The panorama and outcomes of reported pregnancies within a well defined population in rural Vietnam 1999-2004

Background Pregnancy outcomes in the general population are important public health indicators. Purpose The overall aim of this study was to investigate the outcomes of reported pregnancies within a well-defined population, to identify risk groups for adverse pregnancy outcomes, and to suggest preventive measures. Method A prospective population-based cohort study of pregnant women in Bavi district, Vietnam between 1 January 1999 and 30 June 2004. Results Pregnancy outcome was reported for 5,259 cases; 4,152 (79%) resulted in a live birth, 67 (1.3%) in a stillbirth, 733 (14%) in an induced abortion, and 282 (5.4%) in a spontaneous abortion. There was an increased risk of home delivery for women from ethnic minorities (OR?=?1.85; 95%CI?=?1.06–3.24) or with less than 6 years of schooling (OR?=?7.36; 95%CI?=?3.54–15.30). The risk of stillbirth was increased for ethnic minorities (OR?=?6.34; 95%CI?=?1.33–30.29) and women delivering at home (OR?=?6.81; 95%CI?=?2.40–19.30). The risk of induced abortion increased with maternal age. Conclusion Our findings emphasize the public health significance of access to adequate family planning, counselling, and maternal health care for all women. Policies should specifically target women from high-risk groups.

Methodological issues in applying Location Models to Rural areas

Location Models are usedfor planning the location of multiple service centers in order to serve a geographicallydistributed population. A cornerstone of such models is the measure of distancebetween the service center and a set of demand points, viz, the location of thepopulation (customers, pupils, patients and so on). Theoretical as well asempirical evidence support the current practice of using the Euclidian distancein metropolitan areas. In this paper, we argue and provide empirical evidencethat such a measure is misleading once the Location Models are applied to ruralareas with heterogeneous transport networks. This paper stems from the problemof finding an optimal allocation of a pre-specified number of hospitals in alarge Swedish region with a low population density. We conclude that the Euclidianand the network distances based on a homogenous network (equal travel costs inthe whole network) give approximately the same optimums. However networkdistances calculated from a heterogeneous network (different travel costs indifferent parts of the network) give widely different optimums when the numberof hospitals increases.  In terms ofaccessibility we find that the recent closure of hospitals and the in-optimallocation of the remaining ones has increased the average travel distance by 75%for the population. Finally, aggregation the population misplaces the hospitalsby on average 10 km.

Distance measure and the p-median problem in rural areas

The p-median model is used to locate P facilities to serve a geographically distributed population. Conventionally, it is assumed that the population patronize the nearest facility and that the distance between the resident and the facility may be measured by the Euclidean distance. Carling, Han, and Håkansson (2012) compared two network distances with the Euclidean in a rural region witha sparse, heterogeneous network and a non-symmetric distribution of thepopulation. For a coarse network and P small, they found, in contrast to the literature, the Euclidean distance to be problematic. In this paper we extend their work by use of a refined network and study systematically the case when P is of varying size (2-100 facilities). We find that the network distance give as gooda solution as the travel-time network. The Euclidean distance gives solutions some 2-7 per cent worse than the network distances, and the solutions deteriorate with increasing P. Our conclusions extend to intra-urban location problems.

A framework for ICT-based knowledge sharing in sustainable rural development : the case of Gilgit-Baltistan, Pakistan

Some 50% of the people in the world live in rural areas, often under harsh conditions and in poverty. The need for knowledge of how to improve living conditions is well documented. In response to this need, new knowledge of how to improve living conditions in rural areas and elsewhere is continuously being developed by researchers and practitioners around the world. People in rural areas, in particular, would certainly benefit from being able to share relevant knowledge with each other, as well as with stakeholders (e.g. researchers) and other organizations (e.g. NGOs). Central to knowledge management is the idea of knowledge sharing. This study is based on the assumption that knowledge management can support sustainable development in rural and remote regions. It aims to present a framework for knowledge management in sustainable rural development, and an inventory of existing frameworks for that. The study is interpretive, with interviews as the primary source for the inventory of stakeholders, knowledge categories and Information and Communications Technology (ICT) infrastructure. For the inventory of frameworks, a literature study was carried out. The result is a categorization of the stakeholders who act as producers and beneficiaries of explicit and indigenous development knowledge. Stakeholders are local government, local population, academia, NGOs, civil society and donor agencies. Furthermore, the study presents a categorization of the development knowledge produced by the stakeholders together with specifications for the existing ICT infrastructure. Rural development categories found are research, funding, agriculture, ICT, gender, institutional development, local infrastructure development, and marketing & enterprise. Finally, a compiled framework is presented, and it is based on ten existing frameworks for rural development that were found in the literature study, and the empirical findings of the Gilgit-Baltistan case. Our proposed framework is divided in four levels where level one consists of the identified stakeholders, level two consists of rural development categories, level three of the knowledge management system and level four of sustainable rural development based on the levels below. In the proposed framework we claim that the sustainability of rural development can be achieved through a knowledge society in which knowledge of the rural development process is shared among all relevant stakeholders.

Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

How does the use of different road networks effect the optimal location of facilities in rural areas?

The p-median problem is often used to locate P service facilities in a geographically distributed population. Important for the performance of such a model is the distance measure. Distance measure can vary if the accuracy of the road network varies. The rst aim in this study is to analyze how the optimal location solutions vary, using the p-median model, when the road network is alternated. It is hard to nd an exact optimal solution for p-median problems. Therefore, in this study two heuristic solutions are applied, simulating annealing and a classic heuristic. The secondary aim is to compare the optimal location solutions using dierent algorithms for large p-median problem. The investigation is conducted by the means of a case study in a rural region with an asymmetrically distributed population, Dalecarlia. The study shows that the use of more accurate road networks gives better solutions for optimal location, regardless what algorithm that is used and regardless how many service facilities that is optimized for. It is also shown that the simulated annealing algorithm not just is much faster than the classic heuristic used here, but also in most cases gives better location solutions.

Methods and background characteristics of the TOHNN study : a population-based study of oral health conditions in northern Norway

OBJECTIVES: The aim of the Tromstannen - Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection. STUDY DESIGN: Cross-sectional population-based study including a questionnaire and clinical dental examination. METHODS: A randomly selected sample of 2,909 individuals (20-79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20-34, 35-49, 50-64 and 65-79) and ethnicity (Norwegian, Sámi, other European and other world). RESULTS: From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20-34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service. CONCLUSION: The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.

Young adults’ perceptions of and affective bonds to a rural tourism community

Many rural areas, in Sweden and worldwide, experience population decline where the young leave for education and work in urban areas. Employment has declined in several rural industries, such as agriculture, forestry, and fishing, while growing in other industries are often located in urban areas. Politicians and organizations have put much hope in tourism as a tool of rural development, but can tourism help reverse the rural out-migration trend among young adults? This paper explores how tourism affects young inhabitants’ perceptions of and affective bonds to a rural area in Sweden, the ski resort of Sälen. Students from the 1993–1995 elementary school graduating classes were interviewed about their migration history, childhood, and view of and ties to Sälen. The respondents experience that tourism contributes to a more vital community incorporating influences from elsewhere, but without eliminating the positive aspects of rural life. The regular flow of people – tourists, seasonal workers, and entrepreneurs – passing through Sälen presents opportunities to extend one’s social network that are widely appreciated by respondents. The high in and out mobility constitutes a key part of Sälen’s character. Contributions from tourism – such as employment, entertainment, leisure, and opportunities to forge new social relationships – are available during the adult transition, the life phase when rural areas are often perceived as least attractive. Even though out-migration occurs in Sälen, and some respondents still find Sälen too small, tourism has clearly increased the available opportunities and contributed significantly to making Sälen more attractive to young adults.

Young adults in rural tourism areas

This thesis examines how tourism affects conditions for young adults in rural areas. Such a study lies at the intersection of research about tourism impacts, adult transition, and rural areas. The aim is to examine how largescale tourism affects the opportunities for young adults living in rural areas; their perception of place and the perceived opportunities and obstacles that tourism provides. The thesis utilizes a mixed method approach. A quantitative study based on micro-data on individuals identifies the patterns and magnitudes of the mechanisms by which tourism affects population change among young adults. Interview methods are used in the case study area, Sälen, to investigate these mechanisms in depth. Finally, the rural–urban dichotomy is explored in a conceptual study that asks how tourism affects the perception of a local village as either rural or urban. Young inhabitants in rural areas are rarely considered in tourism research; therefore, the main contribution of this thesis is that it illuminates how tourism affects conditions for young adults in rural areas. The thesis reveals a substantial impact on the adult transition, mainly due to easier access to the labor market and a good supply of jobs during the high season. Further, the large number of people passing through creates flows of opportunities to make friends, get a job, or just meet people. All of these factors contribute to high mobility in these places, and to the perception of them as places where things happen. The high mobility in Sälen implies that fixed migrant categories (such as stayers and leavers) are largely insufficient. The tourism environment creates a space that is always under construction and continually producing new social relations mainly perceived as opportunities. Conceptualizing this as a modern rurality is a way to move beyond the often implicit notions of urban as modern and rural as traditional.