Search results for: rural nurse

Authors: S. K. Dewangan, K. R. Sahu, S. Soni

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Unemployment is today’s basic socio-economic problem eroding national income and living standards, aggravating national development and poverty alleviation. The farmers are encouraged to take up non-agriculture practices which are integrated with Sericulture. Sericulture is one of the primary occupations for livelihood of poor people in tribal area. Most of tribal are involved in Sericulture. Tasar, Eri are the main forest-based cultivation. Among these sericultures is the major crop adopted by the Tribal’s and practiced in respective areas. Out of the 6, 38,588 villages in India, sericultures are practiced in about 69000 villages providing employment to about 7.85 million people. Sericulture is providing livelihood for 9, 47,631 families. India continues to be the second largest producer of silk in the World. Among the four varieties of silk produced, as in 2012-13, Mulberry accounts for 18,715 MT, Eri 3116 MT, Tasar 1729 MT and Muga 119MT of the total raw silk production in the country. Sericulture with its unique features plays an important role in upgrading the socio-economic conditions of the rural folk and with employment opportunities to the educated rural youth and women. In view of the importance of sericulture enterprise for the biodiversity conservation as well as its cultural bondage, the paper tries to enlighten and discuss the significance of sericulture and strategies to be taken for the employment generation in Indian sericulture industry. The present paper explores the possible employment opportunities derived from problem analysis and strategies to be adopted aiming at revolutionary biodiversity conservation in the study area. The paper highlights the sericulture is a way for biodiversity conservation, employment generation in Raigarh district, their utilization and needs as they act as a tool for socio-economic change for tribal. The study concludes with some suggestions to improve the feasibility of sericulture in long term.

Keywords: bio-diversity, employment, sericulture, tribal, income, socio-economic

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Authors: Zhaojun Wang, Zongdi Sun, Yongjie Chen, Manman Chen, Linghui Wang

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This paper uses the analytic hierarchy process to study the execution effect of the minimum purchase price of grain in different regions and various grain crops. Firstly, for different regions, five indicators including grain yield, grain sown area, gross agricultural production, grain consumption price index, and disposable income of rural residents were selected to construct an evaluation index system. We collect data of six provinces including Hebei Province, Heilongjiang Province and Shandong Province from 2006 to 2017. Then, the judgment matrix is constructed, and the hierarchical single ordering and consistency test are carried out to determine the scoring standard for the minimum purchase price of grain. The ranking of the execution effect from high to low is: Heilongjiang Province, Shandong Province, Hebei Province, Guizhou Province, Shaanxi Province, and Guangdong Province. Secondly, taking Shandong Province as an example, we collect the relevant data of sown area and yield of cereals, beans, potatoes and other crops from 2006 to 2017. The weight of area and yield index is determined by expert scoring method. And the average sown area and yield of cereals, beans and potatoes in 2006-2017 were calculated, respectively. On this basis, according to the sum of products of weights and mean values, the execution effects of different grain crops are determined. It turns out that among the cereals, the minimum purchase price had the best execution effect on paddy, followed by wheat and finally maize. Moreover, among major categories of crops, cereals perform best, followed by beans and finally potatoes. Lastly, countermeasures are proposed for different regions, various categories of crops, and different crops of the same category.

Keywords: analytic hierarchy process, grain yield, grain sown area, minimum grain purchase price

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Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

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Authors: Pradipta Chandra, Titas Bhattacharjee, Bhaskar Bhowmick

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The foundation of economy in India is primarily based on agriculture while this is the most neglected in the rural setting. More significantly, household women take part in agriculture with higher involvement. However, because of lower education of women they have limited access towards financial decisions, land ownership and technology but they have vital role towards the individual family level. There are limited studies on the institution-wise training barriers with the focus of gender disparity. The main purpose of this paper is to find out the factors of institution-wise training (non-formal education) barriers in technology transfer with the focus of participation of rural women in agriculture. For this study primary and secondary data were collected in the line of qualitative and quantitative approach. Qualitative data were collected by several field visits in the adjacent areas of Seva-Bharati, Seva Bharati Krishi Vigyan Kendra through semi-structured questionnaires. In the next level detailed field surveys were conducted with close-ended questionnaires scored on the seven-point Likert scale. Sample size was considered as 162. During the data collection the focus was to include women although some biasness from the end of respondents and interviewer might exist due to dissimilarity in observation, views etc. In addition to that the heterogeneity of sample is not very high although female participation is more than fifty percent. Data were analyzed using Exploratory Factor Analysis (EFA) technique with the outcome of three significant factors of training barriers in technology adoption by farmers: (a) Failure of technology transfer training (TTT) comprehension interprets that the technology takers, i.e., farmers can’t understand the technology either language barrier or way of demonstration exhibited by the experts/ trainers. (b) Failure of TTT customization, articulates that the training for individual farmer, gender crop or season-wise is not tailored. (c) Failure of TTT generalization conveys that absence of common training methods for individual trainers for specific crops is more prominent at the community level. The central finding is that the technology transfer training method can’t fulfill the need of the farmers under an economically challenged area. The impact of such study is very high in the area of dry lateritic and resource crunch area of Jangalmahal under Paschim Medinipur district, West Bengal and areas with similar socio-economy. Towards the policy level decision this research may help in framing digital agriculture for implementation of the appropriate information technology for the farming community, effective and timely investment by the government with the selection of beneficiary, formation of farmers club/ farm science club etc. The most important research implication of this study lies upon the contribution towards the knowledge diffusion mechanism of the agricultural sector in India. Farmers may overcome the barriers to achieve higher productivity through adoption of modern farm practices. Corporates will be interested in agro-sector through investment under corporate social responsibility (CSR). The research will help in framing public or industry policy and land use pattern. Consequently, a huge mass of rural farm-women will be empowered and farmer community will be benefitted.

Keywords: dry lateritic zone, institutional barriers, technology transfer in India, farm-women participation

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Authors: A. M. Andriano, M. Lombardi, A. Lopolito, M. Prosperi, A. Stasi, E. Iannuzzi

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In according to the scientific debate on the definition of Social Innovation (SI), the present paper identifies SI as new ideas (products, services, and models) that simultaneously meet social needs and create new social relationships or collaborations. This concept offers important tools to unravel the difficult condition for the agricultural sector in marginalized areas, characterized by the abandonment of activities, low level of farmer education, and low generational renewal, hampering new territorial strategies addressed at and integrated and sustainable development. Models of SI in agriculture, starting from bottom up approach or from the community, are considered to represent the driving force of an ecological and digital revolution. A system based on SI may be able to grasp and satisfy individual and social needs and to promote new forms of entrepreneurship. In this context, Vazapp ('Go Hoeing') is an emerging SI model in southern Italy that promotes solutions for satisfying needs of farmers and facilitates their relationships (creation of network). The Vazapp’s initiative, considered in this study, is the Contadinners ('Farmer’s dinners'), a dinner held at farmer’s house where stakeholders living in the surrounding area know each other and are able to build a network for possible future professional collaborations. The aim of the paper is to identify the evolution of farmers’ relationships, both quantitatively and qualitatively, because of the Contadinner’s initiative organized by Vazapp. To this end, the study adopts the Social Network Analysis (SNA) methodology by using UCINET (Version 6.667) software to analyze the relational structure. Data collection was realized through a questionnaire distributed to 387 participants in the twenty 'Contadinners', held from February 2016 to June 2018. The response rate to the survey was about 50% of farmers. The elaboration data was focused on different aspects, such as: a) the measurement of relational reciprocity among the farmers using the symmetrize method of answers; b) the measurement of the answer reliability using the dichotomize method; c) the description of evolution of social capital using the cohesion method; d) the clustering of the Contadinners' participants in followers and not-followers of Vazapp to evaluate its impact on the local social capital. The results concern the effectiveness of this initiative in generating trustworthy relationships within the rural area of southern Italy, typically affected by individualism and mistrust. The number of relationships represents the quantitative indicator to define the dimension of the network development; while the typologies of relationships (from simple friendship to formal collaborations, for branding new cooperation initiatives) represents the qualitative indicator that offers a diversified perspective of the network impact. From the analysis carried out, Vazapp’s initiative represents surely a virtuous SI model to catalyze the relationships within the rural areas and to develop entrepreneurship based on the real needs of the community.

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Authors: Abdulkarim Nasir, Alhassan T. Yahaya, Hauwa T. Abdulkarim, Abdussalam El-Suleiman, Yakubu K. Abubakar

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The need for sustainable and reliable electricity supply in rural communities of Nigeria remains a pressing issue, given the country's vast energy deficit and the significant number of inhabitants lacking access to electricity. This research focuses on the development of a portable hybrid renewable energy system designed to provide a sustainable and efficient electricity supply to these underserved regions. The proposed system integrates multiple renewable energy sources, specifically solar and wind, to harness the abundant natural resources available in Nigeria. The design and development process involves the selection and optimization of components such as photovoltaic panels, wind turbines, energy storage units (batteries), and power management systems. These components are chosen based on their suitability for rural environments, cost-effectiveness, and ease of maintenance. The hybrid system is designed to be portable, allowing for easy transportation and deployment in remote locations with limited infrastructure. Key to the system's effectiveness is its hybrid nature, which ensures continuous power supply by compensating for the intermittent nature of individual renewable sources. Solar energy is harnessed during the day, while wind energy is captured whenever wind conditions are favourable, thus ensuring a more stable and reliable energy output. Energy storage units are critical in this setup, storing excess energy generated during peak production times and supplying power during periods of low renewable generation. These studies include assessing the solar irradiance, wind speed patterns, and energy consumption needs of rural communities. The simulation results inform the optimization of the system's design to maximize energy efficiency and reliability. This paper presents the development and evaluation of a 4 kW standalone hybrid system combining wind and solar power. The portable device measures approximately 8 feet 5 inches in width, 8 inches 4 inches in depth, and around 38 feet in height. It includes four solar panels with a capacity of 120 watts each, a 1.5 kW wind turbine, a solar charge controller, remote power storage, batteries, and battery control mechanisms. Designed to operate independently of the grid, this hybrid device offers versatility for use in highways and various other applications. It also presents a summary and characterization of the device, along with photovoltaic data collected in Nigeria during the month of April. The construction plan for the hybrid energy tower is outlined, which involves combining a vertical-axis wind turbine with solar panels to harness both wind and solar energy. Positioned between the roadway divider and automobiles, the tower takes advantage of the air velocity generated by passing vehicles. The solar panels are strategically mounted to deflect air toward the turbine while generating energy. Generators and gear systems attached to the turbine shaft enable power generation, offering a portable solution to energy challenges in Nigerian communities. The study also addresses the economic feasibility of the system, considering the initial investment costs, maintenance, and potential savings from reduced fossil fuel use. A comparative analysis with traditional energy supply methods highlights the long-term benefits and sustainability of the hybrid system.

Keywords: renewable energy, solar panel, wind turbine, hybrid system, generator

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Authors: Jimena Alarcon, Andrea Llorens, Gabriel Hernandez, Maritza Palma, Lucia Navarrete

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The research has funding from the Government of Chile and is focused on defining the design of rural primary classroom that stimulates creativity. The relevance of the study consists of its capacity to define adequate educational spaces for the implementation of the design-based learning (DBL) methodology. This methodology promotes creativity and teamwork, generating a meaningful learning experience for students, based on the appreciation of their environment and the generation of projects that contribute positively to their communities; also, is an inquiry-based form of learning that is based on the integration of design thinking and the design process into the classroom. The main goal of the study is to define the design characteristics of rural primary school classrooms, associated with the implementation of the DBL methodology. Along with the change in learning strategies, it is necessary to change the educational spaces in which they develop. The hypothesis indicates that a change in the space and equipment of the classrooms based on the emotions of the students will motivate better learning results based on the implementation of a new methodology. In this case, the pedagogical dynamics require an important interaction between the participants, as well as an environment favorable to creativity. Methodologies from Kansei engineering are used to know the emotional variables associated with their definition. The study is done to 50 students between 6 and 10 years old (average age of seven years), 48% of men and 52% women. Virtual three-dimensional scale models and semantic differential tables are used. To define the semantic differential, self-applied surveys were carried out. Each survey consists of eight separate questions in two groups: question A to find desirable emotions; question B related to emotions. Both questions have a maximum of three alternatives to answer. Data were tabulated with IBM SPSS Statistics version 19. Terms referred to emotions are grouped into twenty concepts with a higher presence in surveys. To select the values obtained as part of the implementation of Semantic Differential, a number expected of 'chi-square test (x2)' frequency calculated for classroom space is considered lower limit. All terms over the N expected a cut point, are included to prepare tables for surveys to find a relation between emotion and space. Statistic contrast (Chi-Square) represents significance level ≥ 0, indicator that frequencies appeared are not random. Then, the most representative terms depend on the variable under study: a) definition of textures and color of vertical surfaces is associated with emotions such as tranquility, attention, concentration, creativity; and, b) distribution of the equipment of the rooms, with emotions associated with happiness, distraction, creativity, freedom. The main findings are linked to the generation of classrooms according to diverse DBL team dynamics. Kansei engineering is the appropriate methodology to know the emotions that students want to feel in the classroom space.

Keywords: creativity, design-based learning, education spaces, emotions

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Authors: Tuji Jemal Ahmed, Abdi Mohammed, Geremew Geidare Kailo

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Food security, foodborne illness, and food safety are critical issues that affect the East Harerghe region of Oromia, Ethiopia. Despite the region's potential for agriculture, food insecurity remains a significant problem, with many households experiencing chronic hunger and malnutrition. The region also experiences high rates of foodborne illnesses, including cholera, typhoid, and diarrhea, which are caused by poor hygiene and sanitation practices. Additionally, food safety is a significant challenge, particularly in rural areas, where there is a lack of infrastructure, inadequate food storage facilities, and limited access to information about food safety. There are several factors that contribute to the current situation in the East Harerghe region; firstly, the region is susceptible to natural disasters, for instance, drought, which affects crop yields and livestock production. Secondly, the region also experiences poor infrastructure, which affects the storage and transportation of food, particularly in rural areas. Thirdly, there is a lack of awareness and knowledge on good hygiene and sanitation practices, specifically during food handling, processing, and storage. Fourthly, unitability due to conflict and other forms of land degradation exacerbates food insecurity and malnutrition. Finally, limited access to financial resources and markets commonly affects smallholder farmers by their ability to produce and sell food. To address the current situation in that area, several potential solutions can be implemented; investment in infrastructure is necessary, especially in rural areas, to improve the storage and transportation of food. Education and awareness programs on good hygiene and sanitation practices should target local communities, smallholder farmers, and food vendors. Financial resources and markets should be made more accessible to smallholder farmers, particularly through the provision of credit and improved access to markets. Addressing the underlying causes of conflict and promoting peaceful coexistence can help to reduce displacement and loss of livelihoods. Finally, the enforcement of food safety regulations and the implementation of standards for food processing and storage facilities are necessary to ensure food safety. In conclusion, addressing the challenges of food security, foodborne illness, and food safety in the East Harerghe region requires a coordinated effort from various stakeholders, including the government, non-governmental organizations, and local communities. By implementing the solutions outlined above, the region can improve its food security, prevent foodborne illnesses, and keep food safe for its population. Eventually, building the resilience of communities to shocks such as droughts, floods, and conflict is necessary to ensure long-term food security in the region.

Keywords: foodborne illness, food handling, food safety, food security

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Authors: Khethiwe Mtshali, Zamantungwa T. H. Khumalo, Stanford Kwenda, Ismail Arshad, Oriel M. M. Thekisoe

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Ecologically, the gut, mammary glands and bloodstream consist of distinct microbial communities of commensals, mutualists and pathogens, forming a complex ecosystem of niches. The by-products derived from these body sites i.e. faeces, milk and blood, respectively, have many uses in rural communities where they aid in the facilitation of day-to-day household activities and occasional rituals. Thus, although livestock rearing plays a vital role in the sustenance of the livelihoods of rural communities, it may serve as a potent reservoir of different pathogenic organisms that could have devastating health and economic implications. This study aimed to simultaneously explore the microbial profiles of corresponding faecal, milk and blood samples from lactating cows using 16S rRNA metagenomic sequencing. Bacterial communities were inferred through the Divisive Amplicon Denoising Algorithm 2 (DADA2) pipeline coupled with SILVA database v138. All downstream analyses were performed in R v3.6.1. Alpha-diversity metrics showed significant differences between faeces and blood, faeces and milk, but did not vary significantly between blood and milk (Kruskal-Wallis, P < 0.05). Beta-diversity metrics on Principal Coordinate Analysis (PCoA) and Non-Metric Dimensional Scaling (NMDS) clustered samples by type, suggesting that microbial communities of the studied niches are significantly different (PERMANOVA, P < 0.05). A number of taxa were significantly differentially abundant (DA) between groups based on the Wald test implemented in the DESeq2 package (Padj < 0.01). The majority of the DA taxa were significantly enriched in faeces than in milk and blood, except for the genus Anaplasma, which was significantly enriched in blood and was, in turn, the most abundant taxon overall. A total of 30 phyla, 74 classes, 156 orders, 243 families and 408 genera were obtained from the overall analysis. The most abundant phyla obtained between the three body sites were Firmicutes, Bacteroidota, and Proteobacteria. A total of 58 genus-level taxa were simultaneously detected between the sample groups, while bacterial signatures of at least 8 of these occurred concurrently in corresponding faeces, milk and blood samples from the same group of animals constituting a pool. The important taxa identified in this study could be categorized into four potentially pathogenic clusters: i) arthropod-borne; ii) food-borne and zoonotic; iii) mastitogenic and; iv) metritic and abortigenic. This study provides insight into the microbial composition of bovine faeces, milk, and blood and its extent of overlapping. It further highlights the potential risk of disease occurrence and transmission between the animals and the inhabitants of the sampled rural community, pertaining to their unsanitary practices associated with the use of cattle by-products.

Keywords: microbial profiling, 16S rRNA, NGS, feces, milk, blood, lactating cows, small-scale farmers

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Authors: Taddese Alemu Zerfu, Melaku Umeta Deressa, Kaleab Baye

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Background: Maternal and child under-nutrition is the underlying cause of 3•5 million annual deaths, globally. Anemia during pregnancy is among the leading nutritional disorders with serious short and long term consequences to both the mother and fetus. Objective: Examine the effect of dietary diversity on maternal anemia, nutritional status and key pregnancy outcomes of pregnancy. Methods: A prospective cohort study design, involving a total of 432 eligible pregnant women, in their second antenatal care visit was conducted between August 2014 to March, 2015. The individual dietary diversity status of mothers was used as the exposure variable to select, enroll and follow the mothers. All mothers were enrolled during second antenatal care visit and followed until delivery. Epi-data, SPSS and STATA software are used to enter and analyze the data. Chi-square test, independent 't'-test, and GLM are used to calculate risk, association and differences between key variables at P < 0.05. Results: Study participants did not differ in many of the basic characteristics (p < 0.05). The incidence of maternal anemia increased significantly from 28.6% to 32.1% between baseline and term. Pregnant mothers with inadequate dietary diversity groups had more (56% at baseline and 68% at term) risk of anemia than the comparison (adequate) groups, (RR, 1.56 and 1.68; 95% CI, 1.24 - 1.83 and 1.39 - 2.04). The overall incidence of still birth, low birth weight and pre-term birth was 4.5%, 9.1% and 13.6%, respectively. The variation of these outcomes was significant across study groups (P < 0.05). Conclusion and recommendations: Dietary diversity status of pregnant mothers has significant effect on the incidence of anemia and key pregnancy outcomes in resource limited settings, like rural Ethiopia. Therefore, apart from the ongoing routine IFA supplementation, special emphasis should be given to dietary diversity of mothers to improve related outcomes of pregnancy and maternal health.

Keywords: anemia, birth weight, dietary diversity, pregnancy, pregnancy outcome

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Authors: Najade Sheriff, Malaz Elsaddig, Kevin Jones

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Background: Death in the first month of life accounts for an increasing proportion of under-five mortality. Advancement to reduce this number is being made across the globe; however, progress is slowest in sub-Saharan Africa. Objectives: The study aims to identify differences between neonatal deaths of inpatient babies born in a hospital facility in rural Uganda to those of neonates admitted from the community and to explore whether they can be used to risk stratify neonatal admissions. Results: A retrospective chart review was conducted on records for neonates admitted to the Special Care Baby Unit (SCBU) Kitovu Hospital from 1st July 2016 to 21st July 2017. A total of 442 babies were admitted and the overall neonatal mortality was 24.8% (40% inpatient, 37% community, 23% hospital referrals). 40% of deaths occurred within 24 hours of admission and the majority were male (63%). 43% of babies were hypothermic upon admission, a significantly greater proportion of which were inpatient babies born in labour ward (P=0.0025). Intrapartum related death accounted for ½ of all inpatient babies whereas complications of prematurity were the predominant cause of death in the community group (37%). Severe infection does not seem like a significant factor of mortality for inpatients (2%) as it does for community admissions (29%). Furthermore, with 52.5% of community admissions weighing < 1500g, very low birth weight (VLBW) may be a significant risk factor for community neonatal death. Conclusion: The neonatal mortality rate in this study is high, and the leading causes of death are all largely preventable. A high rate of inpatient birth asphyxiation indicates the need for good quality facility-based perinatal care as well as a greater focus on the management of hypothermia, such as Kangaroo care. Moreover, a reduction in preterm deliveries is necessary to reduce associated comorbidities, and monitoring for signs of infection is especially important for community admissions.

Keywords: community, mortality, newborn, Uganda

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Authors: Manar Aslan, Selver Gokdemir, Chatitze Chousein

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This research was conducted to evaluate the factors affecting the working environment of nurses working in three state hospitals. A favorable working environment contributes to increased job satisfaction of nurses and improved working conditions that affects the quality of the work done in a positive way. The population of the study was composed the three largest state hospitals in the region of Thrace in Turkey and 931 nurses working in there. In this research was not used any sampling method. The sampling was composed of nurses who accepted to take part in this research from three hospitals. It was used nursing work index-the practice work environment scale (Turkish version) for data collection (Cronbach alpha: 0.94).When the total scale scores of the nurses in the research were examined, it was determined that they evaluated the working environment below the average. It was also determined that the adequacy of human and other resources, dimensions of the physician-nurse communication scores were low. As in every profession group, the working environment in nursing has an importance to provide quality health and nursing care. A favorable working environment will increase nurses' performance and satisfaction with their work. Identifying the factors affecting the working environment and carrying out the remedial work for them will increase the quality of the health service.

Keywords: work environment, work index, nursing, hospitals

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Authors: Niraimathi Kesavan, Sangeeta Sharma, Deepa Jagan, Sridhar Sukumar, Mohan Ramachandran, Vidhubala Elangovan

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Background: Childhood is a dynamic period for growth and development. Optimum nutrition during this period forms a strong foundation for growth, development, resistance to infections, long-term good health, cognition, educational achievements, and work productivity in a later phase of life. Underprivileged children living in a resource constraint settings like shelter homes are at high risk of malnutrition due to poor quality diet and nutritional inadequacy. In low-income countries, underprivileged children are vulnerable to being deprived of nutritious food, which stands as a major challenge in the health sector. The present aims to assess the dietary intake, nutritional status, and nutritional inadequacy and their association with malnutrition among children residing in shelter homes in rural Tamil Nadu. Methods: The study was a descriptive survey conducted among all the children aged between 8-18 years residing in two selected shelter homes (Anbu illam, a home for female children, and Amaidhi illam, a home for male children), rural Tirunelveli, Tamil Nadu, India. A total of 57 children were recruited, including 18 boys and 39 girls, for the study. Dietary intake was measured using seven days 24 hours recall. The average nutrient intake was considered for further analysis. Results: Of the 57 children, about 60% (n=35) were undernutrition. The mean daily energy intake was 1298 (SD 180) kcal for boys and 952 (SD155) kcal for girls. The total calorie intake was 55-60% below the estimated average requirement (EAR) for adolescent boys and girls in the age group 13-15 years and 16-18 years. Carbohydrates were the major source of energy (boys 53% and girls 51%), followed by fat (boys 31.5% and girls 34.5%) and protein (boys 14% and girls 12.9%). Dairy intake (<200ml/day) was less than the recommendation (500ml/day). Micro-nutrient-rich foods such as fruits, vegetables, and green leafy vegetables in the diet were <200g/day, which was far less than the recommended dietary guidelines of 400g- 600g/day for the age group of 7-18 years. Nearly 26% of girls reported experiencing menstrual problems. The majority (76.9%) of the children exhibited nutrient deficiency-related signs and symptoms. Conclusion: The total energy, minerals, and micro-nutrient intake were inadequate and below the Recommended Dietary Allowance for children and adolescents. The diet predominantly consists of refined cereals, rice, semolina, and vermicelli. Consumption of whole grains, milk, fruits, vegetables, and leafy vegetables was far below the recommended dietary guidelines. Dietary inadequacies among these children pose a serious concern for their overall health status and its consequences in the later phase of life.

Keywords: adolescents, children, dietary intake, malnutrition, nutritional inadequacy, shelter home

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Authors: Yvonne Kainuku, Wendy Trimmer

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A critical element in closing the gaps in health disparities is the presence of a culturally appropriate health workforce. This study presents one of the findings from a qualitative study that explored the lived experiences of Cook Islands peoples during their three-year nursing training within a Bachelor of Nursing Pacific (BNP) programme in Aotearoa NZ. The study utilized both qualitative and context-specific methods; these included the Tivaevae Research Model and Qualitative Inquiry. The aim of the research was to collect stories from registered nurses about their experiences of culturally responsive pedagogy and their connection to content relating to Pacific world views and Pacific ways of knowing while they were students. Further to this, the researcher sought to recognize factors that supported the participant's successful completion of becoming a registered nurse. This study will introduce the theme of Tiaki moemoeā (dream keeper), identifying essential elements that engage learners along their journey. The various features that define the theme Tiaki moemoeā (dream keeper) have the potential to contribute to transformational change in nursing education training in Aotearoa, New Zealand.

Keywords: education, nursing, pacific, pedagogy

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Authors: Lotsmart Fonjong

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The livelihood of rural communities in the West African state of Cameroon, which is largely dictated by natural forces (rainfall, temperatures, and soil), is today threatened by climate change and armed conflict. This paper investigates the extent to which rural communities are aware of climate change, how their perceptions of changes across different agro-ecological zones have impacted farming practices, output, and lifestyles, on the one hand, and the extent to which local armed conflicts are confounding their efforts and adaptation abilities. The paper is based on a survey conducted among small farmers in selected localities within the forest and savanna ecological zones of the conflict-ridden Northwest and Southwest Cameroon. Attention is paid to farmers’ gender, scale, and type of farming. Farmers’ perception of/and response to climate change are analysed alongside local rainfall and temperature data and mobilization for climate justice. Findings highlight the fact that farmers’ perception generally corroborates local climatic data. Climatic instability has negatively affected farmers’ output, food prices, standards of living, and food security. However, the vulnerability of the population varies across ecological zones, gender, and crop types. While these factors also account for differences in local response and adaptation to climate change, ongoing armed conflicts in these regions have further complicated opportunities for climate-driven agricultural innovations, inputs, and exchange of information among farmers. This situation underlines how poor communities, as victims, are forced into many complex problems outsider their making. It is therefore important to mainstream farmers’ perceptions and differences into policy strategies that consider both climate change and Anglophone conflict as national security concerns foe sustainable development in Cameroon.

Keywords: adaptation policies, climate change, conflict, small farmers, cameroon

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Authors: N. Casado-Sanz, B. Guirao

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The population aged 65 and over is projected to double in the coming decades. Due to this increase, driver population is expected to grow and in the near future, all countries will be faced with population aging of varying intensity and in unique time frames. This is the greatest challenge facing industrialized nations and due to this fact, the study of the relationships of dependency between population aging and road safety is becoming increasingly relevant. Although the deterioration of driving skills in the elderly has been analyzed in depth, to our knowledge few research studies have focused on the road infrastructure and the mobility of this particular group of users. In Spain, crosstown roads have one of the highest fatality rates. These rural routes have a higher percentage of elderly people who are more dependent on driving due to the absence or limitations of urban public transportation. Analysing road safety in these routes is very complex because of the variety of the features, the dispersion of the data and the complete lack of related literature. The objective of this paper is to identify key factors that cause traffic accidents. The individuals under study were the accidents with killed or seriously injured in Spanish crosstown roads during the period 2006-2015. Latent cluster analysis was applied as a preliminary tool for segmentation of accidents, considering population aging as the main input among other socioeconomic indicators. Subsequently, a linear regression analysis was carried out to estimate the degree of dependence between the accident rate and the variables that define each group. The results show that segmenting the data is very interesting and provides further information. Additionally, the results revealed the clear influence of the aging variable in the clusters obtained. Other variables related to infrastructure and mobility levels, such as the crosstown roads layout and the traffic intensity aimed to be one of the key factors in the causality of road accidents.

Keywords: cluster analysis, population ageing, rural roads, road safety

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Authors: Kriangkrai Vathanalaoha

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Misery generates fear and anxiety in readers through its intense plot associated with the unpredictable emotional states of the nurse, Annie Wilkes. At the same time, she mentally and physically abuses the novelist victim, Paul Sheldon. The suspense is not only at the story level, where the violent expressions are used but also at the discourse level, where the linguistic structures may intentionally cause the reader to view language as disturbing performative. This performativity could be reflected through linguistic choices where the writer triggers a new imaginative world through experiential metafunction and schema disruption. This study explores striking excerpts from the fiction through mind style and transitivity analysis to demonstrate how the horrific experience contrasts when the protagonist and the antagonist converse extensively. The results reveal that stylistic deviation can be found at the syntactic levels, where the intensity of emotions can be apparent when the protagonist is verbally abused. In addition, transitivity can flesh out how the protagonist is expressed chiefly through the internalized process, whereas the antagonist is eminent with the externalized process. The findings suggest that the application of cognitive stylistics, such as mind style and transitivity analysis, could contribute to the mental representation of horrific reality.

Keywords: horror, mind style, misery, stylistics, transitivity

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Authors: Chigozie Azunna, Botes Lucius

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Child homelessness remains a significant challenge in South Africa in the upcoming decade. Despite children making up a substantial portion of South Africa's population, the issue of child homelessness continues to pose a socio-economic crisis with diverse impacts. Achieving the UN 2050 Agenda for Sustainable Development Goals (SDGs), especially in terms of equality and non-discrimination, requires an effective approach to curb child homelessness. Addressing this issue will positively influence the economic trajectory of South Africa's evolving demographic landscape. This research uses content analysis through an extensive review of current literature on child homelessness in South Africa. Findings indicate alignment between national policies and international agendas in tackling child homelessness in South Africa. However, the following statistics depict the ongoing challenge: In metropolitan areas, homelessness stands at 74.1%, whereas non-metro regions account for 25.9%. The City of Tshwane has the highest number of homeless individuals at 18.1%, followed by the City of Johannesburg at 15.6%, while Nelson Mandela Bay Metropolitan has the lowest at 2.7%. Despite existing national policy frameworks, child homelessness persists. The lack of accurate data, compounded by issues such as economic challenges, the lingering impacts of the COVID-19 pandemic, poverty, the HIV/AIDS epidemic, and gaps in policy implementation, has exacerbated the problem. The consequences are dire, affecting children’s physical and emotional health, education, and future opportunities. The study recommends reinforcing actionable policies to address child homelessness effectively. Bridging the urban-rural divide and establishing intra-community networks are crucial for tackling this issue comprehensively. This includes addressing multifaceted challenges such as access to education, disease susceptibility, and the overall vulnerability of homeless children.

Keywords: South Africa, child, homeless, SDGs, COVID, urban, rural

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Authors: Qiuying Li, Fan Chen

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It is a shared opinion that sustainable development requires continuously updated, meaning that apparent changes in the way we usually produce our buildings are strongly needed. In China’s construction field, the associated environmental, health problems are quite prominent.Especially low sustainable performance (as opposed to Green creation) flooding the real estate boom and high-speed urban and rural urbanization. Currently, we urgently need to improve the existing design basis,objectives,scope and procedures,optimization design portfolio.More new evaluation system designed to facilitate the building to enhance the overall level.

Keywords: design for sustainability, design and materials, ecomaterials, sustainable architecture and urban design

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Authors: Ejaz Ashraf, Raheel Babar, Muhammad Yaseen, Hafiz Khurram Shurjeel, Nosheen Fatima

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Main purpose of this study was to assess adoption level of farmers for quinoa cultivation after they had been taught through training and visit extension approach. At this time of the 21^st century, population structure, climate change, food requirements and eating habits of people are changing rapidly. In this scenario, farmers must play their key role in sustainable crop development and production through adoption of new crops that may also be helpful to overcome the issue of food insecurity as well as reducing poverty in rural areas. Its cultivation in Pakistan is at the early stages and there is a need to raise awareness among farmers to grow quinoa crops. In the middle of the 2015, a training and visit extension approach was used to raise awareness and convince farmers to grow quinoa in the area. During training and visit extension program, 80 farmers were randomly selected for the training of quinoa cultivation. Later on, these farmers trained 60 more farmers living into their neighborhood. After six months, a survey was conducted with all 140 farmers to assess the impact of the training and visit program on adoption level of respondents for the quinoa crop. The survey instrument was developed with the help of literature review and other experts of the crop. Validity and reliability of the instrument were checked before complete data collection. The data were analyzed by using SPSS. Multiple regression analysis was used for interpretation of the results from the survey, which indicated that factors like information/ training, change in agronomic and plant protection practices play a key role in the adoption of quinoa cultivation by respondents. In addition, the model explains more than 50% of variation in the adoption level of respondents. It is concluded that farmers need timely information for improved knowledge of agronomic and plant protection practices to adopt cultivation of the quinoa crop in the area.

Keywords: farmers, quinoa, adoption, contact, training and visit

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Authors: Gaël Brulé

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The concept of territory seems to be largely absent from the literature on well-being. In the present study, the link between the territory and well-being is analyzed in the context of a rural area, the Morvan, in Burgundy (France). Through qualitative research-mostly interviews- this link is questioned and explored. The relationship between the territory and the actors inform us on several key-concepts often related to well-being: locus of control, mobility and identity. From an interactionist perspective, the relation between territory and actors seems to be a fertile ground to explore the latters’ well-being. The present paper advocates for more research on the field.

Keywords: territory, well-being, identity, mobility

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Authors: Akm Shahidullah

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This paper assessed the medicinal plants production and related entrepreneurial and management aspects with a focus to understand the present medicinal plants-based supply chain of Bangladesh. It delineated the overall supply chain and the extent of benefit that the plant-producingagrientrepreneursderive out of the existing system of the chain. The key objective was to put forward innovative supply chain strategiesthatcan leverage the benefit of the rural farmer-entrepreneur of medicinal plants. A field-based investigation was carried out in the Natore district of northwest Bangladesh, where a total of 225 farmers and households from eight villages were engaged in the production of medicinal plant species. The research had a survey with the agrientrepreneurs of two of those villages and focus group discussions at a union level to gather information about the price, buyers, seasonality, and overall supply infrastructure and trading mechanisms of the plant products. The research also gathered explanations on the overall supply chain system of the plants and plant-based processed products through key informant interviews with the local and regional selling agents, stockists, wholesalers, and secondary processors. The findings revealed that, in the existing supply chain system, the primary and wholesale secondary markets were mostly dominated by middlemen who cause market distortions and inflated prices due to a lack of coordination between the primary producers and secondary processors. The discoordination and inefficiencies in the supply chain system could be offset by the producer-processor relationship integration that could result in a multitude of benefits to both the parties in terms of price, quality, lead time, and overall control of the supply chain. Therefore, to ensure the growth of medicinal plants production, the industry users, secondary processors, and policy stakeholders should ensure that the primary producers get the fair share of the benefit; the producer-processor relationship integration in the supply chain offers to ensure that fairness with maximum producer surplus.

Keywords: medicinal-plants, agrientrepreneur, supply chain, relationship integration, Bangladesh

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Authors: Renee Yi-Mond Yuan

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The fast development of tourism industries around the world, has largely contributed to many cities, and countries economical and social progress. Past year Taiwan in particular was ranked among one of fastest raise growth country. Thanks to the prominent importance of this phenomenon; seasonal mobility or multipurpose trips have reached more than 1 Billion tourists crossing International borders and more than 4 billion intramural travelers that have nourished the economy and employment in the service sector in most attractive regions, representing about one tenth of World GDP amount, including trade, research, cultural or journalistic purposes. Then the increased activities are giving pressure to the consumption of energy, water, resources, and Greenhouse Gas emissions. The further concentration of tourists in most beautiful sites of the World with consistent supply and reduced pollutions and means for waste control and risks management are challenging the preservation and protection of the natural original environment, including species and their ecosystems, ethnics and their cultures or languages, protection of inherited landscapes and monuments for the future generations to come. In this article, few projects will be analyzed, methods and directions in the EU sustainable development scheme giving way to economical and social activities and preserve rural areas and remote countryside as well as smarter cities development. EU ETS forecasting escalation in the next few decades for road and air, and will reconsider investments and reliance on Biobased alternatives that may turn out solutions and contributions to sustain popularization of tourism development. Study of Examples of Stakeholders practices and Governments efforts, consumer’s attitude to bring new forms of more responsible holidays models: ecotourism, eco-certification, partnerships, investment in technologies and facilities, and possibly create greener perceptions and less impacting demands for the longer term through association, organizations and awards.

Keywords: tourism, sustainability, protection, risks management, change in rural/urban environment

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Authors: Rida Wanbha Nongbri, Sabuj Kumar Mandal

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The Sustainable Development Goals (SDGs) for 2016-2030 were adopted in response to Millennium Development Goals (MDGs) which focused on access to sustainable water and sanitations. For over a decade, water has been a significant subject that is explored in various facets of life. Our day-to-day life is significantly impacted by water poverty at the socio-economic level. Reducing water poverty is an important policy challenge, particularly in emerging economies like India, owing to its population growth, huge variation in topology and climatic factors. To design appropriate water policies and its effectiveness, a proper measurement of water poverty is essential. In this backdrop, this study uses the Alkire Foster (AF) methodology to estimate a multidimensional water poverty index for India at the household level. The methodology captures several attributes to understand the complex issues related to households’ water deprivation. The study employs two rounds of Indian Human Development Survey data (IHDS 2005 and 2012) which focuses on 4 dimensions of water poverty including water access, water quantity, water quality, and water capacity, and seven indicators capturing these four dimensions. In order to quantify water deprivation at the household level, an AF dual cut-off counting method is applied and Multidimensional Water Poverty Index (MWPI) is calculated as the product of Headcount Ratio (Incidence) and average share of weighted dimension (Intensity). The results identify deprivation across all dimensions at the country level and show that a large proportion of household in India is deprived of quality water and suffers from water access in both 2005 and 2012 survey rounds. The comparison between the rural and urban households shows that higher ratio of the rural households are multidimensionally water poor as compared to their urban counterparts. Among the four dimensions of water poverty, water quality is found to be the most significant one for both rural and urban households. In 2005 round, almost 99.3% of households are water poor for at least one of the four dimensions, and among the water poor households, the intensity of water poverty is 54.7%. These values do not change significantly in 2012 round, but we could observe significance differences across the dimensions. States like Bihar, Tamil Nadu, and Andhra Pradesh are ranked the most in terms of MWPI, whereas Sikkim, Arunachal Pradesh and Chandigarh are ranked the lowest in 2005 round. Similarly, in 2012 round, Bihar, Uttar Pradesh and Orissa rank the highest in terms of MWPI, whereas Goa, Nagaland and Arunachal Pradesh rank the lowest. The policy implications of this study can be multifaceted. It can urge the policy makers to focus either on the impoverished households with lower intensity levels of water poverty to minimize total number of water poor households or can focus on those household with high intensity of water poverty to achieve an overall reduction in MWPI.

Keywords: .alkire-foster (AF) methodology, deprivation, dual cut-off, multidimensional water poverty index (MWPI)

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Authors: Heather Clark, Jon Kelly

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Burnout among healthcare professionals has been elevated to a high level of concern. The descriptions of the healthcare workplace often include language such as, stressful, long hours, rotating shifts, weekends and holidays, and exhausting. New graduate healthcare professionals are being sent into the workplace with little to no coping skills, knowledge of signs and symptoms of burnout, or resources that are available. The authors of this study created a university course entitled 'coping in your profession' that enrolled registered nurses, licensed practical nurses, EMTs, nurse assistants, and medical assistants. The course addresses burnout, self-analysis, incivility, coping mechanisms, and organizational responsibilities for employee well-being. The students were surveyed using QualtricsXM that included a pre-course and post-course analysis. Pre-course results showed high levels of individual experiences with burnout and limited knowledge of resources to combat burnout. Post-course results included personal growth and that students’ perception of burnout can be prevented at both the individual and the organization levels. Students also indicated that few to no resources to combat burnout existed at their place of employment. Addressing burnout at the educational level helps prepare graduates with the knowledge and tools to combat burnout at the individual and organization level.

Keywords: burnout, coping, healthcare workers, incivility, resilience

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Authors: Mohana Basu, Snehamanju Basu

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Urbanization has an immense impact on the holistic development of a region. In that same context, the level of women empowerment plays a significant role in the development of any region, particularly a region belonging to a developing country. The present study investigates the status of women empowerment in the Asansol Durgapur Planning Area of the state of West Bengal, India by investigating the status of women and their access to various facilities and awareness about the various governmental and non-governmental schemes meant for their elevation. Through this study, an attempt has been to made to understand the perception of the respondents on the context of women's empowerment. The study integrates multiple sources of qualitative and quantitative data collected from various reports, field-based measurements, questionnaire survey and community based participatory appraisals. Results reveal that women of the rural parts of the region are relatively disempowered due to the various restrictions imposed on them and enjoy lower socioeconomic clout than their male counterparts in spite of the several remedial efforts taken by the government and NGOs to elevate their position in the society. A considerable gender gap still exists regarding access to education, employment and decision-making power in the family and significant differences in attitude towards women are observable in the rural and urban areas. Freedom of women primarily vary according to their age group, educational level, employment and income status and also on the degree of urbanization. Asansol Durgapur Planning Area is primarily an industrial region where huge employment generation scope exists. But these disparities are quite alarming and indicate that economic development does not always usher in socially justifiable rights and access to resources for both men and women alike in its awake. In this backdrop, this study will attempt to forward relevant suggestions which can be followed for betterment of the status of women.

Keywords: development, disempowered, economic development, urbanization, women empowerment

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Authors: Marah Joy A. Nanglegan

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A survey was conducted to describe knowledge, attitude, practices, information needs, and information seeking behavior of small-scale farmers on Organic Agriculture Production (OAP) in a rural community in Ifugao, Philippines. Respondents’ age ranged from 23-67 years old. Most of them are male, married, and have reached high school level. The major source of income is farming with an average monthly income of less than Php 5,000 for a household size of seven. More than fifty percent of the respondents are members of a farmer’s organization. Farm size is less than one hectare. Majority of them own their farms and have been farming for more than twenty years. Very few attended training on Organic Agriculture Production (OAP). Most of them are not aware of any OAP program in their community. Hence, their farming practices are mostly conventional. The overall level of knowledge on OAP among all respondents was below the average. On attitude, most of the respondents agreed that organic farming would decrease production costs by reducing input purchases. They believe it benefits both the consumer and the producer. In fact, they are aware of the many benefits of organic farming, especially on health. Likewise, many of them agreed on the benefits of organic farming to soil fertility, to the environment, and to increase the income of farmers. Many of them, however, see organic farming as troublesome and difficult in terms of time and effort, obtaining organic inputs, limited production, and marketing aspects. They also have heavy reliance on pesticides and herbicides to control pests and diseases. On practices, majority of the respondents stated that they practiced crop rotation, manual weeding, and the use of animal manure. Most of them desired to do organic farming but needed information such as production techniques, costs, and marketing opportunities. Their most preferred communication channel is through extension agents and contact farmers. Their most preferred communication method is through trainings and seminars as well as through farm demonstrations. Results of this study will serve as a basis for developing appropriate communication strategies to improve knowledge, attitude, and practices of respondents on organic agriculture as well as enhance the promotion of organic agriculture production in the community.

Keywords: Ifugao, knowledge attitude practices, organic agriculture, Philippines

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Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: Cecilia Sosa, Fernanda Figueroa, Leonardo Calzada

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Biosphere reserves (BR) are considered as the main strategy for biodiversity and ecosystems conservation. Mexican BR are mainly inhabited by rural communities who strongly depend on forests and their resources. Even though the dual objective of conservation and development has been sought in BR, land cover change is a common process in these areas, while most rural communities are highly marginalized, partly as a result of restrictions imposed by conservation to the access and use of resources. Achieving ecosystems conservation and social development face serious challenges. Factors such as financial support for development projects (public/private), environmental conditions, infrastructure and regional economic conditions might influence both land use change and wellbeing. Examining the temporal trends of conservation and development in BR is central for the evaluation of outcomes for these conservation strategies. In this study, we analyzed changes in primary vegetation cover (as a proxy for conservation) and the index of marginalization (as a proxy for development) in Mexican BR (2000-2015); we also explore the influence of various factors affecting these trends, such as conservation-development projects financial support (public or private), geographical distribution in ecoregions (as a proxy for shared environmental conditions) and in economic zones (as a proxy for regional economic conditions). We developed a spatial analysis at the municipal scale (2,458 municipalities nationwide) in ArcGIS, to obtain road densities, geographical distribution in ecoregions and economic zones, the financial support received, and the percent of municipality area under protection by protected areas and, particularly, by BR. Those municipalities with less than 25% of area under protection were regarded as part of the protected area. We obtained marginalization indexes for all municipalities and, using MODIS in Google Earth Engine, the number of pixels covered by primary vegetation. We used a linear mixed model in RStudio for the analysis. We found a positive correlation between the marginalization index and the percent of primary vegetation cover per year (r=0.49-0.5); i.e., municipalities with higher marginalization also show higher percent of primary vegetation cover. Also, those municipalities with higher area under protection have more development projects (r=0.46) and some environmental conditions were relevant for percent of vegetation cover. Time, economic zones and marginalization index were all important. Time was particularly, in 2005, when both marginalization and deforestation decreased. Road densities and financial support for conservation-development projects were irrelevant as factors in the general correlation. Marginalization is still being affected by the conservation strategies applied in BR, even though that this management category considers both conservation and development of local communities as its objectives. Our results suggest that roads densities and support for conservation-development projects have not been a factor of poverty alleviation. As better conservation is being attained in the most impoverished areas, we face the dilemma of how to improve wellbeing in rural communities under conservation, since current strategies have not been able to leave behind the conservation-development contraposition.

Keywords: deforestation, local development, marginalization, protected areas

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