influences.

BACKGROUND: Ethiopia is one of the countries with heavy trachoma burdens states globally. More than 75 million people in Ethiopia live in the trachoma endemic zones. Most populations with neglected tropical diseases (NTDs) live in hard-to-reach residences because of landscape and socio-cultural variances. This survey assessed the status of improved Face hygiene and Environmental cleanliness (F&E) trachoma control practices in children 1-9 years of age. METHODS: A mixed-method study design was applied concurrently. Enumeration was done through interviews using the standard tool and observational technique. Focus Group discussions (FGDs) and Key informant Interviews (KIIs) were used to conduct the qualitative arm. Confounders were controlled by modeling with multivariable logistic regression. RESULTS: For the Quantitative survey: The response rate was 99.8% of participants. The proportion with improved practice was 8%. About 13.9% of a child washed their faces and were visibly clean. About 15.2% of the households had an observable clean environment. High Wealth index, Perceived ability, knowledge about trachoma transmission from person to person, and stance toward preventive behavior were associated with improved practices. The odds of having improved F&E practice were 67% lower for those who reported positive normative preventive behavior than negatives. Qualitative arm: Some key informants reported village dwellers' shortage of basic knowledge; attitude and behavioral change for improved hygienic practices are the challenges. Inhabitants, including elder children, are aware of the hygiene issue though they do not practice it or have no intention to practice it. CONCLUSIONS: Improved F&E practices were much lower in the study region than the regional plan to achieve.

Examining the Relationship Between Existing Community Resources and Community Leaders' Perceptions of Resilience and Rural Health During COVID-19.

This study explored the relationship between existing community resources and community leaders' perceptions of resilience and rural health during COVID-19. Observational data of material capitals (e.g., grocery stores and physical activity resources) present in five rural communities involved in a health promotion project were collected and compared with key informant interviews of perceived community health and resilience during the COVID-19 pandemic. The analysis compares the differences in community leaders' perceptions of resilience during the pandemic to the actual material capitals of the community. While these rural counties were average in terms of available physical activity and nutritional resources, the onset of the pandemic led to varying degrees of disruption in access due to structural closures of mainstay resources, as well as residents perceiving that they cannot or should not access available resources. In addition, county coalition progress was stalled as individuals and groups could not gather together to complete projects, such as building playground equipment. This study demonstrates that existing quantitative instruments, such as NEMS and PARA, fail to take into account perceived access and utility of resources. Therefore, practitioners should consider multiple ways to evaluate resources, capacity, and progress on a health intervention or program and consider community voice to ensure feasibility, relevance, and sustainability-especially when faced with a public health emergency like COVID-19.

Newly qualified registered nurses' and midwives' experiences from rural health district placement in Namibia.

BACKGROUND: The transition period for newly qualified registered nurses/midwives (NQRN/Ms) is a fundamental phase in their career. Yet, transition experiences have been studied mostly within urban and/or specialised healthcare settings in high-resource countries. This study aimed to explore and describe the experiences of NQRN/Ms in a rural health district in Namibia. METHODS: A qualitative, descriptive, explorative, and contextual design was followed. The sample consisted of eight participants who were purposively selected. Data were collected via in-depth individual interviews and analysed following a reflexive thematic analysis. The researchers were guided by Lincoln and Guba's strategies for establishing trustworthiness. FINDINGS: Themes conceptualised from the analysis include encounters with rural community members; encounters with colleagues; staffing, management, and supervision; shortage of resources; poor infrastructure; unreliable communication networks; and the lack of social life. CONCLUSION: The NQRN/Ms had mixed experiences related to a variety of aspects such as social life, resources, colleagues and community members. These findings can be used to improve undergraduate nursing curricula, as well as to create graduate job preparation workshops and support networks.

Demographic determinants of work deviant behaviors of rural community-based primary school teachers: A structural equation modeling approach.

Schools across the globe and especially in Nigeria have witnessed situations in which teachers work outside their work ethics. This situation breeds exhibition of work deviant behaviors among the teachers at different levels of education as evidenced in the literature. However, literature is scarce on the influence of teachers' demographic characteristics on their work deviant behaviors in primary schools. Thus, this study was necessitated to explore the determinants of work deviant behaviors of rural community-based primary school teachers in Enugu State, Nigeria. This study was anchored on the affective events theory propounded by Weiss and Cropanzano. Basing the study on the quantitative research approach, a correlational survey research design was adopted using a sample of 254 rural community-based primary school teachers. Necessary information for the study were collected using researchers' adapted questionnaire on work deviant behaviors with 28 items. The questionnaire items had an internal consistency reliability index of 0.87. Data collected were analyzed using hierarchical multiple regression analysis and the structural equation modeling approach. It was revealed that among the demographic characteristics (age, working status, qualification, marital status, gender, years of teaching experience, and location) of the teachers, only age and qualification were found to be significantly (p < 0.05) related to work deviant behaviors. The implication of this study, therefore, is that the age and qualification of rural community-based primary school teachers determine the nature of their work deviant behaviors. Thus, it was recommended that the age and qualification of teachers should be considered very paramount in the employment of teachers.

Family Circle and Willingness to Subscribe to Community-based Health Insurance (CBHI) for the Elderly in a Rural Community in South-South Nigeria.

BACKGROUND: The older people in most rural communities depend on family members to provide resources for their healthcare. However, such payments for health services are mostly out of pocket. In trying to protect the health of elderly persons who by nature are prone to high morbidity, other younger family members may be contacted for financial support for their healthcare through contributions to the Community based Health Insurance (CBHI). This study assessed the willingness of the significant other in the family to subscribe to the CBHI for the elderly person within the family. METHODS: A cross-sectional survey was used to study 358 elderly people, and their significant other (identified by using the family circle tool). The respondents were selected by a multistage sampling technique from nine clusters of villages within the community. The data were generated with an interviewer-administered semi-structured questionnaire. For the significant other that lived outside the community phone call was used for the interview. Descriptive and inferential analyses were done using SPSS 22. RESULTS: Majority of the significant others (97.8%) were aged less than 60 years and mostly female (67.9%) and had attained the tertiary level of education (75.4%). Most of the significant others were civil servants (83.0%); 94.7% were Christians; 87.4% were married, and 83.2% lived in urban locations. Only 7.5% were aware of CBHI and 56.7% were willing to buy N10,000 (naira) subscriptions for CBHI. Socio-demographic characteristics that were significantly associated with willingness to subscribe for CBHI were age < 60 years (p=0.040), tertiary education (p<0.001), occupation (p<0.001), religion (p=0.008), marital status (p<0.001), place of residence (p<0.001) and monthly income (p<0.001). CONCLUSION: There is a need to create awareness of CBHI in communities, as the majority of the significant others identified in this study were ready to subscribe to CBHI for the elderly members of their families at a convenient cost.

CONTEXTE: Dans la plupart des communautés rurales, les personnes âgées dépendent des membres de leur famille pour financer leurs soins de santé. Cependant, ces paiements pour les services de santé se font le plus souvent de leur poche. En essayant de protéger la santé des personnes âgées qui, par nature, sont sujettes à une morbidité élevée, d'autres membres plus jeunes de la famille peuvent être contactés pour obtenir un soutien financier pour leurs soins de santé par le biais d'une contribution à l'assurance maladie communautaire (CBHI). Cette étude a évalué la volonté de l'autre membre de la famille de souscrire à l'assurance maladie communautaire pour la personne âgée de la famille. MÉTHODES: Une enquête transversale a été menée auprès de 358 personnes âgées et de leur proche (identifié à l'aide de l'outil du cercle familial). Les personnes interrogées ont été sélectionnées par une technique d'échantillonnage à plusieurs degrés dans neuf groupes de villages au sein de la communauté. Les données ont été générées à l'aide d'un questionnaire semi-structuré administré par un enquêteur. Pour la personne significative qui vivait en dehors de la communauté, un appel téléphonique a été utilisé pour l'entretien. Les analyses descriptives et inférentielles ont été effectuées à l'aide de SPSS 22. RÉSULTATS: La majorité des personnes interrogées (97,8 %) étaient âgées de moins de 60 ans, principalement des femmes (67,9 %) et avaient atteint un niveau d'éducation supérieur (75,4 %). La plupart des personnes interrogées étaient des fonctionnaires (83 %), 94,7 % étaient chrétiennes, 87,4 % étaient mariées et 83,2 % vivaient en milieu urbain. Seuls 7,5 % connaissaient l'existence de la CBHI et 56,7 % étaient prêts à souscrire un abonnement de 10 000Naira pour la CBHI. Les caractéristiques sociodémographiques significativement associées à la volonté de souscrire un abonnement à la CBHI étaient l'âge < 60 ans (p=0,040), l'enseignement supérieur (p<0,001), la profession (p<0,001), la religion (p=0,008), la situation matrimoniale (p<0,001), le lieu de résidence (p<0,001) et le revenu mensuel (p<0,001). CONCLUSION: Il est nécessaire de sensibiliser les communautés à l'initiative CBHI, car la majorité des proches identifiés dans cette étude étaient prêts à souscrire à l'initiative CBHI pour les membres âgés de leur famille à un coût raisonnable. Mots-clés: Cercle familial, Volonté, Assurance maladie communautaire, Personnes âgées, Communauté rurale.

Seroprevalence of human leptospirosis in a rural community from Tandil, Argentina. Assessment of risk factors and spatial analysis.

Leptospirosis is a neglected zoonosis that is widely distributed in the world. Although it is endemic in Argentina, prevalence remains unknown. The aims of the study were: (i) to determine the prevalence of leptospirosis in humans from a rural community in Tandil Argentina, (ii) to identify infecting Leptospira spp. serogroups, (iii) to identify factors associated with the infection, (iv) to estimate the population attributable fraction (PAF) of the risk factors and (v) to determine the spatial patterns of disease presentation and related risk factors. Blood samples from 202 participants were collected. A survey was conducted to obtain clinical and epidemiological data. Serological testing was performed by the microscopic agglutination test (MAT). Univariate and multivariate methods were applied to evaluate associations. Spatial clusters were investigated for seroprevalence and risk factors. Antibodies were found in 32.2% of participants (95% CI: 25.8-39.1). The most prevalent serogroup was Hebdomadis followed by Sejroe; Icterohaemorrhagiae; Tarassovi and Canicola. Living at lower altitudes (OR: 13.04; 95% CI: 2.60-65.32); not having access to water supply network (OR: 2.95; 95% CI: 1.30-6.69); living close to flooded streets (OR: 2.94; 95% CI: 1.14-7.69) and practicing water sports (OR: 3.12; 95% CI: 1.12-8.33) were associated with seropositivity. Factors related with housing characteristics, services and infrastructure had the higher PAF (from 17% to 81%). A spatial cluster with higher rates of positivity and of the main risk factors was determined. This work contributes useful data for specific preventive measures that should be implemented for the control of the disease.

Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias.

OBJECTIVES: We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults. METHODS: We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up. RESULTS: A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups. CONCLUSIONS: Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies. CLINICAL IMPLICATIONS: This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.

Epidemiology of premalignant and malignant upper gastrointestinal lesions among patients presenting from a rural community in Karachi, Pakistan.

Objective: Understanding the epidemiology of upper gastrointestinal cancers in Pakistan may help in identifying important demographic risk factors for upper gastrointestinal malignancies in a particular rural population group. This will benefit in implementing tailored prevention approaches as well as effective management of health services. Method: A secondary data analysis of 1193 patients was conducted who went through diagnostic upper GI endoscopy between December 2016 to May 2019 at Fatima Hospital. The endoscopies were performed at Fatima Hospital which is the main health resource for the specifically targeted rural community. Data was analyzed using SPSS version 21. Results: The median age of patients included in the sample was 35 years (IQR=20 years). One third of all endoscopic findings were concluded as normal. The frequency of malignant upper gastrointestinal lesions was relatively higher among male and patients with age 65 years or more. The study didn't find any significant differences in the distribution of malignancies on the basis of ethnicity. Adenocarcinoma of esophagus was the most common malignant lesion. Conclusion: The average age of patients undergoing upper gastrointestinal endoscopy among rural community of Karachi was relatively low. The burden of upper GI malignancies was significantly higher among elderly. Male patients had significantly greater burden of premalignant and malignant lesions as compared to females. No differences in the distribution of diagnostic outcomes were observed on the basis of ethnicity.

Effects of connection to nature on residents' perceptions of conservation policy justice of Natura 2000.

We examined the effects of human connection to nature on residents' concerns about justice in conservation policies of Natura 2000. Expansion of Natura 2000 conservation network has resulted in local communities having to consider Natura 2000 in their development plans, and justice concerns have been strong in some communities near Natura 2000 sites. We conceptualized Natura 2000 justice within a framework composed of 3 domains of conservation justice: distribution, recognition, and representation. To examine the effect of nature connection on perceived justice of Natura 2000, we conducted a door-to-door survey of rural resident (80.09% response rate) in 3 municipalities of Pomerania in Poland. The effect of connection to nature on perceived distribution of Natura 2000 benefits was positive (b = 0.187, t = 7.057, p < 0.001); perceived communication about Natura 2000 was positive (b = 0.089, t = 2.940 p < 0.01); perception of limitations was positive (b = 0.078, t = 2.416, p < 0.01); perceived recognition was positive (b = 0.117, t = 3.367, p < 0.001); and perceived representation was positive (b = 0.123, t = 5.015, p < 0.001). Our results suggest local residents' bonds with nature matter and they should be considered when new conservation approaches, such as Natura 2000, are introduced.

Efectos de la Conexión de los Residentes con la Naturaleza sobre la Percepción de la Política de Justicia de Conservación de Natura 2000 Stzelecka et al. Resumen Examinamos los efectos de la conexión humana con la naturaleza sobre los intereses de los residentes en cuanto a la justicia en las políticas de conservación de Natura 2000. Como resultado de la expansión de la red de conservación Natura 2000, las comunidades locales han tenido que considerarla dentro de sus planes de desarrollo y el interés por la justicia se ha fortalecido en algunas comunidades cercanas a los sitios de esta red. Definimos la justicia de Natura 2000 dentro de un marco compuesto por tres dominios de justicia de la conservación: distribución, reconocimiento y representación. Para analizar el efecto de la conexión con la naturaleza sobre la justicia percibida de Natura 2000, realizamos una encuesta a domicilio a los residentes rurales (80.09% de respuesta) de tres municipios de Pomerania en Polonia. El efecto de la conexión con la naturaleza fue positivo para las percepciones de la distribución de los beneficios (b = 0.187, t = 7.057, p < 0.001), la comunicación (b = 0.089, t = 2.940 p < 0.01), las limitaciones (b = 0.078, t = 2.416, p < 0.01), el reconocimiento (b = 0.117, t = 3.367, p < 0.001) y la representación (b = 0.123, t = 5.015, p < 0.001) de Natura 2000. Nuestros resultados sugieren que los lazos de los residentes locales con la naturaleza son importantes y deberían considerarse cuando se introduzcan nuevas estrategias de conservación, como Natura 2000.

Screening of Endocrine Disrupting Potential of Surface Waters via an Affinity-Based Biosensor in a Rural Community in the Yellow River Basin, China.

Overcoming the limitations of traditional analytical methods and developing technologies to continuously monitor environments and produce a comprehensive picture of potential endocrine-disrupting chemicals (EDCs) has been an ongoing challenge. Herein, we developed a portable nuclear receptor (NR)-based biosensor within 90 min to perform highly sensitive analyses of a broad range of EDCs in environmental water samples. Based on the specific binding of the fluorescence-labeled NRs with their ligands, the receptors were attached to the EDC-functionalized fiber surface by competing with EDCs in the samples. The biosensor emitted fluorescence due to the evanescent wave excitation, thereby resulting in a turn-off sensing mode. The biosensor showed a detection limit of 5 ng/L E2-binding activity equivalent (E2-BAE) and 93 ng/L T3-BAE. As a case study, the biosensor was used to map the estrogenic binding activities of surface waters obtained from a rural community in the Yellow River basin in China. When the results obtained were compared with those from the traditional yeast two-hybrid bioassay, a high correlation was observed. It is anticipated that the good universality and versatility exhibited by this biosensor for various EDCs, which is achieved by using different NRs, will significantly promote the continuous assessment of global EDCs.

The role of traditional birth attendants and problem of integration with health facilities in remote rural community of West Omo Zone 2021: exploratory qualitative study.

BACKGROUND: Mothers in rural Ethiopian communities prefer giving birth at home. In developing countries, traditional birth attendants play an important role in reducing the maternal mortality rate. In Ethiopia, however, their role during pregnancy, childbirth, the postnatal period, and their integration with health professionals is not clearly defined. This study aimed to explore the role of traditional birth attendants in feto-maternal care during pregnancy, childbirth, and the postnatal period, and integration with health professionals in the West Omo Zone, southern Ethiopia. METHODS: A qualitative descriptive design was used with triangulation of methods and data sources. We conducted in-depth interviews with traditional birth attendants, key informant interviews with health care professionals and community or religious leaders, and two focus group discussions with multiparous pregnant women. Each interview and focus group discussion was tape-recorded and the data obtained were transcribed and translated into English for analysis. The analysis was done based on thematic analysis framework. RESULTS: Traditional birth attendants stated that they used herbal remedies to treat nausea and vomiting, decrease pain during labor, and increase pregnant women's desire to push. The absence of incentives for their work, shortage of logistics, and lack of training was mentioned as challenges to the continuity of their roles. All study participants explained the importance of training traditional birth attendants on maternal and child health in rural communities. However, health care professionals reported that few traditional birth attendants advised mothers about traditional practices such as milk tooth extraction and uvulectomy. CONCLUSION AND RECOMMENDATION: Traditional birth attendants continued their roles despite the existing challenges. There was no integration between TBA and the formal health care system. The need for training traditional birth attendants has been emphasized by all study participants and its impact on reducing feto-maternal death was recognized by health care professionals. Therefore, the federal ministry of health should works better for the development of TBAs to scale up their skills across all regions in the country.

Cohort profile of the largest health & demographic surveillance system (Dibrugarh-HDSS) from North-East India.

Dibrugarh Health and Demographic Surveillance System (Dibrugarh-HDSS), was started in the year 2019 with the objective to create the health and demographic database of a population from a defined geographical area and a surveillance system for providing technical assistance for the implementation of programmes and formulating intervention strategies for reducing disease morbidities and mortalities in the population. Dibrugarh-HDSS adopted a panel design and covered 60 contiguous villages and 20 tea gardens. Line listing of all the households was conducted and a unique identification number detailing State, district, village/tea garden and serial number was provided along with geotagging. Detailed sociodemographic variables, anthropometric measurements (subjects ≥five years) and blood pressure data (subjects ≥18 yr), disease morbidity and mortality were collected. All data were collected in pre-designed and pre-tested questionnaires using a mobile application package developed for this purpose. Dibrugarh-HDSS included a total of 106,769 individuals (rural: 46,762, tea garden: 60,007) with 52,934 males (49.6%) and 53,835 females (50.4%). The number of females per thousand males were significantly higher (1042 in tea garden vs. 985 in rural populations) in the tea-garden community as compared to the village population. More than one-third (35.1%) of tea populations were illiterate compared to the rural population (17.1%). Villagers had significantly higher body mass index than the tea-garden community. The overall prevalence of hypertension (adjusted for age) was 29.4 vs. 28.2 per cent, respectively, for the village and tea-garden population. For both these communities, males (village=30.8%, tea garden=31.1%) showed a higher prevalence of hypertension (adjusted for age) than females (village=28.2%, tea garden=25.8%). The findings of the present study give an insight into the profile of the native rural and tea-garden populations that will help to identify risk factors of different health problems, review the effectiveness of different ongoing programmes, implement intervention strategies for reducing morbidity and mortality and assist the State health authorities in prioritizing their resource allocation and implementation strategies.

The impact of Ethiopian community-based health extension program on diarrheal diseases among under-five children and factors associated with diarrheal diseases in the rural community of Kalu district, Northeast Ethiopia: a cross-sectional study.

BACKGROUND: The health extension program is a community-based health care delivery program with eighteen defined packages. The main aim of the health extension program is to help to reduce child mortality. So, the aim of this study is to assess the impact of a health extension program on diarrheal disease under-five children in the rural community of Kalu district, Northeast Ethiopia, 2021. METHODS: A community-based cross-sectional study design was conducted from March to April/2021. A Multi-stage sampling technique was used to get a total sample size of 556 (182 model households and 374 non-model households) with a response rate of 92.22%. Binary logistic regression analysis was done, and P-value < 0.05 was considered statistically significant. Propensity score matching analysis was used to determine the contribution of health extension program "model households" on diarrhea diseases among under-five children. The average treatment effect on the treated was calculated to compare the means of outcomes across model and non-model households. RESULTS: Health extension program (HEP) model household contributed a 17.7% (t = -5.02) decrease in children's diarrheal diseases among under-five children compared with HEP non-model households. Mothers from non-model households were 2.19 times more likely to develop under-five children diarrheal diseases AOR (Adjusted Odds Ratio): 2.19, 95% CI: 1.34-3.57 than mothers from model households. Households who got no frequent home visits were 3.28 times more likely to develop under-five diarrheal diseases AOR (Adjusted Odds Ratio): 3.28, 95% CI: 1.40-7.68. CONCLUSION: When the health extension program is implemented fully (model household), the prevalence of under-five diarrheal disease in the rural community could decrease. The need to develop supportive strategies for the sustainability of model households and encouraging households to be model households is very important.

The Gap Between Self-Rated Health Information Literacy and Internet Health Information-Seeking Ability for Patients With Chronic Diseases in Rural Communities: Cross-sectional Study.

BACKGROUND: The internet has become one of the most important channels for residents to seek health information, particularly in remote rural areas in China. OBJECTIVE: In this study, we aimed to explore the gap between self-rated health information literacy and internet health information seeking ability for patients with chronic diseases in rural communities and to preliminarily evaluate their barriers when seeking health information via the internet. METHODS: Residents from rural communities near Bengbu City and with chronic diseases were included in this study. A self-rated questionnaire was used to evaluate their health information literacy, 3 behavioral competency tasks were designed to preliminarily evaluate their ability to seek health information on the internet and semistructured interviews were used to investigate their barriers to obtaining health information via the internet. A small audiorecorder was used to record the interview content, and screen-recording software was used to record the participants' behavior during the web-based operational tasks. RESULTS: A total of 70 respondents completed the self-rated health information literacy questionnaire and the behavioral competence test, and 56 respondents participated in the semistructured interviews. Self-rated health information literacy (score out of 70: mean 46.21, SD 4.90) of the 70 respondents were moderate. Although 91% (64/70) of the respondents could find health websites, and 93% (65/70) of the respondents could find information on treatment that they thought was the best, 35% (23/65) of respondents did not know how to save the results they had found. The operational tasks indicated that most articles selected by the respondents came from websites with encyclopedic knowledge or answers from people based on their own experiences rather than authoritative health information websites. After combining the results of the semistructured interviews with the DISCERN scale test results, we found that most interviewees had difficulty obtaining high-quality health information via the internet. CONCLUSIONS: Although the health information literacy level of patients with rural chronic disease was moderate, they lack the ability to access high-quality health information via the internet. The vast majority of respondents recognized the importance of accessing health information but were not very proactive in accessing such information.

Assessment of psychosocial work hazards and workplace deviant behaviours of teachers in rural community-based schools.

This is a cross-sectional study that assessed the psychosocial work hazards and workplace deviant behaviours of teachers in rural community-based schools. A total of 254 primary school teachers participated in the study. Copenhagen Psychosocial Questionnaire (COPSOQ) and Work Deviance Behaviour Scale were employed to elicit the teachers' responses. The descriptive statistics (frequency and percentage), and Pearson's correlation (r) statistical analysis were used to analyse the data. The results showed that the primary school teachers experience elements of psychosocial work hazards. It was also indicated that primary school teachers rarely exhibit work deviant behaviours. There is a significant positive relationship between psychosocial work hazards and workplace deviant behaviours of primary school teachers in Enugu State. In conclusion, it was suggested that teachers experience psychosocial work hazards and exhibit workplace deviant behaviours in primary schools in Enugu State Nigeria. Therefore, professionals in workplaces including schools should design practicable interventions that would help to reduce workplace deviance among employees in different works of life. With this, these should be reflected in decision-making and policies implementations to rural communities and beyond.

Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas.

Research examining homelessness in rural areas has been sparse. The current study aims to expand conceptions of rural homelessness by mapping community-level risk factors related to housing insecurity. Geographic information systems (GIS) techniques were used to map the distribution of select community-level risk indicators in the State of Maine. Three methodological choices related to this process are demonstrated: (1) selection and distribution of housing insecurity risk indicators; (2) use of location quotients; and (3) use of spatial lags. After examining and mapping selected risk factors against the location of homeless service supports, four areas in Maine were identified as communities of concern for housing insecurity. Better understanding the extent and location of areas of high need that are resource poor can help service and funding agencies to plan for the more efficient and effective distribution of homeless prevention and mitigation services. Implications for research in rural areas are discussed.

Risk Factors for Delayed Diagnosis of Acute Cholecystitis among Rural Older Patients: A Retrospective Cohort Study.

Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous drainage, depending on the patient's condition. The symptoms of acute cholecystitis in older patients may be atypical and difficult to diagnose, causing delayed treatment. Clarifying the risk factors for delayed diagnosis among older patients could lead to early diagnosis and treatment of acute cholecystitis. This study aimed to explore the risk factors for delayed diagnosis of acute cholecystitis among rural older patients. Material and Methods: This retrospective cohort study included patients aged over 65 years diagnosed with acute cholecystitis at a rural community hospital. The primary outcome was the time from symptom onset to acute cholecystitis diagnosis. We reviewed the electronic medical records of patients with acute cholecystitis and investigated whether they were diagnosed and treated for the condition at the time of symptom onset. Results: The average ages of the control and exposure groups were 77.71 years (standard deviation [SD] = 14.62) and 80.13 years (SD = 13.95), respectively. Additionally, 41.7% and 64.1% of the participants in the control and exposure groups, respectively, were men. The logistic regression model revealed that the serum albumin level was significantly related to a time to diagnosis > 3 days (odds ratio = 0.51; 95% confidence interval, 0.28−0.94). Conclusion: Low serum albumin levels are related to delayed diagnosis of cholecystitis and male sex. The presence of abdominal pain and a high body mass index (BMI) may be related to early cholecystitis diagnosis. Clinicians should be concerned about the delay in cholecystitis diagnosis in older female patients with poor nutritional conditions, including low serum albumin levels, a low BMI, vague symptoms, and no abdominal pain.