Rural Health

Rural Health By Dr. Nihal Salah Shihab Professor of Public Health

Rural Health Definition: Rural Community: account to 56% Magnitude of the problem: The differences between rural and urban communities (traditions as in consanguinous marriage & cultures as in (having a male child is contributed to the mother), economic level) Three classical problems: Poverty

illiteracy diseases more poverty

Problems of the rural community I- Health problems II- Health-related problems I- Health problems: a- Morbidity problems:communicable & non-communicable diseases [nutritional disorders +accidents]. b- Mortality p.: (infants + children) c- Health services: ▼▼health care services + ▼awareness + ▼lack to seek medical care.

A-Morbidity problems: I- Communicable diseases :Predisposing factors: 1- Unsanitary environment: Improper housing with overcrowdness + lack of village planning. Unsafe water supply (use of outdoor (Toromba) water) Improper sewage + waste disposal. Prevalence of rodents and insects. Lack of food sanitation.

2- Lack of personal hygiene and unawareness of the healthful life style. 3- Low socio-economic standards ►►certain cultural and behavioral factors: High fertility motives ►► overpopulation. An extended family structure ►►crowded houses. Reluctance to seek medical care ◄◄ economic factors mainly + ▼▼KAP [Knowledge –Attitude- Practice ]. Inter-relationship between: Poverty ►-◄ Food adequacy ►-◄ Malnutrition ►-◄ ill health (more exposure to infections) ▲▲.

Examples of the common communicable diseases : Diseases of droplet infection such as : T.B., strept. pharyngitis with the possibility of subsequent rheumatic heart dis. Other diseases among children as : meningitis, measles,mumps, German measles, pertussis, (diphtheria), chicken pox. However, due to compulsory immunizations in infants, the incidence of most of those diseases were lowered.

Food borne inf.: ex. Gastroenteritis, hepatitis A, food poisoning and parasitic diseases such as ascaris, oxuris, amaebiasis,. Contact infections : (a)-Fungal : tinea pedis and capetis,.. (b)-Viral : Rabies, herpes simplex,. (c)-Bacterial: : tetanus (d)-Parasitic :e.x scabies, Malaria, Bilharziasis, pediculosis, ankylostoma Why contact infections are common?

2- Non-communicable diseases : All diseases such as heart diseases, diabetes, cancer exist in the rural population but the followings are studied with special consideration to the environment. 1- Nutritional deficiency diseases: Undernourishment

Malnourishment

Quantity

Quality

• Predisposing factors for nutritional deficiencies: 3.Low socio-economic level: which influences either the quantity and or the quality of diet especially the animal food content. 4.Nutritional ignorance: of weaning practice + quality 5.Prevalence of parasitic infestations.

EXAMPLES OF Common NUTRITIONAL DEFICIENCY DISEASES:-

Iron deficiency anemia: the most common deficiency especially in the vulnerable groups. Caused mainly by deficient intake, or lack of absorption (why?), also by parasitic infestations. Protein caloric malnutrition Rickets Ariboflavinosis : vit B2 ▼ Vit A ▼ Pellagra.

2- Accidents: a-Home accidents: due to , poor unsanitary housing Examples: PIEB Poisoning by ingestion of pesticides, potas or kerosene (in children more) Injuries: as due to falls( floor + light), animal kicks, roof collapse Electric shocks from unsafe appliances or connections Burns from the fires (from accumulated dry plant stems on the roofs

b- Environmental accidents: Examples Drowning on bathing or washing in water canals. Poisoning from exposure to acute pollution of pesticides. Injuries by the agricultural machines. Fires and traffic accidents.

II- health-Related Problems A- Socio-economic problems: Underlying factors : limited resources. High fertility and overpopulation. Prevailing illiteracy. Prevalence of diseases with lowered productivity. Effect: Housing-----Nutritional status---diseases—more illiteracy.

B- Education problems: ▲▲Illiteracy which ►► unsound health behaviors + Faulty traditional beliefs ►►------▲▲morbidity & mortality. Examples of unsound behaviors, micturition in canals, washing clothes. Example of faulty traditional b., female mutilation [3rd&4th grades], Mumps in females, nutrition in the inborn twins according to their sex [ especially in certain parts in Africa, Sex discrimination]

C- Environmental problems: Unsanitary environment will supply the ecological factors necessary for endemicity of some diseases Sewage disposal Water sources Waste disposal Food . Insects and rodents

Rural Health Program 1) For the community A). Community development. B). Environmental sanitation of the rural community. 2) Rural health services.

I- A). Rural Community development

Modern villages planning. Industrialization of rural areas. Motivating the educated rural people to work and establish activities. Apply programs of erasing illiteracy I-B). Environmental sanitation:

II- Rural health services: Those are mainly primary health care {PHC} services provided through the different rural health units and centers. [preventive and curative]. Rural health unit Rural health center Combined health units Integrated rural hospitals. Outreach program

1- Rural health unit : (Integrated services 1) Health office services for: A. Registration of births (live & still birth) & deaths. B. Prevention and control of infectious diseases. Reporting of notifiable diseases to the unit. Control for cases, isolation, terminal disinfection Control measures for the contact and for the community including : Immunization and health education

C- Compulsory immunizations. D- Monitoring of the environment.

What are the personnel working in the health office named? They are : Doctors: Health inspectors. Food Inspectors.

2) Maternal and child health services: Maternal services, family planning, infant welfare, preschool and school health services.

4) Out-patient service and dental care service: for first aid and emergency service, examination and treatment of the sick people. 5) A small laboratory and a dispensary. 6) Other services as:, health education, survey studies and family health records

2- Rural health center: It carries all functions of the rural health unit beside the inpatient service. The center has about 15 - 20 beds. Personnel of the rural health center: - 2 physicians, 2 nurses and midwives, clerk, driver, cook, sanitarian, laboratory technician and tomargias.

3- Combined health unit: In the past, Health division, Educational division Socio-agricultural division. At present, Only the health division works as in rural health unit.

4- integrated rural hospitals: 5- Outreach program: For isolated communities For care of special groups as the pregnant mothers, the elderly Form of services: (1) Home visits : (2) Immunization campaigns (3) Mobile units

Problem of urbanization Definition. Causes: Students move with their families ►big towns for higher education. Being ambitious for better lifestyle. In developing countries Limited agriculture resources Overpopulation in the rural communities Industrialization is in big cities

Q. what are the sequels of uncontrolled urbanization? 1-Crowdness of people under poor living conditions with formation of slum areas. Q. what are the slum areas? Unsanitary environment, no privacy, shared bathrooms, .. 2-Increased incidence of skin infectious diseases, food born, droplet infections, psychological problems, increased violence.

Management of urbanization problems: 1-Rural Community development: It takes time but ends with proper results. A proper village re-planning and redesigning. Industrialization in rural community based on agriculture. Social development including correction of unhealthful behaviors and cultures

2-Motivating educated rural people: To settle, work and establish activities 3-Personnel giving rural services: They should be provided with convenient quality of life as efficient schools for their children/ recent housing.

Future ideas: A need for in-house training in the rural health care organization. In-house training can meet both existing and anticipated employee training needs and offers incentives for employee recruitment and retention. Solar Energy: Potential to Facilitate Household Rural Electrification