scholarly journals “Our Tradition Our Enemy”: A Qualitative Study of Barriers to Women’s HIV Care in Jimma, Southwest Ethiopia

2020 ◽  
Vol 17 (3) ◽  
pp. 833
Author(s):  
Hailay Gesesew ◽  
Pamela Lyon ◽  
Paul Ward ◽  
Kifle Woldemichael ◽  
Lillian Mwanri
Keyword(s):  
Treatment Outcomes ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Workers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Negative Consequences ◽  
Framework Analysis ◽  
Southwest Ethiopia

Evidence exists that suggests that women are vulnerable to negative HIV treatment outcomes worldwide. This study explored barriers to treatment outcomes of women in Jimma, Southwest Ethiopia. We interviewed 11 HIV patients, 9 health workers, 10 community advocates and 5 HIV program managers from 10 institutions using an in-depth interview guide designed to probe barriers to HIV care at individual, community, healthcare provider, and government policy levels. To systematically analyze the data, we applied a thematic framework analysis using NVivo. In total, 35 participants were involved in the study and provided the following interrelated barriers: (i) Availability— most women living in rural areas who accessed HIV cared less often than men; (ii) free antiretroviral therapy (ART) is expensive—most women who have low income and who live in urban areas sold ART drugs illegally to cover ART associated costs; (iii) fear of being seen by others—negative consequences of HIV related stigma was higher in women than men; (iv) the role of tradition—the dominance of patriarchy was found to be the primary barrier to women’s HIV care and treatment outcomes. In conclusion, barriers related to culture or tradition constrain women’s access to HIV care. Therefore, policies and strategies should focus on these contextual constrains.

scholarly journals Variation in HIV care and treatment outcomes by facility in South Africa, 2011–2015: A cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. e1003479
Author(s):  
Jacob Bor ◽  
Anna Gage ◽  
Dorina Onoya ◽  
Mhairi Maskew ◽  
Yorghos Tripodis ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Urban Areas ◽  
Viral Suppression ◽  
Laboratory Data ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Hiv Care ◽  
Western Cape ◽  
Care And Treatment

Background Despite widespread availability of HIV treatment, patient outcomes differ across facilities. We propose and evaluate an approach to measure quality of HIV care at health facilities in South Africa’s national HIV program using routine laboratory data. Methods and findings Data were extracted from South Africa’s National Health Laboratory Service (NHLS) Corporate Data Warehouse. All CD4 counts, viral loads (VLs), and other laboratory tests used in HIV monitoring were linked, creating a validated patient identifier. We constructed longitudinal HIV care cascades for all patients in the national HIV program, excluding data from the Western Cape and very small facilities. We then estimated for each facility in each year (2011 to 2015) the following cascade measures identified a priori as reflecting quality of HIV care: median CD4 count among new patients; retention 12 months after presentation; 12-month retention among patients established in care; viral suppression; CD4 recovery; monitoring after an elevated VL. We used factor analysis to identify an underlying measure of quality of care, and we assessed the persistence of this quality measure over time. We then assessed spatiotemporal variation and facility and population predictors in a multivariable regression context. We analyzed data on 3,265 facilities with a median (IQR) annual size of 441 (189 to 988) lab-monitored HIV patients. Retention 12 months after presentation increased from 42% to 47% during the study period, and viral suppression increased from 66% to 79%, although there was substantial variability across facilities. We identified an underlying measure of quality of HIV care that correlated with all cascade measures except median CD4 count at presentation. Averaging across the 5 years of data, this quality score attained a reliability of 0.84. Quality was higher for clinics (versus hospitals), in rural (versus urban) areas, and for larger facilities. Quality was lower in high-poverty areas but was not independently associated with percent Black. Quality increased by 0.49 (95% CI 0.46 to 0.53) standard deviations from 2011 to 2015, and there was evidence of geospatial autocorrelation (p < 0.001). The study’s limitations include an inability to fully adjust for underlying patient risk, reliance on laboratory data which do not capture all relevant domains of quality, potential for errors in record linkage, and the omission of Western Cape. Conclusions We observed persistent differences in HIV care and treatment outcomes across South African facilities. Targeting low-performing facilities for additional support could reduce overall burden of disease.

TURNING FARMERS INTO SOCIAL FARMER ENTREPRENEURS FOR DISADVANTAGED PEOPLE

2020 ◽  
Author(s):  
Remus Runcan
Keyword(s):  
Rural Communities ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health And Safety ◽  
Physical Work ◽  
Healthy Environment ◽  
Rural And Urban Areas ◽  
Rural Development Programme ◽  
Rural And Urban

According to Romania’s National Rural Development Programme, the socio-economic situation of the rural environment has a large number of weaknesses – among which low access to financial resources for small entrepreneurs and new business initiatives in rural areas and poorly developed entrepreneurial culture, characterized by a lack of basic managerial knowledge – but also a large number of opportunities – among which access of the rural population to lifelong learning and entrepreneurial skills development programmes and entrepreneurs’ access to financial instruments. The population in rural areas depends mainly on agricultural activities which give them subsistence living conditions. The gap between rural and urban areas is due to low income levels and employment rates, hence the need to obtain additional income for the population employed in subsistence and semi-subsistence farming, especially in the context of the depopulation trend. At the same time, the need to stimulate entrepreneurship in rural areas is high and is at a resonance with the need to increase the potential of rural communities from the perspective of landscape, culture, traditional activities and local resources. A solution could be to turn vegetal and / or animal farms into social farms – farms on which people with disabilities (but also adolescents and young people with anxiety, depression, self-harm, suicide, and alexithymia issues) might find a “foster” family, bed and meals in a natural, healthy environment, and share the farm’s activities with the farmer and the farmer’s family: “committing to a regular day / days and times for a mutually agreed period involves complying with any required health and safety practices (including use of protective clothing and equipment), engaging socially with the farm family members and other people working on and around the farm, and taking on tasks which would include working on the land, taking care of animals, or helping out with maintenance and other physical work”

scholarly journals Quality of life of the elderly population during the virus Covid-19 pandemic with special reference to agriculturists

2020 ◽  
Vol 67 (4) ◽  
pp. 1155-1167
Author(s):  
Pavle Radanov ◽  
Ivana Lešević ◽  
Pavle Brzaković ◽  
Dragan Pajić
Keyword(s):  
Quality Of Life ◽  
Rural Areas ◽  
Urban Areas ◽  
Elderly Population ◽  
The Elderly ◽  
Special Importance ◽  
Negative Consequences ◽  
State Of Emergency ◽  
The Republic

In the Republic of Serbia, on March 15 th , 2020 Government decided to declare a state of emergency due to the Covid-19 pandemic. One of the measures was a movement ban for people over 65 in urban areas and those over 70 in rural areas. This research should indicate how people over 65 in urban areas have endured this situation, especially in relation to the same population in rural areas, as well as implications of the movement ban on the quality of life of the elderly population. Special importance is given to the rural population engaged in agriculture. A tool of data collection in this research was anonymous survey. Respondents' answers were statistically processed, which led to clear conclusions about the large negative consequences for the elderly population, including the agricultural activities in rural areas. Covid-19 is still present, which opens further questions related to the quality of life of the elderly population, if necessity for similar measures recurs in the future.

scholarly journals Consequences of Promoting Less-Populated Rural Areas to Urban Areas: A Case Study, Bushehr Province

2015 ◽  
Vol 10 (1) ◽  
pp. 91-100
Author(s):  
Ali Bastin
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Residential Buildings ◽  
Urban System ◽  
Population Data ◽  
Target Population ◽  
Positive Outcomes ◽  
Negative Consequences

The modified law of Iranian Administrative divisions has greatly altered the pattern of settlement in recent decades. The promotion of rural areas to urban areas has shifted from mere population standard to combined population-administrative standards. However, all censuses suggest that many rural areas reported as smaller than the minimum population standard have been promoted to urban areas. In the last two decades, this is a clearly prominent phenomenon in the urban system of Iran. This paper evaluates the effects and consequences of promoting small and sparsely populated rural areas to urban areas in the Bushehr province. The used methodology is analytic-descriptive using a questionnaire distributed among 380 members of the target population. Data analysis is conducted in physical, economic, social and urban servicing domains using one-sample T-test and the utility range. The results show that promotion of rural areas to urban areas has positive outcomes such as improved waste disposal system, improved quality of residential buildings, increased monitoring of the construction, increased income, prevented migration and improved health services. However, the results of utility range show that the negative consequences of this policy are more than its positive outcomes, which have been studied in detail.

scholarly journals Willingness and professional motivations of medical students to work in rural areas: a study in Alexandria, Egypt

2013 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Aida M. Mohamed
Keyword(s):  
Medical Students ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Training ◽  
Health Workers ◽  
Work Conditions ◽  
Motivational Factors ◽  
Willingness To Accept ◽  
Cross Sectional Survey ◽  
Rural Service

Retaining health workers in rural areas is challenging for a number of reasons, e.g. personal preferences, difficult work conditions and low remuneration. Our aim was to determine the effect of motivational factors on willingness to accept postings to rural underserved areas in Alexandria, Egypt and to identify perceived attributes of rural service.,A cross-sectional survey involving 302 4th-year medical students was conducted in March-July 2012. Logistic regression analysis was used to assess the association between students&rsquo; willingness to accept rural postings and their professional motivations, rural exposure and family parental professional and educational status (PPES). Perceived attributes to rural service were also assessed. Over 85% students were born in urban areas and 41.4% came from affluent backgrounds. More than half students reported strong intrinsic motivation to study medicine. After controlling for demographic characteristics and rural exposure, motivational factors significantly influenced willingness to practice in rural areas. High-family PPES was consistently associated with lower willingness to work in rural areas. A sizable portion of medical students are motivated to study and practice medicine in rural areas. Efforts should be made to build on motivation during medical training and designing rural postings, as well as favor lower PPES students for admission and improving organizational and contextual issues of rural service.

scholarly journals Groundwater as a Source of Drinking Water in Southeast Asia and the Pacific: A Multi-Country Review of Current Reliance and Resource Concerns

Water ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1605 ◽  
Author(s):  
Naomi Carrard ◽  
Tim Foster ◽  
Juliet Willetts
Keyword(s):  
Drinking Water ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Critical Role ◽  
Water Source ◽  
Groundwater Resource ◽  
Drinking Water Source ◽  
Water Services ◽  
Sustainable Services

Groundwater is widely acknowledged to be an important source of drinking water in low-income regions, and it, therefore, plays a critical role in the realization of the human right to water. However, the proportion of households using groundwater compared with other sources is rarely quantified, with national and global datasets more focused on facilities—rather than resources—used. This is a significant gap in knowledge, particularly in light of efforts to expand water services in line with the inclusive and integrated agenda of the Sustainable Development Goals. Understanding the prevalence of groundwater reliance for drinking is critical for those involved in water services planning and management, so they can better monitor and advocate for management of water resources that supports sustainable services for households. This paper contributes data that can be used to strengthen the integration of resource considerations within water service delivery and inform the work of development partners supporting this area. We approach this issue from two perspectives. Firstly, we collate data on the proportion of households using groundwater as their primary drinking water source for 10 Southeast Asian and Pacific nations, finding an average of 66% (range of 17–93% for individual countries) of households in urban areas and 60% (range of 22–95%) of households in rural areas rely on groundwater for drinking. Together, these constitute 79% of the total population across the case study countries. Secondly, we review current and emerging groundwater resource concerns within each country, using a systems thinking approach to assess how groundwater resource issues influence household water services. Findings support the case for governments and development agencies to strengthen engagement with groundwater resource management as foundational for achieving sustainable water services for all.

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

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.

scholarly journals Socioeconomic and psychosocial factors are associated with poor treatment outcomes in Australian adults living with HIV: a case-control study

Sexual Health ◽  
2019 ◽  
Vol 16 (6) ◽  
pp. 548 ◽  
Author(s):  
Krista J. Siefried ◽  
Stephen Kerr ◽  
Robyn Richardson ◽  
Limin Mao ◽  
John Rule ◽  
...  
Keyword(s):  
Health Care ◽  
Treatment Outcomes ◽  
Psychosocial Factors ◽  
Hiv Treatment ◽  
Hiv Disclosure ◽  
Self Report ◽  
Hiv Care ◽  
Targeted Interventions ◽  
Poor Outcomes ◽  
Living With Hiv

Background A substantial minority of patients living with HIV refuse or cease antiretroviral therapy (ART), have virological failure (VF) or develop an AIDS-defining condition (ADC) or serious non-AIDS event (SNAE). It is not understood which socioeconomic and psychosocial factors may be associated with these poor outcomes. Methods: Thirty-nine patients with poor HIV treatment outcomes, defined as those who refused or ceased ART, had VF or were hospitalised with an ADC or SNAE (cases), were compared with 120 controls on suppressive ART. A self-report survey recorded demographics, physical health, life stressors, social supports, HIV disclosure, stigma or discrimination, health care access, treatment adherence, side effects, health and treatment perceptions and financial and employment status. Socioeconomic and psychosocial covariates significant in bivariate analyses were assessed with conditional multivariable logistic regression, adjusted for year of HIV diagnosis. Results: Cases and controls did not differ significantly with regard to sex (96.2% (n = 153) male) or age (mean (± s.d.) 51 ± 11 years). Twenty cases (51%) had refused or ceased ART, 35 (90%) had an HIV viral load &gt;50 copies mL–1, 12 (31%) were hospitalised with an ADC and five (13%) were hospitalised with a new SNAE. Three covariates were independently associated with poor outcomes: foregoing necessities for financial reasons (adjusted odds ratio (aOR) 3.1, 95% confidence interval (95% CI) 1.3–7.6, P = 0.014), cost barriers to accessing HIV care (aOR 3.1, 95% CI 1.0–9.6, P = 0.049) and lower quality of life (aOR 3.8, 95% CI 1.5–9.7, P = 0.004). Conclusions: Despite universal health care, socioeconomic and psychosocial factors are associated with poor HIV outcomes in adults in Australia. These factors should be addressed through targeted interventions to improve long-term successful treatment.

scholarly journals Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038520
Author(s):  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
Joseph Lamin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Access To Care ◽  
Sierra Leone ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health System Strengthening ◽  
Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

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

BMJ Open ◽  
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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