Volume 26

This Letter to the Editor calls for more research into the factors that improve cervical screening uptake among rural women in low-resource settings.

Child malnutrition is a critical global health challenge, disproportionately affecting low- and middle-income countries, where it contributes significantly to morbidity and mortality among children under 5 years of age. Northern Nigeria presents a unique case of child malnutrition due to its complex socioeconomic and geopolitical challenges. This Review article explores the trends and determinants of child malnutrition in Northern Nigeria, particularly the prevalence of stunting, wasting, and underweight among children aged under 5 years and the underlying factors contributing to these conditions.

The incidence of chronic wounds (eg diabetic foot ulcers, venous ulcers, pressure ulcers, surgical wound dehiscence, and skin tears), is expected to rise alongside the increase in non-communicable chronic diseases (NCDs). Mexico faces significant healthcare challenges due to high rates of NCDs, a situation that is exacerbated in rural populations, which experience high rates of malnutrition, marginalization, discrimination, lack of access to specialized services, and a shortage of trained personnel. This Project Report examines the success of a co-constructed educational strategy for the prevention and basic care of wounds in Maya-Yucatecan Indigenous communities in the municipality of Chankom, Mexico.

Despite recognition that the term ‘allied health’ encompasses disparate professions (differing markedly in their background, training, scope of practice and client populations), evidence related to retaining the allied health workforce in regional, rural and remote areas often treats these professions as a homogeneous group. Grouping allied health professions together risks missing professions and/or geographic differences that could be targeted for the development of specific retention strategies. This Original Research study assesses the retention patterns of different allied health professionals employed in regional, rural and remote regions of Southern Queensland.

Provision of equal access to medical services for all citizens is a challenge for public healthcare systems across many European countries. Medical deserts, where medical services are inadequate for the local population, are caused by insufficient local workforce distribution and service availability, and commonly occur in rural and peripheral regions. A recent audit in Poland highlighted a lack of target numbers for medical professionals and a lack of analytical instruments or data necessary for long-term workforce planning. This Original Research study examines the determinants of professional plans (planned specializations and geographic locations) for future doctors.

Informal workers have few formal legal protections and tend to have more exposure and susceptibility to health-threatening situations than formal workers; they also represent the predominant form of employment globally, making them a key population for improving health equity. In Indonesia, informal workers make up 57.95% of the working population. This Original Research study uses a multilevel modelling approach to monitor disparities in healthcare utilization between formal and informal workers in Indonesia and examines how geographic context and health insurance coverage shape these utilization patterns.

To eliminate cervical cancer as a public health threat, the World Health Organization has set a global strategy that includes achieving 90–70–90 targets by 2030: 90% of girls fully vaccinated against human papillomavirus by age 15 years, 70% of women screened by age 35 years and again by 45 years, and 90% of women identified with cervical disease receiving appropriate treatment. In Nigeria, this need is especially critical in rural populations, which often face disproportionately limited access to health education and preventive services. This Original Research study assesses the level of awareness and perceptions of cervical cancer prevention among participants of a community health outreach program in Ituku, Enugu State, Nigeria

Innovative models are being adopted worldwide to enhance access to essential health services in rural areas. Nevertheless, implementing these models can prove challenging, particularly in low-resource countries. In Papua New Guinea (PNG), there is limited information about the application of health policy frameworks and the challenges affecting their implementation in rural districts. This Original Research study uses qualitative interviews and group discussions with administrators, clinicians, and community members in rural areas of Madang Province, PNG, to examine the socio-ecological factors that influence implementation at all levels of the healthcare system.

Early childhood development is essential for long-term health, educational, and financial outcomes. Among many determinants of childhood development, the mental health of mothers has emerged as a critical, yet often under-addressed, factor, particularly in low- and middle-income countries. Despite this, few studies have explored the relationship between mothers’ mental health and child development in rural Indonesia. Most analyses use aggregated data, obscuring important rural–urban differences. This Original Research study examines nationally representative data to inform equity-focused, context-specific interventions.

Health equity is a crucial aspect of public health, ensuring that all members of society have equal opportunities to achieve their full health potential. In recent years, Aotearoa New Zealand has increased its focus on rural health equity, leading to the development of, for the first time, a specific Rural Health Strategy. The importance of a specific strategy for rural health, particularly in countries with large rural populations and regions, has been well established. This Policy Report delves into the background and context of rural health in Aotearoa New Zealand and the specifics of the development and implementation of the first New Zealand Rural Health Strategy.

Education, exercise prescription, targeted rehabilitation, and addressing risk factors form the cornerstone of prevention and treatment of many musculoskeletal and lifestyle-related health conditions. Although in-person health care at established facilities remains the gold standard of management, alternative options should be considered to assist with the prevention and treatment of musculoskeletal and lifestyle-related health conditions in rural communities in low- and middle-income countries (LMICs). This Scoping Review identifies and describes the use of digital and/or community-based health interventions for exercise and education in the management of musculoskeletal and/or lifestyle-related health conditions in rural communities in LMICs and explores the impact, feasibility, barriers, and facilitators of these interventions.

In rural and remote Australia, children and their families face many barriers to accessing dental care, contributing to poorer oral health-related quality of life and higher caries risk than those in metropolitan areas. This Systematic Review applies an ecological model to identify these barriers at system, policy, community and individual levels for rural and remote Australian children. The authors propose evidence-based solutions tailored to the unique challenges of these communities.

Effective management of open fractures focuses on restoring function, preventing complications and minimising long-term disability. This Original Research study evaluates and compares metropolitan primary presentations with rural and remote secondary presentations in the management of patients with open-fracture injuries in Western Australia, and identifies areas for improvement in the trauma care pathway, particularly for patients requiring aeromedical retrieval.

In Brazil, only 37% of people with type 2 diabetes are receiving treatment and, among this group, only 23% achieve adequate disease control. Therefore, lifestyle modifications (including regular physical activity and adopting a balanced diet) are an essential strategy in combating the type 2 diabetes epidemic. This Original Research study examines the barriers and facilitators to physical activity adherence in a vulnerable population with type 2 diabetes in the Brazilian Amazon setting.

Indigenous communities and isolated rural populations face a range of health challenges shaped by longstanding social, environmental, and structural conditions. Both groups experience a considerable burden of chronic diseases, infectious illnesses, undernutrition, and mental health conditions. Additionally, the continuing effects of colonisation, land dispossession, cultural disruption, and experiences of discrimination within health systems contribute to longstanding inequities in health and wellbeing for Indigenous peoples. These combined circumstances have important implications for maternal health. This Systematic Review evaluates the current evidence on the economic effectiveness of maternal healthcare services and offers recommendations for future research and policy development in maternal health services tailored to these communities.

Although cervical cancer is largely preventable and curable if detected early, in Nigeria, most cases present at advanced stages and nearly half of women diagnosed with cervical cancer are likely to die within 3 years. While inadequate access to appropriate treatment facilities plays a role, late presentation has also been consistently linked to misconceptions, poor awareness, negative attitudes towards preventive practices, and suboptimal utilization of available screening and treatment options. This Original Research study assesses cervical cancer knowledge, attitudes and screening uptake among rural women in North Central Nigeria.

Narratives on the experiences of the COVID-19 pandemic from African Indigenous communities are inadequately represented in the literature, even though historic and structural inequities create vulnerabilities that are best understood by the communities that live and exist within these contexts. This Original Research article explores the pandemic experiences of the Indigenous Xhosa people of Thamarha, in the Eastern Cape Province of South Africa: how they understand health and wellbeing and what actions they took to protect their health and wellbeing in the face of the pandemic.

The probability that healthcare workers choose to practice in rural areas is increased by multiple factors, including having a rural background and having sufficient exposure to rural practice during healthcare training. Given the importance of rural background, encouraging rural young people to consider a career in health care seems like a natural strategy to increase the number of rural healthcare workers. However, rural young people often face barriers to entering healthcare fields, including distances to access schooling, having few personal connections to healthcare ‘role models’, and a lack of confidence in their ability to succeed in the profession. This Original Research study examines the effectiveness of an Alberta-based program that promotes rural healthcare careers in rural areas to local students in grade 8 (aged approximately 14 years).

Children who live in rural Australia experience poorer health, development and education outcomes than those living in metropolitan areas. Recognition of the key role that schools can play in supporting children’s health and wellbeing has led to the implementation of school-integrated healthcare models, including the School-Based Primary Health Care Service (SB-PHCS), a nurse-led model of care developed in Far West New South Wales. This Original Research study reviews the electronic medical records of primary school clients of the SB-PHCS and describes the use of assessment, treatment and therapy services of clients who received primary health care registered nurse support to access other healthcare services.

In Aotearoa New Zealand, rural communities experience poorer health outcomes than urban populations, partly due to shortages of rural health professionals. Since students from rural backgrounds are more likely to return to rural areas after graduating, clear pathways that include ‘rural’ New Zealand are essential for growing the rural health workforce. However, inconsistent definitions of ‘rural’ can limit access to education for rural and Indigenous students and contribute to workforce inequities. This Original Research study created a framework to identify the most appropriate definitions of rurality in New Zealand, aiming to improve the rural admissions scheme at the University of Auckland and strengthen rural health workforce development.

In many rural communities, the scarcity of healthcare professionals, geographic isolation, transportation challenges, and limited access to specialty care means that the work of family and informal caregivers, including relatives, friends, and community members who provide unpaid support, is indispensable. Yet, despite the growing recognition of caregivers’ essential role in rural care, evidence on what families and informal caregivers do, how they interact with rural providers and systems, and where specific supports and policy interventions are most needed remains fragmented. This Scoping Review systematically maps the roles, activities, facilitators, barriers, and outcomes associated with family and informal caregivers in rural health delivery across diverse clinical contexts and geographic regions.

Rural and remote regions across Australia continue to experience chronic shortages in medical workforce capacity. Although various government programs and university-led initiatives have attempted to address this issue, long-term rural retention of medical graduates remains an unresolved challenge. This Commentary draws on national experience and emerging models to reflect on opportunities for improving the retention of medical graduates in rural practice.

Delivering health care in remote emergency contexts is inherently complex and demands timely, effective, and well-coordinated responses to ensure access to appropriate care. In such settings, healthcare professionals’ perceptions of context-specific risks and operational challenges are critical to preventing adverse events and ensuring patient safety. They must be prepared to navigate unpredictable scenarios and take proactive measures to safeguard both patient outcomes and their own wellbeing. This Scoping Review identifies risks, and reports on management and mitigation of risks, to patients, themselves and service delivery among healthcare professionals in remote emergency care.

Pesticide exposure has been associated with a broad range of adverse health outcomes, including malignant, neurodegenerative, reproductive, developmental, respiratory, and metabolic diseases. Targeted strategies to mitigate pesticide exposure, particularly among frontline users such as farmers, therefore remain a public health priority. Several studies have demonstrated that the recommendations provided by pesticide sellers directly influence farmers’ decisions regarding product selection, application methods, and safety practices. This Original Research study assesses occupational health and safety awareness among pesticide retailers in Mersin Province, Türkiye, and examines factors associated with their provision of safety information to buyers during pesticide sales.

Like other countries, Aotearoa New Zealand struggles to train and retain sufficient numbers of GPs. Compounding this, structural inequities affect healthcare access for Māori, other Pacific Islander Peoples and those in rural and socioeconomically deprived communities. While national health strategies acknowledge these disparities, tertiary training remains urban-centric, hospital-based, and misaligned with the healthcare needs of many communities. This Short Communication describes a proposed new graduate-entry, 4-year medical program in Aotearoa New Zealand that emphasises rural and provincial community-based training. The authors argue that this model is both urgently needed and potentially generalisable to other nations grappling with similar workforce inequities.

The provision of eye health care in regional Australia is challenging due to a longstanding medical workforce shortage in regional communities. The Goldfields region of Western Australia does not have a resident ophthalmologist and is serviced by visiting outreach clinics. Lions Outback Vision provides specialist ophthalmology services throughout regional WA by a mobile Vision Van, a permanent tertiary eye clinic in Broome (in the Kimberley region) and scheduled outreach and telehealth, with no out-of-pocket costs for patients. This Project Report describes the trends in the provision of specialist eye care in the Goldfields region for three common causes of vision loss: cataracts, diabetic retinopathy, and neovascular age-related macular degeneration.

Motor skill development through physical play is an essential part of child development. Motor skill impairment poses significant functional, social and educational challenges. While advances in interventions for children with motor skills challenges are encouraging, there has been little research about effective interventions for children in low-resource and rural settings. This Original Research article reports on the feasibility of implementing the Hopscotch program, an intervention delivered by teachers with the support and guidance of motor skill experts, as a small-scale pilot study in a rural area in South Africa. 

Despite the success of many harm-reduction programs for people who inject drugs, they are not always designed to meet the diverse needs of Aboriginal and Torres Strait Islander Peoples. The ‘Enhancing harm reduction services (BBV and STI) for Aboriginal and Torres Strait Islander people who inject drugs through improved engagement’ project worked in partnership with local stakeholders and Aboriginal and Torres Strait Islander people with lived and living experience of injecting drug use to identify culturally safe approaches and local priorities. Using the CONSIDER statement as a reflexive tool, this Project Report critically assesses the project’s research partnerships and processes.

Introducing the National Health Insurance Act in 1963 in South Korea substantially improved healthcare access and costs and has contributed to reduced mortality and morbidity. However, evaluations of health equity among rural–urban populations remains an underexplored area. Using 7 years of data, this Original Research study compares health status, health services accessibility, household finances, and financial burdens (including catastrophic health expenditure) between urban and rural individuals with end-stage kidney disease (ESKD), one of the most costly chronic conditions.

LGBTQ individuals face higher risk for adverse health conditions compared with their cisgender and heterosexual peers as a result of sexual and/or gender minority stress and insufficient social safety, including state-level and interpersonal-level discrimination, internalized stigma, and community disconnection. A large proportion of the LGBTQ population resides in rural areas but the rural LGBTQ population is often overlooked in health research and program initiatives. This Scoping Review maps population, methodological, content, and publishing characteristics of rural LGBTQ health research published since 2000. Identifying trends and gaps in rural LGBTQ health research could guide future research, program, and funding directions for this overlooked yet highly intersectional population.

Liver disease represents a growing global health burden and metabolic dysfunction-associated steatotic liver disease (MASLD) is now the most common liver disease worldwide. In low- and middle-income countries, and rural regions of high-income nations, structural and environmental factors (including limited access to safe drinking water), contribute to disparities in metabolic and liver health. In these settings, mistrust in local water quality may lead people to rely on bottled or sugar-sweetened beverages, behaviors linked to dehydration, excess caloric intake, and metabolic dysfunction. This Original Research article explores the relationships between perceived drinking water quality, beverage consumption patterns, and biomarkers of liver health in rural residents of West Virginia. Understanding how environmental perceptions shape health behaviors may help inform patient-centered interventions to prevent and manage chronic diseases, including MASLD.

High maternal and neonatal mortality rates in South Asia have led to a recent shift towards training professional midwives. This Review article explores the available literature on the experiences of midwives in rural and remote areas of South Asia, highlighting the current strengths, challenges and gaps in midwifery practice.

In this Letter to the Editor, the authors build on a Rural Practice Affinity (RPA) model that explicitly tests emergency medicine competency as a mediator between general self-efficacy and rural practice intentions. The authors propose complementary dimensions that should be considered when translating model findings into recruitment, training and retention strategies.

Indonesia’s National Health Insurance Program (NHI) was introduced with the primary objective of providing broader and more affordable access to healthcare services for all Indonesian citizens. Despite significant growth in membership, there are still significant disparities in NHI coverage across different regions and socioeconomic groups. This Original Research article reports on factors related to NHI membership to determine how to focus efforts to expand the number of NHI members in underprivileged areas in Indonesia.

Intimate partner violence (IPV) and sexual violence (SV) are pervasive public health issues and people marginalized by gender, such as cisgender women, transgender, non-binary, and other gender-diverse individuals, in rural, remote, and Northern (RRN) areas are at a significantly higher risk of experiencing these types of violence than people in urban settings. Unique barriers to addressing IPV and SV in RRN areas include geographical isolation, a lack of services to support IPV and SV victim survivors, social stigma, and a lack of understanding surrounding the complexities of IPV and SV from rural service providers. This Scoping Review explores literature focusing on the lived experience of people experiencing these instances of violence in RRN populations.

Residents of riverine communities in rural Brazil face significant challenges in accessing oral health services, as evidenced by a high percentage of individuals who have never visited a dentist, or who only seek dental care at advanced stages of disease. To address this, fluvial primary healthcare units were set up to travel along the river, offering medical and dental care to the communities they visit. Although this model increased service utilization, health inequities persist. This Original Research study evaluates the effectiveness of participatory community interventions, in which health promotion strategies are conceived, planned, and executed by the residents themselves, on the oral health of a rural riverine population in Brazil.

Securing a sustainable future rural healthcare workforce depends on cultivating individuals and organizations with the right characteristics for delivering holistic medical care in rural settings. This Research Letter reports on what these desirable characteristics are according to healthcare professionals working in rural Japan.