Open defecation free: where do we need to focus ?

BackgroundDespite major national and international efforts, many households in Nepal (as in other low-income and middle-income countries) still lack toilets. This paper assesses various determinants that act as main contributing factors because of which households in Nepal still do not have toilets. MethodsData from the Nepal Demographic and Health Survey (NDHS) 2016 was used for this study. Bivariate analysis was done to assess the association between dependent variables (toilet status- having and not having toilets in the household) and independent variables (demographic, socio-economic and geographical characteristics) using Chi-square test. Then, a multi variate logistic regression model was used to assess significant predictors for a household not having a toilet after controlling other variables. ResultsOut of the total number of sampled households (11040), nearly a fifth (18%) belonged to province no. 2, where nearly half of the households (49%) did not have toilet facilities. Similarly, households in rural areas were found to be less likely to have toilets than households in urban areas (aOR=1.56, CI1.35-1.80). In the Terai, households were almost ten times as likely not to have toilets (aOR=9.65, CI6.56-14.19) as compared to households in the mountain region. Furthermore, there is a strong positive association between households with toilets and their economic status. Poorest (aOR=15.19, CI11.26-20.47), poorer (aOR=8.75, CI6.89-11.11) and middle income (aOR=5.12, CI4.15-6.32) households were less likely to have a toilet than richer or richest households. ConclusionsDespite some real achievements and progress in Open Defecation Free (ODF) status, Nepal still has a large number of residences without a toilet. Thus, it is crucial to address all the multifaceted factors such as geographical, provincial and economic when considering sustainable ODF programming.

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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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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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ANALISIS KONSUMSI PANGAN TINGKAT RUMAH TANGGA DI PROPINSI LAMPUNG

Agro Ekonomi ◽

10.22146/agroekonomi.17108 ◽

2006 ◽

Vol 13 (2) ◽

Author(s):

Meliyanah Meliyanah ◽

Suhatmini Hardyastuti ◽

Djuwari Djuwari

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Household Consumption ◽

Income Level ◽

High Income ◽

Middle Income ◽

Household Level ◽

Rural And Urban Areas ◽

Rural And Urban

This research diamed to: 1) knowing the selft-price elasticity, cross-price elasticity and income elasticity of consumption per food item on household level according to location and income level; and 2) knowing the reation between level of income and food consumption on household level according to location and income level.This research used data from SUSENAS of Lmapung Province in 2002 with number of sample of 2091 household, which being differed between rural and urban areas based on low, middle, and high level of income. The data analysis used tobit model and sensored regression.The result showed that: 1) the demand of rice and beeh for household consumption in every level of income in rural and urban areas were inelastic; 2) Coen only been consumed by low income level household in rural areas and the demand was inelastic; 3) the demand of cassava for household consumption on low income level in urban area was elastic, While in middle income level, high income level and every level of income in rural area, cassava demand was inelastic. Cassava was considered as inferior goods; 4) The demand of fish for household consumption an every level of income in rural and urban areas was elastic. Household in rural area on every level of income and in urban areas on middle and high income level consider fish as a main necessity. While on low income level household in urban areas, it was considered as classy/exclusive good; 5) the demand of chicken; for household in rural areas on middle and high income level was inelastic. When in rural low income level and urban middle and high income level, was inelastic chicken meat was considend as classy/exclusive good the rural low income level household; 6) egg demand for household consumption in rural areas on every level of income was inelastic, while in urban area it was elastic for every level income; 7) the rural and urban household on every level of income considered rice as the stpale food; 8) Household in rural and urban areas on middle and high level of income considered beef as main necessity; 9) On household with middle income level in rural areas, egg was considere as inferior good; while an low income level in urban areas, egg was considere as expensive good.

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Patterns and Determinants of Open Defecation among Urban People

Kesmas National Public Health Journal ◽

10.21109/kesmas.v16i1.3295 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Vera Yulyani ◽

Christin Angelina Febriani ◽

Shaharuddin MS ◽

Dessy Hermawan

Keyword(s):

Urban Communities ◽

Rural Areas ◽

Open Space ◽

Economic Status ◽

Influential Factors ◽

Influential Factor ◽

P Value ◽

Open Defecation ◽

Chi Square ◽

Urban People

At the present time, an estimated of 673 million people defecate in the open space, not in private. Indonesia is a densely populated country with a lot of open defecation (OD) both in urban (37%) and rural areas (43%). Tanjung Karang Pusat Subdistrict is an area in Bandar Lampung City with the highest percentage of OD practice (45%). This study aimed to explore and explain the patterns and determinants of OD among urban people in the Tanjung Karang Pusat Subdistrict in- volving 377 respondents for quantitative analysis. Quantitative data were analyzed using the chi square and regression analysis. After controlling the economic status and education level variables, the data revealed that urban communities were still practicing OD (23.3%) with land ownership, latrine ownership, conative attitude, and occupation as influential factors. Statistical test results showed that the most influential factor in the behavior of OD in the community was latrine ownership (p-value <0.001, OR adj = 58.2). These findings suggested that stakeholders must take action on landowners who do not allow sanitation facilities to be built on their land.

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ANALISIS KONSUMSI BERAS PADATINGKAT RUMAH TANGGA DI PROPINSI DAERAH ISTIMEWA YOGYAKARTA

Agro Ekonomi ◽

10.22146/agroekonomi.16734 ◽

2016 ◽

Vol 14 (1) ◽

pp. 50

Author(s):

Cristovao R ◽

Slamet Hartono ◽

Jangkung Handoyo Mulyo

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Income Elasticity ◽

Income Level ◽

Middle Income ◽

Household Level ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Rice Consumption

The objectives of the study were (1) to determine thefactors influencing rice consumption in urban and rural areas of Yogyakarta Special Province and (2) to determine the own price, cross price and income elasticity of rice consumption at different income levels in rural and urban areas. National Socio-Economic Survey (SUSENAS) data of 2005 Yogyakarta Special Province on rice consumption was used Totalrespondents 1990 households. Regression model used in the analysis was OLS. The result showed that thefactors that influence the consumption of rice are the price of the rice itself, price of the related household goods, income level, education of the mother, number offamily members, and location. Thefactors that individually influence rice consumption vary by kinds of rice, location, and income level. Therefore, the demand of rice in DIY is inelastic, the change of price did not significantly influence rice demand. Generally, rice is normal good at low income household level in the rural and urban areas andfor middle income in the rural, and in middle income and high income in the urban, rice is a inferior good. In other side, rice is Substituted for cassava and sweet potato. Rice is complementary for catfish, fermented soybean cake, cassava, egg, and tofu.Keywords: rice consumption, elasticity, substitution, complementary.

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Safe greywater reuse to augment water supply and provide sanitation in semi-arid areas of rural India

Water Science & Technology ◽

10.2166/wst.2010.414 ◽

2010 ◽

Vol 62 (6) ◽

pp. 1296-1303 ◽

Cited By ~ 7

Author(s):

S. Godfrey ◽

P. Labhasetwar ◽

S. Wate ◽

B. Jimenez

Keyword(s):

Water Supply ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Water Reuse ◽

Cost Effective ◽

Open Defecation ◽

Fourfold Increase ◽

Semi Arid ◽

Greywater Reuse

Water reuse is recognized as a tool to increase water supply in peri-urban areas of semi-arid and arid regions of the world. However, it is an option rarely explored for rural areas in developing countries, and has not been documented extensively in the scientific literature. This paper presents results from 6 greywater reuse systems which were built with the objective to augment water supply and to provide sanitation in rural low income areas of Madhya Pradesh, India. The systems are based on reclaiming greywater from bathing for the use in toilet flushing and kitchen garden irrigation. The reuse systems were implemented based on the scientific rationale presented in the WHO (2006) guidelines. The paper presents evidence from the operation and evaluation of the greywater treatment plants under field conditions between 2005 and 2008. The paper concludes that greywater is a highly cost effective solution for water scarcity. In this study, reusing greywater resulted in a 60% increase in water availability, a reduction in open defecation and a fourfold increase in food availability.

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Determinants of early marriage among female adolescent in Indonesia

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0054 ◽

2018 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Sarni Maniar Berliana ◽

Putu Arry Novelina Kristinadewi ◽

Praba Diyan Rachmawati ◽

Rista Fauziningtyas ◽

Ferry Efendi ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Economic Status ◽

Female Adolescent ◽

Early Marriage ◽

Media Campaign ◽

Health Issues ◽

Chi Square ◽

National Education ◽

The Status

Abstract Background While studies on reproductive health issues are discussed widely, until recently early marriage among adolescent has not received enough attention across stakeholders in Indonesia. This research aims to analyze the determinants of early marriage among female adolescents in Indonesia. Methods This study employs data from the Indonesia Demographic and Health Survey (IDHS) 2012 on females aged 15–19 years (n = 7207). The analytical methods used to determine factors of early marriage were chi-square and multiple logistic regression. Results The results from this research revealed that four determinants are significantly related to early marriage among female adolescent. Females who have not completed primary school tend to be involved in an early marriage more often than those who graduated from high school. Furthermore, underprivileged females tend to get married earlier than those with a high socio-economic status. Additionally, females living in rural areas are more prone to early marriage than those living in urban areas. Finally, well-informed females tend not to get married as early as females who do not have access to media information. Conclusion A stakeholder policy is required that promotes the status of females by improving access to national education, particularly for females in rural areas and those who live in poverty. Marketing and advertising media campaign targeting adolescent are needed to ensure greater access to information.

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The prevalence of hypertension and its distribution by sociodemographic factors in Central Mozambique: a cross sectional study

BMC Public Health ◽

10.1186/s12889-020-09947-0 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Mika Matsuzaki ◽

◽

Kenneth Sherr ◽

Orvalho Augusto ◽

Yoshito Kawakatsu ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Positive Association ◽

Household Survey ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Lifestyle Changes ◽

Cross Sectional ◽

Middle Income ◽

Education Levels

Abstract Background Hypertension (HTN) is a major risk factor for cardiovascular diseases, and its prevalence has been rising in low- and middle-income countries. The current study describes HTN prevalence in central Mozambique, association between wealth and blood pressure (BP), and HTN monitoring and diagnosis practice among individuals with elevated BP. Methods The study used data from a cross-sectional, representative household survey conducted in Manica and Sofala provinces, Mozambique. There were 4101 respondents, aged ≥20 years. We measured average systolic and diastolic BP (SBP and DBP) from three measurements taken in the household setting. Elevated BP was defined as having either SBP ≥140 or DBP ≥90 mmHg. Results The mean age of the participants was 36.7 years old, 59.9% were women, and 72.5% were from rural areas. Adjusting for complex survey weights, 15.7% (95%CI: 14.0 to 17.4) of women and 16.1% (13.9 to 18.5) of men had elevated BP, and 7.5% (95% CI: 6.4 to 8.7) of the overall population had both SBP ≥140 and DBP ≥90 mmHg. Among participants with elevated BP, proportions of participants who had previous BP measurement and HTN diagnosis were both low (34.9% (95% CI: 30.0 to 40.1) and 12.2% (9.9 to 15.0) respectively). Prior BP measurement and HTN diagnosis were more commonly reported among hypertensive participants with secondary or higher education, from urban areas, and with highest relative wealth. In adjusted models, wealth was positively associated with higher SBP and DBP. Conclusions The current study found evidence of positive association between wealth and BP. The prevalence of elevated BP was lower in Manica and Sofala provinces than the previously estimated national prevalence. Previous BP screening and HTN diagnosis were uncommon in our study population, especially among rural residents, individuals with lower education levels, and those with relatively less wealth. As the epidemiological transition advances in Mozambique, there is a need to develop and implement strategies to increase BP screening and deliver appropriate clinical services, as well as to encourage lifestyle changes among people at risk of developing hypertension in near future.

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USIA MENARCHE PEREMPUAN INDONESIA SEMAKIN MUDA: HASIL ANALISIS RISKESDAS 2010

Jurnal Kesehatan Reproduksi ◽

10.22435/kespro.v10i2.2568 ◽

2020 ◽

Vol 10 (2) ◽

pp. 163-171

Author(s):

Sudikno Sudikno ◽

Sandjaja Sandjaja

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Secular Trend ◽

Economic Status ◽

Nationwide Survey ◽

Downward Trend ◽

Bivariate Analysis ◽

Age At Menarche ◽

Industrialized Countries ◽

Cross Sectional

Abstract Background: A downward trend in age at menarche (AAM) has been leveling-off in industrialized countries. However, downward trends were still observed in developing countries. Objective: The aim was to verify secular trend of AAM among Indonesian women and its associated factors. Methods: Data used were from Baseline Health Research (Riskesdas) 2010, a cross-sectional nationwide survey. Samples included were 79,026 women aged 10-59 years. History of menarche, socio-demographic variables, weight, height were taken. Descriptive and bivariate analysis were applied to measure proportion, central tendency measures. Results: Among adolescent 10-19years, overall proportion of menarche was 78.6%, ranging from 42.8%, 96.2%, 99.6% at age 12, 15, 18 years respectively. The overall mean AAM was 12.96 years. AAM was significantly younger in urban than rural areas. BMI was significantly lower among adolescense not experienced menarche yet than experienced menarche. AAM was younger in urban areas, higher socio-economic status, and varied among seven regions. Conclusions: Nutritional status was a significant factor associated with AAM. A downward trend in AAM was observed in Indonesian women. Key words: menarche, secular trend, body mass index, Indonesian woman Abstrak Latar belakang: Tren penurunan usia pada menarche telah meningkat di negara-negara industri. Namun, tren penurunan masih diamati di negara-negara berkembang. Tujuan: untuk memverifikasi tren sekuler usia menarche di kalangan perempuan Indonesia dan faktor-faktor terkaitnya. Metode: Data yang digunakan berasal dari Riskesdas 2010, survei nasional dengan desain cross-sectional. Sampel yang dianalisis adalah 79.026 perempuan berumur 10-59 tahun. Variabel yang dikumpulkan meliputi: riwayat menarche, sosio-demografis, berat badan, tinggi badan. Analisis deskriptif dan bivariat digunakan untuk mengukur proporsi, ukuran kecenderungan sentral. Hasil: Di antara remaja 10-19 tahun, proporsi keseluruhan menarche adalah 78,6 persen, mulai dari 42,8 persen, 96,2 persen, 99,6 persen pada masing-masing umur 12, 15, dan 18 tahun. Rata-rata keseluruhan usia menarche adalah 12,96 tahun. Usia menarche secara signifikan lebih muda di daerah perkotaan daripada pedesaan. IMT secara signifikan lebih rendah di antara remaja yang belum mengalami menarche dibandingkan dengan remaja yang sudah mengalami menarche. Usia menarche lebih muda di daerah perkotaan, status sosial ekonomi yang lebih tinggi, dan bervariasi di antara tujuh daerah. Kesimpulan: Status gizi adalah faktor signifikan yang terkait dengan usia menarche. Terjadi Tren penurunan usia menarche pada perempuan di Indonesia. Kata kunci: menarche, tren sekuler, indeks massa tubuh, perempuan Indonesia

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Prevalence of COVID-19 In Rural Versus Urban Areas in a Low-Income Country: Findings from a State-Wide Study in Karnataka, India

10.1101/2020.11.02.20224782 ◽

2020 ◽

Author(s):

Manoj Mohanan ◽

Anup Malani ◽

Kaushik Krishnan ◽

Anu Acharya

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Agricultural Activity ◽

Middle Income ◽

Low Income Country ◽

Rural And Urban Areas ◽

Middle Income Countries ◽

Rural And Urban ◽

Order Of Magnitude

AbstractAlthough the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries, there are relatively few published studies on the epidemiology of SARS-CoV-2 in these countries. The few there are focus on disease prevalence in urban areas. We conducted state-wide surveillance for COVID-19, in both rural and urban areas of Karnataka between June 15-August 29, 2020. We tested for both viral RNA and antibodies targeting the receptor binding domain (RBD). Adjusted seroprevalence across Karnataka was 46.7% (95% CI: 43.3-50.0), including 44.1% (95% CI: 40.0-48.2) in rural and 53.8% (95% CI: 48.4-59.2) in urban areas. The proportion of those testing positive on RT-PCR, ranged from 1.5 to 7.7% in rural areas and 4.0 to 10.5% in urban areas, suggesting a rapidly growing epidemic. The relatively high prevalence in rural areas is consistent with the higher level of mobility measured in rural areas, perhaps because of agricultural activity. Overall seroprevalence in the state implies that by August at least 31.5 million residents had been infected by August, nearly an order of magnitude larger than confirmed cases.

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