Showing papers on "Rural area published in 2011"

Rural America in an Urban Society: Changing Spatial and Social Boundaries

Abstract: This review outlines several key aspects of the new rural-urban interface and the growing interpenetration of American rural and urban life. The historical coincidence of spatial and social boundaries in America is changing rapidly. This review highlights (a) the enormous scale of rural-urban interdependence and boundary crossing, shifting, and blurring—along many dimensions of community life—over the past several decades, and (b) the symmetrical rather than asymmetrical influences between urban and rural areas, i.e., on bidirectional relational aspects of spatial categories. These general points are illustrated by identifying 10 common conceptions of rural America that reflect both its social and economic diversity and its changing spatial and social boundaries. Here we emphasize symbolic and social boundaries—the distinctions between urban and rural communities and people and the processes by which boundaries are engaged. Placing behaviors or organizational forms along a rural-urban continuum (or within...

Energy services and energy poverty for sustainable rural development

Abstract: In many rural areas, poor people still depend on wood and other biomass fuels for most of their household and income-generating activities. The difficult, time-consuming work of collecting and managing traditional fuels is widely viewed as women's responsibility, which is a factor in women's disproportionate lack of access to education and income, and inability to escape from poverty. Therefore, it is important for energy access programs to have a special focus on women. New options for energy access and sustainable livelihoods, like small-scale biofuels production, can have dramatic benefits for rural women, and their families and communities. Energy development, as both a driving force and a consequence of such tremendous changes, has had profound impact on economic, social, and environmental development. Rural energy has always been a critical issue due to years of energy shortage for both households and industries. Biomass, for long time, has been the only available fuel in many rural areas. The situation in rural areas is even more critical as local demand for energy outstrips availability and the vast majority of people depend on non-commercial energy supplies. Energy is needed for household uses, such as cooking, lighting, heating; for agricultural uses, such as tilling, irrigation and post-harvest processing; and for rural industry uses, such as milling and mechanical energy and process heat. Energy is also an input to water supply, communication, commerce, health, education and transportation in rural areas.

Access to affordable and nutritious food: measuring and understanding food deserts and their consequences.

Abstract: Increases in obesity and diet-related diseases are major public health problems. These problems may be worse in some U.S. communities because access to affordable and nutritious foods is difficult. Previous studies suggest that some areas and households have easier access to fast food restaurants and convenience stores but limited access to supermarkets. Limited access to nutritious food and relatively easier access to less nutritious food may be linked to poor diets and, ultimately, to obesity and diet-related diseases. Congress, in the Food, Conservation, and Energy Act of 2008, directed the U.S. Department of Agriculture (USDA) to conduct a 1-year study to assess the extent of the problem of limited access, identify characteristics and causes, consider the effects of limited access on local populations, and outline recommendations to address the problem.

The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System

Abstract: Background Maternal and perinatal mortality could be reduced if all women delivered in settings where skilled attendants could provide emergency obstetric care (EmOC) if complications arise. Research on determinants of skilled attendance at delivery has focussed on household and individual factors, neglecting the influence of the health service environment, in part due to a lack of suitable data. The aim of this study was to quantify the effects of distance to care and level of care on women's use of health facilities for delivery in rural Zambia, and to compare their population impact to that of other important determinants. Methods and Findings Using a geographic information system (GIS), we linked national household data from the Zambian Demographic and Health Survey 2007 with national facility data from the Zambian Health Facility Census 2005 and calculated straight-line distances. Health facilities were classified by whether they provided comprehensive EmOC (CEmOC), basic EmOC (BEmOC), or limited or substandard services. Multivariable multilevel logistic regression analyses were performed to investigate the influence of distance to care and level of care on place of delivery (facility or home) for 3,682 rural births, controlling for a wide range of confounders. Only a third of rural Zambian births occurred at a health facility, and half of all births were to mothers living more than 25 km from a facility of BEmOC standard or better. As distance to the closest health facility doubled, the odds of facility delivery decreased by 29% (95% CI, 14%–40%). Independently, each step increase in level of care led to 26% higher odds of facility delivery (95% CI, 7%–48%). The population impact of poor geographic access to EmOC was at least of similar magnitude as that of low maternal education, household poverty, or lack of female autonomy. Conclusions Lack of geographic access to emergency obstetric care is a key factor explaining why most rural deliveries in Zambia still occur at home without skilled care. Addressing geographic and quality barriers is crucial to increase service use and to lower maternal and perinatal mortality. Linking datasets using GIS has great potential for future research and can help overcome the neglect of health system factors in research and policy. Please see later in the article for the Editors' Summary

Out in the Country: Youth, Media, and Queer Visibility in Rural America

Abstract: The dilemma of domestic work in postapartheid South Africa should not be viewed as an isolated phenomenon of marginal interest to sociologists. The globalization of paid domestic work means that hundreds of thousands of women from poor countries in the global South are living in a form of servitude, as they work for low wages, under abusive conditions in wealthier countries as part of a ‘‘global care chain.’’ In this brilliant study, Shireen Ally demonstrates how these relations of servitude have resisted change in ‘‘the national care chain’’ in contemporary South Africa. Post-apartheid South Africa is a contradictory place. On the one hand there is deepening inequality, poverty and widespread collective violence in the form of xenophobic attacks against foreigners and violent protests about the failure of the local state to deliver substantive social citizenship in the shape of access to housing, jobs, water, electricity and sanitation. On the other hand the new constitution embodies a powerful vision of participatory democracy, new institutions to protect human rights, and the redrafting of apartheid labor legislation included one of the most extensive and expansive efforts anywhere in the world to recognize paid domestic work as a form of employment. These state efforts to modernize and professionalize domestic work as a form of employment were remarkable. Existing labor legislation was extended inter alia to include a landmark national minimum wage, mandatory formal contracts of employment, extensive leave, formal registration, as well as access to unemployment insurance benefits, which Ally points out was a ‘‘world first.’’ However, a central thesis of the book is that the outcome has been disempowering for domestic workers. With analytical depth and sensitivity, Ally demonstrates the persistence of servitude. Paradoxically, the book suggests that domestic workers’ lives have not changed much under democracy and many feel that ‘‘things are worse than before.’’ While they are the beneficiaries of ‘‘an extensive democratic statecraft’’ attempting to turn ‘‘servants’’ into workers with the same rights as other workers, their social position as migrant ‘‘mother-workers,’’ often caring for their employers’ children at the expense of their own, has not been affected. Ally explains this paradox in the tension between the forms of formal power deployed by the post-apartheid state in its efforts to protect these ‘‘vulnerable’’ workers and the forms of informal power generated by the intimate nature of their work. This involves a ‘‘contradictory collision of depersonalizing rights and personalizing intimacy’’ (p. 187). In the absence of state protection under apartheid, South African domestic workers had elaborate ‘‘practices of power’’ rooted in their highly personalized relationships with employers, as a way to control their work. ‘‘In the absence of labor rights defining leave provisions, sitting down every morning with tea and talking to one’s employer about her problems became a way to ensure an extended Christmas vacation’’ (p. 13). These informal mechanisms for negotiating working conditions have continued and demonstrate these women’s creativity and assertiveness. Another paradox Ally identifies in this highly original exploration is that the political inclusion of domestic workers has ironically depoliticized them. Making domestic workers the subjects of rights through their construction as ‘‘vulnerable’’ defined their political status as incapacitated and inert. With the state positioning itself as the representative and protector of domestic workers’ interests, they were demobilized, their unions displaced and weakened and their voices muted. Thus Ally argues that ‘‘the attempt to turn ‘servants’ into workers through liberal democratic rights, rather

Including the urban heat island in spatial heat health risk assessment strategies: a case study for Birmingham, UK

Abstract: Heatwaves present a significant health risk and the hazard is likely to escalate with the increased future temperatures presently predicted by climate change models. The impact of heatwaves is often felt strongest in towns and cities where populations are concentrated and where the climate is often unintentionally modified to produce an urban heat island effect; where urban areas can be significantly warmer than surrounding rural areas. The purpose of this interdisciplinary study is to integrate remotely sensed urban heat island data alongside commercial social segmentation data via a spatial risk assessment methodology in order to highlight potential heat health risk areas and build the foundations for a climate change risk assessment. This paper uses the city of Birmingham, UK as a case study area. When looking at vulnerable sections of the population, the analysis identifies a concentration of "very high" risk areas within the city centre, and a number of pockets of "high risk" areas scattered throughout the conurbation. Further analysis looks at household level data which yields a complicated picture with a considerable range of vulnerabilities at a neighbourhood scale. The results illustrate that a concentration of "very high" risk people live within the urban heat island, and this should be taken into account by urban planners and city centre environmental managers when considering climate change adaptation strategies or heatwave alert schemes. The methodology has been designed to be transparent and to make use of powerful and readily available datasets so that it can be easily replicated in other urban areas.

Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter?

Abstract: Although there are inequalities in child health and survival in the Democratic Republic of Congo (DRC), the influence of distal determinants such as geographic location on children's nutritional status is still unclear. We investigate the impact of geographic location on child nutritional status by mapping the residual net effect of malnutrition while accounting for important risk factors. We examine spatial variation in under-five malnutrition with flexible geo-additive semi-parametric mixed model while simultaneously controlling for spatial dependence and possibly nonlinear effects of covariates within a simultaneous, coherent regression framework based on Markov Chain Monte Carlo techniques. Individual data records were constructed for children. Each record represents a child and consists of nutritional status information and a list of covariates. For the 8,992 children born within the last five years before the survey, 3,663 children have information on anthropometric measures. Our novel empirical approach is able to flexibly determine to what extent the substantial spatial pattern of malnutrition is driven by detectable factors such as socioeconomic factors and can be attributable to unmeasured factors such as conflicts, political, environmental and cultural factors. Although childhood malnutrition was more pronounced in all provinces of the DRC, after accounting for the location's effects, geographic differences were significant: malnutrition was significantly higher in rural areas compared to urban centres and this difference persisted after multiple adjustments. The findings suggest that models of nutritional intervention must be carefully specified with regard to residential location. Childhood malnutrition is spatially structured and rates remain very high in the provinces that rely on the mining industry and comparable to the level seen in Eastern provinces under conflicts. Even in provinces such as Bas-Congo that produce foods, childhood malnutrition is higher probably because of the economic decision to sell more than the population consumes. Improving maternal and child nutritional status is a prerequisite for achieving MDG 4, to reduce child mortality rate in the DRC.

Low use of contraception among poor women in Africa: an equity issue

Abstract: OBJECTIVE: To examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman's fertility intentions and household wealth. METHODS: The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Wealth-related inequities in the use of contraception were calculated using household wealth and concentration indices. Logistic regression models were fitted for the likelihood of using a long-term contraceptive method, with adjustments for: wealth index quintile, fertility intentions (to space births versus to stop childbearing), residence (urban/rural), education, number of living children, marital status and survey year. FINDINGS: The use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. CONCLUSION: Family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.

The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

Abstract: Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers. Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.

Impact of microcredit in rural areas of Morocco: Evidence from a Randomized Evaluation

Abstract: Policy motivation. Despite claims that microcredit is one of the most powerful tools to alleviate poverty, the evidence on its impact remains scarce, and there is considerable debate on its impacts: does it help the poor or does it hurt them by trapping them in cycles of indebtedness? This study is the first randomized evaluation of a microcredit program conducted in a rural area where there is almost no other credit access (two other recent randomized evaluations provide evidence in dense urban settings where households had access to other sources of credit). Microcredit expanded in Morocco during the second half of the 90s, and today Morocco is one of the countries with the highest number of clients in the North Africa and Middle East region. Al Amana expansion to non-densely populated areas gives the opportunity to analyze the impact of microcredit basic product, the group-liability loan first introduced by Grameen Bank, in a context in which microcredit was almost inexistent and the use of both formal and informal lending was very low.

Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study.

Abstract: Background : Access to antenatal care (ANC) and postnatal care (PNC) services has a great deal of impacts on major causes of infant death and significantly affects trends of mortality in a population. Antenatal care may play an indirect role in reducing maternal mortality by encouraging women to deliver with assistance of a skilled birth attendant or in a health facility. In most rural settings of Ethiopia, there are challenges in increasing such health care service utilization mainly due to the fact that the decisions that lead women to use the services seem to occur within the context of their marriage , household and family setting. Objective : Examining the prevalence and factors associated with antenatal Care (ANC) and Postnatal Care (PNC) service utilizations. Methods : This was a cross-sectional population based study undertaken in 10 rural villages of the Sidama zone, southern Ethiopia. The data were collected from a representative sample of 1,094 households drawn from the study population using a combination of simple random and multistage sampling techniques. Two dependent variables were used in the analysis: The ANC, measured by whether a woman got the service (at least once) from a health professional or not during her last pregnancy and PNC which was approximated by whether the last born child completed the required immunization or not. Household and women’s characteristics were used as explanatory variables for both dependent variables. Results : The study revealed that the level of ANC and PNC service utilizations is 77.4 % and 37.2% respectively. The predicted probabilities, using logistic regression, showed that women who are literate, have exposure to media, and women with low parity are more likely to use both ANC and PNC services. Conclusion : Antenatal care service utilization was generally good while the postnatal care given to new born children was very low compared to other population groups in the region. Promoting women’s education and behavioral change communication at grass root level, provision of the services at both home and health facilities, and improving the quality and capacity of the health providers are some of the recommendations forwarded. Keywords : Antenatal Care, postnatal care, service utilization, complete immunization, Sidama Zone, Southern Ethiopia African Health Sciences 2011; 11(3): 390 - 397

Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: a questionnaire survey

Abstract: Aim This paper is a report of a correlational study of the relationships between demographic variables, job satisfaction, and turnover intent among primary healthcare nurses in a rural area of South Africa. Background Health systems in Southern Africa face a nursing shortage fuelled by migration, but research on job satisfaction and turnover intent of primary healthcare nurses remains poorly described. Method A cross-sectional study with survey design was conducted in 2005 in all local primary healthcare clinics, including nurses on duty at the time of visit (n = 143). Scale development, anova, Spearman's rank correlation, and logistic regression were applied. Results Nurses reported satisfaction with work content and coworker relationships and dissatisfaction with pay and work conditions. Half of all nurses considered turnover within two years, of whom three in ten considered moving overseas. Job satisfaction was statistically significantly associated with unit tenure (P Conclusion Strategies aimed at improving job satisfaction and retention of primary healthcare nurses in rural South Africa should rely not only on financial rewards and improved work conditions but also on adequate human resource management.

Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex, age and habitat: an estimate from population studies.

Abstract: Introduction In sub-Saharan Africa (SSA), data on hypertension prevalence in terms of urban or rural and sex difference are lacking, heterogeneous or contradictory. In addition, there are no accurate estimates of hypertension burden. Objective To estimate the age-specific and sex-specific prevalence of arterial hypertension in SSA in urban and rural adult populations. Methods We searched for population studies, conducted from 1998 through 2008 in SSA. We extracted data from selected studies on available prevalences and used a logistic regression model to estimate all age/sex/habitat (urban/rural)/country-specific prevalences for SSA up to 2008 and 2025. On the basis of the United Nations Population Fund data for 2008 and predictions for 2025, we estimated the number of hypertensives in both years. Results Seventeen studies pertaining to 11 countries were analysed. The overall prevalence rate of hypertension in SSA for 2008 was estimated at 16.2% [95% confidence interval (CI) 14.1-20.3], ranging from 10.6% in Ethiopia to 26.9% in Ghana. The estimated prevalence was 13.7% in rural areas, 20.7% in urban areas, 16.8% in males, and 15.7% in women. The total number of hypertensives in SSA was estimated at 75 million (95% CI 65-93 million) in 2008 and at 125.5 million (95% CI 111.0-162.9 million) by 2025. Conclusion The estimated number of hypertensives in 2008 is nearly four times higher than the last (2005) estimate of the World Health Organization Regional Office for Africa. Prevalences were significantly higher in urban than in rural populations. Population data are lacking in many countries underlining the need for national surveys.

‘Becoming somebody’: youth transitions through education and migration in Peru

Abstract: The past few decades have witnessed international pressure to get more children in the world educated, for longer. The view that school education is core to definitions of good childhoods and successful youth transitions is increasingly widespread, globally and locally. However, structural inequalities persist and migration for education has become an important individual, family and community response to overcome these gaps. This article explores the relationship between migration and educational aspirations among a group of young people participating in Young Lives, an international study of child poverty, in Peru. It draws on survey and qualitative data collected on a cohort of children being tracked by the study over a 15-year period, from the time they were 8 years old (2002) into early adulthood (2017). Young people and their parents connect migration with the process of ‘becoming somebody in life’ and with their high educational aspirations. This is linked to intergenerational dependencies and the ...

Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

Abstract: Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community) level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city residents. The male peer strategy was effective and sustainable at community level. There is need for creation of awareness in men so that they sustain their participation in maternal health care activities of their female partners even in the absence of incentives, coercion or invitation.

Temporal changes in greenspace in a highly urbanized region

Abstract: The majority of the world's population now lives in towns and cities, and urban areas are expanding faster than any other land-use type. In response to this phenomenon, two opposing arguments have emerged: whether cities should ‘sprawl’ into the wider countryside, or ‘densify’ through the development of existing urban greenspace. However, these greenspaces are increasingly recognized as being central to the amelioration of urban living conditions, supporting biodiversity conservation and ecosystem service provision. Taking the highly urbanized region of England as a case study, we use data from a variety of sources to investigate the impact of national-level planning policy on temporal patterns in the extent of greenspace in cities. Between 1991 and 2006, greenspace showed a net increase in all but one of 13 cities. However, the majority of this gain occurred prior to 2001, and greenspace has subsequently declined in nine cities. Such a dramatic shift in land use coincides with policy reforms in 2000, which favoured densification. Here, we illustrate the dynamic and policy-responsive nature of urban land use, thereby highlighting the need for a detailed investigation of the trade-offs associated with different mechanisms of urban densification to optimize and secure the diverse benefits associated with greenspaces.

Rural Roads and Local Market Development in Vietnam

Abstract: We assess impacts of rural road rehabilitation on market development at the commune level in rural Vietnam and examine the geographic, community, and household covariates of impact. Double difference and matching methods are used to address sources of selection bias in identifying impacts. The results point to significant average impacts on the development of local markets. There is also evidence of considerable impact heterogeneity, with a tendency for poorer communes to have higher impacts due to lower levels of initial market development. Yet, some poor areas are also saddled with other attributes that reduce those impacts.

Rural People and Communities in the 21st Century: Resilience and Transformation

Abstract: List of Figures and Tables . Acknowledgments. I. Thinking About Rural Places in Metropolitan Society. 1. Rurality in Metropolitan Society. 2. Urbanization and Population Redistribution. II. Rural Communities, Institutions and Environments. 3. Understanding Community in Rural Society. 4. Community Institutions in Rural Society. 5. Natural Resources and Social Change. III. Rural Populations. 6. Youth, Aging and the Life Course. 7. Racial and Ethnic Minorities in Rural Areas. IV. Rural Economy and Socioeconomic Wellbeing. 8. Making a Living in Rural Communities. 9. Farms, Farmers and Farming. 10. Poverty Across Rural People and Places. V. Conclusions. 11. Rural Transformations and Rural Policies for the Future.