Search Results (822)

Objective: This study explored HIV testing prevalence and its associated factors among reproductive-aged women in Liberia. Study Design: A secondary and descriptive cross-sectional study was performed among Liberian women aged 15–49 years using the 2019 Liberia Demographic and Health Survey (LDHS) data set. Methods: Descriptive statistics were used to describe the characteristics of these women. Bivariate and multivariable logistic regression models were applied to determine factors associated with HIV testing. All analyses were adjusted for unequal probabilities of selection and non-response by use of survey weights. Results: Among the 8065 participants in this survey, 490 women had never had sex and were excluded, leading to the final sample size being 7575 women. The prevalence of HIV testing among Liberian women aged 15 to 49 years in 2020 was 57.17% (95% CI: 56.2 to 60.4). HIV testing among these women is associated with pregnancy history (aOR 6.40, 95% CI:4.99 to 8.22, p < 0.001), STI history (aOR 1.21, 95% CI:1.02 to 3.19, p < 0.001), knowledge of vertical transmission (aOR 1.65, 95% CI:1.23 to 2.21, p = 0.001), and highest educational level (primary (aOR 1.39, 95% CI:1.16 to 1.68, p < 0.001), secondary (aOR 2.10, 95% CI:1.73 to 2.53, p < 0.001), and higher education (aOR 6.80, 95% CI:3.75 to 12.32, p < 0.001)). Conclusions and Contribution: HIV testing prevalence of 57.17% demonstrates an unmet need for HIV testing among Liberian women aged 15 to 49 years and, thus, it is recommended that HIV testing and counseling services should mostly target these women in rural areas, with limited health services and less educated women. Full article

Background: Visual impairment (VI) continues to be a significant global public health concern, especially in underserved rural communities. Objectives: This study aims to assess the prevalence of VI and refractive errors, as well as to identify the causes and risk factors associated with VI in Duhknah, a rural area in Qassim Province, Saudi Arabia. Methods: This cross-sectional study, conducted in May 2024, included 929 participants aged 6–90 years from Duhknah, a rural area in Qassim Province, Saudi Arabia. Refractive errors (REs) were measured using a non-cycloplegic autorefractometer. Anterior and posterior eye examinations were performed using slit lamp biomicroscopy, direct ophthalmoscopy, and 90 D fundus biomicroscopy. VI was classified based on the International Classification of Diseases 11th revision (ICD-11), 2018. Results: The findings revealed that 671 (72.2%) participants had never undergone an eye examination. The overall prevalence of presenting VI was 370 (39.8%), comprising 21.6% with mild VI, 11.0% moderate, 4.1% severe, and 3.1% classified as blind. The prevalence of hyperopia, myopia, and astigmatism was 20.6%, 36.9%, and 13.2%, respectively. Uncorrected REs were the most common cause of VI (81.4%), followed by amblyopia (13.5%) and cataracts (3.2%). Regression analysis showed that women had 1.58 times higher odds of VI (p = 0.001). Participants with eye examinations for one year or more had 3.64 times higher odds (p < 0.001). Additionally, the risk of VI was significantly lower among older participants (ages 18–90) compared to younger ones (ages 6–17), (p < 0.001). Conclusions: This study found most participants had never had an eye exam, and VI was highly prevalent in the rural community. These findings underscore the need to strengthen primary eye care in rural Saudi Arabia. Regular vision screening, particularly for children, and better access to refractive services could significantly reduce VI and support the goals of Saudi Vision 2030. Full article

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

Rural roads are critical for connecting isolated communities to essential services such as education and health and administrative services, as well as production and market opportunities in low-income countries. More than 70% of movements of people and goods in Sub-Saharan Africa are heavily reliant on rural transport systems, using both motorised but mainly alternative means of transport. However, rural roads often suffer from poor construction due to the use of low-strength, in situ soils and limited financial resources, leading to premature failures and subsequent traffic disruptions with significant economic losses. This study investigates the use of rice husk ash (RHA), a waste byproduct from rice production, as a sustainable supplement to Ordinary Portland Cement (OPC) for soil stabilisation in order to increase durability and sustainability of rural roads, hence limit recurrent maintenance needs and associated transport costs and challenges. To conduct this study, soil samples collected from Mulungushi, Zambia, were treated with combinations of 6–10% OPC and 10–15% RHA by weight. Laboratory tests measured maximum dry density (MDD), optimum moisture content (OMC), and California Bearing Ratio (CBR) values; the main parameters assessed to ensure the quality of road construction soils. Results showed that while the MDD did not change significantly and varied between 1505 kg/m³ and 1519 kg/m³, the OMC increased hugely from 19.6% to as high as 26.2% after treatment with RHA. The CBR value improved significantly, with the 8% OPC + 10% RHA mixture achieving the highest resistance to deformation. These results suggest that RHA can enhance the durability and sustainability of rural roads and hence improve transport systems and subsequently improve socioeconomic factors in rural areas. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

Grassland communities consist primarily of perennial herbaceous species, with grasses forming a dominant or significant component. These ecosystems have been utilised for economic purposes since the earliest periods of human history. In the natural environment, they fulfil numerous critical functions that, despite increasing awareness of climate change, often remain undervalued. Grasslands contribute directly to climate regulation, air purification, soil conservation, flood mitigation, and public health—all of which positively affect the well-being of nearby populations. Moreover, they satisfy higher-order human needs known as “cultural” services, providing aesthetic enjoyment and recreational opportunities. These services, in tangible terms, support the development of rural tourism. The objective of this study was to examine the perception of cultural ecosystem services provided by different types of grassland communities—meadows, pastures, and lawns. The study employed a structured questionnaire to evaluate the perceived significance and functions of these communities. Respondents assessed their aesthetic and recreational value based on land-use type. To quantify these dimensions, the study applies the Recreational and Leisure Attractiveness Index (RLAI), the Aesthetic Attractiveness Index (AAI), ranking methods, and contingent valuation techniques. Based on the respondents’ declared WTP (willingness to pay) and WTA (willingness to accept) values, statistically significant differences in the perceived value of land-use types were identified. Lawns were rated highest in terms of recreational attractiveness, meadows in terms of aesthetics, while pastures achieved the highest economic values. Significant differences were also observed depending on respondents’ place of residence and academic background. The results indicate that the valuation of cultural services encompasses both functional and psychological aspects and should be integrated into local land-use and landscape planning policies. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with rural populations experiencing higher prevalence and worse outcomes. This paper explores the transformative potential of nurse-led palliative care models in addressing the unique challenges faced by rural patients with COPD and their informal caregivers and synthesizes current evidence on nurse-led palliative care interventions, highlighting their impact on symptom management, advance care planning, and psychosocial support. Methods: This is a comprehensive synthesis of nurse-led palliative care programs, focusing on home-based care, telehealth, community outreach, and primary care integration. Results: Nurse-led interventions significantly improve patient satisfaction, reduce symptom burden, and enhance the likelihood of advance care planning discussions. Home-based care models and telehealth are particularly effective in rural settings, offering accessible and continuous support. Conclusions: Nurses have a critical role in bridging the palliative care gap for rural patients with COPD and their informal caregivers. Expanding nurse-led palliative care services can improve quality of life, reduce healthcare utilization, and promote health equity. Future research should focus on long-term outcomes, cost-effectiveness, and strategies for scaling nurse-led palliative care programs in rural contexts. Full article

Background/Objectives: Against the backdrop of increasing global aging and the trans-formation of family structures, grandparental caregiving has become commonplace, and its impact on the mental health of older persons is of great concern. Methods: Based on data from the 2023 Xi’an Jiaotong University Urban and Rural Elderly Family Support and Psychological Condition Survey, this study analyzed the impact of grandparental care-giving behaviors on the mental health of the elderly through the Psychological Condition Measurement Scale (PCMS), and comprehensively assessed the presence, intensity, and heterogeneous impact of grandparental caregiving behaviors by gender by applying linear regression modeling, the Propensity Score Matching (PSM) method, and the Instrumental Variables Method (IVM). Results: Grandparental care has a significant positive effect on the mental health of older people, but this positive effect diminishes as the intensity of care increases. The results of the sub-sample estimation show that grandparental caregiving has a positive effect on men’s and low-intensity caregiving on women’s mental health, but high-intensity caregiving has a negative effect on women’s mental health. In addition, in-tergenerational financial support and intergenerational emotional comfort play an im-portant mediating role between grandparental caregiving and the mental health of older persons, in line with the explanatory framework of intergenerational exchange theory. Conclusions: It is recommended that the Government support grandparental care for the elderly at the financial, social security, and policy levels; that society build a diversified system of elderly care services and strengthen public childcare services; and that families establish a value identity of two-way support. Full article

Promoting clean energy transition in rural areas is a key path to achieving global sustainable development, protecting public health, and promoting ecological livability. Based on data from the China Family Panel Studies (CFPS), this paper employs a multi-dimensional fixed effects model to evaluate the impact of income inequality on rural households’ clean energy transition (CET) and examines its underlying mechanisms. Research findings indicate that income inequality significantly suppresses rural households’ CET, primarily by reducing basic energy consumption and hindering the upgrading of basic energy consumption structures. Government governance quality exerts a significant negative moderating effect on the relationship between income inequality and rural households’ CET. Further analysis shows that the inhibitory effect of income inequality on CET is more significant in the regions with a low economic development level and low coal resource endowment, and in the western and northeastern regions of China. Therefore, while continuously promoting rural income growth, the government should prioritize equitable distribution, strengthen institutional capacity-building, improve the social service and security system, and facilitate rural households’ CET. Full article

This article presents a structured review of literature published between 2015 and 2025 on the experiences of rural LGBTQIA+ youth. Using targeted search terms—including “LGBT*,” “rural,” “country,” “young people,” “sexual and gender minority (SGM),” “small town,” “youth,” and “students”—a research team identified 26 peer-reviewed articles that met inclusion criteria. Through team-based thematic analysis, six core themes emerged: (1) gaps in intersectional analysis, (2) mental health outcomes, (3) culturally responsive services and resources, (4) community climate and context, (5) experiences of victimization, and (6) policy. Across these themes, the review highlights the resilience, agency, and strength of LGBTQIA+ youth navigating rural environments. The literature consistently demonstrates how experiences of victimization are closely linked to mental health outcomes, while access to social support—particularly from affirming adults in systems (such as schools)—can mitigate harm and foster well-being. Implications for social work research, practice, and policy are discussed, with an emphasis on supporting LGBTQIA+ youth in U.S. Southern rural settings. Full article

Background: As global ageing accelerates, countries worldwide are increasingly facing social and economic challenges posed by rising older populations. Many nations are responding by optimizing healthcare systems, strengthening community-based ageing models, and promoting healthy ageing policies. The Naturally Occurring Retirement Community (NORC) is gaining recognition as a promising approach due to its cost efficiency and ability to meet diverse ageing-related needs. However, systematic research on the service models of NORCs remains scarce. Objective: This study aims to systematically examine the service offerings of Naturally Occurring Retirement Community Supportive Service Programs (NORC-SSPs) and analyze how these programs contribute to supporting ageing in place. Methods: A qualitative content analysis was conducted on official website information from 60 NORC-SSPs in New York State. Service categories were identified, coded, and compared across different geographic and structural contexts. Results: The analysis shows that education, healthcare management, and recreational activities are the most frequently provided services, with health-related services playing a central role in supporting older adults to age in place. Differences in service priorities were also observed between rural and non-rural settings, as well as between vertical and horizontal built environments, reflecting the adaptability of NORC-SSPs to varying community conditions. Conclusions: By identifying key service characteristics, this study provides insights for policymakers and practitioners in Australia and other countries seeking to implement sustainable, community-based models of ageing support. Grounded in the concept of “ageing in place”, the findings contribute to the development of inclusive and flexible service systems for older adults. Full article

The Roma population is one of Europe’s largest ethnic minorities, often living in inadequate living conditions, worse than those of the majority population. They frequently lack access to essential services, even in high-income countries. This lack of basic services—particularly in combination with proximity to (stray) animals and human and solid waste—significantly increases environmental health risks, and leads to a higher rate of endoparasitic infections. Our study sheds light on the living conditions and health situation in Roma communities in Slovakia, focusing on the prevalence of intestinal endoparasitic infections across various settlement localisations. It highlights disparities and challenges in access to safe drinking water, sanitation, and hygiene (WASH) and other potentially disease-exposing factors among these marginalised populations. This study combines a comprehensive review of living conditions as per national data provided through the Atlas of Roma communities with an analysis of empirical data on parasitological infection rates in humans, animals, and the environment in settlements, applying descriptive statistical methods. It is the first study in Europe to provide detailed insights into how living conditions vary and cause health risks across Roma settlements, ranging from those integrated within villages (inside, urban), to those isolated on the outskirts (edge, sub-urban) or outside villages (natural/rural). Our study shows clear disparities in access to services, and in health outcomes, based on where people live. Our findings underscore the fact that (i) place—geographical centrality in particular—in an already challenged population group plays a major role in health inequalities and disease exposure, as well as (ii) the urgent need for more current and comprehensive data. Our study highlights persistent disparities in living conditions within high-income countries and stresses the need for greater attention and more sensitive targeted health-promoting approaches with marginalised communities in Europe that take into consideration any and all of the humans, ecology, and animals affected (=One Health). Full article

Background: Immunization coverage in Nigeria is low, with many children missing out on important lifesaving vaccines. To enable a better understanding of contextual factors towards increasing uptake, we piloted a Decentralized Immunization Monitoring (DIM) approach in the Kumbotso local government area (LGA) of Kano state, Nigeria, to identify wards with low vaccination rates and understand why this is happening. The findings were used to improve routine immunization (RI) programs and reduce the number of unvaccinated children and children yet to receive their first dose of diphtheria–pertussis–tetanus (DPT) vaccine, referred to as Zero-Dose children (ZD). Methods: This study adopted a cross-sectional design approach using the Behavioural and Social Drivers of Vaccination (BeSD) framework and the Lot Quality Assurance Sampling (LQAS). The study population comprised caregivers of children aged 0–11 months and 12–23 months across the 11 wards in Kumbotso District, Kano State, Nigeria, using a segmentation sampling approach. The study covered 209 settlements selected using probability proportionate to size (PPS) sampling from the wards. Univariate and bivariate analyses were performed to show patterns and relations across variables. Results: Out of 418 caregivers surveyed, 98.1% were female. Delayed vaccination was experienced by 21.9% of children aged 4.5–11 months, while the prevalence of ZD was estimated at 26.8% amongst the older cohort (12–23 months). A total of 71.4% of the delayed group and 89.1% of the ZD group remained unvaccinated. Caregiver education, rural residence, and home births correlated with delayed/ZD status (p < 0.05). Logistic regression associated higher caregiver education with reduced delayed vaccination odds (OR:0.34, p < 0.001) and urban residence with lower ZD odds (OR:1.89, p = 0.036). The antigen coverages of BCG (81.5%), DPT3 (63.6%), and measles 1 (59.7%) all surpassed the national dropout thresholds. Kumbotso, Unguwar Rimi, and Kureken Sani wards were all identified as underperforming and therefore targeted for intervention. Negative vaccine perceptions (50% delayed, 53.6% ZD) and distrust in health workers (46.4% delayed, 48.2% ZD) were significant barriers, though the caregiver intent to vaccinate was protective (OR: 0.27, p < 0.001). The cost of accessing immunization services appeared to have a minor effect on coverage, as the majority of caregivers of delayed and ZD children reported spending less than 200 Naira (equivalent to USD 0.15) on transport. Conclusions: This pilot study highlighted the utility of LQAS and BeSD in identifying low-performing wards, barriers, and routine immunization gaps. Barriers included low caregiver education, rural residence, and negative vaccine perceptions/safety. Caregiver education and urban residence were protective factors against delayed and ZD vaccination, suggesting social and systemic barriers, particularly in rural and less educated populations. Antigen-specific coverage showed disparities, with dropouts for multi-dose vaccines exceeding the national thresholds of 10%. Targeted measures addressing education, trust, and systemic issues are needed. Findings emphasize decentralized monitoring, community engagement, and context-specific strategies to reduce ZD children and ensure equitable vaccination in Nigeria. Full article

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article