• Rural Digital Europe
• Publications close
• Research data close
• 1. No poverty close
• LK close

The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas.We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants.At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group.In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.).

About 60% of southern Africa’s population lives in rural areas with limited access to basic services and amenities such as clean and safe water, affordable and clean energy, and balanced and nutritious diets. Resource scarcity has direct and indirect impacts on nutrition, human health, and well-being of mostly poor rural communities. Climate change impacts in the region are manifesting through low crop yields, upsurge of vector borne diseases (malaria and dengue fever), and water and food-borne diseases (cholera and diarrhoea). This study applied a water–energy–food (WEF) nexus analytical livelihoods model with complex systems understanding to assess rural livelihoods, health, and well-being in southern Africa, recommending tailor-made adaptation strategies for the region aimed at building resilient rural communities. The WEF nexus is a decision support tool that improves rural livelihoods through integrated resource distribution, planning, and management, and ensures inclusive socio-economic transformation and development, and addresses related sustainable development goals, particularly goals 2, 3, 6 and 7. The integrated WEF nexus index for the region was calculated at 0.145, which is marginally sustainable, and indicating the region’s exposure to vulnerabilities, and reveals a major reason why the region fails to meet its developmental targets. The integrated relationship among WEF resources in southern Africa shows an imbalance and uneven resource allocation, utilisation and distribution, which normally results from a ‘siloed’ approach in resource management. The WEF nexus provides better adaptation options, as it guides decision making processes by identifying priority areas needing intervention, enhancing synergies, and minimising trade-offs necessary for resilient rural communities. Our results identified (i) the trade-offs and unintended negative consequences for poor rural households’ livelihoods of current silo approaches, (ii) mechanisms for sustainably enhancing household water, energy and food security, whilst (iii) providing direction for achieving SDGs 2, 3, 6 and 7.

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.

Background: Competition for freshwater between cities and agriculture is projected to grow due to rapid urbanization, particularly in the Global South. Water reallocation from rural to urban regions has become a common strategy to meet freshwater needs in growing cities. Conceptual issues and associated measurement problems have impeded efforts to compare and learn from global experiences. This review examines the status and trends of water reallocation from rural to urban regions based on academic literature and policy documents. Methods: We conduct a systematic literature review to establish the global reallocation database (GRaD). This process yielded 97 published studies (academic and policy) on rural-to-urban reallocation. We introduce the concept of reallocation 'dyads' as the unit of analysis to describe the pair of a recipient (urban) and donor (rural) region. A coding framework was developed iteratively to classify the drivers, processes and outcomes of water reallocation from a political economy perspective. Results: The systematic review identified 69 urban agglomerations receiving water through 103 reallocation projects (dyads). Together these reallocation dyads involve approximately 16 billion m3 of water per year moving almost 13 000 kilometres to urban recipient regions with an estimated 2015 population of 383 million. Documented water reallocation dyads are concentrated in North America and Asia with the latter constituting the majority of dyads implemented since 2000. Synthesis: The analysis illustrates how supply and demand interact to drive water reallocation projects, which can take many forms, although collective negotiation and administrative decisions are most prevalent. Yet it also reveals potential biases and gaps in coverage for parts of the Global South (particularly in South America and Africa), where reallocation (a) can involve informal processes that are difficult to track and (b) receives limited coverage by the English-language literature covered by the review. Data regarding the impacts on the donor region and compensation are also limited, constraining evidence to assess whether a water reallocation project is truly effective, equitable and sustainable. We identify frameworks and metrics for assessing reallocation projects and navigating the associated trade-offs by drawing on the concept of benefit sharing.

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients' reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers' activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients' cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable. The study is supported by a research award: Grant Ref No: MR/N006178/1 from the MRC/DFId/Wellcome Trust, UK.

AbstractImprovements in land use and management are needed at a global scale to tackle interconnected global challenges of population growth, poverty, migration, climate change, biodiversity loss, and degrading land and water resources. There are hundreds of technical options for improving the sustainability of land management and preventing or reversing degradation, but there are many sociocultural, institutional, economic, and policy barriers hindering their adoption at large scale. To tackle this challenge, the Dryland Systems Program of the Consultative Group for International Agricultural Research and the UN Convention to Combat Desertification convened an expert group to consider barriers and incentives to scaling technologies, processes, policies, or institutional arrangements. The group reviewed existing frameworks for scaling sustainable land management (SLM) interventions across a range of contexts and identified eight critical actions for success: (a) plan iteratively; (b) consistently fund; (c) select SLM options for scaling based on best available evidence; (d) identify and engage with stakeholders at all scales; (e) build capacity for scaling; (f) foster institutional leadership and policy change to support scaling; (g) achieve early benefits and incentives for as many stakeholders as possible; and (h) monitor, evaluate, and communicate. Incentives for scaling were identified for the private sector, farmers and their communities, and policy makers. Based on these findings, a new action framework for scaling is presented that analyses the contexts where specific SLM interventions can be scaled, so that SLM options can be screened and adapted to these contexts, piloted and disseminated. The framework can help countries achieve land degradation neutrality.

Summary Background Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning. Methods We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496. Findings Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80–1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88–1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86–1·08) self-harm events involving all methods. Interpretation We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. Funding Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.