Search results for: rural medicine

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: Belal Rahhal, Isra Taha, Insaf Najajreh, Waleed Basha, Hamzeh Alzabadeh, Ahed Zyoud

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Phytochemical Investigation and Diuretic Activity of the Palestinian Crataegus aronia in Mice using an Aqueous Extract Division of Physiology, Pharmacology and Toxicology Faculty of Medicine and Health Sciences An- Najah National University Nablus- Palestine Belal Rahhal, Isra Taha, Insaf Najajreh, Waleed Basha, Hamzeh Alzabadeh and Ahed Zyoud Purpose: Throughout history, various natural materials were used as remedies for treatment of various diseases, and recently a vastly growing and renewed interest in herbal medicine is witnessed globally. In Palestinian folk medicine, Crataegus aronia is used as a diuretic and for treatment of hypertension. This study aimed to assess the preliminary phytochemical properties and the diuretic effect of the aqueous extracts of this plant in mice after its intraperitonial administration. Methods: It is an experimental trial applied on mice (n=8, Male, CD-1, weight range: [25-30 gram]), which are divided into two groups (4 in each). The first group administered with the plant extract (500 mg/kg) , and the second with normal saline as negative control group. Then urine output and electrolyte contents were quantified up to 6 hours for the three groups and then compared to the control one. Results: Preliminary phytochemical screening reveals the presence of tannins, alkaloids and flavoniods as major phytoconstituents in aqueous extract. Significant diuresis was noted in those received the aqueous extract of Crataegus aronia (p < 0.05) compared to controls. Moreover, aqueous extract had an acidic pH and a mild increase in the electrolyte excretion (Na, K). Conclusions: Our results revealed that Crataegus aronia aqueous extract has a potential diuretic effect. Further studies are needed to evaluate this diuretic effect in the relief of diseases characterized by volume overload. Keywords: C. aronia, furosemide, diuresis, mice, medicinal plants.

Keywords: medicinal plants, diuretic activity, mice, C. aronia, , furosemide, , Phytochemical Investigation

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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: Julian Thrash, Douglas Folk, Michael Ciracy, Audrey C. Tseng, Kristen M. Stromsodt, Amber Younggren, Christopher Maciolek

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The cardiopulmonary system is comprised of the heart, lungs, and many dynamic feedback mechanisms that control its function based on a multitude of variables. The next generation of cardiopulmonary medical devices will involve adaptive control and smart pacing techniques. However, testing these smart devices on living systems may be unethical and exceedingly expensive. As a solution, a comprehensive computational model of the cardiopulmonary system was implemented in Simulink. The model contains over 240 state variables and over 100 equations previously described in a series of published articles. Simulink was chosen because of its ease of introducing machine learning elements. Initial results indicate that physiologically correct waveforms of pressures and volumes were obtained in the simulation. With the development of a comprehensive computational model, we hope to pioneer the future of predictive medicine by applying our research towards the initial stages of smart devices. After validation, we will introduce and train reinforcement learning agents using the cardiopulmonary model to assist in adaptive control system design. With our cardiopulmonary model, we will accelerate the design and testing of smart and adaptive medical devices to better serve those with cardiovascular disease.

Keywords: adaptive control, cardiopulmonary, computational model, machine learning, predictive medicine

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Authors: Muhammad Umar Hassan

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Renal cell carcinoma is a subset of kidney cancer that arises in the lining of DCT and is present in parenchymal tissue. Diagnosis is based on lab reports, including urinalysis, renal function tests (RFTs), and electrolyte balance, along with imaging techniques. Organ failure and other complications have been commonly observed in these cases. Over the years, the presentation of patients has varied, so carcinoma was classified on the basis of site, shape, and consistency for detailed analysis. Lifestyle patterns and occupational history were inquired about and recorded. Methods: Data from 100 patients presenting to the oncology and nephrology department of Mayo Hospital in the year 2015-2020 were included in this retrospective study on a random basis. The study was specifically focused on three risk factors. Smoking, occupational exposures, and Hakim medicine are taken by the patient for any cause. After procurement of data, follow-up contacts of these patients were established, resulting in a detailed analysis of lifestyle. Conclusion: The inference drawn is a direct causal link between smoking, industrial workplace exposure, and Hakim medicine with the development of Renal Cell Carcinoma. It was shown in the majority of the patients and hence confirmed our hypothesis.

Keywords: renal cell carcinoma, kidney cancer, clear cell carcinoma

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Authors: Harukuni Tokuda, Xu FengHao, Nobutaka Suzuki

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As part of an ongoing our projects to investigate the anti-tumor promoring properties (chemopreventive potency) of Gromwell seed, dry powder materials and its active compounds were carried out through useful test systems. Gromwell seed (Coix lachryma-jobi seed) (GS) is a grass crop that has long been used and played a role in traditional medicine as a nourishing food, and for the treatment of various aliments, paticularly cancer. The application of a new screening procedure which utilizes the synergistic effect of short-chain fatty acids and phorbol esters in enable rapid and easy detection of naturally occurring substances(anti-tumor promoters chemo-preventive agents) with inhibition of Epstein-Barr virus(EBV) activation, using human lymphblastoid cells. In addition, we have now extended these investigations to a new tumorigenesis model in which we initiated the tumors with DMBA intiation and promoted with 1.7 nmol of TPA in two-stage mouse skin test and other models. these results provide a basis for further development of these botanical supplements for human cancer chemoprevention and observations seem that this materials more extensively as one of the trials for the purpose of complementary and alternative medicine.

Keywords: chemoprevention, medicinal plant, mouse, carcinogenesis systems

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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: Chigozie Azunna, Lucius Botes

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Child homelessness is one of the critical challenges in South Africa in recent times. While children constitute a very significant demography of South Africa, child homeless broods a socio-economic crisis of varying magnitude. In order for the UN 2030 Agenda for Sustainable Development Goals (SDGs) to be achieved, especially with respect to equality and non-discrimination, child homeless needs to be effectively curbed. This will, in turn, contribute positively to the economic derivative of South Africa’s dynamic demography. Methodically, this research employed content analysis involving a comprehensive review of existing literature on child homelessness in South Africa. The study found a convergence of national policy and international agenda on curbing child homelessness in South Africa in spite of the following is a representation of the statistics of child homelessness in South Africa: in the metros, homelessness was (74,1%), while in non-metro is at 25.9%. The figure shows that the City of Tshwane has the highest number of homeless persons (18,1%), followed by the City of Johannesburg (15,6%) while the Nelson Mandela Bay metropolitan has the lowest percentage of homeless persons (2,7%). The study concluded that despite the existence of national policy options, child homeless has remained persistent. Worse still, there is a lack of accurate data, while the Covid pandemic, poverty, economic challenges, the HIV/AIDS epidemic, and implementation gaps in government policies have contributed to the widening challenge. The implication is severe, affecting children's physical and emotional health, education, and future opportunities. The study recommends strengthening actionable policies in addressing child homelessness by bridging the urban-rural gap as well as providing an intra-community network that ensures that child homelessness is effectively addressed, including addressing those manifold challenges like access to education and susceptibility to diseases and vulnerability of the homeless child.

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

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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: Mehani Mouna, Ladjel segni

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Humans use plants for thousands of years to treat various ailments, In many developing countries, Much of the population relies on traditional doctors and their collections of medicinal plants to cure them. Essential oils have many therapeutic properties. In herbal medicine, They are used for their antiseptic properties against infectious diseases of fungal origin, Against dermatophytes, Those of bacterial origin. The aim of our study is to determine the antimicrobial effect of essential oils of the plant Schinus molle on some pathogenic bacteria. It is a medicinal plant used in traditional therapy. Essential oils have many therapeutic properties. In herbal medicine, They are used for their antiseptic properties against infectious diseases of fungal origin, Against dermatophytes, Those of bacterial origin. The test adopted is based on the diffusion method on solid medium (Antibiogram), This method allows to determine the susceptibility or resistance of an organism according to the sample studied. Our study reveals that the essential oil of the plant Schinus molle has a different effect on the resistance of germs: For Pseudomonas aeruginosa strain is a moderately sensitive with an inhibition zone of 10 mm, Further Antirobactere, Escherichia coli and Proteus are strains that represent a high sensitivity, A zone of inhibition equal to 14.66 mm.

Keywords: Essential oil, microorganism, antibiogram, shinus molle

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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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: Farah Naja, Mohamad Alameddine

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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.

Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy

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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: Ntokozo Mthembu

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Access to relevant health indicates people’s likelihood of survival, including craft of indigenous healing and its related practitioners- izinyanga. However, the emergence of a dreaded novel corona virus - COVID-19 that has engulfed almost the whole world has necessitated the need to revisit the state of traditional healers in South Africa. This circumstance tended to expose the reality of social settings in various social structures and related policies including the manner coloniality reveal its ugly head when it comes treatment between western and African based therapeutic practices in this country. In attempting to gain a better understanding of such experiences, primary and secondary sources were consulted when collecting data that perusal of various literature in this instance including face-to-face interviews with traditional healers working on the street of Tshwane Municipality in South Africa. Preliminary findings revealed that the emergence of this deadly virus coincided with the moment when the government agenda was focussed on fulfilment of its promise of addressing the past inequity practices, including the transformation of medical sector. This scenario can be witnessed by the manner in which government and related agencies such as health department keeps on undermining indigenous healing practice irrespective of its historical record in terms of healing profession and fighting various diseases before times of father of medicine, Imhotep. Based on these preliminary findings, it is recommended that the government should hasten the incorporation of African knowledge systems especially medicine to offer alternatives and diverse to assess the underutilised indigenous African therapeutic approach and relevant skills that could be useful in combating ailments such as COVID 19. Perhaps, the plural medical systems should be recognized and related policies are formulated to guarantee mutual respect among citizens and the incorporation of healing practices in South African health sector, Africa and in the broader global community.

Keywords: indigenous healing practice, inyanga, COVID-19, therapeutic, urban, experience

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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: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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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: Adegoke A. Adeyelu, Adeola T. Adeyelu, S. D. Y. Alfred, O. O. Fasina

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This study examines the use of traditional medicines for the treatment of selected illnesses among crop-farming households in Edo State, Nigeria. A sample size of ninety (90) households were randomly selected for the study. Data were collected with a structured questionnaire alongside focus group discussions (FGD). Result shows that the mean age was 50 years old, the majority (76.7%) of the sampled farmers were below 60 years old. The majority (80.0%) of the farmers were married, about (92.2%) had formal education. It exposes that the majority of the respondents (76.7%) had household size of between 1-10 persons, about 55.6% had spent 11 years and above in crop farming. malaria (8th ), waist pains (7th ), farm injuries ( 6th ), cough (5th), acute headache(4th), skin infection (3rd), typhoid (2nd) and tuberculosis (1st ) were the most and least treated illness. Respondents (80%) had spent N10,000.00 ($27) and less on treatment of illnesses, 8.9% had spent N10,000.00-N20,000.0027 ($27-$55) 4.4% had spent between N20,100-N30,000.00 ($27-$83) while 6.7% had spent more than N30,100.00 ($83) on treatment of illnesses in the last one (1) year prior to the study. Age, years of farming, farm size, household size, level of income, cost of treatment, level of education, social network, and culture are some of the statistically significant factors influencing the utilization of traditional medicine. Farmers should be educated on methods of preventing illnesses, which is far cheaper than the curative.

Keywords: crop farming-households, selected illnesses, traditional medicines, Edo State

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Authors: Satoshi Furukawa, Satomu Morita, Katsuji Nishi, Masahito Hitosugi

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We experience the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvement identified in patients who died from traffic trauma and were considered by the quality improvement of education system. The Japan Advanced Trauma Evaluation and Care (JATEC) education program was introduced in 2002. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident between April 1999 and March 2014 subjected to medico-legal autopsy at the department of Forensic Medicine, Shiga University of Medical Science. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meet with accident was 13.5 hours, compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were liver followed by mesentery. We thought delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.

Keywords: abdominal traffic trauma, preventable death, autopsy, emergency medicine

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Authors: M. Umar Hafeez, Furqan Khursheed Hashmi, Nadeem Irfan Bukhari, Shahzad Ali, Muzammil Ali

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The trend of self-medication is increasing due to various factors and is associated with a large number of complications. A cross-sectional study was aimed to investigate self-medication trend in an urban community and its correlates such as level of education, gender and behavior of using psychoactive medicines. A validated questionnaire was used to collect the data from different locations of Lahore, provincial capital of Punjab, Pakistan. The trend of self-medication was noted in reference to difference in educational level and in gender. This study showed that total 110 respondents, all literate,were found to be self-medicating, and their educational status was as 73.13% primary, 63.15% secondary, 61.12% higher secondary and 62.15% university going. In this sample 74.99% were males and 48.00%were females. Twenty nine (26.36%) of the total sample were found to be using psychoactive agents without consulting the physician. The trend of self-medication was 10% higher in individuals having primary level education, whereas there was not much difference of self-medication trend in other levels of education. The main reasons involved in self-medication trend were socio-economic status, medicine accessibility, religious and cultural beliefs, lack of awareness about risks associated with medicine, non-prescription sale of medicines and previous medication experience. The trend of self-medication of psychotropic agents is quite significant.

Keywords: self-medication, educated community, psychotropic drugs, education levels

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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: 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: John Gaber

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Objectives: Complementary and alternative medicine (CAM) is a medicine or health practice that is used alongside conventional practice. Nowadays, CAM is commonly used in North America and other countries, and there is a need for more scientific study to understand its efficacy in different clinical cases. This retrospective study explores the effectiveness and recovery time of CAMs such as cupping, acupuncture, and sotai to treat cases of non-specific low back pain (ANLBP). Methods: We assessed the effectiveness of acupuncture, cupping, and sotai methods on pain and for the treatment of ANLBP. We have compared the magnitude of pain relief using a pain scale assessment method to compare the efficacy of each treatment. The Face Pain Scale assessment was conducted before and 24 hours post-treatment. This retrospective study analyzed 40 patients and categorized them according to the treatment they received. The study included the control group, and the three intervention groups, each with ten patients. Each of the three intervention groups received one of the intervention methods. The first group received the cupping treatment, where cups were placed on the lower back of both sides on points: BL23, BL25, BL26, BL54, BL37, BL40, and BL57. After vacuuming, the cups will stay for 10-15 minutes under infrared light (IR) heating. IR heating is applied by an infrared heat lamp. The second group received the acupuncture treatment, placing needles on points: BL23, BL25, BL26, BL52BL54, GB30, BL37, BL40, BL57, BL59, BL60, and KI3. The needles will be simulated with IR light. The final group received the sotai treatment, a Japanese form of structural realignment that relieves pain, balance, and mobility -moving the body naturally and spontaneously towards a comfortable direction by focusing on the inner feeling and synchronizing with the patient’s breathing. The SPSS statistical software was used to analyze the data using repeated-measures ANOVA. The data collected demonstrates the change in the FPS assessment method value over the course of treatment. p<0.05 was considered statistically significant. Results: In the cupping, acupuncture, and sotai therapy groups, the mean of the FPS value reduced from 8.7±1.2, 8.8±1.2, 9.0±0.8 before the intervention to 3.5±1.4, 4.3±1.4, 3.3±1.3, 24 hours after the intervention, respectively. The data collected shows that the CAM methods included in this study all show improvements in pain relief 24 hours after treatment. Conclusion: Complementary and alternative medicine were developed to treat injuries and illnesses with the whole body in mind, designed to be used in addition to standard treatments. The data above shows that the use of these treatments can have a pain-relieving effect, but more research should be done on the matter, as finding CAM methods that are efficacious is crucial in the landscape of health sciences.

Keywords: acupuncture, cupping, alternative medicine, rehabilitation, acute injury

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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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