Volume 20

Five billion people worldwide do not have access to safe and timely surgical care, the majority of whom live in low- and middle- income countries, including sub-Saharan Africa. This Editorial describes the benefits and challenges of providing essential and emergency surgical services at rural district hospitals. In addition, the importance of buy-in and co-management by specialists from secondary and tertiary hospitals and the role of mobile health technology and monitoring systems are highlighted.

As the world desperately attempts to mount a coordinated and effective response to the recent pandemic outbreak of COVID-19, it is becoming recognised that the greatest impact will likely be felt by the most vulnerable populations. This Editorial examines what we know that could prepare our rural health systems to be more resilient, responsive and reassuring to our patients.

Nurses and midwives make up more than half of the global health workforce. The World Health Organization has designated 2020 as the Year of the Nurse and Midwife to recognize the crucial role played by nurses and midwives in health promotion, disease prevention and treatment. This Editorial highlights the challenges faced by nurses and midwives around the world.

This article reports on the results of a study evaluating a pilot mentorship program for rural nurses. Findings indicate that mentorship programs can be useful in supporting rural nurses; however, more attention to creating and supporting mentorship relationships is needed.

Indigenous populations in low-income regions are often the most acutely affected by social gradients that impact health, including high burdens of infectious disease. Using a mixed methods approach, this study characterized the lived experience of acute gastrointestinal illness in an Indigenous Batwa population in southwestern Uganda.

Rural and remote Australia has long been recognised as an area with reduced help seeking for mental health concerns and an increased suicide mortality. This study investigated the differences between intentions and predictors of help seeking between different locations across Australia to better understand the barriers to seeking help for rural residents.

Community acquired pneumonia (CAP) is an acute respiratory infection with high clinical and economic burden, especially when hospitalisation is required. The present study assessed the mean direct cost per CAP outpatient and inpatient in Greece.

Social factors might bring about health inequities. Vulnerable population groups, including those suffering from non-communicable diseases such as type 2 diabetes and depression, might be more prone to suffering the effects of such inequities. This study describes the social and health inequities for type 2 diabetic patients attending primary healthcare centres in Malta.

Longstanding gaps in physiotherapy service delivery exist in rural areas across Australia. This study explored how stakeholders defined the success of a public-private partnership model of service delivery in a rural setting and examined if the model was successful according to stakeholder definitions. Barriers and enablers (mechanisms) were identified and linked to stakeholder-defined success measures.

Diarrheal diseases are a significant cause of morbidity among school-aged children due to inadequate sanitation, lack of access to potable water and poor hygiene practices. This study compares the prevalence and associated factors of diarrheal diseases in school-aged children between schools in Habru District, northeast Ethiopia that have adopted water, sanitation and hygiene interventions and those that have not.

Maternal and neonatal health is a core focus area in fragile and conflict-affected states and midwives are key actors. This study explores midwives’ experiences, the challenges they face and coping strategies they employ in the challenging and fragile rural areas of the Ituri Region in the north-eastern Democratic Republic of Congo.

The adoption of adequate oral hygiene practices is important for the maintenance of good oral health in children. This study examined rural–urban differences and associated sociodemographic factors in oral hygiene practices in Peruvian children under twelve years of age.

Self-assessment of health status can be considered a good predictor of population morbidity and mortality. However, in rural areas, the identification of morbidities that affect worker’s health and their general health condition is unknown. This study evaluates the relationship between health self-perception and the occurrence of morbidities according to type of work.

Reducing the delay in time to primary percutaneous coronary intervention for acute coronary syndrome patients in the non-urban emergency department (ED) is of critical importance. To reduce ED delay time, this study developed a direct connection between the local ED and the cardiac catheterisation laboratory in the tertiary university hospital.

Early diagnosis and treatment of diabetic retinopathy, the leading cause of blindness in working-age adults in most developed countries, can reduce the incidence of severe vision loss, but fewer than 50% of the diabetic patients in rural areas are reviewed periodically. This study evaluated a teleophthalmology-based screening programme for diabetic retinopathy in a rural area in Castilla y León, Spain.

In Lao People's Democratic Republic, despite a policy to provide free maternal health services in health care facilities, many rural women continue to deliver at home, without a skilled birth attendant. These women are at high risk of postpartum haemorrhage, the leading cause of maternal mortality in the country. This study examined community perceptions and management of postpartum bleeding during home-births in remote Lao communities.

Peru has experienced a significant internal migration from rural to urban areas in recent years. This study estimates the prevalence of depressive symptoms in Peruvian women of childbearing age and their probability of having these symptoms according to the condition of internal migration.

The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway and strengthen trainee commitment to rural practice. This study evaluated whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives.

Over the past few decades, Australia’s population and multicultural landscape have changed significantly. The growing population of culturally and linguistically diverse (CALD) groups requires changes in the provision of health services to meet their special health needs. This qualitative study explored the perspectives of health providers and community members about factors affecting access to, and utilisation of, health services among CALD populations in the south and east regions of the South Australia.

The increasing burden of kidney disease and type-2 diabetes mellitus is a worldwide problem, especially for remote and Indigenous populations. This article reports on the findings of the Western Desert Kidney Health Project, which determined the prevalence of type-2 diabetes, kidney disease and associated risk factors in Aboriginal and non-Aboriginal people in a remote area of Western Australia.

Intimate partner violence (IPV) impacts almost one in four women in Canada, with rural women facing additional challenges related to delivery of and access to care. This analysis of IPV policy in a rural community in Canada identified a lack of integration between provincial, hospital and women's shelter policies. The impact this has on services and support for women experiencing IPV is explored, with recommendations made for improvement.

This original research article reports on a study designed to compare the prevalence of dental caries among rural and urban elementary school-aged children in the United States. Findings indicate higher prevalence of dental caries in rural than in urban communities.

This study explored how lesbian, gay, bisexual and transgender (LGBT) young adults in rural Australian communities experience online mental health services. Online technologies hold potential to overcome health access barriers, but little is known in practice for this community.

The findings of this multi-centered, mixed-method study suggest that physicians should be aware of the possible disconnection between their patients' perceived and actual blood pressure control. Knowledge gaps, intolerance of adverse events, negligence, unmet individual preferences, financial barriers and overtreatment of hypertension are among the identified barriers.

To address the regional differences in the distribution of health workers between rural and urban areas, the Nepalese government has adopted the policy of deploying fresh medical graduates to remote areas for 2 years under a compulsory bonding service programme. This study examines the experience of the medical graduates who participated in the bonding service programme and suggests ways to improve the programme.

Migration status of women and their children (urban, rural, urban to rural, rural to urban) may influence the birth outcomes and health status of children under five years. This study determined the distribution of internal migration and the socio-demographic and socio-economic factors on the child health indicators of birth weight, stunting and overweight / obesity in children under five years of age in Turkey.

Despite the aging population in Brazil, little is known about the occurrence of functional dependency in rural older adults. This cross-sectional study estimated a high prevalence of functional dependency among community-dwelling older adults in a rural area in Rio Grande do Sul state, Brazil.

Chronic conditions, including heart disease and diabetes, significantly contribute to the gap between Indigenous and non-Indigenous life expectancy in Australia. This study found that health promotion initiatives over 3 years may have helped with body weight stabilisation, improved blood pressure and good cholesterol in the community. However, policies that address social and economic disadvantage are needed alongside funding support for community-led health promotion initiatives.

This study determined the prevalence of food insecurity, dietary diversity and nutritional status of mothers and children under five years old from vulnerable families residing in the rural community of La Punta, after the earthquake in Ecuador on 16 April 2016.

Research training is conducted within rural health organisations without a clear understanding of the role of research within the structure of the organisation itself, potentially limiting the effectiveness of that training. This study examined the role of research within the organisational structure of a large rural health organisation in Australia.

In Eswatini, rural populations experience unnecessary snakebite-inflicted injuries and deaths. Children are at the highest risk because of their small size and curious nature. This qualitative study explores the current knowledge and attitudes about snakebite, and the perceptions of a musical intervention, titled Iculo Ngenyoka (“Snake Song” in Zulu), as an educational tool aimed to raise awareness about snakes in the Lubombo region, Eswatini.

Iran's Health Transformation Plan (HTP) has been implemented from 2014 to decrease household expenditures. This study measured the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP.

This paper describes the process of mapping referral pathways to develop a localised resource to enhance the journey to diagnosis, treatment, and support for Fetal Alcohol Spectrum Disorder (FASD) in a regional community setting.

Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. In remote Australia, registered nurses may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. This study examines national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas.

Access to specialized services is limited in rural and remote areas. This study explores the effectiveness and feasibility of training parents to provide intensive speech pathology services for children at home. The authors report multiple social and behavioral challenges faced by parents in implementing the program. They caution that parent training may not be an effective option for all families. Parents in rural and remote areas may face unique social circumstances that limit their capacity to deliver an intensive treatment program.

The shortage of health workers is a worldwide problem but is particularly critical in sub-Saharan Africa. In Mali, there are insufficient health workers and their retention is low, particularly in rural and remote areas. This study examined the factors contributing to the shortage and poor retention of health workers in two rural districts of Mali.

Riverine populations living along the rivers of the Amazon region face difficulties accessing services like health care and education and rely on fishing, subsistence farming, gathering of forest products and federal government aid. This study analyses the work processes of fluvial family health teams who access these communities in boats or ships.

After years of decline, pneumoconiosis in coal miners (black lung) is rising in the USA. Providing specialized care for miners living in rural communities is a challenge. A Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Clinic was developed to provide structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals and others. This study demonstrates the success of the virtual multidisciplinary community of practice in sharing information and skills within and across stakeholder groups, with the goal of ensuring the delivery of high-quality interdisciplinary care to miners in pneumoconiosis mortality hotspots in the USA.

New Zealand faces an ongoing shortage of rural medical professionals. In an effort to increase interest in rural practice, medical schools in NZ offer rural immersion programmes. This study compares the effects of long (>33 weeks) or short (5-week inter-professional) rural immersion with no rural immersion on the career location intentions of medical students.

This article describes the results of a study examining correlates of mental health among men and women in rural Canada, with on-farm / off-farm residence as an explanatory variable. Findings of this study, which included a cross-sectional sample of 1701 women and 1700 men, indicated that non-farm rural residents demonstrate higher levels of binge drinking and depression (as measures of mental health) when compared with on-farm residents.

Recurrent injurious falls are common among the elderly in tribal areas of eastern India. Along with the incidence of unintentional injurious falls, this study also reports on the factors responsible. The findings suggest that proper nutrition and regular check-ups and rehabilitative measures are needed to reduce the frequency of recurrent falls.

This article reports on a study examining barriers and facilitators to physical activity for children living in a rural and isolated region in Canada. Findings suggest a need to understand contextual barriers specific to rural environments, and specific to particular rural regions.

This cross-sectional descriptive study examined differences between rural and urban areas in unpaid caregiver burden. It leveraged nationally representative survey data in the United States to examine differences in financial, emotional and physical burden and caregiver health status.

Rural health services throughout the world face considerable challenges in the recruitment and retention of medical specialists. This study describes the factors that contribute to specialist workforce retention and attrition in a health service in rural Tasmania.

Parent–Child Interaction Therapy (PCIT) is an evidence-based parent training program for the treatment of childhood disruptive behaviour disorders. In Australia, there is a lack of services in regional, rural and remote areas and the program is not accessible to all families who might benefit. This study presents the first qualitative investigation into the experience of I-PCIT for rural or regional Australian families.

In the Solomon Islands, diarrhoea is the second leading causes of under-five mortality with about 1 in every 10 children dying from it before reaching five years of age. This study assesses environmental factors that are associated with under-five diarrhoea prevalence in the Mataniko informal settlements in Honiara, Solomon Islands.

There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care – particularly for chronic diseases. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care.

Geographic maldistribution of medical practise exists worldwide. One strategy for producing doctors for practise in rural areas is to establish a ‘pathway’ that selects students from a region and offers undergraduate and postgraduate clinical training activities in that region. This study examines the association between postgraduate training location and doctors’ practice location once fully qualified in a medical specialty from one regionally based medical school in Australia and one in Canada.

Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of well-being and is associated with better satisfaction with life. This study examined the association between rural doctors’ personal resilience and the duration of rural practice.

Very little is known about the long-term workforce outcomes for nursing and allied health rural placement programmes. This study reports on the long-term (15–17 year) rural practice outcomes for nursing and allied health graduates who have completed an undergraduate rural placement of 2–18 weeks through a University Department of Rural Health.

This article reports on an evaluation of an online diabetes education program, intended to improve rural school personnel's knowledge and capacity to deliver care to students. Findings demonstrate significant change in knowledge and self-efficacy in delivering care following use of the online educational tool.

This article describes the results of a study that used a qualitative approach to provide an in-depth examination of the support needs of female family physicians practicing in rural areas. Findings reflect on specific support needs, how physicians find or access those supports, as well as how their needs change over time. The authors also identify identify information for training to better prepare women for rural family practice.

This study explored factors that contributed to sustainability of a program that facilitates access to resources and provides social support to older persons living in community with serious illness. Using the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) framework, this study identified key factors for facilitating sustainability of this rural community intervention for older adults.

Green Beacons are used by many doctors across the United Kingdom to alert other road users to the doctor’s urgent need to reach a destination when responding to emergencies, particularly in rural areas. While such warning lights have been used for many years, there is a paucity of research into the safety and efficacy of their use. This pilot study explores whether the use of Green Beacons does lead to reduced response times in rural areas.

Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. This study characterises the field of rural health research to inform how it can be fostered.

This qualitative study explores the treatment decision-making practices among Indigenous peoples with cancer in rural Canada, using a storytelling research methodology. Findings suggest that a healthcare system that provides access to both traditional and Western medicine may be essential to culturally safe, high quality cancer care for Indigenous peoples. Given the role of spirituality, ceremony and Elder guidance, the implementation of Indigenous world view into cancer care practice could be beneficial.

There is little available data about neonatal pneumothorax outside of neonatal intensive care units, especially amongst regional health services with paediatric facilities. This study reviews the role of Australian regional health services in managing this condition.

Rural primary health care (PHC) is a field that specifically lacks well-designed randomized controlled trials (RCTs). Electronic search filters on family medicine or general practice studies have been developed and validated in previous work, but there has been no systematic effort to specifically identify and record RCT protocols in PHC. This study systematically identifies published RCT protocols in PHC and captures information about specific protocol characteristics that may describe this field.

Rural health services, and the workforces that provide those services, are under unprecedented pressure due to insufficient health workforce numbers and distribution of health workforce weighted to urban areas. This creates health service access issues in rural areas, further compounding existing health inequalities between rural and urban people. This paper presents a call to action to pursue a complementary approach – that being supporting the capability of the rural health workforce.

Domestic migrant workers were left stranded far from home when India declared nation-wide lockdown to combat the novel coronavirus pandemic. A large number of these workers were left with no economic support, no food and, in many cases, nowhere to live. This Commentary describes the socio-economic and health issues experienced by migrant workers during the COVID-19 crisis, and outlines some of the ways out.

This Commentary examines food insecurity in remote northern Canada. The authors draw attention to dietary challenges for residents of these communities who are living on restricted or therapeutic diets due to chronic disease, particularly advanced chronic kidney disease. Further research into potential solutions is recommended to address the interplay between food insecurity, the ability to maintain a therapeutic diet, and health outcomes for those living with chronic conditions in rural and remote communities.

The current novel coronavirus, COVID-19, has effected a significant change in the way industry based and tertiary health professions education (HPE) can occur. This is the first paper in a series that addresses the risks and opportunities in the current transition to online HPE, and provides practical solutions for educators who are now unable to embrace more traditional face-to-face HPE delivery methods and activities.

Although critically important for maintaining a healthy population, primary health care is not always easily accessible, particularly in rural regions. This is partly due to an insufficient number of medical graduates entering and being retained in the rural workforce. This Commentary discusses key elements of international and national programmes designed to address this shortfall.

During the coronavirus pandemic of 2020, countries rapidly mobilized front-line healthcare workers, including physicians, to address workforce shortages. Yet, international medical graduates remained an under-utilized pool of talent. This commentary describes key barriers faced by physician-migrants seeking licensure in a new country and provides examples from COVID-19 pandemic emergency deregulation efforts that may offer insights into reducing bureaucratic regulatory barriers.

This second paper in a series addressing online professional and tertiary health professions education (HPE) during the current COVID-19 crisis proposes strategies to ensure the ongoing effectiveness, efficiency and engagement of lectures that are transitioning from face-to-face to online delivery.

Health professions education in tertiary, industrial and other contexts often entails face-to-face small group learning through tutorials. The current novel coronavirus, COVID-19, has reduced face-to-face contact, and this has challenged how health professionals and clinical students can access training, accreditation and development. This third paper in a series addressing online professional and tertiary health professions education during the current COVID-19 crisis outlines practical approaches to pedagogically rich online tutorials.

As the effects of climate change escalate, the mental health of rural and remote communities will be placed at increasing risk. This Commentary suggests ways in which current and future research on climate change and rural mental health can be enhanced by social geographic perspectives.

The safe and effective application of psychomotor skills in the clinical environment is a central pillar of the health professions. The current global coronavirus pandemic has significantly impacted routine face-to-face skill education for health professionals and clinical students worldwide, a problem familiar to regional, rural and remote health professionals and students. This Commentary considers how the problem of physical distance might be overcome, so that quality skill education might continue.

Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning three million square kilometres across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems-level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps.

The allied health workforce is one of the largest in the health industry and plays a critical role in cost-effective, preventative health care but it is poorly accessible in rural areas world-wide. This review describes the extent, range and nature of evidence about this workforce to inform policy and research priorities for increasing access to rural allied health services in Australia.

Despite reports suggesting an oversupply of pharmacists, there is currently an inadequate supply in rural and remote Australia. This can lead to a reduction in pharmaceutical services for an already vulnerable population. This study identifies strategies for increasing the pharmacist workforce, and factors associated with retention in rural and remote Australia.

This scoping review provides a synthesis of the literature on patient and provider perspectives of eHealth initiatives in rural Australian and Canadian communities. The focus on first person perspectives draws attention to the importance of centering patient voices in the evaluation of healthcare interventions such as eHealth.

Organophosphates are a class of insecticides used globally by the agricultural industry for insect control. Acute consequences of organophosphate exposures are well known, but there has been limited research on their long-term effects. This review discusses the health effects of chronic organophosphate exposure in farmers.
 

Invasive fungal infections are becoming increasingly more prevalent in clinical practice. Subcutaneous fungal masses can often masquerade and imitate common dermatological lesions such as cysts. This case study describes a subcutaneous knee mass in an immunosuppressed farmer.

Indigenous children and adolescents in Australia and globally bear the burden of acute rheumatic fever (ARF), although it has been virtually eliminated in well-resourced, developed settings. Adherence to the schedule of intramuscular penicillin injections used to manage ARF has been reported as difficult due to the painful nature of the injections, the long timeframes of the prescription, young age of patients, access problems and costs in some locations. This Clinical Case Report reports on the use of clonidine for reducing pain-related distress and facilitating adherence to the penicillin regimen.

In Australia, tuberculosis (TB) has been virtually eradicated in non-Indigenous Australian-born populations but presents a rare but significant public health issue in remote Aboriginal and/or Torres Strait Islander communities. This Case Report outlines the process for diagnosis and treatment of a TB patient in a remote Cape York community and highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services.

Being diagnosed with cancer and undergoing treatment is a life-changing experience, and many cancer patients find the physical, emotional, and social effects of the disease to be stressful. This study explores the experiences of cancer patients and their relatives from all parts of Northern Norway visiting the centralized cancer support centre.

National and state-based minimum data sets remain inadequate in providing a complete representation of emergency presentations, especially among paediatric asthma presentations. This study investigates if a deficit exists in current emergency paediatric asthma hospital presentation datasets and how this may inform our understanding of childhood asthma in Victoria, Australia.

In May 2019, there was a severe diarrhoea outbreak in a very remote and isolated community on Anuta Island, halfway between the Solomon Islands archipelago and Tuvalu. This Short Communication reports on the investigation and response to the outbreak, highlights the system challenges faced in mounting the response and provides suggestions that may help overcome these challenges.

In response to the COVID-19 pandemic, 17 state governors in the USA passed waivers or suspended physician oversight requirements for Advanced Practice Nurses, a key component of the rural health workforce. This short commentary examines this response, including how the waivers or suspensions varied by political affiliation of the governors. This current "natural experiment" could contribute to our understanding of the impact of full autonomy for Advanced Practice Nurses on health care and patient outcomes.

The Rural Adversity Mental Health Program (RAMHP) connects people who need mental health assistance in rural and remote NSW, Australia with appropriate services and resources. This article reports on an assessment of RAMHP program data collection methods for management, monitoring and evaluation.

The phenomenon of ‘brain drain’ is defined as the international transfer of resources, in the form of highly educated workforce, from developing to more developed countries. This study examines the main causes of Greek medical doctors immigrating while their country suffers from a financial crisis.

The Indigenous Youth Mentorship program is a Canadian health promotion initiative designed to reduce chronic disease risk factors, and improve health and well-being for Indigenous youth. This project report draws on a case study approach to describe the implementation of an Indigenous Youth Mentorship Program First Nations community schools in the province of Alberta. It provides information for development and implementation of similar programs health promotion programs for Indigenous youth in Canada and internationally.

The challenges of implementing standardized health promotion programs across diverse settings are clearly articulated in this article. The authors reflect on lessons learned, concluding that flexibility, organization, responsiveness, communication, and collaboration were routinely required to problem solve geographic, intervention-related, and workplace barriers to effective implementation.

Rural and remote Australia suffers from a shortage of allied health clinicians. The provision of quality rural placement experiences for allied health students has been a significant strategy to address these health workforce shortages. This report describes an innovative service learning placement model in Northern NSW, the ‘rural community-based work-ready placement program’.

There is a world-wide shortage of physicians; this is worse in rural areas, which typically have a large underserved rural and remote population. In Japan, this is exacerbated by a specialist-driven approach to medical education and public health. The Rural Generalist Program Japan (RGPJ) has been developed to meet the needs of Japanese rural communities. This paper outlines development of the RGPJ using the World Federation for Medical Education standards.

This Original Research article reports on the implementation of an opportunistic cancer screening and education program for residents of remote First Nations communities while accessing health services in an urban centre. Consideration of the program's successes and challenges may assist others who are interested in improving cancer screening rates among remote populations.

This study describes the availability, use and comfort with ophthalmic equipment and medications by mid-level eye care workers in Papua New Guinea and Pacific Island Countries and Territories, as indicators of the state of eye care in the Pacific.

Pre-COVID-19, rural communities already experienced limited access to mental health care. Lockdown during the COVID-19 pandemic has resulted in social isolation, financial insecurity and weakening of social support systems, resulting in a deterioration in adult mental health. Many ideas and improvements are filling the gaps in mental health care during this difficult time, but, as this Letter to the editor highlights, more emphasis is needed on rural and remote communities.

Lockdown in India and Nepal in response to the COVID-19 outbreak resulted in a mass exodus of Nepalese migrant workers from India to Nepal. To limit the spread of COVID-19, the government of Nepal adopted quarantine measures. Schools, temples, and public spaces at the border between India and Nepal were converted into makeshift quarantine camps. The quarantine camps are now too overpopulated for social distancing, there is a lack of food, shelter, hygiene and sanitation and medical attention is very limited, leading to delays in diagnosis and adverse events including death.

COVID-19 is an important pandemic respiratory disease affecting more than 160 countries around the world. In this Letter, the authors describe an outbreak in a rural Thai tropical forest village, more than 100 km from Bangkok, starting with a man who had attended a Muay Thai fight in the city.

As of 1 May, 2020, more than 3.4 million cases of confirmed SARS-CoV-2 infections and more than 240,000 deaths due to Coronavirus Disease 2019 (COVID-19) had been reported worldwide. In Germany, about 85% of the COVID-19 patients are cared for mostly by family physicians in community practices, which allows hospitals to concentrate on critically ill patients. This Letter to the Editor reports on the first cohort of SARS-CoV-2 infected patients in a rural district in Germany.

The COVID-19 pandemic has not only been affecting people’s health, but has also had negative impacts on social interaction. This Letter to the editor reports on the experiences of elderly rural people in Japan preparing for the celebration of Obon (a traditional Japanese holiday week in August) during the pandemic.

Paediatric burns are a leading cause of childhood injuries, having significant physical and psychological impact to both parents and child. This Research Letter highlights a concerning trend in vehicle exhaust burns in children, requiring complex and challenging wound care in rural and remote Australia.

Under the Bonded Medical Places (BMP) Scheme, the Australian Government provides a place at a medical school and, in exchange, participants agree to work in an area of workforce shortage for a period, particularly in rural and remote areas. This Research Letter identifies Regional Training Hubs as well positioned to play an important role in attracting and retaining doctors in rural areas and proactively supporting bonded doctors as they navigate their career.
 

This analysis uses publicly available county level COVID-19 data to predict case fatality rates by county, across the rural continuum. While acknowledging limitations in calculation of case fatality rates where county-level testing rates are unavailable, the authors report that the mortality burden of COVID-19 is exceptionally high in rural areas in the US, despite their overall lower rate of cases. Many rural areas face substantial challenges in disease surveillance, testing, and treatment. Case fatality rates can provide information beyond crude case rates and numbers of deaths to identify vulnerable and underserved rural populations, so that resources can be allocated more equitably.