Showing papers on "Rural area published in 1996"

How important to India's poor is the sectoral composition of economic growth?

Abstract: Using a new series of consistent, consumption-based poverty measures spanning forty years, the author assess how much India's poor shared in the country's economic growth, taking into account its urban-rural and output composition. Rural consumption growth reduced poverty in both rural and urban areas. Urban growth brought some benefits to the urban poor, but had no impact on rural poverty. And rural-to-urban population shifts had no significant impact on poverty. Decomposing growth by output sectors, we found that output growth in the primary and tertiary sectors reduced poverty in both urban and rural areas but that secondary sector growth did not reduce poverty in either.

Micro-credit initiatives for equitable and sustainable development : who pays?; a case study of the Grameen Bank Program in rural Bangladesh

Abstract: Abstract There is a growing acknowledgement that micro-credit programs have potential for equitable and sustainable development. However, my anthropological research on the micro-credit program of the Grameen Bank shows that bank workers are expected to increase disbursement of loans among their members and press for high recovery rates to earn profit necessary for economic viability of the institution. To ensure timely repayment in the loan centers bank workers and borrowing peers inflict an intense pressure on women clients. In the study community many borrowers maintain their regular payment schedules through a process of loan recycling that considerably increases the debt-liability on the individual households, increases tension and frustration among household members, produces new forms of dominance over women and increases violence in society.

A Community-Based Investigation of Avoidable Factors for Maternal Mortality in Zimbabwe

Abstract: A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of 61 urban deaths Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively Lack of transportation delayed or prevented access to healthy facilities in the rural area, a major problem in 28 percent of the cases studied Suboptimal clinic and hospital management was identified in 67 percent and 70 percent of rural and urban deaths, respectively Lack of appropriately trained personnel contributed to suboptimal care In both settings, the severity of patients' conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment Appropriate community and health-service interventions to reduce maternal mortality are discussed

Sustainability of a water sanitation and hygiene education project in rural Bangladesh: a 5-year follow-up.

Abstract: An integrated water supply, sanitation and hygiene (WSH) education intervention project was run by the International Centre for Diarrhoeal Disease Research, Bangladesh, over the period 1983-87. In the intervention area the project provided handpumps, pit latrines, and hygiene education to about 800 households. The control population did not receive any interventions, but had access to the usual government and private WSH facilities. After 1987 no external support was provided to maintain these provisions. A cross-sectional follow-up survey, which was carried out in 1992, involved about 500 randomly selected households from the intervention and control areas. In 1992 about 82% of the pumps were still in good functional condition and of these, 94% had been functioning well in 1987. Fewer latrines were functional in 1992 (64%) than at the end of 1987 (93%). In the former intervention area about 84% of the adults were using sanitary latrines in 1992 compared with only 7% in the control area. Knowledge related to disease transmission, however, was poor and similar in both areas. People claimed that they used the WSH facilities to improve the quality of their lives. The prevalence of diarrhoeal diseases in the 1992 survey among the control population was about twice that among those in the intervention area.

Access to Primary Health Care Among Persons With Disabilities in Rural Areas: A Summary of the Literature

Abstract: Despite the prevalence of disabilities among persons living in rural areas, scarce data exist on their health care needs. While rural residents generally experience barriers to access to primary health care, these problems are further exacerbated for people with disabilities. This article summarizes findings from the published literature on access to primary health care among people with disabilities living in rural locations. A comprehensive computerized literature search turned up 86 articles meeting the study criteria, focused on the following rural populations affected by disabilities: children and adolescents, working-age adults, the elderly the mentally ill, and people with AIDS. For each of these populations, substantial problems in accessing appropriate health care have been documented. The literature consistently emphasizes the failure of local health care systems in nonmetropolitan areas to adequately address the complex medical and related needs of individuals with disabilities. In the absence of specialized expertise, facilities, and primary care providers trained specifically to care for disabled persons, local programs rely heavily on the use of indigenous paraprofessionals and alternative models of care. Further research is needed to identify and test the efficacy of innovative service delivery strategies to improve health care access for this population.

Effect of economic reforms on child growth in urban and rural areas of China.

Abstract: Background Beginning in 1978, China implemented economic reforms to transform the economy to a free-market system. We compared the effect of the reforms on the growth of children in urban and rural areas. Methods Using data from five large cross-sectional surveys conducted between 1975 and 1992, we examined the trends in height for age of children two to five years of age in urban and rural areas. Mean height for age was expressed as the height in centimeters adjusted to a reference value of 99.1 cm for a 42-month-old boy. Results Height increased before and during the economic reforms. In 1975, the average height of children in periurban rural areas was about 3.5 cm less than that of children in urban areas. Between 1975 and 1985, the average height of children in periurban rural areas increased by 2.0 cm, as compared with 1.3 cm in urban children. Between 1987 and 1992, the average height of both urban and rural children increased, but the net increase for rural children was only one fifth that for urba...

Restructuring the Labour Market: the South African challenge. An ILO Country Review

Abstract: This review by international contributors examines the labour market problems facing South Africa and the range of policy options for tackling these in the context of increasing globalization and greater labour market flexibility. It concentrates on how apartheid's legacy of low growth, severe poverty, extreme inequality and a fragmented labour market can be tackled, through intitiatives in such areas as labour market and employment policies, industrial relations, wage fixing, trade liberalization and industrial strategy. The book relates directly to the Labour Market Policy Commission's mandate to recommend specific measures and a framework for labour market policies to take the country into the 21st century.

Household characteristics affecting where mothers deliver in rural Kenya.

Abstract: Data from a household survey were used to analyse the distribution of newborn deliveries in a rural area of Kenya. It was found that 52% of deliveries occurred at home or with traditional birth attendants. Using regression techniques, the most significant predictors of choosing an informal delivery setting are the household's distance from the nearest maternity bed and whether a household member has insurance. The results suggest that travel time is an important barrier to access. Therefore, quality improvements at existing facilities may not result in greater use of modern sector delivery, particularly if improvements are partially offset by user fees.

Immunization uptake in rural Bangladesh : a multilevel analysis

Abstract: This study examines the effect of the immunization programme in four rural areas of Bangladesh. Using a multilevel discrete time hazards model, this paper identifies the demographic and socioeconomic characteristics which influence the uptake of immunization. However, even after controlling for these observed factors, a considerable amount of variation between households remains due to unobserved characteristics. There is also a large amount of geographical variation in the uptake of immunization with evidence of village level variation within intervention areas.

Rural Tourism Development: Shifting Basis of Community Solidarity:

Abstract: Community solidarity is considered a definitive quality of many rural towns and one that could be dramatically influenced by accommodating tourism development. Previous research indicates that tourism brings people from different cultural backgrounds into a community. In this exploratory study, evidence indicates that tourism development changes residents' relationships to one another and to their community. Five propositions are discussed concerning the impacts of rural tourism: community diversification, delineation of social boundaries, conformity to an ideal town image, shared image as a source of bond ing, and a shifting basis of community solidarity.

Rural Scholars or Bright Rednecks? Aspirations for a Sense of Place Among Rural Youth in Appalachia

Abstract: In this article, we promote sense ofplace as a legitimate aspiration of rural youth, including very able rural youth. The aspiration concerns the quest for rootedness and community as opposed to mobility and individual status. We con­ ducted exploratory analyses ofdata gatheredfrom 158 participants in the 1994 West VirginiaGovernor's Honors Acad­ emy (GHA) andfroma contrasting group of644 students in seven rural high schools. Findingssuggest that GHA students (whether rural or more urban): (I) are lessalienated than students in thecontrast group; (2) that they are not more eager to leave their local community than students in the contrast group; and (3) that GHA students exhibit stronger modem dispositions than students in the contrast group, but do not exhibit weaker rustic dispositions. In addition, GHA students do not pppear to be less satisfied with their (more urbanized) communities than rural students-at-large; however, rural GHA students do appear to be less satisfied with their local communities than GHA students living elsewhere. Findings are discussed in light ofconventional wisdom about aspirations and in view ofemerging rurals~hool improvementaims.

Rural Physician Satisfaction: Its Sources and Relationship to Retention

Abstract: This study uses survey data to identify areas of satisfaction and dissatisfaction for primary care physicians working in rural areas across the country. It also identifies the specific areas of satisfaction associated with longer retention within a given rural practice, as well as the characteristics of individuals, practices, jobs, and communities associated with the areas of satisfaction that predict retention. Study subjects comprised a sample of 1,600 primary care physicians who moved to nonmetropolitan counties nationwide during the years 1987 through 1990, with oversampling of those who moved to federally designated health professional shortage areas (HPSAs). Physicians serving in the National Health Service Corps (NHSC) were excluded. Sixty-nine percent of the eligible subjects returned completed mail questionnaires in 1991. Analyses for this study were limited to the 620 primary care physicians who worked more than 20 hours per week in towns of fewer than 35,000 population; who were neither in the military nor the NHSC; and who were not in urgent care, emergency room, or full-time teaching positions. Analyses revealed that the areas of rural physicians' greatest satisfaction were their relationships with patients, clinical autonomy, the care they provided to medically needy patients, and life in small communities. Physicians were least satisfied with their access to urban amenities and the amount of time they spent away from their practices. Retention was independently associated only with physicians' satisfaction with their communities and their opportunities to achieve professional goals. Retention was also marginally related to physicians' satisfaction with their earnings. Among the areas of satisfaction not related to retention were satisfaction with autonomy, access to medical information and consultants, and the quality of doctor-patient relationships. In a subsequent series of analyses of the factors that predict the three areas of satisfaction that were associated with retention (satisfaction with the community, professional goal attainment, and earnings), a variety of physician, work, and community factors were identified. These findings reveal that specific features of rural physicians, their work, and their communities predict each of the various aspects of satisfaction and that only certain aspects of satisfaction predict rural physicians' retention. There are no magic bullets to make rural physicians satisfied in all ways. Nevertheless, there are identified approaches to elevate the specific aspects of rural physicians' satisfaction important to their retention. Programs to improve the satisfaction of rural physicians should focus on those areas of satisfaction that predict longer retention and other important outcomes.

Transport and the Village: Findings from African Village-Level Travel and Transport Surveys and Related Studies

Abstract: This paper, prepared under the Rural Travel and Transport Project (RTTP) of the sub-Saharan Africa Transport Policy Program (SSATP) focuses on local level transport in rural Africa. Households surveys and case studies on intermediate means of transport (IMT) and the role of transport in women's lives were carried out to enhance the understanding of the circumstances under which local level transport imposes a constraint, of the nature of that constraint, and of the appropriate measures to alleviate the constraint. The report synthesizes the key findings and recommendations from research comprising five village-level surveys of household travel and transport demands in three countries - Burkina Faso, Uganda and Zambia. The paper examines the multi-sectoral implications of rural transport and the related issues in policy formation, institutional structure and planning. It defines a range of policy measures which would facilitate an effective response to rural transport needs. It also advocates a more integrated approach to rural transport planning at the local level and recommends that accessibility be considered in the design of many types of development projects and programs. This report presents a synthesis of key findings from the research and an agenda for those whose aim is to improve rural mobility and access in sub-Saharan Africa.

Rural Crime and Justice: Implications for Theory and Research

Abstract: Theories of crime and research on crime and justice have usually been based on an urban model of social organization. Applying these theories and methods to rural settings provides an opportunity to understand them better and to make clear the assumptions upon which they are based. This article assesses current theories and methods regarding their ability to account for crime and justice in rural areas.

Rural-to-urban migration in China.

Abstract: "One consequence of economic reform in China has been the greatly accelerated migration of labour from rural areas to cities. Estimates suggest an annual migrant labour flow of around 50-60 million people, of whom 10-15 million have settled permanently in cities. This article surveys the information that has become available from a number of population and labour surveys. It covers the volume, spatial and temporal dimension of rural-to-urban migration, the characteristics of migrant labourers, the determinants of migration and the impact of migration on China's rural and urban economy."

Rural Population Decline in the 1980s: Impacts of Farm Structure and Federal Farm Programs

Abstract: Federal farm program benefits accrue disproportionately to large-scale farm operators, and continue largely because of the political influence of their beneficiaries. Some writers argue that these payments stem the movement of labor out of agriculture, ultimately reducing the pace of rural depopulation. Here, a theoretical model linking farm program payments to population loss is presented and empirically estimated for the years 1980–90. Larger farm program payments as a share of total cash marketing receipts were associated with greater population losses from rural counties. This result holds after controlling for other economic variables affecting population migration from rural areas.

Identifying "Spread" versus "Backwash" Effects in Regional Economic Areas: A Density Functions Approach

Abstract: Patterns of spatial structural change are investigated for eight Functional Economic Areas in North Carolina, South Carolina, and Georgia. Residential population density functions are estimated using census tract level data and cubic spline regression methods. Comparisons of 1980 and 1990 density profiles indicate that population decentralization accompanied metropolitan growth during the 1980s. This redistribution was limited, however, to rural tracts at the urban fringe. Population densities were stable or declined in tracts more distant from the nodal center. Thus, backwash effects were evident in most rural areas in the economic regions' hinterlands.

Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania. Adult Morbidity and Mortality Project.

Abstract: To measure age and sex specific mortality in adults (15-59 years) in one urban and two rural areas of Tanzania. Reporting of all deaths occurring between 1 June 1992 and 31 May 1995. Eight branches in Dar es Salaam (Tanzania's largest city), 59 villages in Morogoro rural district (a poor rural area), and 47 villages in Hai district (a more prosperous rural area). 40,304 adults in Dar es Salaam, 69,964 in Hai, 50,465 in Morogoro rural. Mortality and probability of death between 15 and 59 years of age (45Q15). During the three year observation period a total of 4929 deaths were recorded in adults aged 15-59 years in all areas. Crude mortalities ranged from 6.1/1000/year for women in Hai to 15.9/1000/year for men in Morogoro rural. Age specific mortalities were up to 43 times higher than rates in England and Wales. Rates were higher in men at all ages in the two rural areas except in the age group 25 to 29 years in Hai and 20 to 34 years in Morogoro rural. In Dar es Salaam rates in men were higher only in the 40 to 59 year age group. The probability of death before age 60 of a 15 year old man (45Q15) was 47% in Dar es Salaam, 37% in Hai, and 58% in Morogoro; for women these figures were 45%, 26%, and 48%, respectively. (The average 45Q15s for men and women in established market economies are 15% and 7%, respectively.) Survivors of childhood in Tanzania continue to show high rates of mortality throughout adult life. As the health of adults is essential for the wellbeing of young and old there is an urgent need to develop policies that deal with the causes of adult mortality.

Hospitalized pneumonia. Outcomes, treatment patterns, and costs in urban and rural areas.

Abstract: Objectives To describe discharge rates, geographic and patient characteristics, treatment patterns, costs, and outcomes of patients hospitalized with community-acquired pneumonia (CAP) in Pennsylvania hospitals and compare these patients from rural and urban counties. Design A retrospective database study. Patients Adult patients (age > or = 18) with an ICD-9-CM diagnosis of pneumonia discharged from 193 Pennsylvania hospitals (n = 36,222) in 1991 from the MediQual Systems Pennsylvania database. Measurements Patient characteristics included a pneumonia-specific severity index, microbiologic etiology, and a number of comorbid conditions. Treatment indicators included the specialty of the admitting physician, length of stay, admittance to an intensive care unit, and mechanical ventilation. Cost indicators included charges and estimated costs. Outcomes measured were inpatient mortality and discharge disposition. Counties in Pennsylvania were classified into seven urban or rural groups, and patients were classified by the county of residence. Results The discharge rate for CAP was 4.0 per 1,000 and did not vary systematically across urban or rural counties. Most patients were treated in local hospitals. The average distance between residence and hospital was 5.4 miles and varied with urban or rural classification (range 2.5-9.3 miles). Among CAP patients, 37.8% were at low risk of mortality, with no systematic differences across rural or urban patients with respect to pneumonia severity. Rural patients were more likely to be treated by a family physician and somewhat less likely to be admitted to an intensive care unit or to be mechanically ventilated. Costs of treating rural patients were lower. In-hospital mortality rates, with controls for admission severity, were comparable or better for rural patients than for urban patients. Conclusions Patients with CAP are treated in hospitals located in counties similar to ones in which they reside. The cost of treatment was lower for rural patients than for urban patients, but outcomes were not different.

Selected comparisons and implications of a national rural and urban survey on health care access, demographics, and policy issues.

Abstract: As the national health debate evolved over the past two years, a need to better understand the differential constraints of rural health delivery and popular attitudes toward policy initiatives became apparent. Selected 1994 and 1995 results of two national surveys designed to compare rural and urban household responses are reported. The average distance those living in rural households must travel to access medical providers and emergency care is nearly double that of urban household residents. Rural household resident responses show a higher level of acceptance of nonphysician health care providers such as physicians assistants and registered nurses. Means testing of Medicare programs and use of special indicators for providing more Medicaid funds to states with medically underserved and sparsely populated areas are examples of two policy initiatives that receive favorable responses from both urban and rural household residents, but would disproportionately benefit rural areas.