Volume twenty-three, Issue 3

In early 2020, despite efforts to contain the spread of the SARS-CoV-2 virus (COVID-19), transmission across Ecuador grew exponentially, quickly overwhelming the Ecuadorian healthcare system. A similar scenario transpired in several Latin American countries, with the Americas experiencing millions of cases and deaths by 2023. However, a massive screening campaign and travel restrictions were successful in managing transmission in one province of Ecuador, the Galapagos Islands, with one island remaining entirely COVID-19-free during 2020. This retrospective study of testing data from the Galapagos Islands provides lessons from the first wave of the COVID-19 pandemic.

No início de 2020, apesar dos esforços para conter a propagação do vírus SARS-CoV-2 (COVID-19), a transmissão no Equador cresceu exponencialmente, sobrecarregando rapidamente o sistema de saúde equatoriano. Um cenário semelhante ocorreu em vários países latino-americanos, com as Américas experimentando milhões de casos e mortes até 2023. No entanto, uma campanha massiva de triagem e restrições de viagem foram bem-sucedidas no gerenciamento da transmissão em uma província do Equador, as Ilhas Galápagos, com uma ilha permanecendo totalmente livre de COVID-19 durante 2020. Este estudo retrospectivo de dados de teste das Ilhas Galápagos fornece lições da primeira onda da pandemia de COVID-19.

A principios de 2020, a pesar de los esfuerzos para contener la propagación del virus SARS-CoV-2 (COVID-19), la transmisión en Ecuador creció exponencialmente, sobrepasando rápidamente al sistema de salud ecuatoriano. Un escenario similar ocurrió en varios países de América Latina, experimentando millones de casos y muertes hasta 2023. Sin embargo, una campaña de detección masiva y restricciones de viaje lograron controlar la transmisión en una provincia de Ecuador, las Islas Galápagos, con una isla que se mantuvo completamente libre de COVID-19 durante 2020. Este estudio retrospectivo de datos de testeo en las Islas Galápagos brinda lecciones en la primera ola de la pandemia de COVID-19.

The COVID-19 pandemic demonstrated how rapidly a novel viral respiratory pathogen can impact healthcare systems. This is particularly important in low and middle-income countries, where existing health infrastructure is inadequate and where the rate of existing communicable and non-communicable disease is already high. In Papua New Guinea (PNG), despite public health information and guidance, vaccine hesitancy has been identified as a major challenge for local management of COVID-19. Meanwhile, non-government organisations have reported that PNG health systems, already overburdened by escalating rates of communicable diseases including tuberculosis and malaria, are on the brink of collapse as COVID-19 cases increase. In this Original Research study, the authors surveyed community members, community leaders and healthcare workers to understand the accessibility of vaccines for the general community in provincial PNG, the level of (and reasons for) community vaccine hesitancy and ways to strengthen vaccine acceptance among target groups within the community.

Preparing rural youth for careers in health care is essential for addressing workforce shortages and improving access to health services in rural communities. In this study, the authors implemented an online mentoring program for rural youth that successfully increased participants’ interest in healthcare careers and provided the knowledge and skills for transitioning to post-secondary education. Suggested refinements to broaden the impact of the Rural eMentoring program include enabling personalization within the curriculum, adding new discussion topics relevant to rural youth, and meeting the needs of rural Indigenous learners.

Water is scarce for more than 40% of people globally, and among those with access to water, approximately 23% (1.8 billion) rely on a fecally contaminated water source. Diarrheal disease, which is prevalent in areas with limited access to water, sanitation, and hygiene (WASH), causes chronic consequences in children, including decreased growth, undernutrition, and impaired cognitive development. In Latin America, diarrheal disease kills more than 75,000 children annually, while in the Peruvian Amazon, the prevalence is as high as 50% for Indigenous children. This study reports on the prevalence of childhood diarrhea, access to WASH, and the association of childhood diarrhea with WASH indicators in Shawi communities along the Armanayacu River, Peru.

El agua es escasa para mas del 40% de las personas globalmente, y entre aquellos con acceso al agua, aproximadamente un 23% (1,8 billones) depende de una fuente de agua contaminada fecalmente. La enfermedad diarreica, que es prevalente en zonas con acceso limitado al agua, saneamiento e higiene (WASH), causa consecuencias crónicas en los niños tales como retraso del crecimiento, desnutrición y deficit en desarrollo cognitivo. En Latinoamérica, la enfermedad diarreica causa mas de 75 mil muertes en niños anualmente, mientras que en la Amazonia Peruana, la prevalencia es tan alta como el 50% de los niños indígenas. Este estudio muestra la prevalencia de diarrea en niños y su asociación con indicadores de acceso a WASH, en las comunidades SHAWI a lo largo del Rio Armanayacu en Perú.

A água é escassa para mais de 40% das pessoas em todo o mundo. Entre aquelas com acesso à água, aproximadamente 23% (1,8 bilhão) dependem de uma fonte de água contaminada por fezes. A doença diarreica, que é prevalente em áreas com acesso limitado à água, saneamento e higiene (WASH), causa consequências crônicas em crianças, incluindo crescimento reduzido, desnutrição e desenvolvimento cognitivo prejudicado. Na América Latina, a doença diarreica mata mais de 75.000 crianças anualmente, enquanto na Amazônia peruana a prevalência chega a 50% para crianças indígenas. Este estudo relata a prevalência de diarreia infantil, acesso a WASH e a associação de diarreia infantil com indicadores de WASH em comunidades Shawi ao longo do rio Armanayacu, Peru.

Many countries, including Brazil, have a rising life expectancy and an aging population, both of which will have considerable implications for health systems. In Brazil, a quarter of the population will be older adults by 2024. Screening older adults at risk for worsening health can provide an opportunity for detection and intervention, thus preventing adverse clinical outcomes and enabling the most efficient use of health resources. This Original Research article uses data from the first follow-up of the EpiRural Cohort Study to determine the prevalence of, and factors associated with, vulnerability among rural community-dwelling older adults living in the municipality of Rio Grande, Rio Grande do Sul, Brazil.

Vários países, incluindo o Brasil, vivenciam um aumento da expectativa de vida e da população idosa, o que terá consideráveis implicações para os sistemas de saúde. Até 2024, os idosos representarão um quarto da população brasileira. O rastreamento de idosos em risco de piora da saúde é uma oportunidade para detecção e intervenção, prevenindo desfechos clínicos adversos e permitindo o uso mais eficiente dos recursos em saúde. Este artigo original utiliza dados do primeiro acompanhamento da Coorte EpiRural para determinar a prevalência e os fatores associados à vulnerabilidade entre idosos moradores da área rural do município do Rio Grande, Estado do Rio Grande do Sul, Brasil.


Muchos países, incluido Brasil, tienen una esperanza de vida en aumento y una población que envejece, lo que tendrá implicaciones considerables para los sistemas de salud. En Brasil, una cuarta parte de la población serán adultos mayores en 2024. La detección de adultos mayores con riesgo de empeorar su salud puede brindar una oportunidad para la detección y la intervención, previniendo así resultados clínicos adversos y permitiendo el uso más eficiente de los recursos de salud. Este artículo de investigación original utiliza datos del primer seguimiento del Estudio de Cohorte EpiRural para determinar la prevalencia y los factores asociados con la vulnerabilidad entre los adultos mayores que viven en comunidades rurales del municipio de Rio Grande, Estado de Rio Grande do Sul, Brasil.

People living in rural areas experience higher rates of many chronic diseases than people living in urban areas. An issue that is underexplored in rural areas is obstructive sleep apnea (OSA), a condition in which a person’s breathing is paused while asleep as a result of partially or wholly blocked airways, causing drops in oxygen levels. OSA is experienced mostly by men and older people and is strongly associated with serious comorbidities, including hypertension, heart attack, stroke, diabetes, major depression and early mortality. Despite this, rural patients are likely to encounter barriers to diagnosis and treatment because of a lack of locally available healthcare services.This study explores the proportion of diagnosed and undiagnosed OSA in men living in rural areas in Australia.

Viral diseases transmitted by mosquitoes of the Aedes genus are a priority public health problem worldwide. Colombia is one of the most affected countries in Latin America, with a significant burden of dengue, chikungunya, and Zika. In particular, the incidence and mortality rates of dengue have been increasing since the 1950s. There are no specific antiviral therapies for treatment of dengue and mass vaccination is not available yet, so prevention and control requires unprecedented coordination of efforts, including those of the general community. However, previous research has revealed a mismatch between the realities about dengue fever and the understanding of people going about their daily lives. This article analyzes risk discourses around dengue, Zika and chikungunya constructed by lay people, community leaders and disease control experts from the fields of medical anthropology, medical sociology and public health.

As doenças virais transmitidas por mosquitos do gênero Aedes são um problema prioritário de saúde pública em todo o mundo. A Colômbia é um dos países mais afetados da América Latina, com uma carga significativa de dengue, chikungunya e zika. Em particular, as taxas de incidência e mortalidade da dengue têm aumentado desde a década de 1950. Não há terapias antivirais específicas para o tratamento da dengue e a vacinação em massa ainda não está disponível, portanto a prevenção e o controle requerem uma coordenação de esforços sem precedentes, incluindo os da comunidade em geral. No entanto, pesquisas anteriores revelaram uma incompatibilidade entre as realidades sobre a dengue e a compreensão das pessoas sobre suas vidas diárias. Este artigo analisa discursos de risco sobre dengue, zika e chikungunya construídos por leigos, líderes comunitários e especialistas em controle de doenças das áreas de antropologia médica, sociologia médica e saúde pública.

Las enfermedades virales transmitidas por mosquitos del género Aedes son un problema prioritario de salud pública a nivel mundial. Colombia es uno de los países más afectados de América Latina, con una carga importante de dengue, chikungunya y Zika. En particular, las tasas de incidencia y mortalidad del dengue han ido en aumento desde la década de 1950. No existen terapias antivirales específicas para el tratamiento del dengue y la vacunación masiva aún no está disponible, por lo que la prevención y el control requieren una coordinación de esfuerzos sin precedentes, incluidos los de la comunidad en general. Sin embargo, investigaciones anteriores han revelado un desajuste entre las realidades sobre la fiebre del dengue y la comprensión de las personas sobre su vida cotidiana. Este artículo analiza los discursos de riesgo sobre el dengue, el Zika y el chikungunya construidos por legos, líderes comunitarios y expertos en control de enfermedades de los campos de la antropología médica, la sociología médica y la salud pública.

Randomised controlled trials (RCTs) are the gold standard method for evaluating health and care interventions including medicinal products and services. To alleviate health inequalities experienced by rural patients, it is important that researchers are able to effectively recruit rural participants into their RCTs. This systematic review protocol is designed to quantify the effects of randomised evaluations of strategies to recruit rural participants to trials.

The unique history and social context of rural and frontier communities often creates stigma for those seeking to address mental health challenges. Creative expression can be used as a strategy to facilitate community integration and address mental health, particularly in a time where socioeconomic disparities, pandemics, and climate change impacts can intensify health impacts.

People in sexual minorities experience increased risk relative to heterosexual people for a number of chronic diseases. In rural areas, sexual minorities also face substantial barriers to care as a result of persistent internalized stigma and stigma from care providers. As rural populations have a consistently higher burden of chronic disease than urban populations, this study used data from the National Survey on Drug Use and Health to assess the chronic disease risk for rural people in sexual minorities.

Although sex work is not criminalized in Brazil, female sex workers experience prejudice and discrimination. In rural areas, which tend to be poorer regions, female sex workers experience inequities in gender, race, class and, above all, bear marks of struggle and survival. This study reports on the meanings that women in the experience of paid sexual work living in rural areas attribute to the quality of life, according to Sartre's phenomenological perspective.

Aunque el trabajo sexual no esta criminalizado en Brasil, las trabajadoras sexuales femeninas experimentan prejuicios y discriminación. En zonas rurales, que tienden a ser mas pobres, estas trabajadoras sufren inequidades de genero, raciales, socioeconómicas y por sobre todo están marcadas por la lucha y la sobrevivencia. Este estudio describe los significados que le atribuyen a la experiencia de vivir del trabajo sexual pagado en zonas rurales, respecto de la calidad de vida de acuerdo a la perspectiva fenomenológica de Sartre.

Embora o trabalho sexual não seja criminalizado no Brasil, as trabalhadoras do sexo sofrem preconceito e discriminação. Nas áreas rurais, que costumam ser regiões mais pobres, as trabalhadoras do sexo vivenciam desigualdades de gênero, raça, classe e, sobretudo, carregam marcas de luta e sobrevivência. Este estudo relata os significados que as mulheres na experiência do trabalho sexual remunerado residentes no meio rural atribuem à qualidade de vida, segundo a perspectiva fenomenológica de Sartre.

Suicide claims the lives of more than 700,000 people every year worldwide, and for farmers and agricultural workers, who experience a range of personal and occupational stressors, the risk is particularly high. Qualitative research examining farmer suicide has grown in recent years and provides a rich description of farmers' lives leading up to their suicide that cannot be easily captured by quantitative surveys. This systematic review and meta-synthesis, the first to utilize qualitative data about farmer suicide, examines the risk and protective factors preceding farmer suicide from the perspectives of their partner, relatives, or individuals who worked closely with them. The authors use this information to generate a conceptual model, the FARM framework, that offers a new way of understanding farm culture, occupational stressors, and farmers’ well-being and provides direction for future research and guidance for practical interventions.

Indigenous peoples in Latin America often experience a high prevalence of mental ill health and suicide as well as inequitable access to healthcare services. In addition, mental health and wellbeing tools used in community services are often based on western concepts or generalized from non-Indigenous population validations, which can result in inaccurate assessments and misdiagnosis of mental health conditions in Indigenous peoples, as well as a failure to recognize the strengths that Indigenous peoples may possess in coping with challenges. This Original Research article presents the results of a descriptive cross-sectional study that was carried out with the participation of the community leaders of the Indigenous peoples of Colombia.  It describes the intercultural creation and validation and psychometric characteristics of the PACES scale, a tool used to evaluate parenting, behavior, emotions and risk of suicide in community settings or in primary care mental health services in Colombia.

Os povos indígenas da América Latina frequentemente experimentam uma alta prevalência de doenças mentais e suicídio, bem como acesso desigual aos serviços de saúde. Além disso, as ferramentas de saúde mental e bem-estar usadas nos serviços comunitários geralmente são baseadas em conceitos ocidentais ou generalizadas a partir de validações de populações não indígenas, o que pode resultar em avaliações imprecisas e diagnósticos incorretos de condições de saúde mental em povos indígenas, bem como na falha em reconhecer os pontos fortes que os povos indígenas podem possuir para lidar com os desafios. Este artigo de Pesquisa Original apresenta os resultados de um estudo transversal descritivo que foi realizado com a participação dos líderes comunitários dos povos indígenas da Colômbia. Descreve a criação e validação intercultural e as características psicométricas da escala PACES, uma ferramenta usada para avaliar parentalidade, comportamento, emoções e risco de suicídio em ambientes comunitários ou em serviços de atenção primária à saúde mental na Colômbia.

Los pueblos indígenas de América Latina a menudo experimentan una alta prevalencia de problemas de salud mental y suicidio, así como un acceso desigual a los servicios de salud. Además,los instrumentos de salud mental y bienestar que se utilizan en los servicios comunitarios a menudo se basan en conceptos occidentales o se generalizan a partir de validaciones de poblaciones no indígenas, lo que puede resultar en evaluaciones inexactas y diagnósticos erróneos de las condiciones de salud mental en los pueblos indígenas, así como en la falta de reconocimientode las fortalezas que los pueblos indígenas pueden poseer para hacer frente a estos desafíos. Este artículo original de investigación presenta los resultados de un estudio descriptivo de corte transversal que se realizó con la participación de los líderes comunitarios de los Pueblos Indígenas de Colombia. Describe la creación y validación interculturales, así como las características psicométricas de la escala PACES, una herramienta utilizada para evaluar la crianza, el comportamiento, las emociones y el riesgo de suicidio en entornos comunitarios o en servicios de salud mental de atención primaria en Colombia.

There is an undersupply of general surgeons in rural Australia and in rural areas worldwide. Although other medical specialties, including general practice, obstetrics and gynaecology, ophthalmology and emergency medicine, have established rural training schemes in Australia, general surgeons undertaking their 1–3 years of subspecialty Post-Fellowship Education and Training (known as ‘fellowships’) are largely limited to metropolitan institutions and no accredited rural surgical training is funded by the federal government. Despite funding limitations, a rural general surgery fellowship was established in Bendigo, a rural town in central Victoria, in 2011. This Original Research article reviews Bendigo Health’s general surgical fellowship program to determine if rural general surgery fellowships can assist in sustaining a rural general surgery workforce.

Allied health (AH) professionals require discipline-specific expertise and a diverse generalist skill set to manage the complexity and demand for health care in rural and remote areas. Access to relevant continuing professional development (CPD) that sustains the development of generalist capabilities is a key strategy to support workforce development and the retention of rural and remote AH professionals. This study evaluated an online education program specifically designed as CPD for rural and remote practice, and the impact on the professional development, healthcare services and recruitment and retention of AH professionals undertaking this program.

Aspire2Heath is a novel health career outreach program offering rural secondary school students in Queensland, Australia, the opportunity to experience and learn about health careers without leaving their communities. Exposing students to health career promotional activities can increase interest in health careers and potentially increase enrolments in healthcare education, with the aim of eventually alleviating workforce shortages and potentially enhancing population health outcomes. This study assesses Aspire2Heath's short-term impact on student interest in health careers and reports on educational activities that generated the greatest student interest.

Community health worker (CHW) programs can play a significant role in improving health at a community level by providing a range of preventive and treatment services. Although large-scale CHW programs have been implemented in many countries, implementation strategies vary considerably and evidence of program effectiveness is not consistent. South Africa is currently investing in CHW programs. This study explored perspectives on the programs and investigated stakeholder perspectives on the supervision model. The authors provide guidance on how to improve the implementation of CHW programs in South Africa and globally.

Rates of firearm violence and injury are notably high within the United States. This Research Letter uses CDC WONDER data to demonstrate that rates of firearm-involved suicide mortality are higher in very rural areas than metro regions. Further research and development of rural-specific suicide prevention efforts are encouraged.

Aboriginal Community-Controlled Health Organisations (ACCHOs), like other primary care organisations in Australia and internationally, were required to respond rapidly to physical distancing requirements during the COVID-19 pandemic. A key component of the response was the adoption of telehealth to continue meeting the healthcare needs of Aboriginal and Torres Strait Islander Peoples. This study evaluates the uptake, acceptability and requirements for delivery of telehealth primary healthcare services for Aboriginal and/or Torres Strait Islander Peoples by a rural ACCHO, Budja Budja Aboriginal Cooperative, in Halls Gap, Victoria, during the pandemic.

Xingu Indigenous Park (XIP), the largest Indigenous territory in Brazil, protects the environment and the traditional way of life for the 16 Indigenous groups that live there. Access to XIP by non-Indigenous people is limited but, in recent decades, new roads and more people living in the vicinity of the park has increased exposure to different infectious agents. The Indigenous population is constantly dealing with shortages in medical care. This study evaluated the frequency and potential impact of chlamydia, gonorrhea and high-risk human papillomavirus on the Indigenous women of XIP.

El Parque Indigena Xingu (XIP), el mas grande territorio indígena en Brasil, protege el medio ambiente y la forma de vida tradicional de los 16 grupos indígenas que ahi viven. El acceso al XIP por personas no indígenas es limitado, pero en las décadas recientes, nuevos caminos y el aumento de personas viviendo en la proximidad del parque, han incrementado la exposición a diferentes agentes infecciosos. La población indígena esta constantemente lidiando con la escasez de cuidados médicos. Este estudio evalúa la frecuencia y el potencial impacto de agentes como clamidia, gonorrea y papilomavirus humano de alto riesgo en las mujeres indígenas del XIP.

O Parque Indígena do Xingu (PIX), o maior território indígena do Brasil, protege o meio ambiente e o modo de vida tradicional dos 16 grupos indígenas que ali vivem. O acesso ao PIX por não indígenas é limitado, mas, nas últimas décadas, novas estradas e mais pessoas morando no entorno do parque aumentaram a exposição a diferentes agentes infecciosos. A população indígena lida constantemente com a escassez de atendimento médico. Este estudo avaliou a frequência e o potencial impacto da Clamídia, Gonorreia e Papilomavírus Humano de alto risco nas mulheres indígenas do PIX.

There is an increasing number of undergraduate health professions students being trained along a continuum of care from central academic hospitals to remote distributed training sites. This is an essential healthcare education reform for contextually relevant training. With the progressive expansion of distributed training in South Africa academic coordination at these sites is crucial. This study explored the experiences of university employed rural academic coordinators responsible for student learning and community engagement on distributed platforms in South Africa.

In Indonesia, traditional medicine is well-known and practiced from generation to generation. The 2013 and 2018 results of the Indonesian Basic Health Survey indicated that, despite a lack of coverage by the National Health Insurance scheme, the use of traditional health services is increasing and it seems they are even expected to fill the gap in health coverage caused by a lack of modern health facilities in rural areas. This article reports on the use of traditional health services in rural Indonesia and how this relates to socioeconomic factors.

There are limited available data describing referral, triage patterns and wait times for rural paediatric outpatient clinics to guide health service planning and delivery. Collection and reporting of such data are imperative for determining community need for services. To gauge the needs of a local community, this study examined the source of referrals, patient demographics and problem types for all new patients who attended an appointment during the initial year of a new rural paediatric outpatient service in rural Victoria, Australia.

Providing culturally and linguistically appropriate rehabilitation services to older Indigenous adults is challenging, particularly within rural and remote settings. This article describes the community participatory action research process used to develop and evaluate a Community Rehabilitation Worker program to serve First Nation elders in Treaties 5 and 9, Canada. The resulting curriculum, which incorporates culture, spirituality, traditions, local language, and reintegration of elders into the community, is now being implemented. The authors reflect on the importance of a participatory approach when developing programs and services for Indigenous peoples.

The rising prevalence of obesity (which is higher in rural than urban areas) is one of the most serious public health challenges. Over the past decade, several national guidelines have been established for the Norwegian health sector to meet the challenges of childhood overweight and obesity and ensure professionalism and standardization of health services. This study determined the extent to which public health nurses in rural Norway feel equipped to address overweight and obesity within these guidelines.

Adolescent pregnancies are a major public health concern in low- and middle-income countries, affecting more than 20 million girls under 19 years of age globally every year and potentially causing poor health outcomes for mothers and infants. In Turkey, due to the country’s cultural structure, social norms and traditions, minor marriages and adolescent pregnancies continue to be widely seen in some regions. This study determined changes in anxiety, depression and perceived social support in pregnant adolescents after provision of a Psychosocial Support-Based program in rural eastern Turkey.

In the remote Kimberley region of Western Australia, the prevalence of dental disease is significantly higher than other regional centres. Access to timely dental care for remote Aboriginal communities remains a challenge and is both a state and national priority, but establishing permanent full-time dental services is generally not considered viable nor sustainable because of the vast, remote and sparsely populated  area. As a result, the Kimberley Dental Team, a non-government, volunteer-led organisation, was established by community invitation to ‘fill the gaps’ and extend dental care to areas of unmet need. This paper describes the development, resources, operational factors and organisational characteristics of the Kimberley Dental Team.

Bites by venomous snakes, recognised as a high-priority neglected tropical disease by the World Health Organization, are the cause of more than 64,000 deaths annually in India. Extensive spread of COVID-19 meant action to address the pandemic (diversion of health system resources, mobility restrictions and economic impacts) took precedence over action on other health conditions, including snakebite. This study collected facility-level data from multiple health facilities to quantify the effect of containment measures for COVID-19 on snakebite care in several rural areas in India.

Maldistribution and retention of health professionals in underserved areas are global problems, and burnout is one reason that health professionals leave rural areas. Nurses are the frontline health workforce and are critical in a health service facility. National Indonesian regulations have a target of 180 nurses per 100,000 people, but several rural provinces do not meet this target. Chronic burnout is linked to depression, and nurses have a higher risk of depression than the general population. This article reports on resilience and depression in Indonesian nurses and finds that the resilience profiles of Indonesian nurses differ from those of doctors, so tailored approaches are required to support nurses, improve resilience and improve workforce retention.