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In foreign countries, rural tourism is developing with a high rhythm. Kazakhstan also has excellent opportunities for the development of this type of tourism. Currently, rural tourism in Kazakhstan is not fully developed. The article deals with the issues of organising rural tourism based on agriculture in the Aktobe Region. The study aims to improve methodological approaches to rural tourism development as an innovative activity type in the context of agricultural diversification. Three methodological stages have been identified: assessing the potential for rural tourism development, identifying priority types and subtypes of rural tourism, and identifying priority and promising areas for rural tourism development. The work assessed the possibilities of rural tourism development in the districts of the Aktobe Region using the ranking method.

Making Muskoka traces the first decades of Muskoka's transformation from Indigenous homeland to a part-time playground for tourists and cottagers and uncovers the consequences for those who lived there year-round.

Background Routine immunisation (RI) contributes immensely to reduction in mortality from vaccine preventable diseases (VPD) among children. The Nigerian Demographic and Health Survey, 2008 revealed that only 58 % of children in Osun State had received all recommended vaccines, which is far below World Health Organization (WHO) target of 80 %. We therefore, assessed RI uptake and its determinants among children in Atakumosa-west district of Osun State. Methods Atakumosa-west district has an estimated population of 90,525 inhabitants. We enrolled 750 mothers of children aged 12–23 months in this cross-sectional study. Semi-structured questionnaires were used to obtain data on socio-demographic characteristics, knowledge of mothers on RI, history of RI in children and factors associated with full RI uptake. A fully-immunised child was defined as a child who had received one dose of Bacillus-Calmette-Guerin, three doses of Oral-Polio-Vaccine, three doses of Diptheria-Pertusis-Tetanus vaccine and one dose of measles vaccine by 12 months of age. We tested for the association between immunisation uptake and its likely determinants using multivariable logistic regression at 0.05 level of significance and 95 % confidence Interval (CI). Results Mean ± (SD) age of the mothers and children were 27.9 ± 6.1 years and 17.2 ± 4.0 months, respectively. About 94 % (703/750) of mothers had received antenatal care (ANC) and 63.3 % (475) of the children possessed vaccination cards. Seventy-six percent (571/750) had good knowledge of RI and VPD. About 58 % (275/475) of children who possessed vaccination card were fully-immunised. Mothers antenatal care attendance (aOR = 3.3, 95 % CI = 1.1-8.3), maternal tetanus toxoid immunisation (aOR = 3.2, 95 % CI = 1.1-10.0) access to immunisation information (aOR = 1.8, 95 % CI = 1.1-2.5) and mothers having good knowledge of immunisation (aOR = 2.4, 95 % CI = 1.6-3.8) were significant determinants of full immunisation. Conclusions Routine immunisation uptake was still below WHO target in the study area. Encouraging mothers to attend antenatal care and educational interventions targeted at rural mothers are recommended to improve vaccination status of children in the rural communities.

Background This study aimed to assess the influence factors of the mutual-support willingness and identify the mutual-support needs of elderly living in rural areas of Hunan Province, China. Methods Using the Chi-square test and logistic regression to analyze factors influencing Participants’ mutual-support willingness and needs. Results Factors influencing the mutual-support willingness and needs included individual characteristics, family environment, and so on. And the rural elderly’s demand for mutual-support is at a relatively high level. The total score for social support for the aged was 36.944 ± 6.487, at a moderate level. Conclusions It is necessary to objectively evaluate the factors related to mutual-support willingness and needs and take steps to enhance social support and meet elderly the needs of mutual-support, which is of great significance for improving the happiness of the elderly in their later years and alleviating the crisis of population aging in China.

Introduction Essentially all women and babies irrespective of their economic and social status should reach their full potential for health and well-being. The study assessed the readiness of mothers and their preparedness for birth across three disadvantaged rural districts in Ghana. Methods A multi-centre quantitative survey from January to December 2018 using a multistage sampling approach was employed. Using a structured questionnaire data from mothers attending antenatal and postnatal clinics in three main ecological zones of Ghana were collected. Women who provided informed consent were consecutively recruited until the sample size was achieved. For categorical data, summary tables, proportions and percentage are presented. Multivariate logistic regression analysis determined the effect of selected characteristics on birth preparedness. Ethics approval was obtained from the Navrongo Health Research Centre. Results A total of 1058 mothers were enrolled: 33.6%, 33.4% and 33.0% respectively from the Ada west, Upper Denkyira west and Builsa south districts. About 94% of the women had prior knowledge of birth preparedness. Approximately 22.6% (95%CI 20.1, 25. 2) of the mothers were assessed to have poor birth preparedness: 8.0% in Builsa south, 27.8% in Ada west and 31.7% in Upper Denkyira west. Prenatal and postnatal data showed no statistically significant difference in poor preparedness (21.9% vs 23.3%; p -value > 0.05). Maternal age, employment status, religious affiliation and parity were not associated with birth preparedness ( p -value > 0.05). Area of study ( P  < 0.001), educational level ( P  < 0.016), marital status ( p  < 0.001) and antenatal contacts (< 0.001) were significantly associated with birth preparedness. Conclusions As an important safe motherhood strategy woman should plan their pregnancy and birth well to reduce maternal and neonatal mortality. Policy initiatives should take into consideration area of residence, education, marital status and antenatal contacts of women.

Background Optimal nutrition during the first two years of a child’s life is critical for the reduction of morbidity and mortality. In Ghana, majority of children miss out on optimal nutrition and only few (13%) of children receive a Minimum Acceptable Diet (MAD). Several studies have investigated the influence of community-level factors on infants and young children feeding (IYCF) practices. However, little is known about the influence of maternal factors on IYCF practices in rural settings. Therefore, this study assessed the influence of maternal factors on the feeding indicators and nutritional status of children aged 6–23 months in two administrative districts in Ghana. Methods Data were collected among 935 mothers who had children aged 6–23 months and accessed 21 Child Welfare Clinics within the study area. The study involved a face- to-face interview using structured questionnaires to capture maternal characteristics, dietary intake and anthropometric measurements of children. Multivariate logistic regression was used to study the association between maternal factors and child nutrition outcomes (MAD, dietary diversity score (DDS) and anthropometric indicators) using Stata 16.0 software. Results Being employed (AOR = 3.07, 95% CI: 1.71—5.49, p  < 0.001) and attaining secondary or higher education (AOR = 2.86, 95% CI: 1.42—5.78, p  = 0.003) were significant predictors of children receiving MAD. Similarly, having an average decision-making autonomy increased the child’s odds of receiving MAD (AOR = 1.68, 95% CI: 1.02—2.76, p  = 0.040). Children of mothers who attained secondary or a higher level of education (AOR = 0.59, 95% CI: 0.36 -0.97, p  = 0.040) and those whose mothers were employed (AOR = 0.71, 95% CI: 0.47—1.07, p  = 0.043) were associated with a reduced risk of underweight and stunting respectively. Children of mothers with average financial independence status were more likely to receive diversified meals (AOR = 1.55, 95% CI: 1.01–2.38, p  = 0.045). Conclusions High educational level and being employed have positive influence on MAD, stunting and underweight of children. High decision-making power and average financial independence of mothers are good predictors of children receiving MAD. Family planning, women empowerment in decision-making, providing employment opportunities for mothers and promoting girl-child education are recommended.

Background Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. Method We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Results Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11–2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04–2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03–2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361–2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24–0.73)] was associated with a lower probability of experiencing unmet need for family planning. Conclusion Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.

BackgroundEfficient referral systems are essential for improving healthcare and patient outcomes, especially in resource-limited settings where access to public specialist care is limited by too few specialists, growing populations and constrained resources impacting non-emergency and emergency referrals. District hospitals (DHs) must ensure that patients receive the appropriate level of care. High-quality referral systems are necessary for the cost-effective flow of patients between district and regional hospitals (RHs).AimThis study aimed to evaluate emergency and non-emergency patient referral processes between DHs and the RH in two districts in South Africa.SettingTen DHs and the RH in the Garden Route and Central Karoo districts in South Africa.MethodsA mixed-methods design incorporated quantitative survey data and qualitative thematic analysis to provide a comprehensive understanding of referral processes. The study population included all doctors working at 10 DHs and the RH, with 120 voluntary participants.ResultsKey findings revealed disparities in referral satisfaction between emergency (66%) and non-emergency (59%) referrals. Communication breakdowns and systemic barriers hindered timely access to specialist care, mismatched expectations and understanding, coupled with inconsistent referral guidelines. Inadequate capacity building increased inappropriate referrals.ConclusionCommunication breakdowns and differing expectations between DHs and the RH regarding available resources and services negatively impacted referrals. Improved communication, targeted outreach, capacity-building initiatives, stronger collaborative relationships and standardisation of processes could enhance patient referral efficiency.ContributionThis work adds new knowledge to patient referrals between rural district and regional hospitals in resource-limited contexts, highlighting the complexity of the referral process.

This article examines adaptation measures used to sustain indigenous practices and the use of indigenous knowledge systems (IKS) to adapt to climate change in Mutoko rural district of Zimbabwe. Community-based adaptation is able to reduce the vulnerability as well as improve the resilience of the local people to climatic variability and change. Subsistence farmers have always adopted adaptive strategies to some of these changes over the years. As such, the adoption of indigenous practices will significantly help rural community members to adapt to climate change. This study employed a qualitative method and an exploratory design, and the results are derived from 30 purposively selected in-depth interviews. The study discovered that there are numerous measures used to adapt to climate change and subsequently to sustain indigenous practices. The study also found that the community no longer grows maize in large quantities, having shifted to millet and sorghum in order to adapt to climate change. The community also provided various strategies to adapt to climate change. These strategies include mulching, creating large storage houses for produce and creating temporary walls on riverbanks in order to store water when the rivers dry up. This study concludes that climate change adaptation measures employed by the community have significantly helped them to sustain their indigenous practices in many ways. Also, the use of IKS, through activities such as crop type change from maize to traditional millet and sorghum (which facilitates traditional lifestyle and activities), re-establishes the community’s indigenous practices since they are made to observe the practices of yesteryear.

Bridging the Gap: Addressing Health Worker Imbalances in Sub-Saharan Africa This working paper tackles the critical issue of geographical imbalances in the health workforce across Sub-Saharan Africa. It analyzes labor market dynamics and their impact on urban-rural inequities, offering a fresh perspective on why these imbalances persist. Discover effective policy options for improving health resource allocation and achieving better health outcomes. This is for researchers, policy analysts, and policymakers seeking to understand and address health workforce challenges in the developing world. Learn how to: * Analyze health labor markets using economic principles * Evaluate the effectiveness of different policy interventions * Improve health system efficiency and reduce poverty