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Background In 2006, the Government of Pakistan introduced community midwives to provide maternal care services to rural communities. Despite huge investments, evidence from several rural regions of Pakistan suggests that the utilization of maternal care through community midwives is very low and the maternal health indicators have not shown significant improvements. A qualitative study was conducted in Thatta, a rural district of Pakistan to explore the challenges faced by community midwives in the provision of skilled care. Methods We used an exploratory qualitative study design by conducting in-depth interviews using a semi-structured interview guide and a purposive sampling approach. The data was collected using the four domains of the community midwifery model. Interviews were conducted with officials from the health department, three categories of midwives including (i) midwifery students; (ii) trained and working community midwives; and (iii) trained and non-working community midwives. We also carried out interviews with community women. A total of 25 interviews were conducted. A thematic analysis approach was used for analysis. Results Based on the four domains of the community midwifery model that guided our data collection, two overarching themes were identified: (I) Social and cultural challenges faced by CMWs including the young age of midwives, and community women’s varied preferences for their delivery and childbirth processes were major challenges for community midwives (II) Support and acceptance including nonacceptance of community midwives’ services by doctors, other healthcare providers, and community women were identified as significant barriers to community midwives services. Conclusion The study provides key insights to program implementers to work on strategies and interventions to resolve the challenges faced by community midwives and to help achieve the aim of increasing skilled birth attendants in rural regions of Pakistan.

Giardiasis is a globally re-emerging protozoan disease with veterinary and public health implications. The current study was carried out to investigate the zoonotic potential of livestock-specific assemblage E in rural settings. For this purpose, a total of 40 microscopically positive Giardia stool samples from children with gastrointestinal complaints with or without diarrhea were enrolled in the study as well as fecal samples from 46 diarrheic cattle (18 dairy cows and 28 calves). Animal samples were examined by sedimentation method to identify Giardia spp., and then, all Giardia positive samples from human and animals were processed for molecular detection of livestock-specific assemblage E through amplification of assemblage-specific triosephosphate isomerase (tpi) gene using nested polymerase chain reaction (PCR). The results of the study revealed high unexpected occurrence of assemblage E among human samples (62.5 %), whereas the distribution among patients with diarrhea and those without was 42.1 and 81 %, respectively. On the other hand, the prevalence of Giardia spp. among diarrheic dairy cattle was (8.7 %), while only calves yielded positive results (14.3 %) and all bovine Giardia spp. were genetically classified as Giardia intestinalis assemblage E. Moreover, DNA sequencing of randomly selected one positive human sample and another bovine one revealed 100 and 99 % identity with assemblage E tpi gene sequences available at GenBank after BLAST analysis. In conclusion, the current study highlights the wide dissemination of livestock-specific assemblage E among humans in rural areas, and thus, zoonotic transmission cycle should not be discounted during the control of giardiasis in such settings.

Physical inactivity among university students remains a global health concern, especially in semi-rural settings where unique barriers such as limited facilities, cultural norms, and inadequate transportation persist. This study aimed to identify the primary motivations and barriers to physical activity participation among students at a semi-rural university, providing insights for tailored interventions. A mixed-methods explanatory sequential design was used. In the quantitative phase, 414 questionnaires were distributed across four faculties, with 328 completed responses analysed using t-tests and factor analysis. The qualitative phase involved semi-structured interviews with 23 students, analysed through conventional content analysis. The quantitative findings revealed key motivators for physical activity, which included enjoyment (mean = 4.51, p < 0.001), social interaction (mean = 3.99, p < 0.001), and health benefits (mean = 3.27, p = 0.001). However, for barriers, heavy academic workload reached statistical significance (mean = 3.88, p < 0.001). In contrast, qualitative data uncovered additional barriers such as insufficient facilities and poor communication, which were not captured in the quantitative phase. Factor analysis identified four constructs for motivations (e.g., coaching, social, health, enjoyment) and barriers (e.g., club processes, excuses, external factors, lack of interest). Qualitative data corroborated these findings, highlighting issues such as insufficient visibility of physical activity programs, time barriers, and inconsistent coaching quality. This study underscores the importance of addressing structural barriers, such as upgrading facilities, improving communication strategies, and enhancing coaching quality, to increase physical activity participation. By implementing strategic interventions, universities can foster inclusive environments that better support students’ well-being and engagement, ultimately promoting healthier lifestyles among university populations.

Introduction Quality of life (QoL) is a core aspect of healthy ageing, reflecting the ability of older persons to adapt and maintain well-being in later life. Urban–rural differences pose distinct challenges, with urban areas facing overcrowding and high costs, whereas rural areas lack healthcare and infrastructure, necessitating targeted public health strategies. This study identified factors associated with QoL among older Malaysians, with analyses stratified by urban and rural areas. Methods This cross-sectional study analysed data from the National Health and Morbidity Survey 2018: Elderly Health, involving 3,977 community-dwelling older Malaysians aged 60 years and above. QoL was measured using the Control, Autonomy, Self-Realisation, and Pleasure (CASP-19) scale. Independent variables included sociodemographic characteristics, physical activity, chronic disease, dementia, depression, ADL/IADL limitations, sensory and urinary problems, abuse or neglect, and social support. Descriptive statistics profiled respondents, and stratified complex sample linear regressions identified associated factors. Missing data were handled using multiple imputation, incorporating survey weights. STATA version 16 was used for analysis. Results Urban older persons had a higher mean QoL than rural counterparts (46.1 vs. 45.2). In both areas, depression (urban: β = − 7.13, p  < 0.001; rural: β = − 6.17, p  < 0.001), hearing disability (urban: β = − 3.83, p  < 0.001; rural: β = − 2.29, p  < 0.001), ADL limitations (urban: β = − 1.50, p  = 0.010; rural: β = − 1.25, p  = 0.042), and IADL limitations (urban: β = − 1.24, p  < 0.001; rural: β = − 1.68, p  < 0.001), and lower levels of social support (urban: β = -1.82, p  = 0.002; rural: β = -2.41, p  < 0.001) were associated with lower QoL. Urban-specific factors were tertiary education (β = 2.77, p  = 0.001) and physical activity (β = 1.37, p  = 0.001). Rural-specific factors included higher income (β = 2.43, p  < 0.001) and vision disability (β = − 2.63, p  < 0.001). Conclusion This study provides insights into factors associated with QoL among older persons, distinguishing shared factors from those specific to urban and rural areas. Depression, hearing disability, functional ability, and social support were associated with QoL. However, the effects of income, education, and physical activity differed across urban and rural areas, underscoring the need for locally tailored interventions. Trial registration number NMRR ID-25-00097-EZT. 19th February 2025.

Measuring close proximity interactions between individuals can provide key information on social contacts in human communities and related behaviours. This is even more essential in rural settings in low- and middle-income countries where there is a need to understand contact patterns for the implementation of strategies for social protection interventions. We report the quantitative assessment of contact patterns in a village in rural Malawi, based on proximity sensors technology that allows for high-resolution measurements of social contacts. Our results revealed that the community structure of the village was highly correlated with the household membership of the individuals, thus confirming the importance of the family ties within the village. Social contacts within households occurred mainly between adults and children, and adults and adolescents and most of the inter-household social relationships occurred among adults and among adolescents. At the individual level, age and gender social assortment were observed in the inter-household network, and age disassortativity was instead observed in intra-household networks. Moreover, we obtained a clear trend of the daily contact activity of the village. Family members congregated in the early morning, during lunch time and dinner time. In contrast, inter-household contact activity displayed a growth from the morning, reaching a maximum in the afternoon. The proximity sensors technology used in this study provided high resolution temporal data characterized by timescales comparable with those intrinsic to social dynamics and it thus allowed to have access to the level of information needed to understand the social context of the village.

This study assessed the level of fathers' involvement in childcare activities and its association with the diet quality of their children in Northern Ghana. The study was carried out in the Northern, Upper East and Upper West regions of Ghana. The people in the study area mostly depend on agriculture as their main occupation. A community-based comparative analytical cross-sectional study. A sample of 422 rural mother-father pairs who had at least one child aged 6-36 months. The overall level of fathers' involvement in childcare and feeding activities was high among 63·5 % of the respondents in the 6 months prior to the study. The most common childcare activity men were involved in was providing money for the purchase of food for the child. Minimum acceptable diet was higher for children with a higher level of paternal involvement in childcare activities (adjusted OR = 3·33 (95 % CI: 1·41, 7·90)), compared to their counterparts whose father's involvement was poor. Fathers who had a positive attitude to childcare and feeding were 2·9 more likely to get involved in childcare activities (adjusted OR = 2·90 (95 % CI: 1·87, 4·48)). The findings confirm earlier studies that show that fathers' involvement in childcare activities including feeding is positively associated with improved child feeding practices. The findings point to the need to have a policy shift in which both men and women are key actors in interventions designed to improve child nutritional status in rural settings of Northern Ghana.

Refugee resettlement significantly contributes to Australia’s migration programs, with recent policy directives prioritising rural resettlement. As a result, the cultural diversity of populations of several Australian rural towns has substantially expanded. Newcomers may encounter challenges becoming part of closed social networks and accessing the resources they need for a healthy life in resettlement. However, there are also benefits that stem from positive integration for newcomers and for receiving populations. As part of a larger study, which aimed to explore facilitators and barriers to successful resettlement in a rural setting, the objective of this paper was to show how social ties were important for participants’ health, both facilitating access to resources, including health services, and connecting people to health-promoting living conditions. In-depth individual interviews with 44 participants from refugee communities originally from Africa and South-East Asia, settled in a rural South Australian town, were conducted. Participants were invited to the study through snowball sampling via known connections between the researchers and key people within the communities. Interview transcripts were analysed using framework thematic analysis. The findings demonstrate how participants drew on connections within their cultural communities, reflecting collectivist cultural values. These social ties were key to enabling access to resources for health. These included emotional resources, such as a sense of belonging, as well as physical and practical resources, including food, housing, and/or accessing services. Several participants were also working towards a career in the health industry. Populations from refugee communities in rural towns are growing, not only with the continuation of new arrivals to these towns, but also as the settled populations expand their families and communities. Effective health service provision in these locations needs to serve these growing communities, and there is scope for services to tap into community networks to assist with this.

PurposeThe starting premise of this study is that women's empowerment is the goal for self-realization and that the support that comes from local tourism stakeholders represents an adequate base. In many rural areas, women have established self-help groups (SHGs), which facilitate the interaction with a wide range of stakeholders. The objective of this paper is to investigate the effects of SHGs on female entrepreneurship and self-employment in tourism.Design/methodology/approachTo examine the research question, this study adopted a quantitative research that included a sample of 513 women in a less-advanced rural area in Serbia. For the data analysis, the generalized linear regression model (GLM) was used.FindingsAccording to the results, self-employment is the leading goal of women's empowerment.Research limitations/implicationsThe main limitation in the research and the authors’ suggestion for future research is to increase the sample size of female respondents, so examination of their attitudes and role in the travel business in their local settings might reach higher significance. The second issue that the authors would like to point out is a highly local character of our study, so the future research should involve other rural areas in the country and from abroad (e.g. similar undeveloped countryside with noticeable, active women's role in local entrepreneurship).Practical implicationsThe most important practical implications of this paper are twofold: (1) the results of the research have shown that the tourist potential of rural areas can be enhanced through local tourism stakeholders' support; (2) women without professional interest or jobs in rural areas, especially in the areas where the population is traditionally dominated by men (husband/brother/father), have a chance to earn and to be economically more independent. This research can affect future studies to investigate other aspects of empowerment depending on the difference of regions, from one side, and also alternative opportunities for tourism and local development in less-advanced rural areas, from another side.Originality/valueThe study analyzes the tourism potential of the rural areas (which are less advanced and mostly very poor in developing countries, such as Serbia). In this case, there are opportunities to increase employment, social inclusion of women, development of new tourism strategies, implementation of destination marketing, etc. Moreover, it contributes to future research in the field of stakeholders in tourism strategies.

The mental health needs of young people in sub-Saharan African societies remain understudied. This study builds upon the everyday perspectives of young people in Gorongosa, a rural district in central Mozambique, to determine the frequency and severity of key mental health issues, identify significant risk and protective factors, and their associations with demographic factors and mental health predictors. This cross-sectional study gathered culturally and ecologically relevant variables, such as sociodemographic indicators and risk and protective factors. The Beck Depression Inventory-II (BDI-II), Self-Report Questionnaire (SRQ) and Nocturnal Intrusions after Traumatic Experiences Questionnaire (NITE) were used to determine the prevalence and severity of key mental health issues. A convenience sampling was used involving n  = 794 young people of those (45.8%) were females and the mean age of all participants was 17.24 years (SD 2.9). To examine the results, univariate analysis, chi-square tests, binary logistic regression analyses and odds ratio were used. Risk factors were pervasive in households, communities, and schools. Mental health problems were commonly linked to severe depression (14.2%), anxiety-related disorders (39.3%), sleep disturbances (37.3%), and anxiety dreams (27.5%). Gender, age, and protective factors were associated with the frequency and severity of mental health outcomes, while living with both parents protected against the severity of anxiety-related disorders. Understanding the contextual mental health needs of young people in rural Mozambique is crucial for developing insights to craft and implement targeted public mental health interventions in resource-limited settings. Addressing mental health issues among young people necessitates a concentrated effort on understanding and managing the interplay of risks and protective factors within families, communities, and schools.

Dengue fever is a major public health concern in India and Kerala is one of the worst affected states in the country. Kanjirappally, Kottayam district, has been reported to be the epicentre of dengue in the state. In 2016, we carried out a post-epidemic seroprevalence survey in both urban and rural sites of this endemic foci to estimate the disease burden. A systematic sampling technique with a random start (household) was adopted in each study site. Overall, 938 individuals were enrolled in the survey, 470 in the urban and 468 in the rural sites belonging to 103 and 88 households respectively. Rapid diagnostic IgM/IgG test kit was used for the study. The overall dengue IgG seroprevalence observed was 51.28%. Urban sites had higher seroprevalence rate (59.8%) compared to rural sites (42.74%, P < 0.01). No gender difference was recorded in seroprevalence rates among the sites. Exposure was found to be more common among adults than children in both areas. Seroprevalence rate in children <10 years of age was found to be 15 times higher (44.61%) in urban sites, than that in the rural sites (3.03%). The present study indicates that more than half of the population is exposed to DENV (dengue virus) infection in this oldest focus of dengue in Kerala.