Can Domestic Food Production Provide Future Urban Populations with Food and Nutrition Security?—Insights from Bangladesh, Kenya and Uganda

Population growth and urbanization increasingly put pressure on our planet's availability of areas needed for food production. The dependencies on domestically produced food are increasingly judged favourable, following the consequences of the Ukrainian war, with escalating fuel and grain prices and less accessibilities to low-income groups. It is, however, unclear whether land is domestically available. Applying a food system approach, the main aim of this article is to investigate spatial foodsheds and theoretical self-sufficiency for food production needed to supply increasing future populations in a selection of cities, including estimates for Dhaka in Bangladesh, Nairobi in Kenya and Kampala in Uganda. The projected foodshed scenario areas for the years 2020 and 2050 are estimated for the production of three core products currently extensively produced and consumed in the three countries. They show that it is not possible to feed an ever-increasing urban population based on domestic production alone. International trade, new technological developments and new consumer demands for less area-intensive food production systems may give solutions to the immense challenge of feeding the world's population with nutritious food in 2050. However, to ensure fair and inclusive transition pathways for low-income groups: (1) affordability and accessibility of trade opportunities, technologies and products, (2) a common vision aiming for the SDGs, including SDG2: Zero hunger and SDG11: Sustainable Cities and Communities as well as (3) best practices in co-creation and cooperation with the most vulnerable urban and rural populations, are highly needed.

The impact of rural status on pediatric chronic kidney disease.

Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

Building a Pandemic-Responsive, Community-Engaged Research Program to Advance Health Equity for Persons with Diabetes

OBJECTIVES/GOALS: Diabetes mellitus and COVID-19 have converged to form a syndemic. Our team sought to identify and respond to the evolving needs of patients and communities affected by diabetes amid the COVID-19 pandemic and to engage community partners and student leaders in the advancement of health equity research and practice in the state of Iowa. METHODS/STUDY POPULATION: A team of faculty, staff, students, and community partners was assembled to facilitate, design, and implement mixed methods research related to diabetes care in collaboration with more than five sites in Eastern and Western Iowa during the pandemic, with a focus on potentially preventable complications such as diabetes-related foot ulcers and amputations in adult patients. Attention was directed towards the experiences of rural residents, persons working in frontline occupations during the pandemic, persons from minoritized racial or ethnic groups, and persons who speak Spanish. RESULTS/ANTICIPATED RESULTS: A semi-structured interview study about diabetes care revealed themes in the experiences of persons with diabetes during the pandemic. A pilot study of an educational tool called the Foot Book among patients and providers demonstrated the potential for use of this tool in health care and community settings to reduce gaps in diabetes foot care. All study materials and activities were offered in English and Spanish. Study results were combined with input from community partners to develop ongoing interventions to improve care in Iowa communities. DISCUSSION/SIGNIFICANCE: Amid the syndemic of COVID-19 and diabetes, urgent action is needed to mitigate health inequities and prevent further acceleration of these inequities. Our team developed a community-engaged, patient-centered, and student-led research program that can respond to the needs of patients and communities in the pandemic era.

Resident connection to nature and attitudes towards tourism: findings from three different rural nature tourism destinations in Poland

Despite the growing literature arguing for the consideration of community perspectives in tourism destination governance, little is understood about how residents' connection to nature affects their perceptions of and responses to tourism. This is especially relevant for rural areas rich in nature as many of them have become refugees for urban dwellers seeking recreation during the COVID-19 pandemic. This study combines the Nature's Contributions to People framework and Weber's Theory of Formal and Substantive Rationality to shed light on how rural residents of three nature-based tourism destinations connect with nature and how this connection to nature affects perceptions of empowerment from tourism and ultimately support for tourism. Results provide credence to the importance of including measures of residents' connections to nature when examining attitudes towards tourism in nature areas with connections to nature having significant and positive influences on psychological empowerment and social empowerment at all three destinations and direct and positive effects on support for tourism across two of the three destinations. Furthermore, results suggest that understanding the role nature connection plays in how residents perceive changes within their community can help manage locally emerging conflicts within rural tourism-dependent communities.

Promoting or Inhibiting? Digital Inclusive Finance and Cultural Consumption of Rural Residents

Improving the cultural consumption level of rural residents is of great practical significance to help revitalize rural culture and achieve common prosperity. Based on this, this study empirically examines the role and impact mechanism of digital inclusive finance on enhancing the cultural consumption of rural residents using panel data of 30 provinces across China from 2011 to 2020. The results show that: (1) Digital inclusive finance can significantly improve the cultural consumption level of rural residents. After a robustness test and endogenous analysis, this conclusion is still stable. (2) Digital inclusive finance significantly improves the cultural consumption level of rural residents through three paths: raising the income level of farmers, promoting the level of urbanization, and improving the level of financial development. (3) Heterogeneity analysis shows that the breadth of digital inclusive financial coverage can significantly improve the cultural consumption level of rural residents, but the depth of digital inclusive financial use and the degree of digitization do not show an enhancing effect;the development of digital inclusive finance in the eastern area has a significant role in promoting the cultural consumption level of rural residents, but the role is not significant in the central and western areas.

Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study.

BACKGROUND: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. OBJECTIVE: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. METHODS: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. RESULTS: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. CONCLUSIONS: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers' circumstances.

Leveraging CTSA hubs for rapid, large-scale, high-impact research: A case study during a global public health emergency.

As the COVID-19 pandemic took hold in the USA in early 2020, it became clear that knowledge of the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic individuals could inform public health policy decisions and provide insight into the impact of the infection on vulnerable populations. Two Clinical and Translational Science Award (CTSA) Hubs and the National Institutes of Health (NIH) set forth to conduct a national seroprevalence survey to assess the infection's rate of spread. This partnership was able to quickly design and launch the project by leveraging established research capacities, prior experiences in large-scale, multisite studies and a highly skilled workforce of CTSA hubs and unique experimental capabilities at the NIH to conduct a diverse prospective, longitudinal observational cohort of 11,382 participants who provided biospecimens and participant-reported health and behavior data. The study was completed in 16 months and benefitted from transdisciplinary teamwork, information technology innovations, multimodal communication strategies, and scientific partnership for rigor in design and analytic methods. The lessons learned by the rapid implementation and dissemination of this national study is valuable in guiding future multisite projects as well as preparation for other public health emergencies and pandemics.

The Transformation of the Spatial Structure of an Economy in the Crisis and Post-Crisis Periods

—This article is a review of global and Russian research on features and patterns of the development of regions of a country in crisis and post-crisis periods. It is shown that the theoretical foundation of studies on this issue is the concept of regional resilience, as developed in global research since the 2010s. The features of the resilience concept are analyzed and compared with regional growth theories and economic security studies. Factors that influence the resilience of regions of a country to economic crises are summarized: they include features of a region's settlement system (the ratio of the urban to rural populations) and its position in the national settlement system (location in relation to large urban agglomerations), the structure of the region's economy (level of diversification, specific features of specialization and employment structure), innovation potential and quality of human capital, cohesion of the local community, and quality of public administration. It is noted that differences in regional resilience levels are consistent;in particular, the features of regional spatial development observed during the current crisis (associated with the COVID-19 pandemic) follow previously established patterns. Negative consequences of crises, specifically, regional divergence and reduced inclusiveness of economic growth, are also described. Issues of transforming the state spatial development policy during crisis periods, as well as opportunities for managing regional resilience, are discussed.

Starting with us: Imagining relational, co-designed policy approaches to improve healthcare access for rural people with disability.

CONTEXT: Access to healthcare for rural Australians is a wicked problem, particularly for rural people with disability. Contemporary healthcare access frameworks in Australia tend to overlook geography, use a 'one-size-fits-all approach', and disregard the valuable relationships between key rural healthcare stakeholders, including rural people with disability, rural health services and health professionals. The United Nation's Convention on the Rights of Persons with Disabilities requires the Australian Government to engage people with disability in the design of policies that will shape their day-to-day lives, including their access to healthcare. However, the nature and extent to which rural people with disability, rural health professionals and other key rural stakeholders are involved in the design of Australian policies impacting the health of rural people with disability are unknown. AIM: This paper examines approaches taken to engage rural people with disability and health professionals in the design of Australian disability policy impacting healthcare access, and reimagines future processes which can improve healthcare access for rural people with disability. APPROACH: Co-design and ethics of care lenses are applied to policy design approaches in this paper. We approach this work as rural disability and health academics, rural health professionals, and as rural people with disability, neurodivergence and family members of people with disability. CONCLUSION: We argue future co-designed policy approaches could focus on driving change towards equity in healthcare access for rural people with disability by harnessing the relational nature of rural healthcare.

A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South.

The COVID-19 pandemic has led to contentious discourse regarding unproven COVID-19 therapies (UCTs),(e.g. ivermectin). Despite recommendations against it, ivermectin remains, in some areas, highly demanded. The goal of this study is to understand patient and provider perspectives about UCTs (e.g., ivermectin) and how responses to requests for UCTs impact healthcare distrust. This mixed methods observational study was conducted in a rural healthcare system in the Southern United States. Adults (n = 26) with a history of COVID-19 or clinicians (n = 8) from the same system were interviewed using questionnaires assessing healthcare distrust and qualitatively interviewed exploring perceptions about UCTs. Patient themes were: 1) Importance of anecdotal stories for decision-making; 2) Use of haphazard approaches to 'research'; 3) Strong distrust of government and healthcare organizations; 4) Inherent trust in local healthcare; 5) Decision-making as weighing pros/cons; and 6) Feeling a right to try medications. High survey medians indicated high distrust with differences of 8.5 points for those who requested/used ivermectin versus those who did not (p = 0.027). Clinician themes were: 1) Frustration when patients trust social media over clinicians; 2) Acceptance of community beliefs about UCTs; 3) Distrust originating outside of the healthcare system; 4) Feeling torn about prescribing UCTs to build trust; and 5) Variable educational strategies. When clinicians are perceived as aligned with government, this may void patients' trust of clinicians. Clinicians should leverage trust in local healthcare and distance themselves from distrusted information sources. Ethical questions arise regarding appropriateness of acquiescing to patient requests for ivermectin for building trust.

Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States.

BACKGROUND: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. OBJECTIVE: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. METHODS: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators' previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ≥18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. RESULTS: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent's health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. CONCLUSIONS: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers.

Monitoring of COVID-19 in wastewater across the Eastern Upper Peninsula of Michigan.

Wastewater-based epidemiology is being used as a tool to monitor the spread of COVID-19 and provide an early warning for the presence or increase of clinical cases in a community. The majority of wastewater-based epidemiology for COVID-19 tracking has been utilized in sewersheds that service populations in the tens-to-hundreds of thousands. Few studies have been conducted to assess the usefulness of wastewater in predicting COVID-19 clinical cases specifically in rural areas. This study collected samples from 16 locations across the Eastern Upper Peninsula of Michigan from June to December 2021. Sampling locations included 12 rural municipalities, a Tribal housing community and casino, a public university, three municipalities that also contained a prison, and a small island with heavy tourist traffic. Samples were analyzed for SARS-CoV-2 N1, N2, and variant gene copies using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR). Wastewater N1 and N2 gene copies and clinical case counts were correlated to determine if wastewater results were predictive of clinical cases. Significant correlation between N1 and N2 gene copies and clinical cases was found for all sites (⍴= 0.89 to 0.48). N1 and N2 wastewater results were predictive of clinical case trends within 0-7 days. The Delta variant was detected in the Pickford and St. Ignace samples more than 12-days prior to the first reported Delta clinical cases in their respective counties. Locations with low correlation could be attributed to their high rates of tourism. This is further supported by the high correlation seen in the public university, which is a closed population. Long-term wastewater monitoring over a large, rural geographic area is useful for informing the public of potential outbreaks in the community regardless of asymptomatic cases and access to clinical testing.

The Dissemination of Parent-Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study.

The devastating impact of the opioid crisis on children and families in West Virginia was compounded by the COVID-19 pandemic and brought to light the critical need for greater mental health services and providers in the state. Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for child externalizing symptoms that teaches parents positive and appropriate strategies to manage child behaviors. The current qualitative study details barriers and facilitators to disseminating and implementing PCIT with opioid-impacted families across West Virginia during the COVID-19 pandemic. Therapists (n = 34) who participated in PCIT training and consultation through a State Opioid Response grant were asked to provide data about their experiences with PCIT training, consultation, and implementation. Almost all therapists (91%) reported barriers to telehealth PCIT (e.g., poor internet connection, unpredictability of sessions). Nearly half of therapists' cases (45%) were impacted directly by parental substance use. Qualitative findings about the impact of telehealth and opioid use on PCIT implementation are presented. The dissemination and implementation of PCIT in a state greatly impacted by poor telehealth capacity and the opioid epidemic differed from the implementation of PCIT training and treatment delivery in other states, highlighting the critical importance of exploring implementation factors in rural settings.

What Cuts in Federal COVID-19 Funding Could Mean for Rural Communities.

The COVID-19 pandemic has widened the health disparities between urban and rural communities as rural populations face more limited health care capacities and worse COVID-19 outcomes than their urban counterparts. When this article was written, congress was debating continuing federal funds for free COVID-19 testing, vaccines, and treatment. In this article, we discuss the potential consequences rural communities may experience should such funding fail to be approved. Peer-reviewed literature and our research indicate these budget cuts could harm rural communities' financial distress, risk of severe disease outcomes, and trust in health care systems, making continued funding for public health resources critical for vulnerable rural communities.

Long covid and apheresis: a miracle cure sold on a hypothesis of hope

Boris Johnson’s greatest attribute was to sell hope, although Martin McKee argues that Johnson’s empty promises, including those on health, leave him well placed in the race to be the UK’s worst prime minister (doi:10.1136/bmj.o1707).1 One of those hopes was that the covid pandemic was “over” in February (https://www.dailymail.co.uk/news/article-10493765/Boris-Johnson-declares-Covid-rules-MONTH.html),2 a political gambit to lift all restrictions that defied hard evidence and cold logic (doi:10.1136/bmj.o1, doi:10.1136/bmj.o1555, doi:10.1136/bmj-2021-069881).345 SARS-CoV-2 never went away, even if its impact was dulled, and it is now most definitely back, sending people to hospital and intensive care (doi:10.1136/bmj.o1702).6 Hospitals are reintroducing masking for staff (doi:10.1136/bmj.o1712),7 although the general public seems blissfully ignorant of the latest omicron variant. By invoking the Dunning-Kerner effect, David Oliver calls on experts to speak up, in plain language and accessible formats, to counter the “false belief systems that are over-confidently asserted by inexpert people” (doi:10.1136/bmj.o1701).8 One answer is to keep going and caring, even when it’s hard (doi:10.1136/bmj.o1689).9 Another, and not mutually exclusive, is to seek hope in a new health secretary’s desire to cut through commercial determinants, although any hope that he will stop listening to industry, and start “listening to public health experts and GPs” (doi:10.1136/bmj.o1704),10 seems a forlorn one (doi:10.1136/bmj.o1687).11 The many deep rooted problems of population health, as highlighted by the NHS Race and Health Observatory’s inaugural conference on racism in health and medicine last week (doi:10.1136/bmj.o1699, doi:10.1136/bmj.o1715, doi:10.1136/bmj.o1710),121314 are beyond the quick fix of a structural reorganisation of the health system (doi:10.1136/bmj.o1682).15 Other than the covid misadventures of rich countries, a major reason why covid is still troubling us is our collective inability to deliver vaccines to poor countries and increase vaccine uptake. The challenge extends beyond vaccine hesitancy and includes supply restrictions and distribution challenges, especially to remote rural populations (doi:10.1136/bmj-2021-069596).16 Canada is destroying 14 million covid vaccine doses, not because it was unwilling to donate them but because of “distribution and absorption” challenges in recipient countries (doi:10.1136/bmj.o1700).17 Another reason why covid still troubles us is that—as with climate change, poverty, and war—it’s easy to downplay the effects if you’ve never experienced it.

Anxiety and Changes in Health Care Access and Health Behaviors during COVID-in Southwest Tribal Community Patients with Prediabetes and Diabetes

Objective: The impact of COVID-has been devastating to many, but particularly to rural populations of American Indians from Zuni Pueblo who suffer multiple vulnerabilities which places them at greater risk for infection and death. Very little is known about the change in health behaviors owing to the COVID pandemic among a chronically ill (diabetes) rural Zuni population. We evaluated the anxiety and stress about COVID-contributing to poorer mental health outcomes in Zuni Indians with PreDM and T2DM. Methods: We conducted a survey among individuals with hyperglycemia in Zuni Indians. There were 300 participants who responded to the survey, of which 193 participants also had baseline clinical health data. Results: Those with T2DM experienced higher pandemic-related anxiety than those with pre-DM (+3.9 vs. -0.6, p=0.0616, on a scale -30 to +30) . Those with T2DM were more likely to report decreased physical activity (54% vs. 44%) , decreased frequency in lab testing (21% vs. 10%) , and increased virtual contact with providers (61% vs. 48%) during the pandemic. We conducted regression analyses to describe correlations of anxiety and weight change with the changes in health behaviors. We found that participants with improved diet and exercise during the pandemic were less likely to experience weight gain (OR= 0.78, p=0.0017 and OR=0.75, p=0.0094, respectively) . We also found that those who reported worsening health care during the pandemic experienced increased anxiety (+4.9, p=0.0049) . Conclusion: Our study provides important insights into (unintended) consequential effect of COVID crisis in rural Zuni which will contribute to a better understanding of how to preserve mental health and maintain health behaviors in patients with diabetes during the pandemics.

Impact of the COVID-19 lockdown on the economic situation and food security of rural households in India

Purpose>The purpose of the study is to understand what impact the first COVID-19 lockdown in 2020 had on the income and food security of rural households in India and whether it differed across socioeconomic factors. Moreover, the study assesses the needs of rural households and determines whether they had received adequate support services during the lockdown.Design/methodology/approach>The study adopted a repeated-measures quantitative survey design with 1,319 rural women from 16 states of India and conducted a telephonic survey.Findings>The lockdown had directly impacted rural households' employment status and income but the impact differed depending on the type of employment. For example, working in a salaried job or on one's farm led to a lower likelihood of a complete decline in income in states other than Kerala as the lockdown continued. The study also revealed a change in the pattern of food consumption, with higher consumption of subsidized staple foods. It also became evident that the aid announced by the government reached the rural population with some delay.Research limitations/implications>A limitation of the study was that many respondents refused to participate in phase 2, which reduced the sample size when comparing the two phases because the women did not own mobile phones. Instead, they were using their husbands' phones.Originality/value>The study's findings can help better understand the needs of rural populations during crises, such as the COVID-19 pandemic. This can help to plan better and build preventive actions for such populations once their needs are understood. In addition, this can aid disadvantaged people for a minimal level of preparedness and security during such a crisis in the future.

Factors Influencing the Levels of Awareness on Malaysian Healthy Plate Concept among Rural Adults in Malaysia

Malaysian Healthy Plate was launched in 2017 as a vital component of the Malaysian Ministry of Health’s “Quarter-Quarter-Half” program. It is predicted that this concept will bring positive change to the citizen’s dietary habits;however, the residents in rural areas may experience less exposure to this campaign, or lack of understanding to the concept of Malaysian Healthy Plate. Hence, this study aims to assess factors affecting the campaign’s awareness among the rural population in Malaysia. The National Health and Morbidity Survey (NHMS) 2019 focused on Non-Communicable Diseases (NCDs). Data collection was carried out from July to September 2019. Questionnaires that pertained to awareness, knowledge, and practice were included in this nationwide survey. Data collected from adults in rural areas aged 18 years old and above were used as respondents for the statistical analysis. Complex sample multiple logistic regression analysis was conducted to determine the association between the independent variables and awareness of the Malaysian Healthy Plate concept. About four fifths (83.2%) of rural adults in Malaysia were unaware of the Malaysian Healthy Plate concept after three years of implementation. The unawareness was significantly higher in males (91.3%), adults aged above 60 years old (91.8%), adults of others ethnicity (88.5%), those without formal education (95.2%), widows/widowers/divorcees (88.1%), retirees/adults who were not working (88.4%), and household income at the bottom 40% (B40) (85.0%). Unawareness of this concept was significantly associated with male gender (aOR = 4.12;95% CI: 3.06–5.56);age, 40–59 years (aOR = 1.46;95% CI:1.08–1.97);without formal education (aOR = 3.47;95% CI:1.34–9.01);working in private sector (aOR = 2.75;95% CI: 1.59–4.77);self-employed (aOR = 2.78;95% CI: 1.58–4.87);retirees (aOR = 2.32;95% CI: 1.23–4.36);and unpaid workers (aOR = 2.61;95% CI: 1.51–4.51). Awareness of the Malaysian Healthy Plate concept is associated with rural adults being males, with older age, with lower socio-economic status, without partner, and without job. This study suggests that a more effective strategy is needed to increase the awareness of the Malaysian Healthy Plate concept among rural adults.

Indian agriculture sector: impacts from COVID-19

The livelihood of around 70% of the Indian rural population depends on the agriculture sector. In India, even the earnings of the non-agriculture sectors in terms of backward and forward linkage for agro-based businesses also get impacted by the production of agricultural products. However, issues like cereal-centric, regionally-biased, and resource-intensive production are still about the agriculture sector of India. The present study attempts to provide an insight into the present scenario of the Indian agriculture sector after providing a brief review of the agricultural literature. Through empirical analysis using multiple regression technique, it tries to find out the factors responsible for the growth of the Indian agriculture sector. The study also explores the potential impact of COVID-19 on the agriculture sector of India based on various secondary sources. The result shows that agriculture trade, level of rainfall, and infrastructure development is significantly and positively, while life expectancy and employment in agriculture are significantly and negatively impacting the agricultural contribution to the GDP of India.

Role of geographic risk factors and social determinants of health in COVID-19 epidemiology: Longitudinal geospatial analysis in a midwest rural region

Background:Studies examining the role of geographic factors in coronavirus disease-2019 (COVID-19) epidemiology among rural populations are lacking.Methods:Our study is a population-based longitudinal study based on rural residents in four southeast Minnesota counties from March through October 2020. We used a kernel density estimation approach to identify hotspots for COVID-19 cases. Temporal trends of cases and testing were examined by generating a series of hotspot maps during the study period. Household/individual-level socioeconomic status (SES) was measured using the HOUSES index and examined for association between identified hotspots and SES.Results:During the study period, 24,243 of 90,975 residents (26.6%) were tested for COVID-19 at least once;1498 (6.2%) of these tested positive. Compared to other rural residents, hotspot residents were overall younger (median age: 40.5 vs 43.2), more likely to be minorities (10.7% vs 9.7%), and of higher SES (lowest HOUSES [SES] quadrant: 14.6% vs 18.7%). Hotspots accounted for 30.1% of cases (14.5% of population) for rural cities and 60.8% of cases (27.1% of population) for townships. Lower SES and minority households were primarily affected early in the pandemic and higher SES and non-minority households affected later.Conclusion:In rural areas of these four counties in Minnesota, geographic factors (hotspots) play a significant role in the overall burden of COVID-19 with associated racial/ethnic and SES disparities, of which pattern differed by the timing of the pandemic (earlier in pandemic vs later). The study results could more precisely guide community outreach efforts (e.g., public health education, testing/tracing, and vaccine roll out) to those residing in hotspots.