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Agriculture is a very important sector of the economy that has a great influence on rural areas. Almost sixty years of the Common Agricultural Policy (CAP) in the European Union (EU) may impose a question on the impact of this policy on job creation and economic growth in rural areas. By analyzing key indicators, one should note that although there are still many problems to tackle, the CAP has been successful to some extend in increasing employment rate and Gross Domestic Product (GDP) per capita as well as decreasing poverty rate in the EU rural areas. There are also more and more households connected to the next-generation broadband network and there is still a significant number of bed places in the EU rural areas. Although, the situation in specific EU Member States and their rural regions may be different, the overall performance of the EU is satisfactory and shows positive prognostics for the current EU financial perspective of 2021–2027. This paper also provides an empirical approach which checks whether there is a connection between the employment rate and the rural development measured in GDP per capita based on the data from the Baltic States: Estonia, Latvia and Lithuania in the period of 2000–2020. This research confirms that when increasing the level of rural employment, the economic growth rises in rural areas.

Background Maternal education is universally recognised as a major factor in positive societal indicators (health, wellbeing, overall education, etc.) and a country’s growth and economic sustainability, yet the underlying factors contributing to maternal education have not been widely investigated, especially in developing countries. Objective This study investigated the 15-year trend of maternal education in Bangladesh (2004–2018) to identify the factors contributing to maternal education. Method This study used publicly available cross-data from five consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2018). Level of maternal education was grouped as ‘no education’, ‘incomplete primary’, ‘complete primary’, ‘incomplete secondary’, ‘complete secondary’ and ‘higher education’ (reference group). The differences in factors/exposure variables suspected to contribute to maternal education were measured for these groups for 2004–2018, and a survey multinomial logistic regression was performed to estimate the explanatory value of these factors. Results From 2004–2018, there was a 62% gross reduction of the no education group and a 61% gross increase in the higher education group. A gross increase was also observed for complete secondary (49%), incomplete secondary (39%) and complete primary education (14%). In multivariate analysis, in rural areas, in 2018, the probability of a woman being in the complete primary, incomplete primary or no education groups was increased (adjusted relative risk ratio: 1.21, 1.40 and 1.59), compared to 2004 (0.73, 1.09, 1.12), respectively. From 2004–2018, the factor of no television watching reduced the probability of maternal education levels. Having a husband/partner who had no education increased the probability of a woman’s education level. The probability of all maternal education levels decreased across all wealth index groups. Conclusion The data suggest that average maternal education level in Bangladesh increased from 2004–2018. However, an integrated effort is required to improve factors associated with maternal education to both increase maternal education and Bangladesh’s long-term sustainability.

International audience; Social Scientists and policy makers need precise data on market rents. Yet, while housing prices are systematically recorded, few accurate data sets on rents are available. In this paper, we present a new data set describing local rental markets in France based on online ads collected through to webscraping. Comparison with alternate sources reveals that online ads provide a non biased picture of rental markets and allow coverage of the whole territory. We then estimate hedonic models for prices and rents and document the spatial variations in rent-price ratios. We show that rents do not increase as much as prices in the tightest housing markets. We use our dataset to estimate the market rent of each transaction and of social dwellings. In the latter case,this allows us to estimate the in-kind benefit received by social tenants which is mainly driven by the level of private rent in their municipality.

The complex correlation between regions caused by the externality of air pollution increases the difficulty of its governance. Therefore, analysis of the spatio-temporal network of air pollution (STN-AP) holds great significance for the cross-regional coordinated governance of air pollution. Although the spatio-temporal distribution of air pollution has been analyzed, the structural characteristics of the STN-AP still need to be clarified. The STN-AP in the Yangtze River Delta urban agglomeration (YRDUA) is constructed based on the improved gravity model and is visualized by UCINET with data from 2012 to 2019. Then, its overall-individual-clustering characteristics are analyzed through social network analysis (SNA) method. The results show that the STN-AP in the YRDUA was overall stable, and the correlation level gradually improved. The centrality of every individual city is different in the STN-AP, which reveals the different state of their interactive mechanism. The STN-AP could be subdivided into the receptive block, overflow block, bidirectional block and intermediary block. Shanghai, Suzhou, Hangzhou and Wuxi could be key cities with an all above degree centrality, betweenness centrality and closeness centrality and located in the overflow block of the STN-AP. This showed that these cities had a greater impact on the STN-AP and caused a more pronounced air pollution spillovers. The influencing factors of the spatial correlation of air pollution are further determined through the quadratic assignment procedure (QAP) method. Among all factors, geographical proximity has the strongest impact and deserves to be paid attention in order to prevent the cross-regional overflow of air pollution. Furthermore, several suggestions are proposed to promote coordinated governance of air pollution in the YRDUA.

Background Induction of labor is one of the most used obstetric procedures in the world. It is performed in around 20% of all pregnancies. Failed induction of labor, on the other hand, has been associated with poorer mother and newborn health outcomes. Besides, there is a scarcity of data on the current burden and drivers. Therefore, this study aimed to assess the prevalence and factors associated with failed induction in Worabe Comprehensive Specialized Hospital, Southern Ethiopia. Methods A retrospective cross-sectional study was conducted on medical records of mothers who delivered through induction of labor during September 1st, 2018 to August 30th, 2020. The samples were collected using a systematic sampling technique. The data was extracted using a checklist. Data were entered into EpiData (version 3.1) and analyzed using SPSS (version 24). Multivariable logistic regression analyses were used to decide the association of explanatory variables with the outcome variable. Odds ratio with their 95% CI were calculated to identify the presence and strength of an association. A p-value of < 0.05 was used to declare statistical significance. Results In this study, the prevalence of failed induction was observed to be 22.2%. The associated factors included rural residence (AOR = 5.7, 95% CI: 3.12–11.02), primiparity (AOR = 8.4, 95% CI: 2.72–22.36) and unfavourable bishop score (AOR = 5.9, 95% CI: 4.52–16.12). Conclusions In comparison to the rate reported in developed countries, the study area had a high rate of failed induction. Being rural residence, primiparity and unfavourable bishop score were the associated factors of failed induction. Therefore, to reduce of the rate of failed induction, health care practitioners should analyze cervical status (using Bishop Score) to decide the possibility of successful induction, with a focus on associated factors like parity.

We devised and assessed open recruitment of host families for medical student homestays in a rural area of Hyogo Prefecture, Japan, so that program organizers would not have to depend on professional and personal connections. The duration of the homestays was one night and two days, and they were conducted in August 2016, 2017, and 2018. The purpose of this community-based medical education program was to promote interactions between medical students and residents of Tamba area. The study asked one family member from each host family to complete a questionnaire after the homestay, and their experiences were evaluated in the study. The questionnaire results were analyzed using a visual analog scale (VAS; 0–100 mm). Thirty-three host families participated in the homestay program over three years. Results showed that VAS scores were high for enjoyment of homestays (VAS; 92.4 ± 13.0), continuation of the homestay program (91.7 ± 12.7), continuation of participation in the homestay program (89.2 ± 16.2), and desire for the homestay students to work in the area in the future (95.4 ± 6.3). The recruitment of host families through advertising was an efficient method for this community-based medical education homestay program. The results indicate that it is possible to attract more host families through open recruitment, which will contribute to the sustainability of the homestay program. Further research, including a follow-up of the students who participated and whether they chose a rural area or Tamba to practice is needed in the future. Since this is an ongoing program, further research in a similar format can be conducted in the future.

In the last four decades, the problem of income inequality has gradually become one of the most serious social problems in China at both the regional and individual levels. Recently, the central government announced that the main social contradiction is that between people’s growing need for a better life and unbalanced and insufficient economic development. In this study, we analyse the effects of income distribution on individuals’ health using a series of indicators of income distribution and different measures of individuals’ health status. By utilizing data from the China Health and Nutrition Survey (CHNS) from 1989 to 2015, our empirical findings show that self-reported health (SRH), activities of daily living (ADLs), and diabetes mellitus appear to be negatively related to the income share of rich people when average income is equalized among counties, which indicates that individuals’ health will deteriorate as the income share of rich people increases. In addition, our results show that there is an inverted U-shaped relationship between income inequality, as measured by the county-level Gini coefficient, and individuals’ health status. We also find that income inequality affects health through the accessibility of healthcare facilities and public infrastructures and through hazardous health behaviours such as smoking and alcohol use. These findings suggest that reducing income inequality could be an important means of improving the overall health of China’s population.

During the COVID-19 pandemic, US public land managers faced the challenge of catering to large increases in camping demand, while maintaining social distancing guidelines. In this paper, we use multivariate linear regression to analyze weekly changes in reservations to US Forest Service (USFS) campgrounds between 2019 and 2020. The regression models estimate the impact of local COVID infection rates, public health restrictions, and spatial spillovers from proximity to National Parks (NPs), metropolitan areas and wildfire on camping demand. Our sample includes 1,688 individual USFS campgrounds from across the contiguous US. The results illustrate the dramatic increases in camping on USFS land that occurred in the summer of 2020 and demonstrate that increases in local infection rates led to significant increases in camping nights reserved in the summer. The results also illustrate that the increase in camping nights reserved at USFS campgrounds was particularly dramatic for campgrounds located near large metropolitan areas and near NPs that saw increases in overall recreational visits. These results point to the important role that public lands played during the pandemic and can help guide public land resource allocations for campground maintenance and operation.

Due to unreasonable pricing, farmers have low enthusiasm for reclaiming their homesteads, which can be used to generate construction land quota. This paper studies how to design a feasible pricing mechanism to stimulate the enthusiasm of farmers. First, we analyze the practice that the local government gives the developers with quota the selection, the right to select the location of the land to be auctioned. Then, applying sequential auction theory, we propose first- and second-price sealed-bid sequential auction models and design quota auction pricing mechanisms. Through theoretical and numerical analysis, we obtain the equilibrium strategy and analyze the impact of selection and on developers’ bidding pricing on quota. The results show that the selection can enhance the developer’s quota bidding price and farmers’ income. And the higher the value of selection to the developer, the higher the quota bidding price and farmer’s income. Contrarily, the larger the number of developers, the smaller the quota bidding price and farmers’ income. Finally, the quota bidding price and farmers’ income in the second-price sealed-bid sequential auction are higher than in the first-price sealed-bid sequential auction.

Since ride-hailing has become an important travel alternative in many cities worldwide, a fervent debate is underway on whether it competes with or complements public transport services. We use Uber trip data in six cities in the United States and Europe to identify the most attractive public transport alternative for each ride. We then address the following questions: (i) How does ride-hailing travel time and cost compare to the fastest public transport alternative? (ii) What proportion of ride-hailing trips do not have a viable public transport alternative? (iii) How does ride-hailing change overall service accessibility? (iv) What is the relation between demand share and relative competition between the two alternatives? Our findings suggest that the dichotomy—competing with or complementing—is false. Though the vast majority of ride-hailing trips have a viable public transport alternative, between 20% and 40% of them have no viable public transport alternative. The increased service accessibility attributed to the inclusion of ride-hailing is greater in our US cities than in their European counterparts. Demand split is directly related to the relative competitiveness of travel times i.e. when public transport travel times are competitive ride-hailing demand share is low and vice-versa.

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Background Leprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions. Methodology/Principal findings Using data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States. Conclusions/Significance The magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission., Author summary Leprosy remains an important public health problem that affects vulnerable populations in low- and middle-income countries. In this study, we estimated how many cases were not detected in each Brazilian microregion by the surveillance system during the period of 2007 until 2015. Using a mathematical model, we found out that around 10% of the estimated number of cases occurring in the country in the study period were missed by the health system, and this represented over 33 thousand cases overall. These findings are important as undetected and therefore untreated cases can progress and lead to lifelong disabilities. In addition, missing cases prevents the health system from evaluating exposed contacts, which could lead to further delays in diagnosis. Describing the magnitude, location and correlates of leprosy underreporting at the microregional level will inform the efforts of policymakers and program managers in designing interventions and allocating resources to achieve leprosy control targets.

Echinococcosis is a serious zoonotic parasitic disease transmitted from canines to humans and livestock. Periodic deworming is recommended by the WHO/OIE as a highly effective measure against echinococcosis. However, manual deworming involves significant challenges, particularly in remote areas with scarce resources. The insufficient awareness delivering praziquantel (PZQ) baits for dogs leads to low compliance rate. The aim of this study was therefore to develop a novel smart collar for dogs to address these challenges. We developed a smart Internet of Things (IoT)-based deworming collar which can deliver PZQ baits for dogs automatically, regularly, quantitatively with predominant characteristics of being waterproof, anti-collision, cold-proof and long life battery. Its performance was tested in two remote locations on the Tibetan Plateau. A cross-sectional survey was conducted to evaluate the compliance of the dog owners. Further, a randomized controlled study was performed to evaluate the difference between smart-collar deworming and manual deworming. The collar’s effectiveness was further assessed on the basis of Generalized Estimation Equations (GEE). The testing and evaluation was done for 10 smart deworming collars in factory laboratory, 18 collars attached for 18 dogs in Seni district, Tibet Autonomous Region, China, and 523 collars attached for 523 dogs in Hezuo city, Gansu province, China. The anti-collision, waterproof, and coldproof proportion of the smart collars were 100.0%, 99.5%, and 100.0%, respectively. When compared to manual deworming, the dogs’ risk of infection with Echinococcus on smart-collar deworming is down to 0.182 times (95% CI: 0.049, 0.684) in Seni district and 0.355 (95%CI: 0.178, 0.706) in Hezuo city, the smart collar has a significant protective effect. The owners’ overall compliance rate to attach the smart collars for their dogs was 89%. The smart deworming collar could effectively reduce the dogs’ risk of infection with Echinococcus in dogs, significantly increase the deworming frequency and coverage and rapidly remove worm biomass in dogs. Thus, it may be a promising alternative to manual deworming, particularly in remote areas on the Tibetan Plateau., Author summary Echinococcosis remains a critical but neglected zoonotic parasitic disease transmitted between canines and livestock or wild rodents. Dogs play a key role in Echinococcus granulosus sensu lato (s.l.) and E. multilocularis transmission, dual infection also occurs in dogs in co-endemic regions in China. The initial egg-production phase occurs over a span of 34–58 days (E. granulosus) or 28–35 days (E. multilocularis) following infection. The free-living eggs, voided with faeces of the definitive host, can withstand extreme weather conditions and remain viable for 240 days (E. granulosus) or 41 months (E. multilocularis) in the environment. Removal or reduction of the worm biomass in dogs will have the greatest and fastest effect in terms of reducing active transmission. In China, although significant efforts have been expended to achieve monthly manual deworming, the actual frequency and coverage thereof remain low; therefore, Echinococcus spp. is still highly prevalent among dogs. Moreover, echinococcosis transmission is still rampant, as the heavy disease burden suggests. We propose a novel, smart, Internet of Things (IoT)-based deworming tool that can deliver PZQ baits to dogs regularly and automatically. It could increase the deworming frequency and coverage significantly, reduce the risk of infection by down to 0.182–0.355 times, and prevent canine infections by removing the worm biomass in dogs rapidly. This deworming collar could also potentially prevent the transmission of echinococcosis from dogs to humans and livestock completely. It may be an excellent alternative to existing manual deworming methods, and the difficulties associated with performing deworming in remote areas with scarce resources can be overcome. Since the discovery of PZQ as the most effective antiworm drug, few breakthroughs have been achieved in terms of novel tools and technologies for the control of echinococcosis. Over the last 50 years, echinococcosis control measures have lagged to keep up with the World Health Organization (WHO) roadmap for the elimination of the disease owing to the practical difficulties in remote areas with scarce resources as well as the lack of promotion of new technologies. We expect the proposed smart deworming collar to herald the development of more innovative technologies for controlling echinococcosis by accelerating the elimination of the disease.

Visceral leishmaniasis (VL) is one of the most prevalent parasitic diseases worldwide. In 2019, 97% of the total numbers of cases in Latin America were reported in Brazil. In São Paulo state, currently 17.6% of infected individuals live in the western region. To study this neglected disease on a regional scale, we describe the spread of VL in 45 municipalities of the Regional Network for Health Assistance11(RNHA11). Environmental, human VL (HVL), and canine VL (CVL) cases, Human Development Index, and Lutzomyia longipalpis databases were obtained from public agencies. Global Moran’s I index and local indicators of spatial association (LISA) statistics were used to identify spatial autocorrelation and to generate maps for the identification of VL clusters. On a local scale, we determined the spread of VL in the city of Teodoro Sampaio, part of the Pontal of Paranapanema. In Teodoro Sampaio, monthly peri-domicile sand fly collection; ELISA, IFAT and Rapid Test serological CVL; and ELISA HVL serum surveys were carried out. In RNHA11 from 2000 to 2018, Lu. longipalpis was found in 77.8%, CVL in 69%, and HVL in 42.2% of the 45 municipalities, and 537 individuals were notified with HVL. Dispersion occurred from the epicenter in the north to Teodoro Sampaio, in the south, where Lu. longipalpis and CVL were found in 2010, HVL in 2018, and critical hotspots of CVL were found in the periphery. Moran’s Global Index showed a weak but statistically significant spatial autocorrelation related to cases of CVL (I = 0.2572), and 11 municipalities were identified as priority areas for implementing surveillance and control actions. In RNHA11, a complex array of socioeconomic and environmental factors may be fueling the epidemic and sustaining endemic transmission of VL, adding to the study of a neglected disease in a region of São Paulo, Brazil., Author summary Visceral leishmaniasis (VL) is considered the second most important disease caused by a protozoan worldwide. Currently, 97% of the cases in Latin America are in Brazil. In São Paulo state, since 1997, the disease has been found in an increasing number of municipalities, mainly in the western region. The reasons why VL is spreading in a crescent shape in this region is not well understood, however, socioeconomic and environmental risk factors that increase vulnerability to the disease may be involved. From 2000 to 2018, vectors of Lutzomyia longipalpis were found in 77.8%, canine VL in 69%, and human VL in 44.4% of the 45 municipalities of the western region. Dispersion occurred from the epicenter in the north and followed central and radial highways, reaching Teodoro Sampaio in the south. Among the 45 municipalities, 11 were identified as priority areas for implementing surveillance and control actions. Considered the last frontier and one of the poorest regions of São Paulo, our findings are relevant for planning interventions aimed at reducing the cases of VL in the region.

Background The municipality of Caratinga is an important endemic area for American Tegumentary Leishmaniasis (ATL) and no epidemiological studies were performed during the past two decades. Here, we analyzed the epidemiological situation and the geographical distribution of ATL cases in the municipality of Caratinga from 2007 to 2018 using geographic information systems (GIS). Also, we evaluated the impact of several demographic parameters in ATL distribution and the sand flies incriminated in its transmission. Methods All demographic information (gender, age, educational level, clinical form, diagnostic criteria and case evolution) used in this study was retrieved from the public health archives and confirmed in the State Health Services databases. All cases were analyzed using GIS software based on ATL distribution. Also, non-systematic sand fly collections and molecular detection of Leishmania were performed in the hotspots. Results and conclusions During the period, ATL cases continued and increased especially in the past years (2016–2018). Hotspots included urban Caratinga areas and the districts of Patrocínio de Caratinga and Sapucaia. The species Nyssomyia whitmani, Nyssomyia intermedia, Migonemyia migonei and Evandromyia cortelezzii complex were captured. However, ITS1-PCR did not detect Leishmania DNA in those insects. Based on our analyses, urbanization of ATL in Caratinga has occurred in the past years. Due to the increase in the number of cases and vectors presence, it is recommended that health authorities focus on control measures in the most affected areas (Patrocínio of Caratinga and Sapucaia districts and urban Caratinga)., Author summary Leishmaniasis is an important health problem in Latin American countries and worldwide. In some places, notification is limited and underreported hindering correct assessment of existing data. In Brazil, ATL is mainly caused by Leishmania (Viannia) braziliensis. It is transmitted by sand fly vectors Nyssomyia whitmani and Nyssomyia intermedia. ATL comprises different clinical manifestations including cutaneous leishmaniasis, muco-cutaneous leishmaniasis and atypical leishmaniasis. The objective is to present the spatial distribution of cases of ATL notified by the Public Health System of Caratinga between the period of 2007 and 2018. This city is one of the most important endemic areas in the State of Minas Gerais and compose the panel of knowledge on epidemiological aspects of cutaneous leishmaniasis caused by L. braziliensis. This information will be important for developing strategies for ATL control in the affected areas. There is strong evidence that supports ATL urbanization in the city of Caratinga and increase of cases in two rural districts (Sapucaia and Patrocínio de Caratinga).

Background Guinea worm is a debilitating parasitic infection targeted for eradication. Annual human cases have dropped from approximately 3,500,000 in 1986 to 54 in 2019. Recent identification of canine cases in Chad threatens progress, and therefore detection, prevention, and containment of canine cases is a priority. We investigated associations between disease knowledge, community engagement, and canine cases in Chad to identify opportunities to improve active surveillance. Methods We surveyed 627 respondents (villagers, local leaders, community volunteers, and supervisors) across 45 villages under active surveillance. Descriptive statistics were analyzed by respondent category. Logistic regression models were fitted to assess the effects of volunteer visit frequency on villager knowledge. Results Knowledge increased with respondents’ associations with the Guinea worm program. Household visit frequency by community volunteers was uneven: 53.0% of villagers reported visits at least twice weekly and 21.4% of villagers reported never being visited. Villagers visited by a volunteer at least twice weekly had better knowledge of Guinea worm symptoms (OR: 1.71; 95% CI: 1.04–2.79) and could name more prevention strategies (OR: 2.04; 95% CI: 1.32–3.15) than villagers visited less frequently. The primary motivation to report was to facilitate care-seeking for people with Guinea worm. Knowledge of animal “containment” to prevent contamination of water, knowledge of rewards for reporting animal cases, and ability to name any reasons to report Guinea worm were each positively correlated with village canine case counts. Conclusions Community volunteers play crucial roles in educating their neighbors about Guinea worm and facilitating surveillance. Additional training and more attentive management of volunteers and supervisors could increase visit frequency and further amplify their impact. Emphasizing links between animal and human cases, the importance of animal containment, and animal rewards might improve surveillance and canine case detection. The surveillance system should be evaluated routinely to expand generalizability of data and monitor changes over time., Author summary Guinea worm eradication depends on detecting people and animals with the disease in order to prevent transmission. The situation in Chad is especially urgent because the number of domestic dogs with Guinea worm has been rapidly increasing in the past five years, and now represents the vast majority of Guinea worm cases globally. The global Guinea Worm Eradication Program, the Chad Guinea Worm Eradication Program, and the Chad Ministry of Public Health requested an investigation to evaluate the associations between Guinea worm knowledge, community engagement, and case detection and to investigate how the active surveillance system could be improved to more effectively detect and contain every Guinea worm case. We surveyed 627 people across 45 villages in Chad. We found that Chad’s system for monitoring Guinea worm operates unevenly, with some villagers receiving frequent visits by community volunteers and other villagers reporting never being visited. Villagers visited by a community volunteer at least twice per week had much better knowledge of Guinea worm symptoms and prevention, compared with villagers visited less frequently. Community volunteers are instrumental to Guinea worm eradication efforts in Chad because they transmit key educational messages that facilitate disease detection. More efforts should be made to increase volunteer accountability and to provide volunteers and their supervisors with targeted, high quality training.

Background Hand foot and mouth disease (HFMD) is becoming one of the common human infectious diseases in China. Previous studies have described HFMD in tropical or coastal areas of Asia-Pacific countries. However, limited studies have thoroughly studied the epidemiology and potential risk factors for HFMD in inland areas with complex environmental conditions. Methodology/Principal findings Using the data from 2009 to 2018 on reported cases of Xinjiang Uighur Autonomous Region, we characterized the epidemic features of HFMD. Panel negative binomial model was used to identify climate, geographical and demographic determinants for HFMD incidence. A total of 70856 HFMD cases (average annual incidence: 305 per million persons) were reported in Xinjiang during the 10-year study period, of which 10393 (14.7%) were laboratory-confirmed and 98 (0.1%) were severe. HFMD peaked in summer every year during the study period, and incidence in 2012, 2015, 2016 and 2018 had minor peaks in autumn. After adjusting the school or holiday month, multiple factors were found to affect HFMD epidemiology: urban area being major land cover type (incidence risk ratio, IRR 2.08; 95% CI 1.50, 2.89), higher gross domestic product per capita (IRR 1.14; 95% CI 1.11, 1.16), rise in monthly average temperature (IRR 1.65; 95% CI 1.61, 1.69) and monthly accumulative precipitation (IRR 1.20; 95% CI 1.16, 1.24) predicted increase in the incidence of HFMD; farmland being major land cover type (IRR 0.72; 95% CI 0.64, 0.81), an increase of percentage of the minority (IRR 0.91; 95% CI 0.89, 0.93) and population density (IRR 0.98; 95% CI 0.98, 0.99) were related to a decrease in the incidence of HFMD. Conclusions/Significance In conclusion, the epidemic status of HFMD in Xinjiang is characterized by low morbidity and fatality. Multiple factors have significant influences on the occurrence and transmission of HFMD in Xinjiang., Author summary Hand foot and mouth disease (HFMD) is one of the common human infectious disease threating Asia-Pacific countries. To explore the epidemiology and environmental risk factors for HFMD in inland China, we utilized 10-year HFMD surveillance data in Xinjiang Uighur Autonomous Region and combined multiple spatial-temporal statistical analyses. We identified spatial-temporal clusters of HFMD incidence and found that multiple factors could affect HFMD incidence: urban area being major land cover type, higher gross domestic product per capita, rise in monthly average temperature and monthly accumulative precipitation predicted increase in the incidence of HFMD; farmland being major land cover type, an increase of percentage of the minority and population density were related to a decrease in the incidence of HFMD. Our findings facilitate the understanding of HFMD epidemiology and risk factors in different geographic regions, which are crucial for conducting prevention and control strategies of HFMD.

Background Short message service (SMS) based interventions are widely used in healthcare and have shown promising results to improve cancer screening programs. However, more research is still needed to implement SMS in the screening process. We present a study protocol to assess the impact on health and economics of three targeted SMS-based interventions in population-based cancer screening programs. Methods/Design The M-TICs study is a randomized controlled trial with a formal process evaluation. Participants aged 50–69 years identified as eligible from the colorectal cancer (CRC) and breast cancer (BC) screening program of the Catalan Institute of Oncology (Catalonia, Spain) will be randomly assigned to receive standard invitation procedure (control group) or SMS-based intervention to promote participation. Two interventions will be conducted in the CRC screening program: 1) Screening invitation reminder: Those who do not participate in the CRC screening within 6 weeks of invite will receive a reminder (SMS or letter); 2) Reminder to complete and return fecal immunochemical test (FIT) kit: SMS reminder versus no intervention to individuals who have picked up a FIT kit at the pharmacy and they have not returned it after 14 days. The third intervention will be performed in the BC screening program. Women who had been screened previously will receive an SMS invitation or a letter invitation to participate in the screening. As a primary objective we will assess the impact on participation for each intervention. The secondary objectives will be to analyze the cost-effectiveness of the interventions and to assess participants’ perceptions. Expected results The results from this randomized controlled trial will provide important empirical evidence for the use of mobile phone technology as a tool for improving population-based cancer screening programs. These results may influence the cancer screening invitation procedure in future routine practice. Trial registration Registry: NCT04343950 (04/09/2020); clinicaltrials.gov.

We present a novel metric for measuring relative connection between parts of a city using geotagged Twitter data as a proxy for co-occurrence of city residents. We find that socioeconomic similarity is a significant predictor of this connectivity metric, which we call “linkage strength”: neighborhoods that are similar to one another in terms of residents’ median income, education level, and (to a lesser extent) immigration history are more strongly connected in terms of the of people who spend time there, indicating some level of homophily in the way that individuals choose to move throughout a city’s districts. The authors would like to acknowledge the Senseable Stockholm Lab and its partners: City of Stockholm, KTH Royal Institute of Technology, the Stockholm Chamber of Commerce and Newsec, in collaboration with MIT Senseable City Lab. We would also like to acknowledge the H2020 5G-TOURS project. Finally, we would like to thank the City of Stockholm municipality's Statistical Information Service for provision of population counts and socioeconomic data.

In face of high-investment and low-revenue crisis, it is critical for new-born car-sharing companies to focus on niche market. Existing literatures have already discussed the niche market of car sharing based on people’s irregular travel demands and scenarios; however, current research findings are still lack of adequate travel data support. Aiming to solve this problem, we develop a travel scenarios mining method that first define land usage types of travel Origin-Destination (OD) locations using spatial clustering analysis of city’s Points of interests (POI) data, and then discover the most representative travel scenarios using association rules mining method with car-sharing records data. Applying this approach to the car-sharing service case in Beijing, China, we find that: day-time business trips and evening entertainment trips around the city centre, commuting trips in off-peak time, and short-distance city travel for tourism are three travel scenarios suitable for car sharing’s niche in the initial stage of market entering. Furthermore, spatio-temporal consumption profiles and competitive advantages of car sharing in the three travel scenarios are analyzed. Finally, theoretical and managerial implications are discussed. In this study, we address the question of finding niche market and suggest that it is critical for car sharing industry treading through the crisis in the early stage of development.

This study aims to measure the efficacy of drinking water in terms of the economic impacts and risk of illness involved in using perilous water sources. Socio-economic factors were also considered. A multidisciplinary approach was employed to analyze the data, including the cost of illness (COI), regression technique, and irrigation water efficiency methods. The primary data set consisted of 210 peri-urban and urban households. It was found that the average cost of illness was higher in peri-urban ($10.79 USD) areas, while willingness to pay for quality water was higher in urban residents. Social status, income, and family size was positively associated with the cost of illness, while education, the source of drinking water (ground water and others), and awareness about safe drinking were negatively associated with the cost of illness. Furthermore, urban residents were more efficient in terms of conveyance and water use. This is one of the first studies to apply irrigation water efficiency methods to measure drinking water efficiency. The results are timely and important with both practical and social implications, including guiding policy framework. It is suggested that family planning programs be made more effective to control family size. The filtration plants to enhance drinking water quality be installed in the central places of each town/division/union council. A public-private partnership could work to provide affordable quality drinking water.

The efficacy of the public health measures to mitigate COVID-19 is influenced by health literacy which includes the level of knowledge about the disease and the preventive behaviours adopted by individuals. Thailand, being a low- and middle-income country with an ageing society, has to consider both the challenges that its health system has in disseminating information and the disparities in health literacy among its older population. This study investigated the knowledge and behaviour of older adults in Thailand regarding COVID-19 using the Impact of COVID-19 on Older Persons in Thailand, a cross-sectional survey. The data was primarily collected online and included 1,230 adults aged at least 60 years from nine provinces of the five regions of the country. The associated factors with the health literacy outcomes were tested using bivariate logistic regression analyses. It was observed that 43% of the older adults in the sample had proper knowledge of the disease and 33% adopted preventive behaviours. Knowledge about the disease was not associated with preventive behaviour. The associated factors common between the increased levels of knowledge and adoption of behaviours were rural area residence and higher educational attainment levels. Obtaining information from the internet was observed to increase knowledge while having the television and radio as sources of information had negative relationship. Many older adults continued to be employed during the lockdown period and this was associated with decreased adoption of preventive behaviour. The context of vulnerable populations, particularly older adults, is different with regard to their access to information and concern about income. Health information has to be tailored for targeted populations. Their needs also have to be addressed as they have increased risks because of financial and health susceptibilities.

Flooding risk in cities has been recently exacerbated by increased urbanization and climate change, often with catastrophic consequences in terms of casualties and economic losses. Rainwater harvesting systems and green roofs are recognized as being among the most effective blue-green mitigation measures. However, performances of these systems have currently been investigated only at laboratory or very-small local scales. In this work, we assess the potential benefit of the extensive installation of these solutions on all the rooftops of 9 cities, with different climatological and geographical characteristics. Both surface discharge reduction and delay between rainfall and runoff peak generation have been investigated. Green roofs ensure a larger average lag time between rainfall and runoff peaks than rainwater harvesting systems, without significant differences between intensive and extensive structures. On the other hand, the cost-efficiency analysis, considering the entire urban area, shows a higher retention capacity with a lower financial investment for rainwater harvesting rather than for green roofs in most cases. For extreme rainfall events, large-scale installation of rainwater harvesting systems coupled with intensive green roofs over the entire city have shown to be the most efficient solution, with a total discharge reduction that can vary from 5% to 15%, depending on the city characteristics and local climate.

We suggest a mathematical model for the spread of an infectious disease in human population, with particular attention to the COVID-19. Common epidemiological models, e.g., the well-known susceptible-exposed-infectious-recovered (SEIR) model, implicitly assume fast mixing of the population relative to the local infection rate, similar to the regime applicable to many chemical reactions. However, in human populations, especially under different levels of quarantine conditions, this assumption is likely to fail. We develop a continuous spatial model that includes five different populations, in which the infectious population is split into latent (or pre-symptomatic) and symptomatic. Based on nearest-neighbor infection kinetics, we arrive into a “reaction-diffusion” model. Our model accounts for front propagation of the infectious population domains under partial quarantine conditions, which is present on top of the common local infection process. Importantly, we also account for the variable geographic density of the population, that can strongly enhance or suppress infection spreading. Our results demonstrate how infected domains spread outward from epicenters/hotspots, leading to different regimes of sub-exponential (quasi linear or power-law) growth. Moreover, we show how weakly infected regions surrounding a densely populated area can cause rapid migration of the infection towards the center of the populated area. Predicted heat-maps show remarkable similarity to recently media released heat-maps. We further demonstrate how localized strong quarantine conditions can prevent the spreading of the disease from an epicenter/hotspot, significantly reducing the number of infected people. Application of our model in different countries, using actual demographic data and infectious disease parameters, can provide a useful predictive tool for the authorities, in particular, for planning strong lockdown measures in localizes areas.

Background Gynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India. Methodology The study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10–19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables. Results Overall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (β: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (β: 0.09; CI: 0.00, 0.19). The adolescents who had 8–9 (β: 0.17; CI: 0.05, 0.29) or ten and above years of education (β: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (β: -0.09; CI: -0.17, -0.01) than urban counterparts. Conclusion Multi-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.

Blaine County, Idaho, a rural area with a renowned resort, experienced a COVID-19 outbreak early in the pandemic. We undertook an epidemiologic investigation to describe the outbreak and guide public health action. Confirmed cases of COVID-19 were identified from reports of SARS-CoV-2-positive laboratory test results to South Central Public Health District. Information on symptoms, hospitalization, recent travel, healthcare worker status, and close contacts was obtained by medical record review and patient interviews. Viral sequence analysis was conducted on a subset of available specimens. During March 13–April 10, 2020, a total of 451 COVID-19 cases among Blaine County residents (1,959 cases per 100,000 population) were reported, with earliest illness onset March 1. The median patient age was 51 years (interquartile range [IQR]: 37–63), 52 (11.5%) were hospitalized, and 5 (1.1%) died. The median duration between specimen collection and a positive laboratory result was 9 days (IQR: 4–10). Forty-four (9.8%) patients reported recent travel and an additional 37 cases occurred in out-of-state residents. Healthcare workers comprised 56 (12.4%) cases; 33 of whom worked at the only hospital in the county, leading to a 15-day disruption of hospital services. Among 562 close contacts monitored by public health authorities, laboratory-confirmed COVID-19 or compatible symptoms were identified in 51 (9.1%). Sequencing results from 34 specimens supported epidemiologic findings indicating travel as a source of SARS-CoV-2, and identified multiple lineages among hospital workers. Community mitigation strategies included school and resort closure, stay-at-home orders, and restrictions on incoming travelers. COVID-19 outbreaks in rural communities can disrupt health services. Lack of local laboratory capacity led to long turnaround times for COVID-19 test results. Rural communities frequented by tourists face unique challenges during the COVID-19 pandemic. Implementing restrictions on incoming travelers and other mitigation strategies helped reduce COVID-19 transmission early in the pandemic.

Background The Chinese government’s early handling of COVID-19 has been perceived as aggressive and oppressive. Many of the most radical measures were adopted in Henan province, immediately north of Hubei, the pandemic’s epicentre in China. However, little is known about how rural residents—a group systematically disadvantaged in Chinese society—responded to authorities’ draconian restrictions. Methods To understand the lockdown measures and rural community responses at the grassroots level, face-to-face interviewers were conducted with both village cadres and villagers from two Henan villages in May and June 2020. The interviews were analysed with qualitative content analysis methods, with the coding process guided by the concepts of resilience, vulnerability and adaptability from the literature on disaster risk reduction. Results We found that the lockdown measures were indeed radical and disproportionate relative to the level of risk presented; however, they were largely accepted by villagers. This contradiction can be explained by two key contributing factors: (i) shared interests of individual villagers and the converged goal of government and civil society, and (ii) tacit flexibility in COVID-19 adaption strategies to tackle conflict resulting from goal diversion between citizens and local governments. Conclusions These findings highlight the nuances of ground-level politics. Despite their ‘radical’ nature, the lockdown measures were not implemented as simple top-down coercion. Instead, they involved, importantly, the bottom-up, localised response of villagers, and they were negotiated and adapted according to local circumstances.

Background COVID-19 is the novel coronavirus responsible for the ongoing global outbreak of acute respiratory disease and viral pneumonia. In order to tackle the devastating condition of the virus, countries need to attack the virus with aggressive and targeted tactics. Thus, to strengthen the COVID-19 mitigation measures and to give rapid response, there is an urgent need to understand the public’s knowledge and attitude about of the pandemic at this critical moment. Objective This study was aimed to assess the knowledge and attitude of communities about COVID-19 and associated factors among Gondar City residents. Methods A community based cross-sectional study was done among 623 respondents in Gondar city from April 20-27/2020. Data were collected using a structured questionnaire adapted from different literatures. The data were entered using Epi data version 3.1 and then exported into STATA version 14 for analysis. Bi-variable and multivariable binary logistic regression were performed. Adjusted odds ratio with 95% CI was used to declare statistically significant variables on the basis of p value less than 0.05 in the multivariable binary logistic regression model. Results The overall knowledge and attitude of the community towards COVID19 was 51.85% [95% CI (47.91%-55.78%)] and 53.13% [95% CI (49.20, 57.06%)], respectively. In this study, being married [AOR = 0.60 at 95% CI: (0.42, 0.86)], educational level; primary [AOR = 3.14 at 95% CI: (1.78,5.54)], secondary [AOR = 2.81 at 95% CI: (1.70,4.63)], college and above [AOR = 4.49 at 95% CI: 7.92, 13.98)], and family size [AOR = 1.80, at 95% CI: (1.05, 3.08)] were emerged as statistically significant factors impacting the knowledge of the community about COVID-19. Besides, educational level; primary [AOR = 1.76 at 95% CI: (1.03, 3.01)], secondary [AOR = 1.69 at 95% CI: (1.07, 2.68)], and college & above [AOR = 2.38 at 95% CI: (1.50, 3.79)], and family size; four to six members [AOR = 1.84 at 95% CI (1.27, 2.67)], above seven members [AOR = 1.79 at 95% CI (1.08, 2.96)] were factors identified as significantly attribute for positive attitude of the communities towards COVID-19. Conclusion More than half of the respondents had better knowledge and attitude regarding COVID-19. Higher educational level and larger family size were significant factors predominantly affecting the knowledge and attitude of the communities towards COVID-19.

Background The association between girl child marriage and education is widely acknowledged; however, there is no large body of demographic studies from Zimbabwe that have addressed this aspect. This study aimed to examine the extent to which child marriage affects one academic milestone, i.e. completion of the Ordinary Level, the first cycle of high school, which is also the most critical indicator of educational achievement in Zimbabwe. Methods We used the 2015 Zimbabwe Demographic and Health Survey and extracted 2380 cases of ever-married women aged between 20–29 years. We applied a propensity score-based method, which allowed us to mimic a hypothetical experiment and estimate outcomes between treated and untreated subjects. Results Our results suggest that child age at first marriage is concentrated between the ages of 15–22, with the typical age at first marriage being 18 years. Both logistic regression and PSM models revealed that early marriage decreased the chances of completing the first cycle of high school. Regression adjustment produced an estimate of prevalence ratio (PR) of 0.446 (95% CI: 0.374–0.532), while PSM resulted in an estimate (PR = 0.381; 95% CI: 0.298–0.488). Conclusion These results have implications for Zimbabwe’s development policy and suggest that girl-child marriage is a significant barrier to educational attainment. If not addressed, the country will most likely fail to meet sustainable development Goal 4.2 and 5.3. Social change interventions that target adults and counter beliefs about adolescent sexuality and prepubescent marriage should be put in place. Moreover, interventions that keep teenage girls in school beyond the first cycle of high school should be prioritised.

open access article This paper proposes a new dynamic multi-objective optimization algorithm by integrating a new fitting-based prediction (FBP) mechanism with regularity model-based multi-objective estimation of distribution algorithm (RM-MEDA) for multi-objective optimization in changing environments. The prediction-based reaction mechanism aims to generate high-quality population when changes occur, which includes three subpopulations for tracking the moving Pareto-optimal set effectively. The first subpopulation is created by a simple linear prediction model with two different stepsizes. The second subpopulation consists of some new sampling individuals generated by the fitting-based prediction strategy. The third subpopulation is created by employing a recent sampling strategy, generating some effective search individuals for improving population convergence and diversity. Experimental results on a set of benchmark functions with a variety of different dynamic characteristics and difficulties illustrate that the proposed algorithm has competitive effectiveness compared with some state-of-the-art algorithms.

Objectives This study aimed to identify the 15-year trends of handgrip strength-to-weight (relative HS) and assess the association between relative HS and hypertension among Chinese adults aged 20–69. Methods Using a complex, stratified, multistage probability cluster sampling, we analyzed data collected from 712,442 adults aged 20–69 years in four successive national surveys (2000–2014). We used a handheld dynamometer to measure strength and divided by body weight to calculate the relative HS. Blood pressure was recorded with a sphygmomanometer and hypertension was defined as resting systolic blood pressure at least 140 mmHg or diastolic at least 90 mmHg. The Mann-Kendall trend test examined trends in relative HS over time. We also computed odd ratios (OR) and 95% confidence intervals (95% CI) by tertile of relative HS and examined the association between relative HS and hypertension. Results The relative HS level decreased with the increase of age in both male and females (p trend Conclusion In the Chinese adult population, the relative HS level decreased from 2000 to 2014 across all ages in both males and females. A lower relative HS was associated with a higher risk of hypertension. The findings provided evidence for the association between muscle strength and hypertension in large-scaled population.

Background In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. Materials and methods Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. Results We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17–0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06–3.86], women who professed other religions [AOR = 3.45; CI = 1.53–7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64–31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17–0.53], compared to those with no formal education. Conclusion The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.

Background Leptospirosis is one of the most widespread zoonosis in the world and Brazil has the highest number of cases in Latin America. Transmission occurs mainly through exposure to water and soil contaminated by the urine of infected animals. The goals of this study are to describe the geographic distribution, demographic characteristics and exposure factors of urban and rural cases of leptospirosis, and identify spatial clusters in urban and rural areas of Brazil. Methods/results A retrospective epidemiological study was carried out using 16 years (2000–2015) of surveillance data from the Brazilian Ministry of Health. Cases were described by age, sex and race, and exposure factors were characterized in urban and rural areas. A spatial autocorrelation analysis was conducted using local Moran’s I to identify urban and rural clusters of disease. On average 3,810 leptospirosis cases were reported annually with higher numbers in urban areas. National urban and rural incidence rates were the same (1.9 cases/100,000 population), however, regional differences were observed. Urban incidence rates were higher in the North and Northeast regions, while rural incidence rates were higher in the Southeast and South. The main exposure factor reported in urban and rural areas was exposure to places with signs of rodents, followed by flood in urban areas and agriculture and animal farming in rural areas. Clusters of leptospirosis were identified in densely populated urban areas of the North, Southeast and South regions, while rural clusters were concentrated in of the Southern region with large agriculture and animal farming practices. Conclusions This study highlights that leptospirosis is an important public health problem in both urban and rural areas of Brazil. The results provide decision-makers with detailed information about where disease incidence is high and can be used in the development of prevention and control strategies for priority areas and risk groups.

Background Cancer is the second leading cause of death in the world. Knowing the cancer risk factors could help the policy-makers to design appropriate preventive and control strategies. Objective To investigate the awareness regarding risk factors and determinants of cancers among Bahir Dar city residents, northwest, 2019 Methods A community-based cross-sectional study was employed. A systematic random sampling technique was carried out to select 845 study participants from May 1 to June 30, 2019. A validated structured cancer awareness measuring tool was used to collect the data. The data were entered into the Epi-data version 3.1 and analyzed using SPSS version 21 software. A simple logistic regression was run, and AOR (adjusted odds ratio) at a 95% confidence interval was used to identify the determinants of awareness regarding risk factors of cancers. Results Nearly twenty percent of the respondents had a good awareness regarding risk factors of cancers. An orthodox Christian (AOR = 3. 2; 95%CI: 1.8, 5.6), college graduated (AOR = 2. 3; 95%CI:1.1, 4.9), a family member with cancer (AOR = 2. 0; 95%CI: 1.3, 3.3), and living in a rental house (AOR = 0. 6; 95%CI: 0.4, 0.9) were significantly associated with awareness regarding risk factors of cancers. Conclusion The study revealed that awareness regarding risk factors of cancers was very low in the study area. Being Orthodox Christian, college graduated, a family member with cancer, and living in the rental house were the determinants of awareness regarding risk factors of cancers.

Introduction Social mobility is considered as an important indicator of the economic development of a country. However, it varies widely across geographical regions and social groups in developing countries like Bangladesh. This paper intends to evaluate the intergenerational mobility in Bangladesh across generations. Methods and materials This paper considers a nationally representative sample survey of 8,403 respondents (rural: 5,436 and urban: 2,967). The male and female respondents aged 23 years and above were included in the sample. The education attainment of a son or daughter as compared to their father’s education level was considered as the measure of intergenerational mobility. Transition probability matrix and different social mobility indices were used to find out the intergenerational education mobility in Bangladesh. Results The findings reveal that approximately three-fourth (74.5%) of the respondents attained formal education, while more than half (58.3%) of the respondents’ father was illiterate. The educational status of the respondents and their father who lived in urban areas was relatively better than who lived in rural areas. It is also observed that 91.2% and 81.6% of the intergenerational class movement was upward among sons and daughters respectively. The probability of a higher educated father will have a higher educated child is higher in urban areas than in rural areas of Bangladesh. The intergenerational mobility is higher in the primary, secondary, and higher secondary educational levels, though the illiterate and higher education levels are the least mobile classes. In addition, the limiting probabilities reveal that the chance of sending sons to schools by an illiterate father is less as compared to their daughters. Such difference is more obvious in the urban areas, i.e., it is highly likely that sons of the illiterate father are also illiterate. Conclusion Bangladesh has been progressing remarkably in recent years. To keep the pace of the ongoing economic development in the country, it is necessary to give more attention to the illiterate people especially the girls who live in rural areas. The authors anticipate that the findings will be helpful for the policymakers as the relationship between inequality and intergenerational mobility is vital for several aspects of the economic development of a country.

It is necessary in agricultural consulting to take into account the current problems as well as economic and social challenges facing rural areas. Undoubtedly, sustainable economy and energy policy is such a problem in Poland, including the issue of access to energy from renewable sources and financial possibilities of meeting the electricity demand of households and agriculture. Therefore, advisory and information activities in the field of reducing energy poverty and improving air quality are important. The main purpose of the paper was to identify and assess the role of advisory entities in the process of counteracting energy poverty in rural areas in Poland. The basic research method was an expert (survey) study. Research shows that the subject of energy poverty is relatively rarely taken up by consulting institutions as part of training courses, especially issues related to saving electricity in the household/agricultural sector are marginalized; monitoring and analysis of energy consumption; selection of technical devices in terms of energy efficiency. Based on expert research, there were identified consultancy activities that are and may be important in the topic under study. Experts indicated co-financing of activities in the field of energy efficiency as the preferred way to fight energy poverty in agriculture and rural areas. The results may constitute an important direction in the development of consultancy, the basis for building priority programs, which in turn may affect the behaviour and actions of farmers and other inhabitants of rural areas in the context of energy transformation. The performed research may constitute the basis for further, in-depth analyses in other countries and on an international scale.

Introduction In the pursuit of achieving the Sustainable Development Goal targets of universal health coverage and reducing maternal mortality, many countries in sub-Saharan Africa have implemented health insurance policies over the last two decades. Given that there is a paucity of empirical literature at the sub-regional level, we examined the prevalence and factors associated with health insurance coverage among women in in sub-Saharan Africa. Materials and methods We analysed cross-sectional data of 307,611 reproductive-aged women from the most recent demographic and health surveys of 24 sub-Saharan African countries. Bivariable and multivariable analyses were performed using chi-square test of independence and multi-level logistic regression respectively. Results are presented as adjusted Odds Ratios (aOR) for the multilevel logistic regression analysis. Statistical significance was set at p Results The overall coverage of health insurance was 8.5%, with cross-country variations. The lowest coverage was recorded in Chad (0.9%) and the highest in Ghana (62.4%). Individual-level factors significantly associated with health insurance coverage included age, place of residence, level of formal education, frequency of reading newspaper/magazine and watching television. Wealth status and place of residence were the contextual factors significantly associated with health insurance coverage. Women with no formal education were 78% less likely to be covered by health insurance (aOR = 0.22, 95% CI = 0.21–0.24), compared with those who had higher education. Urban women, however, had higher odds of being covered by health insurance, compared with those in the rural areas [aOR = 1.20, 95%CI = 1.15–1.25]. Conclusion We found an overall relatively low prevalence of health insurance coverage among women of reproductive age in sub-Saharan Africa. As sub-Saharan African countries work toward achieving the Sustainable Development Goal targets of universal health coverage and lowering maternal mortality to less than 70 deaths per 100,000 live births, it is important that countries with low coverage of health insurance among women of reproductive age integrate measures such as free maternal healthcare into their respective development plans. Interventions aimed at expanding health insurance coverage should be directed at younger women of reproductive age, rural women, and women who do not read newspapers/magazines or watch television.

Made available in DSpace on 2021-06-25T11:10:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy. Department of Infectious Diseases Botucatu Medical School São Paulo State University (UNESP) Department of Geography Faculty of Science and Technology São Paulo State University (UNESP) Department of Geography Federal University of Espírito Santo Institute of Biosciences São Paulo State University (UNESP) Institute of Mathematics Statistics and Scientific Computation University of Campinas (UNICAMP) Department of Infectious Diseases Botucatu Medical School São Paulo State University (UNESP) Department of Geography Faculty of Science and Technology São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP)

The quantitative relationship between the spatial variation of building’s height and the associated land surface temperature (LST) change in six Chinese megacities is investigated in this paper. The six cities involved are Beijing, Shanghai, Tianjin, Chongqing, Guangzhou, and Shenzhen. Based on both remote sensing and building footprint data, we retrieved the LST using a single-channel (SC) algorithm and evaluate the heating/cooling effect caused by building-height difference via correlation analysis. The results show that the spatial distribution of high-rise buildings is mainly concentrated in the center business districts, riverside zones, and newly built-up areas of the six megacities. In the urban area, the number and the floor-area ratio of high to super high-rise buildings (>24m) account for over 5% and 4.74%, respectively. Being highly urbanized cities, most of urban areas in the six megacities are associated with high LST. Ninety-nine percent of the city areas of Shanghai, Beijing, Chongqing, Guangzhou, Shenzhen, and Tianjin are covered by the LST in the range of 30.2~67.8°C, 34.8~50.4°C, 25.3~48.3°C, 29.9~47.2°C, 27.4~43.4°C, and 33.0~48.0°C, respectively. Building’s height and LST have a negative logarithmic correlation with the correlation coefficients ranging from -0.701 to -0.853. In the building’s height within range of 0~66m, the LST will decrease significantly with the increase of building’s height. This indicates that the increase of building’s height will bring a significant cooling effect in this height range. When the building’s height exceeds 66m, its effect on LST will be greatly weakened. This is due to the influence of building shadows, local wind disturbances, and the layout of buildings.

The development of China’s manufacturing industry has received global attention. However, research on the distribution pattern, changes, and driving forces of the manufacturing industry has been limited by the accessibility of data. This study proposes a method for classifying based on natural language processing. A case study was conducted employing this method, hotspot detection and driving force analysis, wherein the driving forces industrial development during the “13th Five-Year plan” period in Jiangsu province were determined. The main conclusions of the empirical case study are as follows. 1) Through the acquisition of Amap’s point-of-interest (POI, a special point location that commonly used in modern automotive navigation systems.) data, an industry type classification algorithm based on the natural language processing of POI names is proposed, with Jiangsu Province serving as an example. The empirical test shows that the accuracy was 95%, and the kappa coefficient was 0.872. 2) The seven types of manufacturing industries including the pulp and paper (PP) industry, metallurgical chemical (MC) industry, pharmaceutical manufacturing (PM) industry, machinery and electronics (ME) industry, wood furniture (WF) industry, textile clothing (TC) industry, and agricultural and food product processing (AF) industry are drawn through a 1 km× 1km projection grid. The evolution map of the spatial pattern and the density field hotspots are also drawn. 3) After analyzing the driving forces of the changes in the number of manufacturing industries mentioned above, we found that manufacturing base, distance from town, population, GDP per capita, distance from the railway station were the significant driving factors of changes in the manufacturing industries mentioned above. The results of this research can help guide the development of manufacturing industries, maximize the advantages of regional factors and conditions, and provide insight into how the spatial layout of the manufacturing industry could be optimized.

Objective Reports of disparities in COVID-19 mortality rates are emerging in the public health literature as the pandemic continues to unfold. Alcohol misuse varies across the US and is related to poorer health and comorbidities that likely affect the severity of COVID-19 infection. High levels of pre-pandemic alcohol misuse in some counties may have set the stage for worse COVID-19 outcomes. Furthermore, this relationship may depend on how rural a county is, as access to healthcare in rural communities has lagged behind more urban areas. The objective of this study was to test for associations between county-level COVID-19 mortality, pre-pandemic county-level excessive drinking, and county rurality. Method We used national COVID-19 data from the New York Times to calculate county-level case fatality rates (n = 3,039 counties and county equivalents; October 1 –December 31, 2020) and other external county-level data sources for indicators of rurality and health. We used beta regression to model case fatality rates, adjusted for several county-level population characteristics. We included a multilevel component to our model and defined state as a random intercept. Our focal predictor was a single variable representing nine possible combinations of low/mid/high alcohol misuse and low/mid/high rurality. Results The median county-level COVID-19 case fatality rate was 1.57%. Compared to counties with low alcohol misuse and low rurality (referent), counties with high levels of alcohol and mid (β = -0.17, p = 0.008) or high levels of rurality (β = -0.24, p Conclusions Our findings highlight the intersecting roles of county-level alcohol consumption, rurality, and COVID-19 mortality.

This paper investigated the appropriate specifications of Engel curves for non-food expenditure categories and estimated the deprivation indices of non-food needs in rural areas using a semi parametric examination of the presence of saturation points. The study used the extended partial linear model (EPLM) and adopted two estimation methods—the double residual estimator and differencing estimator—to obtain flexible shapes across different expenditure categories and estimate equivalence scales. We drew on data of the Egyptian Household Income, Expenditure, and Consumption Survey (HIEC). Our paper provides empirical evidence that the rankings of most non-food expenditure categories is of rank three at most. Rural households showed high economies of scale in non-food consumption, with child’s needs accounting for only 10% of adult’s non-food needs. Based on semi-parametrically estimated consumption behavior, the tendency of non-food expenditure categories to saturate did not emerge. While based on parametrically estimated consumption behavior, rural areas exhibited higher deprivation indices in terms of health and education expenditure categories, which indicates the need to design specific programs economically targeting such vulnerable households.

Purpose Stuttering is a multifactorial speech disorder with significant social and psychological consequences. There is a lack of knowledge about public attitudes towards people who stutter (PWS) and the factors that can determine such attitudes in underprivileged communities. This study aimed to assess the public attitudes in South Egypt towards PWS and compare our results with those stored in a reference database representing 180 different samples. Methods A multi-stage random sampling approach was used to recruit 650 people from Beni-Suef City in South Egypt. All participants were interviewed using the Arabic version of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) after getting their informed consent. This instrument assesses people’s Beliefs and Self Reactions towards PWS in addition to their sociodemographic characteristics. Results The Beliefs and Self Reactions subscores in addition to the Overall Stuttering Score of the Egyptian sample were remarkably lower than the median values of the reference database (12 versus 34), (-4 versus 2), and (4 versus 18), respectively. TV, radio, and films were the main sources of knowledge about stuttering. Egyptian participants who reported average to high income were more likely to have a positive attitude (≥50% of Overall Stuttering Score) towards PWS than their counterparts with low income (Odds Ratio = 1.57, 95% Confidence Interval: 1.08–2.28). Conclusion People in South Egypt showed a less positive attitude towards PWS compared with other populations worldwide. Further studies should focus on changing the public attitudes towards PWS through awareness programs that consider the cultural perspectives of the society.

Many studies have considered the location of rural waste transfer stations, but most have omitted the impact of transportation network conditions. Traffic accessibility must be considered in optimizing the location of rural waste transfer stations, which is an important difference from the location of rural waste transfer stations. On the basis of previous studies, this study will consider the impact of traffic network on the optimization locations of waste transfer station in the rural areas. The objective of this study was to ensure the minimum Euclidean distance between the waste transfer station and the population center is the maximum, minimize the garbage transportation cost of each population center, construction costs for waste transfer stations, construction and upgrade costs for roads on a traffic network. A multi-objective facility location-network design model and an improved multi-objective simulated annealing algorithm was used to solve the problem. A detailed practical case study was used to illustrate the application of the proposed mathematical model. The results show that transportation network plays an important role in facility location optimization, and the improvement of traffic network conditions can greatly reduce waste transportation costs.

Objectives To model the risk of COVID-19 mortality in British care homes conditional on the community level risk. Methods A two stage modeling process (“doubly latent”) which includes a Besag York Mollie model (BYM) and a Log Gaussian Cox Process. The BYM is adopted so as to estimate the community level risks. These are incorporated in the Log Gaussian Cox Process to estimate the impact of these risks on that in care homes. Results For an increase in the risk at the community level, the number of COVID-19 related deaths in the associated care home would be increased by exp (0.833), 2. This is based on a simulated dataset. In the context of COVID-19 related deaths, this study has illustrated the estimation of the risk to care homes in the presence of background community risk. This approach will be useful in facilitating the identification of the most vulnerable care homes and in predicting risk to new care homes. Conclusions The modeling of two latent processes have been shown to be successfully facilitated by the use of the BYM and Log Gaussian Cox Process Models. Community COVID-19 risks impact on that of the care homes embedded in these communities.

Introduction This study investigates the oral health-seeking behaviour of households and its influence on demand for dental caries treatment services in Enugu state Nigeria. Methods A quantitative descriptive cross-sectional study was used to explore the oral health seeking pattern of 378 urban and 348 rural household respondents in Enugu state Nigeria. The study explored dental caries treatment-seeking, oral health behavior of respondents using the three dynamics of the Andersen and Newman health utilization model; predisposing, enabling and need factors. Findings Recommendations from community members (48.9%), severity of disease (22.1%), and cost of treatment (19.4%) all influenced where oral healthcare was first sought. Gender and type of occupation, influenced positive oral health-seeking behavior (p Conclusion The findings suggest that interventions to create increased oral health awareness targeted at education on preventive strategies, appropriate time and place to seek oral health care and dental caries treatment, as well devising and implementing health financing options such as dental insurance would enable individuals to seek appropriate treatment for dental caries on time. In addition, it will reduce the proportion of people visiting unorthodox healthcare providers for their oral health problems or choosing cheaper but inappropriate treatment options.

Background Ensuring water, sanitation, and hygiene (WASH) facilities for households remains a major public health concern in low- and middle-income countries (LMICs). This study investigated the current situation of basic WASH facilities for households in Bangladesh and drew a national coverage map. Methods We analyzed the publicly available nationally representative 2019 Multiple Indicator Cluster Survey (MICS) dataset that was carried out by the Bangladesh Bureau of Statistics (BBS) with support from the United Nations Children’s Emergency Fund (UNICEF). A total of 61,209 households (weighted) were included in the analysis. Both bivariate and multivariate analyses were employed to examine the relationships between independent variables (socio-demographic and economic status) and their distributions over outcome variables (basic water, sanitation, and hygiene). Further, the spatial distribution of WASH facilities at the household level was depicted. Results Coverage of access to basic water facilities at the household level was 99.5% (95% CI 99.4% to 99.6%), sanitation 60.7% (95% CI 60.0% to 61.5%), and hygiene 56.3% (95% CI 55.6% to 57.0%). However, coverage of combined access to all three components was 40.2% (95% CI 39.4% to 40.9%). Among all 64 administrative districts of Bangladesh, we found comparatively lower coverage of WASH facilities in the South and South-East regions and relatively higher in the households of the North and North-Western regions. An adjusted regression model revealed that richest households [AOR = 29.64, 95% CI 26.31 to 33.39], households in the rural areas [AOR = 1.64, 95% CI 1.50 to 1.79], household heads with higher educational attainment [AOR = 2.28, 95% CI 2.09 to 2.49], and households with 5+ family members [AOR = 1.64, 95% CI 1.56 to 1.71] had the higher likelihood to have basic WASH facilities. Conclusion Less than half of the Bangladeshi households had access to all three major WASH components (basic water, sanitation, and hygiene facilities); however, variation exists at the individual parameter of basic water, sanitation, and hygiene facilities. A comprehensive WASH approach may reduce the gap and improve the quality of WASH facilities in Bangladesh.

Background Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. Methods A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. Results There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Conclusions Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.

As humans are the primary geomorphic agents on the landscape, it is essential to assess the magnitude, chronological span, and future effects of artificial ground that is expanding under modern urbanization at an alarming rate. We argue humans have been primary geomorphic agents of landscapes since the rise of early urbanism that continue to structure our everyday lives. Past and present anthropogenic actions mold a dynamic “taskscape” (not just a landscape) onto the physical environment. For example, one of the largest Pre-Columbian metropolitan centers of the New World, the UNESCO world heritage site of Teotihuacan, demonstrates how past anthropogenic actions continue to inform the modern taskscape, including modern street and land alignments. This paper applies a multi-scalar, long durée approach to urban landscapes utilizing the first lidar map of the Teotihuacan Valley to create a geospatial database that links modern and topographic features visible on the lidar map with ground survey, historic survey, and excavation data. Already, we have recorded not only new features previously unrecognized by historic surveys, but also the complete erasure of archaeological features due to modern (post-2015) mining operations. The lidar map database will continue to evolve with the dynamic landscape, able to assess continuity and changes on the Teotihuacan Valley, which can benefit decision makers contemplating the stewardship, transformation, or destruction of this heritage landscape.