Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Investigation and Countermeasures on the Health-Promoting Lifestyle of the Disabled Elderly in a Rural Area

Objective： To investigate the level of health-promoting lifestyle in the disabled elderly in a rural area and to provide useful countermeasures for health care workers and the government to improve the elderly＇ s lifestyle behaviors. Methods： A total of 446 disabled elderly people were recruited and examined using the General Questionnaire and Health-Promoting Lifestyle Profile II. Results： The mean score of the health-promoting lifestyle was 109.73（ SD = 16.80）, in which 90.6 percent of the disabled elderly demonstrated unhealthy lifestyle behaviors. The average score for each of the subscales includedthe following： interpersonal relations, stress management, nutrition, self-actualization, health responsibility, and sports activity. Conclusions： The health-promoting lifestyle of the disabled elderly needs to be improved; health care workers and the government should pay more attention to the countermeasures that can improve the lifestyle behaviors and promote the health of the disabled elderly.

A Cross-sectional Study of Health-related Behaviors in Rural Eastern China

Objective This study examined the status of health-related behaviors among rural residents and the factors influencing the practice of such behaviors. Methods One thousand and ninety subjects aged 15 years or over in a rural community, Anhui Province, China were surveyed. A questionnaire was used to collect information on the health knowledge, attitude and behavior of the subjects. Information on health behavior included smoking, drinking, dietary habits, regular exercises, sleeping pattern and oral health behavior. Results The prevalence of smoking and drinking in the male subjects was 46.5% and 46.9%, respectively. There was a positive significant association between smoking and drinking. Only 8.3% of all subjects ate three regular meals a day regularly. Among subjects who ate two meals a day, 89.7% did not have breakfast. Only 1.7% of subjects took part in regular exercise. About 85% of subjects slept 6 to 8 h per day. Only 38.4 % of the respondents had the habit of hand washing before eating and after using the lavatory. 79.3% of the subjects brushed their teeth every day, and among them, only 10.6 percent brushed their teeth twice a day Further analyses showed that 64.8% of subjects had 3-5 items of positive health behaviors out of 8 items and only 16.9% had six or more items. Logistical regression analyses suggested that better health behavior was affected by sex, age, years of education, income and health knowledge. Conclusion The status of health behaviors among rural residents was generally poor. It is thus urgent to reinforce health education in rural communities in China.

Health Risk Assessment on Rural Drinking Water Safety —A Case Study in Rain City District of Ya’an City of Sichuan Province

Taking Rain City District of Ya’an for example, this paper based on ComGIS (Component Object Model Geographic Information System) platform takes comprehensive and systematic detection on the exposure dose of chemical carcinogens and non-carcinogens from drinking water sources in this region and discusses health risk assessment of single factor and the whole health risk assessment. As, Hg, Cr, Pb, Cd and fluorides in some drinking water sources of Rain City District are analyzed according to Standards For Drinking Wa-ter Quality (GB5749-2006). A health risk assessment model called USEPA is also applied to drinking water health risk assessment and management countermeasure is proposed. The results show that the greatest health risk for individual person per year is caused by Cr(VI). The health risk of carcinogens is much higher than that of non-carcinogens: the greatest risk value due to non-carcinogen pollutants is caused by fluoride (F), achieving 1.05×10-8/a. The ranking of risk values due to non-carcinogen pollutants by drinking water is Pb>fluoride (F)>Hg, within Pb accounting for 44.77%, fluo-ride (F) accounting for 34.30% and Hg accounting for 20.92%. The average individual carcinogenesis annual risk of Cr(VI) is the greatest, achieving 8.91×10-4/a. The ranking of risk value due to chemical carcinogen by rural drinking water of Ya’an is Cr6+>As>Cd, within Cr6+ accounting for 91.12%, As accounting for 5.89% and Cd accounting for 3.00%. Based on this, the strategy and measures of the health risk management are put forward. This study has worked efficiently in practice. Compared with the same kind of methods which have been found, the paper has the outstanding results for the health risk assessment of the rural drinking water safety.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Better nutrition, healthier mind? Experimental evidence from primary schools in rural northwestern China

Malnutrition and mental health problems are both prevalent among rural students in China. To provide a better understanding of the functional linkage between these two problems, this study estimates the causal effect of improved nutrition on rural students’ mental health status, exploiting a randomized controlled trial involving 6 044 fourth and fifth graders in rural northwestern China. Estimation results show that a nutrition subsidy provided by the project significantly improved students’ mental health status(measured by their anxiety scale). However, an add-on incentive provided to school principals, which was tied to anemia reduction, almost entirely offset the beneficial impact of the nutrition subsidy. These findings suggest that to improve students’ mental health in rural China, not only direct subsidies, such as low-priced school meals, but also correct incentives, especially those tied closely to students’ mental health outcomes, should be provided.

Improving Demand for Health Services with the Involvement of Community Health Workers: A Case Study of Community Dynamics at Mosango Rural Health Zone in the Democratic Republic of Congo

Introduction: DRC is one of Sub-Saharan Africa country with high infant and maternal mortality. The major problem is the underuse of health services because of inaccessibility on all fronts and also the population under-information to the health and development problems. Community participation is one of the basic requirements and basic principles of the Primary Health Care to solve this problem. That is why we choose Mosango RHZ to assess the improvement of demand for health services with the involvement of community health workers. Methods: We conduct a cross-sectional study carried out in Mosango RHZ in 2019. The study combined a mixed method (quantitative and qualitative) based on the realist evaluation approach which takes into account the Context-Mechanisms-Effects explained in the conceptual framework model. Results: Four predictive factors determine the improvement of health indicators with the involvement of CHWS in activities of the Mosango RHZ: Having attended school (p = 0.000;OR = 0.150);Having sufficient theoretical knowledge on malaria, diarrhoea, pneumonia, malnutrition, availability of inputs to treat these diseases (p = 0.004;OR = 0.192);Having taken the training as CHWS and Having undergone more than one training as CHW (p = 0.013;OR = 0.074). This result corroborated with other studies carried in low- and middle-income countries like DRC. Conclusion: The involvement of CHWs on improving demand for health services is effective in Mosango RHZ. The improvement of health service indicators and the effectiveness of this community intervention were conditioned by capacity building of the CHWs, the availability of inputs and the involvement of the community in the activities of the health zone through the Community Action Cells.

Evaluating the Efficiency and Determinants of Efficiency of Rural Health Centers Situated in Punjab, Pakistan

This study calculates the efficiency of Rural Health Centers (RHCs) and investigates the impact of other variables affecting the efficiency of RHCs. The study considers 29 RHCs, 13 of District Faisalabad, 9 of Toba and 7 of Jhang;a survey was conducted to collect data from each RHC for the year 2016. Data Envelopment Analysis (DEA) model was utilized to get the scores for efficiency. Thereafter, after getting the results from DEA Tobit regression was used in the second stage. Out of the 29 Rural Health Centers, only 11 (38%) are working efficiently as compare to others. Distance from the tehsil headquarter, Distance from the road with “0” probability, Distance from private hospital with “0” probability, Behavior of the staff with “0.0064” probability and laboratory equipment’s with “0” probability, have an impact on the efficiency scores. Distance from other health facilitators, Staff’s behavior, list of medicine and equipment’s used at RHCs should be improved to increase the efficiency of RHC’s.

Impact of Village-based Health Education of Tobacco Control on the Current Smoking Rate in Chinese Rural Areas

The number of smokers in Chinese rural areas is more than 200 million, which is twice that in cities. It is very significant to carry out tobacco control interventions in rural areas. We performed this community intervention study to evaluate the efficacy of village-based health education of tobacco control on the male current smoking rate in rural areas. The population of this study was the males above 15 years old from 6 villages in rural areas. The villages were randomly assigned to intervention group or control group（3 villages in each group）. Self-designed smoking questionnaire was applied. The intervention group received the village-based health education of tobacco control for one year. The primary outcome measurement was the male current smoking rate. In the baseline investigation, completed surveys were returned by 814 male residents from the control group and 831 male residents from the intervention group. The male current smoking rate in the control group and the intervention group was 61.2% and 58.5%, respectively, before intervention. There was no significant difference between these two groups（P〉0.05）. After one-year intervention, the current smoking rate in the intervention group（51.2%） was significantly lower than that in the control group（62.8%）（P〈0.001）. Our study suggested that the village-based health education of tobacco control was effective in lowering the male current smoking rate in rural areas, which could be a suitable and feasible way for tobacco control in the Chinese rural areas.

Cross-sectional population based study ascertaining the characteristics of US rural adults with mental health concerns who perceived a stigma regarding mental health issues

Introduction: Mental health is an important component of overall health. Mental illness is a leading cause of morbidity and mortality in the US and is associated with chronic diseases such as heart disease, diabetes, and arthritis. In the US, most people with mental health issues or disorders remain untreated. Epidemiological studies have identified rural residents as being at greater risk for health disparities;as a result, rural residents are a vulnerable population in terms of mental health and mental health care. Research has demonstrated that perceived stigma can be a significant barrier to rural residents seeking mental health care. This study examined the research question: What are the characteristics of US rural adults with mental health concerns who perceived stigma? Methods: 2007 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using bivariate and multivariate techniques to answer the research question. 2007 BRFSS data were used because in that year non-institutionalized US adults in 37 states and territories were queried about their attitudes toward mental illness. BRFSS is a random digit telephone survey that uses a complex multi-stage sampling approach and subsequently a weighting factor is calculated for application to the data in order to ensure that they are representative of the US population based on the most recent census data. Only weighted data were analyzed. Results: Logistic regression analysis revealed that rural adults reporting mental health concerns who perceived stigma regarding mental health were more likely to be unemployed seeking work or not working and not seeking work, military veterans, or to have deferred medical care because of cost. They were also more likely to not have a health care provider and to rarely or never feel supported emotionally. Conclusions: Support systems may render people with mental health issues less vulnerable to perceiving stigma, thus assisting with removing stigma as a barrier to care. Pharmacist may play a role as support in communities, especially where access to health care providers may be limited.

Radio-Medicine and Public Health in Rural Ghana

Radio is know-how that comes with low manufacturing costs, and low infrastructure costs and its marginal cost of distribution is very low which is close to zero. This study was conducted to examine the rate at which radios advertise medical services and products;the factors that promote the patronage of radio-medicine and evaluate the effects of radio-medicine on people who patronize it. The study took place at Agogo by interviewing 50 people belonging to 10 different professional groups as follows: Farmers, Drivers, shopkeepers, tailors/seamstresses, teachers, hairdressers, barbers, market women, students and the unemployed. Through SPSS, the data was analyzed and the result indicated that 44.0% listen to radio once a day, 14.0% listen every hour, and 42.0% listen all day. On the reasons for patronizing radio-medicine, 24% bought per testimonies shared from others, 12% said it is easy to patronize, 12.0% do that for affordability and effectiveness, 8.0% said it is good, 4.0% were highly convinced by suppliers, 4.0% patronized because there are no side effects, 12.0% were for just trials, 10.0% said there is no time to go to the hospital, 8.0% did so because they had minor conditions and 6.0% patronized for first aid and relieve of symptoms. In addition, 68.0% agreed that the medicine worked for them as expected but 32.0% agreed that the medicine did not work as expected. It was concluded that most people listen to radio all day and most of them participate, in medicines advertised on the radio, because of testimonies shared by others. Even-though majority of the respondents thought they could be affected they did not care about it. Recommendations have been made to the Ministry of Health to regulate radio-medicine and its patronage and also for further research by research institutions.

Perception and Information Seeking Behaviour of Rural Households towards Health Promoting Practices in Maigana District of Kaduna State, Nigeria

Information is valuable, increases understanding and reduces uncertainty. Limited knowledge and access to health promoting and disease prevention programmes are more pronounced in rural than urban areas of Nigeria. Furthermore, the paucity of healthcare services in these rural communities also contributes to the prevalence of health challenges in the rural sector. This study investigated the perception and information seeking behavior of rural households in Maigana District of Kaduna State, Nigeria towards health promoting practices. A random sample of 152 respondents selected from five of eleven wards in the district was interviewed using a pre-tested structured questionnaire. The results, based on a 4-point Likert type scale and benchmark of 2.5 showed a very poor perception of health promoting practices among the respondents. Also, the information needs of the respondents were shown to be enormous. Three of the six socio-demographic variables regressed were found to significantly influence the information seeking behavior of the respondents regarding health promoting practices. Constraints limiting the embracement of health promoting practices were identified and measures aimed at promoting healthier living standards in rural communities were recommended. The study concludes that vast knowledge gaps do exist coupled with the poor perception of HPPs by the respondents.

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related in？uencing factors

Objective：To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables.Methods：A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities.Results：The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and100.25±22.56,respectively.Both of these scores significantly differed by age,education level,marital status,and income（P 〈 0.05,P 〈 0.01）.Self-care capability was correlated with health value（r=0.521）.A multivariate linear regression analysis showed that health value,marital status,and age predicted selfcare capability.Conclusions：Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities.The self-care capabilities of the elderly can be enhanced by improving their health value using the ＂knowing-trusting-acting＂ model.

Auditory Health and Risk Factors in Rural Workers Exposed to Pesticides in Piedade de Caratinga County-Minas Gerais

In Brazil, the amount of pesticides consumed doubled in the last 10 years. Thus, in 2008 it assumed the lead position in the world. However, its indiscriminate application in agriculture without the use of the necessary care has contributed to environmental degradation and increased occupational exposures, making it a serious health problem in the country. The recent study looked to evaluate the auditory health and risk factors in rural workers exposed to pesticides in Piedade de Caratinga County—MG, and chart their socioeconomic profile and lifestyle while identifying the types of crops and the use and management of pesticides. Developed, then, a descriptive and exploratory study involving 23 men, rural workers, exposed to pesticides, with no history of exposure to noise, with changes in meatoscopy and aged ≤50 years of age. The results show the sample consisted of 23 men with a mean age of 36.7 ± 9.3, whom have low education, with a monthly income of 1 minimum wage, working in the fields for over 15 years. There was a predominance of horticulture using organophosphate pesticides and pyrethroids. Part of the sample shows auditory loss, the most common sensorineural conductive loss. It is essential that the population exposed to this type of risk is informed and receives guidance from educational campaigns developed by the multidisciplinary team of basic health units.

Mental health services in rural India: challenges and prospects

Mental health services in India are neglected area which needs immediate attention from the government, policymakers, and civil society organizations. Despite, National Mental Health Programme since 1982 and National Rural Health Mission, there has been a very little effort so far to provide mental health services in rural areas. With increase in population, changing life-style, unemployment, lack of social support and increasing insecurity, it is predicted that there would be a substantial increase in the number of people suffering from mental illness in rural areas. Considering the mental health needs of the rural community and the treatment gap, the paper is an attempt to remind and advocate for rural mental health services and suggest a model to reduce the treatment gap.

Maternal and infant health in urban and rural areas in Morocco: Analysis of the preliminary results of the National Survey on Population and Family Health (EPSF 2011)

Background: The last Moroccan population and family health survey (EPSF 2011) was carried out between November 2010 and March 2011. The final report and the whole database are not yet accessible while a preliminary report was released early March 2012. The information given so far does not allow for a complete evaluation of the present health situation in Morocco. However, a partial equity analysis can be devoted to the comparison of health indicators in terms of gender and urban-rural gaps. Method: 1) Questionnaires: a household questionnaire dealt with household characteristics, general health, housing condition and anthropometric data for children less than six years of age. A second questionnaire was devoted specifically to ever married women and dealt with their resources, marriage, reproductive health, family planning, AIDS/SIDA, healthcare and nutrition. 2) Data collection: data were collected through the national survey using a three-stage stratified sampling design to select 640 clusters covering the 16 Moroccan regions. A total of 15,577 households were randomly drawn, providing a sample of 75,061 individuals (51.1% females and 48.9% males) for investigation. 3) Analysis: in this short report, we relied only on partial data released by the Ministry of Health in a preliminary report. We used absolute differences and relative ratios to study the evolution of gender and urban-rural gaps on the basis of socioeconomic indicators. Results and Discussion: The Moroccan population seems to be in the last phase of its demographic transition. The total fertility rate decreased from 5.6 children per woman in 1980 to 2.5 in 2011. The mean age of first marriage went from 24 years for men and 17.5 years for women in 1960 to 31.5 years and 26.3 in 2011 for men and women respectively. The age structure is showing a trend of ageing population. Generally, health indicators related to reproductive and women’s health improved noticeably and consequently, maternal and infant mortality also decreased. However, while these achievements are praiseworthy as national averages, they remain insufficient in terms of equitable healthcare and access to health services since there is still a long way to go in order to reduce the huge gender gaps and rural-urban disparities. Conclusion: In this short report, we showed that, as averages, health indicators improved noticeably during the last decade but gender inequality and urban-rural disparities are still challenging health decision makers. Moroccan health decision makers are urged to adopt an equitable health strategy, starting by giving access to data for analysis, monitoring and evaluation.