Rural and Remote Health

Decentralised clinical training affects retention but not recruitment: a case study in East Nusa Tenggara, Indonesia

Sat, 09 May 26 00:00:00 +0000

Introduction: Medical education interventions are viewed as a solution to the problem of low doctor recruitment and retention in rural areas. One educational intervention is decentralised clinical training (DCT). This study aims to analyse the influence of DCT duration on rural doctor recruitment and retention using a case study of alumni from the classes of 2008-2017 (graduating between 2014 and 2023) from Universitas Nusa Cendana in Kupang, East Nusa Tenggara, Indonesia.Methods: A retrospective cohort study was conducted using total sampling. DCT duration data were obtained from the alumni database. Meanwhile, data on recruitment status and retention duration in rural areas were collected by online questionnaire. Binary logistic regression was used to analyse recruitment, and linear regression was used to analyse retention. Cohort stratification was performed before analysis to control for confounding.Results: DCT duration showed an insignificant association with recruitment across the entire cohort (odds ratio 0.750-0.967, p>0.05). However, the influence on retention showed a significant positive effect in the most recent cohort (β=0.054, p<0.05).Discussion: The analysis results for DCT duration on recruitment (insignificant) and retention (significant) reveal distinct mechanisms underlying initial intent (for recruitment) and adaptability (for retention). These results suggest that DCT may not serve as a primary magnet to attract doctors, but rather as an anchor that prepares them to stay in rural areas.Conclusion: Overall, the results of this case study provide empirical evidence that educational intervention strategies like DCT need to be integrated with multifactorial interventions - including regulation, policy, and the recruitment of students from rural origins - as the key to the sustainability of health services in rural and island regions.

Educational strategy for the prevention and basic care of chronic wounds in Mayan-Yucatecan Indigenous communities

Thu, 07 May 26 00:00:00 +0000

The incidence of chronic wounds (eg diabetic foot ulcers, venous ulcers, pressure ulcers, surgical wound dehiscence, and skin tears), is expected to rise alongside the increase in non-communicable chronic diseases (NCDs). Mexico faces significant healthcare challenges due to high rates of NCDs, a situation that is exacerbated in rural populations, which experience high rates of malnutrition, marginalization, discrimination, lack of access to specialized services, and a shortage of trained personnel. This Project Report examines the success of a co-constructed educational strategy for the prevention and basic care of wounds in Maya-Yucatecan Indigenous communities in the municipality of Chankom, Mexico.

Evolving patterns of child malnutrition in northern Nigeria: trends in stunting, wasting, and underweight from 2013 to 2018

Thu, 07 May 26 00:00:00 +0000

Child malnutrition is a critical global health challenge, disproportionately affecting low- and middle-income countries, where it contributes significantly to morbidity and mortality among children under 5 years of age. Northern Nigeria presents a unique case of child malnutrition due to its complex socioeconomic and geopolitical challenges. This Review article explores the trends and determinants of child malnutrition in Northern Nigeria, particularly the prevalence of stunting, wasting, and underweight among children aged under 5 years and the underlying factors contributing to these conditions.

When eggs in the same basket are apples and oranges: length of stay for public sector allied health professionals in regional, rural and remote southern Queensland, 2010–2021

Wed, 06 May 26 00:00:00 +0000

Despite recognition that the term 'allied health' encompasses disparate professions (differing markedly in their background, training, scope of practice and client populations), evidence related to retaining the allied health workforce in regional, rural and remote areas often treats these professions as a homogeneous group. Grouping allied health professions together risks missing professions and/or geographic differences that could be targeted for the development of specific retention strategies. This Original Research study assesses the retention patterns of different allied health professionals employed in regional, rural and remote regions of Southern Queensland.

Reducing the phenomenon of medical deserts by identifying the career plans of future doctors in Poland. Quo vadis?

Tue, 05 May 26 00:00:00 +0000

Provision of equal access to medical services for all citizens is a challenge for public healthcare systems across many European countries. Medical deserts, where medical services are inadequate for the local population, are caused by insufficient local workforce distribution and service availability, and commonly occur in rural and peripheral regions. A recent audit in Poland highlighted a lack of target numbers for medical professionals and a lack of analytical instruments or data necessary for long-term workforce planning. This Original Research study examines the determinants of professional plans (planned specializations and geographic locations) for future doctors.

Employment status and healthcare utilization in Indonesia: a multilevel analysis across developed and underdeveloped districts

Mon, 04 May 26 00:00:00 +0000

Informal workers have few formal legal protections and tend to have more exposure and susceptibility to health-threatening situations than formal workers; they also represent the predominant form of employment globally, making them a key population for improving health equity. In Indonesia, informal workers make up 57.95% of the working population. This Original Research study uses a multilevel modelling approach to monitor disparities in healthcare utilization between formal and informal workers in Indonesia and examines how geographic context and health insurance coverage shape these utilization patterns.

Awareness of cervical cancer prevention among rural dwellers in Enugu State, Nigeria: findings from Ituku outreach

Fri, 01 May 26 00:00:00 +0000

To eliminate cervical cancer as a public health threat, the World Health Organization has set a global strategy that includes achieving 90-70-90 targets by 2030: 90% of girls fully vaccinated against human papillomavirus by age 15 years, 70% of women screened by age 35 years and again by 45 years, and 90% of women identified with cervical disease receiving appropriate treatment. In Nigeria, this need is especially critical in rural populations, which often face disproportionately limited access to health education and preventive services. This Original Research study assesses the level of awareness and perceptions of cervical cancer prevention among participants of a community health outreach program in Ituku, Enugu State, Nigeria

Using the socio-ecological model to appraise the implementation of the provincial health authority model in rural districts of Madang Province, Papua New Guinea: a qualitative study

Wed, 29 Apr 26 00:00:00 +0000

Innovative models are being adopted worldwide to enhance access to essential health services in rural areas. Nevertheless, implementing these models can prove challenging, particularly in low-resource countries. In Papua New Guinea (PNG), there is limited information about the application of health policy frameworks and the challenges affecting their implementation in rural districts. This Original Research study uses qualitative interviews and group discussions with administrators, clinicians, and community members in rural areas of Madang Province, PNG, to examine the socio-ecological factors that influence implementation at all levels of the healthcare system.

Depression in mothers and early childhood development: rural–urban disparities

Thu, 23 Apr 26 00:00:00 +0000

Early childhood development is essential for long-term health, educational, and financial outcomes. Among many determinants of childhood development, the mental health of mothers has emerged as a critical, yet often under-addressed, factor, particularly in low- and middle-income countries. Despite this, few studies have explored the relationship between mothers' mental health and child development in rural Indonesia. Most analyses use aggregated data, obscuring important rural-urban differences. This Original Research study examines nationally representative data to inform equity-focused, context-specific interventions.

Pae Ora - Healthy Futures: lessons learned from the first New Zealand Rural Health Strategy

Wed, 22 Apr 26 00:00:00 +0000

Health equity is a crucial aspect of public health, ensuring that all members of society have equal opportunities to achieve their full health potential. In recent years, Aotearoa New Zealand has increased its focus on rural health equity, leading to the development of, for the first time, a specific Rural Health Strategy. The importance of a specific strategy for rural health, particularly in countries with large rural populations and regions, has been well established. This Policy Report delves into the background and context of rural health in Aotearoa New Zealand and the specifics of the development and implementation of the first New Zealand Rural Health Strategy.

Digital and community-based health interventions for exercise and education in the management of musculoskeletal- and lifestyle-related health conditions in rural communities in low- and middle-income countries: a scoping review

Thu, 16 Apr 26 00:00:00 +0000

Education, exercise prescription, targeted rehabilitation, and addressing risk factors form the cornerstone of prevention and treatment of many musculoskeletal and lifestyle-related health conditions. Although in-person health care at established facilities remains the gold standard of management, alternative options should be considered to assist with the prevention and treatment of musculoskeletal and lifestyle-related health conditions in rural communities in low- and middle-income countries (LMICs). This Scoping Review identifies and describes the use of digital and/or community-based health interventions for exercise and education in the management of musculoskeletal and/or lifestyle-related health conditions in rural communities in LMICs and explores the impact, feasibility, barriers, and facilitators of these interventions.

Barriers to oral health service access for rural and remote Australian children: a mixed-methods systematic review

Wed, 15 Apr 26 00:00:00 +0000

In rural and remote Australia, children and their families face many barriers to accessing dental care, contributing to poorer oral health-related quality of life and higher caries risk than those in metropolitan areas. This Systematic Review applies an ecological model to identify these barriers at system, policy, community and individual levels for rural and remote Australian children. The authors propose evidence-based solutions tailored to the unique challenges of these communities.

From outback to operating room: aeromedical retrieval and management of open-fracture trauma patients in Western Australia

Tue, 14 Apr 26 00:00:00 +0000

Effective management of open fractures focuses on restoring function, preventing complications and minimising long-term disability. This Original Research study evaluates and compares metropolitan primary presentations with rural and remote secondary presentations in the management of patients with open-fracture injuries in Western Australia, and identifies areas for improvement in the trauma care pathway, particularly for patients requiring aeromedical retrieval.

Understanding physical activity adherence in vulnerable adults with type 2 diabetes in the rural Brazilian Amazon

Mon, 13 Apr 26 00:00:00 +0000

In Brazil, only 37% of people with type 2 diabetes are receiving treatment and, among this group, only 23% achieve adequate disease control. Therefore, lifestyle modifications (including regular physical activity and adopting a balanced diet) are an essential strategy in combating the type 2 diabetes epidemic. This Original Research study examines the barriers and facilitators to physical activity adherence in a vulnerable population with type 2 diabetes in the Brazilian Amazon setting.

Economic evaluation of maternal healthcare services for Indigenous and rural people: a systematic review

Fri, 10 Apr 26 00:00:00 +0000

Indigenous communities and isolated rural populations face a range of health challenges shaped by longstanding social, environmental, and structural conditions. Both groups experience a considerable burden of chronic diseases, infectious illnesses, undernutrition, and mental health conditions. Additionally, the continuing effects of colonisation, land dispossession, cultural disruption, and experiences of discrimination within health systems contribute to longstanding inequities in health and wellbeing for Indigenous peoples. These combined circumstances have important implications for maternal health. This Systematic Review evaluates the current evidence on the economic effectiveness of maternal healthcare services and offers recommendations for future research and policy development in maternal health services tailored to these communities.

‘It’s a lesson learned, now we need to build together moving forward’: narratives of the pandemic from a South African Indigenous community

Tue, 07 Apr 26 00:00:00 +0000

Narratives on the experiences of the COVID-19 pandemic from African Indigenous communities are inadequately represented in the literature, even though historic and structural inequities create vulnerabilities that are best understood by the communities that live and exist within these contexts. This Original Research article explores the pandemic experiences of the Indigenous Xhosa people of Thamarha, in the Eastern Cape Province of South Africa: how they understand health and wellbeing and what actions they took to protect their health and wellbeing in the face of the pandemic.

Cervical cancer screening uptake and its determinants among rural women in North Central Nigeria: a cross-sectional study

Tue, 07 Apr 26 00:00:00 +0000

Although cervical cancer is largely preventable and curable if detected early, in Nigeria, most cases present at advanced stages and nearly half of women diagnosed with cervical cancer are likely to die within 3 years. While inadequate access to appropriate treatment facilities plays a role, late presentation has also been consistently linked to misconceptions, poor awareness, negative attitudes towards preventive practices, and suboptimal utilization of available screening and treatment options. This Original Research study assesses cervical cancer knowledge, attitudes and screening uptake among rural women in North Central Nigeria.

Encouraging youth towards rural health care through Young Medical Minds

Thu, 02 Apr 26 00:00:00 +0000

The probability that healthcare workers choose to practice in rural areas is increased by multiple factors, including having a rural background and having sufficient exposure to rural practice during healthcare training. Given the importance of rural background, encouraging rural young people to consider a career in health care seems like a natural strategy to increase the number of rural healthcare workers. However, rural young people often face barriers to entering healthcare fields, including distances to access schooling, having few personal connections to healthcare 'role models', and a lack of confidence in their ability to succeed in the profession. This Original Research study examines the effectiveness of an Alberta-based program that promotes rural healthcare careers in rural areas to local students in grade 8 (aged approximately 14 years).

Kicking the can down the road? Referral services and a school-based primary healthcare service for rural primary school children

Thu, 26 Mar 26 00:00:00 +0000

Children who live in rural Australia experience poorer health, development and education outcomes than those living in metropolitan areas. Recognition of the key role that schools can play in supporting children's health and wellbeing has led to the implementation of school-integrated healthcare models, including the School-Based Primary Health Care Service (SB-PHCS), a nurse-led model of care developed in Far West New South Wales. This Original Research study reviews the electronic medical records of primary school clients of the SB-PHCS and describes the use of assessment, treatment and therapy services of clients who received primary health care registered nurse support to access other healthcare services.

Defining rurality: evaluating the options for the development of a new regional-rural admission scheme for professional medical programs at the University of Auckland

Thu, 26 Mar 26 00:00:00 +0000

In Aotearoa New Zealand, rural communities experience poorer health outcomes than urban populations, partly due to shortages of rural health professionals. Since students from rural backgrounds are more likely to return to rural areas after graduating, clear pathways that include 'rural' New Zealand are essential for growing the rural health workforce. However, inconsistent definitions of 'rural' can limit access to education for rural and Indigenous students and contribute to workforce inequities. This Original Research study created a framework to identify the most appropriate definitions of rurality in New Zealand, aiming to improve the rural admissions scheme at the University of Auckland and strengthen rural health workforce development.