Spatial accessibility assessment to healthcare facilities: urban and rural areas

This research concentrates on the spatial accessibility assessment to healthcare facilities. Specifically, in doing so it compares the situation in urban and rural areas. In many countries, health inequalities continue to be a major public health challenge. Furthermore, there is also urbanization that occurs when people move from rural areas to urban areas. It leads to an increase in urban population and the extent of urban areas. Driven by population growth, many cities in low and middle-income countries are growing at record rates which puts large pressure on the healthcare system and facilities. Our research demonstrates that due to many political, economic, social and cultural factors, the current inequalities in health care between regions, urban and rural areas and different age and income groups are increasing. Thence, there is a pressing need for the improvement of the healthcare in the lagged regions and areas using such means as the advanced technologies, analysis of data, as well as targeted funding and assistance to those who need it the most.

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Magnitude and Correlates of Caesarean Section in Urban and Rural Areas: A Multivariate Study in Vietnam

10.1101/554964 ◽

2019 ◽

Author(s):

Myriam de Loenzien ◽

Clémence Schantz ◽

Bich Ngoc Luu ◽

Alexandre Dumont

Keyword(s):

Caesarean Section ◽

Rural Areas ◽

Urban Areas ◽

National Level ◽

Multivariate Logistic Regression Analysis ◽

Reproductive Age ◽

Middle Income ◽

Mortality And Morbidity ◽

Healthcare Facilities ◽

Urban And Rural Areas

AbstractCaesarean section can prevent maternal and neonatal mortality and morbidity. However, it involves risks and high costs which can be a burden, especially in low and middle income countries. The international healthcare community considers the optimal caesarean rate to be between 10% and 15%. The aim of this study is to assess its magnitude and correlates among women of reproductive age in urban and rural areas in Vietnam. We analyzed microdata from the national Multiple Indicator Cluster Survey (MICS) conducted in 2013-2014 using representative sample of households at the national level as well as regarding the urban and the rural areas. A total of 1,378 women who delivered in institutional settings in the two years preceding the survey were included. Frequency and percentage distributions of the variables were performed. Bivariate and multivariate logistic regression analysis were undertaken to identify the factors associated with caesarean section. Odds ratios with 95% confidence interval were used to ascertain the direction and strength of the associations. The overall CS rate among the women who delivered in healthcare facilities in Vietnam is particularly high (29.2%) with regards to WHO standards. After controlling for significant characteristics, living in urban areas more than doubles the likelihood of undergoing a CS (OR = 2.31; 95% CI 1.79 to 2.98). Maternal age at delivery over 35 is a major positive correlate of CS. Beyond this common phenomenon, distinct lines of socioeconomic and demographic cleavage operate in urban versus rural areas. The differences regarding correlates of CS according to the place of residence suggest that specific measures should be taken in each setting to allow women to access childbirth services appropriate to their needs. Further research is needed on this topic.

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Suicidal Plans and Attempts Among Adolescents in Mongolia

Crisis ◽

10.1027/0227-5910/a000447 ◽

2017 ◽

Vol 38 (5) ◽

pp. 330-343 ◽

Cited By ~ 10

Author(s):

Sarantsetseg Davaasambuu ◽

Suvd Batbaatar ◽

Susan Witte ◽

Phillip Hamid ◽

Maria A. Oquendo ◽

...

Keyword(s):

Rural Areas ◽

Parental Support ◽

Urban Areas ◽

Individual Characteristics ◽

Rural Adolescents ◽

Middle Income ◽

Middle Income Countries ◽

And Behaviors ◽

Urban And Rural Areas ◽

Suicidal Plans

Abstract. Background: Although 75% of suicides occur in low- and middle-income countries, few studies have examined suicidal behaviors among young people in these countries. Aims: This study aimed to examine what individual characteristics were associated with suicidal plans and attempts among Mongolian youth and whether suicidal risks and behaviors varied by urban and rural locations. Method: Logistic regression analyses were utilized to investigate suicidal plans and attempts among 5,393 adolescents using the Global Student Health Survey – 2013. Results: Adolescents who lived in urban areas were at higher risk for suicidal plans and behaviors than those who lived in rural areas; however, the patterns of suicidal risks were similar. Specifically, individual characteristics, such as being female, feeling lonely and worried, smoking cigarettes, drinking alcohol, and having fights at school, were associated with suicidal plans and behaviors regardless of the residential places. Limitations: A number of important variables have not been included in the questionnaire such as depression, family and parental support, household income, family constructs etc. Conclusion: Given the comparable patterns of risk between urban and rural adolescents and the relatively high rates of suicidal plans and attempts, similar mental health services and interventions are necessitated for both urban and rural areas.

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Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

Health Policy and Planning ◽

10.1093/heapol/czaa051 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1110-1129

Author(s):

Atsede Aregay ◽

Margaret O’Connor ◽

Jill Stow ◽

Nicola Ayers ◽

Susan Lee

Keyword(s):

Palliative Care ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Care Home ◽

Sub Saharan Africa ◽

Integrative Review ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

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Changing Incidence of Uterine Cancer in Rural Egypt: Possible Impact of Nutritional and Epidemiologic Transitions

Journal of Global Oncology ◽

10.1200/jgo.18.00255 ◽

2019 ◽

pp. 1-7

Author(s):

Saad Alshahrani ◽

Ahmed Hablas ◽

Robert M. Chamberlain ◽

Jane Meza ◽

Steven Remmenga ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Uterine Cancer ◽

Population Based ◽

Urban Residence ◽

Middle Income ◽

Rural And Urban Areas ◽

Middle Income Countries ◽

Rural And Urban ◽

Low Incidence

PURPOSE Uterine cancer is a top-ranking women’s cancer worldwide, with wide incidence variations across countries and by rural and urban areas. Hormonal exposures and access to health care vary between rural and urban areas, globally. Egypt has an overall low incidence of uterine cancer but variable rural and urban lifestyles. Are there changes in the incidence of uterine cancer in rural and urban areas in middle-income countries such as Egypt? No previous studies have addressed this question from a well-characterized and validated population-based cancer registry resource in middle-income countries. The aim of this study was to explore the differences in clinical and demographic characteristics of uterine cancer over the period of 1999 to 2010 in rural and urban Gharbiah province, Egypt. METHODS Data were abstracted for all 660 patients with uterine cancer included in the Gharbiah Population-based Cancer Registry. Clinical variables included tumor location, histopathologic diagnosis, stage, grade, and treatment. Demographic variables included age, rural or urban residence, parity, and occupation. Crude and age-adjusted incidence rates (IRs) and rate ratios by rural or urban residence were calculated. RESULTS No significant differences were observed in most clinical and demographic characteristics between rural and urban patients. The age standardized IR (ASR) was 2.5 times higher in urban than in rural areas (6.9 and 2.8 per 100,000 in urban and rural areas, respectively). The rate ratio showed that the IR in urban areas was 2.46 times the rate in rural areas. CONCLUSION This study showed that the disease IR in rural areas has increased in the past decade but is still low compared with the incidence in urban areas in Egypt, which did not show a significant increase in incidence. Nutritional transitions, obesity, and epidemiologic and lifestyle changes toward Westernization may have led to IRs increasing more in rural than in urban areas in Egypt. This pattern of increasing incidence in Egypt, which used to have a low incidence of uterine cancer, may appear in other middle-income countries that experience emerging nutritional and epidemiologic transitions. The rate of uterine cancer in urban areas in Gharbiah is almost similar to the corresponding rates globally. However, the rate in rural areas in this population has increased over the past decade but is still lower than the corresponding global rates. Future studies should examine the etiologic factors related to increasing rates in rural areas and quantify the improvement in rural case finding.

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Mapping poverty using mobile phone and satellite data

Journal of The Royal Society Interface ◽

10.1098/rsif.2016.0690 ◽

2017 ◽

Vol 14 (127) ◽

pp. 20160690 ◽

Cited By ~ 67

Author(s):

Jessica E. Steele ◽

Pål Roe Sundsøy ◽

Carla Pezzulo ◽

Victor A. Alegana ◽

Tomas J. Bird ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Census Data ◽

Data Sources ◽

Human Potential ◽

Public And Private ◽

Middle Income ◽

Mobile Data ◽

Poverty Measures ◽

Urban And Rural Areas

Poverty is one of the most important determinants of adverse health outcomes globally, a major cause of societal instability and one of the largest causes of lost human potential. Traditional approaches to measuring and targeting poverty rely heavily on census data, which in most low- and middle-income countries (LMICs) are unavailable or out-of-date. Alternate measures are needed to complement and update estimates between censuses. This study demonstrates how public and private data sources that are commonly available for LMICs can be used to provide novel insight into the spatial distribution of poverty. We evaluate the relative value of modelling three traditional poverty measures using aggregate data from mobile operators and widely available geospatial data. Taken together, models combining these data sources provide the best predictive power (highest r 2 = 0.78) and lowest error, but generally models employing mobile data only yield comparable results, offering the potential to measure poverty more frequently and at finer granularity. Stratifying models into urban and rural areas highlights the advantage of using mobile data in urban areas and different data in different contexts. The findings indicate the possibility to estimate and continually monitor poverty rates at high spatial resolution in countries with limited capacity to support traditional methods of data collection.

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Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

BMJ Open ◽

10.1136/bmjopen-2020-042654 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042654

Author(s):

Yuxi Liu ◽

Leni Kang ◽

Chunhua He ◽

Lei Miao ◽

Xiaoqiong Qiu ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Middle Income ◽

Government Interventions ◽

Neonatal Deaths ◽

Live Births ◽

Urban And Rural Areas

ObjectiveThe present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.MethodsThe study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.ResultsThe neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.ConclusionsThe NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.

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Urbanisation and asthma in low-income and middle-income countries: a systematic review of the urban–rural differences in asthma prevalence

Thorax ◽

10.1136/thoraxjnl-2018-211793 ◽

2019 ◽

Vol 74 (11) ◽

pp. 1020-1030 ◽

Cited By ~ 7

Author(s):

Alejandro Rodriguez ◽

Elizabeth Brickley ◽

Laura Rodrigues ◽

Rebecca Alice Normansell ◽

Mauricio Barreto ◽

...

Keyword(s):

Low Income ◽

Rural Areas ◽

Epidemiological Studies ◽

Asthma Prevalence ◽

Geographical Differences ◽

Middle Income ◽

Middle Income Countries ◽

Urban Rural ◽

Urban And Rural Areas ◽

The Relationship

BackgroundUrbanisation has been associated with temporal and geographical differences in asthma prevalence in low-income and middle-income countries (LMICs). However, little is known of the mechanisms by which urbanisation and asthma are associated, perhaps explained by the methodological approaches used to assess the urbanisation-asthma relationship.ObjectiveThis review evaluated how epidemiological studies have assessed the relationship between asthma and urbanisation in LMICs, and explored urban/rural differences in asthma prevalence.MethodsAsthma studies comparing urban/rural areas, comparing cities and examining intraurban variation were assessed for eligibility. Included publications were evaluated for methodological quality and pooled OR were calculated to indicate the risk of asthma in urban over rural areas.ResultsSeventy articles were included in our analysis. Sixty-three compared asthma prevalence between urban and rural areas, five compared asthma prevalence between cities and two examined intraurban variation in asthma prevalence. Urban residence was associated with a higher prevalence of asthma, regardless of asthma definition: current-wheeze OR:1.46 (95% CI:1.22 to 1.74), doctor diagnosis OR:1.89 (95% CI:1.47 to 2.41), wheeze-ever OR:1.44 (95% CI:1.15 to 1.81), self-reported asthma OR:1.77 (95% CI:1.33 to 2.35), asthma questionnaire OR:1.52 (95% CI:1.06 to 2.16) and exercise challenge OR:1.96 (95% CI:1.32 to 2.91).ConclusionsMost evidence for the relationship between urbanisation and asthma in LMICs comes from studies comparing urban and rural areas. These studies tend to show a greater prevalence of asthma in urban compared to rural populations. However, these studies have been unable to identify which specific characteristics of the urbanisation process may be responsible. An approach to understand how different dimensions of urbanisation, using contextual household and individual indicators, is needed for a better understanding of how urbanisation affects asthma.PROSPERO registration numberCRD42017064470.

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Does connectivity reduce gender gaps in off-farm employment? Evidence from 12 low- and middle-income countries

10.35188/unu-wider/2021/937-2 ◽

2021 ◽

Author(s):

Eva-Maria Egger ◽

Aslihan Arslan ◽

Emanuele Zucchini

Keyword(s):

Young Women ◽

Gender Gap ◽

Rural Areas ◽

Urban Areas ◽

Sub Saharan Africa ◽

Gender Gaps ◽

Middle Income ◽

Middle Income Countries ◽

Entry Points ◽

Low And Middle Income

Gender gaps in labour force participation in developing countries persist despite income growth or structural change. We assess this persistence across economic geographies within countries, focusing on youth employment in off-farm wage jobs. We combine household survey data from 12 low- and middle-income countries in Asia, Latin America, and sub-Saharan Africa with geospatial data on population density, and estimate simultaneous probit models of different activity choices across the rural-urban gradient. The gender gap increases with connectivity from rural to peri-urban areas, and disappears in high-density urban areas. In non-rural areas, child dependency does not constrain young women, and secondary education improves their access to off-farm employment. The gender gap persists for married young women independent of connectivity improvements, indicating social norm constraints. Marital status and child dependency are associated positively with male participation, and negatively with female participation; other factors such as education are show a positive association for both sexes. These results indicate entry points for policy.

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Screening for various non communicable diseases: a community based multi-diagnostic mega camp approach study from Raichur, Karnataka

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20214855 ◽

2021 ◽

Author(s):

Amruth Reddy S. ◽

Sai Anurag Reddy A. ◽

Anant A. Takalkar

Keyword(s):

Rural Areas ◽

Research Centre ◽

Healthy Population ◽

Community Based ◽

College Hospital ◽

Middle Income ◽

Medical College ◽

Middle Income Countries ◽

Urban And Rural Areas ◽

Rural Part

Background: The 77% of all non-communicable illnesses (NCDs) deaths are in low-and middle-income countries. Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). These 4 groups of diseases account for over 80% of all premature NCD deaths. Objective was to study prevalence of NCDs and its trends with respect to age and gender.Methods: The present community based descriptive observational study was conducted at Navodaya medical college hospital and research centre, Raichur that caters Urban and rural area of Raichur. The 4063 apparently healthy population from urban and rural part of Raichur were screened during the multi diagnostic mega camp at urban and rural areas around Raichur during the period of January to September 2021. Results: Prevalence of diabetes in our study was 46.3%, hypertension 45.3%, cataract 46.3% and COPD as 20.7%. Prevalence of diabetes was more in 41-60 years i.e., 41.6%. Prevalence of hypertension was more in 41-50 years i.e., 25.3%. Prevalence of diabetes was more in males i.e., 54.1%. Prevalence of hypertension was more in males i.e., 50.8%.Conclusions: Prevalence of all NCDs was more in above 40 years and more in males except COPD.

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Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101728 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1728 ◽

Cited By ~ 5

Author(s):

Ahmed Ramdan M. Alanazy ◽

Stuart Wark ◽

John Fraser ◽

Amanda Nagle

Keyword(s):

Systematic Review ◽

Emergency Medical Services ◽

Patient Outcomes ◽

Rural Areas ◽

Urban Areas ◽

Survival Rates ◽

Middle Income ◽

Middle Income Countries ◽

Emergency Medical ◽

Urban Versus

The goal of this systematic review was to examine the existing literature base regarding the factors impacting patient outcomes associated with use of emergency medical services (EMS) operating in urban versus rural areas. A specific subfocus on low and lower-middle-income countries was planned but acknowledged in advance as being potentially limited by a lack of available data. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed during the preparation of this systematic review. A comprehensive literature search of PubMed, EBSCO (Elton B. Stephens Company) host, Web of Science, ProQuest, Embase, and Scopus was conducted through May 2018. To appraise the quality of the included papers, the Critical Appraisal Skills Programme Checklists (CASP) were used. Thirty-one relevant and appropriate studies were identified; however, only one study from a low or lower-middle-income country was located. The research indicated that EMS in urban areas are more likely to have shorter prehospital times, response times, on-scene times, and transport times when compared to EMS operating in rural areas. Additionally, urban patients with out-of-hospital cardiac arrest or trauma were found to have higher survival rates than rural patients. EMS in urban areas were generally associated with improved performance measures in key areas and associated higher survival rates than those in rural areas. These findings indicate that reducing key differences between rural and urban settings is a key factor in improving trauma patient survival rates. More research in rural areas is required to better understand the factors which can predict these differences and underpin improvements. The lack of research in this area is particularly evident in low- and lower-middle-income countries.

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